Multi-institutional evaluation of a Pareto navigation guided automated radiotherapy planning solution for prostate cancer

BACKGROUND

Current automated planning solutions are calibrated using trial and error or machine learning on historical datasets. Neither method allows for the intuitive exploration of differing trade-off options during calibration, which may aid in ensuring automated solutions align with clinical preference. Pareto navigation provides this functionality and offers a potential calibration alternative. The purpose of this study was to validate an automated radiotherapy planning solution with a novel multi-dimensional Pareto navigation calibration interface across two external institutions for prostate cancer.

METHODS

The implemented 'Pareto Guided Automated Planning' (PGAP) methodology was developed in RayStation using scripting and consisted of a Pareto navigation calibration interface built upon a 'Protocol Based Automatic Iterative Optimisation' planning framework. 30 previous patients were randomly selected by each institution (IA and IB), 10 for calibration and 20 for validation. Utilising the Pareto navigation interface automated protocols were calibrated to the institutions' clinical preferences. A single automated plan (VMATAuto) was generated for each validation patient with plan quality compared against the previously treated clinical plan (VMATClinical) both quantitatively, using a range of DVH metrics, and qualitatively through blind review at the external institution.

RESULTS

PGAP led to marked improvements across the majority of rectal dose metrics, with Dmean reduced by 3.7 Gy and 1.8 Gy for IA and IB respectively (p < 0.001). For bladder, results were mixed with low and intermediate dose metrics reduced for IB but increased for IA. Differences, whilst statistically significant (p < 0.05) were small and not considered clinically relevant. The reduction in rectum dose was not at the expense of PTV coverage (D98% was generally improved with VMATAuto), but was somewhat detrimental to PTV conformality. The prioritisation of rectum over conformality was however aligned with preferences expressed during calibration and was a key driver in both institutions demonstrating a clear preference towards VMATAuto, with 31/40 considered superior to VMATClinical upon blind review.

CONCLUSIONS

PGAP enabled intuitive adaptation of automated protocols to an institution's planning aims and yielded plans more congruent with the institution's clinical preference than the locally produced manual clinical plans.

Impact of attenuation correction of radiotherapy hardware for positron emission tomography-magnetic resonance in ano-rectal radiotherapy patients

BACKGROUND

Positron Emission Tomography-Magnetic Resonance (PET-MR) scanners could improve ano-rectal radiotherapy planning through improved Gross Tumour Volume (GTV) delineation and enabling dose painting strategies using metabolic measurements. This requires accurate quantitative PET images acquired in the radiotherapy treatment position.

PURPOSE

This study aimed to evaluate the impact on GTV delineation and metabolic parameter measurement of using novel Attenuation Correction (AC) maps that included the radiotherapy flat couch, coil bridge and anterior coil to see if they were necessary.

METHODS

Seventeen ano-rectal radiotherapy patients received a18 F $\mathrm{^{18}F}$ -FluoroDeoxyGlucose PET-MR scan in the radiotherapy position. PET images were reconstructed without (CTAC std $\mathrm{CTAC_{std}}$ ) and with (CTAC cba $\mathrm{CTAC_{cba}}$ ) the radiotherapy hardware included. Both AC maps used the same Computed Tomography image for patient AC. Semi-manual and threshold GTVs were delineated on both PET images, the volumes compared and the Dice coefficient calculated. Metabolic parameters: Standardized Uptake ValuesSUV max $\mathrm{SUV_{max}}$ ,SUV mean $\mathrm{SUV_{mean}}$ and Total Lesion Glycolysis (TLG) were compared using paired t-tests with a Bonferroni corrected significance level ofp = 0.05 / 8 = 0.006 $p = 0.05/8 = 0.006$ .

RESULTS

Differences in semi-manual GTV volumes betweenCTAC cba $\mathrm{CTAC_{cba}}$ andCTAC std $\mathrm{CTAC_{std}}$ were approaching statistical significance (difference- 15.9 % ± 1.6 % $-15.9\%\pm 1.6\%$ ,p = 0.007 $p = 0.007$ ), with larger differences in low FDG-avid tumours (SUV mean < 8.5 g mL - 1 $\mathrm{SUV_{mean}} < 8.5\;\mathrm{g\: mL^{-1}}$ ). TheCTAC cba $\mathrm{CTAC_{cba}}$ andCTAC std $\mathrm{CTAC_{std}}$ GTVs were concordant with Dice coefficients0.89 ± 0.01 $0.89 \pm 0.01$ (manual) and0.98 ± 0.00 $0.98 \pm 0.00$ (threshold). Metabolic parameters were significantly different, withSUV max $\mathrm{SUV_{max}}$ ,SUV mean $\mathrm{SUV_{mean}}$ and TLG differences of- 11.5 % ± 0.3 % $-11.5\%\ \pm 0.3\%$ (p < 0.001 $p < 0.001$ ),- 11.6 % ± 0.3 % $-11.6\% \pm 0.3\%$ (p < 0.001 $p < 0.001$ ) and- 13.7 % ± 0.6 % $-13.7\%\ \pm 0.6\%$ (p = 0.003 $p = 0.003$ ) respectively. The TLG difference resulted in 1/8 rectal cancer patients changing prognosis group, based on literature TLG cut-offs, when usingCTAC cba $\mathrm{CTAC_{cba}}$ rather thanCTAC std $\mathrm{CTAC_{std}}$ .

CONCLUSIONS

This study suggests that using AC maps with the radiotherapy hardware included is feasible for patient imaging. The impact on tumour delineation was mixed and needs to be evaluated in larger cohorts. However using AC of the radiotherapy hardware is important for situations where accurate metabolic measurements are required, such as dose painting and treatment prognostication.

Evaluating a radiotherapy deep learning synthetic CT algorithm for PET-MR attenuation correction in the pelvis

BACKGROUND

Positron emission tomography-magnetic resonance (PET-MR) attenuation correction is challenging because the MR signal does not represent tissue density and conventional MR sequences cannot image bone. A novel zero echo time (ZTE) MR sequence has been previously developed which generates signal from cortical bone with images acquired in 65 s. This has been combined with a deep learning model to generate a synthetic computed tomography (sCT) for MR-only radiotherapy. This study aimed to evaluate this algorithm for PET-MR attenuation correction in the pelvis.

METHODS

Ten patients being treated with ano-rectal radiotherapy received a [Formula: see text]F-FDG-PET-MR in the radiotherapy position. Attenuation maps were generated from ZTE-based sCT (sCTAC) and the standard vendor-supplied MRAC. The radiotherapy planning CT scan was rigidly registered and cropped to generate a gold standard attenuation map (CTAC). PET images were reconstructed using each attenuation map and compared for standard uptake value (SUV) measurement, automatic thresholded gross tumour volume (GTV) delineation and GTV metabolic parameter measurement. The last was assessed for clinical equivalence to CTAC using two one-sided paired t tests with a significance level corrected for multiple testing of [Formula: see text]. Equivalence margins of [Formula: see text] were used.

RESULTS

Mean whole-image SUV differences were -0.02% (sCTAC) compared to -3.0% (MRAC), with larger differences in the bone regions (-0.5% to -16.3%). There was no difference in thresholded GTVs, with Dice similarity coefficients [Formula: see text]. However, there were larger differences in GTV metabolic parameters. Mean differences to CTAC in [Formula: see text] were [Formula: see text] (± standard error, sCTAC) and [Formula: see text] (MRAC), and [Formula: see text] (sCTAC) and [Formula: see text] (MRAC) in [Formula: see text]. The sCTAC was statistically equivalent to CTAC within a [Formula: see text] equivalence margin for [Formula: see text] and [Formula: see text] ([Formula: see text] and [Formula: see text]), whereas the MRAC was not ([Formula: see text] and [Formula: see text]).

CONCLUSION

Attenuation correction using this radiotherapy ZTE-based sCT algorithm was substantially more accurate than current MRAC methods with only a 40 s increase in MR acquisition time. This did not impact tumour delineation but did significantly improve the accuracy of whole-image and tumour SUV measurements, which were clinically equivalent to CTAC. This suggests PET images reconstructed with sCTAC would enable accurate quantitative PET images to be acquired on a PET-MR scanner.

Comprehensive dose evaluation of a Deep Learning based synthetic Computed Tomography algorithm for pelvic Magnetic Resonance-only radiotherapy

BACKGROUND AND PURPOSE

Magnetic Resonance (MR)-only radiotherapy enables the use of MR without the uncertainty of MR-Computed Tomography (CT) registration. This requires a synthetic CT (sCT) for dose calculations, which can be facilitated by a novel Zero Echo Time (ZTE) sequence where bones are visible and images are acquired in 65 seconds. This study evaluated the dose calculation accuracy for pelvic sites of a ZTE-based Deep Learning sCT algorithm developed by GE Healthcare.

MATERIALS AND METHODS

ZTE and CT images were acquired in 56 pelvic radiotherapy patients in the radiotherapy position. A 2D U-net convolutional neural network was trained using pairs of deformably registered CT and ZTE images from 36 patients. In the remaining 20 patients the dosimetric accuracy of the sCT was assessed using cylindrical dummy Planning Target Volumes (PTVs) positioned at four different central axial locations, as well as the clinical treatment plans (for prostate (n=10), rectum (n=4) and anus (n=6) cancers). The sCT was rigidly and deformably registered, the plan recalculated and the doses compared using mean differences and gamma analysis.

RESULTS

Mean dose differences to the PTV D98% were ≤ 0.5% for all dummy PTVs and clinical plans (rigid registration). Mean gamma pass rates at 1%/1 mm were 98.0 ± 0.4% (rigid) and 100.0 ± 0.0% (deformable), 96.5 ± 0.8% and 99.8 ± 0.1%, and 95.4 ± 0.6% and 99.4 ± 0.4% for the clinical prostate, rectum and anus plans respectively.

CONCLUSIONS

A ZTE-based sCT algorithm with high dose accuracy throughout the pelvis has been developed. This suggests the algorithm is sufficiently accurate for MR-only radiotherapy for all pelvic sites.

The first patients treated with MR-CBCT soft-tissue matching in a MR-only prostate radiotherapy pathway

INTRODUCTION

Magnetic Resonance (MR)-only radiotherapy for prostate cancer has previously been reported using fiducial markers for on-treatment verification. MR-Cone Beam Computed Tomography (CBCT) soft-tissue matching does not require invasive fiducial markers and enables MR-only treatments to other pelvic cancers. This study evaluated the first clinical implementation of MR-only prostate radiotherapy using MR-CBCT soft-tissue matching.

METHODS

Twenty prostate patients were treated with MR-only radiotherapy using a synthetic (s)CT-optimised plan with MR-CBCT soft-tissue matching. Two MR sequences were acquired: small Field Of View (FOV) for target delineation and large FOV for organs at risk delineation, sCT generation and on-treatment verification. Patients also received a CT for validation. The prostate was independently contoured on the small FOV MR, copied to the registered CT and modified if there were MR-CT soft-tissue alignment differences (MR-CT volume). This was compared to the MR-only volume with a paired t-test. The treatment plan was recalculated on CT and the doses compared. Independent offline CT-CBCT matches for 5/20 fractions were performed by three therapeutic radiographers using the MR-only contours and compared to the online MR-CBCT matches using two one-sided paired t-tests for equivalence within ±1 mm.

RESULTS

The MR-only volumes were significantly smaller than MR-CT (p = 0.003), with a volume ratio 0.92 ± 0.02 (mean ± standard error). The sCT isocentre dose difference to CT was 0.2 ± 0.1%. MR-CBCT soft-tissue matching was equivalent to CT-CBCT (p < 0.001), with differences of 0.1 ± 0.2 mm (vertical), -0.1 ± 0.2 mm (longitudinal) and 0.0 ± 0.1 mm (lateral).

CONCLUSIONS

MR-only radiotherapy with soft-tissue matching has been successfully clinically implemented. It produced significantly smaller target volumes with high dosimetric and on-treatment matching accuracy.

IMPLICATIONS FOR PRACTICE

MR-only prostate radiotherapy can be safely delivered without using invasive fiducial markers. This enables MR-only radiotherapy to be extended to other pelvic cancers where fiducial markers cannot be used.

A comprehensive atlas of Aggrecan, Versican, Neurocan and Phosphacan expression across time in wildtype retina and in retinal degeneration

As photoreceptor cells die during retinal degeneration, the surrounding microenvironment undergoes significant changes that are increasingly recognized to play a prominent role in determining the efficacy of therapeutic interventions. Chondroitin Sulphate Proteoglycans (CSPGs) are a major component of the extracellular matrix that have been shown to inhibit neuronal regrowth and regeneration in the brain and spinal cord, but comparatively little is known about their expression in retinal degeneration. Here we provide a comprehensive atlas of the expression patterns of four individual CSPGs in three models of inherited retinal degeneration and wildtype mice. In wildtype mice, Aggrecan presented a biphasic expression, while Neurocan and Phosphacan expression declined dramatically with time and Versican expression remained broadly constant. In degeneration, Aggrecan expression increased markedly in Aipl1-/- and Pde6brd1/rd1, while Versican showed regional increases in the periphery of Rho-/- mice. Conversely, Neurocan and Phosphacan broadly decrease with time in all models. Our data reveal significant heterogeneity in the expression of individual CSPGs. Moreover, there are striking differences in the expression patterns of specific CSPGs in the diseased retina, compared with those reported following injury elsewhere in the CNS. Better understanding of the distinct distributions of individual CSPGs will contribute to creating more permissive microenvironments for neuro-regeneration and repair.

Are cone beam CT image matching skills transferrable from planning CT to planning MRI for MR-only prostate radiotherapy?

Objectives:

Treatment verification for MR-only planning has focused on fiducial marker matching, however, these are difficult to identify on MR. An alternative is using the MRI for soft-tissue matching with cone beam computed tomography images (MR-CBCT). However, therapeutic radiographers have limited experience of MRI. This study aimed to assess transferability of therapeutic radiographers CT-CBCT prostate image matching skills to MR-CBCT image matching.

Methods:

23 therapeutic radiographers with 3 months–5 years’ experience of online daily CT-CBCT soft-tissue matching prostate cancer patients participated. Each observer completed a baseline assessment of 10 CT-CBCT prostate soft-tissue image matches, followed by 10 MR-CBCT prostate soft-tissue image match assessment. A MRI anatomy training intervention was delivered and the 10 MR-CBCT prostate soft-tissue image match assessment was repeated. Limits of agreement were calculated as the disagreement of the observers with mean of all observers.

Results:

Limits of agreement at CT-CBCT baseline were 2.8 mm, 2.8 mm, 0.7 mm (vertical, longitudinal, lateral). MR-CBCT matches prior to training were 3.3 mm, 3.1 mm, 0.9 mm, and after training 2.6 mm, 2.4 mm, 1.1 mm (vertical, longitudinal, lateral). Results show similar limits of agreement across the assessments, and variation reduced following the training intervention.

Conclusion:

This suggests therapeutic radiographers’ prostate CBCT image matching skills are transferrable to a MRI planning scan, since MR-CBCT matching has comparable observer variation to CT-CBCT matching.

Advances in knowledge:

This is the first publication assessing interobserver MR-CBCT prostate soft tissue matching in an MR-only pathway.

Additional Treatments to the Local tumour for metastatic prostate cancer-Assessment of Novel Treatment Algorithms (IP2-ATLANTA): protocol for a multicentre, phase II randomised controlled trial

INTRODUCTION

Survival in men diagnosed with de novo synchronous metastatic prostate cancer has increased following the use of upfront systemic treatment, using chemotherapy and other novel androgen receptor targeted agents, in addition to standard androgen deprivation therapy (ADT). Local cytoreductive and metastasis-directed interventions are hypothesised to confer additional survival benefit. In this setting, IP2-ATLANTA will explore progression-free survival (PFS) outcomes with the addition of sequential multimodal local and metastasis-directed treatments compared with standard care alone.

METHODS

A phase II, prospective, multicentre, three-arm randomised controlled trial incorporating an embedded feasibility pilot. All men with new histologically diagnosed, hormone-sensitive, metastatic prostate cancer, within 4 months of commencing ADT and of performance status 0 to 2 are eligible. Patients will be randomised to Control (standard of care (SOC)) OR Intervention 1 (minimally invasive ablative therapy to prostate±pelvic lymph node dissection (PLND)) OR Intervention 2 (cytoreductive radical prostatectomy±PLND OR prostate radiotherapy±pelvic lymph node radiotherapy (PLNRT)). Metastatic burden will be prespecified using the Chemohormonal Therapy Versus Androgen Ablation Randomized Trial for Extensive Disease (CHAARTED) definition. Men with low burden disease in intervention arms are eligible for metastasis-directed therapy, in the form of stereotactic ablative body radiotherapy (SABR) or surgery. Standard systemic therapy will be administered in all arms with ADT±upfront systemic chemotherapy or androgen receptor agents. Patients will be followed-up for a minimum of 2 years.

PRIMARY OUTCOME

PFS. Secondary outcomes include predictive factors for PFS and overall survival; urinary, sexual and rectal side effects. Embedded feasibility sample size is 80, with 918 patients required in the main phase II component. Study recruitment commenced in April 2019, with planned follow-up completed by April 2024.

ETHICS AND DISSEMINATION

Approved by the Health Research Authority (HRA) Research Ethics Committee Wales-5 (19/WA0005). Study results will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

NCT03763253; ISCRTN58401737.

Cone beam computed tomography for dose calculation quality assurance for magnetic resonance-only radiotherapy

•

Clinical Magnetic Resonance (MR)-only radiotherapy requires a dose quality assurance method.

•

Doses calculated on Cone Beam Computed Tomography (CBCT) were within 2% of MR-only doses calculated using synthetic CT.

•

CBCT with asymmetric dose difference tolerances of [−2%,1%] appears clinically feasible for quality assurance of prostate MR-only radiotherapy.

Background and purpose

Magnetic Resonance (MR)-only prostate radiotherapy using synthetic Computed Tomography (sCT) algorithms with high dose accuracy has been clinically implemented. MR images can suffer from geometric distortions so Quality Assurance (QA) using an independent, geometrically accurate, image could be required. The first-fraction Cone Beam CT (CBCT) has demonstrated potential but has not been evaluated in a clinical MR-only pathway. This study evaluated the clinical use of CBCT for dose accuracy QA of MR-only radiotherapy.

Materials and methods

A total of 49 patients treated with MR-only prostate radiotherapy were divided into two cohorts. Cohort 1 (20 patients) received a back-up CT, whilst Cohort 2 (29 patients) did not. All patients were planned using the sCT and received daily CBCT imaging with MR-CBCT soft-tissue matching. Each CBCT was calibrated using a patient-specific stepwise Hounsfield Units-to-mass density curve. The treatment plan was recalculated on the first-fraction CBCT using the clinically applied soft-tissue match and the doses compared. For Cohort 1 the sCT was rigidly registered to the back-up CT, the plan recalculated and doses compared.

Results

Mean sCT-CBCT dose difference across both cohorts was -0.6±0.1% (standard error of the mean, range −2.3%,2.3%), with 47/49 patients within [-2%,1%]. The sCT-CBCT dose difference was systematically lower than the sCT-CT by -0.7±0.6% (±95% limits of agreement). The mean sCT-CBCT gamma pass rate (2%/2mm) was 96.1±0.4% (85.4%,99.7%).

Conclusions

CBCT-based dose accuracy QA for MR-only radiotherapy appears clinically feasible. There was a small systematic sCT-CBCT dose difference implying asymmetric tolerances of [-2%,1%] would be appropriate.

The accuracy of Magnetic Resonance - Cone Beam Computed Tomography soft-tissue matching for prostate radiotherapy

BACKGROUND AND PURPOSE

Magnetic Resonance (MR)-Only radiotherapy requires a method for matching image with on-treatment Cone Beam Computed Tomography (CBCT). This study aimed to investigate the accuracy of MR-CBCT soft-tissue matching for prostate MR-only radiotherapy.

MATERIALS AND METHODS

Three patient cohorts were used, with all patients receiving MR and CT scans. For the first cohort (10 patients) the first fraction CBCT was automatically rigidly registered to the CT and MR scans and the MR-CT registration predicted using the MR-CBCT and CT-CBCT registrations. This was compared to the automatic MR-CT registration. For the second and third cohorts (five patients each) the first fraction CBCT was independently matched to the CT and MR by four radiographers, the MR-CBCT and CT-CBCT matches compared and the inter-observer variability assessed. The second cohort used a CT-based structure set and the third a MR-based structure set with the MR relabelled as a 'CT'.

RESULTS

The mean difference between predicted and actual MR-CT registrations was Δ R All = - 0.1 ± 0.2 mm (s.e.m.). Radiographer MR-CBCT registrations were not significantly different to CT-CBCT, with mean differences in soft-tissue match ⩽ 0.2 mm and all except one difference ⩽ 3.3 mm . This was less than the MR-CBCT inter-observer limits of agreement [ 3.5 , 2.4 , 0.9 ] mm (vertical, longitudinal, lateral), which were similar ( ⩽ 0.5 mm ) to CT-CBCT.

CONCLUSIONS

MR-CBCT soft-tissue matching is not significantly different to CT-CBCT. Relabelling the MR as a 'CT' does not appear to change the automatic registration. This suggests that MR-CBCT soft-tissue matching is feasible and accurate.

The effects of antimicrobial peptides WAM-1 and LL-37 on multidrug-resistant Acinetobacter baumannii

Increasing multidrug resistance (MDR) in Acinetobacter baumannii warrants therapeutic alternatives, and the bactericidal nature of antimicrobial peptides (AMPs) offers a possible approach. In this study, we examined the interaction of cathelicidin AMPs WAM-1, a marsupial AMP, and LL-37, a human AMP, with A. baumannii clinical isolates. We characterized the antibiotic resistance of the isolates, the bacteriostatic and bactericidal effects of these AMPs, synergistic activity with antibiotics, and their effects on biofilm formation and dispersal. All clinical isolates were resistant to commonly prescribed antibiotics, with four of seven isolates showing MDR. WAM-1 and LL-37 showed variable activity in clinical isolates, with WAM-1 having a stronger bacteriostatic effect than LL-37 and showing rapid bactericidal activity against clinical isolates. Furthermore, synergistic bactericidal activity was observed with WAM-1 and commonly prescribed antibiotics. Both peptides were able to inhibit biofilm formation in all clinical isolates at some concentrations, and WAM-1 dispersed mature biofilm in most isolates. LL-37 was unable to disperse mature biofilms in any strains. Further studies must be done to elucidate the true value of these alternative treatments, but these results suggest that MDR A. baumannii's susceptibility to AMPs may result in innovative therapeutics to prevent or treat these infections.

Improving Staging in Bladder Cancer: The Increasing Role of Multiparametric Magnetic Resonance Imaging

CONTEXT

In bladder cancer (BCa) patients, accurate local and regional tumor staging is required when planning treatment. Clinical understaging frequently occurs and leads to undertreatment of the disease, with a negative impact on survival. An improvement in staging accuracy could be attained by advances in imaging. Magnetic resonance imaging (MRI) is currently the best imaging technique for locoregional staging for several malignancies because of its superior soft tissue contrast resolution with the advantage of avoiding exposure to ionizing radiation. Important improvements in MRI technology have led to the introduction of multiparametric MRI (mpMRI), which combines anatomic and functional evaluation.

OBJECTIVE

To review the fundamentals of mpMRI in BCa and to provide a contemporary overview of the available data on the role of this emerging imaging technology.

EVIDENCE ACQUISITION

A nonsystematic literature search using the Medline and Cochrane Library databases was performed up to March 2016. Additional articles were retrieved by cross-matching references of selected articles. Only articles reporting complete data with regard to image acquisition protocols, locoregional staging, monitoring response to therapy, and detection of locoregional recurrence after primary treatment in BCa patients were selected.

EVIDENCE SYNTHESIS

Standardization of acquisition and reporting protocols for bladder mpMRI is paramount. Combining anatomic and functional sequences improves the accuracy of local tumor staging compared with conventional imaging alone. Diffusion-weighted imaging may distinguish BCa type and grade. Functional sequences are capable of monitoring response to chemotherapy and radiation therapy. Diffusion-weighted imaging enhanced by lymphotropic nanoparticles showed high accuracy in pelvic lymph node staging compared with conventional cross-sectional imaging.

CONCLUSIONS

In BCa patients, mpMRI appears a promising tool for accurate locoregional staging, predicting tumor aggressiveness and monitoring response to therapy. Further large-scale studies are needed to confirm these findings.

PATIENT SUMMARY

Better imaging through improved technology will improve outcomes in bladder cancer patients. We reviewed the emerging use of multiparametric magnetic resonance imaging for staging and monitoring bladder cancer. Multiparametric magnetic resonance imaging appears more accurate than current methods for local and nodal staging and monitoring tumor response to treatment, but requires further investigation.

3'-Deoxy-3'-¹⁸F-fluorothymidine positron emission tomography as an early predictor of disease progression in patients with advanced and metastatic pancreatic cancer

PURPOSE

3'-Deoxy-3'-(18)F-fluorothymidine (FLT) positron emission tomography (PET) has limited utility in abdominal imaging due to high physiological hepatic uptake of tracer. We evaluated FLT PET/CT combined with a temporal-intensity information-based voxel-clustering approach termed kinetic spatial filtering (FLT PET/CTKSF) for early prediction of response and survival outcomes in locally advanced and metastatic pancreatic cancer patients receiving gemcitabine-based chemotherapy.

METHODS

Dynamic FLT PET/CT data were collected before and 3 weeks after the first cycle of chemotherapy. Changes in tumour FLT PET/CT variables were determined. The primary end point was RECIST 1.1 response on contrast-enhanced CT after 3 months of therapy.

RESULTS

Twenty patients were included. Visual distinction between tumours and normal pancreas was seen in FLT PETKSF images. All target lesions (>2 cm), including all primary pancreatic tumours, were visualised. Of the 11 liver metastases, 3 (<2 cm) were not visible after kinetic filtering. Of the 20 patients, 7 progressed (35%). Maximum standardised uptake value at 60 min post-injection (SUV60,max) significantly increased in patients with disease progression (p = 0.04). Receiver-operating characteristic curve analysis indicated that a threshold of SUV60,max increase of ≥ 12% resulted in sensitivity, specificity and positive predictive value (PPV) of 71, 100 and 100%, respectively [area under the curve (AUC) 0.90, p = 0.0001], to predict patients with disease progression. Changes in SUV60,max were not predictive of survival.

CONCLUSION

FLT PET/CT detected changes in proliferation, with early increase in SUV60,max predicting progressive disease with a high specificity and PPV. Therefore, FLT PET/CT could be used as an early response biomarker for gemcitabine-based chemotherapy, to select a poor prognostic group who may benefit from novel therapeutic agents in advanced and metastatic pancreatic cancer.

Outside-the-(cavity-prep)-box thinking

Direct placement restorative materials must interface with tooth structures that are often compromised by caries or trauma. The material must seal the interface while providing sufficient strength and wear resistance to assure function of the tooth for, ideally, the lifetime of the patient. Needed are direct restorative materials that are less technique-sensitive than current resin-based composite systems while having improved properties. The ideal material could be successfully used in areas of the world with limited infrastructure. Advances in our understanding of the interface between the restoration adhesive system and the stages of carious dentin can be used to promote remineralization. Application of fracture mechanics to adhesion at the tooth-restoration interface can provide insights for improvement. Research in polymer systems suggests alternatives to current composite resin matrix systems to overcome technique sensitivity, while advances in nano- and mesoparticle reinforcement and alignment in composite systems can increase material strength, toughness, and wear resistance, foreshadowing dental application.

Effective transplantation of photoreceptor precursor cells selected via cell surface antigen expression

Retinal degenerative diseases are a major cause of untreatable blindness. Stem cell therapy to replace lost photoreceptors represents a feasible future treatment. We previously demonstrated that postmitotic photoreceptor precursors expressing an NrlGFP transgene integrate into the diseased retina and restore some light sensitivity. As genetic modification of precursor cells derived from stem cell cultures is not desirable for therapy, we have tested cell selection strategies using fluorochrome-conjugated antibodies recognizing cell surface antigens to sort photoreceptor precursors. Microarray analysis of postnatal NrlGFP-expressing precursors identified four candidate genes encoding cell surface antigens (Nt5e, Prom1, Podxl, and Cd24a). To test the feasibility of using donor cells isolated using cell surface markers for retinal therapy, cells selected from developing retinae by fluorescence-activated cell sorting based on Cd24a expression (using CD24 antibody) and/or Nt5e expression (using CD73 antibody) were transplanted into the wild-type or Crb1(rd8/rd8) or Prph2(rd2/rd2) mouse eye. The CD73/CD24-sorted cells migrated into the outer nuclear layer, acquired the morphology of mature photoreceptors and expressed outer segment markers. They showed an 18-fold higher integration efficiency than that of unsorted cells and 2.3-fold higher than cells sorted based on a single genetic marker, NrlGFP, expression. These proof-of-principle studies show that transplantation competent photoreceptor precursor cells can be efficiently isolated from a heterogeneous mix of cells using cell surface antigens without loss of viability for the purpose of retinal stem cell therapy. Refinement of the selection of donorphotoreceptor precursor cells can increase the number of integrated photoreceptor cells,which is a prerequisite for the restoration of sight.

Manipulation of the recipient retinal environment by ectopic expression of neurotrophic growth factors can improve transplanted photoreceptor integration and survival

Degeneration of the neural retina is the leading cause of untreatable blindness in the developed world. Stem cell replacement therapy offers a novel strategy for retinal repair. Postmitotic photoreceptor precursors derived from the early postnatal (P) retina are able to migrate and integrate into the adult mouse retina following transplantation into the subretinal space, but it is likely that a large number of these cells would be required to restore vision. The adult recipient retina presents a very different environment to that from which photoreceptor precursor donor cells isolated from the developing postnatal retina are derived. Here we considered the possibility that modulation of the recipient environment by ectopic expression of developmentally regulated growth factors, normally present during photoreceptor development, might enhance the migration and integration of transplanted cells into the adult neural retina. Adeno-associated viral (AAV) vectors were used to introduce three growth factors previously reported to play a role in photoreceptor development, IGF1, FGF2, and CNTF, into the adult retina, prior to transplantation of P4 cells derived from the Nrl.GFP(+ve) neural retina. At 3 weeks posttransplantation the number of integrated, differentiated photoreceptor cells present in AAV-mediated neurotrophic factor-treated eyes was assessed and compared to control treated contralateral eyes. We show, firstly, that it is possible to manipulate the recipient retinal microenvironment via rAAV-mediated gene transfer with respect to these developmentally relevant growth factors. Moreover, when combined with cell transplantation, AAV-mediated expression of IGF1 led to significantly increased levels of cell integration, while overexpression of FGF2 had no significant effect on integrated cell number. Conversely, expression of CNTF led to a significant decrease in cell integration and an exacerbated glial response that led to glial scarring. Together, these findings demonstrate the importance of the extrinsic environment of the recipient retina for photoreceptor cell transplantation and show for the first time that it is possible to manipulate this environment using viral vectors to influence photoreceptor transplantation efficiency.

Cone and rod photoreceptor transplantation in models of the childhood retinopathy Leber congenital amaurosis using flow-sorted Crx-positive donor cells

Retinal degenerative disease causing loss of photoreceptor cells is the leading cause of untreatable blindness in the developed world, with inherited degeneration affecting 1 in 3000 people. Visual acuity deteriorates rapidly once the cone photoreceptors die, as these cells provide daylight and colour vision. Here, in proof-of-principle experiments, we demonstrate the feasibility of cone photoreceptor transplantation into the wild-type and degenerating retina of two genetic models of Leber congenital amaurosis, the Crb1^rd8/rd8 and Gucy2e^−/− mouse. Crx-expressing cells were flow-sorted from the developing retina of CrxGFP transgenic mice and transplanted into adult recipient retinae; CrxGFP is a marker of cone and rod photoreceptor commitment. Only the embryonic-stage Crx-positive donor cells integrated within the outer nuclear layer of the recipient and differentiated into new cones, whereas postnatal cells generated a 10-fold higher number of rods compared with embryonic-stage donors. New cone photoreceptors displayed unambiguous morphological cone features and expressed mature cone markers. Importantly, we found that the adult environment influences the number of integrating cones and favours rod integration. New cones and rods were observed in ratios similar to that of the host retina (1:35) even when the transplanted population consisted primarily of cone precursors. Cone integration efficiency was highest in the cone-deficient Gucy2e^−/− retina suggesting that cone depletion creates a more optimal environment for cone transplantation. This is the first comprehensive study demonstrating the feasibility of cone transplantation into the adult retina. We conclude that flow-sorted embryonic-stage Crx-positive donor cells have the potential to replace lost cones, as well as rods, an important requirement for retinal disease therapy.

Targeted disruption of outer limiting membrane junctional proteins (Crb1 and ZO-1) increases integration of transplanted photoreceptor precursors into the adult wild-type and degenerating retina

Diseases culminating in photoreceptor loss are a major cause of untreatable blindness. Transplantation of rod photoreceptors is feasible, provided donor cells are at an appropriate stage of development when transplanted. Nevertheless, the proportion of cells that integrate into the recipient outer nuclear layer (ONL) is low. The outer limiting membrane (OLM), formed by adherens junctions between Müller glia and photoreceptors, may impede transplanted cells from migrating into the recipient ONL. Adaptor proteins such as Crumbs homologue 1 (Crb1) and zona occludins (ZO-1) are essential for localization of the OLM adherens junctions. We investigated whether targeted disruption of these proteins enhances donor cell integration. Transplantation of rod precursors in wild-type mice achieved 949 +/- 141 integrated cells. By contrast, integration is significantly higher when rod precursors are transplanted into Crb1(rd8/rd8) mice, a model of retinitis pigmentosa and Lebers congenital amaurosis that lacks functional CRB1 protein and displays disruption of the OLM (7,819 +/- 1,297; maximum 15,721 cells). We next used small interfering (si)RNA to transiently reduce the expression of ZO-1 and generate a reversible disruption of the OLM. ZO-1 knockdown resulted in similar, significantly improved, integration of transplanted cells in wild-type mice (7,037 +/- 1,293; maximum 11,965 cells). Finally, as the OLM remains largely intact in many retinal disorders, we tested whether transient ZO-1 knockdown increased integration in a model of retinitis pigmentosa, the rho(-/-) mouse; donor cell integration was significantly increased from 313 +/- 58 cells without treatment to 919 +/- 198 cells after ZO-1 knockdown. This study shows that targeted disruption of OLM junctional proteins enhances integration in the wild-type and degenerating retina and may be a useful approach for developing photoreceptor transplantation strategies.

Neuron network activity scales exponentially with synapse density

Neuronal network output in the cortex as a function of synapse density during development has not been explicitly determined. Synaptic scaling in cortical brain networks seems to alter excitatory and inhibitory synaptic inputs to produce a representative rate of synaptic output. Here, we cultured rat hippocampal neurons over a three-week period to correlate synapse density with the increase in spontaneous spiking activity. We followed the network development as synapse formation and spike rate in two serum-free media optimized for either (a) neuron survival (Neurobasal/B27) or (b) spike rate (NbActiv4). We found that while synaptophysin synapse density increased linearly with development, spike rates increased exponentially in developing neuronal networks. Synaptic receptor components NR1, GluR1 and GABA-A also increase linearly but with more excitatory receptors than inhibitory. These results suggest that the brain's information processing capability gains more from increasing connectivity of the processing units than increasing processing units, much as Internet information flow increases much faster than the linear number of nodes and connections.

Relative economic benefits of tactical anthelmintic treatment and urea-molasses block supplementation of Boer goats raised under extensive grazing conditions at Onderstepoort, Pretoria, South Africa

The potential economic benefits of combining tactical anthelmintic treatment for gastrointestinal nematodes and nutritional supplementation with urea-molasses blocks were examined in Boer goats raised under extensive grazing conditions in the summer rainfall area of South Africa. Eight groups of nine goats were monitored over a 12-month period from 1 October 2002 to 9 October 2003. Ad libitum nutritional supplementation with urea-molasses blocks was provided when the goats were housed at night, during the summer (wet season--December 2002 to February 2003), and/or the winter (dry season--June 2003 to August 2003). All the goats were treated symptomatically for Haemonchus contortus infection when deemed necessary by clinical examination of the conjunctiva for anaemia using the FAMACHA system. Half the groups were tactically treated for gastrointestinal nematodes in mid-summer (28 January 2003). Under the symptomatic treatment, climatic and extensive grazing conditions encountered during the trial, feed supplementation in the winter dry season had the greatest economic benefit and is therefore recommended. Tactical anthelmintic treatment afforded no additional advantage, but the nematode challenge was low.

Stem cell therapy and the retina

Retinal degeneration culminating in photoreceptor loss is the leading cause of untreatable blindness in the developed world. In this review, we consider how photoreceptors might be replaced by transplantation and how stem cells might be optimised for use as donor cells in future clinical strategies for retinal repair. We discuss the current advances in human and animal models of retinal cell transplantation, focussing on stem cell and reproductive cloning biology, in relation to the practical issues of retinal transplantation surgery. Stem and progenitor cells can be isolated from a number of sources including embryonic tissue, adult brain and even the retina, prompting many researchers to investigate the potential for using these cells to generate photoreceptors for transplantation. Nevertheless, several obstacles need to be overcome before these techniques can be applied in a clinical setting. Embryonic or stem cells have so far shown little ability to differentiate into retinal phenotypes when transplanted into the adult retina. We have recently noted, however, that donor cells harvested much later, at the photoreceptor precursor developmental stage, can be transplanted successfully and restore visual function. The current challenge is to understand the developmental processes that guide embryonic or adult stem cells towards photoreceptor differentiation, so that large numbers of these cells might be transplanted at the optimal stage. Future advances in reproductive cloning technology could lead to the successful generation of stem cells from adult somatic cells, thereby facilitating auto-transplantation of genetically identical cells in patients requiring photoreceptor replacement.

Pharmacological disruption of the outer limiting membrane leads to increased retinal integration of transplanted photoreceptor precursors

Retinal degeneration is the leading cause of untreatable blindness in the developed world. Cell transplantation strategies provide a novel therapeutic approach to repair the retina and restore sight. Previously, we have shown that photoreceptor precursor cells can integrate and form functional photoreceptors after transplantation into the subretinal space of the adult mouse. In a clinical setting, however, it is likely that far greater numbers of integrated photoreceptors would be required to restore visual function. We therefore sought to assess whether the outer limiting membrane (OLM), a natural barrier between the subretinal space and the outer nuclear layer (ONL), could be reversibly disrupted and if disruption of this barrier could lead to enhanced numbers of transplanted photoreceptors integrating into the ONL. Transient chemical disruption of the OLM was induced in adult mice using the glial toxin, dl-alpha-aminoadipic acid (AAA). Dissociated early post-natal neural retinal cells were transplanted via subretinal injection at various time-points after AAA administration. At 3 weeks post-injection, the number of integrated, differentiated photoreceptor cells was assessed and compared with those found in the PBS-treated contralateral eye. We demonstrate for the first time that the OLM can be reversibly disrupted in adult mice, using a specific dose of AAA administered by intravitreal injection. In this model, OLM disruption is maximal at 72 h, and recovers by 2 weeks. When combined with cell transplantation, disruption of the OLM leads to a significant increase in the number of photoreceptors integrated within the ONL compared with PBS-treated controls. This effect was only seen in animals in which AAA had been administered 72 h prior to transplantation, i.e. when precursor cells were delivered into the subretinal space at a time coincident with maximal OLM disruption. These findings suggest that the OLM presents a physical barrier to photoreceptor integration following transplantation into the subretinal space in the adult mouse. Reversible disruption of the OLM may provide a strategy for increasing cell integration in future therapeutic applications.

Benefits of urea-molasses block supplementation and symptomatic and tactical anthelmintic treatments of communally grazed indigenous goats in the Bulwer area, Kwazulu-Natal Province, South Africa

This study was carried out with the cooperation of farmers owning communally grazed indigenous goats in southwestern KwaZulu-Natal Province, South Africa, where farmers had identified poor reproductive performance in their herds as one of their major problems. The aim was to quantify the effects of 3 interventions and the interaction between these interventions on goat productivity and gastrointestinal nematode infection. The interventions were: urea-molasses block supplementation during the dry winter seasons of 2004 and 2005, tactical anthelmintic treatment with ivermectin (400 microg/kg) during the wet summer period (on 3 January 2005) and symptomatic treatment with ivermectin (400 microg/kg) of all goats judged anaemic throughout the entire study period. The FAMACHA system was used as a gauge of anaemia. It was noted that goats considered anaemic tended to remain so throughout the study period. The tactical anthelmintic treatment was effective as it markedly reduced (P = 0.066) the summer peak in faecal egg counts and is therefore recommended. By contrast, while the urea-molasses block supplementation appeared to reduce the faecal egg counts immediately following the 2004 supplementation (P < 0.05), this did not hold true in 2005. Interestingly, in the tactically treated anaemic goats, the improvement in the number of kids suckled per doe year-on-year tended to be greater than in the non-anaemic goats. It is considered that the routine symptomatic treatment of anaemic goats may have been a key factor. More detailed investigations into the routine symptomatic treatment of anaemic goats are therefore recommended.

The effect of forage quality and level of feeding on digestibility and gastrointestinal transit time of oat straw and alfalfa given to ponies and donkeys

Four donkeys and four ponies were fed molassed dehydrated alfalfa or oat straw, eitherad libitumor restricted to about 70 %ad libitumintake in a Latin-square design for four periods of 21 d. Measurements of apparent digestibility and gastrointestinal transit time were made on the last 7 d of each period. When the forages were providedad libitum, all animals ate significantly (P<0.01) more of the alfalfa than of the oat straw. Ponies consumed significantly (P = 0.007) more of both diets per unit live weight than donkeys. Higher apparent digestibilities of dietary DM, energy and fibre fractions were seen in donkeys, at both levels of feeding, compared with the ponies. This partly compensated for the lower intakes by the donkeys when fedad libitum. When intake of alfalfa was restricted, the apparent digestibility of DM was higher compared with the corresponding values when fedad libitum,but the reverse was true for straw. This may be because restriction of a low-quality diet reduced selection of the more digestible parts of the forage. Donkeys and ponies consumed more energy and protein than required when fed alfalfaad libitum. Both oat straw treatments provided insufficient protein to meet the predicted requirements of ponies and donkeys. Straw intakesad libitumexceeded the estimated energy requirement for ponies by 34–51 %, but donkey energy requirements were only just met. When the amount of straw offered was restricted, 78–90 % of the estimated energy requirement for donkeys was met compared with 90–105 % for the ponies.

A comparison of the effect of forage type and level of feeding on the digestibility and gastrointestinal mean retention time of dry forages given to cattle, sheep, ponies and donkeys

Four cattle, sheep, ponies and donkeys were fed dehydrated lucerne, early-cut hay, later-cut hay or barley straw in a Latin square-based design for four periods of 35d. In the first sub-period animals were fed the dietsad libitum(1–21d) and in the second sub-period they were fed the same diet restricted to 0·75 ofad libitumintake (days 22–35). Measurements of forage intake, apparent digestibilities and gastrointestinal mean retention times (MRT) were made in the last 7d of each sub-period. Differences between species in voluntary DM intake (VDMI; g/kg live weight LW)0·75and g/LW) were greatest on the lucerne and least on barley straw. Cattle VDMI (g/kg LW0·75) compared with intake of the other species was > ponies > sheep > donkeys on lucerne. On barley straw VDMI (g/kg LW0·75) of cattle compared with intake of the other species was = donkey = ponies > sheep. VDMI of hays were intermediate between the lucerne and straw forages. Apparent digestibilities of DM, organic matter (OM), neutral-detergent fibre (NDF) and acid-detergent fibre (ADF) of the lucerne and hays were higher in the ruminants than in the equids. Effect of feeding level was not significant. Gastrointestinal MRT was shorter in the equids than in the ruminants. On straw diets donkeys showed similar apparent digestibilities of feed components to those of the cattle, whilst apparent digestibility of the straw diet by the ponies was lowest. Results are discussed in relation to evolutionary differences in feeding and digestion strategy associated with fore- or hind-gut fermentation in ruminants and equids.

Retinal repair by transplantation of photoreceptor precursors

Photoreceptor loss causes irreversible blindness in many retinal diseases. Repair of such damage by cell transplantation is one of the most feasible types of central nervous system repair; photoreceptor degeneration initially leaves the inner retinal circuitry intact and new photoreceptors need only make single, short synaptic connections to contribute to the retinotopic map. So far, brain- and retina-derived stem cells transplanted into adult retina have shown little evidence of being able to integrate into the outer nuclear layer and differentiate into new photoreceptors. Furthermore, there has been no demonstration that transplanted cells form functional synaptic connections with other neurons in the recipient retina or restore visual function. This might be because the mature mammalian retina lacks the ability to accept and incorporate stem cells or to promote photoreceptor differentiation. We hypothesized that committed progenitor or precursor cells at later ontogenetic stages might have a higher probability of success upon transplantation. Here we show that donor cells can integrate into the adult or degenerating retina if they are taken from the developing retina at a time coincident with the peak of rod genesis. These transplanted cells integrate, differentiate into rod photoreceptors, form synaptic connections and improve visual function. Furthermore, we use genetically tagged post-mitotic rod precursors expressing the transcription factor Nrl (ref. 6) (neural retina leucine zipper) to show that successfully integrated rod photoreceptors are derived only from immature post-mitotic rod precursors and not from proliferating progenitor or stem cells. These findings define the ontogenetic stage of donor cells for successful rod photoreceptor transplantation.

EIAV vector-mediated delivery of endostatin or angiostatin inhibits angiogenesis and vascular hyperpermeability in experimental CNV

We evaluated the efficacy of equine infectious anaemia virus (EIAV)-based lentiviral vectors encoding endostatin (EIAV.endostatin) or angiostatin (EIAV.angiostatin) in inhibiting angiogenesis and vascular hyperpermeability in the laser-induced model of choroidal neovascularisation (CNV). Equine infectious anaemia virus.endostatin, EIAV.angiostatin or control (EIAV.null) vectors were administered into the subretinal space of C57Bl/6J mice. Two weeks after laser injury CNV areas and the degree of vascular hyperpermeability were measured by image analysis of in vivo fluorescein angiograms. Compared with EIAV.null-injected eyes, EIAV.endostatin resulted in a 59.5% (P<0.001) reduction in CNV area and a reduction in hyperpermeability of 25.6% (P<0.05). Equine infectious anaemia virus.angiostatin resulted in a 50.0% (P<0.05) reduction in CNV area and a 23.9% (P<0.05) reduction in hyperpermeability. Equine infectious anaemia virus.endostatin, but not EIAV.angiostatin significantly augmented the frequency of apoptosis within the induced CNV as compared with injected controls. TdT-dUTP terminal nick end labeling analysis 5 weeks post-injection, and histological and retinal flatmount analysis 12 months post-injection revealed no evidence of vector- or transgene expression-related deleterious effects on neurosensory retinal cells, or mature retinal vasculature in non-lasered eyes. Highly expressing EIAV-based vectors encoding endostatin or angiostatin effectively control angiogenesis and hyperpermeability in experimental CNV without long-term deleterious effects, supporting the use of such a strategy in the management of patients with exudative age-related macular degeneration.

Delivery of health and husbandry improvements to working animals in Africa

Problems have been identified in the delivery of extension messages about the maintenance of healthy and well-fed working animals. The different factors that need to be considered in developing effective disease control and prevention programmes for working oxen and equids including vector-borne diseases, helminth disease, and vaccination programmes have been reported and discussed and experiences in improving husbandry including footcare, harness, and worm management reported. Most draught animals are owned by people who lack the financial means to pay for or to access the information needed on nutritional supplements, vaccinations and drug treatment. Smallholder farms are often remote from veterinary services, thereby requiring greater emphasis on preventive measures and local remedies. Several NGOs have traditionally provided static and mobile treatment teams for equines and training courses for farriers and harness makers. The effectiveness and sustainability of these services and ways in which delivery of health care and husbandry messages could be delivered to improve impact are discussed.

The effect of extended grazing time and supplementary forage on the dry matter intake and foraging behaviour of cattle kept under traditional African grazing systems

An experiment was carried out at Alemaya University in Ethiopia to investigate the effect of night kraaling on the dry matter intake (DMI), live weight gain (LWG) and foraging behaviour of Ogaden cattle. Three groups of four animals were given either 7 h access to pasture per day, simulating traditional grazing (TG) practice; extended grazing (EG) access for 11 h per day; or traditional grazing access plus a nocturnal forage supplement (TF). Live weight gain, DMI and foraging behaviour were measured during the late dry season (EP1) and the wet season (EP2). None of the treatments had any significant effect on either DMI or LWG during EP1 or EP2. Extending pasture access time from 7 h to 11 h did not significantly increase the amount time spent grazing, but grazing intensity was significantly (p < 0.05) reduced during the non-common grazing hours. Step rate was significantly lower (p < 0.01) during EP2 than during EP1 and bites per step were significantly higher (p < 0.001) during EP2 than EP1, indicating that animals had to travel a shorter distance before selecting material to eat during the wet season (EP2). Providing supplementary forage (TF) had no significant effect on any measured parameter. In this study neither of the two low-cost methods (EG and TF) of improving access to forage had any beneficial effect on cattle productivity. It is concluded that, under the prevailing conditions, the traditional grazing practices of this part of Ethiopia do provide sufficient pasture access time to achieve daily voluntary food intake.

A Review of the Factors Affecting the Survival of Donkeys in Semi-arid Regions of Sub-Saharan Africa

The large fluctuations seen in cattle populations during periods of drought in sub-Saharan Africa are not evident in the donkey population. Donkeys appear to have a survival advantage over cattle that is increasingly recognized by smallholder farmers in their selection of working animals. The donkey's survival advantages arise from both socioeconomic and biological factors. Socioeconomic factors include the maintenance of a low sustainable population of donkeys owing to their single-purpose role and their low social status. Also, because donkeys are not usually used as a meat animal and can provide a regular income as a working animal, they are not slaughtered in response to drought, as are cattle. Donkeys have a range of physiological and behavioural adaptations that individually provide small survival advantages over cattle but collectively may make a large difference to whether or not they survive drought. Donkeys have lower maintenance costs as a result of their size and spend less energy while foraging for food; lower energy costs result in a lower dry matter intake (DMI) requirement. In donkeys, low-quality diets are digested almost as efficiently as in ruminants and, because of a highly selective feeding strategy, the quality of diet obtained by donkeys in a given pasture is higher than that obtained by cattle. Lower energy costs of walking, longer foraging times per day and ability to tolerate thirst may allow donkeys to access more remote, under-utilized sources of forage that are inaccessible to cattle on rangeland. As donkeys become a more popular choice of working animal for farmers, specific management practices need to be devised that allow donkeys to fully maximize their natural survival advantages.

Live Weight Estimation of Donkeys in Central México from Measurement of Thoracic Circumference

Body measurements (length from nape of neck to the withers; height to withers; length from withers to tail root; length from shoulder to tuber ischii; thoracic circumference; umbilical circumference) were taken and correlated with live weight from 160 donkeys (mean +/- standard deviation = 6 +/- 2.6 years old) in Central Mexico. The age was assessed from dentition. Sex of the donkeys was also recorded. Sex was an important factor of variation (p = 0.011). Live weight was estimated using two allometric models. Model 1: Live weight = beta x (thoracic circumference)beta1. Model 2: Live weight = betao x (height to the withers) beta1 x (thoracic circumference) beta2. Separate prediction equations were produced for males and females, plus one for the total sampled. The 'best fit' models, were those using thoracic circumference to predict the live weight. Males: live weight = 0.018576 x (thoracic circumference)1.84107 (R2 = 0.9839). Females: live weight = 0.031255 x (thoracic circumference)1.72888 (R2 = 0.9839). The equations derived to estimate the live weight of donkeys in Britain, Morocco and Zimbabwe were less satisfactory for use with donkeys from Central Mexico because they overestimated the live weight.

Estimation of the liveweight of working mules in Morocco from their body measurements

During March 2001, 117 working mules, randomly chosen from four markets in Morocco, were weighed and a series of body measurements recorded; their age and body condition score were also recorded. Linear regression techniques were used to derive a 'best fit' equation for predicting liveweight from the other variables. For the working mules weighing between 131 and 391 kg the best prediction equation using two variables was: liveweight (kg) = -33 + 2.8 x heart girth (cm)+1.36 x length (cm). Other prediction equations available for estimating the liveweight of equidae were tested on the data, but in all cases they significantly overestimated the weights of the Moroccan mules.

Performance of broilers fed on diets containing different amounts of chaya (Cnidoscolus aconitifolius) leaf meal

The performance and gut measurements of broilers fed on diets containing different amounts of chaya (Cnidoscolus aconitifolius) leaf meal (CLM) were examined in two experiments. In the first experiment, 60 Hubbard chickens (30 males and 30 females; 2 weeks old) were fed on five maize diets; these were formulated using 0, 150 (CLM150), 250 (CLM250) or 350 (CLM350) g CLM/kg, and the fifth diet contained soyabean. In the second experiment, 148 Ross male chicks, 1 day old, were fed on three isonitrogenous and isoenergetic maize-soyabean-based diets, which included 0 (control), 150 (C150) or 250 (C250) g CLM/kg. The diets were offered ad libitum for 2 or 3 weeks in the first and second experiments, respectively. Food intake, weight gain and the food:weight gain ratio were recorded. The weight of the gizzard and intestine and the weight and length of the caeca were also determined in the second experiment. In experiment 1, the birds fed on the maize-soyabean diet had a higher (p < 0.05) weight gain and final weight than birds fed on maize only or on the CLM150 diets. There were no differences for any of the variables studied between the birds fed on the maize-soyabean diet and those fed on the CLM250, nor between males and females. In the second experiment, weight gain, food intake and the food:weight gain ratio for birds fed on C250 were lower (p < 0.05) than those in birds fed on either the control or C150 diets. The weights of the gizzard and intestine were the lowest and the highest, respectively, in birds fed on C250 (p < 0.05). The length and weight of the caecum from birds fed on the control diet were lower (p < 0.05) than those of birds fed on either the C150 or C250 diets. The results from this study suggest that CLM may be included up to 150 g/kg in commercial diets without having an adverse effect on poultry performance, and may also be mixed with maize up to 250 g/kg to improve the performance of chickens fed on low-protein diets.

Performance and management of draught animals in agriculture in sub-Saharan Africa: a review

Use of animal power generally enables farmers in sub-Saharan Africa to increase agricultural production and improve the quality of life. Effective use of working animals depends on an understanding of the capabilities of the animals for work, their husbandry requirements and the factors which can influence their performance. These issues are reviewed in this paper in the context of the use of animal power in agriculture in sub-Saharan Africa. The type of animal used for work determines power available to the farmer. The performance of donkeys, horses and cattle have been compared in work tests. Equids are more suited to rapid low draught activities where their faster speed can be used to advantage. At higher draught forces, where speed is less important, the additional weight and power of cattle are an advantage. Use of heart rate recovery after work gives a reasonable indication of fatigue and fitness of equids, when test conditions are standardized. Although feed requirements for work are generally low, feed quality can be so poor that animals are unable to eat enough to meet energy needs for work, and so lose weight during the work season. However, improvements in work performance are not always seen following supplementary feeding in the dry season and the economics need to be considered in each case. Food availability, diseases and heat stress, the major constraints to performance of draught cattle and donkeys working in sub-Saharan Africa, are discussed.

Effect of density and weight of load on the energy cost of carrying loads by donkeys and ponies

Two experiments were designed to compare the energy used in carrying loads by donkeys and ponies. In the first experiment 3 donkeys and 3 ponies were compared on treadmills in the UK. Density of load (lead shot or straw) had no significant effect on the energy cost of carrying loads; however, the energy cost of carrying a load decreased significantly (p < 0.001) as the weight of the load increased (in donkeys 6.44, 4.35 and 3.03 J/kg load/m, in ponies 5.82, 3.75 and 3.68 J/kg load/m, for loads of 13, 20 and 27 kg/100 kg liveweight (M) respectively). Differences between species were not significant. In the second experiment energy expenditures were determined in 3 donkeys carrying loads equivalent to 40 kg/100 kg M over gently undulating gravel tracks in Tunisia. Energy costs of carrying the load were 2.34 (SE 0.07) J/kg load/m. The results of both experiments showed that provided the load is balanced, density does not significantly affect the energy cost of carrying; however, as the load increased then the unit energy cost of carrying it decreased. This suggest that it is more efficient in terms of energy used to carry loads equivalent to 27 to 40 kg/100 kg M than it is to carry lighter loads to less than 20 kg/100 kg M.

An evaluation of the use of cisapride in horses with chronic grass sickness (equine dysautonomia)

A clinical trial was carried out to determine the effect of cisapride on rate of passage of digesta and clinical parameters in horses with chronic grass sickness. Sixteen horses were given intramuscular cisapride (0.1 mg kg-1 three times daily) (group I), and 15 received oral cisapride (0.8 mg kg-1 three times daily) (group O). A liquid-phase marker (cobalt-EDTA) and a solid-phase marker (polystyrene pellets) were given by stomach tube at the beginning of each of three consecutive 7 day periods, i.e., before, during and after cisapride therapy. Seven horses in each group completed the rate of passage trial; the remainder provided clinical data only. The rate of passage was found to be significantly faster after cisapride therapy than before. Comparison with data from 20 normal animals showed a trend towards normal rates of passage after therapy. In cases that died during the trial, the caecum and large colon were the main sites of pellet retention. Dry matter intake was significantly higher after therapy than before in group O and dry matter output was higher after treatment than before in both groups. Gut auscultation score increased in both groups in the periods during and after cisapride administration but heart rate was unaffected. Diarrhoea and colic occurred in each group but its occurrence was not associated with cisapride therapy. The results suggest that by increasing gut motility, cisapride is of benefit in the management of selected cases of chronic grass sickness.

Estimation of the liveweight and body condition of working donkeys in Morocco

The age, sex, liveweight and body measurements (heart girth, umbilical girth, height, length from elbow to tuber ischii and circumference of the foreleg cannon bone) of 516 donkeys used to transport goods in Morocco were recorded. There were few donkeys over 12 years of age. For adult donkeys weighing from 74 to 252 kg, the best equation with only one variable for predicting liveweight was: liveweight (kg) = heart girth (cm)2.65/2188. The inclusion of two variables improved the prediction marginally, but the addition of further variables gave little further improvement. The best prediction equation for adult donkeys was: liveweight (kg) = (heart girth [cm]2.12 x length [cm]0.688)/380. For donkeys under three years of age, weighing from 52 to 128 kg, the best prediction equation was: liveweight (kg) = (umbilical girth [cm]1.41 x length [cm]1.09)/1000. Other liveweight prediction equations for donkeys and horses were tested on the data and tended to overestimate the weight of these working donkeys. A subjective method for assessing the body condition of the donkeys was developed, using a scale from 1 (emaciated) to 9 (obese).

The Centre for Tropical Veterinary Medicine (CTVM) pulling its weight in the field of draught animal research

Draught animal research carried out by scientists at the Centre for Topical Veterinary Medicine (CTVM) in Edinburgh and overseas is reviewed and the major findings are reported. The remit for the work has been to provide basic information on draught animals which can be applied by researchers and extension workers to their own geographic situations. Instrumentation is described which has been designed and manufactured to assist in the measurement of draught animal performance, particularly work output and energy consumption. Energy requirements of cattle, buffaloes and equids for work and ways in which these can be met from feed intake and body reserves reported. Studies on heat stress and diseases, 2 of the constraints to work performance, are also described.

Trypanosoma evansi infection in worked and unworked buffaloes (Bubalus bubalis) in Indonesia

The effect of controlled amounts of exercise on the outcome of Trypanosoma evansi infection was studied in groups of swamp buffaloes (Bubalus bubalis) experimentally infected with T. evansi. Daily body temperature, packed cell volume (PCV) and parasitaemia measurements were obtained from each animal for up to 110 days after infection. Exercise did not appear to exacerbate the effect of T. evansi infection in that similar temperature, PCV and parasitaemia profiles were obtained with both exercised and rested animals. Trypanosoma evansi infection, however, had a marked effect on temperature and PCV profiles, both of which could adversely affect an infected animal's work output and work tolerance.

Intake, digestion and gastrointestinal transit time in resting donkeys and ponies and exercised donkeys given ad libitum hay and straw diets

Four donkeys and four ponies maintained in climate rooms, were provided with meadow hay or barley straw supplemented with minerals and vitamins ad libitum. Both diets were given to all animals for periods of 21 days. Measurements were made during the last seven days following single doses of two non-absorbable markers (Cr-fibre and Co-EDTA). After six weeks the donkeys repeated the trial, walking 14 km and ascending 260 m five days per week. At rest ponies ate more than donkeys, however the donkeys showed a higher digestibility of dry matter (DM), organic matter (OM) and acid detergent fibre (ADF) than the ponies. Both species lost weight, ate less and had a lower digestibility of DM, OM and energy on the straw than on the hay ration. Fibre digestibility (neutral detergent fibre [NDF] and ADF) was higher on the straw than the hay diet. Gastrointestinal transit time was slower in the donkeys than in the ponies on both diets. Both species showed a higher mean retention time of digesta on straw than on hay. Exercise had no significant effect on food intake and liveweight changes in the donkeys. Although digestibility coefficients were higher in exercised animals, the effect was not significant. We conclude that, although it is generally considered that donkeys can thrive better on poor feeds than ponies, when the animals are allowed ad libitum access to hay and straw better intakes by ponies may compensate for any differences in digestibility seen in donkeys. Intake of barley straw by both species was not sufficient to meet maintenance requirements.

Influence of egg storage on hatchability, embryonic development and vitamin status in hatching broiler chicks

Storage of eggs for 14 d prior to incubation depressed hatchability by 10%. Most of the increase in embryonic mortality (64%) occurred during the first week of incubation, with a further 30% taking place during the third week. Chicks hatching from stored eggs did not show any increased incidence of physical abnormalities characteristic of vitamin deficiencies. Chicks from stored eggs showed haematological abnormalities characteristic of mild macrocytic anaemia. Such changes can result from deficiencies of folic acid or cobalamin. Biochemical and haematological data did not suggest impairments in the status of the chicks with respect to a range of other vitamins.

Biotin requirements of broiler breeders fed diets of different protein content and effect of insufficient biotin on the viability of progeny

Production of eggs or normal chicks was depressed when practical diets containing 168 g or 137 g of crude protein (CP)/kg were not supplemented with synthetic biotin. Overall egg production and hatchability of fertile eggs was significantly (P less than 0.05) higher with the diets containing 137 g CP/kg. Biotin requirement was higher with the diet containing 168 g CP/kg and was estimated to be about 100 micrograms of available biotin/kg, equivalent to a daily intake of 16 micrograms for food-restricted hens. Biotin concentrations in egg yolk and chick plasma were related to maternal intake and increased with maternal age. The minimum yolk biotin concentration indicative of adequate maternal status was about 550 micrograms/g. Chicks from young hens fed insufficient biotin had the poorest biotin status at hatching and their growth potential and viability were reduced.

Toxic effects of high concentrations of zinc oxide in the diet of the chick and laying hen

The effects of high dietary concentrations of zinc oxide on chicks and hens were studied in four experiments. Chicks given 2000, 4000 or 6000 mg zinc/kg diet from 2 to 6 weeks of age grew poorly, many showing gizzard erosion and lesions of the exocrine pancreas. Dissecting aneurysms occurred in a few birds receiving 6000 mg zinc/kg. Pancreatic lesions were found in chicks maintained on 1000, 2000 or 4000 mg zinc/kg from 0 to 4 weeks and the two higher concentrations reduced body weight and increased the incidence of gizzard erosion. Histologically, gizzard lesions varied from excessive desquamation of epithelial cells, heterophils and erythrocytes into an abnormally spongiform koilin, to erosion of koilin, glands and pits. Pancreatic lesions could be detected only microscopically and consisted of dilation of the acinar lumina, cytoplasmic vacuolation, cytoplasmic globule formation and necrosis of the exocrine cells with interparenchymal fibrosis. Similar lesions of the gizzard and pancreas were found in hens after they had received 10000 or 20000 mg zinc/kg diet for only 4 d. Hens given 10000 mg zinc/kg for 4 d followed by a normal zinc intake for 28 d had normal gizzards and pancreata.