A comparative study of biweekly disposable contact lenses: silicone hydrogel versus hydrogel

Background: Our aim was to compare the clinical performance of a biweekly (second generation) silicone hydrogel lens and a biweekly hydrogel lens worn for daily wear modality. Methods: We used a double‐masked study, in which non‐presbyopic, asymptomatic and adapted soft lens wearers were recruited. Subjects wore a silicone hydrogel lens in one eye and a hydrogel lens in the other (lens types and eyes were randomly assigned) for one month. Lenses were replaced every two weeks. Contact lens fitting, pre‐lens tear film thinning time, vision, corneal integrity and lens deposits were assessed before and every fortnight after delivery of new lenses. A questionnaire was used to compare the subjective performance of the two lens types. Results: Thirty of the 33 subjects completed the study. There were no significant differences in lens fitting (centration and movement), pre‐lens tear film thinning time, vision or corneal integrity between the two lens types. Statistically, there was no significant difference in lens deposits between the two lens types but silicone hydrogel lenses tended to have more Grade 3 to 4 lipid deposits than hydrogel lenses. Subjects found no significant differences between the two lens types in terms of vision and comfort. Preference for silicone hydrogel lenses increased from 33 at the first after‐care visit to 50 per cent at the second after‐care visit. Conclusion: This short‐term study demonstrates that the performance of silicone hydrogel and hydrogel lenses is comparable but the former tends to build up more lipid deposits than the latter. We did not find better performance in terms of ocular integrity of silicone hydrogel lenses compared to the hydrogel lenses, probably because the subjects were adapted asymptomatic contact lens wearers before commencing the study. Contact lens wearers having hypoxia‐related problems are likely to benefit from using silicone hydrogel lenses, as these lenses provide at least three times more oxygen than conventional hydrogel lenses.     

Serum squamous cell carcinoma antigen in the monitoring of radiotherapy treatment response in carcinoma of the cervix

In this study, squamous cell carcinoma antigen (SCC) was detected in 96 of 157 patients with squamous cell carcinoma of the cervix and the percentage of patients with raised SCC levels increased with the stage of disease (P less than 0.01). The use of serial SCC assays and cervical biopsy histology during the course of radiotherapy to predict tumor response to irradiation was assessed. In patients who were given external irradiation before intracavitary radium, a high SCC level or the presence of viable tumor cells in the biopsy was found to be of no predictive value. However, at completion of radiotherapy, i.e., after intracavitary radium application, patients with persistently high SCC levels had a significantly higher incidence of residual tumor than patients whose SCC levels returned to normal (P less than 0.01). In 60% of patients with a persistently high SCC level, viable tumor was found in the cervical biopsy at the end of radiotherapy. On the other hand, only 5.4% of patients whose SCC level returned to normal had residual tumor.     

Levels of oxytocin-like activity and progesterone in follicular fluid from in vitro fertilization cycles

Oxytocinlike immunoreactivity, estradiol, and progesterone were measured in follicular fluid collected during oocyte collection in an in vitro fertilization program in which clomiphene citrate was used to stimulate follicular development. Follicles which yielded morphologically normal embryos after fertilization of the oocyte had oxytocin concentrations ranging from <10 to 600 ng/liter. Oxytocin concentrations did not differ between follicles from 12 pregnancy cycles (median, 169; N=21 and follicles from 12 nonpregnancy cycles (median, 110; N= 18). Oxytocin concentrations were correlated negatively with progesterone concentrations (Spearman's rank correlation coefficient r=–0.50; P=0.001). In cycles with some follicles having progesterone concentrations <10 and some >10 mol/liter, oxytocin concentrations were higher in the less progestogenic follicles in 15 of 16 cases.     

The regulation and consequences of immune-mediated cell death in atheromatous diseases

Atheromatous diseases are lipid and cell-rich vascular disorders that include coronary artery disease (CAD), transplant vascular disease (TVD), and restenosis. Considering the inflammatory nature of these diseases, cytotoxic immune mechanisms such as the FasL and granzyme/perforin pathways most likely play important roles in the development and remodeling of many lesions. Furthermore, although the contributions of immune responses to each disease vary, the correspondent localization of certain mediators and effectors suggests that they may contribute to a spectrum of atheromatous diseases. In this review, the contribution of immune cell-mediated cell death in the onset and pathogenesis of CAD and TVD is examined.     

Changes in postural stability in women aged 20 to 80 years

BACKGROUND: A study of postural stability was undertaken to identify the relationship between vision and support surface across age decades. Understanding when reliance on vision for postural stability emerges and the support conditions contributing to this instability may provide the evidence required to introduce falls-prevention strategies in younger age decades. METHODS: We measured postural stability in 453 women aged 20 to 80 years using the Balance Master force-plate system while the women performed the modified Clinical Test for the Sensory Interaction and Balance (firm and foam surfaces, eyes open and closed) and the Single-Limb Stance Test (eyes open and closed). RESULTS: Women in their 60s and 70s were more unstable than younger women in bilateral stance on a firm surface with the eyes closed. This instability was evident from the 50s when a foam surface was introduced and from the 40s when single-limb stance was tested with eyes closed. A further decline in stability was demonstrated for each subsequent decade when the eyes were closed in single-limb stance. CONCLUSIONS: Age, visual condition, and support surface were significant variables influencing postural stability in women. Reliance on vision for postural stability was evident for women from the 40s when single-limb stance was tested, from the 50s when bilateral stance on foam was tested, and from the 60s when a firm surface was used. The cause(s) of this decline in stability requires further investigation, and screening for postural instability between the ages of 40 and 60 is advocated.     

Standards of care for anemia management in oncology: focus on lung carcinoma

BACKGROUND: Anemia is common in patients with lung carcinoma, particularly among those undergoing platinum-based cytotoxic chemotherapy. Evidence is growing that anemia can have a profound impact on the patient's quality of life, often manifested as the patient's inability to function normally. METHODS: A literature review was conducted to provide a current picture of the incidence and impact of anemia in patients with lung carcinoma and the usage and limitations of current treatment. RESULTS: The incidence of anemia (a hemoglobin [Hb] level < 11g/dL) in lung carcinoma patients is approximately 50-60%, varying according to treatment regimen. However, despite evidence supporting the treatment of anemia, many clinicians only intervene when Hb levels fall below 8 g/dL. This may be because of a lack of awareness of the incidence and impact of anemia on cancer patients, but most likely is because of limitations of current treatment options (blood transfusion and recombinant human erythropoietin [epoetin-alpha]). Darbepoetin-alpha represents a new generation of erythropoiesis-stimulating proteins. Biochemically distinct from epoetin-alpha, darbepoetin-alpha has a greater sialic acid content and biologic half-life than epoetin-alpha, but stimulates erythropoiesis in the same manner. Clinical trials involving patients with cancer-related anemia have shown that darbepoetin-alpha has a threefold longer half-life than epoetin-alpha, which may allow less frequent dosing. The results from an ongoing clinical trial dedicated to testing the clinical benefits of darbepoetin-alpha in treating anemia in lung carcinoma patients will provide a valuable insight into its full potential in this setting. CONCLUSIONS: Anemia is common but is reported to be undertreated in patients with lung carcinoma. The introduction of darbepoetin-alpha into clinical practice may overcome some of the limitations of current treatments and facilitate improvement in the management of cancer-related anemia.     

Concomitant chemoirradiation for stage III-IV nasopharyngeal carcinoma in Chinese patients: results of a matched cohort analysis

PURPOSE: To evaluate the toxicity and efficacy of concomitant chemoirradiation (CRT) followed by adjuvant chemotherapy compared with radiotherapy (RT) alone in Chinese patients with locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS AND MATERIALS: Between March 1997 and September 2000, 47 Chinese patients with Stage III (n = 9, 19%) and IV (n = 38, 81%) NPC were treated with by CRT using cisplatin 100 mg/m(2) on Days 1, 22, and 43 of RT, plus adjuvant chemotherapy using cisplatin 80 mg/m(2) for 1 day and 5-fluorouracil 1 g/m(2) for 4 days on Days 71, 99, and 127. These patients were then compared with a cohort of 47 patients treated between 1990 and 1993 with RT alone, who were matched with respect to T stage, N stage, nodal bilaterality, nodal level, and nodal size. The RT techniques were similar in the two groups but different dose and fractionation schemes were used. The median biologic equivalent dose to 2 Gy per fraction delivered to the nasopharynx was 68 Gy in the CRT group and 65.3 Gy in the RT-alone group. RESULTS: The compliance rates were 62% for concomitant chemotherapy and 40% for adjuvant chemotherapy. No treatment-related deaths occurred. At the end of treatment, 96% of the CRT group and 79% of the RT-alone group achieved a complete response (p = 0.013). With a median follow-up of 26 months, the 3-year relapse-free survival, disease-specific survival, overall survival, local relapse-free survival, nodal relapse-free survival, and distant metastasis-free survival rate for the CRT group and the RT-alone group was 62% vs. 44% (p = 0.048), 67% vs. 71% (p = 0.88), 65% vs. 69% (p = 0.93), 87% vs. 75% (p = 0.059), 95% vs. 80% (p = 0.026), and 75% vs. 70% (p = 0.84), respectively. CONCLUSION: Our experience indicates that concomitant CRT improves locoregional control in Chinese patients with locoregionally advanced NPC, but our analyses failed to detect any impact on distant failure and survival. The failure to reduce distant metastasis and improve survival may have related in part to the more advanced disease stage in our patients and the relatively low compliance rate of adjuvant chemotherapy. Our findings suggest caution should be exercised in extrapolating the findings of the Intergroup Study 0099 to Chinese patients, and confirmatory results from prospective randomized studies in the endemic population are needed.     

Dose-Tumor Response for Carcinoma of Cervix: An Analysis of 594 Patients Treated by Radiotherapy

This is a retrospective study of 594 histologically proven carcinomas of the uterine cervix treated with radiotherapy alone between January 1970 and December 1986. The age of this group of patients ranged from 22 to 86 years, and the median age was 57 years. There were 544 (91.6%) patients with squamous carcinoma and 36 (6.1%) with adenocarcinoma. There were 24 (4.0%) patients who were treated by two sessions of intracavitary brachytherapy only using intrauterine tandem and vaginal ovoids; 513 (86.4%) patients received whole pelvis irradiation followed by two sessions of brachytherapy at 1-week intervals, with or without additional boost to the parametrium. The dose to point A ranged from 40 to 100.9 Gy for the patients with stage IB to IIIB disease. The 5- and 10-year survival for stages IB, IIA, IIB, IIIA, and IIIB were 90.0, 82.1, 72.0, 50.0, 51.5, and 86.9, 71.0, 67.5, 41.7, and 46.9%, respectively. There was no long-term survivor for stage IV disease; the median survivals for patients with stages IVA and IVB were 15.2 and 9.3 months, respectively. Dose response was demonstrated for stages IIB and III tumors; dose to point A greater than 85 Gy was associated with better central control (P = 0.0036 and 0.0234, respectively). However, further increase in dose to point A beyond 85 Gy was not associated with improvement in central control (P = 0.3128 and 0.3394, respectively, for stages IIB and III). It was also found that the occurrences of rectosigmoid and bladder complications were correlated with the rectal and point A dose. Thus, for these patients, there is no need to increase the dose to point A beyond 85 Gy so that the risk of radiation sequelae can be cut down.     

Patterns of practice survey for nonsmall cell lung carcinoma in the U.S

BACKGROUND: Nonsmall cell lung carcinoma comprises approximately 75% of all lung carcinoma cases in the U.S. Newly evolving strategies have created considerable controversy regarding the optimal treatment for patients diagnosed with this disease. METHODS: A 17-item survey was designed to collect demographic data and information regarding practice patterns for nonsmall cell lung carcinoma, including patient assessment, treatment approaches, and roles of chemotherapy and radiotherapy. Surveys were mailed in the summer of 1997 to approximately 9200 oncologists of all types throughout the U.S. Practice settings included private office, private hospital, academic, university-affiliated office, government, and Veterans Administration institutions. RESULTS: Approximately 10% of the oncologists responded (n = 979), including 499 medical oncologists (51%), 464 radiation oncologists (47%), and 16 others (2%). For the adjuvant treatment of surgically resected N1-2 disease, combined modality treatment was preferred over radiation therapy alone by medical oncologists (48% vs. 16%; P<0.001) and radiation therapy alone was preferred over combined modality treatment by radiation oncologists (55% vs. 38%; P<0.001). The combination of paclitaxel and carboplatin was the preferred first-line regimen for all stages of nonsmall cell lung carcinoma by the majority of medical oncologists (55%), whereas the majority of radiation oncologists (58%) chose the combination of etoposide and platinum. With regard to the optimal combined modality approach, respondents were divided evenly between concurrent chemoradiotherapy (34%) and sequential chemoradiotherapy (31%). Overall, respondents reported basing treatment decisions largely on published literature (55%) compared with personal experience (19%), seminars and colleagues (16%), and clinical trial availability (10%) (P<0.001). CONCLUSIONS: This survey confirms many differences in practice patterns among medical oncologists and radiation oncologists in the treatment of patients with nonsmall cell lung carcinoma and suggests the need for the multidisciplinary management of this entity. In addition, the current study demonstrates that reliance on the medical literature as a basis for treatment steadily declines the longer the physician has been in practice.     

Combined effects of the orally active cisplatin analog, JM216, and radiation in antitumor therapy

Purpose: We evaluated the orally administered platinum agent, JM216, in combination with ionizing radiation both in vivo and in vitro against human tumor cells. Methods: H460 human lung carcinoma cells were used as a subcutaneous xenograft in nude mice. JM216 (30 mg/kg) was administered orally, and radiation treatments (2 Gy) were given 1 h after JM216 delivery for five consecutive days. For in vitro analysis, attached H460 cells were treated with JM216 (15 μM) for 1 h and then irradiated. Cells were rinsed 20 min later, and survival was determined by clonogenic assay. Results: Tumor growth delay measurements showed that the combination of JM216 and radiation was additive in vivo, with an enhancement ratio of 1.24. In vitro clonogenic survival experiments demonstrated a dose enhancement ratio of 1.23. Isobologram analysis showed that this interaction was also additive. Conclusions: These data demonstrate that the combination of JM216 and fractionated radiotherapy is more effective against human lung cancer xenografts than either agent alone, and the in vivo results were supported by those observed using an in vitro system with the same tumor cell line. Received: 20 December 1999 / Accepted: 24 May 2000