Biomedical subjects

R L Davis

Publications and source records attributed to R L Davis.

At least 109 records · Page 6Linked to original sources

PubMed1997

Leonardo, a Drosophila 14-3-3 protein involved in learning, regulates presynaptic function.

The leonardo gene encodes a conserved member of the 14-3-3 protein family, which plays a role in Drosophila learning. Immunological localization of the protein shows that it is expressed at synaptic connections and enriched in presynaptic boutons of the neuromuscular junction (NMJ). Null leonardo mutants die as mature embryos. Electrophysiological assays of the mutant NMJ demonstrate that basal synaptic transmission is reduced by 30% and that transmission amplitude, fidelity, and fatigue resistance properties are reduced at elevated stimulation frequencies and in low external [Ca2+]. Moreover, transmission augmentation and post-tetanic potentiation (PTP) are disrupted in the mutant. These results suggest that Leonardo plays a role in the regulation of synaptic vesicle dynamics, a function which may underlie synaptic modulation properties enabling learning.

14-3-3 Proteins↗

PubMed1997

Treatment of pediatric low-grade gliomas with a nitrosourea-based multiagent chemotherapy regimen.

Between March 9, 1984 and January 29, 1992, 42 children with newly diagnosed symptomatic or previously diagnosed progressive low-grade gliomas received outpatient chemotherapy as their primary treatment. This study was a single arm, phase II trial designed to estimate the time to tumor progression and toxicity of this regimen. Procarbazine, 6-thioguanine, and dibromodulcitol were given before lomustine (CCNU) and vincristine was given 1 and 3 weeks after CCNU. Patients were treated for six treatment cycles or until the tumor progressed, whichever came first. Twenty-three patients had juvenile pilocytic astrocytomas, 11 had astrocytomas, one had oligodendroglioma, one had ganglioglioma, and six had radiographically diagnosed low-grade gliomas. The mean age of the patients was 5 years (median, 3 years). The median time to treatment failure was 132 weeks (95% confidence interval: 106, 186 weeks). Only eight patients have died the estimated 5-year survival rate is 78% (95% confidence interval, 60% 87%). There were two episodes of grade 4 neutropenia, and three episodes of grade 4 thrombocytopenia. This regimen was safe, able to be delivered in the outpatient setting, and produced prolonged periods of disease stabilization in children with low-grade gliomas.

Adolescent↗

PubMed1997

Primary intracerebral osteosarcoma: a case report.

Primary intracerebral sarcomas are rare tumors. Malignant fibrous histiocytoma and fibrosarcoma are the predominant histologies. A 3 year old girl with a primary, intraparenchymal cerebral osteosarcoma, the second case reported in the literature, is described. Partial surgical resection, systemic chemotherapy and radio-surgery has provided tumor control at 18 months. Treatment issues are discussed.

Brain Neoplasms↗

PubMed1997

Acute lung injury in isolated traumatic brain injury.

OBJECTIVE: To determine the incidence of acute lung injury (ALI) in comatose patients after isolated traumatic brain injury, to determine whether specific brain lesions diagnosed by cranial computed tomographic scans are associated with ALI, and to determine the outcome of patients with head injuries who developed ALI. METHODS: Descriptive epidemiology and a case-control study using the Traumatic Coma Data Bank was performed to evaluate clinical features and brain lesions associated with ALI in patients with isolated head trauma. Patients with ALI were defined as those who demonstrated a ratio of partial pressure of arterial oxygen to fractional expired oxygen of 300 or less. RESULTS: Twenty of 100 comatose patients developed ALI. Patients with ALI were almost three times more likely to die or survive in a vegetative state (odds ratio, 2.8; 95% confidence interval, 1.6-4.9). Specific anatomic brain lesions diagnosed by cranial computed tomographic scans were not associated with ALI. However, patients with more severe injuries, i.e., large nonevacuated mass lesions, and those with midline shift demonstrated a 10- and 5-fold increased risk of ALI (odds ratio, 9.9; 95% confidence interval, 1.2-217.1; and odds ratio, 5.5; 95% confidence interval, 1.5-20.0). CONCLUSIONS: ALI was common in comatose victims with an isolated traumatic brain injury and was associated with an increased risk of death or a severe neurological morbidity. ALI was associated with the global severity of head injury but not with specific anatomic lesions diagnosed by cranial computed tomographic scans.

Adolescent↗

PubMed1997

Endogenous firing patterns of murine spiral ganglion neurons.

Current-clamp recordings with the use of the whole cell configuration of the patch-clamp technique were made from postnatal mouse spiral ganglion neurons in vitro. Cultures contained neurons that displayed monopolar, bipolar, and pseudomonopolar morphologies. Additionally, a class of neurons having exceptionally large somata was observed. Frequency histograms of the maximum number of action potentials fired from 240-ms step depolarizations showed that neurons could be classified as either slowly adapting or rapidly adapting. Most neurons (85%) were in the rapidly adapting category (58 of 68 recordings). Measurements of elementary properties were used to define the endogenous firing characteristics of both the neuron classes. Action potential number varied with step and holding potential, spike amplitude decayed during prolonged depolarizations, and spike frequency adaptation was observed in both rapidly and slowly adapting neurons. The apparent input resistance, spike amplitude decrement, and instantaneous firing frequency differed significantly between rapidly and slow adapting neurons. Inward rectification was evaluated in response to hyperpolarizing contrast current injections. Present in both electrophysiological classes, its magnitude was graded from neuron to neuron, reflecting differences in number, type, and/or voltage dependence of the underlying channels. These data suggest that spiral ganglion neurons possess intrinsic firing properties that regulate action potential number and timing, features that may be crucial to signal coding in the auditory periphery.

Action Potentials↗

PubMed1997

Heterogeneous voltage dependence of inward rectifier currents in spiral ganglion neurons.

Inward rectification was characterized in neonatal spiral ganglion neurons maintained in tissue culture. Whole cell current and voltage-clamp techniques were used to show that the hyperpolarization-activated cationic (Ih) current underlies most or all of the inward rectification demonstrated in these neurons. The average reversal potential (-41.3 mV) and cesium sensitivity were typical of that found in other neurons and cell types. What was unique about the hyperpolarization-activated currents, however, was that the half-maximal voltages (V1/2) and slope factors (k) that characterized Ih current activation were graded from neuron to neuron. Voltage-clamp recordings made with standard bath and pipette solutions revealed V1/2 values that ranged from -78.1 to -122.1 mV, with slope factors from 7.6 to 13.1. These gradations in the voltage-dependent features of the Ih current did not result from variability in the recording conditions because independently measured Na+ current-to-voltage relationships were found to be uniform (peak current at -20 mV). Moreover, the range and average V1/2 and slope values could be altered with activators [8-(4-chlorophenylthio) adenosine 3',5'-cyclic monophosphate in combination with okadaic acid] or inhibitors {N-[2-(p-bromocinnamylamino)ethyl]-5-isoquinolinesulfonamide}of protein indicating that Ih current heterogeneity most likely resulted from differential phosphorylation.

Animals↗

PubMed1997

A study of pediatric brain tumors and their association with epilepsy and anticonvulsant use.

OBJECTIVES: To evaluate the risk of childhood brain tumor occurrence in relation to epilepsy and anticonvulsant use. STUDY DESIGN: As part of a multicenter case-control study of pediatric brain tumors, maternal report on epilepsy occurrence before diagnosis of her child's brain tumor was collected for 540 cases and compared with 801 control children. Mothers also reported on any long-term (> or = 2 weeks) use of medications by her child before the date of tumor diagnosis (or a comparable reference date for controls) and these medications were classified according to whether they contained barbiturates. RESULTS: As expected, because seizures are often an early brain tumor symptom, a strong association was observed between epilepsy and brain tumor occurrence (odds ratio, OR = 6.2; 95% confidence limit, CL = 2.9, 14). The association remained elevated even after a > or = 10-year interval between diagnoses of epilepsy and brain tumor (OR = 4.7; CL = 0.8, 48). Elevated odds ratios were observed both for epileptic children who were treated with anticonvulsants containing barbiturates (OR = 5.8; CL = 2.2, 18) and for those not treated with barbiturates (OR = 7.9; CL = 1.7, 74), relative to nonepileptic children. CONCLUSION: Whereas most of the brain tumor risk associated with epilepsy may be due to occult tumors, the finding of an elevated risk many years after diagnosis of epilepsy is of interest.

Adolescent↗

PubMed1997

The Drosophila 14-3-3 protein Leonardo enhances Torso signaling through D-Raf in a Ras 1-dependent manner.

14-3-3 proteins have been shown to interact with Raf-1 and cause its activation when overexpressed. However, their precise role in Raf-1 activation is still enigmatic, as they are ubiquitously present in cells and found to associate with Raf-1 in vivo regardless of its activation state. We have analyzed the function of the Drosophila 14-3-3 gene leonardo (leo) in the Torso (Tor) receptor tyrosine kinase (RTK) pathway. In the syncytial blastoderm embryo, activation of Tor triggers the Ras/Raf/MEK pathway that controls the transcription of tailless (tll). We find that, in the absence of Tor, overexpression of leo is sufficient to activate tll expression. The effect of leo requires D-Raf and Ras1 activities but not KSR or DOS, two recently identified essential components of Drosophila RTK signaling pathways. Tor signaling is impaired in embryos derived from females lacking maternal expression of leo. We propose that binding to 14-3-3 by Raf is necessary but not sufficient for the activation of Raf and that overexpressed Drosophila 14-3-3 requires Ras1 to activate D-Raf.

14-3-3 Proteins↗

PubMed1997

Health care utilization and health status in high-risk children randomized to receive group or individual well child care.

OBJECTIVE: To determine if health care utilization and health status among high-risk children is modified by the use of group well child care (GWCC) as compared with traditional one-to-one individual well child care (IWCC). STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: Children less than 4 months old from families with at least one of the following maternal risk factors: poverty, single marital status, age <20 years at delivery, less than a high school education, previous substance abuse, or history of abuse as a child. SETTING: Two urban, university pediatric clinics in Seattle, Washington. INTERVENTIONS: Children were randomized to receive GWCC or IWCC at the time of enrollment. Health supervision visits with two study nurse practitioners were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. GWCC study visits consisted of a group discussion of age-appropriate child-rearing issues, along with a physical examination, health screening, and immunizations. Health care utilization among children receiving GWCC and those randomized to IWCC was assessed using the following measures: compliance with study visits, compliance with any age-appropriate health supervision visit, emergency department utilization, and immunization rates (defined as the proportion of children in each group who had received all recommended vaccines by 1 year of age). Provider time for GWCC and IWCC study visits was also recorded. Health status was measured using Stein's Functional Status IIR, completed by the mothers of study patients when their children completed the study at 15 months of age. RESULTS: A total of 106 children received GWCC, whereas 104 were randomized to IWCC. Compliance with scheduled study visits was 47% for GWCC patients and 54% for IWCC recipients; overall compliance with any age-appropriate health supervision visit was 68% and 66%, respectively. Provider time was similar for GWCC and IWCC visits. By the age of 1 year, 67% of GWCC recipients and 73% of those receiving IWCC had received three DTP/DT, three OPV/IPV, three Hib, and three hepatitis B immunizations. A total of 242 emergency department visits were made by study patients during their enrollment in the project; there was no difference in the average number of visits between GWCC or IWCC children. However, children receiving IWCC were more likely to have at least one emergency department visit than GWCC recipients. At the conclusion of the project, health status, as measured by the Functional Status IIR, was similar in GWCC and IWCC patients (mean scores 92.4 +/- 1.4 and 92.5 +/- 1.1, respectively). CONCLUSIONS: Health care utilization and health status was similar in high-risk children whether they received GWCC or IWCC. GWCC is a viable format for health supervision visits in this population.

Adult↗

PubMed1997

MMR2 immunization at 4 to 5 years and 10 to 12 years of age: a comparison of adverse clinical events after immunization in the Vaccine Safety Datalink project. The Vaccine Safety Datalink Team.

BACKGROUND: The Advisory Committee on Immunization Practices recommends a second dose of measles, mumps, and rubella vaccine (MMR2) at age 4 to 5 years of age, whereas the American Academy of Pediatrics suggests MMR2 immunization at age 11 to 12 years of age. Because there is little information on whether the rate of adverse reactions to MMR2 immunization varies among these two age groups, we took advantage of differing immunization policies at two large HMOs to compare the frequency of clinical events after, and possibly related to, MMR2 immunization. METHODS: Information was collected on clinical events plausibly associated to MMR immunization (seizures, pyrexia, malaise/fatigue, nervous/musculoskeletal symptoms, rash, edema, induration/ecchymoses, lymphadenopathy, thrombocytopenia, aseptic meningitis, and joint pain) in two cohorts. At three facilities at Northern California Kaiser (Oakland, CA), 8514 children received MMR2 immunization at age 4 to 6 years of age; at Group Health Cooperative (Seattle, WA) 18 036 children received MMR2 immunization at age 10 to 12 years of age. To account for age-related differences in health care use, within each HMO, clinical events in a 30-day period after immunization were compared with a 30-day period before vaccination. RESULTS: Children 10 to 12 years of age were 50% more likely to have a clinical event after MMR2 immunization than in the period before immunization (odds ratio, 1.45; 95% confidence interval: 1.00,2.10). Children 4 to 6 years of age were less likely to have a visit for an event after immunization compared with the period before immunization (odds ratio, 0.64; 95% confidence interval: 0.40,1.01). CONCLUSIONS: These results suggest that the risk for clinical events after MMR2 immunizations is greater in the 10- to 12-year age group.

Adolescent↗

PubMed1997

Pediatric home health care in King County, Washington.

BACKGROUND: Pediatric home health care is one of the fastest growing segments of our health care system. However, our knowledge of the extent and quality of the services provided in this field is generally limited. Despite this shortcoming, pediatric health care providers are increasingly expected to participate in the home health care of their patients. OBJECTIVE: To describe the agencies and services that constitute pediatric home health care in a large metropolitan setting. METHODS: During the summer of 1995, home health care agencies in King County, WA, were surveyed if they had provided any pediatric services within the preceding 6 months. The agencies were queried about their characteristics and services provided, as well as referral and reimbursement sources. Survey data were supplemented by interviews with agency and state health personnel. RESULTS: Fourteen (88%) of the 16 agencies providing pediatric home health care services completed the survey. Agencies were predominantly for-profit, free-standing, and in business fewer than 10 years. Although there were uniform licensing requirements for agencies, no pediatric-specific regulations existed. In addition, many agencies lacked internal methods to ensure the provision of quality pediatric care. Eighty percent of all pediatric home health care services were provided by only 5 agencies. For intermittent (acute) services, agencies served approximately 450 children per month. The average number of visits per child was two, with 40% receiving only one visit. Services included skilled nursing (60%), infusion (27%), and respiratory therapy (9%). Maintenance (chronic) home health care services, for 156 chronically ill children, were provided almost exclusively by skilled nursing for an average of 9 hours per patient per day. The majority of referrals to agencies (75%) originated from health care providers, although a small number came from insurance companies or individual families. Reimbursement for intermittent care services was divided among commercial insurance (35%), captitated contracts (35%), and Medicaid (20%). In contrast, 90% of reimbursement for the chronically ill was from Medicaid. CONCLUSIONS: In King County, WA, pediatric home health care is predominantly an unregulated, for-profit industry, with most agencies having little actual experience in pediatric home health care. In addition, the unique features of pediatric home health care necessitate both a greater understanding of this field and the consideration of more specific guidelines.

Child↗

PubMed1997

Vaccine Safety Datalink project: a new tool for improving vaccine safety monitoring in the United States. The Vaccine Safety Datalink Team.

OBJECTIVE: To fill the large "gaps and limitations" in current scientific knowledge of rare vaccine adverse events identified in recent reviews of the Institute of Medicine. METHODS: Computerized information on immunization, medical outcomes, and potential confounders on more than 500 000 children 0 to 6 years of age is linked annually at several health maintenance organizations to create a large cohort for multiple epidemiologic studies of vaccine safety. RESULTS: Analysis of 3 years of follow-up data shows that 549 488 doses of diphtheria-tetanus-pertussis (DTP) and 310 618 doses of measles-mumps-rubella (MMR) vaccines have been administered to children in the study cohort. Analyses for associations between vaccines and 34 medical outcomes are underway. Screening of automated data shows that seizures are associated with receipt of DTP on the same day (relative risk [RR], 2.1; 95% confidence interval [CI], 1.1 to 4.0) and 8 to 14 days after receipt of MMR (RR, 3.0; 95% CI, 2.1 to 4.2). The diversity of vaccination exposures in this large cohort permits us to show that an apparent association of seizures 8 to 14 days after Haemophilus influenzae type b vaccine (RR, 1.6; 95% CI, 1.2 to 2.1) was attributable to confounding by simultaneous MMR vaccination; the association disappears with appropriate adjustment (RR, 1.0; 95% CI, 0.7 to 1.4). CONCLUSION: Preliminary design, data collection, and analytic capability of the Vaccine Safety Datalink project has been validated by replication of previous known associations between seizures and DTP and MMR vaccines. The diversity in vaccine administration schedules permits potential disentangling of effects of simultaneous and combined vaccinations. The project provides a model of public health-managed care collaborations in addition to an excellent infrastructure for safety and other studies of vaccines.

Adverse Drug Reaction Reporting Systems↗

PubMed1997

A randomized controlled trial of group versus individual well child care for high-risk children: maternal-child interaction and developmental outcomes.

OBJECTIVE: To determine if group well child care (GWCC) for high-risk children affects maternal-child interaction and development as compared to these outcomes in children receiving traditional individual well child care (IWCC). STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: Infants less than 4 months old at the initiation of the study who came from high-risk families. Families were classified as high risk, and eligible for study participation, if the mother had one or more of the following characteristics: poverty, single marital status, less than a high school education, age less than 20 years at delivery, previous substance abuse, or a history of abuse as a child. SETTING: Two urban, university pediatric clinics in Seattle, Washington. INTERVENTIONS: Study children were randomized to receive GWCC or IWCC prior to the first study visit at the age of 4 months. Study health supervision visits were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. For children randomized to receive GWCC, study visits consisted of an age-matched group discussion of child rearing issues, either preceding or following a brief physical examination. After the 15-month visit, development of study patients was assessed by the use of Bayley Scales of Infant Development (Bayley). Maternal-child interaction and the home environment were evaluated by the use of the Nursing Child Assessment Teaching Scale (NCATS) and the Home Observation for Measurement of the Environment (HOME), respectively. RESULTS: At least one outcome measure was obtained on 114 children; 86 patients completed all three outcome measures. Bayley psychomotor mean scores were 103.6 +/- 11.5 for GWCC patients versus 100.0 +/- 12.4 for those receiving IWCC (P = .14); mean scores for the mental section were 99.3 +/- 14.8 and 100.4 +/- 14.3, respectively (P = .71). The prevalence of high-risk maternal-child interactions was 10% in both the GWCC and IWCC groups. A high-risk home environment was found in 16% of IWCC patients versus 4% of those randomized to GWCC (odds ratio comparing IWCC to GWCC 4.6, 95% confidence interval 0.78, 26.0, after controlling for confounding variables). Provider time was similar among groups (mean number of minutes/patient/study visit: 19.8 +/- 5.6 and 20.4 +/- 6.7 for GWCC and IWCC, respectively, P = .66). CONCLUSION: GWCC is a viable alternative to IWCC for high-risk children. Developmental outcomes and maternal-child interaction are at least as good for children who received GWCC as compared to traditional IWCC, without any increase in provider time required.

Adult↗

PubMed1997

Immunization tracking systems: experience of the CDC Vaccine Safety Datalink sites.

Recognizing the potential of large databases within HMOs for the evaluation of vaccine safety, the Centers for Disease Control and Prevention (CDC) funded the Vaccine Safety Datalink project, linking outcome and vaccine exposure information at Group Health Cooperative of Puget Sound, Kaiser Permanente Northwest, Kaiser Permanente Medical Care Program Northern California, and Southern California Kaiser Permanente. Integral to the Vaccine Safety Datalink Project was the development of Immunization Tracking Systems at each site; this report describes the effort required to establish these tracking systems. Essential requirements are the methods used to insure data quality and to educate system users. Tracking systems can be a valuable means for assessing vaccine coverage, evaluating barriers to complete immunization, and studying the effectiveness of interventions design to improve immunization coverage. Finally, we report on recent efforts to link HMO Immunization Tracking Systems with developing regional tracking systems.

California↗

PubMed1997

Competency, board certification, credentialing, and specialization: who benefits?

Pharmacists are concerned with the rapid changes in the healthcare system and what the requirements will be for a pharmacist in the near future. The emergence of board certification, credentialing, and other certification programs for pharmacists are causing significant concern among pharmacists. Pharmacists must assess certification programs and decide on the value of certification to their careers and to the patients they serve. Employers of pharmacists and those paying for healthcare and pharmacy services must also evaluate the value of pharmacists certification. Perhaps the most direct and significant benefit of pharmacist certification lies in the ability of the pharmacist to provide better and more comprehensive care to patients or selected groups of patients (eg, diabetic patients). Better and more comprehensive care provided by a pharmacist benefits the patient, other healthcare professionals, the healthcare system generally, and payers of healthcare and pharmacy services. Demonstrated competence of the pharmacist to provide pharmaceutical care is essential to achieving this benefit. Board certification of pharmacists in current board-recognized specialty areas of nutrition support pharmacy, pharmacotherapy, psychiatric pharmacy, nuclear pharmacy, and oncology pharmacy totaled 2075 board certified pharmacists in the United States as of January 1997.

Certification↗

PubMed1996

Inhibition of selenite-catalyzed superoxide generation and formation of elemental selenium (Se(o)) by copper, zinc, and aurintricarboxylic acid (ATA).

Selenite catalyzes the oxidation of glutathione (GSH) with the subsequent generation of superoxide (O2.-). Copper, zinc, and aurintricarboxylic acid (ATA) were tested for their ability to inhibit both the selenite-catalyzed generation of superoxide and the conversion of selenite to elemental selenium (Se(o)). As measured by lucigenin-dependent chemiluminescence (CL), copper, zinc, and ATA were shown to inhibit significantly (P < 0.05) selenite-catalyzed CL in a concentration-dependent manner. The inhibition of the selenium-catalyzed generation of superoxide by copper(II) was greater than by either zinc or ATA. In addition, Copper, zinc, and ATA all inhibited the conversion of selenite to Se(o). Inhibition of selenite-catalyzed CL by copper, zinc, and ATA is believed to occur as the result of inhibition of Se2- and/or GSSe-, the catalytic selenopersulfide anion of GSH.

Aurintricarboxylic Acid↗

PubMed1996

Necrosis as a prognostic factor in glioblastoma multiforme.

BACKGROUND: Many pathologists require the presence of tumor necrosis within an astrocytic neoplasm to establish the diagnosis of glioblastoma multiforme (GM). Two new grading systems for astrocytic neoplasms allow a tumor to be diagnosed at the highest level of anaplasia without requiring the presence of tumor necrosis. METHODS: To determine whether GMs without necrosis had biologic behavior most compatible with a diagnosis of GM or of anaplastic astrocytoma (AA), we examined the survival of 299 patients whose tumors were diagnosed as GM because they contained endothelial proliferation and who were treated according to prospective clinical protocols. Multivariate proportional-hazards survival analysis was used to assess the importance of tumor necrosis after adjustment for other prognostic factors. RESULTS: Of 275 patients with GMs containing endothelial proliferation, 88% had tumor necrosis. Absence of necrosis was associated with younger age and with less extensive surgical resection. The absence of necrosis predicted longer survival in univariate analysis (P = 0.02) and after adjustment for age, Karnofsky performance score, and extent of resection in a multivariate analysis (P = 0.04). However, the magnitude of the survival difference was not clinically important: patients without tumor necrosis had a median survival of 12.5 months, and those with tumor necrosis had a median survival of 10.9 months. Kaplan-Meier survival rates two years after diagnosis were 13.0% for patients with necrosis and 27.1% for patients without necrosis; the difference in 2-year survival was not statistically significant (difference in survival rates = 14.1%, 95% confidence interval -2.2% to 30.4%). CONCLUSIONS: The survival of patients with astrocytic neoplasms containing endothelial proliferation and no necrosis conforms best to the pattern expected for patients with GM rather than AA. This supports the classification of these tumors as GM in the revised World Health Organization grading system and as grade 4 astrocytomas in the St. Anne-Mayo grading system.

Adolescent↗

PubMed1996

Bromodeoxyuridine labeling index in glioblastoma multiforme: relation to radiation response, age, and survival.

PURPOSE: Various measures of the rate of tumor cell proliferation have been found to predict survival in patients with intracerebral gliomas. We correlated the bromodeoxyuridine labeling index (BrdUrd LI) with the response to radiation therapy, survival, and known prognostic factors in a series of patients with glioblastoma multiforme (GM) to test its utility as a prognostic factor. METHODS AND MATERIALS: The BrdUrd LI was determined in 200 newly diagnosed intracranial GMs. Age and sex were known for all patients. The response to radiation therapy was determined in 116 patients by comparing neuroimaging studies obtained before and after external beam radiation therapy. Survival was analyzed in 64 patients who were treated according to two consecutive prospective clinical protocols. RESULTS: The median BrdUrd LI was 6.5% (mean, 7.2%; range, 1.1-25.4%). The BrdUrd LI did not correlate significantly with age, sex, radiation response, or survival. Age and Karnofsky performance score were independent prognostic factors in our cohort. CONCLUSION: The proliferative rate as measured by BrdUrd LI was not a prognostic factor in our GM cohort. The BrdUrd LI did not correlate significantly with known prognostic factors in GM. There was no significant relationship between BrdUrd LI and radiation response.

Adolescent↗