'Out of house' virtual surgical planning for mandible reconstruction after cancer resection: is it oncologically safe?

The purpose of this study was to investigate whether the time delay between 'out of house' proprietary virtual surgical planning (OH-VSP) of the mandibular resection for oral cancer and the actual surgery results in compromised margins and oncological disadvantage for the patient. Outcomes of patients who had OH-VSP of their mandibular resection and reconstruction were compared with those of patients who had the same surgery using a conventional non-VSP approach. The groups were similar in patient demographics, tumour stage and size, nodal status, and reconstruction complexity. VSP resulted in a significant reduction in operating time (P<0.01). VSP did not affect bony (P=0.49) or soft tissue (P=0.22) margin status. In summary, VSP reduced the operating theatre time, and despite the time interval between bony resection planning and surgery, there was no compromise to the oncological safety of the operation.

The Sydney Modified Alberta Reconstruction Technique (SM-ART) for dental rehabilitation following mandibulectomy or maxillectomy

The Sydney Modification of the Alberta Mandibular Reconstruction technique (SM-ART) is a hybrid of the Rohner method and the Alberta Reconstructive Technique (ART). SM-ART differs from ART in three ways, notably the use of custom plates, intraoral placement of implants via three-dimensionally printed guides and a skin graft buried deep into the skin paddle of the fibula flap in the first stage of the reconstruction.

Elective neck dissection versus observation for early-stage oral squamous cell carcinoma: Systematic review and meta-analysis

INTRODUCTION

Oral squamous cell carcinoma (OSCC) is the seventh most common cancer globally, and has been identified as a growing health concern. This study aims to evaluate the current literature comparing elective neck dissection to observation in the treatment of early-stage tongue SCC, focusing on nodal recurrence, overall survival, disease specific survival statistics from randomised controlled trials comparing the two interventions.

METHODS

Systematic review and meta-analysis was conducted according to PRISMA guidelines. The odds ratio (OR) was used as a summary statistic.

RESULTS

From 8 studies, there was a total of 372 cases of recurrence, 98 (15.1%) in END group and 274 (41.5%) in the Observation group. There was a significantly lower rate of recurrence in the END group compared to observation (OR 0.25, 95% CI 0.16-0.39, I² = 54%, P < 0.00001). END was associated with higher overall survival rates when compared with observation (OR 1.95, 95% CI 1.40-2.73, I² = 14%, P < 0.0001). END was also associated with higher disease-specific survival compared with observation (OR 1.88, 95% CI 1.21-2.93), I² = 47%, P = 0.005), with no significant heterogeneity noted.

CONCLUSIONS

END was associated with significantly lower recurrence rates and higher overall and disease-specific survival compared to a conservative observation approach in early-stage oral SCC with clinically N0 neck.

Prognostic Performance of Current Stage III Oral Cancer Patients After Curative Intent Resection: Evidence to Support a Revision of the American Joint Committee on Cancer Staging System

BACKGROUND

The American Joint Committee on Cancer (AJCC) stage III classification of oral cavity squamous cell carcinoma (OCSCC) represents a heterogeneous group of patients with early local disease with regional metastases (T1N1 and T2N1) and advanced local disease with or without regional metastasis (T3N0 and T3N1).

OBJECTIVE

The aim of this study was to evaluate prognostic heterogeneity in the stage III category.

METHODS AND PATIENTS

An international retrospective multicenter study of 1815 patients who were treated for OCSCC from 2003 to 2011.

RESULTS

Kaplan-Meier survival analysis and multivariate models of stage III patients revealed better overall survival (OS; HR 2.12, 95 % CI 1.03-4.15; p = 0.01) and disease-specific survival (DSS; HR 1.7, 95 % CI 1.16-4.12; p = 0.04) rates for patients with T1-2N1/T3N0 disease than for patients with T3N1 disease. The outcomes of patients with T3N1 and stage IVa disease were similar (p = 0.89 and p = 0.78 for OS and DSS, respectively). Modifying stage classification by transferring the T3N1 category to the stage VIa group resulted in a better prognostic performance [Harrell's concordance index, C index 0.76; Akaike's Information Criterion (AIC) 4131.6] compared with the AJCC 7th edition staging system (C index 0.65; AIC 4144.9) for OS. When DSS was assessed, the suggested staging system remained the best performing model (C index 0.71; AIC 1061.3) compared with the current AJCC 7th edition staging (C index 0.64; AIC 1066.2).

CONCLUSIONS

The prognosis of T3N1 and stage IVa disease are similar in OCSCC, suggesting that these categories could be combined in future revisions of the nodal staging system to enhance prognostic accuracy.

Genetic map of the primocane-fruiting and thornless traits of tetraploid blackberry

Blackberry primocane fruiting, fruiting on first-year canes, has the potential to expand blackberry production both seasonally and geographically. The incorporation of the primocane-fruiting trait into cultivars with desirable horticultural attributes is challenging due to its recessive nature and tetrasomic inheritance. Molecular marker-assisted selection has high potential to facilitate incorporation, because breeders already use morphological marker-assisted selection of seedlings without marginal cotyledonary hairs to identify progeny that will be thornless when mature. The development of a genetic linkage map with these two traits is the first step to utilizing molecular markers in breeding for thornless primocane-fruiting blackberry cultivars. A full-sib family segregating for thornlessness and primocane fruiting, from a cross between 'APF-12' and 'Arapaho', was used to construct the first genetic map of tetraploid blackberry. Segregation patterns of several dominant markers and the two phenotypic traits fit those expected uniquely with tetrasomic inheritance (e.g., 5:1, 11:1 and 35:1). Some loci showed significant double reduction frequencies, but genotypes that could have originated only from double reduction were not found. The map consists of seven linkage groups (LG) in each parent, consistent with the basic number of chromosomes (2n = 4x = 28). Naming of LG1-LG6 followed that of the recently revised system for raspberry using SSR markers in common between blackberry and raspberry, and LG7 was tentatively defined by default. The loci controlling primocane fruiting and thornlessness were not linked to each other; thornless/thorny, the S Locus, was mapped on LG4, and the primocane-/floricane-fruiting locus, named in this work the F Locus, on LG7.

Quantitative Studies of White Matter : I. Enzymes involved in glucose-6-phosphate metabolism

Total lipid and six enzymes closely related to the metabolism of glucose-6-phosphate have been measured in ten tracts of the rabbit. Lipid content appears to be a valid indicator of the degree of myelination. Heavily myelinated tracts have much larger amounts of glucose-6-phosphate dehydrogenase than lightly myelinated ones but there is no corresponding difference in 6-phosphogluconate dehydrogenase. In fact the ratios between the two enzymes were found to vary over a ninefold range. Hexokinase is found in largest amounts in tracts with relatively little lipid, and this tends to be true for phosphofructokinase as well. The fibrillar layer of olfactory bulb is exceptional with regard to both enzymes, and to glucose-6-phosphate dehydrogenase. The enzymes are present in amounts which are more than adequate to support glucose metabolism at a rate commensurate with the known rates of O₂ uptake by various tracts. The distribution of some of the enzymes is compatible with the notion that the nodes of Ranvier are regions of high metabolic activity. A simple algebraic relationship is found to hold fairly well for the distribution of four of the enzymes among the tracts.

Running biomechanics: shorter heels, better economy

Better running economy (i.e. a lower rate of energy consumption at a given speed) is correlated with superior distance running performance. There is substantial variation in running economy, even among elite runners. This variation might be due to variation in the storage and reutilization of elastic energy in tendons. Using a simple musculoskeletal model, it was predicted that the amount of energy stored in a tendon during a given movement depends more critically on moment arm than on mechanical properties of the tendon, with the amount of stored energy increasing as the moment arm gets smaller. Assuming a link between elastic energy reutilization and overall metabolic cost of running, a smaller moment arm should therefore be associated with superior running economy. This prediction was confirmed experimentally in a group of 15 highly trained runners. The moment arm of the Achilles tendon was determined from standardized photographs of the ankle, using the position of anatomical landmarks. Running economy was measured as the rate of metabolic energy consumption during level treadmill running at a speed of 16 km h(-1). A strong correlation was found between the moment arm of the Achilles tendon and running economy. Smaller muscle moment arms correlated with lower rates of metabolic energy consumption (r(2)=0.75, P<0.001).

A phase II study of gefitinib in patients with advanced thyroid cancer

6020

Background: There are few effective treatments for locally advanced or metastatic thyroid cancers that are refractory to radioactive iodine (RaI). The epidermal growth factor receptor (EGFR) is highly expressed on normal and malignant thyroid tissue, and has been associated with a worse prognosis in well-differentiated thyroid cancer. The EGFR tyrosine kinase inhibitor gefitinib is effective in inhibiting the growth of thyroid cancer cells in vitro. This study sought to determine the efficacy and tolerability of gefitinib in patients with advanced thyroid cancer. Methods: In this open-label phase II trial, patients with RaI-refractory, locally advanced or metastatic thyroid cancer received 250mg of daily gefitinib. Anaplastic and medullary thyroid carcinoma were considered RaI refractory based on histology. The primary endpoint was overall response rate. Secondary endpoints were toxicity, progression-free survival (PFS), overall survival (OS), and tumor marker responses. Tumor markers consisted of serum thyroglobulin (Tg) in the differentiated cancers and serum calcitonin and carcinoembryonic antigen in medullary thyroid cancer. Results: A total of 27 patients were enrolled. 59% were male and the median age was 65. Histologic subtypes included papillary (41%), follicular (22%), anaplastic (19%), medullary (15%), and Hürthle cell carcinoma (4%). There were no objective tumor responses among the 25 patients evaluated, at which point the trial was halted. However, 32% of patients had objective reductions in tumor volume that did not meet criteria for PR. 48%, 24%, and 12% of patients had stable disease (SD) after 3, 6, and 12 months of treatment. Median PFS and OS were 3.7 [95% CI; 1.8, 5.7] and 17.5 months [9.2, not yet reached]. Five patients with SD had a decrease in Tg to <90% of baseline level that was maintained for at least 3 months. Gefitinib was well tolerated, with 11% of patients experiencing grade 3 toxicity. Conclusions: Gefitinib therapy did not result in any objective tumor responses. However, reductions in tumor volume, falling Tg levels, and prolonged SD in a subset of patients may indicate biologic activity. The OS of 17.5 months was superior to historical rates in this population. However, the significance of this is difficult to interpret in the absence of a randomized comparison group.

No significant financial relationships to disclose.

Phase I study of panitumumab, chemotherapy and intensity-modulated radiotherapy (IMRT) for head and neck cancer (HNC): Early results

6083

Background: Both chemotherapy and epidermal growth factor receptor (EGFR) antibody therapy improve outcomes in HNC when added to radiotherapy. This phase I study investigates the addition of the fully human anti-EGFR antibody, panitumumab, to chemoradiotherapy (CRT) for HNC. Methods: Treatment naïve adults with stage III/IV HNC (primary sites include oropharynx and unknown primary) with normal hematologic, renal, and liver function are currently enrolling in a 2-part study. Part A determines the maximum tolerated dose (MTD) of paclitaxel in 2 dose levels (DLs) (15 and 30 mg/m2 wkly×7 wks) with fixed-dose carboplatin and panitumumab (AUC of 1.5 and 2.5 mg/kg wkly, respectively) plus IMRT (70 Gy). Patients (pts) are enrolled in sets of 3. Part B determines the MTD of 5-FU in 2 DLs (800 and 900 mg/m2 days 1–4, Q21d) with fixed-dose docetaxel, cisplatin and panitumumab (75 mg/m2, 100 mg/m2 and 9 mg/kg, Q21d, respectively) for 3 cycles followed by panitumumab + CRT, as determined in Part A. Results: To date, 8 pts (n=3 at DL 1, n=5 at DL 2) have enrolled in Part A. One dose-limiting toxicity has occurred in DL 2: grade (gr) 4 febrile neutropenia. Other adverse events include gr 3/4 mucositis (n=6), gr 3/4 radiation dermatitis (n=6), gr 2 acneiform rash (n=6), gr 3 dysphagia (n=6) and gr 2 oral pain (n=6). Dose-reduction has not been necessary thus far. Enrollment will continue in a cohort of 10 pts in DL 2. Of 4 pts evaluated for response, 4 had complete response in the primary and neck, and 1 had a residual neck mass. This pt had 1 positive node on neck dissection. Conclusions: Preliminary results suggest that panitumumab can be added to CRT for treatment of HNC without magnifying the expected toxicities with CRT. Part B will investigate panitumumab + sequential therapy for HNC once the MTD of Part A is established.

No significant financial relationships to disclose.

Higher log position is not associated with better physical fitness in professional soccer teams in South Africa

Objective. To assess the difference in physical fitness of players in successful versus less-successful professional soccer teams in South Africa. Design. Professional soccer players (N = 140) underwent a battery of tests assessing important physiological components during the early part of their competitive season. Players were then separated into two groups on the basis of their teams' final log position in the Premier Soccer League (PSL) in South Africa. Players in successful (N = 70) and less-successful (N = 70) teams were in the top four or bottom six positions on the log respectively. Descriptive statistics (mean ± standard deviation (SD)) were calculated for each group, and independent t-tests were used to compare the means of the groups for each of the physical tests. Main outcome measures. Body composition, flexibility, muscle strength-endurance, power, speed, agility, aerobic endurance, and repeat sprint distance. Results. There were no significant differences between groups for all measures of body composition, flexibility, repeat sprint distance, and agility. Significant differences (p < 0.05) were found for sit-ups, aerobic endurance, and speed, but these were generally small, not meaningful differences in performance. Players in successful squads were significantly (p < 0.01) older than those in less-successful teams. Conclusions. The results demonstrate that in South Africa level of physical fitness is not higher in more-successful compared with less-successful teams in the PSL. Factors other than physical fitness may be more important in determining successful league performance and discrimi-nate better between players in teams with different levels of success. Improving professional soccer performance may require coaches and trainers to focus more attention on technical and tactical skill development in sport-specific training once an acceptable standard of fitness has been attained.. South African Journal of Sports Medicine Vol. 19 (2) 2007: pp. 40-45

Recovery of Four Novel Potato spindle tuber viroid Sequence Variants from Russian Seed Potatoes

First described in the early 1930s, the limited distribution of potato "gothic" disease made it of little economic significance in European Russia until the early 1970s when meristem-tip culture was widely adopted throughout the former USSR to increase production of virus-free seed potatoes. Shortly thereafter, the yield and quality of Russian seed potatoes began a dramatic decline. Symptoms of potato "gothic" resemble those of Potato spindle tuber viroid (PSTVd) (3), and initial suspicions that in vitro plantlets and seed potatoes might be viroid-infected were later proved correct when Kastalyeva et al. (2) showed that approximately 50 to 70% of in vitro plantlets and tubers collected from different regions of Russia as well as the in vitro germplasm collection maintained by the All-Russian Potato Research Institute (ARPRI) were infected with PSTVd. Measures have since been taken to reduce the incidence of PSTVd infection, and numerous PSTVd isolates were collected from territories of the former USSR; however, none of these isolates have been characterized at the molecular level. Overlapping reverse transcription (RT)-PCR products (1) were generated from four PSTVd isolates maintained in field-grown tubers at the VNIIF using two pairs of primers; PSTVd180F (5'-TCACCCTTCCTTTCTTCGGGTGTC-3') + PSTVd179R (5'-AAACCCTGTTTCGGCGGGAATTAC-3') and PSTVd112F (5'-ACT GGCAAAAAAGGACGGTGGGGA-3') + PSTVd359R (5'-AGGAACC AACTGCGGTTCCAAGGG-3'). Automated sequence analysis of the resulting uncloned PCR products revealed the presence of four previously unknown PSTVd variants (GenBank Accession Nos. EF044302-EF044305). All four tubers were also infected with Potato virus M and Potato virus Y and one tuber also contained Potato virus S. ELISA tests for Potato leaf roll virus were negative. Each isolate appeared to contain only a single 358-359 nt variant differing from PSTVd-intermediate strain (GenBank Accession No. V01465) at 2-5 positions. The three closely related variants originating from Leningradskaya Province (Northwest Russia) contain two to three changes in the variable domain and central conserved region and induced intermediate symptoms in Rutgers tomato. The fourth variant originating from Samarskaya Province (Volga River Region) contains additional changes in the pathogenicity domain and induced mild symptoms. Minor differences among the Leningradskaya variants may represent sequence drift during extended (9 to 11 year) tuber passage. The presence of additional sequence changes in the variant from Samarskaya is consistent with independent origin and/or prolonged separation. Additional studies with a wider range of Russian isolates of PSTVd are currently underway to develop diagnostic methods suitable for future large-scale screening programs. References: (1) Y. Hu et al. Virology 219:45, 1997. (2) T. B. Kastalyeva et al. Vestn. RASKHN 3:22, 1992. (3) Y. A. Leontyeva. Potato spindle tuber ('gothic') as one of the most important diseases in the Volga region. (In Russian.) Ph.D. thesis. Agricultural University of Leningrad, Pushkin, 1971.

High-intensity exercise and recovery during short-term supplementation with creatine plus a protein-carbohydrate formula

Objective. To determine the effect of short-term creatine supplementation plus a protein-carbohydrate formula on high-intensity exercise performance and recovery. Design. A repeated-measures, experimental study, employing a randomised, double-blind, placebo-controlled, group comparison design was used. Interventions. Thirty active but not sprint-trained male subjects were randomly assigned to 1 of 3 groups: creatine plus protein-carbohydrate formula (CRF); creatine only (CRE); and control (CON). All groups were exposed to the same high-intensity sprint exercise programme, 3 times per week for 30 days. Main outcome measures. Dependant variables included total repeat sprint distance, fatigue index, perceived muscle pain, and blood lactate, urea, creatine kinase, and cortisol concentrations. Results. All groups significantly (p ≤ 0.05) increased total sprint distance and decreased blood urea concentrations. There were no significant changes in blood lactate or cortisol concentrations in any group. CRF showed significant decreases (p ≤ 0.05) in fatigue index, muscle pain, and creatine kinase concentration. However, no significant differences were found between groups. Conclusion. Short-term creatine supplementation with or without protein-carbohydrate supplementation does not appear to enhance performance or recovery significantly over high-intensity exercise training alone in non-sprint-trained individuals. A longer trial period may be required to evaluate effect on recovery more conclusively. In addition, the prime importance of physical conditioning, and in particular task-specific exercise training, in stimulating performance and recovery adaptations is highlighted. South African Journal of Sports Medicine Vol. 18 (4) 2006: pp. 136-140

Pharmacokinetics of PT523, a novel aminopterin analogue, in patients with solid tumors

2052

Background: Nα-(4-Amino-4-deoxypteroyl)-N5-hemiphthaloyl)-L-ornithine (PT523) is a nonpolyglutamatable aminopterin analogue selected for clinical evaluation based upon properties that confer potential therapeutic advantages over classic and nonclassic antifolates. This report describes the pharmacokinetic (PK) behavior of PT523 in cancer patients as determined in the first phase I trial of the drug. Methods: Adult patients with refractory solid tumors received PT523 as a 5 min iv infusion every 7 days for 3 weeks. Plasma samples were obtained at -5, 4, 10, 15, 20, 30, 45 min; 1, 2, 3, 4, 6, 8, 24, and 48 h after starting the first weekly infusion. Urine was collected and pooled from 0–8, 8–24, and 24–48 h. An LC/MS assay was used to measure PT523 in plasma and urine. Interday accuracy and precision were both <15% at the lowest concentrations measured in plasma (0.50 ng/mL) and urine (50 ng/mL). PK parameters were estimated by standard noncompartmental methods. Results: The PK of PT523 was characterized in 24 patients with normal renal and hepatic function, and a median age of 52 years (range, 28 - 77 years). Data was obtained from groups of at least three patients receiving doses of 5, 6.7, 9, 12, and 16 mg/m2. The PT523 concentration in plasma decreased in a polyexponential manner and the terminal log-linear phase was achieved 4–6 h after dosing. In the 7 patients receiving doses of 16 mg/m2, the mean peak drug concentration in plasma (Cmax) was 5,650 ± 300 ng/mL and the median plasma concentration 48 h after dosing was 1.7 ng/mL (range, 1.0 - 23.4 ng/mL). The apparent biological half-life (t1/2,z), total body clearance (CL) and apparent volume of distribution at steady-state (Vss) were all independent of the dose. Mean ± SD values of PK parameters for the entire cohort of 24 patients were: CL, 1.16 ± 0.31 L/h/m2; t1/2,z, 5.3 ± 1.2 h; Vss, 7.7 ± 1.5 L/m2. The mean amount of the dose excreted as unchanged drug in urine over 48 h was 40 ± 15%. Conclusions: PT523 exhibits linear PK with moderate interpatient variability when administered as a 5 min iv infusion at doses of 5 - 16 mg/m2. Renal clearance is a major route of elimination. Association between the CL of PT523 and creatinine clearance should be evaluated in a future study to assess whether dose modification is warranted for patients with diminished renal function.

No significant financial relationships to disclose.

First Report of Sclerotinia Blight Caused by Sclerotinia sclerotiorum on Peanut in Georgia

Sclerotinia blight is one of the most economically important diseases of peanut (Arachis hypogaea L.) in Oklahoma and Virginia. Yield losses of 10% are common in these areas; however, losses may exceed 50% in highly infested fields (1). While Sclerotinia minor is considered the primary causal agent, S. sclerotiorum may also incite the disease. Symptoms typically appear late in the season and are favored by cool temperatures and high relative humidity (RH). Initial symptoms include wilting and yellowing of main or lateral branches. Dense mats of white mycelium develop on diseased areas, and small water-soaked lesions are apparent near the soil line. Lesions become bleached and infected tissues have a shredded appearance. Sclerotia are produced on and inside infected plant parts (2). During October 2004, following a period of heavy rainfall and cool temperatures, peanut plants (cv. Tifrunner) with these symptoms were observed in a field near Surrency, GA. The field had been planted to cotton (Gossypium hirsutum L.) for many years and peanut was strip-tilled into a heavy rye (Secale cereale L.) cover. Disease foci were found throughout the field and final incidence was 20%. Stem sections were surface disinfested in 0.5% sodium hypochlorite for 1 min and plated on potato dextrose agar (PDA). Cultures of S. sclerotiorum (2) were recovered after incubation at 20°C for 2 weeks. Pathogenicity tests were conducted by inoculating wounded peanut mainstems with PDA plugs either with or without the fungus. Inoculation sites were wrapped with moistened cheesecloth, and plants were incubated in a dew chamber at 20°C and 95% RH. There were a total of four replications and the experiment was repeated once. Symptoms consistent with those observed in the field appeared after 3 days and lesion lengths were measured after 5 days. Average lesion lengths were 1.4 and 1.6 cm for cvs. Georgia Green and Tifrunner, respectively Controls remained symptomless. Sections of symptomatic tissue were plated on PDA, and S. sclerotiorum was reisolated from 100% of symptomatic tissue. Although S. sclerotiorum is a common pathogen of various winter crops and weeds found in the southeast, to our knowledge, this is a first report of Sclerotinia blight on peanut in the region. No other occurrences of the disease have been reported since the initial discovery; however, potential losses could be incurred if peanuts are planted in infested fields and harvest is delayed. References: (1) H. A. Melouk and P. A. Backman. Management of soilborne fungal pathogens. Pages 75-85 in: Peanut Health Management. H. A. Melouk and F. M. Shokes, eds. The American Phytopathologicial Society, St. Paul, MN, 1995. (2) D. M. Porter and H. A. Melouk. Sclerotinia blight. Pages 34-36 in: Compendium of Peanut Diseases. 2nd ed. N. Kokalis-Burelle et al., eds. The American Phytopathologicial Society, St. Paul, MN, 1997.

First Report of Botrytis Blight of Peanut Caused by Botrytis cinerea in Georgia

Because of the importance of spotted wilt caused by Tomato spotted wilt virus (TSWV), most peanut (Arachis hypogaea L.) breeding programs in the southeastern United States are focusing on developing resistance to TSWV. Many of the cultivars with improved resistance to TSWV are late maturing, requiring 150 days to reach optimum maturity. This factor could greatly impact disease problems at harvest. During November of 2004, an unknown disease was observed on peanut cvs. Georgia 02-C and Hull in a commercial field in Appling County. Symptoms included wilting stems with water-soaked lesions and a dense, gray mold growing on infected tissues. Final disease incidence was less than 5%. For isolation, diseased tissue was surface sterilized by soaking in 0.5% sodium hypochlorite for 1 min, air dried, plated on potato dextrose agar (PDA), and incubated at 20°C. Botrytis cinerea Pers.:Fr., causal agent of Botrytis blight, was isolated from the margins of infected tissue. Mycelia were initially white but became gray after 72 h at which time tall, branched, septate conidiophores formed. Mature, unicellular, ellipsoid, hyaline conidia (8.9 × 10.4 μm) formed in botryose heads (1). Hard, black, irregular-shaped sclerotia formed after 2 weeks. Stems of greenhouse-grown peanut plants (cv. Georgia Green) were inoculated with PDA plugs colonized with either B. cinerea or B. allii Munn. Inoculations were made 3 cm below the last fully expanded leaf on wounded and nonwounded tissue. Noncolonized PDA plugs served as controls (n = 9). Plants were arranged in a dew chamber at 20°C in a randomized complete block design. Lesions and spore masses identical to those observed in the field appeared 3 to 5 days after being inoculated with B. cinerea. The B. allii inoculations caused only superficial lesions. After 5 days, mean lesion lengths for B. cinerea were 59 and 37 mm for wounded and nonwounded inoculations, respectively. B. cinerea was recovered from 100% of the symptomatic tissues. Botrytis blight is considered a late-season disease that occurs in cool, wet weather (3). Symptoms similar to those of Botrytis blight were observed on mature and over-mature peanut in Georgia and have been cited as "unpublished observations" (2); however, to our knowledge, this is the first report of the disease in Georgia. Although Botrytis blight is not considered a major peanut disease, it may become more prevalent at harvest as producers utilize late-maturing cultivars to manage spotted wilt. References: (1) H. L. Barnett and B. B. Hunter. Illustrated Guide of Imperfect Fungi. 4th ed. The American Phytopathological Society, St. Paul, MN, 1998. (2) K. H. Garren and C. Wilson. Peanut Diseases. Pages 262-333 in: The Peanut, the Unpredictable Legume. The National Fertilizer Assoc. Washington D.C. 1951. (3) D. M. Porter. Botrytis blight. Pages 10-11 in: Compendium of Peanut Diseases. 2nd ed. N. Kokalis-Burelle et al., eds. The American Phytopathological Society, St. Paul, MN. 1997.

Dosimetric characteristics of the new RadioCoil™ Pd103 wire line source for use in permanent brachytherapy implants

Recently, a novel linear brachytherapy source in the form of a coiled wire has become available for use in interstitial implants of various treatment sites such as prostate gland. This source type employs a design completely different from that of most "seed" sources currently on the market, one which improves upon or eliminates several common problems with such sources. Dosimetric characteristics of these sources with active lengths 0.5 cm to 5.0 cm were determined for clinical application. For 0.5 cm and 1.0 cm active length sources, the dose rate constant, radial dose function, and two-dimensional (2D) anisotropy function were experimentally and theoretically determined following the updated AAPM Task Group 43 (TG-43U1) recommendations. Radial dose functions and/or "along-away" matrix functions were also obtained for sources with active lengths 2.0 cm to 5.0 cm. Measurements were performed with LiF thermoluminescent dosimeters in Solid Water phantoms. Measured data was compared to Monte Carlo simulated data in Solid Water utilizing the PTRAN code, version 7.43. After finding the data to be in agreement, Monte Carlo calculations were performed in liquid water to obtain clinically applicable dosimetric data as per TG-43U1 recommendations. The results indicated the dose rate constant of the 0.5 cm long RadioCoil 103Pd source in Solid Water to be 0.641 cGy h(-1) U(-1) when measured, and 0.636 cGy h(-1) U(-1) when simulated by Monte Carlo. The calculated dose rate constant in liquid water was found to be 0.650 cGy h(-1) U(-1). These values are comparable to other commercially available sources. Complete dosimetric data and simulation results are described in this paper. Per TG-43U1, clinical treatment planning systems should utilize the values reported for liquid water.

An in vivo and ex vivo study to evaluate the use of a glass polyphosphonate cement in orthodontic banding

The purpose of this study was to examine the effectiveness of a new glass polyphosphonate cement (Diamond) for orthodontic banding. Thirty-one subjects underwent in vivo testing to compare the failure rate of bands cemented using the test cement and bands cemented using a conventional glass polyalkenoate cement (Ketac-Cem) over a 6-month period at the beginning of active appliance therapy. In an ex vivo experiment 60 extracted teeth were banded using either the test cement or a glass polyalkenoate cement, and subjected to a debanding force using a Lloyd universal testing machine until failure. In the in vivo study the overall proportion of failure of the bands cemented with each cement was identical at 0.048. However, in the ex vivo study the probability of failure for the glass polyphosphonate cement was significantly higher than for the glass polyalkenoate cement, and the force to deband the glass polyalkenoate cement was greater than that of the glass polyphosphonate cement. In the clinical setting the new glass polyphosphonate cement performed as well as a conventional glass polyalkenoate cement, and these results suggest that it could be used as an alternative cement for orthodontic banding. The results of the ex vivo test bring into question the usefulness of this laboratory test as an indicator of clinical performance.

Gastroduodenal ulceration following hepatic arterial chemotherapy: the role of methylene blue endoscopy in the investigation of pain

BACKGROUND

Unintended perfusion of the gastroduodenum may complicate hepatic arterial chemotherapy leading to mucosal ulceration.

PATIENTS AND METHODS

In a review of 233 consecutive hepatic artery catheters placed, 61 patients were investigated for chemotherapy-related epigastric pain. Investigations included catheter imaging, upper gastrointestinal endoscopy with methylene blue injection via the hepatic artery catheter and angiography.

RESULTS

Twenty patients (33%) demonstrated blue staining of the gastroduodenum. Angiography performed in 15 of these patients confirmed a misperfusing vessel in 13.The aberrant artery was successfully embolised and infusional chemotherapy recommenced in 11 patients. Forty-one patients had a negative dye test, of whom three had gastroduodenal ulcers, 14 had oesophagitis or gastroduodenitis, ten had catheter complications (leak n=2, arteritis n=5, pseudoaneurysm n=1, sepsis n=1), three had liver collections, five had floxuridine cholangitis and one had myocardial ischaemia. No cause could be found in 8 patients. No patient with a negative dye test developed unintended perfusion on repeat investigation.

Functional occlusion: II. The role of articulators in orthodontics

Opinion is divided on whether there is a place for the use of semi-adjustable dental articulators in orthodontics. In this review we explore the validity and reproducibility of the techniques involved in mounting study models on a semi-adjustable dental articulator. We also look at the role of articulated study models in orthodontic diagnosis and treatment planning, in the finishing stages of orthodontics and in planning for orthognathic surgery. We report that each of the many stages involved in mounting study models on a semi-adjustable articulator is a potential source of error and that only if the technique is carried out with a high degree of accuracy is it worth the additional chairside time.

Cirrhosis and laparoscopic cholecystectomy

Although cirrhosis has been regarded as a contraindication to laparoscopic cholecystectomy, there is increasing evidence that patients with mild to moderate cirrhosis may safely undergo laparoscopic cholecystectomy with results superior to those of open cholecystectomy. A prospective evaluation and comparison of outcome in 25 consecutive patients with cirrhosis and 1275 patients without cirrhosis undergoing laparoscopic cholecystectomy was undertaken. Fourteen patients with Child's A cirrhosis, nine with Child's B, and two with Child's C underwent laparoscopic cholecystectomy. After surgery, one patient with Child's C cirrhosis died. The median length of stay was 4 days. Postoperative morbidity occurred in 52% of patients and included hemorrhage (8%), thromboembolism (4%), wound complications (24%), intraabdominal collections (12%), and cardiopulmonary complications (8%). Major comorbidity was present in 60% of patients and contributed to complication rate and prolonged stay. Hemorrhage (P = 0.04) and wound complications (P = 0.02) occurred more frequently in patients with cirrhosis than in patients without cirrhosis. Laparoscopic cholecystectomy in patients with cirrhosis is associated with significant but acceptable morbidity and mortality rates, and complications are frequently related to comorbid conditions.

Comparison of the protective effects against chronic doxorubicin cardiotoxicity and the rates of iron (III) displacement reactions of ICRF-187 and other bisdiketopiperazines

Histologic and biochemical studies were carried out to compare the protective activity of various bisdiketopiperazines against the cardiac and renal toxicity induced by doxorubicin in spontaneously hypertensive rats (SHR), a well-established animal model of this disorder, with: (1) the rates of hydrolysis of these agents to form the iron-chelating derivatives (which are considered to cause a decrease in the formation of reactive oxygen intermediates) and (2) the ability of these derivatives to bind iron. SHR were given 12 weekly injections of doxorubicin, 1 mg/kg i.v. either alone or 30 min after the administration of ICRF-154, ICRF-187, ICRF-192, ICRF-197, ICRF-198, ICRF-239 and ADR-559. Semiquantitative grading of the severity of the resulting cardiac and renal lesions showed that ICRF-187, ICRF-154 and ADR-559 were the most protective, whereas ICRF-197 and ICRF-239 provided intermediate degrees of protection, and ICRF-192 and ICRF-198 were not protective. Quantitative measurements in vitro revealed only relatively small differences in the rates of opening of the two diketopiperazine rings of the various agents to form the corresponding iron-chelating diacid diamide derivatives, and in the ability of these various derivatives to remove iron from the iron-doxorubicin complex. Such differences showed no relationship with cardioprotective activity. Some bisdiketopiperazines (including ICRF-154 and ICRF-187) with cardioprotective activity also are inhibitors of DNA topoisomerase II; however, the significance of this relationship remains uncertain, since ADR-925, the open-ring derivative of ICRF-187, does not inhibit DNA topoisomerase II.

Functional occlusion: I. A review

The features that constitute an "ideal" functional occlusion have not been conclusively established. Orthodontic treatment has the capacity to change static and functional occlusal relationships fundamentally. In this article, we present the evidence on which features of the occlusion are reported to be detrimental to the teeth and masticatory system Deficiencies in this research area are highlighted, together with the need for prospective longitudinal trials to clarify the requirements of an ideal functional occlusion Based on the existing evidence this paper suggests which occlusal features may be significant in producing an "ideal" functional occlusion As no long-term studies exist to measure the impact of non-ideal occlusal relationships on the dentition, it is debatable whether orthodontic treatment should be prolonged in order to ensure that "ideal" occlusal contacts are achieved As the occlusion tends to "settle" in the period following appliance removal, we propose that it may be more appropriate to examine the functional occlusal relationships after retention has ceased rather than prolong active orthodontic treatment to achieve "ideal" functional occlusal goals.

The use of outdoor freshwater pond microcosms. III. Responses of phytoplankton and periphyton to pyridaben

An outdoor freshwater microcosm study was conducted in which pyridaben, an insecticide-miticide, was directly applied to water to determine its biological effects on phytoplankton and periphyton. Twenty-four microcosms (24 m3 each) were monitored for 11 months, then four treatments of pyridaben were applied two times at three concentrations (0.34, 3.4, 34.0 micrograms/L), including an untreated control. The succession of algal groups observed and the major genera found in microcosms during the baseline phase of the study were typical of oligo-mesotrophic systems in Florida. Following application of pyridaben, the most remarkable effect was a positive correlation of phytoplankton abundance with pyridaben concentrations in water; indicating increased abundance as a result of exposure. Both Chlorophyta and Pyrrophyta exhibited a significant increase (p = 0.05) in population abundance at 3.4 and 34.0 micrograms/L pyridaben. Chrysophyta also elicited a trend of increased abundance at 34.0 micrograms/L, although the effect was not significant. The effects on phytoplankton populations were associated with the decline of zooplankton populations as a result of a direct effect of pyridaben exposure. There were no effects of pyridaben on periphyton communities or on functional endpoints.

Aquatic toxicity of two Corexit dispersants

The oil spill dispersants, Corexit 9500 and Corexit 9527 have low to moderate toxicity to most aquatic species in laboratory tests. Toxicity estimates are significantly affected by test variables such as species, lifestage, exposure duration, and temperature. Aquatic toxicity data generated from spiked, declining exposures (107 min half-life) are more reflective of actual dispersant use conditions. Decisions to use oil spill response chemicals should not be based solely on aquatic toxicity. Factors to consider include product effectiveness, toxicity of dispersed oil, species/habitats requiring priority protection, and recovery potential of sensitive habitats and populations. An environmental risk assessment approach is recommended where dispersant toxicity data generated under environmentally relevant exposures are compared to estimated environmental concentrations of dispersants.

Orthodontic auxiliaries: the way forward?

Currently two-thirds of European countries employ orthodontic auxiliaries and the UK is therefore unusual in not permitting their use. There is support from the orthodontic specialty for the concept of delegating routine intra-oral tasks to auxiliary personnel. The following describes a pilot project undertaken to determine the possible training structure for orthodontic auxiliaries. The modular course, which took place over a period of 4 weeks, is described and the results and implications are discussed.

Comparison of test methods and early toxicity characterization for five dispersants

The acute toxicities of a commercial dispersant (Corexit 9527) and four experimental dispersant formulations were evaluated using the 96-h mysid (Mysidopsis bahia) test and two rapid screening tests, Microtox and the Mysid IQ Toxicity Test. During 96-h toxicity tests, survival observations were recorded at 3, 6, 9, 12, and 24 h to document mortalities from short-term exposures more consistent with field exposure times and more approximate to exposure times used in Microtox and the Mysid IQ Toxicity Test. At nominal concentrations (6.25 and 12.5 mg/liter) and exposure times (3-24 h) near the upper range of predicted field conditions, mysid mortalities were </=5% for all test materials. Microtox and Mysid IQ Toxicity Test were evaluated for their ability to differentiate test materials compared with that of the 96-h mysid test. Dispersant formulations were ranked by relative toxicities based on LC50 or EC50 values and ranks compared among test methods. Microtox ranked the test materials similar to the 96-h mysid test. Ranks from the Mysid IQ Toxicity Test were dissimilar to those of the other tests. Early mortality observations during 96-h tests did not provide a better basis for comparing results of the rapid screening tests.

Assessment of risk reduction strategies for the management of agricultural nonpoint source pesticide runoff in estuarine ecosystems

Agricultural nonpoint source (NPS) runoff may result in significant discharges of pesticides, suspended sediments, and fertilizers into estuarine habitats adjacent to agricultural areas or downstream from agricultural watersheds. Exposure of estuarine fin fish and shellfish to toxic levels of pesticides may occur, resulting in significant declines in field populations. Integrated pest management (IPM), best management practices (BMP), and retention ponds (RP) are risk management tools that have been proposed to reduce the contaminant risk from agricultural NPS runoff into estuarine ecosystems. Field studies were conducted at three sites within coastal estuarine ecosystems of South Carolina (SC) from 1985 to 1990 that varied in terms of the amount and degree of risk reduction strategies employed. An intensively managed (IPM, BMP, and RP) agricultural treatment site (TRT) was studied for pesticide runoff impacts. From 1985 to 1987, there were minimal (some IPM and BMP) management activities at TRT, but from 1988 to 1990, TRT was managed using an intensive risk reduction strategy. A second unmanaged agricultural growing area, Kiawah (KWA), was also studied and compared with TRT in terms of pesticide runoff and the resulting impacts on grass shrimp (Palaemonetes pugio) and mummichogs (Fundulus heteroclitus). A third, non-agricultural, reference site (CTL) was used for comparing results from the managed and unmanaged agricultural sites. In situ toxicity tests and field samples of the grass shrimp populations were conducted at each site and compared in terms of survival and the effectiveness of current risk reduction strategies. Significant runoff of insecticides (azinphosmethyl, endosulfan, and fenvalerate) along with several fish kills were observed at TRT prior to the implementation of rigorous risk reduction methods. A significant reduction of in stream pesticide concentrations (up to 90%) was observed at TRT following the implementation of strict NPS runoff controls, which greatly reduced impacts on estuarine fish and shellfish. At the unmanaged KWA, continued impacts due to the runoff of these insecticides were observed, along with several fish kills. Additional monitoring indicated that gravid female grass shrimp populations from KWA had elevated levels of P-glycoprotein (P-gp), a multidrug resistance protein, which may transport various pesticides across cellular membranes. Comparison of field results with laboratory toxicity tests established that pesticide exposure was the primary cause of observed field impacts at each site. These findings clearly indicate the value of an integrated risk reduction strategy (BMP, IPM, and RP) for minimizing impacts from NPS agricultural pesticide runoff.

Congestive heart failure: training for a better life

Congestive heart failure (CHF) patients who exercise regularly can increase exercise tolerance, decrease dyspnea and fatigue, reduce the risk of arrhythmias, and improve quality of life. Initial stress testing is important for assessing a patient's physiologic response to exercise and for establishing a target heart rate for an individualized exercise program. Patients may need to begin aerobic exercise with interval training and progress slowly. Strength exercise is also useful. Exercise used along with the customarily prescribed CHF medications improves symptoms more than either modality alone.

Comparison of the chronic toxicity of piroxantrone, losoxantrone and doxorubicin in spontaneously hypertensive rats

Comparisons were made of the toxic effects produced in the heart, kidney and small intestine of spontaneously hypertensive rats (SHR) by the administration of 12 consecutive weekly doses of doxorubicin (1 mg/kg), and high, intermediate and low doses of piroxantrone (3, 1.5 and 0.75 mg/kg) and losoxantrone (1, 0.5 and 0.25 mg/kg). Animals receiving saline were used as controls. The toxicities of the three drugs were evaluated by clinical chemistry and hematological determinations, light microscopy and transmission electron microscopy. The severity of the histologic alterations in heart, kidney and small intestine was assessed semiquantitatively. Biochemical and molecular modeling studies were made to evaluate the formation of complexes of Fe(III) with piroxantrone and losoxantrone. The cardiac (myofibrillar loss and dilatation of the sarcoplasmic reticulum) and renal (glomerular vacuolization, tubular damage and laboratory evidence of a nephrotic syndrome) lesions induced by all three agents had similar features. However, the cardiac lesions induced by losoxantrone and doxorubicin were significantly more severe (Billingham scores) than those produced by piroxantrone. The renal lesions induced by piroxantrone and losoxantrone were less severe than those produced by doxorubicin. Similarly losoxantrone and piroxantrone-induced intestinal alterations (denudation of epithelial layer and inflammatory cellular infiltration) were less severe than those occurring after treatment with doxorubicin. Both losoxantrone and piroxantrone were shown to form Fe(III): drug complexes that may cause oxidative damage to various tissues.

Functional occlusal relationships in a group of post-orthodontic patients: preliminary findings

This study investigated features of the functional occlusion in a group of 37 patients immediately following two-arch fixed appliance treatment. Study casts were mounted in the retruded axis position on a semi-adjustable articulator and occlusal contacts were recorded with articulating paper in retruded and lateral mandibular positions. The magnitude of the slide between the retruded axis position and the intercuspal position was measured to the nearest 0.5 mm in the antero-posterior, vertical and lateral directions. The results revealed that the majority of subjects had a unilateral contact on initial closure in the retruded axis position, and a slide between this position and the intercuspal position. Most subjects demonstrated canine guidance on the working side in lateral positions. In addition, however, most subjects had contact between the second molars on the non-working side. Based on current concepts of functional occlusion, this group of post-orthodontic patients did not exhibit ideal occlusal relationships. The long-term implications of this finding are unclear, but may be associated with post-orthodontic instability, tooth wear and temporomandibular disorders. A long-term follow-up is planned to attempt to clarify some of these issues.

Pathogenesis and prevention of doxorubicin cardiomyopathy

A review is presented of the various types of cardiotoxicity associated with the clinical use of doxorubicin, a highly effective antineoplastic agent of the anthracycline family. Acute toxicity is related to rapid intravenous administration of the drug and is manifested by vasodilatation, hypotension and cardiac arrhythmias. Subacute toxicity is very uncommon. It develops early in the course of therapy and is characterized by myocarditis and pericarditis. Chronic toxicity is the most common form of doxorubicin-induced cardiac toxicity. It is manifested by chronic dilated cardiomyopathy, which develops late in the course of therapy or shortly after its termination. Morphologic changes are characteristic and consist of myofibrillar loss and cytoplasmic vacuolization (which is due to dilatation of the sarcoplasmic reticulum) of the myocytes. The damaging effects of reactive oxygen species, generated by the interaction of doxorubicin with iron, play a critically important role in the pathogenesis of the chronic cardiotoxicity. Other factors related to this toxicity include inhibition of DNA topoisomerase II, stimulation of certain immune responses and a diversity of other biochemical effects on various cellular organelles. Doxorubicin induces apoptosis in a variety of cell types, but not in cardiac myocytes. The chronic cardiotoxicity of doxorubicin is significantly attenuated by chelation of iron by ICRF-187 (dexrazoxane). A greatly delayed type of doxorubicin cardiotoxicity has been recently found to occur in survivors of childhood cancers who were treated with doxorubicin without any immediate adverse effects, but develop chronic cardiomyopathy at periods of time ranging up to 15 years later. The pathogenesis of this type of toxicity remains to be determined.

Late developing supernumerary teeth in the mandible

This paper presents two cases in which supplemental premolars were an incidental finding. Although anomalies of tooth number and form are quite common, both cases demonstrate late forming supernumeraries with one case illustrating their development in a more unusual site. It is not routine practice to screen for late development of teeth during orthodontic treatment. Therefore the possibility of their interference with occlusal development or orthodontic mechanics such as space closure, should always be kept in mind.

Comparison of the structural changes induced by doxorubicin and mitoxantrone in the heart, kidney and intestine and characterization of the Fe(III)-mitoxantrone complex

Histologic, nick end labeling for apoptosis and electron microscopic studies were made of the heart, kidney and small intestine in spontaneously hypertensive rats (SHR) treated for 12 weeks with doxorubicin (1 mg/kg/week), mitoxantrone (0.5 or 0.25 mg/kg/week) or saline (controls). Semiquantitative scoring showed that the severity of the cardiac lesions produced by doxorubicin was comparable to that resulting from 0.5 mg/kg mitoxantrone, but greater than that induced by 0.25 mg/kg mitoxantrone (to which it is therapeutically equivalent). The nephropathy and the intestinal toxicity produced by doxorubicin were also more severe than those resulting from either dose of mitoxantrone. Apoptosis of cardiac myocytes was not induced by either drug, but involved cardiac dendritic cells in SHR given doxorubicin. Apoptosis in renal tubular epithelium was comparable in SHR given doxorubicin and the higher dose of mitoxantrone. Doxorubicin induced more frequent apoptosis in intestinal epithelium than did the higher dose of mitoxantrone. We also show that mitoxantrone and iron(III) form a strong 2:1 complex, in which the drug may be acting as a tridentate ligand. This complex, like the iron(III)-doxorubicin complex, may be capable of redox cycling and producing reactive oxygen intermediates (ROI) that damage tissue. Decreased formation of ROI by mitoxantrone may account for its reduced cardiotoxicity compared to that of doxorubicin.

Induction chemotherapy with cisplatin, fluorouracil, and high-dose leucovorin for squamous cell carcinoma of the head and neck: long-term results

PURPOSE

A phase II trial of cisplatin, fluorouracil, and leucovorin (PFL) induction chemotherapy in patients with locally advanced squamous cell carcinomas of the head and neck region (HNCA).

PATIENTS AND METHODS

One hundred two patients (stage III/IV, previously untreated) were treated with induction PFL. Patients with resectable primary tumor site lesions and clinical complete response (CR) were offered radiotherapy (RT) without surgery to the primary tumor site. Response, toxicity, local-regional therapy, survival, and preservation of the primary tumor site were assessed.

RESULTS

Among 279 courses, the overall response rate was 81%. Nineteen (19%) failed to respond, including three who died during therapy. Sixty-seven (69%) of 97 with assessable primary lesions had a clinical CR at the primary tumor site. Pathologic CR was recorded in 46 of 55 (84%) clinical CR patients who had biopsies performed on the primary tumor site. Toxicities resulted in unexpected hospitalizations in 19% of cases. After definitive local-regional therapy, 84 (82%) were disease-free including 71 (69%) with preserved primary tumor site anatomy. With a median follow-up time of 63 months, the cause-specific, overall (OS), and failure-free survival (FFS) rates at 5 years are 58%, 52%, and 51%. Local failure occurred in 29 of 102 (29%) and the local control rate at 5 years was 68%.

CONCLUSION

PFL has significant activity with acceptable toxicity in patients with advanced disease who have a good performance status. Preservation of the primary tumor site could be achieved without apparent loss of local control or survival. Management of neck disease by surgery or RT must be individualized and separate from management of primary tumor. Survival compares favorably with similar trials of induction chemotherapy or chemoradiotherapy.

Calreticulin biosynthesis and processing in human myeloid cells: demonstration of signal peptide cleavage and N-glycosylation

Calreticulin is a soluble endoplasmic reticulum protein comprising the major storage reservoir for inositol trisphosphate-releasable calcium. Although its highly conserved primary structure and a wide range of functions have been well described, less attention has been paid to its biosynthesis, particularly in human tissues. We report analyses of synthesis, proteolytic processing and glycosylation of human calreticulin. In both HL-60 and PLB-985 myeloid cell lines calreticulin was immunoprecipitated as a single 60-kD species without evidence of precursor forms. However, in vitro cell-free synthesis produced a 62-kD primary translation product, which in the presence of microsomal membranes, was processed by cotranslational signal peptide cleavage to a 60-kD species that comigrated with mature calreticulin produced in myeloid cells. Neither tunicamycin treatment of the cells nor endoglycosidase digestion of calreticulin resulted in any forms other than the 60-kD protein on sodium dodecyl sulfate-polyacrylamide gel electrophoresis analysis, suggesting that the potential site for N-glycosylation at asparagine-327 was unmodified. However, oxidative derivatization of carbohydrate components with digoxigenin showed that human calreticulin produced in either HL-60 cells or Sf9 insect cells is glycosylated, indicating that glycosylated and nonglycosylated human calreticulin have indistinguishable electrophoretic mobilities. Direct measurement by phenol-H2SO4 confirmed the presence of carbohydrate on recombinant human calreticulin. These data show that human myeloid calreticulin undergoes cotranslational signal peptide cleavage and posttranslational N-linked glycosylation. Although glycosylation of calreticulin has been shown in rat liver and bovine liver and brain, it has been reported to be lacking in other tissues including human lymphocytes.

Sexually transmitted diseases: detection, differentiation, and treatment

Sexually transmitted diseases (STDs) are very common in the young, athletic population. Many STDs cause no symptoms, but even when symptoms occur it can be difficult to distinguish between two different infections. Sexual history, current complaints, physical examination, and laboratory tests are all important in determining the cause. Pharmacologic treatment differs by disease, whether or not the patient is pregnant, and, in some conditions, on the stage of the disease. Prevention is as important as treatment, and all patients should be educated about prevention and the risks associated with sexual activity, especially HIV infection.

Doxorubicin-induced apoptosis in spontaneously hypertensive rats: differential effects in heart, kidney and intestine, and inhibition by ICRF-187

The occurrence of apoptosis in heart, kidney and small intestine was investigated in spontaneously hypertensive rats (SHR) treated with doxorubicin (1 mg/kg/week for 6, 9 and 12 weeks) with and without pretreatment with the iron chelator ICRF-187 [(+)1.2-bis(3.5-dioxopiperazinyl-l-yl)propane] (25 mg/kg, i.p., given 30 min before doxorubicin). Animals receiving either ICRF-187 alone or saline were used as controls. Cells undergoing apoptosis were identified ultrastructurally and by staining using the nick-end labeling method. The results obtained by counting cells with positive nick-end labeling showed that, when given in cumulative doses of 9 and 12 (but not 6) mg/kg, doxorubicin induced significant toxicity in the heart, kidneys and intestine in association with apoptosis in epithelial cells of the intestinal mucosa and renal tubules but not in cardiac myocytes. At these doses nick end labeling in the heart was confined to occasional endothelial cells, interstitial dendritic cells and macrophages. The frequency of doxorubicin-induced apoptosis in renal and intestinal epithelial cells was decreased by pretreatment of the SHR with ICRF-187. Our data support the concept that the chronic cardiomyopathy induced by doxorubicin is not mediated by apoptosis of the cardiac myocytes.

Docetaxel: an active drug for squamous cell carcinoma of the head and neck

PURPOSE

We conducted a phase II study designed to evaluate the activity, safety, and tolerability of docetaxel (Taxotere: Rhône-Poulenc Rorer Pharmaceuticals Inc, Collegeville, PA) in patients with advanced, incurable, or recurrent squamous cell carcinoma of the head and neck (SCCHN) who had not received prior palliative chemotherapy.

PATIENTS AND METHODS

Thirty-one patients with measurable, locoregional, or metastatic SCCHN were treated with docetaxel, administered at a dose of 100 mg/m2 as a 1-hour intravenous (i.v.) infusion once every 21 days on an outpatient basis. All patients were premedicated with dexamethasone, diphenhydramine, and cimetidine. Prophylactic administration of growth factors or antiemetics was not permitted.

RESULTS

Thirty-one patients were treated. Twenty-nine patients were assessable for response and 30 for toxicity. Four of 31 patients (13%) achieved complete response (CR), nine (29%) achieved partial response had stable disease (SD) and seven (23%) experienced progression of disease (PD). The major response rate was 42% (95% confidence interval [CI], 24% to 60%). The median duration of responses was 5 months (range, 2 to 14). The principal toxicity was leukopenia, which occurred with rapid onset and brief duration. Sixteen patients (53%) experienced nadir fever, and 13 required dose reduction. Hypersensitivity reactions occurred in four patients. Grade 3 peripheral neuropathy occurred in two patients; grade 2 or 3 fatigue occurred in six (20%) and 10 (33%), respectively. Minimal edema (grade 1) occurred in five patients (17%). Clinically significant mucositis, diarrhea, or dermatitis were not observed.

CONCLUSION

Docetaxel has major activity against SCCHN. It appears to be well tolerated in this group of patients and can be safely administered on an outpatient basis. Premedication with dexamethasone, cimetidine, and diphenhydramine is associated with a reduced incidence of significant edema, hypersensitivity reactions, and dermatologic toxicities.

Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold

BACKGROUND

Symptomatic treatment is the only recommended therapy for the uncomplicated "common cold." The purpose of this study was to examine the use of antibiotics and other prescription medications for the common cold in a Medicaid population seen in ambulatory care settings.

METHODS

A cross-sectional sample of Kentucky Medicaid claims from July 1, 1993, through June 30, 1994, was analyzed. Subjects were patients seen in an ambulatory setting for the common cold, defined as acute nasopharyngitis. A total of 1439 individuals were seen for 2171 separate outpatient and emergency department encounters for the common cold. Outpatient visits accounted for 99% (2144) of the encounters.

RESULTS

Patients in 35% (752) of the encounters did not fill a prescription for medication, 6% (129) filled a prescription for an antihistamine or other symptomatic medication, and 60% (1290) filled a prescription for an antibiotic for the common cold. Nineteen different antibiotics, 54% of which were amoxicillin, were prescribed for the common cold. Less than 2% of the encounters had a secondary diagnosis of either acute sinusitis or otitis media. These encounters were not more likely than the total sample to receive antibiotics. Adults were more likely than children to receive an antibiotic (P<.001), and urban physicians were more likely than rural physicians to prescribe antibiotics (P=.02). A conservative estimate of the annual cost of antibiotic prescribing for the common cold in the United States was $37.5 million.

CONCLUSIONS

A majority of persons receiving medical care for the common cold are given prescriptions for an unnecessary antibiotic. Unchecked, this practice may lead to greater antibiotic resistance and unnecessary use of health care resources. Future research should focus on the ability to institute behavioral changes for treatment of the common cold in both closed systems (eg, managed care) and open systems (eg, general community of physicians).