Intermittent versus continuous oxaliplatin and fluoropyrimidine combination chemotherapy for first-line treatment of advanced colorectal cancer: results of the randomised phase 3 MRC COIN trial

Background: When cure is impossible, cancer treatment should focus on both length and quality of life. Maximisation of time without toxic effects could be one effective strategy to achieve both of these goals. The COIN trial assessed preplanned treatment holidays in advanced colorectal cancer to achieve this aim. Methods: COIN was a randomised controlled trial in patients with previously untreated advanced colorectal cancer. Patients received either continuous oxaliplatin and fluoropyrimidine combination (arm A), continuous chemotherapy plus cetuximab (arm B), or intermittent (arm C) chemotherapy. In arms A and B, treatment continued until development of progressive disease, cumulative toxic effects, or the patient chose to stop. In arm C, patients who had not progressed at their 12-week scan started a chemotherapy-free interval until evidence of disease progression, when the same treatment was restarted. Randomisation was done centrally (via telephone) by the MRC Clinical Trials Unit using minimisation. Treatment allocation was not masked. The comparison of arms A and B is described in a companion paper. Here, we compare arms A and C, with the primary objective of establishing whether overall survival on intermittent therapy was non-inferior to that on continuous therapy, with a predefined non-inferiority boundary of 1·162. Intention-to-treat (ITT) and per-protocol analyses were done. This trial is registered, ISRCTN27286448. Findings: 1630 patients were randomly assigned to treatment groups (815 to continuous and 815 to intermittent therapy). Median survival in the ITT population (n=815 in both groups) was 15·8 months (IQR 9·4—26·1) in arm A and 14·4 months (8·0—24·7) in arm C (hazard ratio [HR] 1·084, 80% CI 1·008—1·165). In the per-protocol population (arm A, n=467; arm C, n=511), median survival was 19·6 months (13·0—28·1) in arm A and 18·0 months (12·1—29·3) in arm C (HR 1·087, 0·986—1·198). The upper limits of CIs for HRs in both analyses were greater than the predefined non-inferiority boundary. Preplanned subgroup analyses in the per-protocol population showed that a raised baseline platelet count, defined as 400 000 per µL or higher (271 [28%] of 978 patients), was associated with poor survival with intermittent chemotherapy: the HR for comparison of arm C and arm A in patients with a normal platelet count was 0·96 (95% CI 0·80—1·15, p=0·66), versus 1·54 (1·17—2·03, p=0·0018) in patients with a raised platelet count (p=0·0027 for interaction). In the per-protocol population, more patients on continuous than on intermittent treatment had grade 3 or worse haematological toxic effects (72 [15%] vs 60 [12%]), whereas nausea and vomiting were more common on intermittent treatment (11 [2%] vs 43 [8%]). Grade 3 or worse peripheral neuropathy (126 [27%] vs 25 [5%]) and hand—foot syndrome (21 [4%] vs 15 [3%]) were more frequent on continuous than on intermittent treatment. Interpretation: Although this trial did not show non-inferiority of intermittent compared with continuous chemotherapy for advanced colorectal cancer in terms of overall survival, chemotherapy-free intervals remain a treatment option for some patients with advanced colorectal cancer, offering reduced time on chemotherapy, reduced cumulative toxic effects, and improved quality of life. Subgroup analyses suggest that patients with normal baseline platelet counts could gain the benefits of intermittent chemotherapy without detriment in survival, whereas those with raised baseline platelet counts have impaired survival and quality of life with intermittent chemotherapy and should not receive a treatment break.

Feeding and digestive strategies in deposit-feeding holothurians

Deposit-feeding holothurians employ a range of feeding and digestive strategies depending on the Particular environment to which they are adapted. Habitat and feeding specialisation is reflected in the tentacles, which show high diversity.

Tentacular diversity in deep-sea deposit-feeding holothurians: implications for biodiversity in the deep sea

The tentacles of deep-sea holothurians show a wide range of morphological diversity. The present paper examines gross tentacle morphology in surface deposit feeding holothurians from a range of bathymetric depths. Species studied included the elasipods: Oneirophanta mutabilis, Psychropotes longicauda and Benthogone rosea and the aspidochirotids: Paroriza prouhoi, Pseudostichopus sp., Bathyplotes natans and Paroriza pallens. The sympatric abyssal species Oneirophanta mutabilis, Psychropotes longicauda and Pseudostichopus sp. show subtle differences in diet and the structure and filling patterns of the gut that suggest differences in feeding strategies which may represent one mechanism to overcome competition for food resources in an environment where nutrient resources are considered to be, at least periodically, limiting. Interspecific differences in tentacle functional morphology and digestive strategies, which reflects taxonomic diversity could be explained in terms of Sanders'; Stability–Time Hypothesis. Since different tentacle types will turn over sediments to different extents, their impact on sedimentary communities will be enormous so that high diversity in meiofaunal communities may be explained most simply by Dayton and Hessler's Biological Disturbance Hypothesis.

Further observations on tentacular feeding mechanisms in holothurians

Resource partitioning by aspidochirote holothurians from Beacon Island, Western Australia is largely on the basis of distinct macro- and micro-habitat preferences. Where two or more species occur together or overlap, food partitioning may be by using distinct feeding techniques (Holothuria cinerascens (Brandt), H. impatiens (Forskal) and H. difficilis Semper) or by particle selectivity (H. cf. pervicax Selenka and H. hartmeyeri Erwe). Methods of particle handling by the majority of species studied are similar, involving the use of tentacular nodules on sediment deposits but H. cinerascens collects particles from suspension in a dendrochirote-like tentacle. The nature and rôle of surface secretions are considered for both types of tentacles and the taxonomic value of tentacle form in the Holothurioidea questioned.

Deposit-feeding mechanisms and resource partitioning in tropical holothurians

Aspidochirote holothurians found on tropical reef flats feed on particulate deposits which form a variety of substrata. The synaptid holothurian Opheodesoma grisea (Semper) feeds in a similar manner by scraping deposits from the surfaces of sea grasses. Distributional and gut content analyses showed that species partitioning is on the basis of substratum and particle size preference. Scanning electron microscopy revealed that the tentacles of aspidochirotes have a nodular surface while those of O. grisea have a tessellated surface structure. The twelve different species examined were shown to have different tentacular surface textures which bore an apparent relationship with the mean particle sizes selected by the different species. Light microscope studies of tentacle sections confirmed earlier observations on the extent of the water vascular system in aspidochirote and pinnate tentacles. From these observations a functional interpretation is proposed for tentacular operation and the means of particle selection in such holothurians.

Stable breeding despite variable feeding in two sympatric auk species

Capsule Despite substantial inter-annual and inter-specific variance in the composition of chick diet, the breeding success of Guillemots (Common Murres) Uria aalge and Razorbills Alca torda remained constant from 2008 to 2010.
Aims To examine inter-specific and inter-annual differences in breeding success, chick provisioning behaviour and predation between two sympatric auk species.
Methods Focal observations of breeding auks at Rathlin Island, Northern Ireland, during 2008, 2009 and 2010 recorded reproductive success, reasons for breeding failure, prey composition and quality and chick provisioning rates.
Results Breeding success of both species was stable over the three years, despite significant variance in the composition and quality of the diet provided to chicks. Razorbills experienced greater rates of failure than Guillemots owing to chick loss and had lower overall breeding success.
Conclusion Guillemot and Razorbill breeding success was independent of the composition and quality of prey items delivered to chicks. Inter-specific differences in reproductive success may have been attributed to greater rates of predation at Razorbill rather than Guillemot nests.

Responsive homes of old Cairo:Learning from the past, feeding in the future

This is a working paper published in On-line E-book

Studies on the biodegradation of fosfomycin: Synthesis of 13C-labeled intermediates, feeding experiments with rhizobium huakuii PMY1, and Isolation of Labeled Amino Acids from Cell Mass by HPLC

Racemic (1R*,2R*)-1,2-dihydroxy-[1- ^{13C ₁]propylphosphonic acid and 1-hydroxy-[1- 13C ₁]acetone were synthesized and fed to R. huakuii PMY1. Alanine and a mixture of valine and methionine were isolated as their N-acetyl derivatives from the cell hydrolysate by reversed-phase HPLC and analyzed by NMR spectroscopy. It was found that the carbon atoms of the respective carboxyl groups were highly 13C-labeled (up to 65 %). Hydroxyacetone is therefore considered an obligatory intermediate of the biodegradation of fosfomycin by R. huakuii PMY1.}

Responsive homes of old Cairo: Learning from the past, feeding in the future

By investigating the social dynamics of home in one of the enduring communities of Cairo, this paper reveals the way ordinary people construct and consume their private and public domains on a daily basis. It reveals what is central and what is marginal in the cognitive idea of home. This paper adopts an interdisciplinary strategy of investigation, utilizing sociological and anthropological data to read and visit spatial practices in the home. Building on historical as well as contemporary accounts of residents and families, the concept of home is envisioned as a spectrum of social spheres that is liberated from the physical determinants of space, hence revealing a new domain of part-time spaces and dynamic spatiality. The emergent idea of home intertwines work, domesticity, recreation and hospitality in interplay of space-activity-time relationships. Homes of old Cairo have proved to be responsive to continuous change, and have evolved dynamic forms of the temporal settings required for accommodation of emerging home-based professional activities such as hospitality, home-workers, and care-homes.

Behaviour of Brent geese Branta bernicla hrota and wigeon Anas penelope feeding on intertidal Zostera spp

Mixed flocks of pale-bellied Brent geese (Branta bernicla hrota) and wigeon (Anas penelope L.) feeding on intertidal Zostera spp were studied during October 1993 with respect to tidal position, feeding method and duration, and competitive: interactions within and between species. Owing to many disturbance incidents affecting the use of the site by wildfowl, only complete data on flow tides were presented. Brent geese fed over a greater period of the tidal cycle than wigeon. Differences in feeding methods indicated that Brent geese exploited the rhizomes, which are energetically more profitable than the shoot on which wigeon fed. Aggressive interactions were recorded within species but there were no records of aggression between species. More subtle competition for space, however, may have occurred during feeding. Brent geese could reach Zostera spp For a short period after increasing depth of water prevented access by wigeon. However, individual wigeon were observed foraging near feeding Brent geese, picking up the scraps oi material discarded by the latter, and small numbers of wigeon may benefit from the presence of the geese. These benefits for some individual wigeon are not considered to compensate for the disadvantages to the latter species population as a whole in feeding on poorer-quality food for a shorter period of the tidal cycle. This disadvantage is likely to have contributed to the decline in the wigeon population on Strangford Lough, Co. Down, while numbers of Brent geese have been maintained at a high level.