A randomized controlled trial of filgrastim during remission induction and consolidation chemotherapy for adults with acute lymphoblastic leukemia: CALGB study 9111

Recombinant human granulocyte colony-stimulating factor (G-CSF; filgrastim) shortens the time to neutrophil recovery after intensive chemotherapy, but its role in the treatment of adults with acute lymphoblastic leukemia (ALL) is uncertain. We randomly assigned 198 adults with untreated ALL (median age, 35 years; range, 16 to 83) to receive either placebo or G-CSF (5 microgram/kg/d) subcutaneously, beginning 4 days after starting intensive remission induction chemotherapy and continuing until the neutrophil count was >/=1, 000/microL for 2 days. The study assignment was unblinded as individual patients achieved a complete remission (CR). Patients initially assigned to G-CSF then continued to receive G-CSF through 2 monthly courses of consolidation therapy. Patients assigned to placebo received no further study drug. The median time to recover neutrophils >/=1,000/microL during the remission induction course was 16 days (interquartile range [IQR], 15 to 18 days) for the patients assigned to receive G-CSF and 22 days (IQR, 19 to 29 days) for the patients assigned to placebo (P < .001). Patients in the G-CSF group had significantly shorter durations of neutropenia (<1, 000/microL) and thrombocytopenia (<50,000/microL) and fewer days in the hospital (median, 22 days v 28 days; P = .02) compared with patients receiving placebo. The patients assigned to receive G-CSF had a higher CR rate and fewer deaths during remission induction than did those receiving placebo (P = .04 by the chi-square test for trend). During Courses IIA and IIB of consolidation treatment, patients in the G-CSF group had significantly more rapid recovery of neutrophils >/=1,000/microL than did the control group by approximately 6 to 9 days. However, the patients in the G-CSF group did not complete the planned first 3 months of chemotherapy any more rapidly than did the patients in the placebo group. Overall toxicity was not lessened by the use of G-CSF. After a median follow-up of 4. 7 years, there were no significant differences in either the disease-free survival (P = .53) or the overall survival (P = .25) for the patients assigned to G-CSF (medians, 2.3 years and 2.4 years, respectively) compared with those assigned to placebo (medians, 1.7 and 1.8 years, respectively). Adults who received intensive chemotherapy for ALL benefited from G-CSF treatment, but its use did not markedly affect the ultimate outcome.     

Value of image-guided needle aspiration cytology in the assessment of thoracolumbar and sacrococcygeal masses

We have used a primary cloning assay to determine the frequency of 6-thioguanine (TG)-resistant tubular epithelial cells in kidney tissue from 72 human donors ranging in age from 2 to 94 years. The frequency of TG-resistant mutants ranged from approximately 5 x 10(-5) for donors in the first decade of life to approximately 2.5 x 10(-4) for donors in the eighth and later decades of life. Two different statistical analyses indicated that this increase in mutant frequency is exponential with age. We also observed a 2-fold higher TG-resistant mutant frequency in nephrectomy kidneys containing a coincident renal carcinoma. DNA sequence analyses revealed HPRT gene mutations in each of 14 TG-resistant mutants from seven unrelated donors. Thirteen of these 14 mutants resulted from independent mutational events. These results suggest that somatic mutations are common in renal--and perhaps in other human--epithelia, and thus could play an important role in the genesis of age-associated disease.     

Prognostic evaluation of early indicators in fulminant hepatic failure by multivariate analysis

Results of eight multicenter, randomized, placebo-controlled, double-blind, parallel-group studies were pooled to assess the efficacy of the angiotensin II-receptor blocker irbesartan over the dose range of 1 to 900 mg. A total of 2955 adults with a seated diastolic blood pressure of 95 to 110 mm Hg were randomized to treatment with oral irbesartan once daily or placebo for 6 to 8 weeks. Office blood pressure was measured at trough (24+/-3 hours after the last dose) and peak (3+/-1 hours after the last dose) by mercury sphygmomanometry. Demographic characteristics (mean blood pressure; 151/101 mm Hg; mean age, 54 years; 63% male; and 82% white) were similar across all dose groups. After the groups were pooled, antihypertensive efficacy was assessed by therapeutic response (trough seated diastolic blood pressure <90 mm Hg or a reduction from baseline of > or = 10 mm Hg) and by modeling of the maximum reductions in trough and peak seated diastolic and systolic blood pressure. Antihypertensive effects increased with increasing doses and reached a plateau at > or = 300 mg. Irbesartan 150 mg provided placebo-subtracted reductions in trough seated systolic and diastolic blood pressure of approximately 8 and approximately 5 mm Hg, respectively, with 56% of patients displaying a favorable response. In conclusion, irbesartan provides clinically significant blood pressure lowering, with a clear relationship between (log) dose and antihypertensive effect.     

Down-regulation of glial fibrillary acidic protein expression during acute lytic varicella-zoster virus infection of cultured human astrocytes

The effects of the varicella-zoster virus (VZV) OKA vaccine strain in producing morphologic and antigenic changes in dissociated cultures of human fetal brain was investigated. Cultures containing 80% glial acidic fibrillary protein (GFAP), GFAP+ (positive) astrocytes and 20% GFAP- (negative) fibroblastic-like cells were infected with cell-free VZV OKA at a multiplicity of infection of 0.1 plaque-forming units per cell. Cytopathic effects and significant viral antigen labeling with antibodies against VZV gpl and immediate-early (IE) protein 62 were first detected 6 to 7 days postinfection. Several observations indicated that astrocyte GFAP expression was altered and diminished as a result of VZV infection itself, thereby raising doubts about the utility of combining cell markers and viral antigenic labeling in assessing the susceptibility of neural cell types to viral infection. The down-regulation of GFAP expression by VZV appears to be mediated by early rather than late events in the viral replication cycle and may not be the result of virally induced global shut-off of host cell protein synthesis. Similar observations were made using VZV Ellen, a multipassaged, nonvaccine strain. These observations have potential in vivo implications related to histologic analysis of VZV-infected tissues and disease pathogenesis.     

Ultrasonically activated shears in thyroid surgery

BACKGROUND: Ultrasonically activated shears (UAS) have been documented to be both safe and fast devices in laparoscopic surgery. We studied whether the use of UAS would have some advantage in thyroid surgery. METHODS: Thyroidectomies, performed by one senior endocrine surgeon between December 1996 and February 1997, were retrospectively matched, with patients operated on by the same surgeon using the conventional method. RESULTS: Six pairs of total thyroidectomies and one pair of lobectomies could be matched. Mean operating time was 100 minutes for the patients operated on with the UAS and 154 minutes for the patients operated on with the conventional method. The mean operating time with the UAS was thus on average 64.6% of the operation time with the conventional method, with a 95% confidence interval from 50.1% to 83.5% (t = 4.00, 6 df, P = 0.007). CONCLUSIONS: In this material the use of UAS reduced significantly operating time in thyroidectomies.     

Efficient compression and network adaptive video coding for distributed video surveillance

The availability of cheap network based video cameras and the prevalence of wireless networks has lead to a major thrust towards deployment of large scale Distributed Video Surveillance (DVS) systems. This has opened up an important area of research to deal with the issues involved in DVS system for efficient collection and transmission of large scale video streams from the cameras at the guarded sites, to the end users in possibly constrained network conditions. In this paper, we propose a framework based on content-based video classification and scalable compression scheme to provide a robust bandwidth efficient video transmission for DVS. The scheme builds on a Discrete Wavelet Transform (DWT) based Color-Set Partitioning for Hierarchical Trees (CSPIHT) coding to obtain a scalable bitstream. Wavelet domain segmentation and compression assists in development of a DVS architecture. The architecture includes a novel module for dynamic allocation of Network bandwidth based on the current available resources and constraints. Different frame constituents are optimally coded based on their relative significance, perceptual quality, and available estimate of network bandwidth. Experimental result over different video sequences and simulations for Network conditions demonstrate the efficient performance of the approach.     

OS-Guard: on-site signature based framework for multimedia surveillance data management

This paper presents OS-Guard(On-Site Guard), a novel on-site signature based framework for multimedia surveillance data management. One of the major concerns in widespread deployment of multimedia surveillance systems is the enormous amount of data collected from multiple media streams that need to be communicated, observed and stored for crime alerts and forensic analysis. This necessitates investigating efficient data management techniques to solve this problem. This work aims to tackle this problem, motivated by the following observation, more data does not mean more information. OS-Guard is a novel framework that attempts to collect informative data and filter out non-informative data on-site, thus taking a step towards solving the data management problem. In the framework, both audio and video cues are utilized by extracting features from the incoming data stream and the resultant real valued feature data is binarized for efficient storage and processing. A feature selection process based on association rule mining selects discriminant features. A short representative sample of the whole database is generated using a novel reservoir sampling algorithm that is stored onsite and used with an support vector machine to classify an important event. Initial experiments for a Bank ATM monitoring scenario demonstrates promising results.     

Some investigations on fuzzy P + fuzzy I + fuzzy D controller for non-stationary process

The paper addresses the adaptive behaviour of parallel fuzzy proportional plus fuzzy integral plus fuzzy derivative (FP+FI+FD) controller. The parallel FP+FI+FD controller is actually a non-linear adaptive controller whose gain changes continuously with output of the process under control. Two non-stationary processes, whose characteristics change with time, are considered for simulation study. Simulation is performed using software LabVIEW TM . The set-point tracking response of parallel FP+FI+FD is compared with conventional parallel proportional plus integral plus derivative (PID) controller, tuned with the Ziegler-Nichols (Z-N) tuning technique. Simulation results show that conventional PID controller fails to track the set-point and becomes unstable as the process changes its characteristic with time. But the parallel FP+FI+FD controller shows considerably much better set-point tracking response and does not deviate from steady state. Also, a huge spike is observed in the output of PID controller as the reference set-point and process parameters are changed, while the FP+FI+FD controller gives spike free control signal.