Modelling temperature and fish biomass data to predict annual Scottish farmed salmon, Salmo salar L., losses: Development of an early warning tool

Losses due to mortality are a serious economic drain on Scottish salmon aquaculture and are a limitation to its sustainable growth. Understanding the changes in losses, and associated drivers, are required to identify risks to sustainable aquaculture. Data on losses were obtained from two open source data sets: monthly losses of biomass 2003-2018 and losses of salmon over production cycles (numbers input minus output harvest) 2002-2016. Monthly loss rates increased, accelerating after 2010, while losses per production cycle displayed no trend. Two modelling frameworks were investigated to produce an early warning tool for managers about potential increases in losses. Both linear regression and beta regression showed that monthly losses related to biomass and minimum winter air temperatures with high precision and low bias. These relationships apply at both the national and regional levels where the beta regression best fit model explain 82 % and 69 % of variation in mortality, some regional differences apply, particularly for the Northern Isles. The lack of trend in losses per production cycle may have been due to shorter production cycles as more salmon were harvested earlier, and possibly increasing losses of larger salmon (which affects biomass but not numbers lost). In the long-term, the models predict that milder winters and increased biomass will be associated with increased mortality, which will need to be managed. In the short-term, given relatively little year-to-year variation in biomass, minimum winter temperature is a powerful early warning of the likely extent of losses in the Scottish salmon farming industry.

(ICORG 05-03): prospective randomized non-inferiority phase III trial comparing two radiation schedules in malignant spinal cord compression (not proceeding with surgical decompression); the quality of life analysis

BACKGROUND

The optimal primary external beam radiation therapy (EBRT) radiation schedule for malignant epidural spinal cord compression (MSCC) remains to be determined. The ICORG 05-03 trial assessed if a 10 Gy single fraction radiation schedule was not inferior to one with 20 Gray (Gy) in five daily fractions, in terms of functional motor outcome, for the treatment of MSCC in patients not proceeding with surgical decompression. This article reports on two of the secondary endpoints, Quality of life (QoL), assessed according to the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core 30 (QLQ-C30) version 3.0 (EORTC Data Center, Brussels, Belgium) and pain control assessed using a visual analog scale.

METHODS

A randomized, parallel group, multicenter phase III trial was conducted by Cancer Trials Ireland (formerly All-Ireland Cooperative Oncology Research Group, ICORG), across five hospital sites in Ireland and Northern Ireland. Patients were randomized to 10 Gy single fraction of EBRT or 20 Gy in five fractions in a 1:1 ratio. Patients with baseline and 5-week follow up QoL data are included in this analysis.

FINDINGS

From 2006 to 2014, 112 eligible patients were enrolled for whom 57 were evaluated for this secondary analysis. After adjusting for pre-intervention scores, there was no statistically significant difference in post-treatment Summary scores (excl. FI and QL), or pain scores between the two RT schedules at 5 weeks and 3 months following EBRT. There was a statistically significant relationship between the pretreatment and post-treatment Summary scores (p =  .002) but not between the pre-treatment and post-treatment pain scores.

INTERPRETATION

Primary radiotherapy for the treatment of MSCC significantly improves QoL in patients not proceeding with surgical decompression. After adjusting for pre-intervention scores, there was no statistically significant difference between a 10 Gy single fraction radiation schedule and one with 20 Gy in five daily fractions on post-treatment QoL Summary scores. For most patients, an effective treatment with low burden would be desirable. A single fraction schedule should be considered for this group of patients.

Telescoping Dual Covered Stent Graft Construct for Endovascular Treatment of a Giant Extracranial Carotid Artery Pseudoaneurysm

Large pseudoaneurysms which compress the parent vessel are challenging lesions to successfully treat with endovascular therapy. We describe the endovascular treatment of a giant extracranial carotid artery (ECCA) pseudoaneurysm resulting in substantial mass effect on the common carotid artery (CCA) bifurcation using a telescoping dual covered stent graft construct. A 56-year-old male was diagnosed with an 8.5 cm × 13 cm pseudoaneurysm arising from the left CCA bifurcation, which was causing luminal narrowing of the CCA and proximal internal carotid artery (ICA). The patient underwent endovascular intervention, during which a balloon-expandable covered stent was deployed within a heparin-bonded covered stent, such that the overall construct spanned from the CCA to the lower cervical ICA. The employment of a telescoping dual covered stent technique can successfully treat appropriately selected patients with large or giant ECCA pseudoaneurysms, with the concomitant goals of excluding the pseudoaneurysm and restoring the luminal caliber of the parent artery.

Spatial and temporal analysis of litter in the Celtic Sea from Groundfish Survey data: Lessons for monitoring

The Marine Strategy Framework Directive requires EU Member States to sample and monitor marine litter. Criteria for sampling and detecting spatial and/or temporal variation in the amount of litter present have been developed and initiated throughout Europe. These include implementing standardised sampling and recording methods to enable cross-comparison and consistency between neighbours. Parameters of interest include; litter occurrence, composition, distribution and source. This paper highlights the litter-related initiatives occurring in Irish waters; presents an offshore benthic litter sampling series; provides a power analysis to determine trend detection thresholds; identifies areas and sources of litter; and proposes improvements to meet reporting obligations. Litter was found to be distributed throughout Irish waters with highest occurrences in the Celtic Sea. Over 50% of litter encountered was attributed to fishing activities: however only a small proportion of the variability in litter occurrence could be explained by spatial patterns in fishing effort. Issues in implementing standardised protocol were observed and addressed.

Endovascular clot retrieval for acute ischaemic stroke: the Auckland City Hospital experience

AIMS

In acute ischaemic stroke, endovascular therapy with the Solitaire FR stent retriever has been shown to double recanalisation rates and the numbers of patients who recover to be functionally independent, when compared to standard therapy. We present the Auckland City Hospital experience of clot retrieval.

METHODS

Previously independent ischaemic stroke patients with contraindications to, or no response following, i.v. alteplase, were treated with clot retrieval. All patients had proximal large artery occlusions on CT angiography and many also had CT perfusion scans showing salvageable ischaemic tissue.

RESULTS

Clot retrieval was performed in 33 patients (10 women, mean (SD) age of 54 (17) years) since 2011. Twenty-two (67%) patients were first treated with alteplase. Patients fell into three groups: 17 (52%) had anterior circulation occlusion, similar to those in recent clot retrieval studies; 10 (30%) had posterior circulation occlusion; and six (18%) had 'Rescue' clot retrieval, usually with stroke that followed a procedure. Patients with anterior circulation occlusion had a median time from symptom onset to groin puncture of 225 (range 95-450) minutes, full recanalisation occurred in 76%, and by day 90, all 17 were alive and living at home, with 63% functionally independent (modified Rankin Scale (mRS) 0-2). At day 90, eight of 10 posterior circulation occlusion group patients were alive and living at home, four with a mRS of 0-2. In contrast, four of six 'Rescue' patients had died, and another was functionally dependent with a mRS of 4.

CONCLUSIONS

Endovascular clot retrieval can be safely and effectively performed in a New Zealand setting with similar results to recent trials in anterior circulation occlusion patients. We suggest that District Health Boards develop clot retrieval services as part of regional hyperacute stroke treatment pathways.

A Multicenter, Randomized, Controlled Study to Investigate Extending the Time for Thrombolysis in Emergency Neurological Deficits with Intra-Arterial Therapy (EXTEND-IA)

Background and Hypothesis

Thrombolysis with tissue plasminogen activator is proven to reduce disability when given within 4.5 h of ischemic stroke onset. However, tissue plasminogen activator only succeeds in recanalizing large vessel arterial occlusion in a minority of patients. We hypothesized that anterior circulation ischemic stroke patients, selected with ‘dual target’ vessel occlusion and evidence of salvageable brain using computed tomography or magnetic resonance imaging ‘mismatch’ within 4.5 h of onset, would have improved reperfusion and early neurological improvement when treated with intra-arterial clot retrieval after intravenous tissue plasminogen activator compared with intravenous tissue plasminogen activator alone.

Study Design

EXTEND-IA is an investigator-initiated, phase II, multicenter prospective, randomized, open-label, blinded-endpoint study. Ischemic stroke patients receiving standard 0.9 mg/kg intravenous tissue plasminogen activator within 4.5 h of stroke onset who have good prestroke functional status (modified Rankin Scale <2, no upper age limit) will undergo multimodal computed tomography or magnetic resonance imaging. Patients who also meet dual target imaging criteria: vessel occlusion (internal carotid or middle cerebral artery) and mismatch (perfusion lesion: ischemic core mismatch ratio >1.2, absolute mismatch >10 ml, ischemic core volume <70 ml) will be randomized to either clot retrieval with the Solitaire FR device after full dose intravenous tissue plasminogen activator, or tissue plasminogen activator alone.

Study Outcomes

The coprimary outcome measure will be reperfusion at 24 h and favorable clinical response (reduction in National Institutes of Health Stroke Scale by ≥8 points or reaching 0–1) at day 3. Secondary outcomes include modified Rankin Scale at day 90, death, and symptomatic intracranial hemorrhage.

Arsenic speciation in blue mussels (Mytilus edulis) along a highly contaminated arsenic gradient

Arsenic is naturally present in marine ecosystems, and these can become contaminated from mining activities, which may be of toxicological concern to organisms that bioaccumulate the metalloid into their tissues. The toxic properties of arsenic are dependent on the chemical form in which it is found (e.g., toxic inorganic arsenicals vs nontoxic arsenobetaine), and two analytical techniques, high performance liquid chromatography coupled with inductively coupled plasma mass spectrometry (HPLC-ICP-MS) and X-ray absorption spectroscopy (XAS), were used in the present study to examine the arsenic species distribution in blue mussels (Mytilus edulis) obtained from an area where there is a strong arsenic concentration gradient as a consequence of mining impacted sediments. A strong positive correlation was observed between the concentration of inorganic arsenic species (arsenic compounds with no As-C bonds) and total arsenic concentrations present in M. edulis tissues (R(2) = 0.983), which could result in significant toxicological consequences to the mussels and higher trophic consumers. However, concentrations of organoarsenicals, dominated by arsenobetaine, remained relatively constant regardless of the increasing As concentration in M. edulis tissue (R(2) = 0.307). XANES bulk analysis and XAS two-dimensional mapping of wet M. edulis tissue revealed the presence of predominantly arsenic-sulfur compounds. The XAS mapping revealed that the As(III)-S and/or As(III) compounds were concentrated in the digestive gland. However, arsenobetaine was found in small and similar concentrations in the digestive gland as well as the surrounding tissue suggesting arsenobetaine may being used in all of the mussel's cells in a physiological function such as an intracellular osmolyte.

Whipple's procedure for an oligometastasis to the pancreas from a leiomyosarcoma of the thigh

BACKGROUND

Pancreatic tumours are most frequently primary, with lesions secondary to metastasis uncommon.

METHODS

This report describes the case of a 61-year-old man who underwent resection of a right thigh leiomyosarcoma 2 years prior to presentation with obstructive jaundice. Subsequent CT and endoscopic ultrasound (EUS) diagnosed metastatic leiomyosarcoma to the pancreatic head for which he underwent a Whipple's pancreaticoduodenectomy.

CONCLUSION

Metastasis from an extremity leiomyosarcoma to the pancreas is an extremely rare entity, which can be diagnosed by EUS and treated successfully by pancreaticoduodenectomy.

Interventional radiology in the treatment of intracranial vascular injuries and fistulae

Traumatic intracranial vascular injuries are uncommon. However prompt diagnosis and management is essential because of the high morbidity and mortality associated with these conditions. The imaging evaluation and potential endovascular management of traumatic intracranial aneurysms and traumatic intracranial fistulae is discussed.

A simplified tumor regression grade correlates with survival in locally advanced rectal carcinoma treated with neoadjuvant chemoradiotherapy

BACKGROUND

Locally advanced rectal cancer is frequently treated with neoadjuvant chemoradiotherapy to reduce local recurrence and possibly improve survival. The tumor response to chemoradiotherapy is variable and may influence the prognosis after surgery. This study assessed tumor regression and its influence on survival in patients with rectal cancer treated with chemoradiotherapy followed by curative surgery.

METHODS

One hundred twenty-six patients with locally advanced rectal cancer (T3/T4 or N1/N2) were treated with chemoradiotherapy followed by total mesorectal excision. Patients received long-course radiotherapy (50 Gy in 25 fractions) in combination with 5-flourouracil over 5 weeks. By means of a standardized approach, tumor regression was graded in the resection specimen using a 3-point system related to tumor regression grade (TRG): complete or near-complete response (TRG1), partial response (TRG2), or no response (TRG3).

RESULTS

The 5-year disease-free survival was 72% (median follow-up 37 months), and 7% of patients had local recurrence. Chemoradiotherapy produced downstaging in 60% of patients; 21% of patients experienced TRG1. TRG1 correlated with a pathological T0/1 or N0 status. Five-year disease-free survival after chemoradiotherapy and surgery was significantly better in TRG1 patients (100%) compared with TRG2 (71%) and TRG3 (66%) (P = .01).

CONCLUSION

Tumor regression grade measured on a 3-point system predicts outcome after chemoradiotherapy and surgery for locally advanced rectal cancer.

A randomized prospective study of extended tocopherol and pentoxifylline therapy, in addition to carbogen, in the treatment of radiation late effects

Purpose:

pentoxifylline (PTX) and tocopherol (vitamin E) are antioxidants previously shown to be useful in combination in the treatment of late radiation induced toxicity. The purpose of this study was to investigate the benefit of combination therapy with carbogen pentoxifylline and tocopherol in the mitigation of late radiation effects. As the optimal duration of PTX and tocopherol treatment has not been fully established, we studied short versus extended treatment duration.

Methods:

we conducted a phase II prospective randomized study of short versus prolonged treatment with pentoxifylline (800 mg) and tocopherol (1000 IU) orally once daily in patients with grade three toxicity post-radical radiotherapy. In addition, all 18 patients received inhaled carbogen (95% O + 5% CO₂) over 90 minutes, five days/week, for three weeks. The primary end point was improved in maximum Lent-Soma toxicity scores.

Results:

maximum Lent-Soma scores improved in six of the 18 patients (response rate 33%). The proportion of patients responding to treatment in the prolonged treatment arm B was more than double than in the shorter arm A, but this did not reach statistical significance (p=0.321). Two patients who had prolonged treatment (arm B) had complete resolution of their symptoms, which was maintained at two and three year follow-ups.

Conclusions:

we recommend prolonged treatment for 12 months, with PTX and tocopherol in combination with carbogen therapy, in the management of late radiation effects.

A randomised prospective study of prolonged treatment with tocopherol and pentoxifylline, in addition to carbogen in the management of radiation late effects

19682

Background: Pentoxifylline (PTX) and tocopherol (Vitamin E) are antioxidants previously shown to be useful in combination in the treatment of late radiation effects. To our knowledge, this is the first study to examine the clinical benefit of combination therapy with carbogen, tocopherol and pentoxifylline in the mitigation of late radiation effects. The optimal duration of PTX and tocopherol treatment has not been fully established. Therefore, we also studied short versus extended treatment duration. Methods: We conducted a phase II prospective randomised study of inhaled carbogen (95% oxygen + 5% carbon dioxide) over 90 minutes, 5 days per week for 3 weeks in addition to short versus prolonged treatment with pentoxifylline (800 mg) and tocopherol (1,000 IU) orally once daily. All 18 patients received carbogen therapy. Patients with grade 3 toxicity post radical radiotherapy for a variety of cancer primaries were eligible for the trial. The primary endpoint was improvement in maximum Lent-Soma toxicity scores. Ethical approval was obtained. Results: Maximum Lent-Soma scores improved with treatment in six of the eighteen patients giving a 33% response rate. The proportion of patients responding to treatment in the prolonged treatment arm B was more than double than in the shorter arm A (Fisher’s exact test: p = 0.321). Two patients in arm B had complete resolution of their symptoms, which was maintained at 2 and 3 years follow up. Conclusions: As late radiation effects are progressive by nature and have such a negative impact on quality of life in long-term cancer survivors, any treatment, which may ameliorate their symptoms, should be considered of benefit. This study confirms the benefit of prolonged treatment and we would recommend clinical use of these agents with treatment duration of at least 12 months, in the management of late radiation effects.

No significant financial relationships to disclose.

Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer

AIMS

To standardize the pathological analysis of total mesorectal excision specimens of rectal cancer following neoadjuvant chemoradiotherapy for locally advanced disease (T3/T4), including tumour regression.

METHODS AND RESULTS

Standardized dissection and reporting was used for 60 patients who underwent total mesorectal excision following long-course chemoradiotherapy. Tumour regression was scored by two pathologists (K.S., D.G.) using both an established 5-point tumour regression grade (TRG), and a novel 3-point grade. Both scores were evaluated for interobserver variability. A complete or near-complete pathological response (3-point TRG 1) was found in 10 patients (17%). Using the 5-point TRG, there was good agreement between both pathologists (kappa = 0.64). Using the 3-point grade, agreement was excellent (kappa = 0.84). No disease recurrence has been reported in patients with a complete, or near complete pathological response (3-point TRG 1), after a mean follow-up of 22 months.

CONCLUSION

Tumour regression grade is a useful method of scoring tumour response to chemoradiotherapy in rectal cancer. TRG 1 and 2 can be regarded as a complete pathological response (ypT0). A modified 3-point grade has the advantage of better reproducibility, with similar prognostic significance.

Monoamine oxidase inhibitors l-deprenyl and clorgyline protect nonmalignant human cells from ionising radiation and chemotherapy toxicity

l-Deprenyl (R-(−)-deprenyl, selegiline) is an inhibitor of monoamine oxidase-B (MAO-B) that is known to protect nerve cells from a variety of chemical and physical insults. As apoptosis is a common mechanism of radiation-induced cell death, the effect of l-deprenyl on the survival of cultured cells and tissue explants was studied following exposure to gamma radiation. The results obtained were compared with the effects of the less-selective MAO-B inhibitor pargyline and the MAO-A inhibitor clorgyline. l-Deprenyl at a concentration of 10⁻⁹ M protected the nontumorigenic cell line (HaCaT) and normal human urothelial explants from the effects of cobalt-60 gamma radiation, but did not protect tumorigenic human cell lines HaCaT-ras, HPV-transfected human keratinocytes (HPV-G cells), or PC3. Human bladder carcinoma explants were not protected. Clorgyline showed a smaller protective effect of normal cells, whereas pargyline had no effect. Radiation-induced delayed effects (genomic instability measured as delayed cell death) were prevented in normal cells by l-deprenyl but, interestingly, deprenyl appeared to increase the amount of delayed death in the tumorigenic cell lines. Studies using l-deprenyl prior to the exposure of nonmalignant cells to cisplatin showed that cell death due to this agent was also reduced. Treatment of cultures of nontumorigenic cells with l-deprenyl or clorgyline significantly increased the levels of the protein Bcl-2 following irradiation, but there was no such effect on the already-elevated levels of this protein in the tumour samples. Since the Bcl-2 has been shown to be an inhibitor of apoptosis or programmed cell death, this would imply that the protective effects of l-deprenyl and clorgyline involve activation of antiapoptotic pathways within the normal cell. This hypothesis is supported by data showing reduced levels of apoptosis in HaCAT cells and in normal bladder explant cultures following treatment with l-deprenyl.

Improvement in efficacy of chemoradiotherapy by addition of an antiangiogenic agent in a murine tumor model

BACKGROUND

Chemoradiotherapy improves survival for some cancer patients. Methods of enhancing treatment response would further enhance survival rates. The effect of the addition of an antiangiogenic agent to a chemoradiotherapy regime has not previously been examined.

MATERIALS AND METHODS

C57B16 mice were inoculated with 1 x 10(6) Lewis lung carcinoma cells into the flank and randomized to 1 of 10 treatment groups when tumor volume approached 1000 mm(3). Animals received combinations of standard doses of intraperitoneal cisplatin, 5-fluorouracil, and the antiangiogenic agent genistein, together with 10 or 20 Gy of external beam radiotherapy. Animals were sacrificed at day 6 when tumor volume, microvessel density, and serum VEGF were determined.

RESULTS

Mean (SEM) tumor volume in the chemoradiotherapy group was 762 (212) mm(3) versus 565 (79) mm(3) in the chemoradiotherapy plus genistein group (P = 0.04, unpaired t-test). The addition of genistein produced a significant reduction in tumor microvessel density (P = 0.01) as well as serum VEGF levels (P < 0.05) compared to those animals receiving chemoradiation alone.

CONCLUSIONS

This study provides proof of principle that chemoradiation can be enhanced by the addition of an antiangiogenic agent to the regime and suggests that further examination of such regimes is warranted.

BB-10010, an analog of macrophage inflammatory protein-1alpha, protects murine small intestine against radiation

Irradiation of the small intestine can result in depletion of the epithelial stem cell compartment and is often the dose-limiting factor for radiotherapeutic treatment of tumors in the abdominal and pelvic region. Since mitotic cells are most sensitive to radiation, significant radioprotection can be achieved by reducing the number of cells in mitosis at the time of irradiation. We have previously shown that administration of macrophage inflammatory protein (MIP) -1alpha induces a transient 50% reduction in the number of mitotic cells in small intestinal crypts, including the stem cell region, and therefore, MIP-1alpha pretreatment before radiation exposure could result in a substantial reduction of the side effects associated with radiotherapy. Groups of adult mice were exposed to different doses of radiation (6, 8, 10, or 12 Gy), with or without prior administration of 200 microg BB-10010/kg 3 hr before irradiation and radiation damage was assessed by means of the microcolony survival assay. MIP-1alpha pretreatment resulted in significantly increased numbers of surviving crypts (10%) when compared to untreated irradiated animals. The observed radioprotective effects of MIP-1alpha in the small intestine should translate into reduced side effects in a clinically relevant radiotherapy context and could allow larger doses of radiation to be delivered to patients with tumors in the abdominal or pelvic region.

Value of a contrast agent in equivocal carotid ultrasound studies: pictorial essay

The aim of the present study was to assess the use of an echo-enhancing agent (Levovist; Schering AG) in equivocal carotid bifurcation ultrasound studies and compare the information obtained with digital subtraction angiography (DSA). Contrast-enhanced carotid ultrasound studies were performed on 30 carotid bifurcations in 28 patients. The standard carotid ultrasound examinations were considered equivocal for two reasons: apparent acute internal carotid artery occlusions (n = 10), and possibly patent but critically stenosed internal carotid arteries with the residual flow lumen being incompletely visualized (n = 20). All patients underwent subsequent carotid digital subtraction angiography. All patients with apparent acute carotid occlusions (n = 10) were correctly characterized on contrast-enhanced ultrasound when compared with DSA. The majority were complete occlusions (n = 8) although in two cases there were critical carotid stenoses requiring surgical endarterectomy. In the 'incompletely visualized lumen' group (n = 20), the majority (n = 16) were correctly characterized on contrast enhanced ultrasound: 13 cases of critically stenotic but patent internal carotid arteries, two cases without a haemodynamically significant stenosis and one case of a carotid occlusion with patent vasa vasorum. One of the critical carotid stenoses was prospectively reported as occluded on the 'gold standard' angiography. In three cases the flow lumen was still incompletely visualized due to calcified plaque despite an echo-enhancing agent; angiography revealed no significant stenosis in all cases. There was one false negative for internal carotid occlusion. This occurred early in the series and could be considered to be a technical error. Importantly, there were no false positives for carotid occlusion. Contrast-enhanced carotid ultrasound significantly improves diagnostic confidence in equivocal carotid ultrasound studies. In appropriate clinical settings this may reduce the need for subsequent carotid angiography.

Quality-of-life measurement in advanced cancer: assessing the individual

PURPOSE

Despite the increasing importance of assessing quality of life (QoL) in patients with advanced cancer, relatively little is known about individual patient's perceptions of the issues contributing to their QoL. The Schedule for the Evaluation of Individual Quality of Life (SEIQoL) and the shorter SEIQoL-Direct Weighting (SEIQoL-DW) assess individualized QoL using a semistructured interview technique. Here we report findings from the first administration of the SEIQoL and SEIQoL-DW to patients with advanced incurable cancer.

PATIENTS AND METHODS

QoL was assessed on a single occasion using the SEIQoL and SEIQoL-DW in 80 patients with advanced incurable cancer.

RESULTS

All patients were able to complete the SEIQoL-DW, and 78% completed the SEIQoL. Of a possible score of 100, the median QoL global score was as follows: SEIQoL, 61 (range, 24 to 94); SEIQoL-DW, 60.5 (range, 6 to 95). Psychometric data for SEIQoL indicated very high levels of internal consistency (median r =.90) and internal validity (median R(2) = 0.88). Patients' judgments of their QoL were unique to the individual. Family concerns were almost universally rated as more important than health, the difference being significant when measured using the SEIQoL-DW (P =.002).

CONCLUSION

Patients with advanced incurable cancer were very good judges of their QoL, and many patients rated their QoL as good. Judgments were highly individual, with very high levels of consistency and validity. The primacy given to health in many QoL questionnaires may be questioned in this population. The implications of these findings are discussed with regard to clinical assessment and advance directives.

A 25 year review of parotid surgery

At a single institution over 25 years, 110 patients were operated upon for a mixture of parotid disease. The mean duration of symptoms for benign disease was 40.8 months compared with 15.6 months for malignant disease. Pain was a significant feature of malignant parotid disorders (46.1% compared with 17.8% for benign conditions). The pathology of these masses was diverse, with pleomorphic adenoma being the commonest (44%). Superficial parotidectomy was the commonest procedure employed (69/110) with local excision being performed only prior to 1984 (15/110). There were five cases of permanent facial palsy, all following radical resection for malignancy. One patient developed Frey's syndrome. Recurrence rate for pleomorphic adenomas was 7/48 (15%), three following enucleations prior to 1984. In primary malignancy of the parotid, 3/21 (14%) developed recurrences. Parotid tumours have a low incidence. Surgery for these tumours can be safely performed by those with a special interest in parotid surgery.

Trp64Arg substitution in the beta 3-adrenergic receptor does not relate to body weight in healthy, premenopausal women

OBJECTIVE

To examine the contribution of the substitution of arginine for tryptophan at amino acid position 64 (Trp64Arg) of the beta 3-adrenergic receptor to body weight and weight-related factors in healthy, premenopausal women.

SUBJECTS

Five hundred and five healthy, premenopausal women 44-50 y, body mass index (BMI) 20-40 kg/m2.

MEASUREMENTS

Subjects were genotyped for the Trp64Arg substitution using restriction fragment length polymorphism (RFLP) analysis. Measurements for weight and weight-related factors (for example, weight, waist-hip ratio, lipid levels) were also taken.

RESULTS

Two women were homozygous Arg/Arg, 75 women were heterozygous Trp/Arg, and 428 women were homozygous Trp/Trp. The frequency of the Arg substitution was 0.078. When subjects with and without the arginine substitution were compared, no significant differences were found on measures of weight or weight-related risk factors.

CONCLUSION

The results confirm previous studies suggesting that the Trp64Arg substitution of the beta 3-adrenergic receptor is not related to weight or weight-related phenotypes in healthy, premenopausal women.

Cancer of the pyriform fossa: hyperfractionated radiotherapy as a primary treatment modality

Carcinoma of the pyriform fossa carries one of the worst prognoses of all head and neck cancers. A prospective trial was set up to study the efficacy of hyperfractionated radiotherapy as a primary treatment modality in the management of these patients. Seventeen patients entered the trial and were followed for up to 3 years. Results for local control, regional control and survival compare favourably with patients treated primarily with surgery with or without radiotherapy. Hyperfractionated radiotherapy offers a logical and standardized approach to the management of this tumour and reduces the significant morbidity associated with the use of surgery as a primary treatment.

Thyroid disorders and breast cancer

We have investigated the controversial association between diseases of the thyroid gland and breast carcinoma using methodology which allows positive exclusion of cases of breast disease from control groups and the detection of subclinical alterations in thyroid volume using high resolution ultrasonography, thus addressing the deficiencies of earlier studies. Whereas the prevalence of hyperthyroidism and hypothyroidism in patients with breast carcinoma and in healthy controls without clinical evidence of breast disease was similar, non-toxic goitre was more than twice as common in the breast carcinoma patients. Thyroid volumes were also significantly higher in breast carcinoma patients than in controls; using World Health Organisation criteria, 45.5% of breast carcinoma patients had thyroid enlargement compared with only 10.5% of controls. Finally, antithyroid peroxidase autoantibodies were twice as common in breast cancer patients than in controls. These findings provide clear evidence of a relationship between thyroid disease and breast carcinoma, although the mechanisms underlying this relationship require further study, future studies of breast cancer risk factors should therefore include assessment of thyroid function, antibody status and volume.

Absence of correlation between chemo- and radioresistance in a range of human tumour cell lines

The correlation between cellular resistance to radiation and to chemotherapeutic drugs has been investigated in a number of solid tumour cell lines, and preliminary results indicate no direct relationship. The acquisition of a multidrug resistance (MDR) profile by adriamycin-selected variants of a human squamous lung carcinoma, an ovarian carcinoma, a cervical carcinoma and by a colchicine-selected variant of a Chinese hamster ovarian carcinoma resulted in alterations to their radiosensitivity. However, the degree of change in the radiosensitivity of the MDR cell lines could not be predicted from their level of resistance to adriamycin. Clonal populations derived from DLKP-A, an adriamycin-selected MDR variant of the human lung carcinoma cell line DLKP, exhibited individual radiosensitivity profiles, which did not correlate with their chemoresistance. Exposure of DLKP to consecutive increasing doses of radiation did not confer cross-resistance to chemotherapeutic drugs.

Neuropeptide Y analog with selective antagonism of effects mediated by postjunctional Y1 receptors

Neuropeptide, a 36 amino acid peptide, is one of the most ubiquitous neuropeptides in the nervous system. It is released during stimulation of sympathetic nerves and is implicated as an important neurotransmitter regulating cardiovascular activity. Administration of neuropeptide Y results in vasoconstriction and inhibition of neurotransmitter release. However, the absence of any effective inhibitors of neuropeptide Y action have precluded the examination of its possible role in hypertension. Here we describe a synthetic hexapeptide (BRC 672), corresponding to residues 22-27 of neuropeptide Y. Following the administration of BRC 672 (6.7 mumol/kg), neuropeptide Y-induced pressor responses were reduced by 32-48% in a dose-dependent fashion. The inhibition was specific for neuropeptide Y, as the pressor response to phenylephrine, an alpha-adrenoceptor agonist, was unchanged. It was selective for the postsynaptic (neuropeptide Y Y1 receptor-mediated) vasoconstrictor activity, because the presynaptic (neuropeptide Y Y2 receptor-mediated) cardiac vagal inhibition evoked by injection of neuropeptide Y to rats was not affected. The hexapeptide inhibited the neuropeptide Y-induced increase in cytosolic free Ca2+ in mammalian cells expressing the cloned human neuropeptide Y Y1 receptor. Injections of BRC 672 significantly reduced blood pressure in anaesthetised rats and in conscious spontaneously hypertensive rats. Resting arterial blood pressure decreased from 136 +/- 4 mm Hg to 122 +/- 3 mm Hg and remained depressed 2 h after the administration of the hexapeptide in anaesthetised rats. In spontaneously hypertensive rats blood pressure was decreased for up to 4 h.

The influence of continuous ambulatory peritoneal dialysis connection technique on peritonitis rate and technique survival

Peritonitis is still the most common complication of continuous ambulatory peritoneal dialysis (CAPD). Several measures have been used to prevent peritonitis, including prophylactic antibiotics and a variety of connection techniques. This study was designed to evaluate the effects of different connection techniques, age at the start of CAPD, sex, and diabetic status on peritonitis rate and technique survival. Three hundred twenty-seven patients treated with CAPD and followed for 8,804.4 patient-months at the Vancouver General Hospital between February 13, 1978, and August 31, 1992, were reviewed. The mean age of the patients was 57.1 +/- 16.3 years. The overall peritonitis rate was 16.6 patient-months per episode. The overall technique survival was 79.6%, 60.2%, and 41.8%, at 1, 2, and 3 years, respectively. Patients using "standard" spike technique (group A, n = 87), Luer lock connector (group B, n = 77), and Luer lock with iodine instillation at the dialysis bag connection site (group C, n = 120) had peritonitis rates of 10.4, 14.7, and 33.3 patient-months per episode, respectively. The relative risk (RR) of peritonitis was 3.5 for group A (95% confidence interval, 2.1 to 4.5) and 2.6 for group B (95% confidence interval, 1.7 to 3.9) compared with group C. Patient age at the start of CAPD, sex, and diabetic status had no effect on the RR of peritonitis. None of the variables studied, except patient age, affected technique survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Desensitization by neuropeptide Y of effects of sympathetic stimulation on cardiac vagal action in anaesthetised dogs

The effects of a long-lasting intravenous infusion of neuropeptide Y (NPY, 180 +/- 8 min, 53 +/- 4 micrograms/kg/h) on the prolonged inhibition of cardiac vagal action evoked by cardiac sympathetic nerve stimulation and bolus intravenous injections of NPY were investigated in anaesthetised dogs. Sympathetic stimulation and NPY injection were performed on four separate occasions; once in control conditions, then once early and again late in the period of NPY infusion, and then on a final occasion 60-90 min after the cessation of NPY infusion. The maximum inhibition of cardiac vagal action evoked by an injection of NPY was significantly less late in the NPY infusion when compared with the other three injection groups (ANOVA, P < 0.001). Also the time to half-recovery of this response was significantly less than that seen in the other three injection groups (ANOVA, P < 0.001). The maximum inhibition of cardiac vagal action evoked by sympathetic stimulation was significantly reduced late in the NPY infusion when compared with the other three stimulation groups (ANOVA, P < 0.0001). The time for half-recovery of this response was also less than that of the other three stimulation groups (ANOVA, P < 0.001). The results indicate that desensitisation of the vagal attenuation to both exogenous NPY and sympathetic stimulation occurred during a long-lasting period of NPY infusion. This is consistent with the proposal that NPY is a mediator of this sympathetic-evoked vagal attenuation.

Galanin antagonist effects on cardiac vagal inhibitory actions of sympathetic stimulation in anaesthetized cats and dogs

1. Galantide, a putative galanin antagonist composed of twenty amino acids, caused a significant reduction in the vagal attenuating action of galanin injection (20 micrograms/kg; 6.2 nmol/kg) in anaesthetized cats at both ten times (137 micrograms/kg; 62 nmol/kg) and twenty-five times (343 micrograms/kg: 156 nmol/kg) the molar dose of galanin. Galantide did not block the depressor action of galanin in these animals. 2. Galantide, at both doses, also significantly reduced the vagal attenuating action of a 5 min period of cardiac sympathetic stimulation at 16 Hz in anaesthetized cats. 3. In anaesthetized dogs, galantide, at the same dose used in cats (137 micrograms/kg; 62 nmol/kg) had no significant effect on the vagal attenuation evoked by cardiac sympathetic stimulation or injection of neuropeptide Y (35 micrograms/kg; 8.2 nmol/kg). 4. This study therefore demonstrates antagonist properties of galantide on the vagal inhibitory action of galanin. It supports the hypothesis that the vagal inhibitory factor released by cardiac sympathetic nerve stimulation in the cat, but not the dog, is galanin, although it does not exclude the possibility of other factors playing a more minor role. Because galantide was not shown to block the depressor action of galanin, this study also suggests that there may be more than one galanin receptor subtype.

Pharmacological separation of cardio-accelerator and vagal inhibitory capacities of sympathetic nerves

Prolonged attenuation of vagal action at the heart, proposed to be due to release of the sympathetic cotransmitter neuropeptide Y (NPY), follows stimulation of cardiac sympathetic nerves. It has been shown that pretreatment with reserpine depletes cardiac and neuronal stores of both noradrenaline and NPY, while combined pretreatment with reserpine and the ganglion blocking agent chlorisondamine reduces depletion of NPY, while still depleting noradrenaline. The effects of reserpine pretreatment and combined chlorisondamine and reserpine pretreatment on the inhibition of cardiac vagal action evoked by cardiac sympathetic nerve stimulation (16 Hz, 2 min) were compared in anaesthetised dogs. In dogs with no pretreatment (n = 6), sympathetic stimulation evoked an immediate cardio-acceleration, and a prolonged inhibition of cardiac vagal action, with a maximum percent inhibition (MPI) and time to half-recovery (T50) of 78 +/- 6% and 16 +/- 2 min respectively. In dogs pretreated with reserpine (n = 6, 1 mg/kg, 24 h), the immediate cardio-acceleration (ANOVA, P < 0.01), and the magnitude (MPI = 31.8%, ANOVA, P < 0.001) and duration (T50 = 6 +/- 1 min, ANOVA, P < 0.05) of inhibition of cardiac vagal action following sympathetic stimulation were significantly attenuated. In dogs with combined chlorisondamine (n = 5, 2 mg/kg, 48 and 24 h) and reserpine pretreatment, there was again significantly reduced cardio-acceleration (ANOVA, P < 0.01), but the inhibition of cardiac vagal action following sympathetic stimulation did not significantly differ from untreated animals (MPI = 79 +/- 8%, T50 = 21 +/- 6 min). Intravenous injections of NPY (25-50 micrograms/kg) evoked prolonged inhibition of cardiac vagal action in untreated and both groups of pretreated animals. These experiments indicate that the cardio-accelerator and vagal inhibitory capacities of sympathetic nerve stimulation can be separated, and are consistent with the sympathetic vagal inhibitory factor being NPY.

Clinical significance of cellular resistance in tumours to cytotoxic chemotherapy and radiotherapy

Cellular resistance is a significant component of tumour treatment failure. More detailed understanding of resistance mechanisms has enabled us to plan circumvention strategies, though these are not yet in routine clinical use. Such resistance is, however, only one of several factors which render cure of advanced malignant disease difficult. It is important for researchers in this field to see not only therapeutic opportunities but also limitations of these approaches. It is hoped that increased cooperation between clinicians and scientists in the field of cellular resistance will yield further improvement in tumour response rates and cure.

Inhibition of arterial baroreceptor and chemoreceptor reflex responses by neuropeptide Y in anaesthetised dogs

The effects of bolus intravenous injections of neuropeptide Y (NPY) on increases in pulse interval (PI) evoked reflexly by arterial chemoreceptor and baroreceptor stimulation were investigated in anaesthetised dogs. The arterial chemoreceptors were stimulated by rapid injections of small volumes of CO2 into the carotid sinus or brief episodes of tracheal occlusion. Intravenous injections of NPY produced a prolonged attenuation of the reflex prolongation of PI induced by both methods. Two methods of testing the arterial baroreceptor reflex were used: steady-state increases in PI evoked in response to maintained step increases in systolic arterial blood pressure (SABP) from inflation of an aortic balloon-tipped catheter, and beat-by-beat increases in PI evoked reflexly by 'ramp' increases in blood pressure caused by intravenous injections of phenylephrine. In both methods the relationship between SABP and PI is linear over the range tested (up to SABP 200 mmHg), the slope of the line indicating the sensitivity of the reflex response. Intravenous injections of NPY produced a prolonged attenuation of the baroreceptor-cardiodepressor reflex measured by both methods. No significant differences were observed between the NPY-mediated inhibition of the direct effects on PI of electrical stimulation of a vagus nerve, and its inhibition of the reflex responses of PI to chemoreceptor or baroreceptor stimulation. The results indicate that the attenuation of reflex PI responses to arterial chemoreceptor and baroreceptor stimulation following an intravenous injection of NPY can be accounted for in terms of the action of NPY on vagal nerve endings at the heart, although additional sites of action cannot be ruled out.

Comparison of the inhibitory roles of neuropeptide Y and galanin on cardiac vagal action in the dog

Prolonged attenuation of cardiac vagal action occurs following cardiac sympathetic nerve stimulation or intravenous neuropeptide Y (NPY) injections in anaesthetised dogs. Equimolar intravenous injections of galanin (GAL) had no effect on cardiac vagal action in this species. Immunohistochemical analysis of dog stellate ganglia and cardiac muscle showed that most nerve cell bodies showing tyrosine hydroxylase immunoreactivity (TH-IR) also showed immunoreactivity to both NPY and GAL. The results are consistent with the proposal that NPY released from cardiac sympathetic nerves is responsible for the prolonged inhibition of cardiac vagal action known to be caused by such stimulation. A role for GAL, shown here to exist in cardiac sympathetic nerves in the dog, has yet to be determined.