Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized Intergroup study 0099

PURPOSE

The Southwest Oncology Group (SWOG) coordinated an Intergroup study with the participation of Radiation Therapy Oncology Group (RTOG), and Eastern Cooperative Oncology Group (ECOG). This randomized phase III trial compared chemoradiotherapy versus radiotherapy alone in patients with nasopharyngeal cancers.

MATERIALS AND METHODS

Radiotherapy was administered in both arms: 1.8- to 2.0-Gy/d fractions Monday to Friday for 35 to 39 fractions for a total dose of 70 Gy. The investigational arm received chemotherapy with cisplatin 100 mg/m2 on days 1, 22, and 43 during radiotherapy; postradiotherapy, chemotherapy with cisplatin 80 mg/m2 on day 1 and fluorouracil 1,000 mg/m2/d on days 1 to 4 was administered every 4 weeks for three courses. Patients were stratified by tumor stage, nodal stage, performance status, and histology.

RESULTS

Of 193 patients registered, 147 (69 radiotherapy and 78 chemoradiotherapy) were eligible for primary analysis for survival and toxicity. The median progression-free survival (PFS) time was 15 months for eligible patients on the radiotherapy arm and was not reached for the chemo-radiotherapy group. The 3-year PFS rate was 24% versus 69%, respectively (P < .001). The median survival time was 34 months for the radiotherapy group and not reached for the chemo-radiotherapy group, and the 3-year survival rate was 47% versus 78%, respectively (P = .005). One hundred eighty-five patients were included in a secondary analysis for survival. The 3-year survival rate for patients randomized to radiotherapy was 46%, and for the chemoradiotherapy group was 76% (P < .001).

CONCLUSION

We conclude that chemoradiotherapy is superior to radiotherapy alone for patients with advanced nasopharyngeal cancers with respect to PFS and overall survival.

Anti-inflammatory, procollagen, and wound repair properties of topical insulin gel

Diabetes mellitus is associated with impaired wound healing. The topical use of insulin is a promising therapy because it may favor all phases of the wound healing process. This study aimed to investigate the therapeutic outcomes of insulin gel in wounds of hyperglycemic mice. After diabetes induction, a 1-cm2 full-thickness wound was created on each animal's dorsum. The lesions were treated daily for 14 days with insulin gel (insulin group) or vehicle gel without insulin (vehicle group). Tissue samples were extracted on days 4, 7, 10, and 14 after the creation of the lesion. The samples were analyzed with hematoxylin/eosin and Sirius red staining, immunohistochemistry, Bio-Plex immunoassays, and western blotting. Insulin gel favored re-epithelialization at day 10 and increased the organization and deposition of collagen. Additionally, it modulated the expression of cytokines (interleukin (IL)-4 and IL-10) and increased the expression of arginase I, VEGF receptor 1, and VEGF on day 10. Activation of the insulin signaling pathway occurred via IRβ, IRS1, and IKK on day 10 and activation of Akt and IRS1 on day 14. These results suggested that insulin gel improved wound healing in hyperglycemic mice by modulating the expression of inflammatory factors, growth factors, and proteins of the insulin signaling pathway.

The reproducibility of remotely piloted aircraft systems to monitor seasonal variation in submerged seagrass and estuarine habitats

Seasonal variation in seagrass growth and senescence affects the provision of ecosystem services and restoration efforts, requiring seasonal monitoring. Remotely piloted aircraft systems (RPAS) enable frequent high-resolution surveys at full-meadow scales. However, the reproducibility of RPAS surveys is challenged by varying environmental conditions, which are common in temperate estuarine systems. We surveyed three eelgrass ( Zostera marina) meadows in Newfoundland, Canada, using an RPAS equipped with a three-color band (red, green, blue [RGB]) camera, to evaluate the seasonal reproducibility of RPAS surveys and assess the effects of flight altitude (30–115 m) on classification accuracy. Habitat percent cover was estimated using supervised image classification and compared to corresponding estimates from snorkel quadrat surveys. Our results revealed inconsistent misclassification due to environmental variability and low spectral separability between habitats. This rendered differentiating between model misclassification versus actual changes in seagrass cover infeasible. Conflicting estimates in seagrass and macroalgae percent cover compared to snorkel estimates could not be corrected by decreasing the RPAS altitude. Instead, higher altitude surveys may be worth the trade-off of lower image resolution to avoid environmental conditions shifting mid-survey. We conclude that RPAS surveys using RGB imagery alone may be insufficient to discriminate seasonal changes in estuarine subtidal vegetated habitats.

1079 USE OF AN ADVANCE CARE PLAN CHECKLIST TO IMPROVE COMMUNICATION AND ASSESSMENT OF THE IMPACT ON HOSPITAL READMISSIONS

Introduction

Advance care planning (ACP) is a vital part of holistic and person-centred care. It allows formalising of an individual’s wishes and best interests, and avoids unnecessary or unwanted interventions including, potentially, hospital admissions. It is crucial that any decisions or recommendations are communicated to all relevant healthcare professionals to ensure peoples’ wishes are upheld. We developed this project to review and improve documentation and communication on discharge when a decision had been made to limit care to the community and avoid admission.

Method

A checklist was developed comprising 11 criteria to be documented in the discharge letter and actions to disseminate information including; updating the ReSPECT form and alerting the hospital frailty and community out of hours teams. We carried out a closed loop audit of patients where admission should be avoided and reviewed discharge letters against the criteria. Where patients were readmitted we reviewed the notes to determine whether the admission was appropriate.

Results

We compared patients discharged between February 2020–February 2021 and then from March–September 2021. 161 and 27 patients were identified respectively. Average age was 84.6 and 87.3 years respectively. In cohort 2 48.1% of patients were readmitted, up from 8.7% during the previous cycle. 33% of admissions in cohort 2 and 38.9% of readmissions in cohort 1 were deemed appropriate. Documentation improved in 10 of the 11 criteria. Average length of stay for readmissions was reduced from 16.7 to 5.7 days.

Conclusion

As evidenced by our study utilising a checklist has improved documentation and dissemination of ACPs to the Community. This did not lead to a reduction in hospital admissions but this may have been skewed by factors relating to the Covid-19 pandemic. We did find a significant reduction in length of stay for those subsequently readmitted.

Demand for regional level III neonatal services is not reduced during national COVID lockdowns

Following the first peak of the COVID-19 pandemic, reports from around the world suggested a reduction in preterm deliveries during lockdown periods. We reviewed preterm admissions to a large tertiary neonatal unit in inner North East London during two United Kingdom (UK) national lockdowns in 2020 and 2021. We found no evidence of difference in admissions during two national lockdowns compared to previous years. Based on these findings, we recommend that neonatal services remain as vigilant and prepared as ever for the unpredictable nature of preterm birth, and their staff protected to provide this highly specialist care.

123 Nerve growth factor-induced ovulation in llamas: Evidence of hypothalamic refractoriness to nerve growth factor during the declining phase of the luteinising hormone surge

Nerve growth factor (NGF) in semen is responsible for triggering ovulation after copulation in camelids. Interaction of NGF with its cognate receptors results in a preovulatory luteinising hormone (LH) surge that leads to ovulation, but the pharmacokinetics of NGF and the mechanism by which it mediates LH release are unknown. In an effort to elucidate the site and mechanism of action involved, the objective of this study was to determine whether the decline in the LH surge occurs as a result of pituitary depletion (i.e. diminished response to gonadotrophin-releasing hormone (GnRH)) or as an obtunded response at the level of the hypothalamus (diminished GnRH). Adult nonpregnant, nonlactating llamas (n=18) were synchronized by the administration of an ovulatory dose of a GnRH analogue (100μg IM; Fertiline, Vetoquinol). At 10 to 14 days later, the ovaries were examined to confirm the presence of a dominant follicle measuring ≥ 7mm, and a jugular catheter was put in place. The following day, a pretreatment blood sample was taken, and llamas were treated intravenously with 1mg of purified NGF from llama seminal plasma. Blood samples were taken every 30min for 7h from the time of NGF treatment. After the last blood sample was taken, llamas were treated with NGF (n=6; 1mg IV), GnRH (n=5; 100μg IV), or saline (Sal; IV; n=6), and blood samples were taken every 30min for another 7h. The ovaries were examined 48h after initial NGF treatment, via transrectal ultrasonography, to detect ovulation. Plasma was harvested and stored for analysis of LH concentration by radioimmunoassay. Data were compared using ANOVA for repeated measures, and single-point data were analysed using paired t-tests. As expected, most llamas ovulated in response to the initial NGF treatment (5 out of 5 in NGF-GnRH; 5 of 6 in NGF-NGF; 5 of 6 in NGF-Sal). Compared with pretreatment values, all llamas showed a 4-fold increase in plasma LH concentrations within 2h of the initial NGF treatment (P&lt;0.05). Plasma LH concentrations peaked at 3h after initial NGF treatment and began to decline 4.5 to 5h after treatment (P&lt;0.05). Plasma LH concentrations continued to decline following the second dose of NGF or Sal, whereas a transient elevation of LH was detected in llamas treated with GnRH (P&lt;0.05). The LH concentration returned to basal levels (pretreatment) 8, 12, and 13h after NGF treatment in llamas treated with NGF-Sal, NGF-GnRH, and NGF-NGF, respectively. We conclude that the lack of LH response to the second dose of NGF is not because of pituitary depletion but rather due to diminished GnRH. The latter may be attributed to either a downregulation of NGF receptors within the hypothalamus or to temporary depletion of GnRH at the nerve terminals within the median eminence. Research was supported by the Natural Sciences and Engineering Research Council of Canada.

175 Use of equine chorionic gonadotrophin in a minimum-handling protocol for oocyte collection in bison

Wood bison (Bison bison athabascae) and plains bison (Bison bison bison) are threatened subspecies native to North America. The creation of a germplasm biobank will connect valuable and inaccessible genetics from geographically distant herds in a biosecure manner. Protocols that are feasible in field conditions are required for cumulus-oocyte complex (COC) collection for the purpose of invitro embryo production (IVP). The efficacy of a single dose of equine chorionic gonadotrophin (ECG) was tested in an effort to develop a minimum-handling ovarian superstimulation protocol for bison. The experimental design enabled comparison between ECG-treated and non-superstimulated bison. Transvaginal ultrasound-guided follicle ablation was performed in mature wood bison (n=24) during May (anovulatory season) to induce follicular wave emergence the following day. Immediately after ablation, the bison were assigned to one of three groups (n=8 per group) and treated intramuscularly with 5000IU of ECG (Folligon, Merck), 2500IU of ECG, or saline (control). Transvaginal COC collection was performed 5 days later. Follicular and COC data were recorded, and only grade 1 and 2 COC were used for IVP. The COC were matured invitro for 25-28h at 38.8°C, fertilised (2×106 spermmL−1), and co-incubated at 38.8°C in 5% O2, 5% CO2, and 90% N2 for 18h. Presumptive zygotes were denuded and cultured at 38.8°C in 5% O2, 5% CO2, and 90% N2. Nominal data were compared among groups using analysis of variance, and proportional data were compared using GLIMMIX. The total number of follicles ≥3mm on the day of COC collection was greater in the 5000-IU ECG group than in the 2500-IU ECG and control groups (37.5±6.9, 17.5±2.0, and 16.9±2.0, respectively; P&lt;0.005). The number of follicles 5-8mm was also greater in the 5000-IU ECG group than in the 2500-IU ECG and control groups (12.5±2.1, 7.6±1.0, and 5.8±0.9, respectively; P&lt;0.01), as was the number of follicles &gt;8mm (21.1±5.4, 3.3±1.2, and 0.9±0.2, respectively; P&lt;0.0005). The proportion of grade 1 and 2 COC/total COC recovered was greater in the 5000-IU ECG group than in the 2500-IU ECG and control groups (84/124 (68%), 39/76 (51%), and 37/75 (49%), respectively; P&lt;0.05). The proportion of cleaved zygotes/number of COC matured, assessed at 56h after fertilisation, was similar among the 5000-IU ECG, 2500-IU ECG, and control groups (42/84 (50%), 27/39 (69%), and 21/37 (57%), respectively; P=0.20). The proportion of embryos of IETS grades 1-3/number of COC matured was also similar among the 5000-IU ECG, 2500-IU ECG, and control groups (15/84 (17.9%), 8/39 (20.5%), and 7/37 (18.9%), respectively; P=0.94), but the bison in the 5000-IU ECG group produced twice as many embryos than those in the other groups. In summary, a single dose of 5000IU of ECG increased the number and size of follicles available for COC collection, more than doubled the number of COC collected for IVP, and resulted in the production of more embryos than the other groups. A single dose of 5000IU of ECG is effective in a minimum-handling protocol for ovarian superstimulation and IVP in bison. This research was supported by NSERC.

Tolerogenic dendritic cell-based treatment for multiple sclerosis (MS): a harmonised study protocol for two phase I clinical trials comparing intradermal and intranodal cell administration

INTRODUCTION

Based on the advances in the treatment of multiple sclerosis (MS), currently available disease-modifying treatments (DMT) have positively influenced the disease course of MS. However, the efficacy of DMT is highly variable and increasing treatment efficacy comes with a more severe risk profile. Hence, the unmet need for safer and more selective treatments remains. Specifically restoring immune tolerance towards myelin antigens may provide an attractive alternative. In this respect, antigen-specific tolerisation with autologous tolerogenic dendritic cells (tolDC) is a promising approach.

METHODS AND ANALYSIS

Here, we will evaluate the clinical use of tolDC in a well-defined population of MS patients in two phase I clinical trials. In doing so, we aim to compare two ways of tolDC administration, namely intradermal and intranodal. The cells will be injected at consecutive intervals in three cohorts receiving incremental doses of tolDC, according to a best-of-five design. The primary objective is to assess the safety and feasibility of tolDC administration. For safety, the number of adverse events including MRI and clinical outcomes will be assessed. For feasibility, successful production of tolDC will be determined. Secondary endpoints include clinical and MRI outcome measures. The patients' immune profile will be assessed to find presumptive evidence for a tolerogenic effect in vivo.

ETHICS AND DISSEMINATION

Ethics approval was obtained for the two phase I clinical trials. The results of the trials will be disseminated in a peer-reviewed journal, at scientific conferences and to patient associations.

TRIAL REGISTRATION NUMBERS

NCT02618902 and NCT02903537; EudraCT numbers: 2015-002975-16 and 2015-003541-26.

202 ANTRAL FOLLICULAR COUNTS AND SUPERSTIMULATORY RESPONSE IN PREPUBERTAL CALVES

The number of follicles recruited in successive waves are consistent in postpubertal cattle (Singh et al. 2004 Theriogenology 62, 227), but ovarian response to gonadotropin stimulation is highly variable among animals. We tested the hypotheses that the number of follicles present at wave emergence are repeatable and are predictive of superstimulatory response in prepubertal calves; therefore, we expected that calves with higher antral follicular counts (AFC; follicles = 1mm) at wave emergence will result in a greater number of follicles available for oocyte collection after a conventional 4-day gonadotropin treatment. Hereford crossbreed calves (n = 52; 5.1 to 6.8 months of age) were ranked according to the number of follicles = 1 mm detected in transrectal ultrasound video recordings of both ovaries at the time of wave emergence (First AFC; range: 12 to 53 follicles). Calves in the bottom (Low AFC; <20 follicles; n = 6) and top (High AFC; >32 follicles; n = 5) quartiles were selected for ovarian superstimulation. Emergence of a new follicular wave (Day 0) was induced by transvaginal follicle ablation (14 to 57 days after first AFC; 5.7 to 7.1 months of age), AFC were performed again (Second AFC), and calves were given eight 12-hourly IM injections of 25 mg of pFSH (Folltropin-V®, Bioniche Animal Health Inc., Belleville, Canada) beginning on Day 0.5. All calves were given 12.5 mg of pLH (Lutropin-V®, Bioniche Animal Health Inc.) IM 12 h after the last FSH and number of follicles equal to 3, 3 to 5, 6 to 8, and equal to 6 and 9 were counted 24 h after LH treatment (at the time of oocyte collection). A t-test was used to compare the number of follicles and ovarian response (Low v. High AFC). Values of Pearson (0.8; P < 0.001) and Spearman (0.9; P < 0.001) correlation coefficients between First and Second AFC indicate strong repeatability of numbers of follicles present at the time of wave emergence. As expected, mean number of follicles were greater (P = 0.01) in the High- than Low-AFC group (24.2 ± 2.0 v. 15.7 ± 1.0) at the Second AFC. The High-AFC group had a greater number of follicles at oocyte collection than Low AFC for 6 to 8 mm (13.4 ± 2.1 v. 5.3 ± 1.7; P = 0.01), but not for 3 to 5 mm (9.4 ± 2.5 v. 5.3 ± 2.1; P = 0.2) or 9 mm (7.6 ± 2.9 v. 4.8 ± 2.0; P = 0.4) size categories. However, High AFC resulted in a greater total number of follicles 3 (30.4 ± 3.1 v. 15.5 ± 3.2; P = 0.009) and 6 mm (21.0 ± 4.1 v. 10.2 ± 2.9; P = 0.05). The number of 6-mm follicles at the end of superstimulation represented 80 and 60% of 1-mm follicles at wave emergence in the High- and Low-AFC groups (P = 0.3). In conclusion, the number of follicles at the beginning of a wave are predictive of follicles recruited into subsequent waves in 7-month-old calves, and higher AFC at wave emergence resulted in a greater number of 3- and 6-mm follicles available for oocyte collection. Research was supported by the Natural Science and Engineering Council of Canada (NSERC). Hormones provided by Vetoquinol Inc. ARTK funded by CNPq-Science Without Borders, Brazil.

121 THREE-DIMENSIONAL ASSESSMENT OF EARLY CORPUS LUTEUM VASCULARITY IN BUFFALO (BUBALUS BUBALIS)

The aim of the study was to develop an objective method to assess the vascular flow to the early corpus luteum (CL) in buffaloes using colour Doppler ultrasound data. Our hypothesis was that 3-dimensional (3D) volumetric analysis of vascularity would demonstrate lower variability between animals compared with conventional 2-dimensional (2D) analysis of single images. Wave emergence and ovulation was synchronized in buffalo (n = 16) using prostaglandin-GnRH based protocols. Colour Doppler ultrasonography (MyLab5, 7.5-MHz linear array, colour gain 65%) was performed daily from Day −2 to 4 (Day 0 = ovulation). Video clips of the ovaries (20 s at 18–28 frames per second, AVI) were recorded by slow and uniform free-hand movement of the transducer. Day 4 CL was used for analysis of vascular area and volume. For 2D vascularity assessment, 3 images (800 × 652 pixels, RGB, BMP) of each CL (at maximum apparent vascularity) were acquired through the clip image function on the ultrasound machine and analysed by ImageJ (Fiji) software (NIH, Bethesda, MD, USA). For 3D vascularity assessment, a portion of the video clip encompassing an entire ovary was identified and exported as a series of 2D TIFF images using Videomach software. The ultrasound scale bar was used to calculate the number of pixels per millimetre and to calibrate the X (horizontal) and Y (vertical) dimensions. For 2D analyses, the CL boundary was drawn using the free-hand manual selection tool in Fiji, the area of the CL (mm2) was recorded, and the border was then enlarged by 1.5 mm to include the peripheral vascular region of the CL. The colour threshold was adjusted to select the vascular region. The 2D vascularity score was calculated as the ratio of the coloured area to the enlarged luteal area. For 3D volumetric analyses, each series of TIFF images was imported as an image sequence in Fiji and colour thresholding (similar to 2D analysis) was applied to save a second TIFF series containing luteal vascular regions (coloured areas) only. The remaining volumetric analyses were completed in Imaris software using the ovarian volume (original TIFF series) and luteal vascular volume (second TIFF series) as separate channels. The Z-dimension thickness of each image was estimated by using the dimensions of a follicle within the same ovary (Z-axis diameter = mean diameter along X- and Y-axes). Similar to 2D analyses, the volume of the CL was obtained by drawing a border along the edge of the CL, the CL border was enlarged by 1.5 mm, and a 3D vascularity score was obtained by building a surface on the luteal vascular image and calculating the vascular to luteal volume ratio. The 2D vascularity score differed from 3D vascularity score (0.21 ± 0.02 v. 0.13 ± 0.02, paired t-test P < 0.01); however, variance did not differ (Bartlett’s test P = 0.32). Our initial results support the notion that the described technique of quantifying vascular volume of the corpus luteum may decrease the technical variability during image assessment and therefore better reflect the true vascularity compared with 2D image analyses. Research was supported by a grant from the Natural Sciences and Engineering Research Council of Canada.

Infection control link professionals' knowledge of Clostridium difficile

lostridium difficile is a common cause of diarrhoea in hospitalised patients. It can result in longer hospital stays and due to the need for strict isolation procedures can add significantly to nursing workload. Additionally, it can be very distressing for the patient and if patients are vulnerable to infection it can have serious health consequences. Cross-transmission can be limited by good infection prevention and control practices, however this relies on a sound knowledge base and support from the infection control team. This small-scale study reports on infection control link professionals' knowledge and assesses how they would utilise this knowledge in practice situations. Findings imply that the knowledge base concerning the microorganism was poor, but knowledge relating to general infection procedures was good.

The micro-architecture of human cancellous bone from fracture neck of femur patients in relation to the structural integrity and fracture toughness of the tissue

Osteoporosis is clinically assessed from bone mineral density measurements using dual energy X-ray absorption (DXA). However, these measurements do not always provide an accurate fracture prediction, arguably because DXA does not grapple with ‘bone quality’, which is a combined result of microarchitecture, texture, bone tissue properties, past loading history, material chemistry and bone physiology in reaction to disease. Studies addressing bone quality are comparatively few if one considers the potential importance of this factor. They suffer due to low number of human osteoporotic specimens, use of animal proxies and/or the lack of differentiation between confounding parameters such as gender and state of diseased bone. The present study considers bone samples donated from patients (n = 37) who suffered a femoral neck fracture and in this very well defined cohort we have produced in previous work fracture toughness measurements (FT) which quantify its ability to resist crack growth which reflects directly the structural integrity of the cancellous bone tissue. We investigated correlations between BV/TV and other microarchitectural parameters; we examined effects that may suggest differences in bone remodelling between males and females and compared the relationships with the FT properties. The data crucially has shown that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV. Correlations between FT critical stress intensity values and microarchitecture parameters (BV/TV, BS/TV, TbN, BS/BV and SMI) for osteoporotic cancellous tissue were observed and are for the first time reported in this study. Overall, this study has not only highlighted that the fracture model based upon BMD could potentially be improved with inclusion of other microarchitecture parameters, but has also given us clear clues as to which of them are more influential in this role.

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first time ever study to relate microarchitecture to the fracture toughness of cancellous bone from the femoral head of FNF victims

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reduction in bone mass relates to a reduction in the number of trabeculae and trabecular thickness and an increase in trabeculae spacing

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bone loss observed appears to be a consequence of thinning of the trabeculae in males and perforation of the trabeculae in females

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study hints that TbTh, TbSp, SMI and TbN may provide a proxy or surrogate for BV/TV

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fracture models can be improved by including microarchitecture, BMD and the bone mineral quality of osteoporotic cancellous bone

287 EFFECT OF FOLLICULAR AGING ON THE ATP CONTENT AND DISTRIBUTION OF MITOCHONDRIA IN BOVINE OOCYTES

Our objective was to determine how follicular aging affects the distribution and content of mitochondrial population and ATP in in vivo-matured bovine oocytes. We hypothesised that in vivo-matured bovine oocytes obtained from aged follicles (84 h of gonadotropin starvation) have altered mitochondrial distribution and decreased cytoplasmic ATP content compared to those obtained immediately at the end of a superstimulatory protocol (no starvation). Follicular waves were synchronized by ablation 5 to 8 d after ovulation and a CIDR device was given. Starting on the day of wave emergence (Day 0), short FSH and FSH starvation groups (n = 5 heifers each) were given 8 doses of FSH im over 4 d and the long FSH group (n = 4) was given 14 doses over 7 d. Two doses of PGF were given on Day 4 (short FSH) or Day 7 (FSH starvation and long FSH groups), the CIDR was removed, and LH was given 24 h after second PGF treatment. The ovaries were removed 24 h later by colpotomy and cumulus-oocyte-complexes (COC) were collected from follicles ≥8 mm. Denuded oocytes were either stained with Mitotracker Deep Red FM and imaged by confocal microscopy or processed for ATP assay. Mitochondria numbers were assessed by segmentation of 3D datasets. Proportions of COC within each grade were compared using Fischer's exact test, and ATP and mitochondrial data were compared by analysis of variance. Short and long FSH groups had a greater proportion of Grade 1 expanded COC than the FSH starvation group (P = 0.02). The ATP content of oocytes (from expanded COC) tended to be higher in the long FSH group than short FSH (P = 0.09), and the FSH starvation group was intermediate. The ATP content of oocytes from compact COC did not differ among groups (P = 0.49). The proportion of mitochondrial clusters was highest (P = 0.01) and the proportion of individual mitochondria was lowest (P = 0.01) in the FSH starvation group compared to short and long FSH groups. Mitochondria from the long FSH and FSH starvation groups had twice the relative intensity compared to the short FSH group (P < 0.01). In conclusion, follicular aging (FSH starvation) was associated with a decrease in oocyte morphologic grade and marked clustering of mitochondria, which may be a reflection of oxidative stress and atresia.

Radiotherapy for optic nerve sheath meningioma: a case for earlier intervention?

AIMS

To assess tumour control, visual outcomes and toxicity after radiotherapy for all patients with optic nerve sheath meningiomas (ONSM) treated by a single radiation oncologist at a single institution over a 15 year period. To explore potential predictors of outcomes.

MATERIALS AND METHODS

All patients underwent ophthalmological and radiological assessments before radiotherapy. These were repeated at regular intervals after treatment. A retrospective analysis of clinical, dosimetric and radiological data was carried out. Patients with useful vision before radiotherapy were divided into two groups - those with maintained or improved vision and those with a deterioration in vision. The groups were compared using the Mann-Whitney U-test with regard to eight potential predictors of outcome.

RESULTS

Seventeen patients with 18 ONSM were treated with fractionated radiotherapy (46.8-55.8 Gy in 26-31 fractions). No evaluable tumours grew after treatment: control rate 100% (95% confidence interval 82-100%). Using the most common definition of visual function described in the literature, vision was maintained or improved in 89% (95% confidence interval 67-97%) of cases. In those with useful vision before treatment (13 evaluable eyes), visual acuity was maintained or improved in eight (62%, 95% confidence interval 36-82%). There was a suggestion that the time from the onset of symptoms to radiotherapy may influence outcome. Those with stable or better visual acuity after radiotherapy had been observed for a shorter time compared with those who had worse visual acuity (median of 18 months versus 62 months). Acute and late toxicity from radiotherapy was manageable.

CONCLUSION

Radiotherapy is an extremely effective modality in arresting the growth of ONSM. A longer time from symptom onset to the start of radiotherapy may predict for poorer outcomes.

Platinum-based adjuvant chemotherapy for early-stage epithelial ovarian cancer: single or combination chemotherapy?

OBJECTIVE

To evaluate the clinical benefit and toxicity of two regimens; single agent carboplatin (C) and a carboplatin/paclitaxel (CP) combination in early epithelial ovarian cancer.

DESIGN

A retrospective review.

SETTING

Single cancer centre serving a population of 2.1 million in the northwest of England.

POPULATION

All women treated with adjuvant chemotherapy for International Federation of Obstetrics and Gynecology stage Ia-IIc ovarian cancer between 2002 and 2005.

METHODS

Case and operation notes were reviewed. Details of the surgery performed, performance status (PS), tumour histology, stage, grade, intended chemotherapy, chemotherapy received, acute and late toxicity, relapse and death were all recorded.

MAIN OUTCOME MEASURES

Overall survival (OS), relapse-free survival (RFS), acute and late toxicity.

RESULTS

Sixty women received CP and 35 received C. Younger women (P < 0.0001) and those with a better performance status (P = 0.045) were more likely to receive CP. Median follow- up was 38 months (range 0-70). Five-year OS was 62% (95% CI 44-81%) for C and 73% (95% CI 61-85%) for CP P= = 0.316. For the subgroup with stage I disease and good PS (0/1) 5-year OS was 80% (59-100%) for C and 79% (63-95%) for CP; P = 1.0. For those with stage 2 disease, 5-year OS was 29% (95% CI 0-62%) for C and 63% (95% CI 44-82%) for CP; P = 0.025. Subgroup analyses by grade or histology showed no difference in OS. P was discontinued prematurely in nine (15%) women on account of toxicity, whereas C was not stopped early. P-related neuropathy (G1/2) was reported in ten (17%) women at 6 months and in two (3%) at 1 year.

CONCLUSIONS

Combination therapy is administered more often than carboplatin; especially in those with younger age, better PS and nonmucinous histology. Recurrence and death rates were similar with both treatments. Well-designed trials are needed to identify the optimum chemotherapy regimen in this group.

Precise measurement of the neutron magnetic form factor G(M)n in the few-GeV2 region

The neutron elastic magnetic form factor was extracted from quasielastic electron scattering on deuterium over the range Q;{2}=1.0-4.8 GeV2 with the CLAS detector at Jefferson Lab. High precision was achieved with a ratio technique and a simultaneous in situ calibration of the neutron detection efficiency. Neutrons were detected with electromagnetic calorimeters and time-of-flight scintillators at two beam energies. The dipole parametrization gives a good description of the data.

Search for the photoexcitation of exotic mesons in the pi+pi+pi- system

A search for exotic mesons in the pi;{+}pi;{+}pi;{-} system photoproduced by the charge exchange reaction gammap-->pi;{+}pi;{+}pi;{-}(n) was carried out by the CLAS Collaboration at Jefferson Lab. A tagged-photon beam with energies in the 4.8 to 5.4 GeV range, produced through bremsstrahlung from a 5.744 GeV electron beam, was incident on a liquid-hydrogen target. A partial wave analysis was performed on a sample of 83 000 events, the highest such statistics to date in this reaction at these energies. The main objective of this study was to look for the photoproduction of an exotic J;{PC}=1;{-+} resonant state in the 1 to 2 GeV mass range. Our partial wave analysis shows production of the a_{2}(1320) and the pi_{2}(1670) mesons, but no evidence for the a_{1}(1260), nor the pi_{1}(1600) exotic state at the expected levels. An upper limit of 13.5 nb is determined for the exotic pi_{1}(1600) cross section, less than 2% of the a_{2}(1320) production.

19 THE EFFECT OF PROGESTERONE ON FOLLICULAR DEVELOPMENT AND PREGNANCY RATE IN BEEF CATTLE

The objective was to determine the effect of the level of progesterone (P4) during the ovulatory wave on fertility. Low v. high progesterone concentrations which were expected to result in high v. low LH pulse-frequency were compared. Lactating, postpartum beef cows (n = 69) at random stages of the estrous cycle were given cloprostenol (PGF; Schering-Plough Animal Health, Pointe-Claire, QC, Canada) twice at an 11-day interval to synchronize ovulation (Day 0 = day of 2nd PGF). Cows were given 1.5 mg estradiol benzoate on Day 10 (7 days after expected ovulation). On Day 10, the Low-P4 group was given PGF and an intravaginal CueMate (Bioniche Animal Health, Belleville, ON, Canada) containing one P4 pod (expected to achieve a P4 plasma level of 1 ng mL–1). The High-P4 group also received a CueMate with one pod on Day 10, but no PGF was administered (i.e., cows were allowed to retain their CL for 4 days after expected emergence of the estradiol-induced wave). On Day 18, CueMates were removed and PGF was administered to both groups. Fifty-four to 56 h later, all animals received 12.5 mg of Lutropin-V (Bioniche) IM and were timed AI (TAI). Dominant follicle diameter was measured on Day 18 and at the time of AI. Pregnancy diagnosis was done by ultrasonography 27 days after AI to compare fertility between groups. Follicle diameter data were analyzed by Student's t-test and pregnancy rate data were compared by the chi-square test. The dominant follicle in the Low-P4 group was larger (P < 0.05) than in the high-P4 group on the day of the CueMate removal (Day 18) and on the day of the TAI (11.8 � 0.4 and 13.7 � 0.5 v. 13.3 � 0.6 and 15.3 � 0.6 in the High-P4 and Low-P4 groups, respectively). Pregnancy rate was similar (P = 0.16) between the groups (High-P4: 55.6% (20/36) and Low-P4: 44.4% (16/33)); however, a larger study is in progress to confirm these results. To conclude, Low-P4 resulted in a larger dominant follicle without any apparent effect on pregnancy rate. The project was funded by Saskatchewan ADF and NSERC. L. Pfeifer is funded through a CAPES scholarship. We acknowledge Schering-Plough and Bioniche for donation of pharmaceuticals.

Search for medium modifications of the rho meson

The photoproduction of vector mesons on various nuclei has been studied using the CLAS detector at Jefferson Laboratory. The vector mesons, rho, omega, and varphi, are observed via their decay to e;{+}e;{-}, in order to reduce the effects of final-state interactions in the nucleus. Of particular interest are possible in-medium effects on the properties of the rho meson. The rho mass spectrum is extracted from the data on various nuclei, 2H, C, Fe, and Ti. We observe no significant mass shift and some broadening consistent with expected collisional broadening for the rho meson.

Experimental study of exclusive 2H(e,e'p)n reaction mechanisms at high Q2

The reaction 2H(e,e'p)n has been studied with full kinematic coverage for photon virtuality 1.75<Q2<5.5 GeV2. Comparisons of experimental data with theory indicate that for very low values of neutron recoil momentum (p(n)<100 MeV/c) the neutron is primarily a spectator and the reaction can be described by the plane-wave impulse approximation. For 100<p(n)<750 MeV/c, proton-neutron rescattering dominates the cross section, while Delta production followed by the NDelta-->NN transition is the primary contribution at higher momenta.

Statin use and inflammation in prostate biopsy tissue

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Background: The statin class of drugs has been shown to affect tumors through a number of mechanisms including inhibiting tissue inflammation. Inflammation is a common finding in men undergoing a prostate biopsy and may play a role in prostatic tumorigenesis. We set out to determine whether the use of statin drugs was associated with altered tissue inflammation on prostate biopsy. Methods: Data were collected on all men with a PSA </= 10 ng/ml that underwent a prostate biopsy. A urinalysis to rule out the presence of infection was carried out in all men. The presence or absence of cancer and/or inflammation was determined by pathology report review. Statin data were recorded from the VA electronic pharmacy database. Statin duration and intensity variables were calculated for each subject based on total days used for each statin at each prescribed dose. Only men with a negative biopsy were considered in our analyses. Odds ratios (OR) as estimates of the relative risk for prostate inflammation associated with each level of statin use and 95 percent confidence intervals (CI) were obtained using pooled conditional logistic regression stratified on year of biopsy. Results: Out of 1,482 men with data available on inflammation, family history of prostate cancer, age and race; 436 were found to have prostatic inflammation. In final adjusted models stratified on year of biopsy (prior to 1997, 1997–2001, 2001 -2006) we found no association between any statin use (OR=0.88, 95% CI (0.70–1.11)), intensity of use (OR=0.93, 95% CI (0.86–1.01)), or duration of use (OR=0.932, 95% CI (0.86–1.01). These results did not change when individual statin types were analyzed. Conclusions: Statin use was not associated with a reduction in tissue inflammation in men undergoing a prostate biopsy. If statin use affects prostatic carcinogenesis, it is unlikely to do so by affecting tissue inflammatory networks.

No significant financial relationships to disclose.

A comparison of two chlorhexidine gel brushing regimens and a conventional toothpaste brushing regimen for the development of tooth staining over a 6-week period

AIMS

A single-centre, randomized single-blind parallel study was undertaken to compare staining seen with three brushing regimens and to determine subject perception of side effects such as staining and effects on taste.

METHODS

This 6-week parallel study used 157 volunteers who were randomized into one of three treatment groups: (i) brushing in the morning and evening with a normal dose of a 1% chlorhexidine gel, (ii) brushing with a low dose of chlorhexidine gel in the evening and a whitening dentifrice in the morning, and (iii) brushing with a standard fluoride paste in the morning and evening. Following home usage of their allocated products, the study volunteers returned after 3 and 6 weeks to record the amount of stain present. After the 6-week period, subject perception of taste and stain acceptability was determined using a questionnaire.

RESULTS

After 6 weeks of use of the low-dose chlorhexidine gel and whitening dentifrice, significantly more stain was seen compared with the use of a standard dentifrice (P<0.0001). Similarly, significantly more stain was seen with use of the normal-dose chlorhexidine gel compared with the low-dose gel and whitening dentifrice (P=0.0007). Approximately 30% of individuals on the low-dose chlorhexidine gel regimen found the amount of stain unacceptable and 10% noted an effect on their taste perception.

CONCLUSIONS

The use of low dose of chlorhexidine gel at night and a whitening paste in the morning produced a significant amount of stain that 30% of subjects considered unacceptable.

Measurement of the N-->Delta(+)(1232) transition at high-momentum transfer by pi(0) electroproduction

We report a new measurement of the exclusive electroproduction reaction gamma(*)p-->pi(0)p to explore the evolution from soft nonperturbative physics to hard processes via the Q(2) dependence of the magnetic (M(1+)), electric (E(1+)), and scalar (S(1+)) multipoles in the N-->Delta transition. 9000 differential cross section data points cover W from threshold to 1.4 GeV/c(2), 4pi center-of-mass solid angle, and Q(2) from 3 to 6 GeV(2)/c(2), the highest yet achieved. It is found that the magnetic form factor G(M)(*) decreases with Q(2) more steeply than the proton magnetic form factor, the ratio E(1+)/M(1+) is small and negative, indicating strong helicity nonconservation, and the ratio S(1+)/M(1+) is negative, while its magnitude increases with Q(2).

Measurement of deeply virtual compton scattering with a polarized-proton target

The longitudinal target-spin asymmetry AUL for the exclusive electroproduction of high-energy photons was measured for the first time in ep-->e;'pgamma. The data have been accumulated at JLab with the CLAS spectrometer using 5.7 GeV electrons and a longitudinally polarized NH3 target. A significant azimuthal angular dependence was observed, resulting from the interference of the deeply virtual Compton scattering and Bethe-Heitler processes. The amplitude of the sinvarphi moment is 0.252+/-0.042stat+/-0.020sys. Theoretical calculations are in good agreement with the magnitude and the kinematic dependence of the target-spin asymmetry, which is sensitive to the generalized parton distributions H and H.