Use of Bevacizumab for neurological complications during initial treatment of malignant gliomas

INTRODUCTION

High grade gliomas are the most common primary malignant brain tumours. Treatment with chemoradiation and adjuvant chemotherapy with Temozolomide may prolong survival but some patients develop complications during or soon after therapy due to radiation necrosis, oedema or tumour progression.

PATIENTS

We report the use of Bevacizumab in four patients with newly diagnosed high grade gliomas who developed cerebral oedema due to tumour progression or radiation necrosis that did not respond to corticosteroids, and who were not candidates for surgical debulking.

OUTCOMES

All four patients had a rapid response to treatment with bevacizumab, tolerating a decrease of the dose of corticosteroids, and were able to continue their standard therapy.

CONCLUSIONS

Bevacizumab is effective in controlling some of the neurological complications from oedema, radiation necrosis, or rapid tumour progression during the initial treatment of malignant gliomas.

Medical devices in the home: present and future applications

Putting together a comprehensive telehealth program is similar to putting together a puzzle. You have to fit all of the pieces together to see the big picture. An important piece of that puzzle is medical devices for telemonitoring. The equipment used in a telehealth program can span from low end, such as simply using a telephone; to high end, in which two-way audio-video systems are used with computer documentation, outcome software, and various medical device options.

Conjugated linoleic acid (CLA) content of milk from cows offered diets rich in linoleic and linolenic acid

Two experiments were conducted to determine the conjugated linoleic acid (CLA) content of milk from cows offered diets rich in linoleic and linolenic acid. In experiment 1, 36 cows were assigned to a control and five treatment groups. Cows in the control group received a diet containing 51% forage and 49% grain on a dry matter basis. In the treatment group, grain was partly replaced by either 18% raw cracked soybeans, 18% roasted cracked soybeans, 3.6% soybean oil, 2.2% linseed oil, or 4.4% linseed oil. Experimental diets were fed for 5 wk. Average CLA contents in milk fat from wk 2 through 5 were 0.39% in control and 0.37, 0.77, 2.10, 1.58, and 1.63% of total fatty acids in the raw soybean, roasted soybeans, soybean oil, 2.2% linseed oil, and 4.4% linseed oil treatments, respectively. In experiment 2, 36 cows were assigned to a control and 5 treatment groups. Cows in the control group received a diet containing 55% forage and 45% grain. In the treatment groups, grain was partly replaced by soybean oil at 0.5, 1.0, 2.0, 4.0, or by linseed oil at 1.0% of the dietary dry matter. Experimental diets were fed for 5 wk. Average CLA contents in milk fat from wk 2 through 5 were 0.50% in control and 0.75, 0.76, 1.45, 2.08, and 0.73% of total fatty acids in 0.5, 1.0, 2.0, 4.0 soybean oil and 1.0% linseed oil treatments, respectively. Diets rich in linoleic or linolenic acid can increase CLA content of milk when dietary oil is accessible to the rumen microorganisms.

Vertebral development and amphibian evolution

Amphibians provide an unparalleled opportunity to integrate studies of development and evolution through the investigation of the fossil record of larval stages. The pattern of vertebral development in modern frogs strongly resembles that of Paleozoic labyrinthodonts in the great delay in the ossification of the vertebrae, with the centra forming much later than the neural arches. Slow ossification of the trunk vertebrae in frogs and the absence of ossification in the tail facilitate the rapid loss of the tail during metamorphosis, and may reflect retention of the pattern in their specific Paleozoic ancestors. Salamanders and caecilians ossify their centra at a much earlier stage than frogs, which resembles the condition in Paleozoic lepospondyls. The clearly distinct patterns and rates of vertebral development may indicate phylogenetic separation between the ultimate ancestors of frogs and those of salamanders and caecilians within the early radiation of ancestral tetrapods. This divergence may date from the Lower Carboniferous. Comparison with the molecular regulation of vertebral development described in modern mammals and birds suggests that the rapid chondrification of the centra in salamanders relative to that of frogs may result from the earlier migration of sclerotomal cells expressing Pax1 to the area surrounding the notochord.

The newborn with hearing loss: detection in the nursery

BACKGROUND

Early detection of hearing loss coupled with appropriate early intervention is critical to speech, language, and cognitive development. These competencies serve as the foundation for later academic skills. For these reasons, many states are undertaking aggressive efforts to screen all newborns before hospital discharge. Universal detection of hearing loss in newborns is a three-stage process composed of 1) the birth admission screen, 2) follow-up and diagnosis, and 3) intervention services. Breakdown at any stage jeopardizes the entire effort. The goals of this research are to examine the birth admission screen by reviewing outcome measurements for 54 228 Texas newborns and to evaluate factors that impact outcomes positively or negatively.

METHODOLOGY

All newborns were screened for hearing loss using a physiologic test of auditory function; either screening auditory brainstem responses or transient evoked otoacoustic emissions. Screening occurred in the newborn and intensive care nurseries, before hospital discharge in 9 sites as part of the nursery protocol. Patients. A total of 54 228 newborns were available for screening.

OUTCOME MEASURES

Four measures were evaluated and are reported: the number of births screened, the number of newborns who passed the screen before discharge, the number of infants who returned for follow-up, and the number of infants identified with hearing loss. A Birth Screening Performance Index is also calculated.

RESULTS

Results are reported for calendar years 1994, 1995, 1996, and through June 1997. A total of 54 228 newborns were available for screening; 52 508 were screened before hospital discharge during their birth admission and 50 721 passed this screen. Infants returning for follow-up screen as outpatients numbered 1224. Over this 31/2-year span, 113 infants who failed the birth admission screening had hearing loss that was sensorineural in nature. From these data, the estimated incidence of hearing loss is 3.14/1000 infants.

CONCLUSIONS

Screening in the nursery with low false-positive rates can be achieved when three elements are present: audiology involvement, hospital support, and automated data and information management. Follow-up measures need improvement. Better tracking methods may help assure that at-risk newborns are connected to services.

Inhibition of benzo[a]pyrene-induced mouse forestomach neoplasia and reduction of H2O2 concentration in human polymorphonuclear leucocytes by flavour components of Japanese-style fermented soy sauce

Previously it was reported that 4-hydroxy-2 (or 5)-ethyl-5 (or 2)-methyl-3(2H)-furanone (HEMF), a characteristic flavour component of Japanese-style fermented soy sauce that exhibits antioxidant activity, inhibits benzo[a]pyrene-induced forestomach neoplasia in mice. The antioxidant and anticarcinogenic activities of other structurally similar soy sauce flavour components are now reported. 4-Hydroxy-5-methyl-3(2H)-furanone (HMF) and 4-hydroxy-2,5-dimethyl-3(2H)-furanone (HDMF) were found to be antioxidants. In particular, HMF and HDMF (as well as HEMF) reduced hydrogen peroxide concentration in human polymorphonuclear leucocytes stimulated by arachidonic acid or 12-O-tetradecanoylphorbol-13-acetate. HMF and HDMF were administered individually in semipurified diet to female ICR mice previously treated with benzo[a]pyrene (1.5 mg/wk, orally for 4 wk) to initiate forestomach neoplasia. The mice were killed at 30 wk of age. Both furanones reduced forestomach neoplasms, with HDMF exhibiting more potency. The data indicate that HDMF and HMF, like HEMF, inhibit carcinogenesis in this system by acting at the post-initiation stage.

Molecular mapping of mouse chromosomes 4 and 6: use of a flow-sorted Robertsonian chromosome

The development of dense genetic maps of mammalian chromosomes is facilitated when chromosome-specific libraries are used as a source of genetic markers. To saturate the genetic maps of mouse chromosomes 4 and 6, we have made use of fluorescent-activated chromosome sorting to purify a 4:6 Robertsonian chromosome from a cell line harboring the Rb(4:6)2Bnr translocation. After staining with chromomycin A3 and Hoechst 33528, this chromosome was separated from the other mouse chromosomes. DNA was isolated from the fraction containing the Robertsonian chromosome and subcloned into the insertion vector lambda gt10, generating a library with 4.6 x 10(5) independent phage. A total of 19 single-copy sequences were used to type the progeny of a C57BL/6J x Mus spretus backcross that had previously been typed for loci on chromosomes 4 and 6. Approximately 70% of the clones in the library mapped to either chromosome 4 or 6 as assessed by genetic mapping and by use of a somatic cell hybrid panel. Simple sequence repeats have also been isolated from this library. Further characterization of these microsatellites should accelerate efforts to map mouse chromosomes 4 and 6 using PCR. In addition, flow sorting of Robertsonian chromosomes suggests a general approach for making chromosome-specific libraries in mouse.

Formation and action of anticarcinogenic fatty acids

Conjugated dienoic derivatives of linoleic acid (referred to by the acronym CLA) constitute a newly recognized class of anticarcinogenic fatty acids. Of the eight major CLA isomers, the cis-9, trans-11 isomer alone is incorporated into phospholipid and may be the most biologically relevant isomer. CLA exhibits potent antioxidant activity; evidence is presented indicating that CLA acts both as an in vitro and in vivo antioxidant. The formation of CLA in foods, and its possible biological significance in cell membranes, is discussed.

Corticotropin releasing factor stimulates growth hormone secretion in neonatal rats

Corticotropin releasing factor (CRF) both stimulates ACTH secretion from the pituitary and inhibits secretion of growth hormone (GH) in adult rats through actions in the CNS. The purpose of the present study was to evaluate these pituitary and central actions of CRF in neonatal rats, in which the hypothalamo- pituitary adrenal (HPA) axis is relatively hypo-functional. The results of this study show that central or peripheral administration of CRF evokes a marked dose-related rise in serum corticosterone in 6-day old rats. The same doses of CRF stimulate, rather than inhibit GH secretion. These results suggest that CRF has unique central actions early in ontogeny.

Correlation of 31P nuclear magnetic resonance chemical shifts in aryl phosphinates with Hammett substituent constants: Inductive versus resonance interactions and relevance to pπ–dπ bonding

Substituent-induced chemical shifts and coupling constants in the 31P, 13C, and 1H nuclear magnetic resonance spectra of meta- and para-substituted phenyl dimethylphosphinates (1), methylphenylphosphinates (2), and diphenylphosphinates (3) have been determined in CDCl3 solvent. For all three series, a correlation of δ 31P with Hammett–Taft σ0 (or σ) constants is preferred over σ− on the basis of the correlation coefficient and standard deviations of the slope and intercept values. Electron-withdrawing substituents induce downfield shifts in δ 31P, in contrast to the inverse trends observed for structurally related series of oxyphosphorus acids and their derivatives. It is proposed that electron-withdrawing substituents act to deplete the electron density on the aryl oxygen, thereby weakening a pπ–dπ bonding interaction between the aryl oxygen and phosphorus. The resultants loss of d-orbital density on phosphorus causes a downfield shift in δ 31P in each of the phosphinate series. Phenyl substituents attached directly to phosphorus in series 2 and 3 increase the phosphoryl pπ–dπ back-bonding interactions, either through inductive or resonance effects, which leads to shielding of the phosphorus atom, overriding the anticipated downfield shift through inductive electron withdrawal of the phenyl substituents in series 2 and 3, relative to the methyls in series 1. Trends in Hammett ρ values for the plots of δ 31P and δ 13C versus σ0 and differences in the shielding of 13C and 1H nuclei of the methyl attached to phosphorus in series 1 and 2 suggest that the phenyl groups may interact in π bonding with the phosphorus atom through a resonance interaction.