Identification of occult brain metastases amenable to stereotactic radiosurgery by motexafin gadolinium (MGd) based treatment planning MRI: Results of a phase II trial of MGd and whole brain radiotherapy (WBRT) with stereotactic radiosurgery (SRS)

2037

Background: Motexafin gadolinium (MGd) is a novel anti-cancer agent that selectively localizes in tumors and is detectable by MRI. Previous studies of patients (pts) with brain metastases (BM) demonstrated the detection of occult lesions after MGd administration not visible with gadolinium MRI contrast. The purpose of this study was to evaluate if MRI scanning after MGd improves SRS treatment-planning and treatment outcome by identifying and better defining lesions that can be treated with the SRS boost. Methods: Pts with 1–4 BM (< 4 cm diameter, or, if multiple, < 3cm) received WBRT (37.5 Gy) and MGd, 5 mg/kg/day during weeks 2–3 of WBRT, plus MGd, 5 mg/kg prior to treatment planning MRI and prior to SRS (21 Gy for lesions = 2 cm, 18 Gy for lesions 2.1–3.0 cm, and 15 Gy for lesions 3.1–4.0 cm). MRI was obtained within 4 weeks prior to enrollment with standard contrast, and after WBRT for SRS treatment planning with MGd and standard contrast. Patients were followed for neurologic progression and survival. Results: 45 patients with either lung cancer (76%), breast cancer (11%), melanoma (7%), or other cancers (7%), a median age of 58 years (range 42–74), and a median of 2 BM (range 1–4) were evaluable. In 9 of 42 patients (21%) with MRI data available, the MGd-based treatment planning MRI demonstrated at least one occult lesion not visualized on the screening MRI. The MGd-based treatment planning MRI detected 1 occult lesion in 6 pts, 2 occult lesions in 1 patient, and 3 occult lesions in 2 patients. Median survival for evaluable pts is 10 months; median time to neurologic progression or radiologic progresssion is not reached at 15 months. Grade 3+ neurotoxicity was limited to 1 pt with tumor necrosis and 1 pt with motor weakness. Most common Grade 3+ adverse events were pneumonia (9%) and DVT (9%). Conclusions: MGd-based treatment planning MRI for SRS identified occult BM that are amenable to SRS and are undetected with standard gadolinium contrast agents in 21% of the pts enrolled in this phase II trial. Treatment with MGd, WBRT and SRS to all lesions visualized resulted in improved survival and local control compared with historical results.

[Table: see text]

[Planning and assessing the activity of a school health service based on health and social indicators: the experience of Villeurbanne]

In 1998, the municipality of Villeurbanne decided to review its school health service in order to restructure and adjust its activity to better meet the needs of schools which had evolved and developed differently according to their areas of location. In view of the rarity of available information to measure the needs, an information system was built using a participatory and consensual approach. The system has been operational since the year 2000. It was evaluated in 2003 and then adapted according to the results. It has a variety of uses for planning purposes: to classify the schools according to their requirements, to plan the working time and schedules of the nurses, and to programme and evaluate specific actions. It also allows for mapping the health status of the pupils in Villeurbanne and to describe the service's activity. This article presents the design and construction of the information system and serves as a platform to debate the benefits and limitations of this approach in Villeurbanne.

Cumulative Illness Rating Scale was a reliable and valid index in a family practice context

BACKGROUND AND OBJECTIVE

The goal of this study was to validate an instrument measuring the clinical burden of several medical problems in the same patient (multimorbidity), in a family practice context and, more specifically, to verify if trained nurses can score the Cumulative Illness Rating Scale (CIRS) from chart review.

STUDY DESIGN AND SETTING

A convenience sample of 40 patients was selected. The attending physicians scored the CIRS during clinical interview (CIRS-MD/I), then three nurses scored the CIRS during clinical interview (CIRS-NUR/I) and three other nurses scored the CIRS from chart review (CIRS-NUR/C) (interrater reliability). Two of these nurses scored the CIRS-NUR/C again 2 months later (intrarater reliability).

RESULTS

For interrater reliability, the intraclass correlation coefficients were 0.81 (0.70-0.89) for the CIRS-NUR/I and 0.78 (0.66-0.87) for the CIRS-NUR/C. The intrarater reliability of the CIRS-NUR/C was 0.89 (0.80-0.94) for one of the nurses and 0.80 (0.65-0.89) for the other. Concomitant validity of these two forms of CIRS with the CIRS-MD/I ranged from 0.73 to 0.84.

CONCLUSION

The CIRS appears to be a reliable and valid instrument in a primary care context and trained nurses can score the CIRS from chart review.

An approach to the development of hearing standards for hearing-critical jobs

Many jobs at the Department of Fisheries and Oceans Canada (DFO) have several features in common: they are often performed in noisy environments and involve a number of auditory skills and abilities, such as speech communication, sound localization, and sound detection. If an individual lacks these skills and abilities, it may constitute a safety risk for this individual, as well as for fellow workers and the general public. A number of scientific models have been developed to predict performance on these auditory skills based on diagnostic measures of hearing such as pure-tone audiograms. While these models have significant scientific and research value, they are unable to provide accurate predictions of real life performance on auditory skills necessary to perform hearing-critical jobs. An alternative and more accurate approach has been developed in this research project. A direct measure of functional speech perception in noise (Hearing in Noise Test: HINT) has been identified and validated for use in screening applicants for hearing-critical jobs in DFO. This screening tool has adequate and well-defined psychometric properties (e.g. reliability, sensitivity, and validity) so that screening test results can be used to predict an individual's ability to perform critical auditory skills in noisy environments, with a known degree of prediction error. Important issues must be considered when setting screening criteria. First, the concept of hearing-critical tasks must be reviewed, since these tasks are often performed in high noise levels where normally-hearing people cannot hear adequately. Second, noise-induced hearing loss is frequent in these noisy environments, and workers who acquire a hearing loss might not continue to meet the minimal auditory screening criteria throughout their career. Other senses (e.g., vision, touch) also play an important role in these environments. Third, adaptation strategies have to be considered when recruits or incumbents fail the screening test.

[Fertility goals among students at the University of Sherbrooke]

This paper describes intentions in the matters of fertility expressed by 900 first-year students surveyed at the University of Sherbrooke in Canada. The study seeks to ascertain links between certain attitudes, perceptions, or personal situations and the desired number of children. The desired number of children is shown to be strongly influenced by attitudes regarding marriage and by the importance placed on family life. Other variables which also have a significant impact on projected lifetime fertility, albeit to a lesser degree, include: the perception of the role of housewives, the importance granted to the stability of family income, and the number of siblings among members of the surveyed group. However, one surprising result is that the average desired number of children is 2.45. Given the high level of education of the sample, this appears to be quite a high figure.

Temperature and food quality effects on growth, consumption and post-ingestive utilization efficiencies of the forest tent caterpillar Malacosoma disstria (Lepidoptera: Lasiocampidae)

Temperature and food quality can both influence growth rates, consumption rates, utilization efficiencies and developmental time of herbivorous insects. Gravimetric analyses were conducted during two consecutive years to assess the effects of temperature and food quality on fourth instar larvae of the forest tent caterpillar Malacosoma disstria Hübner. Larvae were reared in the laboratory at three different temperatures (18, 24 and 30 degrees C) and on two types of diet; leaves of sugar maple trees Acer saccharum Marsh. located at the forest edge (sun-exposed leaves) or within the forest interior (shade-exposed leaves). In general, larvae reared at 18 degrees C had lower growth rates and lower consumption rates than larvae reared at the warmer temperatures (24 and 30 degrees C). Moreover, the duration of the instar decreased significantly with increasing temperatures. Type of diet also affected the growth rates and amount of food ingested by larvae but did not affect the duration of the instar. Larvae fed sun-exposed leaves consumed more food and gained higher biomasses. Values of approximate digestibility and efficiency of conversion of ingested food were also higher when larvae were fed sun-exposed leaves. Higher growth rates with increasing temperatures were primarily the result of the shorter stadium duration. The higher growth rates of larvae fed sun-exposed leaves were possibly the result of stimulatory feeding and consequently greater food intake and also a more efficient use of food ingested. This study suggests that the performance of M. disstria caterpillars could be enhanced by warmer temperatures and higher leaf quality.

Detection of a decrease in green fluorescent protein fluorescence for the monitoring of cell death: an assay amenable to high-throughput screening technologies

BACKGROUND

Reliable assessment of cell death is now pivotal to many research programs aiming at generating new anti-tumor compounds or at screening cDNA libraries. Such approaches need to rely on reproducible, easy-to-handle, and rapid microplate-based cytotoxicity assays that are amenable to high-throughput screening (HTS) technologies. We describe a method for the direct measurement of cell death, based on the detection of a decrease in fluorescence observed following death induction in cells expressing enhanced green fluorescent protein (EGFP).

METHODS

Cell death was induced by a variety of apoptotic stimuli in various EGFP-expressing mammalian cell lines, including those routinely used in anti-cancer drug screening. Decrease in fluorescence was assessed either by flow cytometry (and compared with other apoptotic markers) or by a fluorescence microplate reader.

RESULTS

Cells expressing EGFP exhibited a decrease in fluorescence when treated by various agents, such as chemotherapeutic drugs, UV irradiation, or caspase-independent cell death inducers. Kinetics and sensitivity of this EGFP-based assay were comparable to those of traditional apoptosis markers such as annexin-V binding, propidium iodide incorporation, or reactive oxygen species production. We also show that the decrease in EGFP fluorescence is directly quantifiable in a fluorescence-based microplate assay. Furthermore, analysis of EGFP protein content in cells undergoing cell death demonstrates that the decrease in fluorescence does not arise from degradation of the protein.

CONCLUSIONS

This novel GFP-based microplate assay combines sensitivity and rapidity, is easily amenable to HTS setups, making it an assay of choice for cytotoxicity evaluation.

Derivatives of monoglycerides as apoptotic agents in T-cells

Recently, lipids have received considerable attention for their potential to induce apoptosis when added exogenously to cells. In this study, we directly demonstrate that murine T-cells undergo rapid apoptosis following treatment with various forms of monoglycerides, which are a family of naturally occurring lipids consisting of a single fatty acid moiety attached to a glycerol backbone. The potency of these lipids varied depending on their chemical structure, whereas glycerol backbone or corresponding fatty acids alone were ineffective. Moreover, monoglyceride-mediated apoptosis was suppressed either by Bcl-2 overexpression, treatment with a broad inhibitor of caspases, or RNA and protein synthesis inhibitors. In addition, treatment of cells with derivatives of monoglycerides induced a calcium flux, which could be inhibited by both extracellular (EGTA) or intracellular (EGTA-AM) calcium chelators. To our knowledge, this is the first report demonstrating a role for derivatives of monoglycerides as inducers of apoptosis in mammalian cells.

Salmonella Give infection in 2 dairy herds

Salmonella Give infection was investigated in 2 adjacent dairy herds because of the impact of milk contamination on public health. Once the status of the infection in a herd was established by fecal analyses, consecutive fecal testings, in conjunction with preventive measures, appeared to be consistent and cost-effective tools for the monitoring and control of salmonellosis in dairy herds.

The osteoblastic phenotype in calcium-depleted and calcium-repleted rats: a structural and histomorphometric study

In a previous report we showed that young rats fed a calcium-free diet for 28 days developed severe hypocalcaemia and showed a significant increase in serum alkaline phosphatase activity. The main histological and cytochemical changes exhibited by these animals in bone of the metaphyseal primary spongiosa were: (1) hyperplasia of osteoblasts, (2) an increase in the frequency of tartrate-resistant acid phosphatase (TRAP)-positive osteoblasts apposed to osteoid, and (3) an excessive amount of osteoid tissue. In addition to typical osteoblasts, there was a subpopulation of osteoblast-like cells with coated pits, lysosome-like bodies and large cytoplasmic processes. In the present study, we investigated how the above parameters change when calcium-depleted rats are placed on a normal diet for 7 days. Such a regimen normalized calcium concentration and alkaline phosphatase activity in the serum. The osteoid thickness returned to normal and, in some areas, was fully calcified. Most osteoblasts no longer showed TRAP activity and their ultrastructure was similar to that found in controls. Despite an intense alkaline phosphatase activity, some of them still exhibited a number of macrophagic characteristics. They were TRAP-positive, and showed electron-dense bodies in the cytoplasm facing bone, an abundance of coated pits, calcified spicules impinging on the cell membrane and large processes extending into the mineralized matrix. We concluded that calcium deficiency causes hyperplasia of osteoblasts in primary spongiosa and an increase in expression of TRAP. It also induces changes in their phenotype characterized by the acquisition of macrophagic cellular features. While TRAP activity is normalized by calcium repletion, macrophagic characteristics persist. These results suggest that the osteoblast can modulate its phenotype according to its physiological status.

[Post-traumatic stress disorder. After the flood in Saguenay]

OBJECTIVE

To measure the prevalence of posttraumatic stress disorder and emotional distress among victims of the Saguenay flood compared with those who were not affected by the flood.

DESIGN

Cross-sectional study using a telephone survey of victims and a control group.

SETTING

Chicoutimi, Que.

PARTICIPANTS

Sixty-two adults in a flooded area and a control group of 79 volunteers chosen randomly from an adjacent area.

MAIN OUTCOME MEASURES

Diagnostic criteria for posttraumatic stress disorder measured using the Post-traumatic Stress Disorder Reaction Index and high scores on the Self-Reporting Questionnaire on emotional distress.

RESULTS

Socially and demographically, study group and control group were comparable. Prevalence of posttraumatic stress disorder in the study group was close to 20% (odds ratio [OR] 6.08; 95% confidence interval [CI] 1.63 to 22.64). Prevalence of emotional distress in the study group was 29% (OR 2.42; 95% CI 1.04 to 5.61).

CONCLUSION

The Saguenay flood caused psychological distress that was measurable 4 months later. Health care professionals should be aware of the psychological effects of natural disasters.

Potent nonpeptide endothelin antagonists: synthesis and structure-activity relationships of pyrazole-5-carboxylic acids

We have previously reported the identification of pyrazole-5-carboxylic acids as a new class of endothelin antagonists from low affinity pyrazol-5-ol ligands, which were obtained by random screening assays. We describe herein the synthesis and the structure activity relationships (SARs) of these pyrazole-5-carboxylic acids with potent ET(A) selective, mixed ET(A)/ET(B) or moderately ET(B) selective antagonist activities.

1,3-Disubstituted-2-carboxy quinolones: highly potent and selective endothelin A receptor antagonists

The design, synthesis, and in vitro biological activity of a series of 2-carboxy quinolone antagonists selective for the endothelin A receptor are presented. Introduction of a second acid group in position 3 of the quinolone ring increases dramatically the selectivity for ET(A).

Nonpeptide endothelin antagonists: from lower affinity pyrazol-5-ols to higher affinity pyrazole-5-carboxylic acids

Random screening of compounds in endothelin receptor (ET(A) and ET(B)) binding assays led to the discovery of a new class of pyrazol-5-ol ligands. Characterization of structural features crucial for binding activities of these pyrazol-5-ols, by structure activity-relationship (SAR) studies, allowed us to design a novel class of pyrazole-5-carboxylic acids as more potent ET antagonists.

EMG and kinematics of normal subjects performing trunk flexion/extensions freely in space

Ten normal subjects performed continuous trunk flexion/extensions (F/E) without any restraining apparatus at free, 3, 2.25 and 1.5 s periods and a fatiguing task of F/E at 1.5 s period during 45 s. Kinematics of the trunk was obtained with bilateral electromyographic (EMG) activity of the erector spinae (three levels), the abdominal oblique muscles and the rectus abdominis muscles. The free period chosen by the subjects was found to vary between 3.05 and 1.47 s. Lateral flexion of the spine was similar in each task but rotation about its longitudinal axis increased as the F/E period shortened. When left and right side EMG signals were grouped by level of recording, a significant difference in activity was found. Subjects who produced the slowest free F/E displayed larger fatigue indexes derived from the EMG signals for some of their back muscles than for other subjects. The flexion/relaxation phenomenon was considered present in a muscle if a level <10% of the maximum signal recorded during extension was detected. The phenomenon was found in >50% of the observations and occurred at a similar angle in each task. Kinematics and several characteristics of the EMG signals of the trunk were statistically independent of the speed of motion.

Unconfined compression of articular cartilage: nonlinear behavior and comparison with a fibril-reinforced biphasic model

Mechanical behavior of articular cartilage was characterized in unconfined compression to delineate regimes of linear and nonlinear behavior, to investigate the ability of a fibril-reinforced biphasic model to describe measurements, and to test the prediction of biphasic and poroelastic models that tissue dimensions alter tissue stiffness through a specific scaling law for time and frequency. Disks of full-thickness adult articular cartilage from bovine humeral heads were subjected to successive applications of small-amplitude ramp compressions cumulating to a 10 percent compression offset where a series of sinusoidal and ramp compression and ramp release displacements were superposed. We found all equilibrium behavior (up to 10 percent axial compression offset) to be linear, while most nonequilibrium behavior was nonlinear, with the exception of small-amplitude ramp compressions applied from the same compression offset. Observed nonlinear behavior included compression-offset-dependent stiffening of the transient response to ramp compression, nonlinear maintenance of compressive stress during release from a prescribed offset, and a nonlinear reduction in dynamic stiffness with increasing amplitudes of sinusoidal compression. The fibril-reinforced biphasic model was able to describe stress relaxation response to ramp compression, including the high ratio of peak to equilibrium load. However, compression offset-dependent stiffening appeared to suggest strain-dependent parameters involving strain-dependent fibril network stiffness and strain-dependent hydraulic permeability. Finally, testing of disks of different diameters and rescaling of the frequency according to the rule prescribed by current biphasic and poroelastic models (rescaling with respect to the sample's radius squared) reasonably confirmed the validity of that scaling rule. The overall results of this study support several aspects of current theoretical models of articular cartilage mechanical behavior, motivate further experimental characterization, and suggest the inclusion of specific nonlinear behaviors to models.

[Psychological and physical health of the July 1996 disaster victims: A comparative study between victims and non-victims.]

In July 1996, the Saguenay-Lac-St-Jean region suffered one of the greatest natural disasters in Québec's history. This article presents results of a study aiming at comparing, two years after the flood, the physical and psychological health condition of victims (n=177) to that of non-victims (n=168). The results indicate that victims, - regardless of their gender - present a psychological well-being as well as a post-disaster physical health that is different from non-victims. Disaster victims are much more numerous than non-victims in considering that their health is bad or average and in witnessing new health problems or the exacerbation of existing problems. Victims also present more manifestations of prosttraumatic stress and somatic complaints, have higher levels of depression, anxiety and social dysfunction than non-victims. However, no significant difference between subjects was revealed concerning severe depression. Results obtained corroborated that of other studies. After a natural or technological disaster involving important material damages to individual belongings, victims are more affected than non-victims concerning their psychological and physical health.

Surface antigen detection with non-fluorescent, antibody-coated microbeads: an alternative method compatible with conventional fluorochrome-based labeling

BACKGROUND

Our goal was to devise a new labeling technique allowing the flow cytometric detection of an additional cell surface marker without the need for a supplementary fluorochrome.

METHODS

Non-fluorescent polystyrene latex microbeads (0.1 or 0.5 microm in diameter) were coated with monoclonal antibodies (mAbs) by adsorption. Upon binding to their specific antigen on the surface of the cell, mAb-coated beads induced a dramatic shift in the side scatter channel (SSC), resulting in a well-defined cell population.

RESULTS

We show that expression of CD4 on murine peripheral lymphocytes, labeled with anti-CD4 mAb-coated beads, can be readily detected through an amplification of the SSC signal. Simultaneous labeling of lymphocytes with phycoerythrin- (PE)-conjugated anti-CD4 mAb and anti-CD4 mAb-coated beads, showed that all PE+ cells were SSChigh, thus establishing the specificity of the technique. Hence, we have demonstrated that staining with mAb-coated beads could be combined to conventional labeling methods with fluorochrome-conjugated mAbs. Using a standard 488 nm single laser cytometer, we have performed a five-parameter analysis, simultaneously detecting fluorescein isothiocyanate (FITC), PE, RED670 and RED613, in combination with SSC signal modulation induced by mAb-coated beads. Moreover, we have shown that beads coated with mAbs directed against various antigens (CD45R, Mac-1, and TCRbeta) can be used on various tissues, namely lymph nodes, spleen, or bone marrow.

CONCLUSIONS

mAb-coated latex beads can therefore easily be used as an additional surface label, and provide a simple and reliable mean to upgrade the analysis capabilities of standard flow cytometry units.