US Army basic combat training alters the relationship between body mass index and per cent body fat

INTRODUCTION/BACKGROUND

As a proxy for adiposity, body mass index (BMI) provides a practical public health metric to counter obesity-related disease trends. On an individual basis, BMI cannot distinguish fat and lean components of body composition. Further, the relationship between BMI and body composition may be altered in response to physical training. We investigated this dynamic relationship by examining the effect of US Army basic combat training (BCT) on the association between BMI and per cent body fat (%BF).

METHODS

BMI and %BF were measured at the beginning (week 1) and end (week 9) of BCT in female (n=504) and male (n=965) trainees. Height and weight were obtained for BMI, and body composition was obtained by dual X-ray absorptiometry. Sensitivity and specificity of BMI-based classification were determined at two BMI thresholds (25 kg/m2 and 27.5 kg/m2).

RESULTS

A progressive age-related increase in fat-free mass index (FFMI) was observed, with an inflection point at age 21 years. In soldiers aged 21+, BMI of 25.0 kg/m2 predicted 33% and 29% BF in women and 23% and 20% BF in men and BMI of 27.5 kg/m2 predicted 35% and 31% BF in women and 26% and 22% BF in men, at the start and end of BCT, respectively. Sensitivity and specificity of BMI-based classification of %BF were poor. Soldiers below BMI of 20 kg/m2 had normal instead of markedly reduced %BF, reflecting especially low FFMI.

CONCLUSIONS

BCT alters the BMI-%BF relationship, with lower %BF at a given BMI by the end of BCT compared with the beginning, highlighting the unreliability of BMI to try to estimate body composition. The specific BMI threshold of 25.0 kg/m2, defined as 'overweight', is an out-of-date metric for health and performance outcomes. To the extent that %BF reflects physical readiness, these data provide evidence of a fit and capable military force at BMI greater than 25.0 kg/m2.

Factors important for bull purchasing decisions and management in extensive rangeland production systems of New Mexico: a producer survey

There were 463,000 head of beef cows in New Mexico as of January 1, 2021 (NASS, 2020), down roughly 4% from 2020 (NASS, 2019). Frequent drought often results in herd reduction and loss of valuable genetic progress. Bull selection is critical due to their influence on herd development. A survey was conducted to identify traits important to bull selection in New Mexico. Surveys were collected digitally (n = 83) and via the mail (n = 74). Responses were largely by cow/calf producers averaging 57 ± 1 years old with 24 ± 1 years' experience. Survey respondents represented 4,384,296 acres of private owned, private leased, and leased public rangeland and irrigated pasture meadow in New Mexico and surrounding states. Average cow/calf operation size was 294 ± 39 head and average bull herd size was 21 ± 3 head. Average price paid for a bull in the past 2 years was $3,981 ± 213. Physical characteristics, individual bull performance information, and genetic information are all important traits to New Mexico bull buyers; however, most producers (56%) indicated that structural soundness was the most important factor influencing their selection decisions. Amongst expected progeny differences (EPDs), New Mexico producers consider the calving ease direct (CED) and birth weight (BW) EPDS to be most important (40% and 35%, respectively). Producers also indicated that multitrait selection indexes used by the American Angus Association were important to their selection decisions, with the beef value ($B) and weaned calf value ($W) indexes being cited most often (35% and 31%, respectively). Elements important to bull purchase include the bull's sale preview (87%), body condition score (86%), feed efficiency/average daily gain information (85%), and actual scrotal circumference (82%). Following purchase of a new bull, most (60%) keep the bull separate from the cow herd until the following breeding season, while the remaining 40% of producers turn newly purchased bulls out within 30 days of purchase. Sixty eight percent of producers evaluate semen quality annually or prior to the start of the breeding season. Interestingly, 39% of producers indicated they used reproductive technologies like artificial insemination and synchronization of estrus while most (80%) test for trichomoniasis. The primary factor influencing culling decisions is age, followed by soundness and fertility.

Phosphorylation of zinc channel ZIP7 drives MAPK, PI3K and mTOR growth and proliferation signalling

Zinc is an essential trace element participating in diverse biological processes. Cellular zinc levels are strictly controlled by two families of transport proteins: ZIP channels (SLC39A) and ZnT transporters (SLC30A). ZIP channels increase cytosolic zinc levels by importing zinc into cells or releasing zinc from intracellular stores such as the ER. Among all the 14 human members of the ZIP family, ZIP7 is a gatekeeper of zinc release from intracellular stores, requiring post-translational activation by phosphorylation on residues S275 and S276, resulting in activation of multiple downstream pathways. Employing site-directed mutagenesis, we investigated the importance of these individual serine residues as well as other predicted phosphorylation sites on ZIP7, showing that all four sites are required for maximal ZIP7 activation. Using phosphor-protein arrays, we also discovered the major signalling pathways that were activated as a direct result of ZIP7-mediated zinc release from intracellular stores. These data reveal the role of ZIP7-mediated zinc release from intracellular stores in driving major pathways, such as MAPK, mTOR and PI3K-AKT, involved in providing cell survival and proliferation and often over activated in cancer.

Paediatric extracorporeal priming procedures: does low temperature priming promote histamine release?

We have recently reported pathologically elevated plasma histamine levels in adult patients undergoing cardiac surgery throughout the perioperative period. We have found markedly higher histamine levels in paediatric practice. The priming volume of the smallest extracorporeal systems is invariably greater than the circulating blood volume of neonates and infants, necessitating the use of stored donor blood in the initial priming procedure. In 40 paediatric cases, arbitrarily selected, sampling from the arterial port of the oxygenator prior to the initiation of bypass revealed massively elevated plasma histamine levels (>30ng/ml) in those extracorporeal circuits in which the priming volume was smallest and the priming temperature lowest - at 10-12°C. It is clear that the use of donor blood (in this series less than five days old) may contribute to the delivery of histamine into the paediatric patient's circulation at the onset of cardiopulmonary bypass and that the priming temperature may play a role.

Histamine release during cardiopulmonary bypass

Plasma histamine concentrations were measured in 15 adult patients undergoing open-heart surgery (coronary artery bypass grafting) and in three control patients undergoing major noncardiac surgery. Plasma histamine levels rose in both open-heart and control patients in the early phase of operation before the onset of cardiopulmonary bypass (CPB). In the open-heart patients, significant elevations in plasma histamine concentrations occurred in the first 30 minutes of CPB (p < 0.05) in spite of haemodilution (median 36%). Plasma histamine changed neither by the application of X-clamp nor by its removal. No significant differences were observed between pulsatile and nonpulsatile flow of bypass perfusion. Two of the three patients who required infusion of sodium nitroprusside had high concentrations of plasma histamine (over 2ng/ml) throughout the observation period. DC shock induced an immediate response in histamine release. In the immediate post-CPB period when spontaneous circulation was resumed, the open-heart surgery patients exhibited a second rapid rise in plasma histamine, significantly higher than in the control patients (p < 0.05) in whom elevation in plasma histamine levels was not seen in the postoperative period. One of the CPB patients with persistent high histamine in the postoperative period had severe bronchospasm. Thus, in patients undergoing open-heart surgery, histamine release occurs at the onset of CPB and soon after the discontinuation of CPB. H1 + H2 blockade may be indicated in those at risk from histamine-mediated responses or receiving sodium nitroprusside or DC shocks.

The effect of normothermic cardiopulmonary bypass on hepatic blood flow in the dog

Hepatic blood flow was investigated in two groups of eight anaesthetized dogs during and after one hour of either pulsatile or non-pulsatile cardiopulmonary bypass (CPB). Mean perfusion pressure was maintained at 60 mmHg. Hepatic arterial (HA) and portal venous (PV) blood flows were measured using electromagnetic flow probes, and hepatic O 2 consumption determined. The results demonstrate that: (a) pulsatile CPB reduces peripheral vascular resistance during and after perfusion, and more effectively preserves pump flow rate and cardiac output than non-pulsatile CPB; (b) total liver blood flow is sustained more effectively by pulsatile CPB than by non-pulsatile CPB due to relative preservation of both HA and PV flows; (c) hepatic O2 consumption is only marginally better preserved during and after pulsatile CPB than with non-pulsatile perfusion. We conclude that: (a) pulsatile CPB tends to maintain hepatic blood flow through a relative reduction in HA vascular resistance and an improvement in PV flow produced passively by a greater pump flow rate; (b) pulsatile CPB less effectively benefits hepatic O2 consumption because of poor O2 uptake from the hepatic PV blood supply.

Performance characteristics of a new arterial line filter

A new 40 micron polyester screen arterial line filter with integral automatic blood gas separator has been designed with the potential for improved removal characteristics for gas microbubbles and massive air. A simple in vitro evaluation has been carried out comparing the new filter (Pall EC+) against a standard widely-used reference arterial line filter (Pall EC 3840). The filters have been compared in terms of their haemodynamic performance, specifically pressure drop at incremental flow rates and haemolysis characteristics measuring generated plasma free haemoglobin. In addition, the relative abilities of the test and reference filters to remove gaseous microbubbles, and also to vent massive air introduced into the test circuits have been assessed using an ultrasound based microbubble detection system. The results of the studies indicate that the test and reference filters are identical in terms of haemodynamics, with maximal pressure drops of 30 mmHg at 4-5 litres mean flow rate. Neither filter is associated with significant haemolysis in bovine blood test circuits flowing at 4 I/min for 60 minutes. However, the EC+ filter has significantly superior performance over the reference EC 3840 filter in both microbubble removal and in removal of nitrogen gas introduced directly into the test circuit at up to 5 litres gas/min ( p < 0.01). The new EC+ filter appears to offer safety in terms of haemodynamics and haemolysis, while providing maximal protection against massive arterial gas embolism.

A double blind clinical trial of Iloprost during cardiopulmonary bypass

Twenty patients undergoing elective coronary surgery were randomized to receive either the prostacyclin analogue Iloprost (Zk 36374) 5 ng/kg/min for 30 minutes before cardiopulmonary bypass (CPB) increasing to 10 ng/kg/min during CPB, or placebo, to investigate any beneficial effect on platelet preservation, or protection of the central nervous system during clinical CPB. Originally 50 patients were to have entered the trial, but unacceptable hypotensive effects occu rred in five patients who received Iloprost, lead i ng to early data analysis. No significant improvement in platelet number, volume or function; bleeding time; arterial line filter δ dry weight; retinal microembolism; or neuropsychological function, attributable to Iloprost, could be identified. The role and optimal dose of Iloprost in clinical CPB remains to be established.

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review

WHAT IS KNOWN AND OBJECTIVE

Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life.

METHODS

A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified.

RESULTS

  Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed.

WHAT IS NEW AND CONCLUSION

Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review

WHAT IS KNOWN AND OBJECTIVE

Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life.

METHODS

A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified.

RESULTS

  Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed.

WHAT IS NEW AND CONCLUSION

Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.

The inflammatory effect of cardiopulmonary bypass on leukocyte extravasation in vivo

OBJECTIVE

Extravascular trafficking of leukocytes into organs is thought to play a major role in the pathophysiologic mechanisms of the inflammatory response to cardiopulmonary bypass, yet leukocyte extravasation is difficult to study clinically. Here we have tested the hypothesis that leukocyte emigration into skin blisters can provide a way to monitor the inflammatory effect of cardiopulmonary bypass that allows testing of anti-inflammatory interventions (exemplified by aprotinin).

METHODS

Patients undergoing primary elective coronary artery bypass grafting (n = 14) were randomized into 2 equal groups to receive saline infusion during cardiopulmonary bypass (control group) or high-dose aprotinin. Experimental skin blisters (in duplicate) were induced on the forearm by means of topical application of the vesicant cantharidin, and blister fluid was sampled at 5 hours postoperatively. Inflammatory leukocyte subsets in blister fluid were analyzed by means of flow cytometry by using expression of CD11b and CD62L as a phenotypic marker of activation.

RESULTS

In the control group of patients, cardiopulmonary bypass surgery triggered a 381% increase in leukocyte extravasation into the skin compared with reference blisters carried out before surgical intervention, with neutrophil (P = .014), monocyte (P = .014), and eosinophil (P = .009) levels all statistically significantly increased. In the aprotinin group there was no statistically significant increase during cardiopulmonary bypass surgery in any inflammatory leukocyte subset. The activation phenotype of extravascular leukocytes was not significantly altered between surgical groups.

CONCLUSIONS

This study introduces the cantharidin blister technique as a powerful new research tool for analyzing the inflammatory effect of cardiopulmonary bypass in vivo. It has provided detailed molecular insight into the extravascular leukocyte population during cardiopulmonary bypass. Although aprotinin blocked cardiopulmonary bypass-dependent extravasation of leukocytes, there was no change in their CD11b/CD62L activation status. The cantharidin skin test thus represents a novel research tool for evaluating future anti-inflammatory interventions in cardiothoracic surgery.

Dual targeting of Src and ER prevents acquired antihormone resistance in breast cancer cells

Acquired resistance to endocrine therapies presents a major obstacle to the successful treatment of breast cancer patients. Previously, we have shown that acquisition of resistance to tamoxifen in breast cancer cells is accompanied by an elevation in Src kinase activity which promotes an aggressive, invasive phenotype in vitro. Here, we have explored the potential therapeutic effects of combining Src inhibition with anti-oestrogen treatment on the development of endocrine insensitivity in breast cancer cells. Treatment of MCF7 and T47D cells with tamoxifen alone resulted in an initial growth inhibitory phase followed by the eventual development of tamoxifen resistance together with an elevation of Src kinase activity, which was central to their increased invasive capacity. Chronic exposure of both cell types to the Src inhibitor, AZD0530, as a monotherapy resulted in outgrowth of AZD0530-resistant cells, in which Src kinase activity remained suppressed as did their in vitro invasive nature. Treatment of both MCF7 and T47D cells with AZD0530 in combination with tamoxifen resulted in a reduction of Src activity together with inhibition of focal adhesion kinase phosphorylation and a complete abrogation of their in vitro invasive behaviour. Furthermore, combination therapy significantly suppressed expression of cyclinD1 and c-myc and prevented cell proliferation and the subsequent emergence of a resistant phenotype, with total cell loss occurring by 12 weeks. These data demonstrate that pharmacological targeting of Src kinase, in conjunction with antihormone therapies, effectively prevents antihormone resistance in breast cancer cells in vitro and suggests a potential novel therapeutic benefit of Src kinase inhibitors clinically.

Prospective audit of colonoscopy quality in Kent and Medway, UK

AIM

To compare the quality of colonoscopy in the Kent and Medway Strategic Health Authority with national standards and previous audits.

METHOD

A prospective 12-month audit of colonoscopy quality as assessed by number of procedures performed, total colonoscopy rates, sedation usage, and complications. Data were collected by 7 endoscopy units on 5905 colonoscopies performed by 62 colonoscopists. The endoscopy unit nurses, as opposed to the colonoscopists, verified that colonoscopy was total.

RESULTS

Seven doctors stopped performing colonoscopy during the study period. Thirty-nine of 55 colonoscopists (71 %) achieved total colonoscopy in at least 90 % of cases; 12 (22 %) completed colonoscopy in 80 - 89 % of their cases and 4 (7 %) in 79 % or less of their cases. Seventy-nine percent of colonoscopists used sedation in accordance with British Society of Gastroenterology (BSG) guidelines. Only 22 of 55 (40 %) of colonoscopists performed more than 100 colonoscopies during the 12-month audit period. Reported complications were below expected levels.

CONCLUSION

In our study almost one-third of colonoscopists did not achieve colonoscopy completion rates of at least 90%, and less than half performed more than 100 colonoscopies during the 12 month study. Adherence to quality standards appears to be inadequate.

Influence of socioeconomic status on survival after primary aortic or mitral valve replacement

OBJECTIVES

We sought to evaluate whether socioeconomic status influences outcome after first-time single aortic or mitral valve replacement.

SETTING

National Heart Valve registry.

DESIGN AND PATIENTS

Between 1 January 1986 and 31 December 2001, 51 844 consecutive patients who underwent primary aortic or mitral valve replacement were registered on the United Kingdom (UK) Heart Valve Registry. Data included age, gender, valve position, type of valve implant, postcode, follow-up time, date and cause of death. The Carstairs deprivation score (1991 Census data for the UK) was used to stratify cases by level of social deprivation according to postcodes.

RESULTS

Both 30-day and 1-year survival/mortality rates were similar across all socioeconomic levels. However, long-term survival rate (up to 15 years) was significantly higher in the least deprived socioeconomic level than in the two most deprived levels. There was an 18% lower survival rate amongst women in the most deprived levels (35.9%, 95% CI: 32.4 to 39.4) versus the least deprived level (43.7%, 95% CI: 38.1 to 49.2, p<0.004). In men, survival in the most deprived levels (39.5%, 95% CI: 36.4 to 42.5) was 7% lower than in the least deprived level (42.7%, 95% CI: 37.7 to 47.7, p<0.005). Biological valve, mitral position, female gender, and low socioeconomic status were all associated with long-term mortality.

CONCLUSIONS

A disadvantaged social background has a negative influence on long-term survival after aortic or mitral valve replacement, especially among women.

Growth factor signalling in endocrine and anti-growth factor resistant breast cancer

Growth factors provide powerful mitogenic and survival signals to breast cancer cells and it is therefore not surprising that they are able to subvert inhibitory responses to anti-hormonal drugs. In this review we discuss several mechanisms by which this may be achieved and expand our observations to encompass recently emerging anti-growth factor treatments. The information presented is underpinned by inhibitor studies that show the targeting of such mechanisms in advance of anti-hormone or anti-growth factor resistance development is able to substantially delay this event, thus pointing the way forward to intelligent combination therapies relevant to the future management of breast cancer.

Aprotinin and the protease-activated receptor 1 thrombin receptor: antithrombosis, inflammation, and stroke reduction

Cardiopulmonary bypass, although remaining an indispensable asset in cardiac surgery, especially in more complex and repeat operations, is associated with significant thrombin generation in the bypass circuit, leading to the activation of platelets, the coagulation system, an inflammatory response, and perioperative stroke. Recent clinical studies and meta-analyses of clinical trials in coronary artery bypass grafting surgery have confirmed that aprotinin not only reduces transfusion requirements in cardiac surgery but also confers significant protection against platelet dysfunction, activation of the systemic inflammatory response, and perioperative stroke when administered at the full (or "Hammersmith") dose. This article reviews research from several independent groups to propose a novel mechanism through which the antithrombotic, anti-inflammatory, and neuroprotective mechanism might be mediated, via protection of the high-affinity thrombin receptor protease-activated receptor 1 (PAR1).

Inhibition of complement activation by pexelizumab reduces death in patients undergoing combined aortic valve replacement and coronary artery bypass surgery

OBJECTIVE

We sought to evaluate the effects of pexelizumab, a C5 complement inhibitor, on death and myocardial infarction in patients undergoing combined aortic valve replacement and coronary artery bypass grafting surgery.

METHODS

The Pexelizumab for Reduction in Myocardial Infarction and Mortality in Coronary Artery Bypass Graft surgery trial, a phase III prospective, randomized, double-blind, placebo-controlled study, enrolled 3099 patients at 205 centers. The primary end point was the composite of death, myocardial infarction, or both at postoperative day 30 in patients undergoing coronary artery bypass grafting without valve surgery. Postoperative myocardial infarction was defined as a creatine kinase MB fraction value of 100 ng/mL or greater, Q-wave myocardial infarction with a creatine kinase MB fraction value of 70 ng/mL or greater, or new Q-wave evidence of myocardial infarction by postoperative day 30. Because patients undergoing coronary artery bypass grafting with a valve procedure were not included in the primary population, separate analysis of death and myocardial infarction was conducted in 218 patients undergoing combined aortic valve replacement and coronary artery bypass grafting surgery.

RESULTS

Of the 353 patients randomized to any valve procedure, 106 (61%) underwent combined aortic valve replacement and coronary artery bypass grafting in the pexelizumab treatment group compared with 112 (63%) patients in the placebo group. Coronary artery bypass grafting was performed with 1 or more internal thoracic artery grafts in 139 (64%) patients and with 1 or more saphenous vein grafts in 179 (82%) patients. There were 4 (3.8%) deaths in the pexelizumab group versus 11 (9.9%) in the placebo group by postoperative day 30 and 6 (5.7%) deaths in the active group versus 16 (14.4%) in the placebo group by postoperative day 180 (P =.107 and P =.043, respectively, Fisher exact test). The incidence of myocardial infarction 30 days after surgical intervention was identical in the 2 groups, but the study was not designed to detect differences in this cohort of patients.

CONCLUSIONS

Inhibition of complement activation by pexelizumab resulted in a decreased mortality at 180 days among 218 patients who underwent combined aortic valve replacement and coronary artery bypass grafting surgery. Additional studies are warranted to confirm this decrease in mortality with pexelizumab in combined aortic valve replacement and coronary artery bypass grafting procedures.

Development of strategies for the use of anti-growth factor treatments

Aberrant signalling through the epidermal growth factor receptor (EGFR) is associated with increased cancer cell proliferation, reduced apoptosis, invasion and angiogenesis. Over-expression of the EGFR is seen in a variety of tumours and is a rational target for antitumour strategies. Among the classes of agent targeting the EGFR are small-molecule inhibitors, which include gefitinib (IRESSA), which acts by preventing EGFR phosphorylation and downstream signal transduction. De novo and acquired resistance, however, have been reported to gefitinib and here we describe evidence which indicates that the type II receptor tyrosine kinases (RTKs) insulin-like growth factor-I receptor (IGF-IR) and/or insulin receptor (InsR) play important roles in the mediation of responses to gefitinib in the de novo- and acquired-resistance phenotypes in several cancer types. Moreover, combination strategies that additionally target the IGF-IR/InsR can enhance the antitumour effects of gefitinib.

Interferon-alpha-2b and oral cytarabine ocfosfate for newly diagnosed chronic myeloid leukaemia

BACKGROUND

Treatment with interferon and subcutaneous cytarabine produces superior cytogenetic responses in chronic myeloid leukaemia (CML) than treatment with interferon alone, but at the expense of greater toxicity. Cytarabine ocfosfate (YNK01) is an oral precursor of cytarabine that may overcome some of the inconvenience and toxicities associated with subcutaneous cytarabine administration.

PATIENTS AND METHODS

We studied the efficacy and tolerability of combination therapy with interferon-alpha-2b and YNK01 in patients with newly diagnosed, untreated CML. Forty patients were treated with interferon-alpha-2b (5 MU/m2/day) plus monthly courses of YNK01 (600 mg/day for 10 days) for 1 year.

RESULTS

The 6-month complete haematological response rate was 63% and the 1-year major cytogenetic response rate was 30%, with 10% of cytogenetic responses being complete. With a median follow-up of 57 months, the estimated 5-year overall survival was 86% (95% confidence interval 70% to 94%). Treatment tolerability was poor, with toxicity leading to discontinuation of one or both drugs in 60% of cases. The median daily dose of interferon alpha-2b was 7.75 MU and the median dose of YNK01 was 600 mg/day for each 10-day treatment cycle.

CONCLUSIONS

Interferon-alpha-2b and YNK01 produce cytogenetic responses comparable to those achieved with interferon-alpha-2b and parenteral cytarabine, although toxicity was excessive. Alternate dosing strategies may enhance the tolerability of YNK01.

The systemic inflammatory response syndrome and cardiopulmonary bypass

Cardiac surgery using cardiopulmonary bypass (CPB) provokes a systemic inflammatory response. This is mainly triggered by contact activation of blood by artificial surfaces of the extracorporeal circuit. Although often remaining sub-clinical and resolving promptly at the end of CPB, in its most extreme form this inflammatory response may be associated with the development of the systemic inflammatory response syndrome (SIRS) that can often lead to major organ dysfunction (MODs) and death. Here, we review the pathophysiology behind the development of this "whole body" inflammatory response and some of the methods currently used to minimise it.

Structure-function analysis of a novel member of the LIV-1 subfamily of zinc transporters, ZIP14

Here, we report the first investigation of a novel member of the LZT (LIV-1 subfamily of ZIP zinc Transporters) subfamily of zinc influx transporters. LZT subfamily sequences all contain a unique and highly conserved metalloprotease motif (HEXPHEXGD) in transmembrane domain V with both histidine residues essential for zinc transport by ZIP (Zrt-, Irt-like Proteins) transporters. We investigate here whether ZIP14 (SLC39A14), lacking the initial histidine in this motif, is still able to transport zinc. We demonstrate that this plasma membrane located glycosylated protein functions as a zinc influx transporter in a temperature-dependant manner.