Functional data analysis with application to periodically stimulated foetal heart rate data. II: functional logistic regression

We present a basis solution for the modelling of a binary response with a functional covariate plus any number of scalar covariates. This can be thought of as singular longitudinal data analysis as there are more measurements on the functional covariate than subjects in the study. The maximum likelihood parameter estimates are found using a basis expansion and a modified Fisher scoring algorithm. This technique has been extended to model a functional covariate with a repeated stimulus. We used periodically stimulated foetal heart rate tracings to predict the probability of a high risk birth outcome. It was found that these tracings could predict 94.1 per cent of the high risk pregnancies and without the stimulus, the heart rates were no more predictive than chance.     

Stroke in ovarian hyperstimulation syndrome in early pregnancy treated with intra-arterial rt-PA

Ovarian hyperstimulation syndrome (OHSS) caused by fertility medications can predispose women to thrombosis. The authors present a case of a previously healthy woman who underwent in vitro fertilization and experienced a middle cerebral artery thrombosis that was subsequently lysed with intra-arterial recombinant tissue plasminogen activator (rt-PA). To the authors' knowledge, this is the first reported case of successful use of rt-PA to lyse a cerebral arterial thrombus resulting from severe OHSS. The patient made a near complete neurologic recovery and delivered a healthy infant at term, illustrating that intra-arterial thrombolysis can be used with relative safety even in very early pregnancy.     

Factors predictive of response and survival in patients with metastatic colorectal cancer in Taiwan

5-Fluorouracil in combination with leucovorin has been shown to be active in therapeutic trials of metastatic colorectal carcinoma. In this study, we administered these drugs to 72 patients with metastatic colorectal carcinoma. Thirty-six of them without previous exposure to 5-fluorouracil were treated with weekly bolus injections of 5-fluorouracil (425 mg/m2) and leucovorin (25 mg/m2) supplemented with oral levamisole. Another 36 patients with or without prior 5-fluorouracil treatment received 5-fluorouracil 3,000 mg/m2 and leucovorin 300 mg/m2 in a 48-hour continuous infusion every two weeks. Clinical efficacy and toxicity were assessed by WHO criteria. Variables were tested for relations to response and survival by univariate and multivariate analysis. The response rate was 19.4% in weekly bolus arm and 13.9% in biweekly high-dose infusion arm (P = 0.527). Median survivals in the two arms were 18.4 months (weekly) and 21 months (biweekly) respectively (P = 0.708). Gastrointestinal side effects including nausea, vomiting, diarrhea and mucositia were the major toxicities of these regimens. By multivariate analysis, the only factor to influence response rate was the site of metastases (P = 0.009). The only factor to affect survival was performance status of the patient (P = 0.0001). We concluded that the two 5-fluorouracil based regimens are well-tolerated and shown to have a response rate comparable with previous reports of similar regimens in patients with metastatic colorectal cancer. Only liver metastases seemed to have a better response to therapy. Performance status is the most important prognostic factor in patients with metastatic colorectal cancer.      

Continuous Intrapartum Fetal Monitoring: A Prospective Randomized Comparison of 2 Types of Fetal Scalp Electrode

Summary: This trial was conducted to compare 2 commonly used fetal scalp electrodes with regard to ease of use, frequency and extent of neonatal injury and quality of cardiotocographic record. A randomized design was employed to study a group of 106 patients divided between a Surgicraft Copeland clip fetal scalp electrode (52 patients) and a Meditrace spiral single helix scalp electrode (54 patients). Patients were eligible for trial entry if they required an intrapartum fetal scalp electrode, at term with a singleton cephalic pregnancy. Ease of application was rated by the operator using a linear analogue score. Unidentified traces were reviewed independently for quality by 2 obstetricians and neonates were examined on day-2 postpartum for injury. The Meditrace spiral fetal scalp electrode was significantly easier to apply (unpaired t-test p <0.02). It also obtained higher ratings for trace quality (unpaired t-test p <0.02). There were no serious neonatal injuries and no difference was found between the 2 electrodes in this regard.     

HIV-1tat induced apoptosis of T-cells is not mediated by TGF-β

Recent reports have demonstrated that the HIV-1 transactivator protein,tat, induces apoptosis in T-lymphocyte cell lines, as well as in peripheral blood mononuclear cells, and stimulates a cascade of events resulting in up-regulation of the potent immunosuppressive cytokine, transforming growth factor-β (TGF-β). In this study we evaluated the ability of TGF-β to mediatetat induced apoptosis in T-lymphocyte cell lines. T-cells treated exogenously with either TGF-β1 or a combination of tat and pan-specific TGF-β neutralizing antibodies showed little change in the amount of apoptosis. When treated with pan-specific TGF-β neutralizing antibodies, Jurkat cells that stably expresstat protein (Jurkat-tat) showed only a modest decrease in apoptosis, while CEM-TART cells (CEM T-cells expressing both HIV-1tat andrev) demonstrated little change in the amount of apoptosis. In conclusion, we have demonstrated that TGF-β does not play a significant role in mediatingtat induced T-cell apoptosis.     

Myoglobin: an evaluation of its role as a marker of rhabdomyosarcomas

Tumour markers now have an established role in tumour diagnosis and patient management. However, antibodies used to detect these tumour markers have in some instances proved unreliable, with a low rate of sensitivity and specificity. In this study we wished to evaluate the role of a commercial antibody to myoglobin as a marker of rhabdomyosarcomas. The purpose of this investigation was to assess the sensitivity and specificity of myoglobin antiserum as a marker of rhabdomyosarcomas. This was performed by reacting a large number of tumours (sarcomas, carcinomas and melanomas) with a polyclonal anti human myoglobin antiserum. Staining was demonstrated in 60% of rhabdomyosarcomas. Only two tumours from a total of 226 non-skeletal muscle tumours showed a positive reaction (0.88%). One was a leiomyosarcoma and the other had been classified as an undifferentiated sarcoma but a rhabdomyosarcoma was included in its differential diagnosis. It is of interest that both had been earlier irradiated. This antiserum was therefore a specific but not a very sensitive tumor marker. Its rate of staining of rhabdomyosarcomas is compared with the results in the literature. A great disparity is found and the reasons for this are discussed.     

Successful first trimester abortion with 15(S) 15-methyl-prostaglandin F2alpha-methyl ester vaginal suppositories.

First trimester abortion was successfully performed in 58 women by the serial self-administration of vaginal suppositories containing 15(S)15-methyl PGF_2α-methyl ester. A total of 4 or 6 mg of the compound was given over a 12-hour period and vacuum aspiration was performed 18 hours after the start of therapy. Cervical dilatation, operative bleeding and the presence of the products of conception were noted. All patients aborted prior to vacuum aspiration and cervical dilatation was sufficient to perform easy curettage. The major side effect was pain; this was easily controlled. Based on the microscopic examination of the aspirated material, 36 per cent of the patients who received the lower dose aborted completely, while 57 per cent of those who received a total of 6 mg of the compound, aborted completely. A greater proportion of women in the 8–9th week than those in the 11–12th week aborted completely. There was no significant relationship between the parity of the patients and the completeness of the abortion. The results of this study suggest that the compound may be a safe, effective and easily administered method of inducing complete abortion through the 9th week of pregnancy. In the 10–12th week, pre-treatment with this prostaglandin facilitates the evacuation of the uterus by surgical means.