Workload of official contests, net cost of transport, and metabolic power of Mangalarga Marchador horses of marcha batida or picada gaits

This study aimed to characterize the maximum heart rate (HR) and the intensity of official marcha contests (OMC) and to compare the cost of transport (COT) and metabolic power (Pmet) of Mangalarga Marchador (MM) horses of marcha batida (MB) and marcha picada (MP) gaits. Twenty-two MM horses participated in this study. The experiment was conducted in 3 phases: 1) maximum effort test (MET), 2) OMC, and 3) standardized marcha test (SMT). To characterize the HR, 19 horses (14 MB and 5 MP) underwent a MET. Of those, 13 (9 MB and 4 MP) were monitored during the OMC, which consisted of 4 stages: marcha, walk, functional trial, and rest. The average heart rate (HR) in each stage of the OMC was related to the HR to determine their relative intensity. The SMT was performed with 14 horses (9 MB and 5 MP), of which 11 had already participated in the previous stages. The COT and Pmet were calculated from the HR values obtained during the SMT. Blood samples were collected to analyze plasma lactate concentration ([Lac]). One-way ANOVA or 1-way repeated-measures ANOVA followed by the Tukey's test ( < 0.05) were used to analyze the results. The average HR was 211 ± 11 and 214 ± 11 beats/min (bpm) for the MB and MP groups, respectively, with no difference ( = 0.7066) between them. The [Lac] increased as a result of the MET ( < 0.05), with no difference between groups ( > 0.05). This indicated that horses of both groups had the same physical fitness levels. The OMC stages defined in our study differed ( < 0.05) regarding the relative intensity of the HR, except for the walk and standing stages, which were similar ( = 0.0875). The MP group presented greater COT ( = 0.0247) and Pmet ( = 0.0193). It can be concluded that the mean HR of MM horses (MB and MP) is 212 ± 11 bpm. The OMC of the MM breed can be characterized as an effort of intermittent and submaximal intensity. In addition, the locomotion of the MB horses is probably more energetically efficient than that of MP horses.

Chemical characterization of atmospheric particles and source apportionment in the vicinity of a steelmaking industry

The objective of this work was to provide a chemical characterization of atmospheric particles collected in the vicinity of a steelmaking industry and to identify the sources that affect PM10 levels. A total of 94 PM samples were collected in two sampling campaigns that occurred in February and June/July of 2011. PM2.5 and PM2.5-10 were analyzed for a total of 22 elements by Instrumental Neutron Activation Analysis and Particle Induced X-ray Emission. The concentrations of water soluble ions in PM10 were measured by Ion Chromatography and Indophenol-Blue Spectrophotometry. Positive Matrix Factorization receptor model was used to identify sources of particulate matter and to determine their mass contribution to PM10. Seven main groups of sources were identified: marine aerosol identified by Na and Cl (22%), steelmaking and sinter plant represented by As, Cr, Cu, Fe, Ni, Mn, Pb, Sb and Zn (11%), sinter plant stack identified by NH4(+), K and Pb (12%), an unidentified Br source (1.8%), secondary aerosol from coke making and blast furnace (19%), fugitive emissions from the handling of raw material, sinter plant and vehicles dust resuspension identified by Al, Ca, La, Si, Ti and V (14%) and sinter plant and blast furnace associated essentially with Fe and Mn (21%).

Medidas morfométricas do rebanho atual de fêmeas Mangalarga Marchador e das campeãs da raça

Objetivou-se comparar as medidas morfométricas do rebanho atual de fêmeas Mangalarga Marchador (MM) com os exemplares campeões. O delineamento experimental foi inteiramente ao acaso, sendo os tratamentos constituídos pelo rebanho atual de fêmeas da raça MM, representado por todas as éguas registradas entre 2000 e 2012 que tiveram suas medidas armazenadas no banco de dados do Serviço de Registro Genealógico da Associação Brasileira de Criadores do Cavalo Mangalarga Marchador, totalizando 51993 animais; e pelas campeãs da raça, representadas por 266 animais campeões. Foram avaliadas a altura na cernelha e na garupa, comprimento da cabeça, pescoço, espádua, dorsolombo, garupa e corpo, largura da cabeça e da garupa e perímetro torácico e da canela. As medidas lineares foram relacionadas ao comprimento da cabeça, de acordo com o Sistema Eclético de Proporções. Os resultados das 12 medidas lineares foram submetidos à análise de variância e as médias comparadas pelo teste de Fisher (p<0,05). Em relação ao rebanho atual de fêmeas MM, as éguas campeãs da raça apresentaram maior comprimento da cabeça, corpo, pescoço, dorso-lombo e garupa, altura na cernelha e na garupa, largura da garupa e perímetro torácico e da canela. Concluiu-se que embora apresentem maiores medidas lineares, as éguas campeãs MM são proporcionalmente semelhantes ao rebanho atual de fêmeas da raça.

Levels and spatial distribution of airborne chemical elements in a heavy industrial area located in the north of Spain

The adverse health effects of airborne particles have been subjected to intense investigation in recent years; however, more studies on the chemical characterization of particles from pollution emissions are needed to (1) identify emission sources, (2) better understand the relative toxicity of particles, and (3) pinpoint more targeted emission control strategies and regulations. The main objective of this study was to assess the levels and spatial distribution of airborne chemical elements in a heavy industrial area located in the north of Spain. Instrumental and biomonitoring techniques were integrated and analytical methods for k0 instrumental neutron activation analysis and particle-induced x-ray emission were used to determine element content in aerosol filters and lichens. Results indicated that in general local industry contributed to the emissions of As, Sb, Cu, V, and Ni, which are associated with combustion processes. In addition, the steelwork emitted significant quantities of Fe and Mn and the cement factory was associated with Ca emissions. The spatial distribution of Zn and Al also indicated an important contribution of two industries located outside the studied area.

CIMMYT's use of synthetic hexaploid wheat in breeding for adaptation to rainfed environments globally

The International Maize and Wheat Improvement Center (CIMMYT) has had significant impact on wheat production in rainfed regions of the developing world. During the last decade, yield potential has increased in drought-prone areas partly due to the use of synthetic hexaploid wheat (SHW), produced through interspecific hybridisation of Triticum turgidum spp. and Aegilops tauschii, followed by chromosome doubling. The objectives of this study were to document the use of SHW in wheat breeding at CIMMYT and quantify its potential effect on global wheat adaptation. The first SHW-derived lines targetted at rainfed conditions appeared in the 5th Semi-Arid Wheat Yield Trial (SAWYT) representing 8% of the lines, increasing to 46% by the 15th SAWYT. During the same period the average coefficient of parentage of SHW in all synthetically derived crosses decreased from 75 to 19%. Average yield rank of genotypes across locations and years was used as a performance indicator of the SHW-derived lines in SAWYT 5–12. In the 5th SAWYT the average rank of the SHW-derived lines was 30 (out of 50) increasing to 25 by the 12th SAWYT. SAWYT 11 was the first trial to include SHW-derived lines bred exclusively for rainfed environments, using directed selection for drought tolerance. International trial data from SAWYT 11 and 12 showed that the SHW-derived line Vorobey was a top-performing line. Vorobey performed well across all environments compared with the best locally adapted check cultivar at each location; trial means ranged from 1 to 8 t/ha. To further exploit genetic diversity for adaptation to drought, SHW has been produced using emmer wheat (T. turgidum L. subsp. dicoccon) as the tetraploid parent. Yield trial data from Mexico show that SHW derivatives based on emmer wheat improved yield performance under drought compared with their drought-tolerant recurrent parents. The use of SHW in wheat breeding for rainfed environments at CIMMYT has increased significantly over the past 10–15 years and the performance and effect of the derived lines have improved with time.

Use of synthetic hexaploid wheat to increase diversity for CIMMYT bread wheat improvement

To date, the International Maize and Wheat Improvement Center (CIMMYT) has produced more than 1000 synthetic hexaploid wheats (SHWs), using diverse accessions of the D genome donor species (Aegilops tauschii). Many of these SHWs produced from many different Ae. tauschii have shown resistance or tolerance to various biotic and abiotic stresses, indicating the potential importance of the Ae. tauschii gene pool for breeding purposes. SHWs were backcrossed to CIMMYT improved germplasm to produce synthetic backcross-derived lines (SBLs), which are agronomically similar to the improved parents, but retain the introgressed traits of interest under selection and thereby new diversity. Molecular studies show that SHWs and SBLs are genetically diverse at the DNA level when compared with traditional bread wheat cultivars and preferential transmission of some alleles from the SHW parent has been seen in all genomes, indicating positive selection. Marker analyses of wheat cultivars released over time indicate that SBLs are ideal materials to simultaneously increase yield and diversity for other traits. Following successful diversification of the wheat D genome, CIMMYT has shifted to target improvement of hexaploid wheat via the A and B genomes, focusing on specific traits. Screening the CIMMYT germplasm collection of T. turgidum subsp. dicoccum for Russian wheat aphid resistance and drought tolerance revealed varying levels of phenotypic expression. Promising accessions will be used for the production of new SHWs for future introgressions into elite bread wheat backgrounds.

Field evaluation of emmer wheat-derived synthetic hexaploid wheat for resistance to Russian wheat aphid (Homoptera: Aphididae)

Broadening the genetic base for resistance to Russian wheat aphid, Diuraphis noxia (Mordvilko) (Homoptera: Aphididae), in bread wheat, Triticum aestivum L., is desirable. To date, identified Russian wheat aphid resistance genes are either located to the D chromosomes or to rye translocation of wheat, and resistance derived from the A or B genomes of tetraploid Triticum spp. would therefore be highly beneficial. Fifty-eight synthetic hexaploid wheat, derived from interspecific crosses of Triticum dicoccum Schrank. and Aegilops tauschii (Coss.) Schmal. and their parents were evaluated for resistance to Russian wheat aphid under field conditions. Plots infested with aphids were compared with plots protected with insecticides. The T. dicoccum parents were highly resistant to Russian wheat aphids, whereas the Ae. tauschii parents were susceptible. Resistance levels observed in the synthetic hexaploids were slightly below the levels of their T. dicoccum parents when a visual damage scale was used. but no major resistance suppression was observed among the synthetics. Russian wheat aphid infestation on average reduced plant height and kernel weight at harvest in the synthetic hexaploids and the T. dicoccum parents by 3-4%, whereas the susceptible control 'Seri M82' suffered losses of above 20%. Because resistance in the synthetic hexaploid wheat is derived from their T. dicoccum parent, resistance gene(s) must be located on the A and/or B genomes. They must therefore be different from previously identified Russian wheat aphid resistance genes, which have all been located on the D genome of wheat or on translocated segments.

Field evaluation of emmer wheat-derived synthetic hexaploid wheat for resistance to Russian wheat aphid (Homoptera: Aphididae)

Broadening the genetic base for resistance to Russian wheat aphid, Diuraphis noxia (Mordvilko) (Homoptera: Aphididae), in bread wheat, Triticum aestivum L., is desirable. To date, identified Russian wheat aphid resistance genes are either located to the D chromosomes or to rye translocation of wheat, and resistance derived from the A or B genomes of tetraploid Triticum spp. would therefore be highly beneficial. Fifty-eight synthetic hexaploid wheat, derived from interspecific crosses of Triticum dicoccum Schrank. and Aegilops tauschii (Coss.) Schmal. and their parents were evaluated for resistance to Russian wheat aphid under field conditions. Plots infested with aphids were compared with plots protected with insecticides. The T. dicoccum parents were highly resistant to Russian wheat aphids, whereas the Ae. tauschii parents were susceptible. Resistance levels observed in the synthetic hexaploids were slightly below the levels of their T. dicoccum parents when a visual damage scale was used. but no major resistance suppression was observed among the synthetics. Russian wheat aphid infestation on average reduced plant height and kernel weight at harvest in the synthetic hexaploids and the T. dicoccum parents by 3-4%, whereas the susceptible control 'Seri M82' suffered losses of above 20%. Because resistance in the synthetic hexaploid wheat is derived from their T. dicoccum parent, resistance gene(s) must be located on the A and/or B genomes. They must therefore be different from previously identified Russian wheat aphid resistance genes, which have all been located on the D genome of wheat or on translocated segments.

Characterization of greenbug (Homoptera: Aphididae) resistance in synthetic hexaploid wheats

Twelve greenbug (Schizaphis graminum (Rondani)) biotype E-resistant synthetic hexaploid wheats synthesized by crossing Triticum dicoccum Schrank. and Aegilops tauschii (Coss.) Schmal. were evaluated for the three known insect resistance categories, including antibiosis, anti-xenosis, and tolerance. Different methods were evaluated for calculating antibiosis and tolerance. Calculating intrinsic rate of population increase and measuring leaf chlorophyll content with a SPAD chlorophyll meter proved to be time- and labor-efficient for antibiosis and tolerance determination, respectively. The resistance in all synthetic hexaploids proved to be the result of a combination of antibiosis, antixenosis, and tolerance, which makes them valuable sources of greenbug resistance. To assist plant breeders in selecting the best germplasm for greenbug resistance, a plant resistance index was created that revealed differences among the synthetic hexaploid wheats.

Expression and suppression of resistance to greenbug (Homoptera: Aphididae) in synthetic hexaploid wheats derived from Triticum dicoccum x Aegilops tauschii crosses

Fifty-eight synthetic hexaploid wheats, developed by crossing Triticum dicoccum Schrank. and Aegilops tauschii (Coss.) Schmal., were evaluated at the seedling stage, together with their parents, for resistance to greenbug (Schizaphis graminum Rondani) under greenhouse conditions. Seedlings of different synthetic hexaploids showed large phenotypic differences for resistance. All the T. dicoccum parents were susceptible, while high levels of resistance were observed in some of the Ae. tauschii parents. Of the synthetic hexaploids derived from resistant Ae. tauschii parents, a high proportion (76%) showed levels of resistance to the greenbug biotype used that were comparable to those of the resistant parent. While there were clear indications of the presence of suppressor genes for greenbug resistance in the A and/or B genomes of T. dicoccum in some synthetics, positive epistatic interaction was also found in synthetic hexaploids with higher levels of resistance than that of either parent. Resistance from different Ae. tauschii accessions was expressed differently when crossed with the same T. dicoccum, indicating diversity among the resistance genes present in the test synthetic hexaploid wheats. Based on resistance reactions, the genes conferring greenbug resistance in these synthetic hexaploids are probably different from resistance genes previously transferred to wheat from Ae. tauschii.

Expression and suppression of resistance to greenbug (Homoptera: Aphididae) in synthetic hexaploid wheats derived from Triticum dicoccum x Aegilops tauschii crosses

Fifty-eight synthetic hexaploid wheats, developed by crossing Triticum dicoccum Schrank. and Aegilops tauschii (Coss.) Schmal., were evaluated at the seedling stage, together with their parents, for resistance to greenbug (Schizaphis graminum Rondani) under greenhouse conditions. Seedlings of different synthetic hexaploids showed large phenotypic differences for resistance. All the T. dicoccum parents were susceptible, while high levels of resistance were observed in some of the Ae. tauschii parents. Of the synthetic hexaploids derived from resistant Ae. tauschii parents, a high proportion (76%) showed levels of resistance to the greenbug biotype used that were comparable to those of the resistant parent. While there were clear indications of the presence of suppressor genes for greenbug resistance in the A and/or B genomes of T. dicoccum in some synthetics, positive epistatic interaction was also found in synthetic hexaploids with higher levels of resistance than that of either parent. Resistance from different Ae. tauschii accessions was expressed differently when crossed with the same T. dicoccum, indicating diversity among the resistance genes present in the test synthetic hexaploid wheats. Based on resistance reactions, the genes conferring greenbug resistance in these synthetic hexaploids are probably different from resistance genes previously transferred to wheat from Ae. tauschii.

Resistance to apoptosis and up regulation of Bcl-2 in benign prostatic hyperplasia after androgen deprivation

PURPOSE

Benign prostatic hyperplasia (BPH) is related to advancing age and the presence of androgens and occurs in virtually all older men. BPH causes morbidity, most often by urinary obstruction, in a substantial fraction of men over sixty. Both finasteride and androgen ablation induce partial diminution in BPH that occurs over weeks to months. This is in contrast to the often rapid involution seen in both normal prostatic epithelium and prostatic carcinoma in response to androgen withdrawal. This study was performed to analyze the response of prostatic cells, and in particular BPH, to acute androgen ablation.

MATERIALS AND METHODS

We subjected a cohort of 26 men to androgen ablation with goserelin, a gonadotrophin releasing hormone agonist, for 3-4 weeks prior to radical prostatectomy for prostate cancer. Preablation biopsy specimens and prostatectomy specimens were immunohistochemically stained for apoptotic cells and for expression of apoptosis regulatory proteins Bcl-2, Bax, Bcl-x, and Bak.

RESULTS

Normal prostatic epithelial cells and prostate cancer responded to hormone deprivation by undergoing apoptosis, but in 19/26 specimens prostatic hyperplasia had a total absence of apoptosis. In all 26 specimens, benign prostatic hyperplasia demonstrated increased expression of the Bcl-2 protein, but no change in the expression of Bax, Bcl-x, and Bak. In contrast, adjacent normal and malignant prostatic epithelium showed positive staining for apoptosis and did not alter Bcl-2 expression in response to androgen ablation.

CONCLUSIONS

BPH demonstrated increased staining for Bcl-2 after androgen deprivation that may render hyperplastic epithelium relatively resistant to apoptosis induced acutely by androgen withdrawal.

Diving energetics in king penguins (Aptenodytes patagonicus)

Dive duration in wild king penguins and the energetic cost of swimming in a 30m long swim channel were determined at Ile de la Possession, Crozet Archipelago, using external data loggers and respirometry, respectively. Calibrated electronic data loggers equipped with a pressure sensor were used to determine dive durations: 95% of dives were less than 6 min long and 66% of dives were less than 4 min long. Dive patterns show that king penguins may intersperse long dive durations (4-6.3 min) with short ones (1.5-3 min) and make surface pauses of variable duration between them (0.5-3.5 min), or dive regularly (for up to 5 h) with long dive durations (5 min) and constant interdive surface intervals (1.5 min). The latter indicates that the aerobic dive limits (ADL) of this species could be higher and oxygen consumption lower than previously reported. Assuming that king penguins dive within their aerobic limit, different approaches to the analysis of the data obtained in the swim channel are discussed to derive the ADL. Swimming speeds observed in the channel ranged from 0.9 to 3.4 m s-1. Transport costs were lowest between 1.8 and 2.2 m s-1. Although at 2.2 m s-1 king penguins used only 10.3 Wkg-1 over a dive+surface cycle (minimal transport costs of 4.7 J kg-1 m-1), we speculate that tisse oxygen consumption during submergence may be as low as 0.23 ml O2 kg-1 s-1 (2.1 times standard metabolic rate, SMR) or perhaps lower (which gives an ADL of 4.2 min). During surface phases, oxygen uptake would be increased to at least 1 ml O2kg-1 s-1 (9.3 times SMR). This implies that at least 70% of all dives are aerobic. Potential physiological mechanisms allowing king penguins to partition O2 consumption between submergence and surface periods remain, however, unclear.

Reliability of stomach temperature changes in determining feeding characteristics of seabirds

We examined the accuracy of stomach temperature archival units (STAUs), which are typically used to determine feeding activity in marine endotherms, with regard to determination of the time of prey ingestion as well as the number of prey items ingested and their masses. Units were deployed in nine species of free-living seabirds, where feeding conditions were uncontrolled, eight species of captive seabirds, where feeding conditions could be partially controlled, and in laboratory stomach simulations, where variables could be strictly controlled. The quality of data obtained on the timing of feeding, the mass ingested and the number of prey items ingested was subject to two main sources of error (i) those induced by changes in animal activity and (ii) those resulting from the physical form of the STAUs themselves. Animal activity factors considered important included the following: variability in (a) body temperature, (b) stomach blood perfusion, (c) consistency of stomach contents and (d) stomach churning and changes in body orientation. The physical form (size and buoyancy) of the STAU affected the location of the unit within the stomach, and thus the likelihood that ingested prey comes into contact with the sensor. The timing of prey ingestion can generally be determined accurately; however, considerable errors in mass estimates can occur if data acquired using STAUs are not critically assessed. An understanding of these sources of errors will allow researchers to construct STAUs appropriate to the species being studied and to analyze data critically so that errors are reduced.

[The pectoral implant of an automatic defibrillator by cardiologists in an electrophysiology laboratory]

We have performed 2 implantations of transvenous automatic cardioverter defibrillator in a cardiac laboratory devoted to electrophysiology and pacemaker implantation. This is a preliminary experience with a novel implant strategy. Cardiologists were the primary operators. The automatic cardioverter defibrillator were placed in a subcutaneous pectoral region, with a non-thoracotomy lead system. The automatic cardioverter defibrillator were two Medtronic 7219D PCD Jewel, with a Transvene system. There were no perioperative complications. Acceptable defibrillation threshold were obtained in both patients, 12 and 20 J, respectively. Leads were inserted percutaneously through the left subclavian vein. After 8 months of follow-up the patients continue to tolerate the device satisfactorily. Implantation of automatic cardioverter defibrillator systems by trained cardiologists in an electrophysiology laboratory is safe and feasible. Moreover, its cost-effectiveness is superior, the saving includes the surgeons, and the reduction of stay in unit of intensive care and hospitalization.

[Usefulness of the RR variability in the diagnosis of neurogenic syncope]

INTRODUCTION AND PURPOSES: Autonomic nervous system plays an important role in the pathogenesis of vasovagal/vasodepressor syncope and may also be assessed by the RR variability analysis. Head up tilt test (HUT) is a currently established tool to evaluate patients with neuromediated syncope. However, the relationship between heart rate variability and tilt induced syncope is not established. The purpose of this study was to assess the differences in heart rate variability among patients with syncope and negative or positive tilt test.

METHODS

Fifty patients (mean age 33 +/- 17 years, 24 female, 26 male) with syncope underwent tilt test (20 min, 80 degrees tilt and 20 min more under isoproterenol infusion). Twenty-three patients have a negative tilt, the rest had a positive test. There were not significant differences in age or sex. Immediately after the HUT a 24-hour ambulatory electrocardiogram was performed (Marquette system 8000, 002A program). The parameters measured during Holter monitoring were: SDANN, SD, rMSSD, pNN50 and frequency analysis of heart rate spectrum (low frequency 0.04-0.15 Hz, high frequency 0.15-0.4 Hz and the relation low/high). No significant differences were detected in age and sex in patients with and without positive HUT.

RESULTS

pNN50 and rMSSD were the best predictors of the results of tilt (p = 0.006). SDANN and SDNN were not useful parameter. The finding of a value of pNN50 > 25% (value significantly different between patients with HUT--and +) have a specificity for predicting a positive HUT of 82.6%, with a sensibility of 51.8%. Positive predictive value was 77%. As can be easily understood, if the cut value of pNN50 is lowered, its sensibility increased and the specificity. decreased. In the frequency analysis only the relation low/high (L/H) was significantly different between both populations.

CONCLUSIONS

Heart rate variability is a useful tool in the evaluation of patients with vasovagal syncope, that may identify patients with chronically elevated vagal tone and thus may predict tilt test results.

Multiple nodules of intermediate trophoblast following hydatidiform moles

After removal of a complete hydatidiform mole, seven patients developed an unusual complication characterized by a proliferation of intermediate trophoblast-forming nodules in the endometrium or myometrium. The patients were examined because of vaginal bleeding or mildly elevated human chorionic gonadotrophin (HCG) titers. Three patients were cured by hysterectomy, one by endometrial curettage, one by endometrial curettage plus chemotherapy, and one (who also had choriocarcinoma) by multiple doses of chemotherapy after hysterectomy; the seventh patient was lost to follow-up. These nodules probably represent a mild form of postmolar trophoblastic disease.

An unusual variant of congenital dyserythropoietic anaemia with mild maternal and lethal fetal disease

An unusual variant of congenital dyserythropoietic anaemia is described presenting as mild haemolytic anaemia with multinucleated erythroblasts in the marrow of the proband. The outcome of her non-consanguineous pregnancy was a third trimester, in utero, fetal demise. The hydropic fetus had dyserythropoiesis with circulating multinucleated erythroblasts, and haemosiderosis. Re-evaluation of the proband revealed a variant of congenital dyserythropoietic anaemia with an inheritance pattern, and with morphological, serological and biochemical features which are not consistent with any of the three described variants of congenital dyserythropoietic anaemias.

A clinicopathologic study of 153 cases of complete hydatidiform mole (1980-1990): histologic grade lacks prognostic significance

Although the significance of histologic grading in hydatidiform mole has previously been investigated, most studies evaluated patients treated before 1975. Since 1975, many advances have been made in the understanding and treatment of hydatidiform mole, including the division of molar pregnancy into complete and partial hydatidiform mole. We retrospectively studied 153 cases of complete hydatidiform mole diagnosed and treated at the Brigham and Women's Hospital between 1980-1990 to determine the current prognostic significance of histologic grading in this disease. The histologic grade (based on the criteria of Hertig and Sheldon) was compared with the subsequent clinical course, including the rates of spontaneous remission, persistent gestational trophoblastic tumor, metastatic disease, "high-risk" metastatic disease, chemotherapy resistance, and survival. The histologic grade of the original complete hydatidiform mole did not correlate significantly with any index of clinical outcome evaluated.

Prognostic value of purified protein derivative skin test and granuloma formation in patients treated with intravesical bacillus Calmette-Guerin

We evaluated the prognostic value of purified protein derivative skin test reactivity and a granulomatous response in intravesical bacillus Calmette-Guerin therapy. We treated 62 patients with intravesical bacillus Calmette-Guerin once a week for 6 weeks. Purified protein derivative skin tests were performed before and after therapy. Cold cup bladder biopsies were examined in a blind retrospective manner for the presence of granulomas 6 weeks after completion of therapy. A significant correlation between status free of tumor and the presence of either granulomas or positive purified protein derivative skin tests was observed for the total patient population. Of 25 patients whose purified protein derivative test was converted from negative to positive 19 (77 per cent) remained free of tumor, while only 11 of 32 (34 per cent) whose test did not convert to purified protein derivative positive remained free of tumor (p equals 0.0006, chi-square). Similarly, 28 of 37 patients (77 per cent) who had a granulomatous response remained free of tumor, while only 8 of 25 (32 per cent) without a granulomatous response remained free of tumor (p less than 0.003, chi-square). The correlation was similar for each parameter when the total patient population was subdivided into patients treated for carcinoma in situ, residual tumor or prophylaxis. Calculation of predictive values showed that neither purified protein derivative responsiveness, granuloma formation nor a combination of both provided a highly accurate predictive index of therapeutic response in individual patients. False positive or negative rates, ranging from 23 to 24 per cent and 32 to 39 per cent, respectively, were observed. These results suggest that a link between immunological responsiveness and response to therapy exists but that neither the purified protein derivative skin test nor the granulomatous response exhibits sufficient immunological specificity to serve as accurate prognostic indicators in individual patients.