Efficacy of two adjuvant systems to promote humoral immunity to the pre-proghrelin peptide obestatin in pigs: consequences for the growth of piglets to weaning

The poor antigenicity of peptide antigens demands the selection of effective adjuvants to induce humoral immunity. The peptides obestatin and ghrelin from the pro-hormone pre-proghrelin were initially identified as antagonistic in regulating feeding behaviour, with obestatin being suppressive. The efficacy of two adjuvant systems, DEAE with the oil polysorbate emulsion of BP85:Span80 and the surfactant-oil system Montanide (ISA 50v) were therefore assessed with an obestatin-ovalbumin conjugate injected into late pregnant sows. This enabled the supply of antibodies directed against obestatin to newborn piglets through colostrum with the objective of promoting ghrelin secretion and therefore increasing feeding behaviour. Pregnant Landrace × Large White sows (n = 28) were immunised with 0.5 mg obestatin-ovalbumin in 2 mL DEAE:BP85:Span80 (DEAE; n = 14) or with 2 mL Montanide (ISA 50v: n = 14) as adjuvants at days 91 and 105 of gestation. After farrowing, piglets remained with their mothers during the lactation period and were weighed after weaning at Day 28. Antibody titres (unitless) in colostrum were assessed by ELISA as 5543 ± 2388 and 3139 ± 1151 for the DEAE and Montanide adjuvants respectively. These were associated with total IgG of 67.7 ± 3 and 82.3 ± 4.8 mg/mL respectively (P = 0.018). Piglet plasma titres were 5100 ± 1576 and 5762 ± 1688 for DEAE and Montanide respectively at Day 5 postpartum. These titres were still detectable through to Day 28 (titres of 1213 ± 389 and 665 ± 203 respectively (P = 0.176). However, sow colostral antibody titres were not related to piglet antibody concentrations on D5 (r = –0.225, P = 0.341). Sow plasma antibody titres were not related to titres at Day 28 in piglets across treatments (r = 0.198, P = 0.402). The concentration of ghrelin in colostrum was 672 ± 78 and 666 ± 39 pg/mL for the DEAE and Montanide groups, respectively, leading to piglet plasma concentrations on Day 5 of 1105 ± 164 and 530 ± 84 pg/mL (P = 0.002). Animals grew from birthweights of 1.7 ± 0.1 and 1.8 ± 0.1 (P = 0.993) to 7.7 ± 1.2 and 7.8 ± 1.0 kg (P = 0.295) at weaning, representing growth rates of 200.5 ± 52.9 and 225.5 ± 53.4 g/day (P = 0.181). There was a significant negative correlation between piglet D28 antibody titre and growth rate to weaning with the Montanide adjuvant (r = 0.116, P = 0.035) but not for the DEAE (r = –0.118, P = 0.411). Although both adjuvants were capable of generating high antibody titres, the DEAE dextran was likely to be the most effective adjuvant to induce a humoral immune response to develop further with a commercial vaccine.

Spin rotation induced by applied pressure in the Cd-doped Ce2RhIn8 intermetallic compound

The pressure evolution of the magnetic properties of the Ce₂RhIn_7.79Cd_0.21 heavy fermion compound was investigated by single crystal neutron magnetic diffraction and electrical resistivity experiments under applied pressure. From the neutron magnetic diffraction data, up to P = 0.6 GPa, we found no changes in the magnetic structure or in the ordering temperature T _N = 4.8 K. However, the increase of pressure induces an interesting spin rotation of the ordered antiferromagnetic moment of Ce₂RhIn_7.79Cd_0.21 into the ab tetragonal plane. From the electrical resistivity measurements under pressure, we have mapped the evolution of T _N and the maximum of the temperature dependent electrical resistivity (T _MAX) as a function of the pressure (P ≲ 3.6 GPa). To gain some insight into the microscopic origin of the observed spin rotation as a function of pressure, we have also analyzed some macroscopic magnetic susceptibility data at ambient pressure for pure and Cd-doped Ce₂RhIn₈ using a mean-field model including tetragonal crystalline electric field (CEF). The analysis indicates that these compounds have a Kramers doublet Γ 7 - -type ground state, followed by a Γ 7 + first excited state at Δ₁ ∼ 80 K and a Γ₆ second excited state at Δ₂ ∼ 270 K for Ce₂RhIn₈ and Δ₂ ∼ 250 K for Ce₂RhIn_7.79Cd_0.21. The evolution of the magnetic properties of Ce₂RhIn₈ as a function of Cd doping and the rotation of the direction of the ordered moment for the Ce₂RhIn_7.79Cd_0.21 compound under pressure suggest important changes of the single ion anisotropy of Ce³⁺ induced by applying pressure and Cd doping in these systems. These changes are reflected in modifications in the CEF scheme that will ultimately affect the actual ground state of these compounds.

‘Bridging the Continuum' - Reporting Population-Level Trends Across the Continuum of Care: The Australian National Cancer Control Indicator (NCCI) Web Site

Background: High-quality data can assist the development of policy and cancer strategies, stimulate lines of research, and inform the provision of care leading to better cancer outcomes. In November 2017 Cancer Australia launched the National Cancer Control Indicators (NCCI) Web site ( https://ncci.canceraustralia.gov.au ), Australia's first interactive Web site of cancer-specific, national population-based data across the continuum of care. The NCCI Web site presents a set of indicators for monitoring national cancer trends and benchmarking internationally across seven key aspects of cancer control; prevention, screening, diagnosis, treatment, psychosocial care, research and outcomes. Aim: By presenting a set of indicators using seven domains from the cancer care continuum, the NCCI Web site presents the most current Australian national data for a range of cancer control indicators in an accessible and interactive format. The primary aim of the NCCI Web site (hosted as part of the Cancer Australia Web site) is to monitor and report the most recent population-level trends to drive improvements across the cancer control continuum in Australia, and to facilitate international benchmarking of Australia's cancer control efforts. Methods: National data level on 33 individual measures across the seven cancer continuum domains was accessed from both government and nongovernment data custodians. Where applicable and available for measures, data were disaggregated and presented by age, sex, indigenous status, remoteness area of residence and socioeconomic status. Review of the data analysis was undertaken by 46 external reviewers including data custodians and subject matter experts. Results: Example summary data from several indicators across the NCCI Web site, including demographic disaggregation by age, sex, remoteness area of residence and socioeconomic status (where available) will be provided. e.g., • Smoking prevalence has decreased substantially over the past 30 years, and smoking rates among both adolescents and adults in Australia are among the lowest in the world. • Cancer mortality rates have been falling steadily since 1995, across most cancer types. Australia has lower mortality rates from cancer when compared with most other similar developed countries, about 6% lower than the estimated global average in 2012. National population-level data showing incidence by stage at diagnosis for the top five most common cancers has also been reported on the Web site - making Australia one of the few countries in the world where these data are available. Conclusion: The NCCI Web site is a flagship data Web site providing, for the first time, an evolving high-level national data resource to monitor Australian population-level trends in cancer control across the continuum. As one of the very few cross-continuum cancer reporting resources in the world, this is a valuable resource for use by those within the international cancer control community.

Collection and Reporting of National Cancer Stage at Diagnosis Data in Australia (STaR Project)

Background: Stage at diagnosis is an important prognostic factor for cancer, providing contextual information for interpreting population health indicators such as mortality from cancer and cancer survival. Australian population-based cancer registries (PBCRs) routinely collect information on cancer incidence and mortality. The need for high quality, comprehensive national data on stage at diagnosis to supplement these data are widely recognized in Australia. The collection and dissemination of quality national stage data will enhance the: • ability to better monitor cancer outcomes, inform cancer control policy; • understand variations across different populations; and • identify where further research and targeted strategies may be required to improve cancer outcomes. Linking data on cancer stage at diagnosis with other administrative cancer data will also allow for a better understanding of the relationship between stage at diagnosis, treatments received, patterns of cancer recurrence, and survival outcomes. Aim: To strengthen national data capacity by collecting and reporting cancer stage at diagnosis for Cancer Australia's Stage, Treatment and Recurrence (STaR) project. Methods: Working with state and territory population-based cancer registries (PBCRs) and the Australian Pediatric Cancer Registry, Cancer Australia supported the development and testing of Business Rules for the collection of national cancer stage at diagnosis for: • The top 5 incident cancers based on the Tumor, Node, and Metastasis (TNM) staging system. These rules were endorsed by the Australasian Association of Cancer Registries (AACR) as a national standard in May 2016; and • Childhood cancers, with a separate set of Business Rules for 16 childhood cancer types based on the Toronto Pediatric Cancer Stage Guidelines. These rules were supported by the AACR as a national standard. Results: Using the AACR-endorsed Business Rules, comprehensive national cancer stage at diagnosis data for the top 5 incident cancers (for 2011) have been collected in Australia for the first time. Over 90% of incidence cases were able to be assigned a value for registry-derived (RD) stage at diagnosis for melanoma (97%), prostate (97%), and female breast (94%) cancers. Lower staging completeness was found for colorectal cancers (88%), and for lung cancers (72%). Business Rules for the collection of stage at diagnosis data for pediatric cancers have also been developed; 93% of sample cases diagnosed in the period 2006-2010 were able to be staged, ranging from 84% for nonrhabdomyosarcoma to 100% for hepatoblastoma. Conclusion: The Business Rules enabled the uniform collection of cancer stage at diagnosis data for the first time in Australia. The collection of these data will allow for the linkage of stage at diagnosis to other sources of information, including patterns of treatments applied, and enable reporting of survival and recurrence outcomes by stage.

Collection and Reporting of System-Wide Cancer Treatment Activity Data As Part of the Stage, Treatment and Recurrence (STaR) Project

Background: The need for high quality, comprehensive national data on the treatments applied to cancers is widely recognized within the Australian cancer control community. The analysis and reporting of cancer treatment data will greatly enhance our ability to better understand cancer care activity and outcomes - and in particular the treatments being applied across population groups. Aim: To collect and report national data on cancer treatments, as part of Cancer Australia's Stage, Treatment and Recurrence (STaR) project. The linking of this data with national data on stage at diagnosis, survival and recurrence, will help inform policy and practice and ultimately improve cancer outcomes. Methods: Cancer Australia developed a dataset of selected surgical procedures for the treatment of the top five incidence cancers (prostate, breast, colorectal, lung, and melanoma). A dataset of key selected radiotherapy, and systemic therapies for the treatment of all cancer types was also developed.

Data for reporting system-wide treatment activity were extracted from existing national health administrative datasets, including: the Pharmaceutical Benefits Scheme (PBS), the Medicare Benefits Schedule (MBS) and the National Hospital Morbidity Database (NHMD). The scope of the analysis was selected surgical procedures, radiotherapy procedures, or pharmaceutical agents administered with the general intent to change the outcome of the cancer and/or provide symptom relief/ palliative care. Results: The data reported provide a high-level national system-wide overview of cancer treatments applied, including: • More than 1 million radiotherapy services were provided for all cancers combined in Australia (as indicated by MBS reimbursement claims data) for the years 2013 to 2015 inclusive; • The number of people receiving systemic anticancer therapies in Australia for all cancers combined (as indicated by PBS reimbursement claims data) increased from 198,756 in 2012 to 247,939 in 2016; and • The number of hospital separations recorded in the NHMD (i.e., episodes of admitted patient care) for patients with a principal diagnosis of cancer undergoing surgery for the treatment of the top five high incidence cancers in Australia increased from 53,516 in 2010 to 57,651 in 2015. Conclusion: National cancer treatment data were successfully collected and reported. Australia is one of very few countries in the world to collect and report national system-wide treatment data with a specific focus on cancer. These data will be linked to cancer incidence, stage at diagnosis, survival and recurrence data to help inform for population-level reporting of cancer outcomes.

Student obesity prevalence and behavioral outcomes for the massachusetts childhood obesity research demonstration project

OBJECTIVE

To examine changes in prevalence of obesity and target health behaviors (fruit, vegetable, and beverage consumption; physical activity; screen time; sleep duration) among students from communities that participated in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project compared to controls.

METHODS

MA-CORD was implemented in two low-income communities. School-level prevalence of obesity among students in first, fourth, and seventh grades was calculated for the intervention communities and nine matched control communities pre and post intervention. Fourth- and seventh-grade students' self-reported health behaviors were measured in intervention communities at baseline and post intervention.

RESULTS

Among seventh-graders (the student group with greatest intervention exposure), a statistically significant decrease in prevalence of obesity from baseline to post intervention in Community 2 (-2.68%, P = 0.049) and a similar but nonsignificant decrease in Community 1 (-2.24%, P = 0.099) was observed. Fourth- and seventh-grade students in both communities were more likely to meet behavioral targets post intervention for sugar-sweetened beverages (both communities: P < 0.0001) and water (Community 1: P < 0.01; Community 2: P = 0.04) and in Community 2 for screen time (P < 0.01).

CONCLUSIONS

This multisector intervention was associated with a modest reduction in obesity prevalence among seventh-graders in one community compared to controls, along with improvements in behavioral targets.

Using School Staff Members to Implement a Childhood Obesity Prevention Intervention in Low-Income School Districts: the Massachusetts Childhood Obesity Research Demonstration (MA-CORD Project), 2012-2014

Introduction

Although evidence-based interventions to prevent childhood obesity in school settings exist, few studies have identified factors that enhance school districts’ capacity to undertake such efforts. We describe the implementation of a school-based intervention using classroom lessons based on existing “Eat Well and Keep Moving” and “Planet Health” behavior change interventions and schoolwide activities to target 5,144 children in 4th through 7th grade in 2 low-income school districts.

Methods

The intervention was part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project, a multisector community-based intervention implemented from 2012 through 2014. Using mixed methods, we operationalized key implementation outcomes, including acceptability, adoption, appropriateness, feasibility, implementation fidelity, perceived implementation cost, reach, and sustainability.

Results

MA-CORD was adopted in 2 school districts that were facing resource limitations and competing priorities. Although strong leadership support existed in both communities at baseline, one district’s staff reported less schoolwide readiness and commitment. Consequently, fewer teachers reported engaging in training, teaching lessons, or planning to sustain the lessons after MA-CORD. Interviews showed that principal and superintendent turnover, statewide testing, and teacher burnout limited implementation; passionate wellness champions in schools appeared to offset implementation barriers.

Conclusion

Future interventions should assess adoption readiness at both leadership and staff levels, offer curriculum training sessions during school hours, use school nurses or health teachers as wellness champions to support teachers, and offer incentives such as staff stipends or play equipment to encourage school participation and sustained intervention activities.

Biostatistical analysis of quantitative immunofluorescence microscopy images

Semiquantitative immunofluorescence microscopy has become a key methodology in biomedical research. Typical statistical workflows are considered in the context of avoiding pseudo-replication and marginalising experimental error. However, immunofluorescence microscopy naturally generates hierarchically structured data that can be leveraged to improve statistical power and enrich biological interpretation. Herein, we describe a robust distribution fitting procedure and compare several statistical tests, outlining their potential advantages/disadvantages in the context of biological interpretation. Further, we describe tractable procedures for power analysis that incorporates the underlying distribution, sample size and number of images captured per sample. The procedures outlined have significant potential for increasing understanding of biological processes and decreasing both ethical and financial burden through experimental optimization.

Redrawing the US Obesity Landscape: Bias-Corrected Estimates of State-Specific Adult Obesity Prevalence

BACKGROUND

State-level estimates from the Centers for Disease Control and Prevention (CDC) underestimate the obesity epidemic because they use self-reported height and weight. We describe a novel bias-correction method and produce corrected state-level estimates of obesity and severe obesity.

METHODS

Using non-parametric statistical matching, we adjusted self-reported data from the Behavioral Risk Factor Surveillance System (BRFSS) 2013 (n = 386,795) using measured data from the National Health and Nutrition Examination Survey (NHANES) (n = 16,924). We validated our national estimates against NHANES and estimated bias-corrected state-specific prevalence of obesity (BMI≥30) and severe obesity (BMI≥35). We compared these results with previous adjustment methods.

RESULTS

Compared to NHANES, self-reported BRFSS data underestimated national prevalence of obesity by 16% (28.67% vs 34.01%), and severe obesity by 23% (11.03% vs 14.26%). Our method was not significantly different from NHANES for obesity or severe obesity, while previous methods underestimated both. Only four states had a corrected obesity prevalence below 30%, with four exceeding 40%-in contrast, most states were below 30% in CDC maps.

CONCLUSIONS

Twelve million adults with obesity (including 6.7 million with severe obesity) were misclassified by CDC state-level estimates. Previous bias-correction methods also resulted in underestimates. Accurate state-level estimates are necessary to plan for resources to address the obesity epidemic.

Design of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study

BACKGROUND

Childhood obesity is highly prevalent, is associated with both short- and long-term adverse outcomes, disproportionately affects racial/ethnic minority and economically deprived children, and represents a major threat to public health. Among the most promising approaches for its prevention and management are multilevel, multisector strategies.

METHODS/DESIGN

The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) Study was a comprehensive, systematic intervention to prevent and reduce childhood obesity among low-income children ages 2-12 years in two selected cities in Massachusetts. Building on the Obesity Chronic Care Model, MA-CORD expanded a state public health department community-level obesity prevention initiative that incorporated evidence-based interventions in primary healthcare, the Women, Infants, and Children program, early care and education, schools/afterschool programs, as well as community-wide programs to improve food, beverage, physical activity (PA), and messaging environments. The study used a combination of pre- and post-time series and quasi-experimental designs to examine the extent to which the intervention resulted in changes in BMI, individual-level lifestyle behaviors, satisfaction with healthcare services, and quality of life among children, as well as changes in health policies, programs, and environments in the two intervention cities, compared to a comparison city. The intervention period was 2 years.

CONCLUSIONS

MA-CORD will determine the extent to which a multisetting, multilevel intervention that integrates activities in primary care with broader public health interventions in schools, early care and education, and the community at large can improve children's dietary and PA behaviors and ultimately reduce obesity in low-income children.

Interactive learning activities for the middle school classroom to promote healthy energy balance and decrease diabetes risk in the HEALTHY primary prevention trial

The HEALTHY trial evaluated the effectiveness of a multicomponent intervention program to reduce risk for type 2 diabetes in middle school students. The comprehensive intervention addressed nutrition, physical activity, and behavior in the context of a social marketing-based communications campaign to promote healthy energy balance. One element was a classroom-based program called FLASH (Fun Learning Activities for Student Health). Five FLASH modules were delivered, one per semester. Process evaluation data were collected from teachers at 21 schools and study staff at seven national sites via survey, interview, and in-class observation. Data from the first four modules were evaluated and showed that FLASH was delivered with high fidelity. Sessions that required peer interaction were rated as the most effective in engaging students and promoting knowledge. Study-provided material resources and on-site support were identified as key facilitators. Student misbehavior was viewed as the greatest barrier. Although the high level of support provided by the study is not likely to be replicated in school systems, those developing wellness policies, health curricula, and teacher training programs may benefit from using the evidence-supported, publicly available HEALTHY materials in their efforts to reduce diabetes risk factors in middle school youth.

Aging-related changes in blood-brain barrier integrity and the effect of dietary fat

BACKGROUND

Disturbances in blood-brain barrier (BBB) integrity contribute to the onset and progression of neurodegenerative diseases including Alzheimer's disease (AD) and vascular dementia (VaD). Aging is positively associated with AD and VaD risk, but this may reflect comorbidities or the effects of other chronic modulators of vascular function such as diet.

OBJECTIVE

To explore putative synergistic effects of aging with diet, in this study genetically unmanipulated mice were maintained on diets enriched in saturated fatty acids (SFA) or cholesterol and compared to mice provided with low-fat (LF) feed formula.

METHODS

The functional integrity of the BBB was assessed following 3, 6 and 12 months of dietary intervention commenced at 6 weeks of age, by determining the brain parenchymal extravasation of immunoglobulin G (IgG).

RESULTS

Mice maintained on the SFA- or cholesterol-enriched diet showed significant parenchymal IgG abundance following 3 months of feeding, concomitant with diminished expression of the tight junction protein occludin. LF control mice had essentially no evidence of BBB disturbances. Six months of SFA feeding exacerbated the difference in IgG abundance compared to the LF mice. At 12 months of feeding, the control LF mice also had significant parenchymal IgG that was comparable to mice fed the SFA- or cholesterol-enriched diet for 3 months. However, there may have been an adaptation to the fat-enriched diets because SFA and cholesterol did not exacerbate IgG parenchymal accumulation beyond 6 months of feeding.

CONCLUSION

Collectively, the study suggests that diets enriched in SFA or cholesterol accelerate the onset of BBB dysfunction that otherwise occurs with aging.

Anharmonic transitions in nearly dry L-cysteine I

Two special dynamical transitions of universal character have recently been observed in macromolecules (lysozyme, myoglobin, bacteriorhodopsin, DNA and RNA) at T* ~100-150 K and T(D) ~180-220 K. The underlying mechanisms governing these transitions have been the subject of debate. In the present work, a survey is reported on the temperature dependence of structural, vibrational and thermodynamical properties of a nearly anhydrous amino acid (orthorhombic polymorph of the amino acid l-cysteine at a hydration level of 3.5%). The temperature dependence of x-ray powder diffraction patterns, Raman spectra and specific heat revealed these two transitions at T* = 70 K and T(D) = 230 K for this sample. The data were analyzed considering amino acid-amino acid, amino acid-water, water-water phonon-phonon interactions and molecular rotor activation. Our results indicated that the two referred temperatures define the triggering of very simple and particular events that govern all the interactions of the biomolecular: activation of CH(2) rigid rotors (T < T* ), phonon-phonon interactions between specific amino acid and water dimer vibrational modes (T* < T < T(D)), and water rotational barriers surpassing (T > T(D)).

Electron spin resonance study of the LaIn(3-x)Sn(x) superconducting system

The LaIn(3-x)Sn(x) alloy system is composed of superconducting Pauli paramagnets. For LaIn3 the superconducting critical temperature T(c) is approximately 0.7 K and it shows an oscillatory dependence as a function of Sn substitution, presenting its highest value T(c) ≈ 6.4 K for the LaSn3 end member. The superconducting state of these materials was characterized as being of the conventional type. We report our results for Gd3+ electron spin resonance measurements in the LaIn(3-x)Sn(x) compounds as a function of x. We show that the effective exchange interaction parameter J(fs) between the Gd3+ 4f local moment and the s-like conduction electrons is almost unchanged by Sn substitution and observe microscopically that LaSn3 is a conventional superconductor.

Intravascular coagulation in gestational hypertension and pre-eclampsia: the value of haematological screening tests

Routine investigations designed to detect excessive intravascular coagulation in patients with gestational hypertension and pre-eclampsia have been analysed in 936 cases. Reticulocyte counts did not differ significantly from those in normal controls and abnormal red cell morphology was detected in only two patients. Fibrinogen degradation products and thrombocytopenia were found in about 10% of all hypertensive women and macrothrombocytosis in 32%. Neither reticulocyte counts nor the scanning of stained blood films for evidence of microangiopathic haemolysis have a place in the routine investigation of pre-eclampsia and it is doubtful whether any of the other screening tests can influence the management of patients with uncomplicated gestational hypertension. In fully developed pre-eclampsia, macrothrombocytosis is found in about 50% of patients, fibrinogen degradation products and thrombocytopenia in about 15%. All three parameters reflect the degree of clinical severity of the disease.

LACE-conditioned autologous stem cell transplantation for relapsed or refractory Hodgkin's lymphoma: treatment outcome and risk factor analysis in 67 patients from a single centre

High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is a recognized treatment option for patients with relapsed Hodgkin's lymphoma. We have analysed 67 patients who underwent ASCT after LACE (lomustine (CCNU), cytarabine (Ara-C), cyclophosphamide, etoposide) conditioning for relapsed (n=61) or primary refractory (n=6) Hodgkin's lymphoma. The 100-day treatment-related mortality was 3%. With a median follow-up of 67 months (range 3.3-161.0) the probabilities of overall survival (OS) and progression-free survival (PFS) at 5 years were 68 and 64%, respectively. Probabilities for OS and PFS at 5 years for patients with chemosensitive relapse (n=40) were 81 and 78% versus 50 and 35%, respectively, for patients (n=27) with chemoresistant relapse (P=0.012 for OS, P=0.002 for PFS). In multivariate analysis mixed cellularity classical or lymphocyte-depleted classical histology subtype and haemoglobin level of 10 g/dl or less at the time of ASCT were identified as risk factors for worse OS, whereas stage III or IV disease at diagnosis and disease status at ASCT other than complete or partial remission predicted inferior PFS. LACE followed by ASCT is an effective treatment for the majority of patients with chemosensitive relapsed Hodgkin's lymphoma and a proportion of chemorefractory patients also benefit.

Predictive factors for survival in myeloma patients who undergo autologous stem cell transplantation: a single-centre experience in 211 patients

High-dose therapy with autologous stem cell therapy (ASCT) has become the treatment of choice for eligible patients with myeloma. We analysed retrospectively the prognostic influence of pre-transplant characteristics and transplant modalities on response and survival in 211 myeloma patients who were transplanted in our centre between 1994 and 2004. All patients received peripheral blood stem cell support after conditioning with melphalan alone (183 patients), or melphalan and total blood irradiation (28 patients). We evaluated the influence of age, type of multiple myeloma, status prior and post ASCT, previous treatment regimens, time of ASCT from diagnosis, year of autograft, dose of re-infused CD34(+) cells, plasma cell infiltration and beta2-microglobulin at diagnosis on overall survival (OS) and event-free survival (EFS) to define patients with better prognosis. Median OS and EFS from transplantation were 50.9 and 20.1 months, respectively. Median OS from diagnosis was 68.8 months. Transplant-related mortality was 1.4%. Lower beta2-microglobulin levels, achievement of complete remission (CR) post transplant and lower plasma cell infiltration at diagnosis and transplant correlated with longer EFS and OS, whereas CR at transplant and low international prognostic index at transplant correlated with better EFS. Higher CD34(+) cell dose correlated with improved OS. We conclude that ASCT is safe and effective and the outcome is independent of age, time from diagnosis, previous treatment and conditioning regimen.

Long-term outcome of high-dose melphalan and autologous stem cell transplantation for AL amyloidosis

Light chain (AL) amyloidosis is the result of a clonal plasma cell expansion, in which amyloidogenic monoclonal light chains deposit in various tissues resulting in organ dysfunction and organ failure. The median survival of patients with AL amyloidosis without therapy is 10-14 months. Several phase II studies report haematological and clinical remission in up to 50% of patients after high-dose melphalan and autologous stem cell transplantation. We analysed retrospectively the long-term outcome of 19 patients treated in this way between August/1996 and December/2001. We observed a relatively high treatment-related mortality of 26%, but 12 patients (63%) were high-risk candidates. Eight patients (42%) surviving longer than 100 days achieved haematological remission and long-term survival, whereas 6 (32%) obtained no clear benefit from high-dose therapy. However, 62% of patients survived beyond 2 years and the median survival from transplant was 48 months (range 0-104 months).

Lattice distortion effects on the magnetostructural phase transition of MnAs

We present a systematic experimental and theoretical study of the first-order phase transition of epitaxially grown MnAs thin films under biaxial tensile stress. Our results give direct information on the dependence of the phase-transition temperature of MnAs films on the lattice parameters. We demonstrate that an increase of the lattice constant in the hexagonal plane raises the phase-transition temperature (T(p)), while an increase of the perpendicular lattice constant lowers T(p). The results of calculations based on density functional theory are in good agreement with the experimental ones. Our findings open exciting prospects for magneto-mechanical devices, where the critical temperature for ferromagnetism can be engineered by external stress.

Paclitaxel-containing high-dose chemotherapy for relapsed or refractory testicular germ cell tumours

High-dose regimes containing etoposide, carboplatin and an oxazaphospharine can salvage 30–40% of patients with relapsed or refractory male germ cell tumours (GCTs). The additional benefit of paclitaxel in such high-dose therapy has not been tested. Between March 1995 and November 2002, 36 male GCT patients were treated with Carbop-EC-T (paclitaxel 75 mg m⁻², etoposide 450 mg m⁻², carboplatin AUC 10 on days −7, −5 and −3 and cyclophosphamide 60 mg kg⁻¹ on days −5 and −3) followed by peripheral blood stem cell infusion (day 0). The 1-year overall survival rate for all patients is 67% (median follow-up 29 months). For the 24 patients with cisplatin-sensitive disease, the 1-year overall and event-free survivals are 88 and 64%, respectively. For those with cisplatin refractory or absolutely refractory disease, the 1-year overall survival is 25%. In all, 12 patients relapsed at a median duration of 5 months, 11 of whom have died. There were also six treatment-related deaths, five associated with pneumonitis. Pulmonary toxicity has been reported with paclitaxel in other high-dose regimes. Since altering our protocol so that paclitaxel is infused over 24 h with steroid prophylaxis, only one of 18 patients (13 testicular GCTs and five other tumour types) has had a treatment-related death. Our results suggest that Carbop-EC-T may enable a greater proportion of patients with relapsed and refractory GCTs to enter long-term remission.

High-resolution X-ray diffraction beamline at the LNLS for the study of charge, orbital and magnetic structures

A high-resolution X-ray diffraction beamline at the Brazilian Synchrotron Light Laboratory (LNLS) has been commissioned for the study of crystalline magnetic materials. The beamline optics is based on a Rh-coated vertical-focusing X-ray mirror and a sagittal-focusing double-crystal monochromator. The primary instrument is a six-circle diffractometer equipped with energy and polarization analysers and a closed-cycle He cryostat. The beamline source is a bending magnet of the 1.37 GeV storage ring of the LNLS, delivering approximately 4 x 10(10) photons s(-1) at 8 keV at the sample position. Resonant and non-resonant scattering are the main techniques used to study charge, orbital and magnetic structures. Examples of magnetic scattering in Ho and NiO single crystals, as well as orbital ordering in manganites thin films, are presented.

First experiments on diffraction-enhanced imaging at LNLS

Diffraction-enhanced images have been obtained using two silicon crystals in a non-dispersive set-up at the XRD2 beamline at the Brazilian Synchrotron Light Laboratory (LNLS). A first asymmetrically cut silicon crystal using the (333) reflection vertically expanded the monochromated beam from 1 mm to 20 mm allowing the imaging of the whole sample without movements. A symmetrically cut Si(333) second crystal was used as a Bragg analyzer. Images of biological samples including human tissue were recorded using a direct-conversion CCD detector resulting in enhancement of the contrast compared with absorption-contrast images.

The Effect of Vitamin E-Modified Dialyzers on Acute Intra-dialytic Symptoms: A Comparative Crossover Study

We performed a crossover study to compare the effect of vitamin E-modified dialyzers on acute intra-dialytic symptoms, with other membranes. Twenty patients on hemodialysis were studied. They were divided into two equal groups of low-flux (C15NL, E15NL) and high-flux (F60, EE15NL) membrane dialyzers. Within each group, a vitamin E-modified dialyzer was compared with another dialyzer in a crossover design over a two-month period. All study patients were seen during each dialysis session by a physician and the occurrence of intra-dialytic symptoms were recorded. There was a significant overall improvement in the incidence of acute intra-dialytic symptoms with the use of vitamin E-modified dialyzers as compared with the other membranes. This effect was more for cuprophane than polysulfone. The occurrence of hypotensive episodes did not differ. Our study indicates that we can achieve a reduction in the incidence of acute intra-dialytic symptoms with the use of vitamin E-modified membrane as compared to cuprophane and polysulfone.

Autologous stem cell transplantation in multiple myeloma: improved survival in nonsecretory multiple myeloma but lack of influence of age, status at transplant, previous treatment and conditioning regimen. A single-centre experience in 127 patients

High-dose therapy with autologous stem cell transplantation (ASCT) has become the treatment of choice for symptomatic eligible patients with multiple myeloma (MM). We report our centre experience and analyse retrospectively the prognostic influence of pretransplant characteristics and transplant modalities on response and survival. A total of 127 MM patients (median age: 55.2 years) were transplanted between 1994 and 2001. In all, 69 patients had IgG, 28 IgA, 23 light chain, one IgD and six non secretory MM. At the time of autograft, 6% of patients were in complete remission (CR), 73% in partial remission (PR), 12% showed minor response to previous treatment and 9% had stable or refractory disease. Prior to autograft, 79% of cases had received only one line of chemotherapy and 21% two or more lines. All patients received PBSC support after conditioning with 200 mg/m(2) melphalan alone (100 patients) or melphalan and TBI (27 patients). We evaluated the influence of age (using as cutoff value the ages of 55, 60 and 65 years), type of MM, status pre- and post-ASCT, number of lines of previous regimens, time of ASCT from diagnosis, year of autograft, dose of reinfused CD34+ cells, plasma cell infiltration and beta(2)-microglobulin at diagnosis on overall (OS) and progression-free survivals (PFS) to define patients with better prognosis. Following ASCT, 15% of patients were in CR and 81% in PR, while only two patients progressed. Median OS and PFS from transplantation were 50.4 and 23.5 months, respectively. Median OS from diagnosis was 79.7 months. Transplant-related mortality was 2.3%. Low levels of beta(2)-microglobulin and the achievement of CR post-transplant correlated with longer PFS (P<0.03 and P<0.01, respectively). The median PFS was 36.1, 23.9, 21.1 and 16.4 months for nonsecretory, IgG, IgA and light chain subtypes, respectively. Age was not an important prognostic factor at a cutoff value of 55 or 60 years. We conclude that ASCT is a safe and effective procedure even in resistant cases. The outcome was independent of age, time from diagnosis, previous treatment and conditioning regimen, but there was a tendency for better survival in the nonsecretory patients.

Post-antibiotic growth suppression of linezolid against Gram-positive bacteria

The in vitro post-antibiotic effects (PAEs) of eight different concentrations of linezolid against Gram-positive cocci were investigated and the results analysed using the sigmoid E(max) model for mathematically modelling the PAE. Mean maximal linezolid PAEs against strains of Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Enterococcus faecium and Streptococcus pneumoniae were 2.2, 1.8, 2.8, 2.0 and 3.0 h, respectively. Resistance to methicillin (for the staphylococci), vancomycin (for the enterococci) and penicillin (for the pneumococci) had no effect on the duration of the PAE. Results of PAE testing support twice-daily dosing of linezolid in humans.

Immune neutropenia associated with anti-human neutrophil antigen-2a (NB1) antibodies following unrelated donor stem cell transplantation for chronic myeloid leukaemia: perpetuation by granulocyte colony-stimulating factor

A case of immune neutropenia following unrelated stem cell transplantation for chronic myeloid leukaemia is described. The neutropenia developed following herpes zoster viral infection and was associated with antibodies to the human neutrophil antigen (HNA)-2a (formerly known as NB1). The neutropenia was prolonged, profound and unresponsive to granulocyte colony-stimulating factor (GCSF). The neutrophil count recovered after GCSF was discontinued. HNA-2a has been reported to be upregulated following GCSF administration. In the present case, it appears that the immune neutropenia may have been perpetuated by GCSF administration.

The Effect of Vitamin E-Modified Dialyzers on Acute Intra-dialytic Symptoms: A Comparative Crossover Study

We performed a crossover study to compare the effect of vitamin E-modified dialyzers on acute intra-dialytic symptoms, with other membranes. Twenty patients on hemodialysis were studied. They were divided into two equal groups of low-flux (C15NL, E15NL) and high-flux (F60, EE15NL) membrane dialyzers. Within each group, a vitamin E-modified dialyzer was compared with another dialyzer in a crossover design over a two-month period. All study patients were seen during each dialysis session by a physician and the occurrence of intra-dialytic symptoms were recorded. There was a significant overall improvement in the incidence of acute intra-dialytic symptoms with the use of vitamin E-modified dialyzers as compared with the other membranes. This effect was more for cuprophane than polysulfone. The occurrence of hypotensive episodes did not differ. Our study indicates that we can achieve a reduction in the incidence of acute intra-dialytic symptoms with the use of vitamin E-modified membrane as compared to cuprophane and polysulfone.

Effect of vitamin-E-modified dialysers on dialyser clotting, erythropoietin and heparin dosage: a comparative crossover study

We performed a crossover study to compare the effects of different dialysis membranes on 20 patients with frequent dialyser clotting and requiring > or = 5,000 units of heparin per dialysis session. Low-flux dialysers are C15NL (cellulose - Terumo) and E15NL (vitamin-E-coated - Terumo) while high-flux dialysers were F60 (polysulphone) and EE15NL (vitamin-E-coated - Terumo). Ten patients underwent dialysis for 2 months with C15NL then switched to E15NL for 2 months. Similarly, the other 10 patients were started on the high-flux dialyser F60 and then switched over to EE15NL for 2 months. The following parameters were measured at the beginning of the study, 2 weeks, 1 month and then at 2 months: hemoglobin, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, protein C, protein S, antithrombin III (ATIII) and factor 12 activity. Dialyser clotting, heparin and erythropoietin requirements were assessed during each dialysis session. There was a significant reduction in clotting with E15NL in comparison to C15NL (22.8 +/- 17 and 44.1 +/- 22.8 (p = 0.0233), respectively). Similarly, heparin requirements were less in the vitamin-E-coated (E15NL) dialysers, 4, 754 +/- 1,427 vs. 6,011 +/- 856 units (p = 0.0281) and erythropoietin usage was also significantly reduced, 4,630 +/- 2,620 vs. 7,850 +/- 4,069 units (p = 0.049). There was a significant increase in hemoglobin with E15NL compared to C15NL, 115 +/- 10.4 vs. 108 +/- 13.1 (p = 0.0343). When the high-flux dialysers were compared there was a tendency towards less dialyser clotting with the EE15NL compared to F60, though this did not achieve statistical significance (p = 0.0561). We could not demonstrate any significant changes between the different dialysers with regards to PT, PTT, fibrinogen factor 12 activity, protein C, protein S and ATIII. In conclusion, we have shown that the use of vitamin-E-modified dialysers is associated with less clotting in patients with persistent clotting problems. In addition, this was associated with less heparin and erythropoietin requirements.

CCNU (lomustine), idarubicin and dexamethasone (CIDEX): an effective oral regimen for the treatment of refractory or relapsed myeloma

We report the results of a non-randomized pilot study of an oral regimen comprising CCNU (lomustine; 25 or 50 mg/m2 on day 1), idarubicin (4-demethoxydaunorubicin) (10 mg/m2 on days 1-3) and dexamethasone (10 mg b.d. on days 1-4) in patients with relapsed or refractory myeloma. Treatment was given every 28 d for a maximum of six courses. Sixty patients were entered of whom 57 were evaluable. Overall response rate (partial or minor response) was 49% with 30% of patients achieving a partial response (50% tumour reduction). Response rates were higher in patients with untested relapse than in those with refractory disease (overall response rates 56% vs. 31%). The major toxicity was neutropenia and the regimen was otherwise well tolerated. The median survival from entry of all patients was 15 months, with 30% of patients alive at 2 years. This regimen represents a useful addition to available treatment options.

CD34+-selected peripheral blood progenitor cell transplantation in patients with multiple myeloma: tumour cell contamination and outcome

Thirty-six patients with multiple myeloma (23 PR1, nine PR2, four stable disease) were entered into a pilot study evaluating the use of CD34+-selected peripheral blood progenitor cell transplantation (PBPCT) following high-dose melphalan alone or high-dose melphalan and total body irradiation. Peripheral blood progenitor cells (PBPCs) were mobilized with cyclophosphamide and granulocyte colony stimulating factor (G-CSF). CD34+ selection using the Cellpro Ceprate-SC system was performed in 22 cases with an adequate yield in 20. 10 patients failed to mobilize sufficient cells to permit selection and in four cases selection was not performed for other reasons. 16 patients therefore received unselected PBPC. Tumour cell contamination was evaluated by IgH gene fingerprinting (fpPCR). Harvested PBPC were fpPCR positive in 13/20 CD34+-selected cases and remained positive after selection in seven. Harvested PBPC were studied in 9/16 patients receiving unselected cells; fpPCR was positive in five and negative in four. There was no difference in event-free survival (EFS) between the CD34+-selected group and the unselected group (median 21 and 26 months, respectively, P=ns). The CD34+-selection process therefore reduced contamination but did not eliminate it completely, and in this small non-randomized study there was no apparent clinical benefit of CD34+ selection.

A versatile X-ray diffraction station at LNLS (Brazil)

Versatility was a major consideration in the project to provide an X-ray diffraction station at LNLS. At least two techniques are possible at the station: powder diffraction and multiple single-crystal diffraction. A two-crystal monochromator based on monolithic elastic translators, developed at LNLS, with sagittal focusing by the second crystal, allows 10 mrad of a >/=2 keV monochromatic beam to be used on the diffractometer. The station is equipped with a fast scintillation detector, imaging plates, a high-energy-resolution pin-diode detector, an ionization chamber and a high-angular-resolution soller slit. The data collection and control hardware and software were also developed at LNLS. The theta-2theta goniometry for powder diffraction on this 1 m-diameter diffractometer is based on commercial rotation tables. The multiple single-crystal goniometry is realized by an independent elastic axis driven by differential micrometers for both high- and low-resolution angular movements. At least four independent axes can be positioned as necessary on the diffractometer table. Powder diffractograms and double-crystal rocking curves collected with the synchrotron beam show the expected quality.

High-dose therapy including carboplatin adjusted for renal function in patients with relapsed or refractory germ cell tumour: outcome and prognostic factors

Thirty-one consecutive patients with relapsed or refractory GCT received an HDT schedule including carboplatin, the dose of which was adjusted to measured glomerular filtration rate. There was one HDT-associated death (3%), due to acute renal failure. The 3-year probability of overall and disease-free survival for 21 patients with primary refractory disease or responsive relapse was 60% and 42%, respectively, while none of ten patients with refractory relapse have survived disease free.

Nanosecond-resolved XMCD on ID24 at the ESRF to investigate the element-selective dynamics of magnetization switching of Gd-Co amorphous thin film

The one-bunch filling mode of the ESRF is combined with a microcoil to generate a pulsed-magnetic-field pump phased with respect to the probe that is given by the bunch of photons emitted each turn (357 kHz). Nanosecond-resolved X-ray magnetic circular dichroism (XMCD) is carried out. Besides the microcoil, the two other key-elements are the energy-dispersive XAS spectrometer, which yields parallel data acquisition, and the diamond-based quarter-wave plate, which tunes the helicity of the photon alternatively left and right.

Design of an X-ray Phase-Plate Analyzer to Measure the Circular Polarization Rate of a Helical Undulator Source

A quarter-wave plate made of a ca 16 mum-thick silicon single-crystal was used at energies as low as 2.8 keV to convert circularly polarized photons into linearly polarized photons. Coupled to a linear polarimeter, this quarter-wave plate enabled the characterization of the circular polarization rate of the radiation emitted by one of the ESRF helical undulators, Helios-I. The measured value (ca 97%) is in good agreement with theoretical predictions. Special attention was paid to the alignment procedures of all relevant optical components of the beamline.