Development and validation of a predictive score, for identifying poor eastern cooperative oncology group performance status (performance status 3-4) advanced nonsmall cell lung cancer patients who are likely to benefit from tyrosine kinase inhibitors.

BACKGROUND: One of the ten advanced lung cancer patients presents with poor eastern cooperative oncology group performance status (ECOG PS). There are no clear guidelines about management of these patients. The benefit of tyrosine kinase inhibitors (TKI) in this patient population remains questionable. Hence, in this study, we attempted to develop and validate a predictive score which would predict benefit from oral TKI. METHODS: This was a prospective observational study done at Tata Memorial Hospital, India. Patients with nonsmall cell lung cancer with ECOG PS 3-4 were included in this study. All these patients had received oral TKI on compassionate grounds and were followed up till death. The overall survival (OS) was calculated from date of start of TKI to date of death. R software was used for development and validation of the predictive model. RESULTS: The median survival duration of the discovery cohort and validation cohort were 170.5 and 115 days, respectively. The model predicted OS accurately, within ±2 months in 72.1% and within ±3 months in 81.7% of patients. CONCLUSION: The current model can predict OS in poor PS patients treated with TKI within a satisfactory clinical range and can be used for decision-making of these patients.

Nocardia nova mycetoma over forehead in a lepromatous leprosy patient.

We present a case of a 31-year-old male, a known patient with lepromatous leprosy with a type 2 lepra reaction, who presented with a slowly growing asymptomatic swelling with multiple discharging sinuses over the forehead that developed over 6 months. Smears of the serosanguinous discharge on Gram staining showed Gram-positive branching filamentous bacilli, which on culture on blood agar showed chalky-white colonies. Histology of the lesion showed suppurative granulomas with polymorphs surrounding characteristic grains. The isolate was identified as Nocardia nova by gene sequencing and the patient was started on combined antibiotic therapy that resulted in complete resolution of the infection in six months. To the best of our knowledge, this is the first report of mycetoma related to Nocardia nova in association with leprosy.

Metabolic specialization in fast and slow muscle fibers of the developing rat.

Individual fibers of prospective fast (extensor digitorum longus; EDL) and slow (soleus) muscles of rats have been analyzed to determine the profiles of key energy-generating enzymes at successive stages of postnatal development. Mean activities of lactate dehydrogenase (LDH) and adenylokinase (AK), 2 enzymes associated with contractile function, are significantly different in the 2 fiber populations at birth; furthermore, wide variations in enzyme activities exist among the individual fibers. There is a progressive refinement of enzyme levels in the soleus into a more uniform fiber population, while the fibers in the EDL progressively diverge into 2 distinct phenotypes. Changes in EDL and soleus are punctuated by periods of rapid change, with the period between 10 and 21 d being most eventful. Generally, the maturation profiles of LDH and AK coincide with the transition from neonatal to adult fast myosins and closely reflect the timing of energy demands imposed by contractile activity patterns. In contrast, activities of the oxidative enzymes malate dehydrogenase and beta-hydroxyacyl CoA dehydrogenase are similar in both muscles at birth and steadily increase during the first 3 weeks, suggesting a progressive adaptation to the aerobic extrauterine environment. After 30 d, there are differential changes in the oxidative profiles of enzymes for fatty acid and glucose metabolism. The profiles follow dietary changes associated with weaning, which suggests a phenotypic dependence of neonatal muscle on the particular available energy substrate. All enzymes are low in all fibers of EDL and soleus at birth, indicating their modest metabolic capacity.(ABSTRACT TRUNCATED AT 250 WORDS)

Association between biochemical and physiological properties in single motor units.

Motor units from the cat tibialis posterior muscle were examined for an association between physiological and biochemical properties. Functionally isolated motor units were categorized on the basis of their physiological properties. This was followed by quantitative microbiochemical analysis of single muscle fibers from each unit, identified in cross sections using the glycogen-depletion method. The activities of malate dehydrogenase and beta-hydroxyacyl-CoA dehydrogenase distinguished between fatigable (type FF) and fatigue-resistant (types FR and S) units. The activities of both lactate dehydrogenase and adenylokinase were higher in fast- than in slow-contracting units. Cluster analyses, based on both physiological and biochemical properties or on biochemical properties alone, produced groupings identical to types FF, FR, and S. The association between physiological and biochemical properties substantiates the idea that biochemically distinct groups of motor units correspond to physiologically identifiable groups.

Fluorometric procedures for measuring triglyceride concentrations in small amounts of tissue and plasma.

It has been previously shown that triglycerides can be specifically hydrolyzed by lipase from Rhizopus arrhizus in the presence of hog liver esterase and sodium dodecyl sulfate. The glycerol produced can then be measured by sequential reactions with glycerokinase, pyruvate kinase, and lactate dehydrogenase: glycerol and ATP are converted to glycerol-3-phosphate and ADP by glycerokinase; the ADP reacts with phosphoenolpyruvate and pyruvate kinase to yield pyruvate; the pyruvate is converted to lactate with lactate dehydrogenase, and the cofactor NAD+ is simultaneously reduced to NADH. This report describes procedures by which either the disappearance of NADH or the appearance of NAD+ was determined fluorometrically, with 10- to 100-fold greater sensitivity than by spectrophotometry. In addition, enzymatic cycling of NAD+ was used to increase the sensitivity of the assay over 1000-fold, and thereby provided accurate measurement of less than 1 ng of triglyceride. Results obtained from the three fluorometric methods were highly correlated with an automated periodate oxidation method using serum samples and lipid extracts of muscle tissue.

Uniformity of metabolic enzymes within individual motor units.

Individual muscle fibers of 10 motor units from the tibialis posterior muscle of cat were identified by glycogen depletion techniques, characterized for histochemical type, diameter, and intramuscular locations, and analyzed by quantitative biochemical methods. Four enzymes, representing different energy-yielding pathways, were quantitatively assayed in muscle fibers belonging to motor units selected from each of the three major physiological types. All four enzymes demonstrated identical activities among fibers within a motor unit, while showing up to 11-fold differences among fibers belonging to different motor units. Moreover, fibers within a single motor unit, but of substantially different diameters, were nevertheless homogeneous in specific enzyme activities.

Control of enzyme activities in individual myotubes cultured without nerve.

The activities of lactate dehydrogenase, malate dehydrogenase, phosphorylase, and adenylate kinase were measured in single myotubes dissected from primary cultures of rat skeletal muscle. For a given enzyme, activities among the spontaneously contracting cells varied as much as eightfold. When the myotubes were paralyzed with tetrodotoxin, the variability in enzyme levels was markedly decreased. These and other findings suggest that differences in enzyme levels among individual myotubes may arise as a result of differences in their pattern of contractile activity.

Isolation and partial characterization of Fc gamma-binding proteins of human leukocytes.

We isolated and partially characterized three Fc-binding macromolecules from human leukocytes. Mononuclear cells from normal individuals and from five patients with chronic lymphocytic leukemia and neutrophils from normal donors were surface radiolabeled by using 125I and lactoperoxidase. After detergent solubilization of the cells, Fc gamma-binding macromolecules were purified by repetitive affinity chromatography under a variety of conditions and analyzed by sodium dodecyl sulfate (SDS)-polyacrylamide gel electrophoresis. Three radiolabeled macromolecules were isolated that retained specific ability to bind to Fc fragments. A 52,000-64,000-mol wt macromolecule was isolated from normal mononuclear and polymorphonuclear cells. A 43,000-mol wt band was characteristic of mononuclear cells, particularly from patients with chronic lymphocytic leukemia. A 33,000-mol wt molecule could be obtained from normal leukocytes under conditions that suggest it might be a proteolytic fragment.