Palliative Lung Radiotherapy: Higher Dose Leads to Improved Survival?

AIMS: Choosing the optimal palliative lung radiotherapy regimen is challenging. Guidance from The Royal College of Radiologists recommends treatment stratification based on performance status, but evidence suggests that higher radiotherapy doses may be associated with survival benefits. The aim of this study was to investigate the effects of fractionation regimen and additional factors on the survival of palliative lung cancer radiotherapy patients. MATERIALS AND METHODS: A retrospective univariable (n = 925) and multivariable (n = 422) survival analysis of the prognostic significance of baseline patient characteristics and treatment prescription was carried out on patients with non-small cell and small cell lung cancer treated with palliative lung radiotherapy. The covariates investigated included: gender, age, performance status, histology, comorbidities, stage, tumour location, tumour side, smoking status, pack year history, primary radiotherapy technique and fractionation scheme. The overall mortality rate at 30 and 90 days of treatment was calculated. RESULTS: Univariable analysis revealed that performance status (P < 0.001), fractionation scheme (P < 0.001), comorbidities (P = 0.02), small cell histology (P = 0.02), 'lifelong never' smoking status (P = 0.01) and gender (P = 0.06) were associated with survival. Upon multivariable analysis, only better performance status (P = 0.01) and increased dose/fractionation regimens of up to 30 Gy/10 fractions (P < 0.001) were associated with increased survival. Eighty-five (9.2%) and 316 patients (34%) died within 30 and 90 days of treatment, respectively. CONCLUSION: In this retrospective single-centre analysis of palliative lung radiotherapy, increased total dose (up to and including 30 Gy/10 fractions) was associated with better survival regardless of performance status.

Evaluation of an intervention system for parents of children with intellectual disability and challenging behaviour.

BACKGROUND: Signposts is a flexible intervention system for families of children who have intellectual disability and challenging behaviour. The Signposts materials include eight information booklets, a workbook and videotape for parents, and a series of instructional manuals for therapists. The system was designed so that it can be delivered in several different ways, i.e. group support, telephone support and self-directed modes. METHODS: The present study was an evaluation of these three modes of delivery and involved 115 families. RESULTS: Following the use of the Signposts materials in parent training programmes, the subjects reported that they were less stressed, felt more efficacious about managing their children's behaviour, were less hassled about meeting their own needs and that their children's behaviour had improved. Additionally, families generally reported high levels of satisfaction with the content and delivery of the materials. CONCLUSIONS: Finally, there were minimal differences among the three modes of delivery on the measures used, although families who used the self-directed mode were less likely to complete the materials. Implications of these results for service delivery are discussed.

Dual resonant birdcage coils for 1H detected 13C microscopic imaging at 11.7 T.

Liquid state, rotating frame cross polarisation experiments are very sensitive to RF field inhomogeneity. In this work, we present an easily fabricated, co-resident high- and low-pass linear birdcage resonator, optimised to perform liquid state rotating frame polarisation transfer at 1H and 13C frequencies. Both the RF fields have been experimentally mapped, and used to validate the spatial signal dependence of a proton detected, 13C image. The predicted performance was then confirmed using PRAWN-based, cyclic J-cross polarisation (CYCLCROP) imaging. A novel variant of a B(1)-field mapping approach is also presented, using the signal enhancement of the CYCLCROP sequence to generate proton detected, 13C field maps.

Open access birdcage coils for microscopic imaging of plants at 11.7 T.

The use of a U-shaped high-pass birdcage coil for microscopic imaging at 11.7 T has been investigated. The study was motivated by the requirement for a side access coil, permitting higher filling factors for the in-vivo imaging of plant petioles and stems. The performance of a U-shaped coil (with a cross section consisting of a 16 mm diameter semi-circle plus two 12 mm length straight sections) has been experimentally assessed, and compared both in terms of homogeneity and sensitivity to a 16 mm diameter conventional (linear) birdcage and a saddle coil of the same diameter. The U-shaped coil, which offers 12 mm width side access, has a significantly better performance than the saddle coil, whilst providing 57% of the B(1) sensitivity of the bird-cage.

Formation of the Drosophila ovarian ring canal inner rim depends on cheerio.

In Drosophila oogenesis, the development of a mature oocyte depends on having properly developed ring canals that allow cytoplasm transport from the nurse cells to the oocyte. Ring canal assembly is a step-wise process that transforms an arrested cleavage furrow into a stable intercellular bridge by the addition of several proteins. Here we describe a new gene wc named cheerio that provides a critical function for ring canal assembly. Mutants in cheerio fail to localize ring canal inner rim proteins including filamentous actin, the ring canal-associated products from the hu-li tai shao (hts) gene, and kelch. Since hts and kelch are present but unlocalized in cheerio mutant cells, cheerio is likely to function upstream from each of them. Examination of mutants in cheerio places it in the pathway of ring canal assembly between cleavage furrow arrest and localization of hts and actin filaments. Furthermore, this mutant reveals that the inner rim cytoskeleton is required for expansion of the ring canal opening and for plasma membrane stabilization.

Relationships between habitual physical activity and osteoarthrosis in ageing women.

The examination of middle-aged women specialist teachers of physical education, who have undertaken habitual physical activity over many years, demonstrated a lower prevalence of osteoarthrosis in the knee joints, a greater prevalence of degenerative joint disease in the lumbar spine and a similar prevalence of osteoarthrosis in the hips, compared with a closely age-matched group. A further review 12 years later revealed significantly less joint pain and joint stiffness in active women compared with less active controls.

Hepatic microsomal metabolism of the anthelmintic benzimidazole fenbendazole: enhanced inhibition of cytochrome P450 reactions by oxidized metabolites of the drug.

Potentiation of the anthelmintic action of benzimidazole carbamates, such as fenbendazole [methyl 5(6)-(phenylthio)-1H-benzimidazol-2-ylcarbamate], has been noted during concurrent administration of benzimidazoles that possess no intrinsic anthelmintic activity. This study investigated the possibility that inhibition of P450 enzymes by fenbendazole and its metabolites could play a role in the potentiation phenomenon. Fenbendazole underwent P450-mediated oxidation in microsomes from untreated rat liver to the sulfoxide and (4'-hydroxyphenyl)thio metabolites [2.92 and 2.87 nmol/(mg of protein.h)]. Pretreatment of rats with phenobarbital or dexamethasone enhanced sulfoxidation by 1.9- and 2.9-fold, respectively. 4'-Hydroxylation was increased slightly (by 28%) by phenobarbital and decreased slightly (by 41%) by dexamethasone. Induction also promoted further metabolism of the sulfoxide to fenbendazole sulfone. Immunoinhibition and chemical inhibition studies suggested that P450 3A proteins and the flavin-containing monooxygenase are involved in sulfoxide and sulfone formation whereas 4'-hydroxylation involved the P450s 2C11, 2C6, and 2B1, depending on the type of induction. In untreated rat liver, the sulfoxide and (4'-hydroxyphenyl)thio metabolites of fenbendazole were relatively potent inhibitors of P450-mediated androstenedione 16 alpha-, 16 beta-, and 6 beta-hydroxylation (IC50 values of 42, 36, and 74 microM, respectively); 7 alpha-hydroxylase activity was uninhibited. In contrast, fenbendazole and its sulfone metabolite were not inhibitors of these reactions. Mixed-function oxidase activities in phenobarbital-induced rat hepatic microsomes were refractory to inhibition by most compounds, but P450 1A1 mediated activities in microsomes from beta-naphthoflavone-induced rat liver were quite susceptible to inhibition by fenbendazole sulfoxide. Studies with two analogous sulfoxides yielded similar findings.(ABSTRACT TRUNCATED AT 250 WORDS)

Immunophenotypic analysis of clonogenic cells in acute lymphoblastic leukemia using an in vitro colony assay.

A culture system was used to analyze the expression of membrane differentiation antigens on the proliferative or clonogenic fraction of cells from cases of common (precursor B) acute lymphoblastic leukemia (c-ALL). Colonies of leukemic cells were obtained in 18 of 20 cases after 1 week in culture in a liquid layer containing recombinant interleukin-2 (IL-2), phytohemagglutinin (PHA), and B-cell growth factor over an agar feeder layer containing irradiated peripheral blood mononuclear cells plus fetal calf serum (FCS) and horse serum. Cultured cells expressed HLA-DR, CD-9, CD-10, CD-20, and CD-34 antigens, indicating conservation of precursor B phenotype. Differentiation antigen expression on the clonogenic subpopulation giving rise to leukemic colonies was assessed by treating cells prior to culture with selected cytotoxic monoclonal antibodies (MoAbs) and complement or by fluorescence-activated cell sorting. Lytic treatment with HLA-DR, CD-10, CD-9, and CD-20 antibodies produced median reductions in colony formation of 93%, 81%, 73%, and 58% respectively. Combined treatment with CD-9 and CD-10 antibodies produced complete inhibition in 11 of 13 cases. Cell-sorting experiments after CD-10 staining indicated a good correlation with complement lysis studies and also demonstrated that the CD-19 antigen is expressed on a high proportion of clonogenic cells. Colony formation was also significantly reduced in 13 of 17 cases by lytic treatment of cells with the CD-33 antibody MY-9, suggesting expression of this "myeloid" lineage antigen on ALL clonogenic cells. The substantial case-to-case variation in expression of individual differentiation antigens indicates that leukemic cellular heterogeneity is a major consideration in ex vivo bone marrow purging using MoAbs and emphasizes the need for more critical evaluation of purging techniques.

The fate of nor-muramyl dipeptide (3H-labelled) after local administration in incomplete Freund's adjuvant in the guinea pig.

The fate of 3H-nor-muramyl dipeptide has been investigated after administration with bovine serum albumin (BSA) in Freund's incomplete adjuvant in the guinea pig footpad. Emulsions of two different stiffnesses , both of which were capable of inducing delayed-type hypersensitivity to BSA, were compared. Both emulsions produced stable depots of intact nor-MDP at the injection site. At early times retention of nor-MDP was greater with the stiffer emulsion and circulating levels of nor-MDP were greater with the looser emulsion; at 24 h there were no differences between the two. Distribution of nor-MDP to the draining lymph nodes was highly variable and no difference was apparent between the two emulsions. Levels of radioactivity in more distant lymph nodes were minimal, and in other tissues no radioactivity was detected. Thus it has not been possible to clarify the role of nor-MDP in this system in terms of its distribution through the local lymphatics, however, some information has emerged about the stability and integrity of nor-MDP in local adjuvant formulation.

Pharmacokinetics and metabolism of muramyl dipeptide and nor-muramyl dipeptide [3H-labelled] in the mouse.

The fates of 3H-muramyl dipeptide (MDP) and 3H-nor-MDP have been investigated after intravenous (i.v.), intraperitoneal, and subcutaneous injection of a range of doses in the mouse. After i.v. injection both compounds were cleared rapidly from the circulation, distributed initially to the tissues, and finally excreted largely intact in the urine. Most of the tissues contained intact material at 2 min after injection, but the much lower levels of radioactivity persisting at 1 h had undergone considerable metabolism (except in intestine, where some intact material persisted for as long as 24 h). Some accumulation of radioactivity was observed in liver and kidney and there were quantitative and qualitative differences between the two compounds. Characterisation of some of the metabolites in these tissues was undertaken, and the deamidated muramyl dipeptide was tentatively identified which is known to have some biological activity. The mechanism of the biological effects, which may be expressed over a relatively long time period, remains to be explained in view of the rapid excretion of most of the dose.

Fate of human corticotrophin immediately after intravenous administration to the rat.

The distribution and degradation of tritium-labelled human 1-39 corticotrophin have been studied after intravenous administration to the rat. Within 5 min of injection of single major metabolite, 3-39 corticotrophin, appears in the circulation. This metabolite, however, has only 3.6% of the steroidogenic potency of 1-39 corticotrophin and the evidence suggests that it is formed in muscle and skin. By 5 min, extensive degradation had occurred in all the major tissues in the body (muscle, skin, liver, kidney, gut).

A method for studying synaptosomal release of neurotransmitter candidates, as evaluated by studies on cortical cholecystokinin octapeptide release.

A method for perfusing rat cortical synaptosomes for studying the regulation of cholecystokinin octapeptide (CCK-8) release has been developed and was found to have advantages over the static incubation system. Synaptosomes isolated from rat cortex were suspended in Biogel P2 columns and perfused with Krebs Ringer Bicarbonate buffer. One hundred mM KCl and 75 microM veratine stimulated CCK-8 release, which was Ca++-dependent. The synaptosomes were functionally viable for at least 135 min of incubation as indicated by multiple 100 mM KCl depolarizations and uptake of (3H)-norepinephrine and (14C)-choline. Dopamine and acetylcholine (10(-6)M) stimulated CCK-8 release while serotonin and norepinephrine were without effect. Approximately 20% of total occluded CCK-8 was released from synaptosomes by 100 mM KCl and degradation of CCK-8 was less than 10%. Perfusion of synaptosomes has several advantages over static incubation systems and allows systematic studies on the role of neurotransmitter in the regulation of neuropeptide secretion.

Mechanisms of catabolism of corticotrophin-(1--24)-tetracosapeptide in the rat in vivo.

The fragmentation of corticotrophin-(1--24)-tetracosapeptide in vivo has been studied, using tritium-labelled hormone and chromatography, in the rat. After intravenous injection the levels of peptide in the circulation declined rapidly caused by its distribution to the tissues and from 2 min after injection a range of different cleavage products appeared. Many of the fragments in the circulation after 2 min have been identified and in this way cleavage has been shown to occur after residues 1, 2, 8, 15, 16, 17, 19, 20 and 21. It is believed that this is the result of aminopeptidase attack at the NH2 terminal, and of attack on the basic region of the molecule by trypsin-like endopeptidase followed by carboxypeptidase. The sulphoxide has been identified as a major metabolite in some experiments but the extent of its formation was very variable. Seventy per cent of the dose was distributed to the tissue beds by 1 min. Part of this was present, mainly as intact peptide, in liver and kidney but the greater proportion was found in muscle, skin and intestine where extensive degradation had already occurred. Further characterization of the fragments formed in the muscle provided good evidence that this tissue may have been the site of generation of many of the fragments which later appeared in the circulation.

A rapid method, using octadecasilyl-silica, for the extraction of certain peptides from tissues.

Peptides can be recovered from tissues by homogenization in a carefully selected extraction medium followed by adsorption from the supernatant on a small bed of octadecasilyl-silica. Recoveries of corticotropins and somatostatin added to a variety of tissues were quantitative, and the peptides undamaged as determined by high-pressure liquid chromatography.

Use of octadecasilyl-silica for the extraction and purification of peptides in biological samples. Application to the identification of circulating metabolites of corticotropin-(1-24)-tetracosapeptide and somatostatin in vivo.

Peptides can be adsorbed on octadecasilyl-silica from large volumes of aqueous solution and eluted with aqueous solvent mixtures containing methanol or acetonitrile. These properties may be used for the extraction and purification of peptide fragments in plasma samples collected from rats. After intravenous injection of Synacthen [corticotropin-(1-24)-tetracosapeptide], it was shown that within 2 min the main circulating products were intact peptide and its sulphoxide. In addition, a number of fragments indicative of cleavage at the N- and C-termini were present. Most of the products formed from Synacthen have low biological activity. Somatostatin was rapidly cleaved in vivo and in vitro to a single product, which probably retains biological activity. The absence of other circulating products suggests that somatostatin is only inactivated once it leaves the circulation.

On the metabolism of two adrenocorticotrophin analogues.

The metabolism of Synacthen (corticotrophin-(1--24)-tetracosapeptide) and C-41795-Ba ([D-Ser1,Lys17,Lys18]-corticotrophin-(1--18)-octadecapeptide amide) have been compared in the rat following intravenous injection. Using Synacthen and C-41795-Ba labelled with tritium it was possible to follow the tissue distribution of the two peptides. The kidney was shown to concentrate intact peptide and fragments of both peptides. Autoradiography of perfused kidney sections demonstrated the uptake of radioactivity into the lysosomes of the kidney proximal tubule cells. Comparison of the distribution of radioactive products formed from the tetracosapeptide labelled in different positions indicates that, prior to renal uptake, metabolism is taking place at other sites in the body. It is suggested that rapid cleavage occurs extracellularly at or near the N- and C-termini. Then large fragments remaining in the circulation, together with any intact material, are filtered through the glomerulus and are taken up by endocytosis into the proximal tubule cells of the kidney. The synthetic N- and C-terminal protection of the octadecapeptide appears to inhibit the extracellular attack and so the concentration of intact peptide in the kidneys is initially higher than the tetracosapeptide. Although concentrations of radioactivity in other tissues are low in comparison with the kidneys, the quantities are quite high when the weight of the tissues are considered. Chromatographic analysis of this radioactivity reveals that the octadecapeptide gives rise to much higher tissue levels of intact peptide and we believe that this acts as a depot and gives rise to the sustained blood concentrations and prolonged biological effects observed with this peptide.

An investigation of the involvement of adenosine 3':5'-cyclic monophosphate in steroidogenesis by using isolated adrenal cell column perfusion.

The involvement of cyclic AMP in corticosteroidogenesis was investigated by using isolated adrenal cell column perfusion. Steroids were produced in response to 0.5, 1.0 and 5.0 mg of cyclic AMP/ml. Analysis of the shape of the response curves indicated an inverse relationship between rate of onset of steroid production and dose. A further increase in steroid production during the washout period after the 5 mg/ml dose was considered to indicate an intracellular inhibitory effect of cyclic AMP. Release of cyclic AMP into the perfusate only occurred in response to supramaximal steroidogenic doses of ACTH (adrenocorticotrophin). A connexion between dose and response was demonstrated over a narrow concentration range. Variation in the time-lag before cyclic AMP production and in the duration of the response was marked; further, no reproducible ratio of steroid output to cyclic AMP output was shown at any level of stimulation. These results are discussed together with those of other recent investigations. It is considered that these findings do not support an obligatory role for cyclic AMP as mediator of ACTH action in the adrenal.