Pooled historical MRI data as a basis for research in multiple sclerosis--a statistical evaluation

Pooled data from placebo groups of different trials can serve as historical control for ongoing or future therapeutic studies and as a reference for power calculations. In order to assess their usefulness for this purpose, we investigated the degree of heterogeneity of placebo arm data from 14 controlled studies included in the database of the Sylvia Lawry Centre for Multiple Sclerosis Research. Since different criteria for the inclusion/exclusion of patients were used in these studies, an attempt was made to adjust the distribution of magnetic resonance imaging (MRI) measures for the differences in the study populations. The analyses showed that, even after adjustment, significant differences remained. This heterogeneity does not reduce the usefulness of the database for statistical analysis of inter-relationships between variables, provided that it is explicitly taken into account as a stratification factor. However, care must be taken when trying to compare the results of a newly treated group with the patients of this pool. Heterogeneity in some MRI variables was greatly reduced when only studies from the same image analysis centre were compared.

Versorgungsqualität von Patienten nach Schlaganfallrehabilitation

PURPOSE

Since only insufficient information concerning the further development of patients after stroke and rehabilitation is currently available, and since the quality of care provided by family doctors is often classified as insufficient, this quality of care was to be examined on the basis of the rehabilitation results. Of particular interest were the co-operation, the therapeutical quality standards and the risk management, as well as the quality of life and compliance of the patients.

METHODS

In 2000, all 223 stroke patients were asked prior to their discharge from three large rehabilitation clinics in North Baden, and subsequently their 210 family doctors, whether they were prepared to participate in this follow-up study. The participating patients were examined at their discharge from the clinic as well as 6 and 18 months later using a standardised documentation package, and quality circles for family doctors were initiated.

RESULTS

All patients with atrial fibrillation were treated to prevent thrombosis. Smoking showed a positive trend. Quality of life and knowledge of the sickness trend to increase, depressiveness decreases. 60 % of the contacted family doctors participated in the study, 29 % (33 out of 114 physicians at the end of the study) contributed to improve interdisciplinary co-operation. Although 87 % of the patients said to be well informed, 25 % were dissatisfied with their own compliance.

CONCLUSION

The quality of care of stroke patients by family doctors as assessed by indicators for secondary prevention and quality of life is satisfactory under present conditions. Apart from the hypertension control there was no negative trend. However, participation of GPs was insufficient. Co-operative after-care by GP can relatively easily stabilise health conditions following inpatient rehabilitation.

Treosulfan in the treatment of advanced ovarian cancer: a randomised co-operative multicentre phase III-study

BACKGROUND

In August 1988 a randomised phase III multicenter trial was started in order to compare cisplatinum/treosulfan (PT) with standard cisplatinum/cyclophosphamide (PC) in advanced ovarian carcinoma, aiming at lower toxicity and maintained efficiency.

PATIENTS AND METHODS

Five hundred and nineteen patients were enrolled into the protocol. Final evaluation after a median observation time of more than five years was made in July 1996 and included 398 eligible patients, of whom 366 were evaluable regarding efficiency and 290 in respect of toxicity. The tumour stages were classified as FIGO II in 53, FIGO III in 244 and FIGO IV in 68 patients. The patients were stratified regarding post-operative tumour burden.

RESULTS

Hematological and gastrointestinal toxicity WHO > = 3 were comparable between the two study arms though a significant difference could be demonstrated regarding alopecia (PT 8% vs. PC 47% after six cycles). The median time to progression as the main efficiency item was in favour of the study schedule (PT 20.6 vs. PC 15.1 months) while significant differences were neither observed in the whole study group nor in the analysed subgroups (R0, < 2 cm, > = 2 cm). The same held true for overall survival.

CONCLUSION

PT may be recommended as a less toxic substitute for the former standard PC. After the acceptance of paclitaxel/cisplatin as a new standard, the role of treosulfan should be investigated regarding adjuvant therapy in patients without residual tumor, as a potential partner in triple or sequential treatment and in second-line treatment.

Duration of breastfeeding and associated factors in Western and Eastern Germany

Ten years after the German political reunification, specific lifestyle habits still vary between the former Western (FRG) and Eastern (GDR) sectors of Germany. We have analysed data from the first nationwide SuSe Study on breastfeeding 1997-1998 (n = 1593 healthy, term German infants) stratified in a Western (80.3%) and Eastern (19.7%) subgroup. In the Eastern subgroup, breastfeeding was higher for the first 2 wk but decreased more rapidly thereafter. The adjusted relative risk (odds ratios, OR) for short-term breastfeeding was strongly associated (OR >2) with maternal age, supplementary feeding, single parent status, maternal educational status, breastfeeding problems and partner's attitude towards breastfeeding. In the multivariate model, not the geographical location where the mother grew up but the different distribution of risk factors was associated with short-term breastfeeding. Moreover, mothers from both the Western and Eastern sectors mentioned different reasons for giving up breastfeeding.

CONCLUSION

More breastfeeding promotion is necessary for women from the former GDR.

Quinoline 2-oxidoreductase and 2-oxo-1,2-dihydroquinoline 5,6-dioxygenase from Comamonas testosteroni 63. The first two enzymes in quinoline and 3-methylquinoline degradation

The enzymes catalysing the first two steps of quinoline and 3-methylquinoline degradation by Comamonas testosteroni 63 were investigated. Quinoline 2-oxidoreductase, which catalyses the hydroxylation of (3-methyl-)quinoline to (3-methyl-)2-oxo-1,2-dihydroquinoline, was purified to apparent homogeneity. The native enzyme, with a molecular mass of 360 kDa, is composed of three non-identical subunits (87, 32, and 22 kDa), occurring in a ratio of 1.16:1:0.83. Containing FAD, molybdenum, iron, and acid-labile sulfur in the stoichiometric ratio of 2:2:8:8, the enzyme belongs to the molybdo-iron/sulfur flavoproteins. Molybdopterin cytosine dinucleotide is the organic part of the pterin molybdenum cofactor. Comparison of N-terminal amino acid sequences revealed similarities to a number of procaryotic molybdenum-containing hydroxylases. Especially the N-termini of the beta-subunits of the quinoline 2-oxidoreductases from Comamonas testosteroni 63, Pseudomonas putida 86, and Rhodococcus spec. B1, and of quinoline-4-carboxylic acid 2-oxidoreductase from Agrobacterium spec. 1B showed striking similarities. Further degradation of (3-methyl-)2-oxo-1,2-dihydroquinoline proceeds via dioxygenation at the benzene ring, i.e. at 5,6-position [Schach, S., Schwarz, G., Fetzner, S. & Lingens, F. (1993) Biol. Chem. Hoppe-Seyler 374, 175-181]. 2-Oxo-1,2-dihydroquinoline 5,6-dioxygenase was partially purified; NADH and oxygen are required for the reaction, and the enzymic activity is enhanced 1.5-fold by addition of Fe2+ ions. Unexpectedly, this aromatic ring dioxygenase did not separate into distinct protein components, but is apparently a single-component enzyme. The molecular mass was estimated to be about 260 kDa. 2-Oxo-1,2-dihydroquinoline 5,6-dioxygenase is very thermolabile. However, dithioerythritol and low concentrations of substrate had a moderately stabilizing effect. 2-Oxo-1,2-dihydroquinoline 5,6-dioxygenase is inhibited by sulfhydryl-blocking agents, by metal-chelating agents, and by the flavin analogues quinacrine and acriflavin.

Microbial metabolism of quinoline and related compounds. XVII. Degradation of 3-methylquinoline by Comamonas testosteroni 63

A bacterial strain which utilizes 3-methylquinoline as sole source of carbon, nitrogen and energy was isolated from activated sludge. On the basis of its morphological and physiological characteristics, this isolate was classified as Comamonas testosteroni. Four metabolites of 3-methylquinoline degradation were isolated from the culture supernatant and identified as 3-methyl-2-oxo-1,2-dihydroquinoline, 6-hydroxy-3-methyl-2-oxo-1,2-dihydroquinoline, 5,6-dihydroxy-3-methyl-2-oxo-1,2-dihydroquinoline and 2,5,6-trihydroxy-3-methylpyridine. Based on these results, a degradation pathway for 3-methylquinoline is proposed.

[Frequency of medical consultation as reflected in 2 representative surveys: DHP-Survey and EVaS-Study (German Cardiovascular Disease Prevention and Survey of Ambulatory Care)]

The frequency of patient-doctor contacts in outpatient care is determined via two representative inquiries supplying complementary perspectives. They concern, on the one hand, a sample of contacts in the consultation room, and, on the other hand, contacts as stated in a population-based survey. In the 25-69 years age bracket, both surveys yielded a contact incidence of 2 to more than 5 contacts per person and quarter of a year. The figure is higher in women than in men. Both surveys agree very well if the consultation-room survey is limited to personal contacts between the doctor and the patient. The distribution of contacts over specialties is similar in both surveys. Compared to other countries, the frequency of outpatient consultations is high in the Federal Republic of Germany. Periodic surveys help to get insight into frequency and structure of medical services.

[Age-dependent accumulation of lead in teeth]

Teeth from people aged 5-73 years old, who differ in their occupational type of exposure to lead and who live in different areas of Dortmund, were collected in 1980/81 and were investigated by means of flameless atomic absorption spectrometry. The major result obtained from the 163 permanent and 22 deciduous teeth studied was a statistically significant dependence of the lead content of the permanent teeth on the donor's age. This was superior to all other influences, showing an increase of 3.4% per year of life. There were no sex specific differences, and no correlations with height and body weight were found. To find different lead concentrations within samples of teeth of various living areas and various occupational types of exposure would have required more variation in these variables than was available in the population of our study. It must be emphasized that the reliability of the measured values of dental-lead concentration greatly depends upon the methodical and analytical procedures used, especially because of the overall lead contamination. The analytical method we finally used is described. The factors which influence the dental lead concentration are discussed. The investigation of whole teeth is tolerable. The age-dependent values of the lead content of teeth could be a useful indicator of the overall lead uptake especially in continuous low level lead exposure. Under the conditions described, at least 150 permanent teeth are needed to compare samples of different regions or periods.