Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099

PURPOSE

The Southwest Oncology Group (SWOG) coordinated an Intergroup study with the participation of Radiation Therapy Oncology Group (RTOG), and Eastern Cooperative Oncology Group (ECOG). This randomized phase III trial compared chemoradiotherapy versus radiotherapy alone in patients with nasopharyngeal cancers.

MATERIALS AND METHODS

Radiotherapy was administered in both arms: 1.8- to 2.0-Gy/d fractions Monday to Friday for 35 to 39 fractions for a total dose of 70 Gy. The investigational arm received chemotherapy with cisplatin 100 mg/m2 on days 1, 22, and 43 during radiotherapy; postradiotherapy, chemotherapy with cisplatin 80 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d on days 1 to 4 was administered every 4 weeks for three courses. Patients were stratified by tumor stage, nodal stage, performance status, and histology.

RESULTS

Of 193 patients registered, 147 (69 radiotherapy and 78 chemoradiotherapy) were eligible for primary analysis for survival and toxicity. The median progression-free survival (PFS) time was 15 months for eligible patients on the radiotherapy arm and was not reached for the chemo-radiotherapy group. The 3-year PFS rate was 24% versus 69%, respectively (P < .001). The median survival time was 34 months for the radiotherapy group and not reached for the chemo-radiotherapy group, and the 3-year survival rate was 47% versus 78%, respectively (P = .005). One hundred eighty-five patients were included in a secondary analysis for survival. The 3-year survival rate for patients randomized to radiotherapy was 46%, and for the chemoradiotherapy group was 76% (P < .001).

CONCLUSION

We conclude that chemoradiotherapy is superior to radiotherapy alone for patients with advanced nasopharyngeal cancers with respect to PFS and overall survival.

Mesenchymal precursor cells in the blood of normal individuals

STATEMENT OF FINDINGS: Mesenchymal precursor cells found in the blood (BMPCs) of normal persons adhere to plastic and glass and proliferate logarithmically in DMEM-20% fetal calf serum (FCS) without growth factors. They form cells with fibroblast-like and stromal morphology, which is not affected by eliminating CD34, CD3, or CD14 cells. Osteogenic supplements (dexamethasone, ascorbic acid, and beta-glycerophosphate) added to the culture inhibited fibroblast formation, and BMPCs assumed the cuboidal shape of osteoblasts. After 5 days in supplemented medium, the elutriated cells displayed alkaline phosphatase (AP), and the addition of bone morphogenetic protein (BMP)2 (1 ng) doubled AP production (P < 0.04). Two weeks later, 30% of the cells were very large and reacted with anti-osteocalcin antibody. The same cultures also contained sudanophlic adipocytes and multinucleated giant cells that stained for tartrate-resistant acid phosphatase (TRAP) and vitronectin receptors. Cultured BMPCs immunostain with antibodies to vimentin, type I collagen, and BMP receptors, heterodimeric structures expressed on mesenchymal lineage cells. In addition, BMPCs stain with anti-CD105 (endoglin), a putative marker for bone-marrow mesenchymal stem cells (MSCs).

A controlled double blind study of azathioprine in the management of Crohn's disease

While immunosuppressive agents are used widely in the management of Crohn's disease, their efficacy has not been well established in randomised controlled trials. This study was designed to examine whether azathioprine increases remission rate when used in conjunction with a diminishing dose regimen of prednisolone over a period of 12 weeks. It further examined whether azathioprine offers any therapeutic advantage over placebo in the maintenance of remission in Crohn's disease over a period of 15 months. Sixty three patients with active Crohn's disease were treated with a 12 weeks diminishing dose of prednisolone and at the same time entered into a randomised, double blind 15 month trial of either azathioprine (2.5 mg/kg) or placebo. Remission rates between the two groups were compared at 12 weeks and at 15 months. There was no significant difference in the proportion of patients who had achieved and maintained remission by week 12 but at 15 months there was a highly significant difference in the proportion of patients in remission (42% receiving azathioprine v 7% receiving placebo), p = 0.001. Using life tables this beneficial effect was reflected as the difference in the median number of days on the trial (p = 0.02). There were significantly greater decreases over the trial period in the median erythrocyte sedimentation rate, C reactive protein, and leucocyte count in the azathioprine group. There were no cases of severe bone marrow suppression or clinical pancreatitis. In conclusion, azathioprine offers a therapeutic advantage over placebo in the maintenance of remission in Crohn's disease.

Association between surges of follicle-stimulating hormone and the emergence of follicular waves in heifers

The effects of ablation of a dominant follicle and treatment with follicular fluid on circulating concentrations of follicle-stimulating hormone (FSH) were studied and the temporal relationships between surges of FSH and follicular waves were studied in heifers with two or three follicular waves/interovulatory interval. Cauterization of the dominant follicle on Day 3 or Day 5 (ovulation on Day 0) (six control and six treated heifers/day) resulted in a surge (P less than 0.05) in FSH beginning the day after cautery. The FSH surge prior to wave 2 (first post-treatment follicular wave) occurred 4 days (Day 3 cautery) and 2 days (Day 5 cautery) before the surge in control groups, corresponding to a 4-day and a 2-day advance in emergence of wave 2 compared with controls. It was concluded that the dominant follicle on Day 3 and Day 5 was associated with the suppression of circulating FSH concentrations. Heifers (n = 4/group) were untreated or treated intravenously with a proteinaceous fraction of bovine follicular fluid on Days 0-3, 3-6, or 6-11. Concentrations of FSH were suppressed (P less than 0.05) for the duration of treatment, regardless of the days of treatment. Cessation of treatment was followed within 1 day by the start of a surge in FSH. The FSH surge prior to wave 2 occurred 2 days earlier (treatment on Days 0-3), 1 day later (treatment on Days 3-6), and 6 days later (treatment on Days 6-11) than in controls, corresponding to an equivalent advance or delay, respectively, in the emergence of wave 2 compared with controls. The results suggest that the effects of exogenous follicular fluid on follicular development were mediated, in whole or in part, by altering plasma FSH concentrations. Control heifers combined for the two experiments were separated into those with 2-wave (n = 11) or 3-wave (n = 5) interovulatory intervals. Two-wave heifers had two FSH surges and 3-wave heifers had three apparent FSH surges during the interovulatory interval. Results of the cautery and follicular fluid experiments indicated that a surge in FSH necessarily preceded the emergence of a wave. The FSH surges in treated and control heifers began 2-4 days before the detectable (ultrasound) emergence of a follicular wave (follicles of 4 and 5 mm), peaked 1 or 2 days before emergence and began to decrease approximately when the follicles of a wave begin to diverge into a dominant follicle and subordinate follicles (follicles 6-7 mm).

Isolation of picomolar affinity anti-c-erbB-2 single-chain Fv by molecular evolution of the complementarity determining regions in the center of the antibody binding site

We determined the extent to which additional binding energy could be achieved by diversifying the complementarity determining regions (CDRs) located in the center of the antibody combining site of C6.5, a human single-chain Fv (scFv) isolated from a non-immune phage library which binds the tumor antigen c-erbB-2. CDR3 of the light (V(L)) and heavy (V(H)) chain variable region of C6.5 were sequentially mutated, the mutant scFv displayed on phage, and higher affinity mutants selected on antigen. Mutation of V(L) CDR3 yielded a scFv (C6ML3-9) with a 16-fold lower Kd (1.0 x 10(-9) M) than C6.5. Due to its length of 20 amino acids, four V(H) CDR3 libraries of C6ML3-9 were constructed. The greatest increase in affinity from a single library was ninefold (Kd = 1.1 x 10(-10) M). Combination of mutations isolated from separate V(H) CDR3 libraries yielded additional ninefold decreases in Kd, resulting in a scFv with a 1230-fold increase in affinity from wild-type C6.5 (Kd = 1.3 x 10(-11) M). The increase in affinity, and its absolute value, are comparable to the largest values observed for antibody affinity maturation in vivo or in vitro and indicate that mutation of V(L) and V(H) CDR3 may be a particularly efficient means to increase antibody affinity. This result, combined with the location of amino acid conservation and substitution, suggests an overall strategy for in vitro antibody affinity maturation. In addition, the affinities and binding kinetics of the single-chain Fv provide reagents with potential tumor targeting abilities not previously available.

Isolation of high-affinity monomeric human anti-c-erbB-2 single chain Fv using affinity-driven selection

The use of antibodies to target tumor antigens has had limited success, partially due to the large size of IgG molecules, difficulties in constructing smaller single chain Fv (scFv) antibody fragments, and immunogenicity of murine antibodies. These limitations can be overcome by selecting human scFv directly from non-immune or semi-synthetic phage antibody libraries; however, the affinities are typically too low for therapeutic application. For hapten antigens, higher-affinity scFv can be isolated from phage antibody libraries where the VH and VL genes of a binding scFv are replaced with repertoires of V genes (chain shuffling). The applicability of this approach to protein binding scFv is unknown. For this work, chain shuffling was used to increase the affinity of a non-immune human scFv, which binds the glycoprotein tumor antigen c-erbB-2 with an affinity of 1.6 x 10(-8) M. The affinity of the parental scFv was increased sixfold (Kd = 2.5 x 10(-9) M) by light-chain shuffling and fivefold (Kd = 3.1 x 10(-9) M) by heavy-chain shuffling, values comparable to those for antibodies against the same antigen produced by hybridomas. When selections were performed on antigen immobilized on polystyrene, spontaneously dimerizing scFv were isolated, the best of which had only a slightly lower Kd than wild type (Kd = 1.1 x 10(-8) M). These scFv dimerize on phage and are preferentially selected as a result of increased avidity. Compared to scFv which formed only monomer, dimerizing scFv had mutations located at the VH-VL interface, suggesting that VH-VL complementarity determines the extent of dimerization. Higher-affinity monomeric scFv were only obtained by selecting in solution using limiting concentrations of biotinylated antigen, followed by screening mutant scFv from bacterial periplasm by koff in a BIAcore. Using the proper selection and screening conditions, protein binding human scFv with affinities comparable to murine hybridomas can be produced without immunization.

Characterization of ovarian follicular wave dynamics in women

A wave phenomenon of ovarian follicular development in women has recently been documented in our laboratory. The objective of the present study was to characterize follicular waves to determine whether women exhibit major and minor wave patterns of follicle development during the interovulatory interval (IOI). The ovaries of 50 women with clinically normal menstrual cycles were examined daily using transvaginal ultrasonography for one IOI. Profiles of the diameters of all follicles >or=4 mm and the numbers of follicles >or=5 mm were graphed during the IOI. Major waves were defined as those in which one follicle grew to >or=10 mm and exceeded all other follicles by >or=2 mm. Minor waves were defined as those in which follicles developed to a diameter of <10 mm and follicle dominance was not manifest. Blood samples were drawn to measure serum concentrations of estradiol-17beta, LH, and FSH. Women exhibited major and minor patterns of follicular wave dynamics during the IOI. Of the 50 women evaluated, 29/34 women with two follicle waves (85.3%) exhibited a minor-major wave pattern of follicle development and 5 women (14.7%) exhibited a major-major wave pattern. Ten of the 16 women with three follicle waves (62.5%) exhibited a minor-minor-major wave pattern, 3 women (18.8%) exhibited a minor-major-major wave pattern, and 3 women (18.8%) exhibited a major-major-major wave pattern. Documentation of major and minor follicular waves during the menstrual cycle challenges the traditional theory that a single cohort of antral follicles grows only during the follicular phase of the menstrual cycle.

A new model for ovarian follicular development during the human menstrual cycle

OBJECTIVE

To evaluate changes in ovarian follicle dynamics during the human menstrual cycle to test the hypothesis that folliculogenesis occurs in a wave-like fashion.

DESIGN

Prospective longitudinal study.

SETTING

Healthy volunteers in an academic research environment.

PATIENT(S)

Fifty healthy women of reproductive age (range 19-43 years) with a history of regular menstrual cycles not taking medications known to interfere with reproductive function were evaluated.

INTERVENTION(S)

Transvaginal ultrasonography was performed daily for one interovulatory interval (IOI).

MAIN OUTCOME MEASURE(S)

Changes in the diameter and number of follicles > or =5 mm were evaluated.

RESULT(S)

Sixty-eight percent of women exhibited two waves of follicle development during the IOI and 32% exhibited three waves. Waves were characterized by an increase and subsequent decrease in the number of follicles > or =5 mm occurring in association with the growth of > or =2 follicles to > or =6 mm. A day effect and day by wave interaction were detected in the mean diameter of the largest three follicles and the number of follicles > or =5 mm.

CONCLUSION(S)

The follicular wave phenomenon in women provides a new model for ovarian function during the menstrual cycle and will improve our understanding of the ovarian response to fertility and hormonal contraceptive regimens.

Effect of progesterone on ovarian follicles, emergence of follicular waves and circulating follicle-stimulating hormone in heifers

The hypothesis was tested that greater growth of the dominant follicle of wave 1 (first follicular wave of an interovulatory interval), compared with that of subsequent anovulatory waves, is due to lower circulating concentrations of progesterone during the growing phase of the follicle. Control heifers (n = 6) were compared with heifers (n = 6) treated with a decreasing dose of progesterone from day 0 to day 5 (ovulation = day 0). Maximum diameter (12.7 +/- 0.9 versus 15.3 +/- 0.7 mm) and mean diameter of the dominant follicle of wave 1, averaged over days, were smaller (P < 0.05) in the progesterone-treated than in the control group. Progesterone treatment did not suppress circulating follicle-stimulating hormone (FSH); but the second FSH surge was earlier, resulting in earlier emergence of wave 2 as indicated by a tendency (P < or = 0.1) for group x day interactions attributed to earlier detection of the dominant follicle and an earlier rise in the total number of follicles detected. The stated hypothesis was supported. We also tested the hypothesis that exposure to low circulating concentrations of progesterone at the end of the growing phase of the anovulatory dominant follicle of wave 1 results in continued growth and prolonged maintenance of the dominant follicle. Heifers (n = 6 per group) were given a luteolytic dose of prostaglandin F2 alpha (PGF2 alpha) on day 6 and treated with a low (30 mg day-1), physiological (150 mg day-1), or high (300 mg day-1) dose of progesterone on days 6 to 20. Continued periodic emergence of anovulatory follicular waves occurred (2.1 +/- 0.0 waves, 2.8 +/- 0.2 waves, 3.8 +/- 0.3 waves, respectively; P < 0.05) until treatment was stopped (interovulatory intervals: 26.2 +/- 1.0, 30.8 +/- 0.6 and 40.3 +/- 1.7 days, respectively; P < 0.05). Compared with the physiological dose group, the growth of the dominant follicle was inhibited to a lesser degree in the low-dose group since it grew for longer (P < 0.05) and to a larger diameter (P < 0.05), and persisted for longer (P < 0.05). Prolonged dominance of this oversized (> 20 mm) follicle was associated with delayed emergence of wave 2. The hypothesis was supported. Results also showed that the high dose of progesterone suppressed the dominant follicle more than the physiological dose when given during the growing phase, but not when given after the growing phase.(ABSTRACT TRUNCATED AT 400 WORDS)

Restriction endonuclease fingerprinting of herpes simplex virus DNA: a novel epidemiological tool applied to a nosocomial outbreak

In a blind study, 14 isolates of herpes simplex virus type 1 (HSV-1) that included nine isolates from a temporal cluster of HSV infections in a hospital Pediatric Intensive Care Unit and five unrelated isolates were analyzed by digestion of their DNA with four restriction endonucleases. These enzymes (HsuI, BglII, EcoRI, and HpaI) cleave the DNA in about 52 sites. To date, at least 16 sites have been found to be variable in the sense that they may be present or absent independently of any other cleavage site. This characteristic is stable, and no change was observed on serial propagation of the strains in culture or following repeated isolation, as long as 12 years apart, from humans. Analyses of the isolates readily discriminated between those belonging to the temporal cluster of hospital infections and the unrelated strains. They also showed that there were two independent introductions of HSV-1 into the Pediatric Intensive Care Unit resulting in two clusters of epidemiologically related infections. This type of analysis has the potential of becoming a powerful tool for tracing the spread of HSV-1 and very likely of other herpesviruses in the human population.

Prolonged in vivo tumour retention of a human diabody targeting the extracellular domain of human HER2/neu

Single-chain Fv (scFv) molecules exhibit highly specific tumour-targeting properties in tumour-bearing mice. However, because of their smaller size and monovalent binding, the quantities of radiolabelled scFv retained in tumours limit their therapeutic applications. Diabodies are dimeric antibody-based molecules composed of two non-covalently associated scFv that bind to antigen in a divalent manner. In vitro, diabodies produced from the anti-HER2/neu (c-erbB-2) scFv C6.5 displayed approximately 40-fold greater affinity for HER2/neu by surface plasmon resonance biosensor measurements and significantly prolonged association with antigen on the surface of SK-OV-3 cells (t1/2 cell surface retention of > 5 h vs 5 min) compared with C6.5 scFv. In SK-OV-3 tumour-bearing scid mice, radioiodinated C6.5 diabody displayed a highly favourable balance of quantitative tumour retention and specificity. By as early as 4 h after i.v. administration, significantly more diabody was retained in tumour (10 %ID g(-1)) than in blood (6.7 %ID ml(-1)) or normal tissue (liver, 2.8 %ID g(-1); lung, 7.1 %ID g(-1); kidney, 5.2 %ID g(-1)). Over the next 20 h, the quantity present in blood and most tissues dropped approximately tenfold, while the tumour retained 6.5 %ID g(-1) or about two-thirds of its 4-h value. In contrast, the 24-h tumour retention of radioiodinated C6.5 scFv monomer was only 1 %ID g(-1). When diabody retentions were examined over the course of a 72-h study and cumulative area under the curve (AUC) values were determined, the resulting tumor-organ AUC ratios were found to be superior to those previously reported for other monovalent or divalent scFv molecules. In conclusion, the diabody format provides the C6.5 molecule with a distinct in vitro and in vivo targeting advantage and has promise as a delivery vehicle for therapeutic agents.

Improved detection of recurrent bladder cancer using the Bard BTA stat Test

OBJECTIVES

To evaluate the BTA stat Test in the detection of recurrent bladder cancer.

METHODS

Sensitivity and specificity were determined using frozen voided urine samples from patients with recurrent bladder cancer, volunteers, patients with nonurologic conditions, and patients with a history of bladder cancer but free of disease. Results of cytology and the original BTA Test were compared with the sensitivity of the BTA stat Test in a large subgroup of the patients with cancer.

RESULTS

The BTA stat Test detected 147 (67%) of 220 recurrent cancers. For those urine samples with previous cytologic and BTA Test results available, cytology had a sensitivity of 23%, the BTA Test 44%, and the BTA stat Test 58% for detection of recurrent cancer (P < 0.001, stat versus cytology). The specificity of the BTA stat Test was 72% for benign genitourinary disease and 95% in healthy volunteers.

CONCLUSIONS

The BTA stat Test has high sensitivity and is significantly superior to voided urine cytologic analysis in the detection of recurrent bladder cancer.

Recent advances in the superovulation in cattle

The variability in the superovulatory response continues to be one of the most frustrating problems with embryo transfer in cattle. The removal of LH from pituitary extracts has tended to reduce the variability in response, and several studies involving the use of the purified porcine pituitary extract. Folltropin-V are reviewed. The major source of variability in the superovulatory response in cattle is the status of ovarian follicles at the time of initiation of gonadotrophin treatments. Data support the benefits of initiating gonadotrophin treatments at the time of emergence of a follicular wave. Incorporation of techniques designed to control follicular wave dynamics, such as follicular ablation, or treatment with estradiol/progesterone, have reduced the variability caused by treating cows at different stages of follicular development, and at the same time improved response by taking advantage of endogenous recruitment and selection mechanisms. New protocols offer the convenience of being able to initiate gonadotrophin treatments quickly and at a self-appointed time, without the necessity of estrus detection and without sacrificing response. Methods can be used for repeated superstimulation of donor animals at 25 to 30 day intervals, without regard to estrus detection or stage of the estrous cycle, and without compromising embryo production.

Selection and characterization of HER2/neu-binding affibody ligands

Affibody (affibody) ligands that are specific for the extracellular domain of human epidermal growth factor receptor 2 (HER2/neu) have been selected by phage display technology from a combinatorial protein library based on the 58 amino acid residue staphylococcal protein A-derived Z domain. The predominant variants from the phage selection were produced in Escherichia coli, purified by affinity chromatography, and characterized by biosensor analyses. Two affibody variants were shown to selectively bind to the extracellular domain of HER2/neu (HER2-ECD), but not to control proteins. One of the variants, denoted His6-ZHER2/neu:4, was demonstrated to bind with nanomolar affinity (approximately 50 nM) to the HER2-ECD molecule at a different site than the monoclonal antibody trastuzumab. Furthermore, radiolabeled His6-ZHER2/neu:4 affibody showed specific binding to native HER2/neu, overexpressed on the SKBR-3 tumor cell line. Such affibody ligands might be considered in tumor targeting applications for radionuclide diagnostics and therapy of adenocarcinomas such as breast and ovarian cancers.

Ovarian synchronization following ultrasound-guided transvaginal follicle ablation in heifers

In Experiments 1 and 2, ultrasound-guided transvaginal follicle aspiration was used as a method of follicle ablation to induce and synchronize subsequent follicular wave emergence and enhance ovulation synchrony following PGF2alpha administration. Heifers were at unknown stages of the estrous cycle at the start of both experiments in which all follicles>or=5 mm in diameter were ablated; luteolysis was induced 4 d later with cloprostenol (500 ug/dose, im). In Experiment 1, heifers were randomly assigned to either an ablation (n=17) or a procedural control (no follicle ablation, n=17) group. Ablation-induced wave emergence was indicated by a significant increase in the total number of follicles>or=5 mm within 2 d of ablation (mean, 1.5 d), which was preceded by a significant surge in circulating FSH. Although the mean (+/-SEM) interval from PGF2alpha administration to ovulation did not differ between follicle-ablated heifers (5.1+/-0.5 d range, 3 to 9 d) and control heifers (5.1+/-1.0 d; range, 1 to 5 d), the variability of the interval was different (P<0.05). Inequality of variance between the 2 groups was attributed to a greater (P<0.08) degree of ovulation synchrony in the ablation group than in the control group; 13/16 (81%) versus 9/17 (53%), respectively, ovulated within 5 d of cloprostenol administration. Relative asynchrony of ovulations in control heifers was associated with the status of the follicular wave at the time of PGF2alpha administration and, in part, to incomplete luteolysis following a single dose of PGF2alpha. Experiment 2 was designed to examine the efficacy of 2 doses of cloprostenol 12 h apart (n=7) versus a single dose (n=8) to induce complete luteolysis subsequent to follicle ablation-induced wave emergence. Two doses of cloprostenol potentiated ovulation synchrony; more (P<0.05) 2-dose heifers (7/7, 100%) than single-dose heifers (4/8, 50%) ovulated within 5 d after PGF2alpha administration. In summary, ultrasound-guided transvaginal follicle ablation, done at random during the estrous cycle, induced and synchronized subsequent follicular wave emergence, and resulted in a high degree of ovulation synchrony among heifers after PGF2alpha induced luteolysis, especially when 2 doses of PGF2alpha were administered 12 h apart.

Treatment of advanced Hodgkin's disease with chemotherapy--comparison of MOPP/ABV hybrid regimen with alternating courses of MOPP and ABVD: a report from the National Cancer Institute of Canada clinical trials group

PURPOSE

This randomized, prospective trial compares outcomes for patients with advanced Hodgkin's disease treated with mechlorethamine, vincristine, procarbazine, and prednisone (MOPP)/doxorubicin, bleomycin, and vinblastine (ABV) hybrid regimen or alternating MOPP/doxorubicin, bleomycin, vinblastine, and dacarbazine (ABVD).

METHODS

Three hundred one patients with advanced Hodgkin's disease were randomized to receive MOPP/ ABV hybrid regimen or alternating MOPP/ABVD after stratification for prior treatment, B symptoms, and treatment center. Eligible patients were either previously untreated and found to have stage IIIB, IVA, or IVB disease or previously treated with wide-field irradiation. Responding patients received a minimum of eight cycles of chemotherapy. Those with residual disease in a localized region received irradiation between the sixth and seventh cycle of treatment.

RESULTS

Response rates to the two regimens were similar. Five-year overall survival rates were 81% and 83% for MOPP/ABV hybrid and alternating MOPP/ ABVD, respectively (P = .74; 95% confidence interval [CI] for the difference, -11% to 7%). Five-year failure-free survivals were 71% and 67% for MOPP/ABV hybrid and alternating MOPP/ABVD, respectively (P = .87; 95% CI for the difference, -9% to 17%). Significantly more episodes of febrile neutropenia and stomatitis were observed with the MOPP/ABV hybrid regimen; there was no significant difference in fatal toxicity. Patients with predefined, high-quality partial responses (PR-1s) had results similar to those with complete responses (CRs). Planned subset analysis showed no significant difference in outcome between the two arms of the trial for patients with newly diagnosed disease (5-year failure-free survival rates were 70% for MOPP/ABV hybrid and 59% for alternating MOPP/ABVD; P = .180), but superiority of alternating MOPP/ABVD for patients with prior irradiation (5-year failure-free survival 94% v 73%; P = .017).

CONCLUSION

MOPP/ABV hybrid and alternating MOPP/ABVD regimens are equally effective for patients with advanced Hodgkin's disease.

Bovine model for the study of reproductive aging in women: follicular, luteal, and endocrine characteristics

At present, there is no well-characterized animal model to study the effects of aging on fertility in women. The objectives of the study were to characterize age-related changes in ovarian and endocrine functions in old cows and to investigate the validity of a bovine model for the study of human reproductive aging. We tested the hypotheses that aging in cattle is associated with 1) elevated concentrations of gonadotropins and reduced concentrations of steroid hormones in systemic circulation and 2) increased recruitment of ovarian follicles during wave emergence. Daily ultrasonography was performed in 13- to 14-yr-old cows (n = 10) and their 1- to 4-yr-old daughters (n = 9) for one interovulatory interval to study ovarian function. Plasma samples were obtained every 12 h for determination of FSH, LH, progesterone, and estradiol concentrations. Circulating FSH concentrations were higher (P = 0.009) during follicular waves in old cows than in their daughters, but the number of 4- to 5-mm follicles recruited into a wave was lower (P = 0.04) in old cows. Plasma LH concentrations did not differ between groups (P = 0.4), but the ovulatory follicle in two-wave cycles was smaller in old cows (P = 0.04). Plasma estradiol concentrations were higher (P = 0.01) in old cows, and luteal phase progesterone tended to be lower (P = 0.1). We conclude that these changes are consistent with those reported for women approaching menopause transition. Therefore, our results validate the use of the bovine model to study reproductive aging in women.

Quality of life following bone marrow transplantation: a comparison of patient reports with population norms

All surviving patients who had received an allogeneic bone marrow transplant at the Princess Margaret Hospital were asked to participate in a health-related quality of life (HQL) study using the Medical Outcomes Survey-Short Form 36 (MOS SF-36), the Satisfaction with Life Domains Scale-Bone Marrow Transplantation (SLDS-BMT) and a current symptoms checklist. The main objective was to compare the health status of BMT survivors with age-adjusted population norms. Of the 251 patients contacted, 93% returned questionnaires. The median follow-up after BMT was 40 months, ranging from 1-253 months. On average, survivors had some diminished HQL relative to the health status of the population in general. Time since transplant had a significant influence on HQL; those less than 3 years from transplant experienced considerable impairment while those who had survived beyond this point were indistinguishable from the normal population in most domains and significantly better in certain psychosocial aspects of health. Many patients still reported symptoms months after BMT; some were mildly affected while others experienced more troublesome symptoms. However, 81% of patients were satisfied with the HQL outcome that they had achieved and 94% would recommend a transplant for someone in similar circumstances.

A simple ultrasound test to predict the superstimulatory response in cattle

We tested the hypotheses that: (1) the superstimulatory response is related to the intrinsic number of follicles recruited into a follicular wave; and (2) the number of follicles recruited into a wave is correlated to the number of follicles recruited into the successive wave. A positive correlation will form the basis of a test for predicting the superstimulatory response. Cows (n = 141) were treated with estradiol and progesterone to synchronize follicular wave emergence (first synchronization) and ranked according to the number of follicles > or =2mm at wave emergence to select the upper and lower 10% of the herd. Follicular wave emergence was synchronized again in the high-end (n = 16) and low-end (n = 20) groups (second synchronization), and cows were treated with FSH twice daily for 3 days. High-end cows had a greater number of follicles (P < 0.001) than low-end cows at the time of wave emergence after both the first and second synchronizations in the 2-3 and 4-6mm categories. The numbers of 2-3 and 4-6mm follicles at wave emergence after the first and second synchronizations were positively correlated (P < 0.001; r = 0.77 and 0.71, respectively). Endogenous FSH peak at the time of wave emergence was higher in the low-end group than in the high-end group. Superstimulatory treatment resulted in more than double the number of follicles (P < 0.003) in the 5-7mm and > or =8mm categories in the high-end group than in the low-end group (16.8 +/- 2.2 versus 8.1 +/- 0.9 and 22.7 +/- 4.1 versus 9.7 +/- 1.6, respectively). The number of follicles > or =5 and > or =8mm at the end of superstimulation was positively correlated (P < 0.001) with the total number of follicles > or =2mm at the time of wave emergence after both the first (r = 0.64 and 0.54, respectively) and second ( r = 0.65 and 0.5, respectively) synchronizations. Based on the results of this study, the superstimulatory response can be predicted by the number of follicles > or =2mm at wave emergence. For practical purposes, practitioners can expect the number of follicles > or =5mm after ovarian superstimulation to be approximately 71% of the number of follicles > or =2mm at the time of wave emergence. Results validated the proposed simple ultrasound-based test for predicting the superstimulatory response of individual cows.

Ovarian superstimulatory response relative to follicular wave emergence in heifers

Two experiments were designed to evaluate the responsiveness of beef heifers to superstimulatory treatments administered during the first follicular wave. Heifers were examined daily (Experiment 1) or twice daily (Experiment 2) by ultrasonography to determine the status of follicular wave development and the day of initiation of superstimulatory treatment. Heifers in both experiments were superstimulated with a total dose of 10 ml Folltropin (equivalent to 200 mg of NIH-FSH-P1), divided into 10 equal intramuscular injections over 5 days. On the last day of treatment, heifers received 500 mug of cloprostenol after each injection of Folltropin to induce luteolysis. In the respective groups, superstimulatory treatments were initiated on Day -1, Day 0 (day of ovulation) or Day +1 for Experiment 1, and on Day -1, Day 0, Day +1 or Day +2 for Experiment 2. In Experiment 1, the number of ovulations in each ovary was assessed by ultrasonography and by counting the number of corpora lutea (CL) in each ovary at slaughter. The correlation between both techniques for assessing ovulatory response was high (r= 0.98; P< 0.0001), and there was no significant difference in the mean number of ovulations detected by ultrasound (5.7+/-1.1) versus the mean number of CL counted at slaughter (6.2+/-1.2). In Experiment 1, the mean (+/- SEM) number of CL counted at slaughter in heifers treated on Day -1 (9.4+/-3.8) and Day 0 (7.3+/-1.6) was higher (P< 0.05) than that of heifers treated on Day +1 (0.7+/-0.3). The mean number of follicles >/=7 mm in diameter on the last day of treatment was also higher (P<0.05) in the Day -1 group compared with the Day +1 group; the Day 0 group was intermediate. In Experiment 2, the mean number of ovulations was higher (P< 0.05) in the Day 0 group (18.4+/-3.4) than the Day -1 (9.5+/-2.3), Day +1 (6.7+/-2.2) or Day +2 (6.5+/-2.3) groups. Heifers in the Day -1, and Day 0 groups had more (P< 0.05) follicles >/=7 mm at the end of treatment compared with heifers in the Day +1 or the Day +2 group. The stated hypothesis was supported: exogenous FSH treatment initiated at the time of wave emergence, near the expected time of the endogenous wave-eliciting FSH surge, has a positive effect on the superstimulatory response. A higher superstimulatory response was elicited when treatments were initiated on the day of, or the day before, wave emergence compared with that of later treatments.

Generating improved single-chain Fv molecules for tumor targeting

Due to their ease of isolation from phage display libraries and their ability to recognize conserved antigens, single-chain Fv (scFv) molecules are rapidly becoming commonplace. However, the monovalent nature of the scFv molecule often dictates, at best, transient interactions with target antigens when molecules with moderate to low affinity are employed. This, along with their rapid elimination from circulation, has limited the utility of scFv molecules for applications in the fields of cancer imaging and therapy. Recently, a number of strategies, including affinity maturation and modification of size and valence, have been evaluated for improving the in vivo efficacy of scFv molecules. In this review, we describe a number of these methods and discuss some of the characteristics that may belong to an optimal antibody-based targeting vehicle.

Effect of LH or GnRH on the dominant follicle of the first follicular wave in beef heifers

A study was designed to characterise ovarian follicular dynamics in heifers treated with porcine luteinizing hormone (pLH) or gonadotropin releasing hormone (GnRH) on days 3, 6 or 9 (ovulation = day 0), corresponding to the growing, early-static, and late-static phases of the first follicular wave. Following ovulation, 65 beef heifers were assigned, by replicate, to the following seven treatment groups: 25 mg im of pLH on days 3, 6 or 9 (n = 9 per group); 100 microg im of GnRH on days 3, 6 or 9 (n = 9 per group); or controls (no treatment; n = 11). Ovulation occurred within 36 h in 67%, 100% and 67% of heifers treated with pLH and in 89%, 56% and 22% of heifers treated with GnRH on days 3, 6 or 9, respectively (treatment-by-day interaction, P < 0.09). Combined for all treatment days, ovulation rates were 78% and 56% in pLH- and GnRH-treated groups, respectively (P < 0.09). Overall, mean day (+/- SD) of emergence of the second follicular wave in heifers that ovulated was different from that in controls or in heifers that did not ovulate (P < 0.05). Mean (+/- SD) day of emergence of the second wave occurred earlier (day 5.6+/-1.2; P < 0.05) in heifers that ovulated after treatment on day 3 (n = 14) than in controls (day 8.7+/-1.6; n = 11); however, wave emergence in all heifers treated on day 6 (day 8.1+/-0.5; n = 18) did not differ from controls, regardless of whether or not ovulation occurred. In the heifers that ovulated in response to treatment on day 9 (n = 8), the emergence of the second follicular wave was delayed (day 10.9+/-0.4; P < 0.05). The day of emergence of the second wave in the 14 treated heifers that failed to ovulate, irrespective of the day of treatment (day 8.9+/-1.4) did not differ from control heifers. The emergence of the second wave was more synchronous in day 6 heifers (regardless of whether they ovulated) and in day 9 heifers that ovulated compared to control heifers (P < 0.05). Results did not support the hypothesis that the administration of pLH or GnRH at known stages of the follicular wave in cycling heifers would consistently induce ovulation or atresia and, thereby, induce emergence of a new follicular wave at a predictable interval. New wave emergence was induced consistently (1.3 days post-treatment) only in those animals that ovulated in response to treatment. However, 22% of LH-treated heifers and 44% of GnRH-treated heifers failed to ovulate. Treatments did not induce atresia of the dominant follicle or alter the interval to new wave emergence in animals that did not ovulate in response to treatment.

Intraclass correlation coefficient and outcome prevalence are associated in clustered binary data

BACKGROUND AND OBJECTIVE

To describe the association between values for a proportion and the intraclass correlation coefficient (ICC).

METHODS

Analysis of data obtained from the General Practice Research Database (GPRD) for variation between United Kingdom general practices and results from a Health Technology Assessment (HTA) review for a range of outcomes in community and health services settings.

RESULTS

There were 188 ICCs from the GPRD, the median prevalence was 13.1% (interquartile range IQR 3.5 to 28.4%) and median ICC 0.051 (IQR 0.011 to 0.094). There were 136 ICCs from the HTA review, with median prevalence 6.5% (IQR 0.4 to 20.7%) and median ICC 0.006 (IQR 0.0003 to 0.036). There was a linear association of log ICC with log prevalence in both datasets (GPRD, regression coefficient 0.61, 95% confidence interval 0.53 to 0.69, P < 0.001; HTA, 0.91, 0.81 to 1.01, P < 0.001). When the prevalence was 1% the predicted ICC was 0.008 from the GPRD or 0.002 from the HTA, but when the prevalence was 40% the predicted ICC was 0.075 (GPRD) or 0.046 (HTA).

CONCLUSION

The prevalence of an outcome may be used to make an informed assumption about the magnitude of the intraclass correlation coefficient.

Ovulation-inducing factor in the seminal plasma of alpacas and llamas

Studies were conducted to document the existence of an ovulation-inducing factor in the seminal plasma of alpacas (experiment 1) and llamas (experiment 2) and to determine if the effect is mediated via the pituitary (experiment 3). In experiment 1, female alpacas (n = 14 per group) were given alpaca seminal plasma or saline intramuscularly or by intrauterine infusion. Only alpacas that were given seminal plasma i.m. ovulated (13/ 14, 93%; P < 0.01). In experiment 2, ovulation was detected in 9/10 (90%) llamas at a mean of 29.3 +/- 0.7 h after seminal plasma treatment. Plasma progesterone concentrations were maximal by Day 9 and were at nadir by Day 12 posttreatment. In experiment 3, female llamas were given llama seminal plasma, GnRH, or saline i.m., and ovulation was detected in 6/6, 5/ 6, and 0/6 llamas, respectively (P < 0.001). Treatment was followed by a surge (P < 0.01) in plasma LH concentration beginning 15 min and 75 min after treatment with GnRH and seminal plasma, respectively. Plasma LH remained elevated longer in the seminal plasma group (P < 0.05) and had not yet declined to pretreatment levels after 8 h. Compared with the GnRH group, corpus luteum tended to grow longer and to a greater diameter (P = 0.1) and plasma progesterone concentration was twice as high in the seminal plasma group (P < 0.01). Results document the existence of a potent factor in the seminal plasma of alpacas and llamas that elicited a surge in circulating concentrations of LH and induced an ovulatory and luteotropic response.