Molecular MRD is strongly prognostic in patients with NPM1-mutated AML receiving venetoclax-based nonintensive therapy

ABSTRACT

Assessment of measurable residual disease (MRD) by quantitative reverse transcription polymerase chain reaction is strongly prognostic in patients with NPM1-mutated acute myeloid leukemia (AML) treated with intensive chemotherapy; however, there are no data regarding its utility in venetoclax-based nonintensive therapy, despite high efficacy in this genotype. We analyzed the prognostic impact of NPM1 MRD in an international real-world cohort of 76 previously untreated patients with NPM1-mutated AML who achieved complete remission (CR)/CR with incomplete hematological recovery following treatment with venetoclax and hypomethylating agents (HMAs) or low-dose cytarabine (LDAC). A total of 44 patients (58%) achieved bone marrow (BM) MRD negativity, and a further 14 (18%) achieved a reduction of ≥4 log10 from baseline as their best response, with no difference between HMAs and LDAC. The cumulative rates of BM MRD negativity by the end of cycles 2, 4, and 6 were 25%, 47%, and 50%, respectively. Patients achieving BM MRD negativity by the end of cycle 4 had 2-year overall of 84% compared with 46% if MRD was positive. On multivariable analyses, MRD negativity was the strongest prognostic factor. A total of 22 patients electively stopped therapy in BM MRD-negative remission after a median of 8 cycles, with 2-year treatment-free remission of 88%. In patients with NPM1-mutated AML attaining remission with venetoclax combination therapies, NPM1 MRD provides valuable prognostic information.

Transmission of canine transmissible venereal tumour between two dogs in the UK

Canine transmissible venereal tumour (CTVT) is a contagious cancer spread by transfer of living cancer cells. Occasional cases are observed in the UK in dogs imported from endemic regions. Here, we report a case of imported canine transmissible venereal tumour that was transmitted to a second dog within the UK. Transmission of genital canine transmissible venereal tumour occurred despite neutered status of the second dog. The aggressive course of disease in both cases, which included metastasis, resistance to therapeutic interventions and ultimate euthanasia of both dogs, is described. The diagnosis of canine transmissible venereal tumour was made using a combination of cytology, histology, immunohistochemistry and PCR to detect the LINE-MYC rearrangement. Practitioners unfamiliar with canine transmissible venereal tumour are reminded of this disease of concern, particularly when imported dogs are placed in multi-dog households, irrespective of neuter status.

36 Predicting Long-Term Survival and Time-to-Recurrence After Oesophagectomy in Patients with Oesophageal Cancer

Aim

Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer.

Method

Patients undergoing curative surgery from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities).

Results

This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4–79.1%) and 77.1% (95% CI 76.1–78.1%) for OS and a tAUC of 79.4% (95% CI 78.5–80.2%) and 78.6% (95% CI 77.5–79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20–80%.

Conclusions

This study demonstrated that a statistical model can accurately predict long-term survival and time-to-recurrence after oesophagectomy. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by optimising treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to understand the clinical utility derived from prognostic model use.

36 Predicting Long-Term Survival and Time-to-Recurrence After Oesophagectomy in Patients with Oesophageal Cancer

Aim

Long-term survival after oesophagectomy remains poor, with recurrence a feared common outcome. Prediction tools can identify high-risk patients and optimise treatment decisions based on their prognostic factors. This study developed a prediction model to predict long-term survival and time-to-recurrence following surgery for oesophageal cancer.

Method

Patients undergoing curative surgery from the European iNvestigation of SUrveillance After Resection for Esophageal Cancer study were included. Prediction models were developed for overall survival (OS) and disease-free survival (DFS) using Cox proportional hazards (CPH) and Random Survival Forest (RSF). Model performance was evaluated using discrimination (time-dependent area under the curve (tAUC)) and calibration (visual comparison of predicted and observed survival probabilities).

Results

This study included 4719 patients with an OS of 47.7% and DFS of 48.4% at 5 years. Sixteen variables were included. CPH and RSF demonstrated good discrimination with a tAUC of 78.2% (95% CI 77.4–79.1%) and 77.1% (95% CI 76.1–78.1%) for OS and a tAUC of 79.4% (95% CI 78.5–80.2%) and 78.6% (95% CI 77.5–79.5%) respectively for DFS at 5 years. CPH showed good agreement between predicted and observed probabilities in all quintiles. RSF showed good agreement for patients with survival probabilities between 20–80%.

Conclusions

This study demonstrated that a statistical model can accurately predict long-term survival and time-to-recurrence after oesophagectomy. Identification of patient groups at risk of recurrence and poor long-term survival can improve patient outcomes by optimising treatment methods and surveillance strategies. Future work evaluating prediction-based decisions against standard decision-making is required to understand the clinical utility derived from prognostic model use.

Missed irradiation of cellular blood components for vulnerable patients: Insights from 10 years of SHOT data

Background

Irradiation of cellular blood components is recommended for patients at risk of transfusion‐associated graft‐vs‐host disease (TA‐GvHD). Prestorage leucodepletion (LD) of blood components is standard in the UK since 1999.

Study Design and Methods

Analysis of 10 years' reports from UK national hemovigilance scheme, Serious Hazards of Transfusion (2010‐2019), where patients failed to receive irradiated components when indicated according to British Society for Haematology guidelines (2011).

Results

There were 956 incidents of failure to receive irradiated components all due to errors. One hundred and seventy two incidents were excluded from analysis, 125 of 172 (72.7%) because of missing essential information. No cases of TA‐GvHD were reported in this cohort. The 784 patients received 2809 components (number unknown for 67 incidents). Most failures occurred in patients treated with purine analogues (365) or alemtuzumab (69), or with a history of Hodgkin lymphoma (HL) (192). Together these make up 626 of 784 (79.9%). Poor communication is an important cause of errors.

Conclusion

Leucodepletion appears to reduce the risk for TA‐GvHD. None of 12 cases of TA‐GvHD reported to SHOT prior to introduction of LD occurred in patients with conditions recommended for irradiated components by current guidelines. Irradiation indefinitely for all stages of HL is not based on good evidence and is a difficult guideline to follow. Further research on long‐term immune function in HL is required. Variation between different national guidelines reflects the very limited evidence.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Determination of Moisture and Fat in Meats by Microwave and Nuclear Magnetic Resonance Analysis: Collaborative Study

Ten laboratories participated in a collaborative study to determine the total moisture and fat in raw and processed meat products by microwave drying and nuclear magnetic resonance (NMR) spectroscopy. Meat products were prepared following the AOAC Method and analyzed using CEM Corp.'s SMART Trac Moisture and Fat Analysis system. SMART Trac provides moisture results by measuring the weight loss on drying by microwave energy. The dried sample is then analyzed by NMR spectrometry for fat content. Moisture and fat results are displayed and reported by the SMART Trac as a percentage (g/100 g). Microwave drying is an AOAC-approved reference method (Method 985.14), Moisture in Meat and Poultry Products. NMR spectrometry is a secondary technique used to determine the concentration of various constituents in biological, organic, or chemical samples. The study design was based on Youden's matched pair principle for collaborative tests. For the purposes of this study, 10 laboratories each tested 10 Youden matched pairs, for a total of 20 samples. The study samples represented a range of products processed daily in plant operations. Included were raw meat samples (beef, pork, chicken, and turkey) as well as processed meats (beef hot dog, pork sausage, and ham). The total moisture content of the undiluted samples, as received for the purposes of this study, was determined by AOAC Method 950.46 and ranged from 54.03 to 74.99. The total fat content of the undiluted samples was determined by AOAC Method 960.39 and ranged from 1.00 to 29.79. Statistical analysis of study results for total moisture yielded a relative standard deviation for repeatability (RSDr) range of 0.14 to 0.95 and a relative standard deviation for reproducibility (RSDR) range of 0.26 to 0.95. Statistical analysis for total fat yielded similar RSDr and RSDR range of 0.74 to 4.08. Results for turkey had higher RSDr and RSDR values, both at 12.6, due to low fat content and possibly to the separation of the samples observed by some of the collaborators. Results demonstrate that microwave drying with NMR is a rapid, practical method providing results equivalent to AOAC Methods 950.46 (Forced Air Oven Drying) and 960.39 (Soxhlet Ether Extraction) in raw and processed meat products.

Parasitism perturbs the mucosal microbiome of Atlantic Salmon

Interactions between parasite, host and host-associated microbiota are increasingly understood as important determinants of disease progression and morbidity. Salmon lice, including the parasitic copepod Lepeophtheirus salmonis and related species, are perhaps the most important problem facing Atlantic Salmon aquaculture after feed sustainability. Salmon lice parasitize the surface of the fish, feeding off mucus, scales and underlying tissue. Secondary bacterial infections are a major source of associated morbidity. In this study we tracked the diversity and composition of Salmo salar skin surface microbiota throughout a complete L. salmonis infection cycle among 800 post-smolts as compared to healthy controls. Among infected fish we observed a significant reduction in microbial richness (Chao1, P = 0.0136), raised diversity (Shannon, P < 7.86e-06) as well as highly significant destabilisation of microbial community composition (Pairwise Unifrac, beta-diversity, P < 1.86e-05; P = 0.0132) by comparison to controls. While undetectable on an individual level, network analysis of microbial taxa on infected fish revealed the association of multiple pathogenic genera (Vibrio, Flavobacterium, Tenacibaculum, Pseudomonas) with high louse burdens. We discuss our findings in the context of ecological theory and colonisation resistance, in addition to the role microbiota in driving primary and secondary pathology in the host.

A longitudinal cohort study of HIV 'treatment as prevention' in gay, bisexual and other men who have sex with men: the Treatment with Antiretrovirals and their Impact on Positive And Negative men (TAIPAN) study protocol

BACKGROUND

Australia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014. While ART reduces AIDS-related deaths, accumulating evidence suggests that it could also bolster prevention efforts by reducing the risk of HIV transmission ('treatment as prevention'). While promising, evidence of community-level impact of treatment as prevention on reducing HIV incidence among gay and bisexual men is limited. We describe a study protocol that aims to determine if scale up of testing and treatment for HIV leads to a reduction in community viraemia and, in turn, if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men in Australia's two most populous states.

METHODS

Over the period 2009 to 2017, we will establish two cohorts making use of clinical and laboratory data electronically extracted retrospectively and prospectively from 73 health services and laboratories in the states of New South Wales and Victoria. The 'positive cohort' will consist of approximately 13,000 gay and bisexual men (>90% of all people living with HIV). The 'negative cohort' will consist of at least 40,000 HIV-negative gay and bisexual men (approximately half of the total population). Within the negative cohort we will use standard repeat-testing methods to calculate annual HIV incidence. Community prevalence of viraemia will be defined as the proportion of men with a viral load ≥200RNA copies/mm³, which will combine viral load data from the positive cohort and viraemia estimates among those with an undiagnosed HIV infection. Using regression analyses and adjusting for behavioural and demographic factors associated with infection, we will assess the temporal association between the community prevalence of viraemia and the incidence of HIV infection. Further analyses will make use of these cohorts to assess incidence and predictors of treatment initiation, repeat HIV testing, and viral suppression.

DISCUSSION

This study will provide important information on whether 'treatment as prevention' is associated with a reduction in HIV incidence at a community level among gay and bisexual men.

Assessing the quality of written information provision for surgical procedures: a case study in oesophagectomy

OBJECTIVE

To examine the content and quality of written information provided by surgical centres for patients undergoing oesophagectomy for cancer.

DESIGN

Cross-sectional study of the content of National Health Service (NHS) patient information leaflets (PILs) about oesophageal cancer surgery, using a modified framework approach.

DATA SOURCES

Written information leaflets from 41 of 43 cancer centres undertaking surgery for oesophageal cancer in England and Wales (response rate 95.3%).

ELIGIBILITY CRITERIA

All English language versions of PILs about oesophagectomy.

RESULTS

32 different PILs were identified, of which 2 were generic tools (Macmillan 'understanding cancer of the gullet' and EIDO 'oesophagectomy'). Although most PILs focused on describing in-hospital adverse events, information varied widely and was often misleading. Just 1 leaflet described survival benefits of surgery and 2 mentioned the possibility of disease recurrence.

CONCLUSIONS

Written information provided for patients by NHS cancer centres undertaking oesophagectomy is inconsistent and incomplete. It is recommended that surgeons work together with patients to agree on standards of information provision of relevance to all stakeholders' needs.

Cardiovascular-renal axis disorders in the domestic dog and cat: a veterinary consensus statement

OBJECTIVES

There is a growing understanding of the complexity of interplay between renal and cardiovascular systems in both health and disease. The medical profession has adopted the term "cardiorenal syndrome" (CRS) to describe the pathophysiological relationship between the kidney and heart in disease. CRS has yet to be formally defined and described by the veterinary profession and its existence and importance in dogs and cats warrant investigation. The CRS Consensus Group, comprising nine veterinary cardiologists and seven nephrologists from Europe and North America, sought to achieve consensus around the definition, pathophysiology, diagnosis and management of dogs and cats with "cardiovascular-renal disorders" (CvRD). To this end, the Delphi formal methodology for defining/building consensus and defining guidelines was utilised.

METHODS

Following a literature review, 13 candidate statements regarding CvRD in dogs and cats were tested for consensus, using a modified Delphi method. As a new area of interest, well-designed studies, specific to CRS/CvRD, are lacking, particularly in dogs and cats. Hence, while scientific justification of all the recommendations was sought and used when available, recommendations were largely reliant on theory, expert opinion, small clinical studies and extrapolation from data derived from other species.

RESULTS

Of the 13 statements, 11 achieved consensus and 2 did not. The modified Delphi approach worked well to achieve consensus in an objective manner and to develop initial guidelines for CvRD.

DISCUSSION

The resultant manuscript describes consensus statements for the definition, classification, diagnosis and management strategies for veterinary patients with CvRD, with an emphasis on the pathological interplay between the two organ systems. By formulating consensus statements regarding CvRD in veterinary medicine, the authors hope to stimulate interest in and advancement of the understanding and management of CvRD in dogs and cats. The use of a formalised method for consensus and guideline development should be considered for other topics in veterinary medicine.

Dose Adjustment for Normal Eating: a qualitative longitudinal exploration of the food and eating practices of type 1 diabetes patients converted to flexible intensive insulin therapy in the UK

AIM

To explore whether, and why, patients change their food and eating practices following conversion to flexible intensive insulin therapy (FIIT), a regimen which requires quick acting insulin doses to be matched to the carbohydrate content of meals/snacks consumed.

METHODS

repeat, in-depth interviews with 30 type 1 diabetes patients converted to FIIT recruited from Dose Adjustment for Normal Eating (DAFNE) courses in the UK. Data were analysed using an inductive, thematic approach.

RESULTS

despite the potential of FIIT to enable greater dietary flexibility and freedom, most patients reported food and eating practices which were remarkably resistant to change. In some cases, FIIT adoption resulted in greater dietary rigidity over time. The opportunities FIIT presented for greater dietary freedom were counterbalanced by new challenges and burdens (e.g. having to simplify food choices to make carbohydrate estimation easier). Due to the emphasis FIIT places on carbohydrate counting, and patients' fears of hypos, low/no carbohydrate foodstuffs sometimes came to be seen as the healthiest or safest options.

CONCLUSION

concerns that FIIT may result in more excessive or unhealthy eating appear largely unfounded; however, consideration needs to be paid to the ways in which patients' conceptualisations of, and relationship with, food may change following FIIT conversion.

Extracellular matrix components and regulators in the airway smooth muscle in asthma

There is an intimate relationship between the extracellular matrix (ECM) and smooth muscle cells within the airways. Few studies have comprehensively assessed the composition of different ECM components and its regulators within the airway smooth muscle (ASM) in asthma. With the aid of image analysis, the fractional areas of total collagen and elastic fibres were quantified within the ASM of 35 subjects with fatal asthma (FA) and compared with 10 nonfatal asthma (NFA) patients and 22 nonasthmatic control cases. Expression of collagen I and III, fibronectin, versican, matrix metalloproteinase (MMP)-1, -2, -9 and -12 and tissue inhibitor of metalloproteinase-1 and -2 was quantified within the ASM in 22 FA and 10 control cases. In the large airways of FA cases, the fractional area of elastic fibres within the ASM was increased compared with NFA and controls. Similarly, fibronectin, MMP-9 and MMP-12 were increased within the ASM in large airways of FA cases compared with controls. Elastic fibres were increased in small airways in FA only in comparison with NFA cases. There is altered extracellular matrix composition and a degradative environment within the airway smooth muscle in fatal asthma patients, which may have important consequences for the mechanical and synthetic functions of airway smooth muscle.

Reduced apoptosis of memory T-cells in the inner airway wall of mild and severe asthma

Effector memory T-cells (CD45RO+) may provide pro-inflammatory signals that contribute to the persistent airway inflammation that is characteristic of asthma, and reduced apoptosis of these cells may prolong their effects. The present authors compared apoptosis of CD45RO+ T-cells in the inner airway wall in nonfatal asthma (n = 7), fatal asthma (n = 7) and control (n = 8) cases. Apoptotic cells were identified using both the terminal deoxynucleotidyl transferase dNTP nick end-labelling (TUNEL) technique and cell morphology. The percentage of CD45RO+ T-cells that were apoptotic was significantly greater in control cases compared with nonfatal and fatal cases of asthma, respectively, in small (42+/-19, 16+/-9, 7+/-6%), medium (40+/-12, 15+/-11, 12+/-8%) and large airways (42+/-15, 23+/-18, 18+/-12%). The reduction in the percentage of apoptotic CD45RO+ cells in the cases of asthma was observed in both blood vessels and the interstitium in large airways. In conclusion, these data suggest that reduced apoptosis may prolong the active life of effector memory T-cells in the airways. It is possible that survival signals may be received before cells migrate into the interstitium of the inner airway wall.

Evaluation of a community intervention programme for preschool behaviour problems

OBJECTIVES

To evaluate an early intervention project focused on improving child prereading skills and parent behaviour-management skills, for 4-year-old children in the western suburbs of Melbourne (Victoria, Australia).

METHODOLOGY

Following screening of a large sample of preschoolers, four groups were constructed: (i) children receiving a phonological skills-based prereading package in their normal preschool programme; (ii) children whose parents attended six sessions of child behaviour management skill training; (iii) children who received both interventions; and (iv) a control group. Pre-, post-, 1 and 2 year follow-up measures were taken to assess effects on child behavioural and learning adjustment.

RESULTS AND CONCLUSIONS

This community based intervention resulted in positive effects, despite being of low intensity, in achieving significantly less hyperactive/distractable behaviour in children from the combined intervention group at 2 years postintervention. Anxiety problems were also reduced at the post-treatment phase. The prereading package did not demonstrate any effects on reading skills and was deemed to be insufficiently intensive to affect a population of disadvantaged preschoolers. This universal-type of intervention was well accepted by the community, but there is need for further effort to increase recruitment of families of at-risk children into such programmes.

The stability of benzoyl peroxide by isothermal microcalorimetry

Isothermal microcalorimetry may be used to determine kinetic and thermodynamic parameters for chemical reactions. This paper reports rate constants, determined as a function of temperature, and the activation enthalpy for the degradation of solid benzoyl peroxide as determined by isothermal microcalorimetry. Studies were conducted on aqueous suspension phase, solid benzoyl peroxide. In addition, supporting evidence is cited from work carried out in this laboratory on the solution phase degradation of benzoyl peroxide using UV-visible spectrophotometry. The activation energy obtained by microcalorimetry was E(a)=137.8+/-6.6 kJ mol(-1) and the activation energy obtained from UV-visible spectrophotometry was E(a)=112.7+/-4.2 kJ mol(-1).

The stability of benzoyl peroxide formulations determined from isothermal microcalorimetric studies

Recent developments in the analysis of microcalorimetric data output allow the possibility of determining both thermodynamic and kinetic parameters for complex reaction systems. Such experiments routinely take around 50 h, hence qualifying for the description rapid. The methods have earlier been applied to a study of the stability of benzoyl peroxide itself in aqueous suspension. This paper reports the results of isothermal microcalorimetric study of the stability of benzoyl peroxide in the presence of a wide range of excipients and in formulated materials. The results are shown to assist in formulation design, are achieved rapidly and are derived from direct experimental study of the complex systems themselves. That is, no ancillary information is required nor are the studies invasive or destructive.

Increased airway responsiveness and decreased alveolar attachment points following in utero smoke exposure in the guinea pig

Maternal smoking during pregnancy has been shown to result in abnormalities in lung function in newborn infants, including reduced expiratory flow and increased airway responsiveness to inhaled agonists. The mechanisms by which this occurs remain unclear. Using a guinea pig model of in utero smoke exposure, we measured airway responsiveness and lung morphology in a group of neonatal guinea pigs 21 d after delivery. Pregnant guinea pigs were exposed to cigarette smoke from Day 28 to term (Day 68 of gestation). After delivery newborn animals did not receive any smoke exposure. Airway wall thickness, smooth muscle area, and the number of points where the alveoli attached to the airway adventitia were measured. Airway responsiveness was increased (p < 0.05) and the mean distance between alveolar attachment points was increased (mean 0.052 +/- SE 0.001 mm versus 0.046 +/- 0.001, p = 0.001) in animals exposed to cigarette smoke in utero compared with nonexposed animals. Although not statistically significant, both the inner and outer airway wall and the smooth muscle area were greater in exposed animals compared with nonexposed animals. The increased mean distance between alveolar attachments in the smoke-exposed group was the result of a reduction in the number of attachments and an increase in the outer airway wall perimeter. These findings suggest that the increased airway responsiveness observed in postnatal animals, subsequent to in utero cigarette smoke exposure, may be the result of decreased alveolar attachment points to the airways and changes in airway dimensions.

Modulation of [3H]MK-801 binding to NMDA receptors in vivo and in vitro

[3H]MK-801 binding in vivo was used to determine the occupancy of NMDA receptor ligands shown to allosterically modulate binding in vitro. ED(50) values (mg/kg) were obtained for the channel blockers (+)-5-methyl-10,11-dihydro-5,4-dibenzo[a,d]cyclohepten-5,10-imine maleate ((+)-MK-801, 0.2), 1-(1-phenylcyclohexyl)piperidine (phencyclidine, PCP, 1.7) and ketamine (4.4). Antagonists at the glutamate (DL-(2-carboxypiperazine-4-yl)propyl-1-phosphonate (DL-CPP, 5.7)) and glycine site (7-Chloro-4-hydroxy-3-(3-phenoxy)-phenyl-2(H)quinolinone (L-701,324, 14.1), 3R(+)cis-4-methyl-pyrrollid-2-one (L-687,414, 15.1)) inhibited [3H]MK-801 binding in vivo to varying maximum levels (69%, 103% and 45%, respectively). NR2B subunit-selective compounds acting at the ifenprodil site inhibited [3H]MK-801 in vivo by a maximum of 52-72% and gave ED(50) values (mg/kg) of: (+/-)-(1S*, 2S*)-1-(4-hydroxyphenyl)-2-(4-hydroxy-4-phenylpiperidino)-1-propanol ((+/-)CP-101,606), 1.9; (+/-)-(3R, 4S)-3-[4-(4-fluorophenyl)-4-hydroxypiperidin-1-yl]chroman-4,7-diol ((+/-)CP-283,097), 1.8; (+/-)-(R*, S*)-alpha-(4-hydroxyphenyl)-beta-methyl-4-(phenylmethyl)-1-piperidine propanol ((+/-)Ro 25-6981), 1.0; ifenprodil, 6.0. The glycine site agonist D-serine stimulated binding to 151% of control with an ED(50) of 1.7 mg/kg. Results show that [3H]MK-801 binding in vivo may be used to measure receptor occupancy of ligands acting not only within the ion channel but also at modulatory sites on the NMDA receptor complex.

Effects of one year of resistance training on the relation between muscular strength and bone density in elderly women

OBJECTIVES

There is a paucity of long term studies on exercise training in elderly women. The purpose of this study was to investigate the effects of one year of progressive resistance exercise (PRE) on dynamic muscular strength and the relations to bone mineral density (BMD) in elderly women.

METHODS

Forty four healthy sedentary women (mean age 68.8 years) volunteered for this study and were randomly assigned to either an exercise group or a control group. The exercise group were involved in three one hour sessions a week for 52 weeks of supervised PRE to strengthen the large muscle groups of the body, while the control group were instructed to continue their normal lifestyle. The exercise circuit included three sets of eight repetitions at 75% of one repetition maximum focused on the large muscle groups. BMD was measured by dual energy x ray absoptiometry (Lunar DPX) at the lumbar spine and at three sites in the proximal femur. Other selected parameters of physical fitness were also measured.

RESULTS

Statistical analyses (analysis of covariance) showed significant strength gains (p < 0.01) in bilateral bench press (> 29%), bilateral leg press (> 19%), and unilateral biceps curl (> 20%). No significant difference between groups was evident in body weight, grip strength, flexibility, waist to hip ratio, or the sum of eight skinfolds. Significant relations (p < 0.05) were recorded between dynamic leg strength and the BMD of the femoral neck, Ward's triangle, and the lumbar spine.

CONCLUSIONS

Significant strength changes, after one year of PRE, were evident in elderly women, and the muscle increases may parallel changes in BMD; however, correlation coefficients were moderate.

Factors associated with exercise adherence among older adults. An individual perspective

This paper reviews the literature concerning factors at the individual level associated with regular exercise among older adults. Twenty-seven cross-sectional and 14 prospective/longitudinal studies met the inclusion criteria of a mean participant age of 65 years or older. The findings are summarised by demographics, exercise experience, exercise knowledge, physiological factors, psychological factors, activity preferences and perceived social influences. In general, education and exercise history correlate positively with regular exercise, while perceived physical frailty and poor health may provide the greatest barrier to exercise adoption and adherence in the elderly. Social-cognitive theories identify several constructs that correlate with the regular exercise behaviour of older adults, such as exercise attitude, perceived behavioural control/self-efficacy, perceived social support and perceived benefits/barriers to continued activity. As well, stage modelling may provide additional information about the readiness for regular exercise behaviour among older adults. However, relatively few studies among older adults exist compared with middle-aged and younger adults. Further, the majority of current research consists of cross-sectional designs or short prospective exercise trials among motivated volunteers that may lack external validity. Future research utilising longitudinal and prospective designs with representative samples of older adults will provide a better understanding of significant causal associations between individual factors and regular exercise behaviour.

Increased airway smooth muscle in sudden infant death syndrome

The underlying pathophysiological mechanism behind death in the sudden infant death syndrome (SIDS) is uncertain. Although infants dying of SIDS frequently have a postmortem examination performed, no specific diagnostic pathology in any organ system has been identified. Previous theories relating to the cause of death in SIDS have included increased lower airway closure. We examined the airway morphometry of 57 infants who died of SIDS and compared these findings with those obtained from 21 age-matched infants who had died of non-SIDS causes. Airway wall dimensions, epithelial thickness, and the area of smooth muscle within the airway wall were measured. Airways from infants who died of SIDS showed a significantly higher proportion of airway smooth muscle than control airways when corrected for age and sex (p < 0.01). There was no significant difference between the groups for wall thickness or epithelial thickness. Increased airway smooth muscle in infants who have died of SIDS may contribute to excessive airway narrowing, raising the possibility that the cause of death in this condition is related to abnormalities in lower airway function.

Maternal cigarette smoking is associated with increased inner airway wall thickness in children who die from sudden infant death syndrome

The harmful effects of passive cigarette smoke exposure to infants include an increased frequency of asthma exacerbations, lower respiratory viral infections, and the sudden infant death syndrome (SIDS). Because of a difficulty in obtaining airway tissue from infants, little information is available on the effects of passive cigarette smoke exposure on the structure of the infant airway wall. We examined airway dimensions in 19 children who died from SIDS whose mothers smoked more than 20 cigarettes a day prenatally and postnatally, and compared these data with those from 19 infants who died from SIDS and had nonsmoking mothers. Total inner and outer wall areas were calculated for each airway and expressed in terms of the basement membrane perimeter (Pbm). Inner airway wall thickness was greater in the larger airways of those infants whose mothers had smoked more than 20 cigarettes a day. These findings suggest that infants exposed to a high level of passive cigarette smoke develop significant structural changes in their airways. Increased airway wall thickness may contribute to exaggerated airway narrowing and may help explain the previously observed abnormalities in neonatal lung function that have been described in infants of smoking mothers.

A function for CD2 on murine B cells?

CD2 is expressed on murine B cells, probably as a result of a chromosomal translocation event during speciation. There are no activating antibodies to mouse CD2, but when activated non-specifically, only T cells up-regulate their expression of CD2. We investigated the expression and function of CD2 on B cells using mice transgenic for human CD2 under the control of a modified version of the autologous promoter/enhancer that included the immunoglobulin enhancer. This construction directs expression of human CD2 to the B cell compartment as well as to the T cell compartment. In this paper, we confirm that activating pairs of anti-CD2 monoclonal antibodies are mitogenic for mouse T cells transgenic for human CD2. In contrast, mouse B cells that express similar amounts of human CD2 are not stimulated to proliferate by equivalent doses of these antibodies. We were also unable to show any functional consequence for these B cells as a result of CD2 ligation.

Exercise for the older woman: choosing the right prescription

Many elderly women in industrially developed countries are at, or near to, functionally important strength related thresholds and so have either lost, or are in danger of losing, the ability to perform some important everyday tasks. The increased rate of healthcare expenditure due to loss of physical function is a major economic issue. Even though women make up most of the senior population, little current research on the impact of physical activity on strength and function in elderly people has included women. Elderly women typically have more barriers to participation in physical activity than do other groups and because of decreased participation, may possibly experience higher disability rates. Physical activity in old age may delay the progression of osteoporosis and is of paramount importance for maintaining the functional abilities needed to carry out daily tasks. Current research on exercise and the elderly population suggests that strength training may be the exercise mode of choice for maintenance of strength, physical function, bone integrity, and psychosocial health. This review summarises recent research on the impact of strength training on the fitness and health of elderly women and highlights considerations and potential barriers to physical activity that must be taken into account when planning exercise programmes for them.

190-fs passively mode-locked thulium fiber laser with a low threshold

We report a self-starting passively mode-locked thulium-doped silica fiber laser capable of 190-fs pulses. This practical, compact package is driven by a single 50-mW passively cooled diode laser, has a launched pumppower threshold of 18 mW for mode locking, and produces a 50-MHz train of mode-locked 20-pJ pulses at a wavelength near 1.9 microm.

Invasive group B streptococcal disease: the emergence of serotype V

Group B streptococci (GBS) cause invasive disease in neonates, pregnant adults, and nonpregnant adults with underlying or chronic disease. Previous studies found capsular serotypes Ia, Ib, II, and III cause invasive disease. Prospective population-based surveillance of invasive GBS disease was done from June 1992 to June 1993 in metropolitan Atlanta: 279 patients had invasive disease. Of these, 43% were < or = 6 months old, and 57% were adults. The incidence among all adults was 7.7/100,000/year, 33% higher than in 1989-1990 (P < .01). The incidence in nonpregnant adults was 5.9/100,000/year, 37% higher than in 1989-1990 (P < .02). Serotyping of 178 patient isolates revealed that 34% had GBS serotype Ia or Ia/c, 8% had Ib/c, 6% had II or II/c, 29% had III, 0% had IV, 21% had V, and 2% were nontypeable. Serotype V was recovered from all groups and was the most common serotype from nonpregnant adults. Serotype V isolates appeared to be highly related genetically. The increasing incidence of GBS disease in adults, the changing distribution of serotypes, and the emergence of serotype V will impact vaccine strategies.

Effect of land-based and water-based fitness programs on the cardiovascular fitness, strength and flexibility of women aged 65-75 years

The purpose of this study was to determine the effectiveness of a generalized water-based exercise program (WBE) compared to a land-based exercise program (LBE) on improving cardiorespiratory fitness, body composition, forward trunk flexion and strength measurements of elderly women aged 70 +/- 3.2 years (mean +/- SD). Forty-one healthy, sedentary women were selected to participate in the study and were randomly assigned to the LBE or WBE. The 2 groups exercised for 12 weeks, 3 times/week for 45 min. Fitness testing was done before, during and after training, and included measurements of peak aerobic power (VO2 peak), forward trunk flexion, sum of skinfolds, grip strength, curl-ups and push-ups. Between the tests performed before and after training, there were significant improvements in VO2 peak in both groups (p < 0.05) with no significant differences between the groups (p > 0.05). The LBE group also showed a significant improvement in the total number of curl-ups performed (p < 0.05). There were no significant differences in trunk forward flexion, total (right plus left) grip strength, push-ups, waist to hip ratio, sum of skinfolds or body mass index between the tests performed before and after training over time within groups or between groups (p > 0.05). The results show that general exercise interventions resulted in improvements in cardiovascular fitness (for both groups) and abdominal endurance (in the LBE only), but the two exercise programs used were not specific enough or long enough to cause improvements in muscular strength, flexibility or body composition. Furthermore, except for changes in abdominal endurance, the type of exercise venue (land vs. water) did not have a significant effect on the results obtained.

IL-10 prevents naturally occurring fetal loss in the CBA x DBA/2 mating combination, and local defect in IL-10 production in this abortion-prone combination is corrected by in vivo injection of IFN-tau

CBA x DBA/2 placentae are quantitatively or qualitatively deficient in their production of the anti-inflammatory Th2-type cytokines IL-4 and IL-10 compared with the nonresorption-prone CBA x BALB/c mating combination. Wastage in this mating combination is accompanied by increased levels of local inflammatory cytokines. In addition, alloimmunization enhances the placental production of IL-4 and IL-10 in CBA x DBA/2 matings. Furthermore, rIL-10 by itself completely reverses the high incidence of fetal resorption after i.p. injection. Conversely, anti-IL-10 increases the resorption rate, but only in CBA x DBA/2 matings. On the other hand, injecting either anti-IFN-gamma or pentoxifillin (an anti-TNF agent) partially reduces the resorption. When given together, they produce a synergistic remission of fetal loss. Finally, we report that recombinant ovine trophoblast protein, an IFN-tau which is known to influence reproductive outcome in ruminants, can also counteract increased CBA x DBA/2 fetal resorption. It simultaneously induces increased placental IL-4 and IL-10 production in this mating combination. These results indicate that the placentally produced anti-inflammatory cytokines can play a vital role in the survival to term of the fetal allograft, by counteracting deleterious inflammatory cytokines.

IL-10 prevents naturally occurring fetal loss in the CBA x DBA/2 mating combination, and local defect in IL-10 production in this abortion-prone combination is corrected by in vivo injection of IFN-tau

CBA x DBA/2 placentae are quantitatively or qualitatively deficient in their production of the anti-inflammatory Th2-type cytokines IL-4 and IL-10 compared with the nonresorption-prone CBA x BALB/c mating combination. Wastage in this mating combination is accompanied by increased levels of local inflammatory cytokines. In addition, alloimmunization enhances the placental production of IL-4 and IL-10 in CBA x DBA/2 matings. Furthermore, rIL-10 by itself completely reverses the high incidence of fetal resorption after i.p. injection. Conversely, anti-IL-10 increases the resorption rate, but only in CBA x DBA/2 matings. On the other hand, injecting either anti-IFN-gamma or pentoxifillin (an anti-TNF agent) partially reduces the resorption. When given together, they produce a synergistic remission of fetal loss. Finally, we report that recombinant ovine trophoblast protein, an IFN-tau which is known to influence reproductive outcome in ruminants, can also counteract increased CBA x DBA/2 fetal resorption. It simultaneously induces increased placental IL-4 and IL-10 production in this mating combination. These results indicate that the placentally produced anti-inflammatory cytokines can play a vital role in the survival to term of the fetal allograft, by counteracting deleterious inflammatory cytokines.

Estrus and pregnancy rate of dairy cows given one or two doses of prostaglandin F2 alpha 8 or 24 hours apart

A total of 329 cows was used in 2 experiments to study the effect of PGF2a given 8 or 24 h apart on the number of cows observed in estrus within 7 d and the pregnancy rate to a single insemination at this time. In Experiment 1, 233 cows were divided into 2 groups. Cows in Group 1 (n = 117) were treated twice with 25 mg, im of PGF2a (0 and 8 h) while cows in Group 2 (n = 116) were treated only once (0 h). In Experiment 2, 96 cows were divided into 2 groups. Cows in Group 1 (n = 49) were treated twice with 25 mg, im of PGF2a (0 and 24 h) while cows in Group 2 (n = 47) were treated only once (0 h). In Experiment 1, blood samples were obtained from cows in both groups on Days 0 and 2. However, in Experiment 2, blood samples were obtained from cows in both groups only on Day 0. Plasma progesterone concentration was determined using radioimmunoassay. Cows in both experiments were observed for estrus within 7 d of treatment and were inseminated within 12 h of the observed estrus. In Experiment 1, more cows in Group 1 were observed in estrus within 7 d than in Group 2 (P <0.03). In Experiment 2, there was no significant difference in the number of cows in both groups that were observed in estrus within 7 d. However, the interval from treatment to the first observed estrus for cows not observed in estrus within 7 d was significantly longer in cows treated at 0 and 24 h compared with the cows treated once at 0 h. In both experiments, the pregnancy rate for cows inseminated within 7 d was similar for cows in all groups. From the results of this study, it is concluded that treatment of dairy cows with 2 luteolytic dosages of PGF2a at an 8-h interval resulted in more cows being observed in estrus than at a 24-h interval.

The structure of large and small airways in nonfatal and fatal asthma

Asthma is characterized by excessive airway narrowing and airway wall inflammation. In cases of fatal asthma, increased thickness of the airway wall is observed and may account for excessive airway narrowing when smooth muscle contracts. This study was undertaken to examine airway dimensions in large and small airways in both fatal and nonfatal cases of asthma. Airway wall areas (total, inner, and outer relative to smooth muscle layer), epithelial integrity, smooth muscle shortening, and the areas of smooth muscle, cartilage, and mucous glands were compared in transverse sections of large and small airways of subjects dying of asthma (fatal asthma, n = 11), those dying suddenly of nonrespiratory diseases and having a definite history of asthma (nonfatal asthma, n = 13), and those dying suddenly without any history of respiratory illness (control, n = 11). Airways were grouped by size using the basement membrane perimeter for comparison. All areas were expressed as areas per millimeter of basement membrane. In cartilaginous airways, the cases of fatal asthma had greater (p < 0.05) total wall, inner wall, outer wall, smooth muscle, mucous gland and cartilage areas than did control and nonfatal cases. The inner wall area was greater in the fatal and nonfatal cases than in the control cases (p < 0.05) in the small cartilaginous airways and membranous bronchioles (MB). In small MB (perimeter < 2 mm), the total and outer wall areas were greater (p < 0.05) in cases of fatal and nonfatal asthma than in control cases.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of descending venography in the management of patients with chronic venous disease of the lower extremity

The purpose of this paper is to evaluate the efficacy and clinical information obtained from the authors' first 17 consecutive descending venograms. All 17 patients had chronic venous disease refractory to standard conservative and surgical measures. The standard classification of valvular insufficiency was used in evaluating these venograms. There were no deaths, slight morbidity and minimal patient discomfort. In 16 patients meaningful clinical information was derived from the venograms, with 7 patients having deep venous valvular surgery. Descending venography will demonstrate the site of incompetent valves and estimate the degree of reflux. This test is necessary before anticipated reconstruction of deep vein valves.

Synthetic parathyroid hormone-like protein-(1-74): biochemical and physiological characterization

PTH-like protein-(1-74) [PTHLP-(1-74)] was synthesized and purified. On the basis of chromatographic criteria and amino acid composition of the full-length peptide, direct amino acid sequencing of the N-terminus, and amino acid composition and internal sequence of proteolytic fragments of PTHLP-(1-74), the synthetic peptide appears to be of high quality and purity. Physiological comparison of PTHLP-(1-74) to [Tyr36]-PTHLP-(1-36) amide and bovine (b) PTH-(1-34) indicates that all three peptides are of equivalent potency in the fetal rat long bone and rat osteosarcoma 17/2.8 adenylate cyclase assays. However, as in earlier studies with native and N-terminal PTHLPs, PTHLP-(1-74) is considerably less potent (2%) in stimulating the canine renal cortical adenylate cyclase assay than is bPTH-(1-34). Further, PTHLP-(1-74) displayed only 12% of the activity of bPTH-(1-34) in inducing hypercalcemia when infused into rats in vivo. These studies support the possibility that subclasses of PTH receptors or varying PTH- and PTHLP-signalling transduction mechanisms may exist. In addition, they emphasize the need to precisely define the naturally occurring secretory and circulating species of this novel class of peptide hormones.

An inquiry into staffing, organisation and teaching in South African medical schools

A comparative analysis of student/staff ratios (SSRs) revealed a very marked difference (2:1-5.3:1) between the most and least liberally staffed medical schools in South Africa. A study of workloads determined how the average medical teacher allocates time between teaching, clinical work, research and other activities. How medical teachers teach, their preparation for teaching, factors influencing teaching practices, teaching methods used and their attitudes to the use of educational resources were investigated. Just over 70% of medical teachers are teaching without any formal preparation although opposition to teaching courses appears to be diminishing. That medical education is teacher-orientated is obvious from the fact that resources that transmit information are used more than those that propagate interaction between teacher and student and encourage more complex forms of learning. Only 13% of medical teachers 'often' use educational objectives and the majority (58%) never use them at all. Criterion-referenced evaluation should have a place in medical education, where a core of minimum knowledge is considered essential, but over 80% of medical teachers 'never' use this method in assessing students.