Determination of the cryoprotective effect of n-methylacetamide in rabbit semen

BACKGROUND

Amides are low molecular weight cryoprotectants. N-methylacetamide (MA) is one of the cryoprotectant agents in this group.

OBJECTIVE

To investigate the cryoprotective effect of MA in rabbit semen.

MATERIALS AND METHODS

For this purpose, six ejaculates from six New Zealand rabbits were collected and pooled using an artificial vagina. Pooled semen was divided into four equal parts and diluted with TCG+ egg yolk. CPA was added to form the following groups: Control with 6% DMSO; Group 1 with 1% MA; Group 2 with 2% MA; and Group 3 with 3% MA. After the addition of CPA, the semen eqilibration procedure was started. Sperm were then drawn into 0.25 mL straws, frozen by automatic semen freezing and stored in a liquid nitrogen container. Pipettes were thawed after 24 h and analyses were performed.

RESULTS

Total, progressive and rapid motility values of the Control group were higher than those of the MA groups (p<0.05). However, there was no statistical difference between the Control and Group 2 in terms of these parameters. While there was no statistical difference between the groups in terms of acrosome damage and mitochondrial membrane potential, the best results were observed in Control, Group 2, Group 1 and Group 3, respectively. When we compared all groups, no difference was found in terms of MDA, CAT and GSH-Px. There was a statistical difference between Group 3 and the Control in terms of GSH level (p<0.05).

CONCLUSION

DMSO appeared to be more useful for the cryopreservation of rabbit semen compared to MA. Doi.org/10.54680/fr23610110812.

Efficacy of a pharmacist-managed diabetes clinic in high-risk diabetes patients, a randomized controlled trial - "Pharm-MD" : Impact of clinical pharmacists in diabetes care

BACKGROUND

Diabetes mellitus affects 13% of American adults. To address the complex care requirements necessary to avoid diabetes-related morbidity, the American Diabetes Association recommends utilization of multidisciplinary teams. Research shows pharmacists have a positive impact on multiple clinical diabetic outcomes.

METHODS

Open-label randomized controlled trial with 1:1 assignment that took place in a single institution resident-run outpatient medicine clinic. Patients 18-75 years old with type 2 diabetes mellitus and most recent HbA1c ≥9% were randomized to standard of care (SOC) (continued with routine follow up with their primary provider) or to the SOC + pharmacist-managed diabetes clinic PMDC group (had an additional 6 visits with the pharmacist within 6 months from enrollment). Patients were followed for 12 months after enrollment. Data collected included HbA1c, lipid panel, statin use, blood pressure control, immunization status, and evidence of diabetic complications (retinopathy, nephropathy, neuropathy). Intention-to-treat and per-protocol analysis were performed.

RESULTS

Forty-four patients were enrolled in the SOC + PMDC group and 42 patients in the SOC group. Average decrease in HbA1c for the intervention compared to the control group at 6 months was - 2.85% vs. -1.32%, (p = 0.0051). Additionally, the odds of achieving a goal HbA1c of ≤8% at 6 months was 3.15 (95% CI = 1.18, 8.42, p = 0.0222) in the intervention versus control group. There was no statistically significant difference in the remaining secondary outcomes measured.

CONCLUSIONS

Addition of pharmacist managed care for patients with type 2 diabetes mellitus is associated with significant improvements in HbA1c compared with standard of care alone. Missing data during follow up limited the power of secondary outcomes analyses.

TRIAL REGISTRATION

ClinicalTrials.gov , ID: NCT03377127 ; first posted on 19/12/2017.

Real world results of venetoclax combined with hypomethylating agents in relapsed/refractory AML

OBJECTIVE

Relapsed/refractory AML cases are much more resistant to chemotherapy. Venetoclax is a highly sensitive BCL-2 inhibitor. It was aimed to evaluate the effects of venetoclax therapy on real-world R/R AML survival outcomes, the effects of the cytogenetic characteristics of the patients and previous clinical applications on treatment response, and venetoclax treatment toxicity.

PATIENTS AND METHODS

The study included patients who only received a venetoclax-based salvage on R/R AML patients from Turkey. The study included a total of 62 patients from 6 different centers in Turkey. Response to 2 cycles of venetoclax treatment was assessed by bone marrow blast rate. The demographic data, cytogenetic characteristics, AML type, MDS type, response rates and overall survival of the patients after venetoclax combination treatment were assessed. Median age of the patients was 65 (19-85). Mean number of prior treatments was 2.67 ±1.75.

RESULTS

13 patients (21%) had a history of allogenic stem cell transplantation. 58 (93.5%) had received HMA therapy before venetoclax. 36 patients (58.1%) had de-novo AML, and 25 (40.3%) previously had MDS. Treatment response was evaluated as complete remission (n = 21, 33.9%), partial response (n = 17, 27.4%), and treatment failure (n = 24, 38.7%). Patients in the TF group were significantly more likely to have poor cytogenetic and to have received allogeneic transplants. The mean estimated overall survival after the venetoclax treatment was 9.13 ± 0.75 months.

CONCLUSIONS

The study population consisted of a group of patients who had relapsed or primary refractory disease with poor prognosis, despite numerous rounds of chemotherapy. It is our belief that the high response rates obtained with the combination of venetoclax/HMA, and having obtained positive results with poor risk patients, indicated a promising perspective for R/R AML patients.

A subset of patients with acquired partial lipodystrophy developing severe metabolic abnormalities

Purpose/Aim of the study: Acquired partial lipodystrophy (APL) is a rare disease characterized by selective loss of adipose tissue. In this study, we aimed to present a subset of patients with APL, who developed severe metabolic abnormalities, from our national lipodystrophy registry.

MATERIALS AND METHODS

Severe metabolic abnormalities were defined as: poorly controlled diabetes (HbA1c above 7% despite treatment with insulin more than 1 unit/kg/day combined with oral antidiabetics), severe hypertriglyceridemia (triglycerides above 500 mg/dL despite treatment with lipid-lowering drugs), episodes of acute pancreatitis, or severe hepatic involvement (biopsy-proven non-alcoholic steatohepatitis (NASH)).

RESULTS

Among 140 patients with all forms of lipodystrophy (28 with APL), we identified 6 APL patients with severe metabolic abnormalities. The geometric mean for age was 37 years (range: 27-50 years; 4 females and 2 males). Five patients had poorly controlled diabetes despite treatment with high-dose insulin combined with oral antidiabetics. Severe hypertriglyceridemia developed in five patients, of those three experienced episodes of acute pancreatitis. Although all six patients had hepatic steatosis at various levels on imaging studies, NASH was proven in two patients on liver biopsy. Our data suggested that APL patients with severe metabolic abnormalities had a more advanced fat loss and longer disease duration.

CONCLUSIONS

We suggest that these patients represent a potential subgroup of APL who may benefit from metreleptin or investigational therapies as standard treatment strategies fail to achieve a good metabolic control.

Effects of Concurrent Expression of Myc and Bcl-2 on the Treatment and Prognosis in Extranodal Diffuse Large B Cell Lymphoma

Aim: We aimed to investigate the effects of immunohistochemical and molecular presence of double-hit lymphomas (DHL) (combined expression of myc and bcl-2) on overall and progression-free survival rates of patients with extranodal diffuse large B-cell lymphoma (DLBCL). Methods: A total of 31 patients (17 female, 14 male; mean age 57 years) with diagnosis of extranodal DLBCL were included into the study. Patients transforming from low grade B cell lymphoma, and patients with HIV positivity were not included. In a retrospective manner, patient characteristics were noted (age at diagnosis, sex, sites of extranodal involvement, stage, high-risk group, histopathological diagnosis, IPI score, LDH level at diagnosis, bone marrow involvement, and treatment modalities). Histopathological specimens underwent immunohistochemical (bcl-6, bcl-2, myc, CD10, Mum-1) and molecular (bcl-2 and myc, by means of PCR) analysis. All patients was treatment with R-CHOP protocol. Results: DHL was observed immunohistochemically in only one patient, while molecular studies found 6 cases. Three-month overall survival rates were 50% and 88% in DHL positive and negative groups, respectively. Six-month overall survival rates were 16% and 76% in DHL positive and negative groups, respectively. Progression-free 3-month survival rates were 51% and 88% in DHL positive and negative groups, respectively. Progression-free 6-month survival rates were 33% and 76% in DHL positive and negative groups, respectively. No relation with histopathological type of the disease was noted. Conclusion: We conclude that DHL presence in patients with extranodal DLBCL was an independent factor leading to shortened overall or progression-free survival.

Renal complications of lipodystrophy: A closer look at the natural history of kidney disease

OBJECTIVES

Lipodystrophy syndromes are a group of heterogeneous disorders characterized by adipose tissue loss. Proteinuria is a remarkable finding in previous reports.

STUDY DESIGN

In this multicentre study, prospective follow-up data were collected from 103 subjects with non-HIV-associated lipodystrophy registered in the Turkish Lipodystrophy Study Group database to study renal complications in treatment naïve patients with lipodystrophy.

METHODS

Main outcome measures included ascertainment of chronic kidney disease (CKD) by studying the level of proteinuria and the estimated glomerular filtration rate (eGFR). Kidney volume was measured. Percutaneous renal biopsies were performed in 9 patients.

RESULTS

Seventeen of 37 patients with generalized and 29 of 66 patients with partial lipodystrophy had CKD characterized by proteinuria, of those 12 progressed to renal failure subsequently. The onset of renal complications was significantly earlier in patients with generalized lipodystrophy. Patients with CKD were older and more insulin resistant and had worse metabolic control. Increased kidney volume was associated with poor metabolic control and suppressed leptin levels. Renal biopsies revealed thickening of glomerular basal membranes, mesangial matrix abnormalities, podocyte injury, focal segmental sclerosis, ischaemic changes and tubular abnormalities at various levels. Lipid vacuoles were visualized in electron microscopy images.

CONCLUSIONS

CKD is conspicuously frequent in patients with lipodystrophy which has an early onset. Renal involvement appears multifactorial. While poorly controlled diabetes caused by severe insulin resistance may drive the disease in some cases, inherent underlying genetic defects may also lead to cell autonomous mechanisms contributory to the pathogenesis of kidney disease.

Parallel transmit excitation at 1.5 T based on the minimization of a driving function for device heating

PURPOSE

To provide a rapid method to reduce the radiofrequency (RF) E-field coupling and consequent heating in long conductors in an interventional MRI (iMRI) setup.

METHODS

A driving function for device heating (W) was defined as the integration of the E-field along the direction of the wire and calculated through a quasistatic approximation. Based on this function, the phases of four independently controlled transmit channels were dynamically changed in a 1.5 T MRI scanner. During the different excitation configurations, the RF induced heating in a nitinol wire immersed in a saline phantom was measured by fiber-optic temperature sensing. Additionally, a minimization of W as a function of phase and amplitude values of the different channels and constrained by the homogeneity of the RF excitation field (B1) over a region of interest was proposed and its results tested on the benchtop. To analyze the validity of the proposed method, using a model of the array and phantom setup tested in the scanner, RF fields and SAR maps were calculated through finite-difference time-domain (FDTD) simulations. In addition to phantom experiments, RF induced heating of an active guidewire inserted in a swine was also evaluated.

RESULTS

In the phantom experiment, heating at the tip of the device was reduced by 92% when replacing the body coil by an optimized parallel transmit excitation with same nominal flip angle. In the benchtop, up to 90% heating reduction was measured when implementing the constrained minimization algorithm with the additional degree of freedom given by independent amplitude control. The computation of the optimum phase and amplitude values was executed in just 12 s using a standard CPU. The results of the FDTD simulations showed similar trend of the local SAR at the tip of the wire and measured temperature as well as to a quadratic function of W, confirming the validity of the quasistatic approach for the presented problem at 64 MHz. Imaging and heating reduction of the guidewire were successfully performed in vivo with the proposed hardware and phase control.

CONCLUSIONS

Phantom and in vivo data demonstrated that additional degrees of freedom in a parallel transmission system can be used to control RF induced heating in long conductors. A novel constrained optimization approach to reduce device heating was also presented that can be run in just few seconds and therefore could be added to an iMRI protocol to improve RF safety.

Assessment of traumatic deaths in a level one trauma center in Ankara, Turkey

Trauma management shows significant progress in last decades. Determining the time and place of deaths indicate where to focus to improve our knowledge about trauma. We conducted this retrospective study from data of trauma victims who were brought to a major tertiary hospital which is a level one trauma center in Ankara, Turkey, and died even if during transport or in the hospital between 1 March 2010 and 1 March 2013. The patients' demographic characteristics, trauma mechanisms, time frames and causes of deaths determined by physicians were recorded. Traumas were grouped as "high energy trauma" (HET) and "low energy trauma" (LET). Falls from ground level were defined as LET. 209 traumatic deaths due to trauma or trauma-related conditions were found in the study period. 161 of 209 (78 %) patients suffered from HET. Motor vehicle collisions (MVC) (56 %) were the most common mechanism of trauma followed by burns (16 %), falls (11 %), gunshots (9 %) and stabs (6 %) in this group and traumatic brain injuries (TBI) (41 %) were the most common cause of death followed by circulatory collapse (22 %) and multi-organ failure (20 %). 36 % of deaths occurred before arrival at hospital, 25 % in the first 24 h of admission, 18 % between 2nd and 7th day and 21 % after first week. Trimodal distribution of traumatic deaths was not valid for all types of injuries and the most important factor to decrease traumatic deaths is still prevention. Also we have to keep on searching to improve our knowledge about trauma management.

Crimean-Congo hemorrhagic fever infections reported by ProMED

OBJECTIVE

There are limited sources describing the global burden of emerging diseases. We reviewed the Crimean-Congo hemorrhagic fever virus (CCHFV) infections reported by ProMED and assessed the reliability of the data retrieved compared to published reports. We evaluated the effectiveness of ProMED as a source of epidemiological data by focusing on CCHFV infections.

METHODS

Using the keywords "Crimean Congo hemorrhagic fever" and "Crimean Congo" in the ProMED search engine, we reviewed all the information about the news and harvested data using a structured form, including year, country, gender, occupation, the number of infected individuals, and the number of fatal cases.

RESULTS

We identified 383 entries reported between January 1998 and October 2013. A total 3426 infected cases were reported, with 451 fatal cases, giving an overall case fatality rate (CFR) of 13%. Out of 144 cases for which the gender was reported, 97 (67%) were male. Most of the cases were reported from Turkey, followed by Russia, Iran, Pakistan, and Afghanistan.

CONCLUSIONS

Case reporting systems such as ProMED are useful to gather information and synthesize knowledge on the emerging infections. Although certain areas need to be improved, ProMED provided good information about Crimean-Congo hemorrhagic fever.

The effect of alcohols on red blood cell mechanical properties and membrane fluidity depends on their molecular size

The role of membrane fluidity in determining red blood cell (RBC) deformability has been suggested by a number of studies. The present investigation evaluated alterations of RBC membrane fluidity, deformability and stability in the presence of four linear alcohols (methanol, ethanol, propanol and butanol) using ektacytometry and electron paramagnetic resonance (EPR) spectroscopy. All alcohols had a biphasic effect on deformability such that it increased then decreased with increasing concentration; the critical concentration for reversal was an inverse function of molecular size. EPR results showed biphasic changes of near-surface fluidity (i.e., increase then decrease) and a decreased fluidity of the lipid core; rank order of effectiveness was butanol > propanol > ethanol > methanol, with a significant correlation between near-surface fluidity and deformability (r = 0.697; p<0.01). The presence of alcohol enhanced the impairment of RBC deformability caused by subjecting cells to 100 Pa shear stress for 300 s, with significant differences from control being observed at higher concentrations of all four alcohols. The level of hemolysis was dependent on molecular size and concentration, whereas echinocytic shape transformation (i.e., biconcave disc to crenated morphology) was observed only for ethanol and propanol. These results are in accordance with available data obtained on model membranes. They document the presence of mechanical links between RBC deformability and near-surface membrane fluidity, chain length-dependence of the ability of alcohols to alter RBC mechanical behavior, and the biphasic response of RBC deformability and near-surface membrane fluidity to increasing alcohol concentrations.

Efficacy of low and high fixed dose radioactive iodine therapy in patients with toxic nodular goiter

AIM

The efficacy of low and high fixed dose radioactive iodine (RAI) therapy in patients with toxic nodular goiter was investigated.

METHODS

Ninety-three patients (25 males, 68 females) were included into the study (32 patients with toxic adenoma, 61 patients with toxic multinodular goiter). Patients were treated with a fixed dose of 370 MBq (10 mCi) or 740 MBq (20 mCi) RAI. The average follow-up period was 17±10 months.

RESULTS

The overall cure rate (eutyhroidism and hypothyroidism) was 81% in patients treated with 740 MBq RAI and 51% in patients treated with 370 MBq RAI (p<0.05). RAI therapy with a dose of 370 MBq and 740 MBq provided the cure in 73% and 91% of the patients with toxic adenoma and 42% and 76% of the patients with toxic multinodular goiter, respectively. No significant difference for gender was observed. Hypothyroidism developed in 4 and 15 patients with a dose of 370 MBq and 740 MBq RAI, respectively.

CONCLUSION

A dose of 740 MBq RAI was found to be more effective for the treatment of toxic nodular goiter as compared to a dose of 370 MBq RAI.

Breakthrough Trichosporon asahii fungemia in neutropenic patient with acute leukemia while receiving caspofungin

A 47-year-old man with newly diagnosed acute myeloblastic leukemia and non-insulin-dependent diabetes mellitus developed Trichosporon asahii fungemia while receiving caspofungin as empirical antifungal therapy. The diagnosis was based on repeated isolation of T. asahii in culture of blood for three times. Despite treatment with amphotericin B and voriconazole, the patient died. The in vitro antifungal susceptibilities of the T. asahii isolates were only available after the patient died. In vitro antifungal susceptibility tests showed high caspofungin and amphotericin B minimal inhibitory concentrations (MICs) value for this Trichosporon strain (MICs, 16 microg/ml, and>32 microg/ml, respectively). Fluconazole, itraconazole, and voriconazole exhibited low MICs in vitro (MICs, 4 microg/ml, 0.5 microg/ml, and<or=0.015 microg/ml, respectively). Our experience strongly suggest that identification and antifungal susceptibility testing for T. asahii in neutropenic patients who may develop signs of infection in the presence of caspofungin as well as broadspectrum antibiotics treatment should not be overlooked.

Active immunotherapy for cancer patients using tumor lysate pulsed dendritic cell vaccine: a safety study

Cancer vaccine therapy represents a promising therapeutical option. Consistently, with these new treatment strategies, the use of dendritic cell vaccines is becoming increasingly widespread and currently in the forefront for cancer treatment. The purpose of this study was to evaluate the feasibility and safety of tumor lysate-pulsed dendritic cell (DC) vaccine in patients with advanced cancers. For this purpose, eighteen patients with relapsed or refractory cancer were vaccinated with peripheral monocyte-derived DCs generated with GM-CSF and IL-4, and pulsed consequently with 100 microg/ml of tumor lysate before maturation in culture in the presence of IL-1beta, PGE2 and TNF alpha for two days. The first two vaccinations were given intradermally every two weeks while further injections were given monthly. Tumor lysate-pulsed dendritic cell injections were well-tolerated in all patients with no more than grade 1 injection-related toxicity. Local inflammatory response was mainly erythematous which subsided in 48 hrs time. No end organ toxicity or autoimmune toxicity was identified. Clinical responses observed in our study were satisfactory for a phase I clinical study. We observed 4 (22%) objective clinical responses. These responses are significantly correlated with delayed type hypersensitivity testing (DTH) (p < 0.01). The results showed that this active immunotherapy is feasible, safe, and may be capable of eliciting immune responses against cancer.

Philadelphia negative, Bcr-Abl positive chronic myeloid leukemia associated with pure red cell aplasia

Pure red cell aplasia (PRCA) is a rare disorder which is associated with thymoma, viral infections and autoimmune diseases. A few cases of PRCA during the clinical course of CML have been reported and these usually terminate in blastic crisis and death, suggesting a poor prognosis. However, only one case of Philedelphia chromosome negative, Bcr-Abl positive CML associated with PRCA has been reported. Here, we present a second case report of a Philedelphia negative, Bcr-Abl positive CML associated with PRCA who was unresponsive to all the chemotherapeutic regimens. We conclude that the present case supports the idea that the development of PRCA in the course of CML may be a bad prognostic sign.

EEG source localization: a neural network approach

Functional activity in the brain is associated with the generation of currents and resultant voltages which may be observed on the scalp as the electroencephelogram. The current sources may be modeled as dipoles. The properties of the current dipole sources may be studied by solving either the forward or inverse problems. The forward problem utilizes a volume conductor model for the head, in which the potentials on the conductor surface are computed based on an assumed current dipole at an arbitrary location, orientation, and strength. In the inverse problem, on the other hand, a current dipole, or a group of dipoles, is identified based on the observed EEG. Both the forward and inverse problems are typically solved by numerical procedures, such as a boundary element method and an optimization algorithm. These approaches are highly time-consuming and unsuitable for the rapid evaluation of brain function. In this paper we present a different approach to these problems based on machine learning. We solve both problems using artificial neural networks which are trained off-line using back-propagation techniques to learn the complex source-potential relationships of head volume conduction. Once trained, these networks are able to generalize their knowledge to localize functional activity within the brain in a computationally efficient manner.

Experimental prophylaxis of Staphylococcus aureus endophthalmitis after vitrectomy: the use of antibiotics in irrigating solution

PURPOSE

To test the efficacy of clindamycin and gentamicin in irrigating solution during vitrectomy to prevent experimental Staphylococcus aureus endophthalmitis.

MATERIALS AND METHODS

Thirty-six New Zealand white rabbits were divided into six groups. Vitrectomy using two different irrigating solutions was followed by intravitreal injection of S. aureus: Group 1, balanced salt solution (BSS) followed by 1,000 colony-forming units (CFU) S. aureus; Group 2, BSS fortified with clindamycin, 10 microg/mL, and gentamicin, 8 microg/mL (CGBSS), followed by intravitreal injection of 1,000 CFU S. aureus; Group 3, BSS followed by 2,000 CFU S. aureus; Group 4, CGBSS followed by 2,000 CFU S. aureus; Group 5, BSS followed by 4,000 CFU S. aureus; and Group 6, CGBSS followed by 4,000 CFU S. aureus. The eyes were examined clinically after surgery. Vitreous samples were cultured and histologic studies were performed.

RESULTS

Severe endophthalmitis developed in all eyes in Groups 1, 3, and 5 (not given antibiotics). No endophthalmitis developed in Group 2. In Group 4, five of the six eyes were normal and one eye had endophthalmitis. In Group 6, one eye had clear vitreous and fundus, three eyes had moderate vitreous haze, and the other four eyes demonstrated severe endophthalmitis. Bacterial growth in Groups 1, 2, 3, 4, 5, and 6 were 4/4, 0/4, 6/6, 1/6, 4/6, and 2/8 eyes, respectively.

CONCLUSION

When 1,000 to 2,000 CFU S. aureus were injected after vitrectomy, clindamycin and gentamicin in the irrigating solution significantly diminished the intraocular inflammation and the rate of positive bacterial culture. Clindamycin and gentamicin in the irrigating solution were not significantly effective when 4,000 CFU bacteria was injected; however, the degree of inflammation was less severe than in the control group.

Blood velocity in an experimental iris tumor

BACKGROUND AND OBJECTIVE

Greene strain melanoma was implanted into the irides of eight nonpigmented rabbits to evaluate the blood flow in tumor vasculature.

MATERIALS AND METHODS

Conventional scanning laser ophthalmoscopy was used in conjunction with fluorescent microsphere angiography (FMA). Changes were documented on SVHS videotape for later analysis. Individual microsphere movement was tracked through the tumor vessels. Subsequently, blood velocity measurements were taken.

RESULTS

The tumor vessels were poorly organized and inefficient. Tumor blood velocity was up to 2.5 times slower compared with normal blood velocity in the unaffected iris of the same eye of the same rabbit (P = .05). Tumor blood flow could be qualitatively visualized in real time in the liver rabbit model.

CONCLUSION

The ability to visualize fluorescent microspheres within the poorly organized tumor vasculature coupled with the reduced blood velocity in the tumor helps to explain the success of hyperthermic tumoricidal therapy, and may allow for development of more efficient and selective drug delivery systems and tumoricidal agents.

Effect of high-dose medroxyprogesterone acetate on tumor necrosis factor-alpha release in patients with chemotherapy-induced neutropenia

The aim of the study was to investigate the effects of high-dose medroxyprogesterone acetate (MPA) on the tumor necrosis factor-alpha (TNF-alpha) release in patients with chemotherapy-induced neutropenia. We also evaluated the effects of high-dose MPA on hematological parameters (leukocyte, neutrophil, platelet, hemoglobin, hematocrit) and side effects of MPA. One week following the first cycle chemotherapy, 20 patients who developed neutropenia were enrolled in the study. One gram/day MPA was administered orally to the patients and was continued from one week following the first chemotherapy cycle to one week after the second chemotherapy cycle. The patients received the second chemotherapy cycle at the same dosages as the first cycle. Before MPA treatment TNF-alpha levels were lower than post-treatment levels, but the difference was not statistically significant (P > 0.05). The differences in the mean leukocyte and neutrophil counts before and after the high-dose MPA treatment were statistically significant (p < 0.05).