Pacritinib is a potent ACVR1 inhibitor with significant anemia benefit in patients with myelofibrosis

In patients with cytopenic myelofibrosis, treatment with the JAK2/IRAK1 inhibitor pacritinib was associated with anemia benefit in the phase 3 PERSIST-2 study. The impact of pacritinib on transfusion independence (TI) has not been previously described, nor has the mechanism by which pacritinib improves anemia been elucidated. Because it has been previously postulated that inhibition of activin A receptor, type 1 (ACVR1)/activin receptor-like kinase-2 improves anemia in patients with myelofibrosis via suppression of hepcidin production, we assessed the relative inhibitory potency of pacritinib compared with other JAK2 inhibitors against ACVR1. Pacritinib inhibited ACVR1 with greater potency (half-maximal inhibitory concentration [IC50] = 16.7 nM; Cmax:IC50 = 12.7) than momelotinib (IC50 = 52.5 nM; Cmax:IC50 = 3.2), fedratinib (IC50 = 273 nM; Cmax:IC50 = 1.0), or ruxolitinib (IC50 > 1000; Cmax:IC50 < 0.01). Pacritinib's inhibitory activity against ACVR1 was corroborated via inhibition of downstream SMAD signaling in conjunction with marked suppression of hepcidin production. Among patients on PERSIST-2 who were not transfusion independent at baseline based on Gale criteria, a significantly greater proportion achieved TI on pacritinib compared with those treated on best available therapy (37% vs 7%, P = .001), and significantly more had a ≥50% reduction in transfusion burden (49% vs 9%, P < .0001). These data indicate that the anemia benefit of the JAK2/IRAK1 inhibitor pacritinib may be a function of potent ACVR1 inhibition.

Retrospective analysis of pacritinib in patients with myelofibrosis and severe thrombocytopenia

Thrombocytopenia is common in patients with myelofibrosis and is a well-established adverse prognostic factor. Both of the approved Janus kinase (JAK) inhibitors, ruxolitinib and fedratinib, can worsen thrombocytopenia and have not been evaluated in patients with severe thrombocytopenia (.

Determining the recommended dose of pacritinib: results from the PAC203 dose-finding trial in advanced myelofibrosis

PAC203 is a randomized dose-finding study of pacritinib, an oral JAK2/IRAK1 inhibitor, in patients with advanced myelofibrosis who are intolerant of or resistant to ruxolitinib. Patients were randomized 1:1:1 to pacritinib 100 mg once per day, 100 mg twice per day, or 200 mg twice per day. Enhanced eligibility criteria, monitoring, and dose modifications were implemented to mitigate risk of cardiac and hemorrhagic events. Efficacy was based on ≥35% spleen volume response (SVR) and ≥50% reduction in the 7-component total symptom score (TSS) through week 24. Of 161 patients, 73% were intolerant of and 76% had become resistant to ruxolitinib; 50% met criteria for both. Severe thrombocytopenia (platelet count <50 × 103/μL) was present in 44%. SVR rates were highest with 200 mg twice per day (100 mg once per day, 0%; 100 mg twice per day, 1.8%; 200 mg twice per day, 9.3%), particularly among patients with baseline platelet counts <50 × 103/μL (17%; 4 of 24). Although TSS response rate was similar across doses (100 mg once per day, 7.7%; 100 mg twice per day, 7.3%; 200 mg twice per day, 7.4%), median percent reduction in TSS suggested a dose-response relationship (-3%, -16%, and -27%, respectively). Pharmacokinetic and pharmacodynamic modeling based on all available data showed greatest SVR and TSS reduction at 200 mg twice per day compared with lower doses. Common adverse events were gastrointestinal events, thrombocytopenia, and anemia. There was no excess of grade ≥3 hemorrhagic or cardiac events at 200 mg twice per day. Pacritinib 200 mg twice per day demonstrated clinical activity and an acceptable safety profile and was selected as the recommended dose for a pivotal phase 3 study in patients with myelofibrosis and severe thrombocytopenia. This trial was registered at www.clinicaltrials.gov as #NCT03165734.

Abstract C198: PDK1 inhibitors SNS-229 and SNS-510 cause pathway modulation, apoptosis and tumor regression in hematologic cancer models in addition to solid tumors

Background and purpose: Phosphatidyl-inositol (PI) dependent kinase 1, PDK1, is a master kinase that activates kinases important in cell growth and survival including members of the AKT, PKC, RSK and SGK families. PDK1 can interact with its substrates through PI-dependent (PH-mediated) or PI-independent (PIF-mediated) mechanisms. Here we report characterization of two potent PDK1 kinase inhibitors, SNS-229 and SNS-510, that block both PI-dependent and PI-independent substrate phosphorylation and have broad anti-tumor activity in hematologic cancers. Methods and results: SNS-229 and SNS-510 belong to a series of novel PDK1 inhibitors that bind the inactive conformation of PDK1 as determined by X-ray crystallography. The compounds bind deep in the adaptive pocket, distorting the N-terminal domain and perturbing the PIF-pocket, thereby affecting PI-independent substrate binding. SNS-510 was evaluated in more than 20 cell lines derived from hematologic cancers including AML, MM, DLBCL, and MCL and showed strong anti-proliferative activity with EC50s ranging from 3 nM to 900 nM, with particularly strong activity observed in the AML cell lines Molm-13 and MV4-11 (EC50 3 and 7 nM), the DLBCL cell line U-2932 (EC50 56 nM) and the MM cell lines U-266 and RPMI-8226 (EC50 130 and 163 nM). Anti-proliferative activity correlated with pathway modulation as assessed by inhibition of phosphorylation of PDK1, RSK, and AKT. Interestingly, inhibition of PDK1 phosphorylation was time-dependent showing 2 to 5-fold more inhibition after 24 hours than at 4 hours. In addition, SNS-510 produced substantial apoptosis after 24 hours. SNS-510 was compared to the PDK1 inhibitor GSK2334470, showing comparable biochemical potency. However, SNS-510 was 10 to 30 fold more potent at inhibiting PDK1 and RSK phosphorylation in all cell lines tested. SNS-510 was at least 10-fold more potent than GSK2334470 in 72 hour viability assays. In mice, SNS-229 and SNS-510 showed good oral bioavailability (%F&gt;40%) with a Tmax of 4 to 8 hours and prolonged exposure. Pathway modulation was evaluated in vivo in a MV4-11 xenograft mouse model. Potent, dose-dependent pathway modulation was observed at 4 and 24 hours after a single oral dose of SNS-229 and SNS-510 (1 to 25 mg/kg). After 21- day dosing in MV4-11 xenografts, both SNS-229 and SNS-510 showed dose-related efficacy with &gt; 95% tumor growth inhibition and partial regression (&gt;50% tumor shrinkage) in 70% and 100% of animals at the highest dose. Conclusion: With this class of PDK1 inhibitors, we have previously reported strong tumor growth inhibition (66%-95%) in gastric, lung, pancreatic and colorectal cancer xenograft models. Here we report a PK/PD (pathway modulation) relationship that correlates with profound tumor growth inhibition in hematologic cancers. Thus, targeting the inactive conformation of PDK1 and inhibiting PI-independent substrate binding has broad potential for the treatment of solid and hematologic cancers.

Citation Format: Stig Hansen, Johan Enquist, Jeff Iwig, Minke E. Binnerts, Gene Jamieson, Judith A. Fox, Adam R. Craig. PDK1 inhibitors SNS-229 and SNS-510 cause pathway modulation, apoptosis and tumor regression in hematologic cancer models in addition to solid tumors. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2015 Nov 5-9; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(12 Suppl 2):Abstract nr C198.

Vosaroxin plus cytarabine versus placebo plus cytarabine in patients with first relapsed or refractory acute myeloid leukaemia (VALOR): a randomised, controlled, double-blind, multinational, phase 3 study

BACKGROUND

Safe and effective treatments are urgently needed for patients with relapsed or refractory acute myeloid leukaemia. We investigated the efficacy and safety of vosaroxin, a first-in-class anticancer quinolone derivative, plus cytarabine in patients with relapsed or refractory acute myeloid leukaemia.

METHODS

This phase 3, double-blind, placebo-controlled trial was undertaken at 101 international sites. Eligible patients with acute myeloid leukaemia were aged 18 years of age or older and had refractory disease or were in first relapse after one or two cycles of previous induction chemotherapy, including at least one cycle of anthracycline (or anthracenedione) plus cytarabine. Patients were randomly assigned 1:1 to vosaroxin (90 mg/m(2) intravenously on days 1 and 4 in a first cycle; 70 mg/m(2) in subsequent cycles) plus cytarabine (1 g/m(2) intravenously on days 1-5) or placebo plus cytarabine through a central interactive voice system with a permuted block procedure stratified by disease status, age, and geographical location. All participants were masked to treatment assignment. The primary efficacy endpoint was overall survival and the primary safety endpoint was 30-day and 60-day all-cause mortality. Efficacy analyses were done by intention to treat; safety analyses included all treated patients. This study is registered with ClinicalTrials.gov, number NCT01191801.

FINDINGS

Between Dec 17, 2010, and Sept 25, 2013, 711 patients were randomly assigned to vosaroxin plus cytarabine (n=356) or placebo plus cytarabine (n=355). At the final analysis, median overall survival was 7·5 months (95% CI 6·4-8·5) in the vosaroxin plus cytarabine group and 6·1 months (5·2-7·1) in the placebo plus cytarabine group (hazard ratio 0·87, 95% CI 0·73-1·02; unstratified log-rank p=0·061; stratified p=0·024). A higher proportion of patients achieved complete remission in the vosaroxin plus cytarabine group than in the placebo plus cytarabine group (107 [30%] of 356 patients vs 58 [16%] of 355 patients, p<0·0001). Early mortality was similar between treatment groups (30-day: 28 [8%] of 355 patients in the vosaroxin plus cytarabine group vs 23 [7%] of 350 in the placebo plus cytarabine group; 60-day: 70 [20%] vs 68 [19%]). Treatment-related deaths occurred at any time in 20 (6%) of 355 patients given vosaroxin plus cytarabine and in eight (2%) of 350 patients given placebo plus cytarabine. Treatment-related serious adverse events occurred in 116 (33%) and 58 (17%) patients in each group, respectively. Grade 3 or worse adverse events that were more frequent in the vosaroxin plus cytarabine group than in the placebo plus cytarabine group included febrile neutropenia (167 [47%] vs 117 [33%]), neutropenia (66 [19%] vs 49 [14%]), stomatitis (54 [15%] vs 10 [3%]), hypokalaemia (52 [15%] vs 21 [6%]), bacteraemia (43 [12%] vs 16 [5%]), sepsis (42 [12%] vs 18 [5%]), and pneumonia (39 [11%] vs 26 [7%]).

INTERPRETATION

Although there was no significant difference in the primary endpoint between groups, the prespecified secondary analysis stratified by randomisation factors suggests that the addition of vosaroxin to cytarabine might be of clinical benefit to some patients with relapsed or refractory acute myeloid leukaemia.

FUNDING

Sunesis Pharmaceuticals.

A phase 1b/2 study of vosaroxin in combination with cytarabine in patients with relapsed or refractory acute myeloid leukemia

Vosaroxin is a first-in-class anticancer quinolone derivative that intercalates DNA and inhibits topoisomerase II. This study assessed the safety and tolerability of vosaroxin plus cytarabine in patients with relapsed/refractory acute myeloid leukemia. Escalating vosaroxin doses (10-minute infusion; 10-90 mg/m(2); days 1, 4) were given in combination with cytarabine on one of two schedules: schedule A (24-hour continuous intravenous infusion, 400 mg/m(2)/day, days 1-5) or schedule B (2-hour intravenous infusion, 1 g/m(2)/day, days 1-5). Following dose escalation, enrollment was expanded at the maximum tolerated dose. Of 110 patients enrolled, 108 received treatment. The maximum tolerated dose of vosaroxin was 80 mg/m(2) for schedule A (dose-limiting toxicities: grade 3 bowel obstruction and stomatitis) and was not reached for schedule B (recommended phase 2 dose: 90 mg/m(2)). In the efficacy population (all patients in first relapse or with primary refractory disease treated with vosaroxin 80-90 mg/m(2); n=69), the complete remission rate was 25% and the complete remission/complete remission with incomplete blood count recovery rate was 28%. The 30-day all-cause mortality rate was 2.5% among all patients treated at a dose of 80-90 mg/m(2). Based upon these results, a phase 3 trial of vosaroxin plus cytarabine was initiated in patients with relapsed/refractory acute myeloid leukemia. (Clinicaltrials.gov identifier: NCT00541866).

Induction of complete remission using single agent clofarabine in a patient with primary refractory acute myeloblaste leukemia

Refractory AML patients have a very poor prognosis. Therefore, rationally designed new therapies, including clofarabine, are being investigated as potential treatments for this patient population. This is a case report of a patient with primary refractory AML who was treated with clofarabine and achieved a complete response.

Recommendations for a mammography quality assurance program

In 1989 the ACPSEM published a position paper entitled "A Quality Assurance Programme for Mass Screening in Mammography". This paper described test parameters and performance specifications for the equipment related aspects of a mammography quality assurance program. Advice on test equipment selection was also provided. In the intervening period of time there have been considerable advances in mammography technology creating a need to review a number of the paper's recommendations. There have also been considerable developments in the mammography quality assurance (QA) field, not the least of which includes the American College of Radiology Mammography Accreditation Program (ACR-MAP) and the similarly structured Royal Australian and New Zealand College of Radiologists' Mammography Accreditation Program (RANZCR-MAP). In light of these developments it was decided by the Radiology Interest Group to review the ACPSEM position on those aspects of mammography QA that fall within the medical physicist's area of expertise. This document represents the outcome of those deliberations.

Positioning long lines: contrast versus plain radiography

AIM

To assess the value of contrast versus plain radiography in determining radio-opaque long line tip position in neonates.

METHODS

In a prospective study, plain radiography was performed after insertion of radio-opaque long lines. If the line tip was not visible on the plain film, a second film with contrast was obtained in an attempt to visualise the tip.

RESULTS

Sixty eight lines were inserted during the study period, 62 of which were included in the study. In 31, a second radiographic examination with contrast was necessary to determine position of the tip. In 29 of these, the line tip was clearly visualised with contrast. On two occasions, the line tip could not be seen because the contrast had filled the vein and obscured the tip from view. Eight of the lines that required a second radiograph with contrast were repositioned.

CONCLUSION

Intravenous contrast should be routinely used in the assessment of long line position in the neonate.

Automated homogeneous immunoassay for gentamicin on the dimension clinical chemistry system

BACKGROUND

Monitoring of the concentration of gentamicin in serum and plasma during therapy is widely recommended and practiced in hospitals. Our aim was to develop a homogeneous immunoassay based on particle-enhanced turbidimetric inhibition immunoassay technology to quantify gentamicin on the Dimension clinical chemistry system.

METHODS

Assay performance was assessed on each of the Dimension models in a 15-instrument interlaboratory comparison study. A split-sample comparison (n = 1171) was also performed between the gentamicin methods on the Dimension system and the Abbott TDx analyzer, using multiple reagent and calibrator lots on multiple instruments.

RESULTS

The Dimension method was linear to 25.1 micromol/L (12.0 microg/mL) with a detection limit of 0.63 micromol/L (0.3 microg/mL). Calibration was stable for 30 days. The within-run imprecision (CV) was <1.3%, and total imprecision ranged from 1.8% to 3.2% between 4.2 micromol/L (2.0 microg/mL) and 16.7 micromol/L (8.0 microg/mL) gentamicin. Linear regression analysis of the results on the Dimension method (DM) vs the Abbott TDx yielded the following equation: DM = 0.98TDx - 0.42; r = 0.987. Minimal interference was observed from structurally related compounds such as sagamicin, netilmicin, and sisomicin.

CONCLUSION

The monoclonal antibody used in this method has similar reactivities toward the individual gentamicin subspecies C1, C1a, and C2, thus providing analytical recovery not significantly dependent on relative subspecies concentrations.

Immunizing against depression and anxiety after spinal cord injury

OBJECTIVE

To further report on the effectiveness of early psychological intervention in reducing anxiety and depressive mood in persons with spinal cord injury 2 years after injury.

DESIGN

A nonrandomized, longitudinal, controlled trial. SETTING, OUTCOME MEASURES, AND INTERVENTION: Twenty-eight spinal cord injured persons participated in group cognitive behavior therapy during hospital rehabilitation. They were assessed for depressive mood and anxiety before, immediately after, and 12 and 24 months after treatment. The intervention group's responses on the measures were compared with a control group of 31 spinal cord injured persons who only received traditional rehabilitation services during their hospitalization.

RESULTS

Subjects in the treatment group with high depression and anxiety scores before treatment were significantly less depressed and reduced their anxiety to a greater extent 2 years after the injury in comparison with similar persons in the control group.

CONCLUSIONS

Group cognitive behavior therapy for spinal cord injured persons who are abnormally depressed and anxious appears to reduce depressive mood and anxiety in the short and long term.

Kinetics and proposed mechanism of the reaction of an immunoinhibition, particle-enhanced immunoassay

We report kinetic studies on the reaction of a latex agglutination immunoassay used to quantify phenytoin in serum. In this assay, polystyrene particles with a covalently attached analog of phenytoin react with an antiphenytoin monoclonal antibody to form light-scattering aggregates, with the rate of this reaction being decreased by addition of phenytoin from sample. In the absence of free (sample) phenytoin, this reaction did not exhibit a maximum rate of agglutination in the presence of excess antibody, i.e., an equivalence point. Furthermore, agglutination was inhibitable by free phenytoin even when the latter was added after agglutination of particles with antibody had begun. Most significantly, the immunoagglutination proceeded in an identical fashion with monovalent F(ab) fragment. These data are consistent with low-affinity immunospecific particle-antibody complexation, which then induces colloidal aggregation, without requiring immunospecific bridging by antibody molecules. The described mechanism is not generalizable to all latex agglutination immunoassays, although disturbance of colloidal stability may be a component in most assays.

Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy

OBJECTIVE

Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury (SCI), there are little data to support this assertion. To date, reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published. This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation.

DESIGN

The study employed a nonrandomized controlled trial, and measures were taken on three occasions: before, immediately after, and 12 months after treatment. SETTING, OUTCOME MEASURES, AND INTERVENTION: Anxiety, depressive mood, and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital, who participated in specialized group cognitive behavior therapy (CBT) during rehabilitation.

CONTROLS

The intervention group's responses on the measures were compared with a control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization.

RESULTS

There were no overall group differences on anxiety, depressive mood, and self-esteem, although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group. However, those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury, compared to similar persons in the control group.

CONCLUSIONS

While it appears not everyone who experiences SCI needs CBT, at least in the hospital phase of their rehabilitation, those who report high levels of depressive mood benefited greatly from CBT.

Development and validation of a particle-enhanced turbidimetric inhibition assay for urine albumin on the Dade aca analyzer

The measurement of urine albumin now has a well-established role in the monitoring of patients with diabetes mellitus. We have developed a particle-enhanced immunoturbidimetric inhibition assay for urine albumin on the Dade aca analyzer. The inhibition approach removes any of the potential antigen excess difficulties that could be expected from the wide clinical range of urine albumin, but retains the sensitivity advantages of latex-enhanced immunoturbidimetry. Human serum albumin (HSA) is covalently attached to 40-nm poly(chloromethyl)styrene-modified latex particles. This reagent, along with monoclonal antibody to HSA, is aliquoted into the aca reagent pack along with polyethylene glycol 8000 in a tablet form (giving a final reaction concentration of 15 g/L). A 150 mmol/L phosphate buffer, pH 7.8, is used to fill the reagent pack in the instrument and the agglutination reaction is monitored at 340 nm. The sample volume is 100 microL and the calibration curve covers the range 2-250 mg/L. Evaluation of commercial scale reagents against the Beckman Array nephelometric immunoassay system gave a Deming regression correlation of aca = 0.87 x Beckman + 8.5, r = 0.995, n = 145. Mean analytical recovery was 104+/-4.5%, n = 20, and there was no evidence of a lack of parallelism. Interassay precision was 8.8% at 10.0 mg/L and <2.5% at >65 mg/L. Calibrator stability was in excess of 60 days. A small reference range study (24-h urine collections, n = 27) gave a mean of 5.6 mg/L with a range of 0.5-16.2 mg/L. Analytical sensitivity (2.5 SD from zero) was 0.40 mg/L.

Validation of a particle enhanced immunoturbidimetric assay for serum beta 2-microglobulin on the Dade aca

We describe the development and validation of a fully automated homogeneous immunoassay for serum beta 2-microglobulin on the Dade aca clinical analyzer. The assay employs latex enhanced immunoturbidimetry, with an affinity purified polyclonal antibody covalently coupled to a 40 nm latex particle. The assay working range is < 0.5 to 20 mg/l with no evidence of loss of signal due to antigen excess at concentrations up to 120 mg/l. The assay sensitivity is 0.2 mg/l; within run and between run imprecision showed coefficients of variations of < 7%, across the assay range 1-20 mg/l. A method comparison with an established RIA procedure gave a regression equation of (aca) = 1.14 (RIA)-0.26, r = 0.996, n = 109. Good analytical recovery (98-101%), no evidence of a lack of parallelism and no interference from rheumatoid factor (tested up to 1.2 x 10(6) U/l) were observed. The low method to be considered as an effective means of monitoring seroconversion in HIV infected subjects and treatment of patients with myelomatosis.

Mean glandular dose and the standard breast

Mean glandular dose limits in mammography are defined in terms of a "standard breast". However, accrediting bodies do not always use the same standard breast. In this study, dose was measured following the guidelines of the National Program for the Early Detection of Breast Cancer (NPEDBC) and the Royal Australasian College of Radiologists (RACR). The RACR dose was found to be 32% less than the NPEDBC dose. This highlights the need for breast characteristics to be included in any statement of mean glandular dose.

Results of a traditional acupuncture intervention for stuttering

It is important that researchers investigate alternative strategies for treating stuttering, as contemporary treatments are not entirely successful in reducing stuttering with all people. Furthermore, many who have been "successfully" treated suffer from high relapse rates in the long term. Acupuncture has been shown to be a promising treatment for several diverse disorders, so a pilot investigation into its effectiveness for stuttering was considered worthwhile. This study investigated traditional acupuncture-based treatments for two adult males who had stuttered since childhood. A single-case experimental ABAB multiple baseline design was employed to test for treatment effectiveness. Subjects were followed up for a further 12 weeks to evaluate maintenance (C phase) of possible improvements. No significant ABAB reversal effects were observed, and stuttering frequency through the treatment phases remained at baseline levels for the two subjects. Speech rate also remained at baseline levels throughout the treatment phases, as did naturalness of speech and anxiety levels. This research is important as claims that acupuncture may successfully reduce stuttering need to be tested, and the scope and usefulness of treatments like acupuncture for a wide variety of problems needs to be determined. However, the low subject numbers involved suggest caution in concluding acupuncture is not a successful intervention for stuttering. Perhaps alternative acupuncture points need to be evaluated and a wider variety of persons who stutter need to be involved in any future research.

A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury

This study is a 1 year extension of a controlled 1 year follow up study of spinal cord injured persons. The study assessed the extent of spinal cord injury (SCI) persons' depression and anxiety in comparison to an able bodied control group matched for age, sex, education and as far as possible, occupation. Psychological adjustment to SCI was assessed in terms of scores on the Trait Anxiety Inventory and the Beck Depression Inventory. Results obtained at the 2 year follow up were not significantly changed from those obtained over the first year. There was no significant improvement in anxiety and depression scores in the SCI group 2 years post injury. Examination of the SCI scores suggest that psychological morbidity was confined to a group of approximately 30% of persons, whilst the remaining persons were not severely anxious or depressed. Traditional stage models of adjustment to SCI which suggest that the passage of time is associated with better adjustment were not supported by the present data.

The influence of spinal cord injury on coping styles and self-perceptions two years after the injury

This study is a two year follow-up of previous longitudinal research which investigated the effects of spinal cord injury (SCI) on perceptions of control, self-esteem and coping styles over the first year of SCI. Persons with SCI and a demographically matched able-bodied control group completed standardised questionnaires on four occasions over two years. The instruments included the Locus of Control of Behaviour Scale (LCB), Rosenberg's Self-Esteem Scale, and an adapted Mental Adjustment to Cancer Scale (MAC), which measures coping styles, including fighting spirit, helplessness/hopelessness and fatalism. Results obtained in the first year were replicated in the two year data, except for the LCB Scale. After one year, the SCI group were found to perceive their life to be externally controlled, to be lower in self-esteem, and have more helpless/hopeless and fatalistic attitudes than the controls. There were no differences in self esteem and coping styles after two years for the SCI group. However, locus of control fluctuated over the two years, though there was a trend for the SCI group to be more externally focussed. There were no significant interactions between group and time. Implications for the adjustment of SCI persons are discussed.

Spinal cord injury: a search for determinants of depression two years after the event

A prospective longitudinal study employing repeated measures was used to isolate factors which might predispose a person to depression two years after sustaining spinal cord injury (SCI). Thirty-one subjects who suffered acute spinal injuries resulting in permanent loss of movement, and who had no head injuries or any pre-existing psychopathology, were at least 17 years of age, and who were able to speak English, participated in the study. Using the Beck Depression Inventory (BDI) as a measure of depression, a regression analysis demonstrated that the experience of pain two years post-injury and feeling out of control of one's life prior to hospital discharge were predictive of depression two years post-injury. No demographic variables or injury characteristics such as level of lesion or completeness of lesion were related to long-term depression. Pain management and rehabilitation techniques that enhance the individual's belief of control over their lives are therefore recommended as interventions that could act to reduce depression in the long term in persons with spinal cord injury.

Anxiety and depression over the first year of spinal cord injury: a longitudinal study

The literature concerning the psychological consequences following spinal cord injury (SCI) indicates a discordance between clinical impressions and empirical research. Although many studies report that psychological morbidity is not an inevitable consequence of SCI, much of this research is characterised by methodological inadequacies and the conclusions are therefore tenuous. The present study assessed 41 persons with SCI for depression and anxiety using objective psychological measures on three occasions over the first year of SCI and compared them with 41 able bodied controls matched for age, sex, education and, as far as possible, occupation. Results demonstrated significant differences between the two groups, with the SCI group being more anxious and depressed. However, psychological morbidity was not an inevitable consequence of SCI, with group means reflecting mild levels of depression and anxiety. No significant differences were found across time and no interactions between groups and time were detected. Implications for the treatment of SCI are discussed.

Stabilization of turbidimetric immunoassay by covalent coupling of antibody to latex particles

Turbidimetric immunoassay is commonly used to quantify serum proteins. Latex-particle enhancement of this type of assay has been primarily associated with increasing assay sensitivity. However, covalent coupling of an antibody to a latex particle can offer other advantages that are also pertinent in measurement of high concentrations of analytes. By using a common antibody with IgG as a model analyte, we describe the development of a nonenhanced and a latex-particle-enhanced turbidimetric assay for measuring serum IgG. Both assays show adequate analytical recovery and parallelism, and results compare well with those by rate nephelometry. The latex-enhanced assay has equivalent sensitivity, working range, and interassay precision, but much greater signal change and calibration stability than the nonenhanced assay. In addition, with latex particles, less antiserum is needed. Coupling antibodies to latex particles offers considerable advantages, even when an improved assay detection limit is not required.

Stabilization of turbidimetric immunoassay by covalent coupling of antibody to latex particles

Turbidimetric immunoassay is commonly used to quantify serum proteins. Latex-particle enhancement of this type of assay has been primarily associated with increasing assay sensitivity. However, covalent coupling of an antibody to a latex particle can offer other advantages that are also pertinent in measurement of high concentrations of analytes. By using a common antibody with IgG as a model analyte, we describe the development of a nonenhanced and a latex-particle-enhanced turbidimetric assay for measuring serum IgG. Both assays show adequate analytical recovery and parallelism, and results compare well with those by rate nephelometry. The latex-enhanced assay has equivalent sensitivity, working range, and interassay precision, but much greater signal change and calibration stability than the nonenhanced assay. In addition, with latex particles, less antiserum is needed. Coupling antibodies to latex particles offers considerable advantages, even when an improved assay detection limit is not required.

Psychological consequences of spinal injury: a review of the literature

The traumatic nature of spinal cord injury necessitates adjustments for the individual physically, socially, vocationally and sexually, as well as placing great strain on the family. Although one would suspect a high prevalence of psychological disruption following spinal cord injury, there is still much debate concerning the extent of the psychological reaction to such a trauma. This situation can partly be attributed to the lack of systematic research characteristic of most studies in this area. This paper reviews more recent literature which has investigated psychological morbidity in persons with spinal cord injury. The inadequacies of this research are discussed and suggestions for future research and psychological treatment for the spinal injured are provided.

A quantitative automated immunoassay for fibrinogen/fibrin degradation products

We describe a prototype quantitative automated assay for fibrin and fibrinogen degradation products, a particle-enhanced turbidimetric inhibition immunoassay (PETINIA) in the Du Pont aca discrete clinical analyzer. This assay involves a latex particle reagent with covalently bound fibrinogen and a polyclonal antiserum raised in rabbits against human fibrinogen. A special secondary sample-collection tube quantitatively removes fibrinogen from citrated plasma and inhibits further fibrinolysis, independent of heparin concentration. The assay range is 0-100 mg/L, in fibrinogen equivalents. The CV for the assay is less than 10% when performed with the aca. Nonclottable fibrin and fibrinogen fragments are measured by the assay, the greatest sensitivity being directed at the E domain of the fibrinogen molecule. We illustrate with case studies the potential of this assay for providing clinical information not obtainable with currently available qualitative and semi-quantitative assays.

A quantitative automated immunoassay for fibrinogen/fibrin degradation products

We describe a prototype quantitative automated assay for fibrin and fibrinogen degradation products, a particle-enhanced turbidimetric inhibition immunoassay (PETINIA) in the Du Pont aca discrete clinical analyzer. This assay involves a latex particle reagent with covalently bound fibrinogen and a polyclonal antiserum raised in rabbits against human fibrinogen. A special secondary sample-collection tube quantitatively removes fibrinogen from citrated plasma and inhibits further fibrinolysis, independent of heparin concentration. The assay range is 0-100 mg/L, in fibrinogen equivalents. The CV for the assay is less than 10% when performed with the aca. Nonclottable fibrin and fibrinogen fragments are measured by the assay, the greatest sensitivity being directed at the E domain of the fibrinogen molecule. We illustrate with case studies the potential of this assay for providing clinical information not obtainable with currently available qualitative and semi-quantitative assays.

Novel shell/core particles for automated turbidimetric immunoassays

Recent innovations in particle design have led to the development of highly sensitive and reproducible immunoassay methods for the Du Pont aca discrete clinical analyzer. Key advances include the synthesis and use of particles less than 1 micron in diameter with high refractive index cores surrounded by thin, chemically reactive shells. The cores are prepared by emulsion polymerization to a well-defined size that depends on the choice of monomer and the requirements for turbidimetric signal. Methods for measuring therapeutic drugs (e.g., theophylline) involve particles with polystyrene cores; other methods require cores with higher refractive indices such as polyvinylnaphthalene. The shells are critical for overall method performance because they bind covalently the immunochemicals of interest. Polyglycidyl methacrylate shells have been used effectively to attach antigens and haptens to the particle surface.

Novel shell/core particles for automated turbidimetric immunoassays

Recent innovations in particle design have led to the development of highly sensitive and reproducible immunoassay methods for the Du Pont aca discrete clinical analyzer. Key advances include the synthesis and use of particles less than 1 micron in diameter with high refractive index cores surrounded by thin, chemically reactive shells. The cores are prepared by emulsion polymerization to a well-defined size that depends on the choice of monomer and the requirements for turbidimetric signal. Methods for measuring therapeutic drugs (e.g., theophylline) involve particles with polystyrene cores; other methods require cores with higher refractive indices such as polyvinylnaphthalene. The shells are critical for overall method performance because they bind covalently the immunochemicals of interest. Polyglycidyl methacrylate shells have been used effectively to attach antigens and haptens to the particle surface.

A scale to measure locus of control of behaviour

Many behaviour, psychotherapy and healthy life-style programmes require subjects to take responsibility for the control of the old unwanted behaviours or to be responsible for maintaining new desired behaviours after therapy has ended. A scale to measure the locus of control of behaviour would be valuable if it could predict persons likely to relapse following apparently successful therapy. A 17-item Likert-type scale to measure this construct was developed and shown to have satisfactory internal reliability, to be test-retest reliable in the absence of treatment, to be independent of age, sex and social desirability, and to distinguish clinical disorder from normal non-clinical subjects. Furthermore, change towards internality (a reduced LCB score) during therapy was shown to predict maintenance or, alternatively, change towards externality (an increase or no change in the LCB score) was shown to predict relapse 10 months later in treated stutterers. The scale was shown to be related to the personal control factor of the Rotter I-E scale but to be more powerful a predictor of relapse than this personal control subscale or the full Rotter scale.

Reduction of stuttering by young male stutterers using EMG feedback

A clinical program was designed in which male stutterers (age 10-14 years) were trained to reduce speech muscle tension by application of electromyograph (EMG) feedback. The program was designed (a) to reduce nonspeech EMG activity of facial muscles involved in speech, (b) to use this skill for control of muscle EMG activity while speaking, (c) to maintain the physiological EMG activity reduction with behavioral self-control techniques. Three subjects were treated on a single-subject ABCD baseline design, with an ABABAB reversal design within the treatment (B) phase. EMG feedback was shown to reduce stuttering in the clinic. After maintenance techniques were taught, stuttering was shown to have reduced 60-80% in the home environment while speech rate remained constant or increased. A 9-month follow-up showed that the improvement produced in treatment was continuing.