Dietary patterns and their associations with postpartum weight retention: results of the MINA cohort study

PURPOSE

To examine the association of prepregnancy dietary patterns with postpartum weight retention at 6 months (PPWR6) among Lebanese and Qatari women.

METHODS

Data for this study were derived from the Mother and Infant Nutrition Assessment (MINA) prospective cohort study conducted in Lebanon and Qatar. Pregnant women were recruited during their first trimester and were followed up for three years. For the purpose of this study, data belonging to sociodemographic characteristics of participants, prepregnancy dietary intake, prepregnancy BMI as well as weight retention at 6 months were used. Dietary intake was examined using a 98-item food frequency questionnaire. Principal component analysis was used for the derivation of dietary patterns. The associations of dietary patterns with PPWR6 were examined using simple and multiple linear regressions.

RESULTS

Data was available for 177 participants (Lebanon: 93; Qatar: 84). Mean PPWR6 was 4.05 ± 5.29 kg. Significantly higher PPWR6 was observed among participants with pre-pregnancy overweight/obesity and among those with excessive gestational weight gain. Two dietary patterns were identified: the "Western" and the "Varied" patterns. After adjustment for confounders, a positive association was observed between the 'Western' pattern scores and PPWR6 (ß = 1.27; 95% CI 0.68-1.86; p value: < 0.0001).

CONCLUSION

Higher adherence to the Western pattern was associated with higher PPWR6 amongst women, hence underscoring the importance of public health interventions aimed at fostering healthier dietary habits during this crucial stage of the lifecycle.

A triangulated perspective for understanding CAM use in Lebanon: a qualitative study

Background

Existing evidence marked a prevalent use of Complementary and Alternative Medicine (CAM) therapies in Lebanon that is concomitant with low rates of disclosure to health care providers and limited knowledge among the general public of safety and side effects of CAM use.

Objectives

To examine the perspectives of Lebanese CAM users, CAM providers, and health care providers (HCPs) regarding their understanding of CAM and of the Push and Pull factors that drive its use.

Methods

A qualitative research study was conducted using in-depth interviews, targeting Lebanese adults (CAM users; 18-65 years) (n=14), CAM providers such as yoga instructors, owners of CAM product outlets, herbalists, and religious figures (n=13); and HCPs including physicians, nurses, dietitians, and pharmacists (n=14). The topic guide covered, in addition to the understanding of CAM, the Push and Pull factors driving CAM use. The adults were recruited by convenient sampling, and CAM providers and HCPs using a purposive sampling approach. Interviews were audiotaped, transcribed, and translated into English. Analysis was performed using a qualitative thematic approach. Similarities and differences in the perceptions of the participants with regards to factors that influence CAM use were charted and contrasted, using a triangulated approach.

Results

The three study groups exhibited a similar understanding of CAM, referring to non-conventional therapies used to prevent/treat diseases or to enhance wellbeing. CAM users and CAM providers identified “distrust in HCPs”, “lack of patient-centered care in CM”, and “limitations and side effects of CM” as important Push factors. All study groups highlighted the limited CAM knowledge of HCPs as a main reason for the lack of patient-centered care. All three groups also underscored the affordability and the social and cultural support for CAM as main enablers of its prevalent use. Unlike HCPs who were skeptical about the safety and effectiveness of CAM, CAM users and CAM providers indicated that most of CAM therapies are safe and efficient.

Conclusions

The triangulation of perspectives (CAM users, CAM providers, and HCPs) in this study allowed a comprehensive appraisal of CAM use and its drivers. Improving the HCPs’ CAM-related knowledge, promoting patient-centered care and fostering an open dialogue between HCPs and CAM providers are among the recommendations of the study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03685-z.

A qualitative investigation of the perceptions of complementary and alternative medicine among adults in Hawai'i

Background

Complementary and alternative medicine (CAM) is defined as a group of diverse medical and healthcare practices outside of conventional medicine modalities. The use of CAM is steadily increasing despite gaps in the scientific evidence supporting its use and the challenges of its regulation and integration into conventional healthcare practices. In this context, perceptions concerning CAM become important. The purpose of this study is to identify the perceptions of CAM among adult residents of Hawaiʻi.

Methods

Two researchers conducted audio-recorded interviews at the University of Hawaiʻi Mānoa (UHM) campus. Participants were over the age of 18, spoke English fluently, and self-identified as Hawaiʻi residents. Interviews were conducted to the point of data saturation and audio recordings were transcribed verbatim. Researchers collaboratively developed a codebook and used NVivo 12 to analyze transcripts. New codes were added as required. Inter-rater reliability was determined by calculating Cohen’s kappa coefficient. Key themes were identified by both researchers individually and then discussed and evaluated together.

Results

Participants were mostly female, white, and affiliated with UHM. Perceptions were categorized as positive, negative, and neutral. The majority of participants had positive perceptions of CAM with few reporting negative perceptions. The positive perceptions were related to CAM’s perceived effectiveness, the desirability of CAM compared to conventional medicine, and CAM’s ability to foster well-being. Negative perceptions were attributed to the lack of scientific evidence and ineffective outcomes of CAM use. Neutral perceptions of CAM related to its safety and natural characteristics.

Conclusions

The study found mainly positive perceptions of CAM among Hawaiʻi residents. Use of CAM is on the rise despite CAM lacking robust empirical evidence demonstrating efficacy across various medical conditions. With insufficient data and understanding of current medical literature, CAM users place themselves at risk for harmful herb-herb and herb-drug interactions. These findings have implications for healthcare providers of both conventional medicine and CAM traditions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12906-022-03603-3.

Review of the Nutrition Situation in Jordan: Trends and Way Forward

Jordan is witnessing an escalating pace of nutrition transition, which may be associated with an increased burden of malnutrition and related non-communicable diseases. This review analyzes the nutrition situation in Jordan by exploring specific nutrition indicators, namely infant and young child feeding, low birthweight, micronutrient deficiencies, anthropometric indicators, and food consumption patterns. Results showed that although most children were ever breastfed and early initiation of breastfeeding had a two-fold increasing trend, rates of exclusive breastfeeding below 6 months of age and continued breastfeeding until two years of age were low. Complementary feeding indicators, particularly minimum diet diversity and minimum acceptable diet standards, were suboptimal. An overall low burden of stunting, wasting, and underweight among children under 5 years and remarkable progress in optimizing iodine status among school-aged children were reported. Conversely, the burden of low birthweight and overweight/obesity exacerbated, coexisting with anemia, vitamin A deficiency, and vitamin D deficiency. Overall, fruit and vegetable consumption were inadequate. The consumption of soft drinks and salt on the other hand was higher than recommended. This review acknowledges the double burden of malnutrition in Jordan and recommends the prioritization and evaluation of interventions towards improving the population's nutritional status and achieving nutrition targets.

Development of national dietary and lifestyle guidelines for pregnant women in Lebanon

Although a number of international diet and lifestyle guidelines during pregnancy (DLGP) exist in the literature, contextualization to low- and middle-income settings is less common. The aim of this study was to present the Lebanese DLGP and to describe the process followed for their development. A mixed-method approach was used including a review and synthesis of existing international DLGP and a consensus building nominal group technique (NGT) with a multidisciplinary group of experts (n = 11). During the meeting, participants identified the themes of the guidelines, formulated the wording of each themes' guideline and translated the guidelines to the Arabic language. Consensus was defined as an agreement of 80%. Reviewing the literature, a list of 17 main topics were found to be common themes for the DLGP. For the Lebanese DLGP, participants in the NGT meeting selected seven themes from this list: gestational weight gain, diet diversity, hydration, food safety, harmful foods, physical activity and breastfeeding. In addition, the group formulated three themes based on merging/modifying existing themes: supplementation, alcohol and smoking and religious fasting. Two context-specific new themes emerged: wellbeing and nutrition resilience. For each of the identified themes, the group agreed upon the wording of its guidelines and description. This study is the first from the Eastern Mediterranean Region to develop through consensus building, context and culture-specific dietary and lifestyle guidelines for pregnant women. Putting maternal nutrition at the heart of tackling malnutrition and its detrimental health outcomes is a core investment for a better maternal and child health.

Sex disparities in dietary intake across the lifespan: the case of Lebanon

BACKGROUND

Little is known about sex-based dietary differences in middle-income countries, particularly those undergoing the nutrition transition. This study aims at examining sex disparities in energy and macronutrients' intakes, food consumption patterns, and micronutrients' adequacy in Lebanon, while adopting a life course approach.

METHODS

Data were derived from a national cross-sectional survey conducted in Lebanon in 2008/2009. The study sample consisted of 3636 subjects: 956 children and adolescents aged 6-19.9 years; 2239 adults aged 20-59.9 years and 441 older adults aged above 60 years. At the households, trained nutritionists conducted face-to-face interviews with participants to complete a sociodemographic questionnaire and one 24-h diet recall. Food items were categorized into 25 food groups. The Nutritionist Pro software was used for the analysis of dietary intake data and the estimation of energy, macronutrients', and micronutrients' intakes.

RESULTS

In all age groups, males had significantly higher energy intakes, while females had significantly higher fiber intakes. In addition, in adolescents aged 12-19.9 years, females had higher fat intakes as compared to males (37.02 ± 0.6% vs 35.03 ± 0.61%), and in adults aged 20-59.9 years, females had significantly higher total fat (37.73 ± 0.33% vs 36.45 ± 0.38%) and saturated fat intakes (11.24 ± 0.15% vs 10.45 ± 0.18%). These differences in macronutrient intakes were not observed in younger children nor in older adults. Sex-based differences in food groups' intakes were also observed: men and boys had significantly higher intakes of red and processed meat, bread, fast food, soft drinks, and alcohol, while girls and women had higher intakes of fruits, vegetables, milk, and sweets. In all age groups, females had lower micronutrient intakes compared to males, including calcium, iron, and zinc.

CONCLUSIONS

This study identified sex-specific priorities that ought to be tackled by context-specific interventions to promote healthier diets in Lebanon. The fact that sex-based differences in nutrient intakes and food consumption patterns were the most noticeable in the adolescent and adult years, hence women's reproductive years call for concerted efforts to improve nutrition for women and girls as this would lay the foundation not only for their future education, productivity, and economic empowerment, but also for the health of future generations.

SVM based colon polyps classifier in a wireless active stereo endoscope

This work focuses on the recognition of three-dimensional colon polyps captured by an active stereo vision sensor. The detection algorithm consists of SVM classifier trained on robust feature descriptors. The study is related to Cyclope, this prototype sensor allows real time 3D object reconstruction and continues to be optimized technically to improve its classification task by differentiation between hyperplastic and adenomatous polyps. Experimental results were encouraging and show correct classification rate of approximately 97%. The work contains detailed statistics about the detection rate and the computing complexity. Inspired by intensity histogram, the work shows a new approach that extracts a set of features based on depth histogram and combines stereo measurement with SVM classifiers to correctly classify benign and malignant polyps.

Abdominal and fetal echography tele-operated in several medical centres sites, from an expert center, using a robotic arm & telephone or satellite link

OBJECTIVE

to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site where the patient stays.

METHOD

A dedicated robotic arm (ESTELE) holding a real ultrasound probe is remotely controlled from the expert site with a fictive probe, and reproduces on the real probe all the movements of the expert hand. The isolated places, are areas with reduced medical facilities, (secondary hospitals 20 to 100 km from the main hospital in Europ, dispensaries in Africa, Amazonia, the a rescue vehicles....

RESULTS

ESTELE was tested on 87 adults and 29 pregnant with ISDN or satellite lines. During fetal tele-operated echography the expert was able to perform appropriate views of the fetal structures in 95% of the cases. During exploration of adult abdomen the expert visualized the main organs in 87% of the cases. Presently the ESTELE system is installed in 4 secondary hospitals, 40 to 100 km from our University Hospital and tele-operated daily by our staff.

CONCLUSION

Robotized tele-echography provide similar information as direct examination. No false diagnostic was reported. Moreover the patients were examined by an expert from the University Hospital while staying in the Medical center proximal to their home.

[Asymptomatic pneumothorax diagnosis on pre-biopsy sonogram of the liver]

Liver biopsy is an invasive procedure which is widely used for the management of liver diseases. An asymptomatic pneumothorax was detected on sonography prior to biopsy for chronic hepatitis C. The complications from biopsy, potentially severe, are decreased by ultrasound guidance. Currently, ultrasound guidance is recommended at the time of liver biopsy.

Phase II trial with carboplatin/gemcitabine induction chemotherapy followed by radiotherapy concomitantly with paclitaxel/gemcitabine in stage III non-small cell lung cancer (NSCLC)

7139

Background: The optimal combination of concomitant thoracic radiotherapy (TRT) and CT in stage III unresectable NSCLC remains unclear. The role of induction CT with Cb/G regimen, less toxic than Cisplatin/G, has not been established in stage III NSCLC. Methods: Forty-two patients (pts), 41 evaluable, entered this trial between January 2003 and November 2004, 27 males, 14 females, median age 60 (37–70), 19 pts with ECOG PS 0, 22 pts with PS 1, 22 pts with stage III A (N2), and 19 pts with stage III B (N2, N3). They received Cb AUC 5 i.v. on day 1 and G 1000 mg/m2 i.v. on days 1 + 8 every three weeks x 2 cycles, followed on day 50 by TRT, 60 Gy over 6 weeks, concomitantly with P 50 mg/m2 i.v. and G 100 mg/m2 i.v. on days 1 + 8 every three weeks x 2 cycles. Results: After induction CT, partial response (PR) was 73.1% (30 pts), stable disease (SD) 24.4% (10 pts), and 2.5% (1 pt) had progressive disease. After TRT and P/G, 19.5% (8 pts) had CR, 75.6% (31 pts) PR, and 4.9% (2 pts) PD. Median time-to-disease progression was 11.5 months. Median survival has not been reached yet, but surpassed 16.5 months; one-year survival is 71% (29 pts). Twenty three patients are still alive, after minimal follow-up of 13 months. First site of PD was in lungs in 7 pts, in brain 5 pts, in bones 4 pts; 2 pts died without PD, of cardiovascular disease. Toxicity of induction CT was minimal. During TRT and CT, grade 3 neutropenia, thrombocytopenia, and anemia occurred in 8 pts, 3 pts, and 3 pts respectively, grade 4 neutropenia and thrombocytopenia in one pt each. Nine pts received red cell transfusions, one pt platelet transfusion. One patient developed esophageal fistula with grade 4 toxicity, 3 pts had grade 3 esophagitis, 2 pts grade 3 infections, and one pt grade 3 dermatitis and elevation of liver enzymes. Conclusions: This regimen is effective, well tolerated, and appears to be an excellent choice for stage III NSCLC. Sponsored by Eli Lilly Canada.

[Table: see text]

Phase II Study of Troxacitabine (BCH-4556) in Patients with Advanced Non-Small-Cell Lung Cancer

Troxacitabine. a promising new L-nucleoside, inhibits DNA polymerase and leads to complete DNA chain termination. The National Cancer Institute of Canada Clinical Trials Group (NCIC-CTG) conducted a phase II study to assess the efficacy and toxicity of troxacitabine in untreated patients with advanced non-small-cell lung cancer (NSCLC). Previously untreated patients were eligible if they had inoperable stage IIIB or IV NSCLC, ECOG PS < or = 2, adequate hematology and biochemistry, and at least one bidimensionally measurable lesion. Patients with prior malignancy or brain metastases were excluded. Troxacitabine (10 mg/m(2)) was administered intravenously over 30 minutes every 3 weeks. Between June 1999 and May 2000, 17 eligible patients received treatment. Patient characteristics included: median age 64 years; female 41%; stage IV (94%); PS 0 (12%), 1 (59%), and 2 (29 %), 3 or more disease sites (59%). In 17 patients, there were 8 stable disease, 9 disease progression, and no objective responses. Median duration of stable disease was 3.6 months (range = 2.0-7.1). A total of 56 cycles were administered (median = 3), and 88% of patients received 90% or more of the planned dose intensity. The majority (82%) of patients experienced skin rash. Hematologic and biochemical toxicities, grade 3/4 (%) were: granulocytopenia (41), anemia (12), thrombocytopenia (6), and hyperglycemia (6). Troxacitabine appears to have little activity in NSCLC in the dose and schedule tested.

Liquid chromatographic–tandem mass spectrometric assay for the simultaneous quantification of Camptosar® and its metabolite SN-38 in mouse plasma and tissues

A simple, rapid and sensitive LC-MS/MS bioanalytical method has been developed to simultaneously quantify Camptosar (CPT-11) and its active metabolite, SN-38, in mouse plasma and tissues. A single step protein precipitation with acetonitrile in 96-well plates was used for sample preparation. Camptothecin (CPT) was used as the internal standard. Fast separation of SN-38, CPT-11 and CPT was carried out isocratically on a C18, 2 mm x 50 mm, 5 microm HPLC column with a mobile phase containing acetonitrile and 20 mM ammonium acetate (pH 3.5) and a 2.5 min chromatographic run time. The API 4000 MS/MS system was operated in positive ionization multiple reaction monitoring mode, and the transitions for SN-38, CPT-11 and CPT were 393.4 --> 349.3, 587.6 --> 167.2 and 349.3 --> 305.3, respectively. The SN-38 and CPT-11 concentrations in samples were calculated from a standard curve of peak area ratios of the analyte to that of the internal standard using a 1/chi2 weighted linear regression. The quantitation limit of 0.5 ng/mL was achieved by using a low sample volume (100 microL) of plasma or tissue homogenates. The assay was linear over the concentration range of 0.5-500 ng/mL with acceptable precision and accuracy. The method was used for the quantification of CPT-11 and SN-38 in plasma and tissues to support a preclinical pharmacokinetics and tissue distribution study of CPT-11 in mice.

Directional selection for specific sheep cell antibody responses affects natural rabbit agglutinins of chickens

Agglutination data from generations 8 through 19 indicate that bidirectional selection for specific SRBC antibody responses was successful in a line cross of ISA x Warren medium heavy layers. After 11 generations titers of the high SRBC selected line (H line) were nearly 1:32,000; those of the low SRBC selected line (L line) were less than 1:2, but titers of the randombred control line remained stable at 1:32. Directional SRBC selection also affected levels of a naturally occurring rabbit cell agglutinating antibody (RRBC), presumably the avian form of alpha-galactose antibody (anti-Gal). This indirect response was biphasic and opposite in direction to the SRBC responses through generation 14 after which anti-Gal titers of all 3 lines increased. At generation 19, line H had the highest agglutinin titers; of both types, control line was intermediate, and line L was lowest. The correlation between SRBC and RRBC titers was 0.43 (P = 0.0). Females had higher titers than males, but the difference was only significant for the SRBC antibody (P = 0.028). Qualitative changes in anti-Gal accompanied SRBC selection. Rabbit agglutinins of 4 types were recognizable: classic, granular, annular, and one negative or very weak reaction. The score type means in line L were highest, in the control line were intermediate, and in line H were lowest, suggesting avidity differences now exist among these lines. The results show integration of natural and acquired immune systems because selection for one temporarily affected the other. Given the importance of anti-Gal in primates, our results should stimulate further study of this antibody in poultry species.

Is ultrasound lymph node examination superior to clinical examination in melanoma follow-up? A monocentre cohort study of 373 patients

BACKGROUND

There is still lack of consensus regarding the most effective follow-up for stage I and II melanoma patients although some consensus conferences have provided guidelines stating that clinical examination should be the standard.

OBJECTIVES

Our aim was to study the value of adding ultrasound lymph node examination (7.5 MHz) to the routine clinical examination recommended by French guidelines in melanoma follow-up.

METHODS

A cohort of melanoma patients was enrolled between 1 July 1995 and 1 July 2000 in a follow-up protocol including clinical examination performed four times a year for thick melanomas (Breslow index > or = 1.5 mm) and twice a year for thin melanomas (Breslow index < 1.5 mm) according to French guidelines, and ultrasound lymph node examination performed every 6 months for thick melanomas and every year for thin melanomas. Follow-up was continued up to 1 July 2003. When clinical or ultrasound examination indicated signs of node recurrence, surgical biopsy of the involved node was performed. When ultrasound examination was only suspicious, another ultrasound examination was performed within the following 3 months. The results of both clinical and ultrasound examinations were compared with histopathology examination when node biopsy was performed.

RESULTS

Ultrasound follow-up was performed for 373 patients (213 females and 160 males). Mean age at diagnosis of melanoma was 59 years (range 14-90, SD 15). In total, 1909 ultrasound examinations combined with clinical examination were analysed. Node biopsy was performed in 65 patients and demonstrated melanoma metastases in 54. Sensitivity of clinical examination and ultrasound examination was 71.4%[95% confidence interval (CI) 55.4-84.3] and 92.9 (95% CI 80.5-98.5), respectively, P = 0.02. Specificity of clinical examination and ultrasound examination was 99.6% (95% CI 99.2-99.8) and 97.8% (95% CI 97.0-98.4), respectively. Despite this apparent superiority of ultrasound examination over palpation, only 7.2% of the patients really benefited from ultrasound examination (earlier lymph node metastasis detection or avoidance of unnecessary surgery), while 5.9% had some deleterious effect from ultrasound examination (unnecessary stress caused by repetition of ultrasound examination for benign lymph nodes, useless removal of benign lymph node).

CONCLUSIONS

This study confirms the greater sensitivity of ultrasound examination to clinical examination in the diagnosis of node metastases from cutaneous melanoma. However, the place of ultrasound in routine follow-up is at least questionable as only a very small proportion of patients (1.3%) really benefited from adding ultrasound examination to clinical examination.

The robot and the satellite for tele-operating echographic examination in Earth isolated sites, or onboard ISS

The objective was to design and validate a method for tele-operating (from an expert site) an echographic examination in an isolated site.

METHOD

The isolated places, defined as areas with reduced medical facilities, could be secondary hospitals 20 to 50 km from the university hospital, or dispensaries in Africa or Amazonia, or a moving structure like a rescue vehicle or the International Space Station (ISS). At the expert center, the ultrasound medical expert moves a fictive probe, connected to a computer (n degrees 1) which sends, the coordinate changes of this probe via an ISDN or satellite line to a second computer (n degrees 2), located at the isolated site, which applies them to the robotic arm holding the real echographic probe.

RESULTS

The system was tested at Tours Hospital on 105 patients. A complete investigation (visualization) of all the organs requested for different clinical cases was obtained in 76% of the cases with the robot, and 87% at the reference echography: In 11% of the cases, at least one of the organ visualized at reference echo could not be investigated by the robot, thus the diagnostic was not done. The number of repositioning was higher for the robot (6.5 +/- 2) than for the reference echo (5.1 +/- 2 = or > 24% more with robot). The duration of the examination was higher with the robot (16 +/- 10 min) than for the reference echography (11 +/- 4 min = or > +43% with the robot compare to reference echography. The system was also tested successfully using satellite links in a limited number of cases (approx 30).

Potential of 5-aza-2'-deoxycytidine (Decitabine) a potent inhibitor of DNA methylation for therapy of advanced non-small cell lung cancer

Although new agents and drug combinations have increased the response rate in advanced non-small cell lung cancer (NSCLC), long-term survivors are rare. There is an urgent need to develop new chemotherapeutic approaches for disease. In a previous pilot phase I-II study on 5-aza-2'-deoxycytidine (5-AZA-CdR) in patients with stage IV NSCLC, we observed several interesting responses, including one patient that was still alive (68 months) at the time of publication of our results. In the present report, we want to point out the long-term follow up of this patient, who survived 81 months, and discuss the interesting mechanism of action of 5-AZA-CdR that may have been responsible for this interesting response. 5-AZA-CdR is a potent inhibitor of DNA methylation. Recent progress in this field has shown that aberrant methylation of the promoter region of tumor suppressor genes inhibits their expression. This epigenetic event can contribute to tumorigenesis. Since 5-AZA-CdR can reactivate these genes by blocking DNA methylation, it has the potential to reverse tumorigenesis. This novel mode of action makes it an interesting agent to investigate for the chemotherapy of malignant disease, including lung cancer.

Flexible chemotherapy regimen with gemcitabine and vinorelbine for metastatic nonsmall cell lung carcinoma: a phase II multicenter trial

BACKGROUND

This Phase II study evaluated a flexible 3- or 4-week dosing schedule of gemcitabine and vinorelbine to determine its effect on response rate and survival of patients with metastatic nonsmall cell lung carcinoma (NSCLC).

METHODS

Thirty-four response-evaluable patients, 24 with performance status (PS) 0-1 and 10 with a PS of 2, 30 with Stage IV, and 4 with Stage IIIB NSCLC were treated with gemcitabine 1000 mg/m(2) intravenously and vinorelbine 25 mg/m(2) intravenously (first 15 patients) or 30 mg/m(2) intravenously (next 19 patients) on Days 1, 8, and 15 of a 4-week cycle, if on Day 15 neutrophils were > or = 1500/uL and platelets > or = 100,000/uL. If chemotherapy could not be administered on Day 15, then Day 22 became Day 1 of the next cycle.

RESULTS

When vinorelbine 25 mg/m(2) was given with gemcitabine 1000 mg/m(2), 11 patients received 4-week cycles, 3 patients 3-week cycles, and 1 patient both 3- and 4-week cycles. With vinorelbine 30 mg/m(2) and gemcitabine 1000 mg/m(2), 7 patients received 4-week cycles, 2 patients 3-week cycles, and 10 patients both 3- and 4-week cycles. The partial response rate for 34 patients was 53% (18 patients). Median survival (MS) was 11.1 months, and 1-year survival 50% (17 patients). Patients with PS 0+1 had a MS of 17.5 months compared with patients with PS 2, who had MS of 3.3 months. Patients < 70 years of age had a MS of 18 months, and those >/= 70 years had a MS of 5.5 months.

CONCLUSION

This flexible schedule with gemcitabine and vinorelbine enabled optimal dose delivery and suggested excellent efficacy but less toxicity than treatment with platinum regimens.

Diaphragm movement before and after cholecystectomy: a sonographic study

Respiratory disorders after abdominal surgery are commonly explained by changes in diaphragmatic movement that are difficult to demonstrate and quantify. Our aim was thus to quantify these changes using a noninvasive method. We used M-mode sonography for the prospective study to measure diaphragmatic amplitude in 14 patients before and after cholecystectomy. During quiet breathing, the diaphragm inspiratory amplitude (DIA) was significantly decreased after surgery from 1.4 +/- 0.2 cm to 1 +/- 0.1 cm and from 1.6 +/- 0.3 cm to 1.2 +/- 0.3 cm in the Laparoscopic and Open Cholecystectomy groups, respectively. The total time cycle of diaphragmatic motion decreased significantly in the two groups. The DIA also decreased significantly during deep breathing after cholecystectomy from 6.0 +/- 0.8 cm to 3.0 +/- 1.8 cm and from 6.1 +/- 1.3 cm to 3.1 +/- 1.6 cm in the Laparoscopic and Open Cholecystectomy groups, respectively. The six patients who underwent spirometric examination showed, during quiet breathing, a significant decrease in DIA without change in tidal volume, i.e., 0.51 +/- 0.08 L to 0.45 +/- 0.08 L. We found a significant decrease in DIA after cholecystectomy and a significant interindividual correlation between DIA during deep inspiration and inspiratory capacity. Using M-mode sonography techniques, we were able to demonstrate changes in diaphragmatic mobility after laparoscopic or open cholecystectomy.

IMPLICATIONS

Cholecystectomy at times results in impaired respiratory and diaphragmatic functions. The techniques currently used to study these repercussions are both laborious and invasive. Our sonographic technique is completely noninvasive and can be used to study diaphragm morphology and movement in real time.

Effects of aging on cardiorespiratory responses to brief and intense intermittent exercise in endurance-trained athletes

The aim of this study was to investigate the effects of aging on athletes' cardiorespiratory responses to a brief intense intermittent effort, using the force-velocity test as an exercise model. Twelve young athletes (24.8 +/- 1.3 years) and twelve master athletes (65.1 +/- 1.2 years) with similar heights, body masses, and endurance training schedules participated in this study. They performed both a maximal graded exercise and the force-velocity tests. The force-velocity test consisted of the repetition of 6-second sprints against increasing braking forces with 5-minute recovery periods. None of the subjects presented abnormal electrocardiogram responses to the tests. During the force-velocity test, the heart rate magnitudes of response in all subjects were correlated to the corresponding sprint power output (p < .001), with higher values for the young athletes (p < .001). Both groups had similar systolic blood pressure peaks of response during the force-velocity test. Both groups had similar preexercise and end-of-recovery oxygen consumption (VO2), but the young athletes had higher peaks of response (p < .001). The VO2 magnitudes of response increased during the test (p < .01) in all subjects, with higher values for the young athletes (p < .001). There was a positive correlation between the VO2 magnitude of response and (1) the corresponding sprint power output (R = .58,p < .001) and (2) the corresponding number of sprint repetitions (R = .29, p < .02). The young athletes had higher end-of-recovery and peak carbon dioxide production (VCO2) responses than the master athletes (p < .001). Pulmonary ventilation (V(E)) peaks of response to the sprints were higher in the young athletes (p < .001). There was a positive relation between the V(E) and VCO2 peaks of response (R = 84,p < .001). In both groups the peak heart rate, VO2, VCO2, and V(E) values attained during the force-velocity test represented similar percentages of the maximal values reached at exhaustion of maximal graded exercise. These results showed that aging does not alter the percentage of the cardiorespiratory response to a brief intense intermittent exercise such as the force-velocity test. Moreover, the arterial blood pressure response is not significantly altered, whereas the vasodilatatory response is.

Lower limb vein enlargement and spontaneous blood flow echogenicity are normal sonographic findings during pregnancy

PURPOSE

We studied pregnancy-induced changes in lower limb venous function.

METHODS

We used plethysmography and sonography to assess the changes in venous wall distensibility, saphenous vein diameters, and spontaneous blood flow echogenicity in the common femoral veins in 190 consecutive women during and after uncomplicated pregnancies (total of 409 examinations).

RESULTS

The percentage of women with clinical symptoms and signs of venous insufficiency increased significantly during pregnancy. The mean diameters of the great and small saphenous veins also increased significantly, while occlusive venous plethysmography showed a decrease in parameters indicating vein distensibility. Spontaneous blood flow echogenicity in the common femoral veins was clearly visible or marked in 6% of cases during the first trimester of pregnancy, 63% during the second trimester, and 96% during the third trimester, versus 6% after delivery (p < 0.0001). The mean hematocrit decreased and the mean fibrinogen concentration increased during pregnancy.

CONCLUSIONS

The increase in lower limb venous pressure seen during pregnancy leads to venous overdistention and worsens blood stasis. Decreased venous flow velocity and rheological alterations result in increased red cell aggregation, giving rise to spontaneous blood flow echogenicity. Spontaneous blood flow echogenicity is therefore a normal finding during pregnancy and should not be mistaken for venous thrombosis.

Study of blood flow parameters measured in femoral artery after exercise: correlation with maximum oxygen uptake

To study the recovery periods of blood flow parameters in muscles after anaerobic exercise, instantaneous and mean blood flow velocity curves were recorded in the femoral artery in 22 sportsmen at rest and during the first 4 min of recovery after exercise (Ruffier-Dickson test). A flat ultrasonic probe connected to a Doppler system (Flow-Tester) was fixed on the skin at the level of the common femoral artery. From Doppler recordings, we calculated periods of recovery (return to baseline) of femoral blood flow velocity (FBFV RP), heart rate (HR RP) and femoral stroke distance (FSD RP). Also, Ruffier-Dickson index (RDI), VO(2)max in mL/kg(-1)/min(-1) and number of training hours were determined. We observed a high correlation between FBFV RP and VO(2)max (p = 0. 0002), and significant correlation between FSD RP and VO(2)max (p = 0.0238) and RDI (p = 0.0451). In conclusion, there is a excellent correlation between blood flow velocity recovery period in femoral artery after moderate exercise and VO(2)max in high-level sportsmen. The method of testing is simple and based on conventional Doppler technique. It can be used for the follow-up of training levels in sportsmen.

Tirapazamine plus cisplatin versus cisplatin in advanced non-small-cell lung cancer: A report of the international CATAPULT I study group. Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors

PURPOSE

A phase III trial, Cisplatin and Tirapazamine in Subjects with Advanced Previously Untreated Non-Small-Cell Lung Tumors (CATAPULT I), was designed to determine the efficacy and safety of tirapazamine plus cisplatin for the treatment of non-small-cell lung cancer (NSCLC).

PATIENTS AND METHODS

Patients with previously untreated NSCLC were randomized to receive either tirapazamine (390 mg/m(2) infused over 2 hours) followed 1 hour later by cisplatin (75 mg/m(2) over 1 hour) or 75 mg/m(2) of cisplatin alone, every 3 weeks for a maximum of eight cycles.

RESULTS

A total of 446 patients with NSCLC (17% with stage IIIB disease and pleural effusions; 83% with stage IV disease) were entered onto the study. Karnofsky performance status (KPS) was >/= 60 for all patients (for 10%, KPS = 60; for 90%, KPS = 70 to 100). Sixty patients (14%) had clinically stable brain metastases. The median survival was significantly longer (34.6 v 27. 7 weeks; P =.0078) and the response rate was significantly greater (27.5% v 13.7%; P <.001) for patients who received tirapazamine plus cisplatin (n = 218) than for those who received cisplatin alone (n = 219). The tirapazamine-plus-cisplatin regimen was associated with mild to moderate adverse events, including acute, reversible hearing loss, reversible, intermittent muscle cramping, diarrhea, skin rash, nausea, and vomiting. There were no incremental increases in myelosuppression, peripheral neuropathy, or renal, hepatic, or cardiac toxicity and no deaths related to tirapazamine.

CONCLUSION

The CATAPULT I study shows that tirapazamine enhances the activity of cisplatin in patients with advanced NSCLC and confirms that hypoxia is an exploitable therapeutic target in human malignancies.

Evaluation in humans of the effects of radiocellular telephones on the circadian patterns of melatonin secretion, a chronobiological rhythm marker

A decrease in melatonin secretion has been observed in small mammals under exposure to extremely low frequency electromagnetic fields. As there is some concern about possible health effects of the increasing use of radiocellular telephones emitting radiofrequency electromagnetic fields, we examined whether such fields would alter melatonin levels in the human. Volunteers were two groups totalling 38 men, 20-32 yr old. Exposures were to commercially available cellular telephones of the GSM 900 type (Global System for Mobile communication at 900 MHz) or DCS 1800 type (Digital Communication System at 1800 MHz), for 2 hr/day, 5 days/wk, for 4 wk, at their maximum power. Attention of the volunteers was sustained by TV projection of movies. Blood samples were collected hourly during the night and every 3 hr in the daytime. Four sampling sessions were performed at 15-day intervals: before the beginning of the exposure period, at the middle and the end of the exposure period, and 15 days later to evaluate the persistence or late appearance of potential effects. Evaluated parameters were the maximum serum concentration, the time of this maximum, and the area under the curve of the hormone profile. Melatonin circadian profile was not disrupted in 37 young male volunteers submitted to a typical pattern of exposure to the electromagnetic fields generated by two common types of cell phones.

Placebo-controlled trial of 13-cis-retinoic acid activity on retinoic acid receptor-beta expression in a population at high risk: implications for chemoprevention of lung cancer

PURPOSE

To establish the incidence of abnormalities in the expression of retinoic acid receptor-beta (RARbeta) in bronchial cells and determine the capacity of 13-cis-retinoic acid (13-CRA) to correct such abnormalities.

PATIENTS AND METHODS

One hundred eighty-eight smokers had a medical indication for bronchoscopy and were studied with bronchial brushings. Bronchial brushing samples were obtained for cytology analysis and for molecular analysis. After RNA was extracted, RARbeta sequences were amplified by reverse transcriptase polymerase chain reaction and Southern blots were performed to assess RARbeta expression. Forty-four eligible individuals with diminished RARbeta expression consented to double-blind randomization to receive a placebo or 13-CRA 30 mg orally daily for 6 months. A second bronchoscopy was performed at the end of the treatment period. An analysis of variance was used to analyze changes in RARbeta expression before and after treatment.

RESULTS

The 6-month treatment course was completed by 27 patients, and results were obtained for a total of 18 patients (eight patients treated with 13-CRA and ten treated with the placebo). In the placebo group, there was no difference between the results of RARbeta expression before and after treatment (P =.43). In the 13-CRA group, there was an upregulation of RARbeta expression at the end of 13-CRA treatment (P =.001). Cytologic changes were uncommon. Toxicities were primarily of grade 1. Palatal brushings were compared with bronchial brushings in 40 smokers. A perfect correlation of the results of RARbeta expression was obtained from 27 patients.

CONCLUSION

RARbeta expression is frequently decreased in the bronchial epithelium of smokers and is upregulated at the end of 13-CRA treatment. These results support undertaking a phase III chemoprevention trial of 13-CRA treatment for lung cancer.

A phase I/II trial of neoadjuvant chemotherapy with cisplatin and vinorelbine followed by accelerated irradiation for patients with inoperable nonsmall cell lung carcinoma

BACKGROUND

Both locoregional and distant disease control remains poor in the treatment of Stage III nonsmall cell lung carcinoma (NSCLC). This trial was conducted to evaluate the tolerance and responses of patients with NSCLC given a neoadjuvant regimen of cisplatin and vinorelbine chemotherapy followed by accelerated thoracic radiotherapy.

METHODS

Forty-two patients with Stage IIIA and IIIB NSCLC were entered into the study. Treatment consisted of cisplatin 100 mg/m2 given on Days 1 and 29 and vinorelbine 30 mg/m2 given weekly for 5 weeks, with a planned 50% dose reduction to 15 mg/m2 planned for Week 2. This was followed by thoracic irradiation of 60 gray (Gy) in 30 fractions of 2 Gy over 4 weeks (once daily during Weeks 1 and 2 and twice daily during Weeks 3 and 4).

RESULTS

With a median follow-up time of 12.2 months (27-65 months for survivors), the median survival was 12.2 months (16.6 months for patients with no prior weight loss and 7.8 months for those with prior weight loss). The response rate after induction chemotherapy was 46.1%, increasing to 74.4% after radiation therapy (8 complete responses and 21 partial responses). The rate of progression was 13 of 18 (72%) for those who responded to chemotherapy (4 distant, 9 local) and 18 of 21 (86%) for those who did not respond to chemotherapy (14 distant, 7 local). The most frequent acute Grade 3 toxicity was nausea (21.4%).

CONCLUSIONS

Accelerated thoracic irradiation after induction chemotherapy is well tolerated and yields therapeutic results that compare favorably with those reported for other regimens of chemotherapy and standard fractionated radiotherapy. The data from this study suggest that the responses of patients with clinically apparent disease to induction chemotherapy might indicate a likelihood of controlling microscopic distant metastases.

Carcinoma of the lung in three brothers and two sisters

Documentation of familial aggregation of five siblings with lung cancer is presented. Lung cancer was not observed in their parents nor among their children, which is consistent with the hypothesis of recessive inheritance, although strong environmental factors such as tobacco smoking may contribute to the development of lung cancer in such families.

Diagnosis of acute lower limb deep venous thrombosis with ultrasound: trends and controversies

Acute deep venous thrombosis of the lower limb is a common and threatening condition whose clinical diagnosis is known to be unreliable. Sonography has gradually superseded venography as the primary diagnostic procedure. A review of the medical literature shows that sonography offers a high level of sensitivity and specificity in symptomatic patients but suffers from a lack of sensitivity at the calf level and in asymptomatic patients. Technologic progress, as well as increased operator experience, may improve sensitivity. Nevertheless, several critical issues remain unresolved, such as the significance of free-floating thrombi, the usefulness of calf and bilateral examination, the criteria that are essential to the diagnosis, the risk of compression sonography, and sonography's role in the direct detection of venous emboli.

[Diaphragm kinetics coupled with spirometry. M-mode ultrasonographic and fluoroscopic study; preliminary results]

Most techniques used so far for the evaluation of diaphragm kinetics are either invasive (electromyography, fluoroscopy), or indirect (respiratory pressures, impedance plethysmography). The aim of this study was to determine whether assessment with ultrasound or fluoroscopy differed, and which technique appeared more suitable in the investigation of quantitative hemidiaphragmatic displacement. Six patients (3 female, 3 male, aged 29 to 40) without respiratory disease were studied during systematic X-Ray chest examination, spirometry, and abdominal sonography. The amplitude of the right diaphragm motion could be measured in all patients with M-mode sonography as well as with fluoroscopy. The vertical ascending motion of the diaphragm measured by M-mode sonography, reached 60% of its maximum amplitude at 50% of inspiratory capacity. There was a significant correlation between the maximum amplitude of diaphragm motion as measured by M-mode sonography (5.8 +/- 0.4 cm; r = 0.89; p = 0.019) or fluoroscopy (5.6 +/- 0.7 cm; r = 0.84; p = 0.036) and the inspiratory capacity (2.73 +/- 0.39 l). M-mode sonography has technical, quantitative and qualitative advantages over fluoroscopy and should be the method of choice in the investigation of suspected diaphragmatic movement disorder. When coupled with other techniques like spirometry, this technique could represent a useful adjunct to functional respiratory studies.

Non-invasive quantification of diaphragm kinetics using m-mode sonography

PURPOSE

The standard conditions of spirometry (i.e., wearing a noseclip and breathing through a mouthpiece and a pneumotachograph) are likely to alter the ventilatory pattern. We used "time motion" mode (M-mode) sonography to assess the changes in diaphragm kinetics induced by spirometry during quiet breathing.

METHODS

An M-mode sonographic study of the right diaphragm was performed before and during standard spirometry in eight patients without respiratory disease (age 34 to 68 yr).

RESULTS

During spirometry, the diaphragm inspiratory amplitude (DIA) increased from 1.34 +/- 0.18 cm to 1.80 +/- 0.18 cm (P = 0.007), whereas the diaphragmatic inspiratory (T1 diaph) increased from 1.27 +/- 0.15 to 1.53 +/- 0.23 sec, (P = 0.015, without change in diaphragmatic total time interval (Ttot diaph). Therefore, the diaphragm duty cycle (T1 diaph/Ttot diaph) increased from 38% +/- 1% to 44% +/- 4% (P = 0.023). The diaphragm inspiratory (DIV) and expiratory (DEV) motion velocity (P = 0.007).

CONCLUSION

M-mode sonography enabled us to demonstrate that the wearing of a nose clip and breathing through a mouthpiece and a pneumotachograph induce measurable changes in diaphragm kinetics.

Pilot phase I-II study on 5-aza-2'-deoxycytidine (Decitabine) in patients with metastatic lung cancer

5-Aza-2'-deoxycytidine (5-AZA-CdR, Decitabine) is a nucleoside analog and an active drug for the therapy of acute leukemia. The incorporation of 5-AZA-CdR into DNA blocks DNA methylation and can result in the activation of specific genes, such as tumor suppressor genes. This novel mechanism of action of 5-AZA-CdR stimulated our interest in its potential for cancer therapy in patients with lung cancer. Using a colony assay we observed that 5-AZA-CdR showed a potent antineoplastic effect against two human lung carcinoma cell lines. The objective of this preliminary phase I-II study was to evaluate the toxicity and clinical efficacy of 5-AZA-CdR in patients with stage IV non-small cell lung carcinoma. There were 15 patients that entered the clinical study. For nine assessable patients that received 5-AZA-CdR by a single 8 h i.v. infusion of 200-660 mg/m2 for one or more cycles, the median survival duration was 6.7 months, with three patients surviving more than 15 months. The steady-state plasma concentration of 5-AZA-CdR during the infusion was estimated in some patients and was in the same range that produced activation of a tumor suppressor gene in human lung tumor cell lines as reported by other investigators. The major side effect of 5-AZA-CdR was hematopoietic toxicity which required a 5-6 week recovery period before the next cycle of therapy. This study suggests that 5-AZA-CdR may have some clinical activity against metastatic lung carcinoma using this type of dose schedule.

Pulse wave velocity measurement by cross-correlation of Doppler velocity signals. Application to elderly volunteers during training

Pulse wave velocity (PWV) measurement is widely used for the indirect assessment of arterial wall distensibility. In order to improve its measurement technique, we built a system performing the calculation of the cross-correlation function of Doppler velocity signals. In 12 normal subjects and 10 patients, the mean difference between duplicate measurements was 0.7 +/- 7.8% (NS). We tested this technique in 15 elderly volunteers before and after a three months training period. Brachial and tibial systolic blood pressure decreased respectively from 18.1 +/- 2.2 kPa to 16.7 +/- 1.9 kPa (p = 0.008) and from 21.1 +/- 3.4 kPa to 18.4 +/- 2.5 kPa (p = 0.003), while lower limb PWV decreased from 8.96 +/- 1.26 to 7.92 +/- 1.22 m.s-1 (p = 0.016). Therefore, automatic PWV measurement using the cross-correlation technique allows to demonstrate training induced changes in PWV, although concomitant changes in blood pressure must be considered in their interpretation.

Tallimustine is inactive in patients with previously treated small cell lung cancer. A phase II trial of the National Cancer Institute of Canada Clinical Trials Group

Tallimustine binds to the minor groove of DNA where it alkylates the N3 position of adenine and may interfere with gene transcription. We conducted a phase II trial of Tallimustine given at a dose of 750 micrograms/m2 intravenously every 4 weeks in patients with small cell lung cancer progressing or relapsing following cisplatin or carboplatin-based chemotherapy. We treated 14 eligible patients with a performance status 0, 1 or 2, bi-dimensionally measurable disease and adequate end-organ function. The main toxicity was neutropenia with a median granulocyte count of 0.1 x 10(9) per liter (range 0-3.9) and four patients (27%) developing febrile neutropenia. In addition, most patients (93%) experienced lethargy. No objective responses were seen. A mixed response was seen in one patient and three others had stable disease for a median of 3.7 months. We conclude that Tallimustine is an ineffective agent in previously treated small cell lung cancer.

[Right diaphragmatic kinetics measured by TM-mode ultrasonography with concomitant spirometry in normal subjects and asthmatic patients. Preliminary results]

The purpose of this study was to assess the diaphragmatic excursion using the TM-mode ultrasonography with concomitant pneumotachography in eight normal and five asthmatic subjects before and after salbutamol. We report the results in normal and asthmatic patients of this procedure. Particular findings were demonstrated in asthma. Different significant correlations were found between sonographic and respiratory measurements. In view of the safety of this direct and real-time diaphragmatic investigation, we conclude that this new method could offer an effective and reliable procedure in the evaluation of patients with diaphragmatic dysfunction. However, our study was limited by the small number of patients included and definite conclusions should await further investigations.

Cost utility of chemotherapy and best supportive care in non-small cell lung cancer

Polychemotherapy is the therapeutic option recommended for nonresectable, non-small cell lung cancer (NSCLC). However, the modest gains in survival, and the frequent and often serious adverse effects, associated with chemotherapy should also be considered when deciding on therapy. We therefore performed a cost-utility analysis of chemotherapy and best supportive care in NSCLC. Effectiveness and costs were analysed on 70 patients who were randomised to receive one of 3 treatments: VP (vindesine and cisplatin), CAP (cyclophosphamide, doxorubicin and cisplatin), or best supportive care. Subsequently, an assessment of the value of polychemotherapy and best supportive care was performed by oncology personnel using the time trade-off technique. Polychemotherapy was found to be more effective than best supportive care, but was also more costly and had a lower value score. Because of its cost utility and its higher value, best supportive care should not be discarded as an alternative for the treatment of NSCLC.

Vinorelbine (Navelbine) in the adjuvant and neoadjuvant treatment of non-small cell lung cancer

Several Canadian centers are studying the favorable activity and toxicity profile of vinorelbine (Navelbine; Burroughs Wellcome Co, Research Triangle Park, NC; Pierre Fabre Médicament, Paris, France) in current and future trials of adjuvant and neoadjuvant treatment of non-small cell lung cancer. In locally advanced, unresectable disease, the 10-week regimen in cisplatin 100 mg/m2 during weeks 1 and 5, vinorelbine 30 mg/m2 weekly for 5 weeks with a 50% dose reduction planned for week 2 only, and accelerated fractionation thoracic irradiation during weeks 7 to 10 (30 fractions of 2 Gy in 4 weeks, once daily during weeks 7 and 8, and twice daily during weeks 9 and 10). Preliminary data on 17 patients who have completed treatment to date show it has been well tolerated, with only four cases of grade 3 nonhematologic toxicities. Favorable results from combined therapy with cisplatin and vinorelbine in advanced disease have led the National Cancer Institute of Canada Clinical Trials Group to consider testing adjuvant cisplatin and vinorelbine in completely resected non-small cell lung cancer. Surgically staged patients with T2, N0 and T1-2N1 tumors will be stratified according to nodal status and presence or absence of ras oncogene mutations in resected tumor DNA. Patients will be randomized to observation or a 16-week trial of adjuvant chemotherapy with cisplatin 50 mg/m2 days 1 and 8 every 4 weeks during the 16 weeks, and vinorelbine 30 mg/m2 weekly for 16 weeks. All resected tumors will be banked for further correlative studies to identify a clinically meaningful panel of molecular prognostic markers.

Gemcitabine is an active new agent in previously untreated extensive small cell lung cancer (SCLC). A study of the National Cancer Institute of Canada Clinical Trials Group

BACKGROUND

The new pyrimidine antimetabolite Gemcitabine has shown preclinical efficacy in a number of solid tumour lines and acceptable toxicity in phase I trials. As part of an ongoing effort to identify active new agents in small cell lung cancer, the NCIC Clinical Trials Group studied Gemcitabine in previously untreated patients with extensive disease.

PATIENTS AND METHODS

Twenty-nine newly diagnosed patients with untreated extensive small cell lung cancer and at least one bidimensionally measurable site received Gemcitabine as a 30 minute intravenous infusion weekly x 3 every 4 weeks. The starting dose was 1000 mg/m2/week in the first 17 patients and 1250 mg/m2/week in the remainder. Patients were reevaluated for response every 4 weeks. Those failing to respond after 2 cycles of therapy were to be offered standard chemotherapy.

RESULTS

Of the 29 patients entered, all were evaluable for toxicity and 26 for response. One complete and 6 partial responses were seen giving a response rate of 27% (95% CI: 11%-47%). Median response duration was 12.5 weeks and the median survival of the entire population was 12 months. Toxic effects were mild to moderate: in particular serious myelosuppression was uncommon.

CONCLUSIONS

Gemcitabine is active in previously untreated small cell lung cancer in doses which produce little toxicity. Combination studies of Gemcitabine with other agents active in this disease are warranted.

[Chemoprevention of lung cancer]

Chemoprevention, or pharmacological intervention in healthy individuals at risk of developing cancer, is attracting attention as a potential tool in cancer prevention. Lung cancer, with its high incidence and poor prognosis, is a particularly interesting disease for these studies. The retinoids are a promising group of chemopreventive agents, since they are involved in growth control and are a necessary cofactor for proper activity of a protein receptor which we have shown to be a lung cancer suppressor. Nevertheless, the toxic side effects of retinoids at pharmacological dose present difficulties and current studies are aimed at determining the efficacy of various forms of retinoids and chemoprevention protocols in the target populations.

DNA alterations at proto-oncogene loci and their clinical significance in operable non-small cell lung cancer

DNA from tumor samples of 54 patients with operable non-small cell lung cancer (NSCLC) was analyzed to determine whether proto-oncogene alterations could be correlated with the clinical behavior of lung cancer. Among seven proto-oncogenes tested, changes in the copy number of Ha-ras, c-myc and c-raf-1 were found in only seven tumors. Most of them were epidermoid carcinomas without lymph node involvement (N0). In spite of a localized disease with complete surgical resection, six of these patients relapsed within a mean disease-free interval (DFI) of only 6.5 months. There is a significant correlation between DNA alterations at proto-oncogene loci and clinical relapse within 12 months of surgical resection (P less than 0.025).

Phase II study of amonafide: results of treatment and lessons learned from the study of an investigational agent in previously untreated patients with extensive small-cell lung cancer

Thirteen previously untreated patients with extensive small-cell lung cancer (SCLC) were treated with the investigational agent amonafide in a dose of 300 mg/m2 intravenously (IV) over 1 hour daily for 5 consecutive days. No responses were seen in 12 eligible patients. Myelosuppression was only occasionally seen. Other toxicities included diaphoresis, chest pain, local irritation at the injection site, arthralgias, nausea and vomiting, and neuromuscular problems. There were two early deaths, both attributable to tumor progression with resultant obstruction of a vital structure. Ten patients crossed over to alternate active therapy (etoposide [VP-16]-cisplatin) and five responded. The median survival time (MST) of the whole group of treated patients was 31 weeks. In future trials of investigational new drugs in previously untreated SCLC, we recommend that patients with the following characteristics be excluded: Eastern Cooperative Oncology Group (ECOG) performance status 2, 3, and 4; superior vena cava (SVC) obstruction; any major paraneoplastic syndrome; serious comorbid illness; and extensive hepatic involvement by tumor. The trial design should include prompt crossover to active alternative therapy, such as VP-16 and cisplatin, for disease progression or for failure to respond after two treatment cycles. Also, the trial design should use an early stopping rule based on interest in identifying only very active agents with a minimum response rate of 30%.

Research utilizaton: an evaluation and critique of research related to oral temperature measurement

The problem addressed was whether a research-based protocol on oral temperature measurement could be developed and used in the practice setting. The first phase of the study proposed to (a) identify research articles related to the subject; (b) evaluate the quality of the research; (c) assess the adequacy of the research base; and (d) select areas for future study. The results indicated that further clinically-based studies are needed before a protocol can be designed and tested in clinical practice.