Thermodynamic study of ibuprofen by adiabatic calorimetry and thermal analysis

Molar heat capacities of ibuprofen were precisely measured with a small sample precision automated adiabatic calorimeter over the temperature range from 80 to 400 K. The polynomial functions of C-p,C-m (J K-1 mol(-1)) versus T were established on the heat capacity measurements by means of the least fitting square method. The functions are as follows: for solid ibuprofen, at the temperature range of 79.105 K less than or equal to T less than or equal to 333.297 K, C-p,C-m = 144.27 + 77.046X + 3.5171X(2) + 10.925X(3) + 11.224X(4), where X = (T - 206.201)/127.096; for liquid ibuprofen, at the temperature range of 353.406 K less than or equal to T less than or equal to 378.785 K, C-p,C-m = 325.79 + 8.9696X - 1.6073X(2) - 1.5145 X-3, where X = (T - 366.095)/12.690. A fusion transition at T = 348.02 K was found from the C-p-T curve. The molar enthalpy and entropy of the fusion transition were determined to be 26.65 kJ mol(-1) and 76.58 J mol(-1) K-1, respectively. The thermodynamic functions on the base of the reference temperature of 298.15 K, (H-T - H-298.15) and (S-T - S-298.15), were derived. Thermal characteristic of ibuprofen was studied by thermo-gravimetric analysis (TG-DTG) and differential scanning calorimeter (DSC). The temperature of fusion, the molar enthalpy and entropy of fusion obtained by DSC were well consistent with those obtained by adiabatic calorimeter. The evaporation process of ibuprofen was investigated further by TG and DTG, and the activation energy of the evaporation process was determined to be 80.3 +/- 1.4 kJ mol(-1). (C) 2003 Elsevier B.V. All rights reserved.

Multi-armed poly(L-glutamic acid)-graft-oligoethylenimine copolymers as efficient nonviral gene delivery vectors

Background The application of polyethylenimine (PEI) in gene delivery has been severely limited by significant cytotoxicity that results from a nondegradable methylene backbone and high cationic charge density. It is therefore necessary to develop novel biodegradable PEI derivates for low-toxic, highly efficient gene delivery.Methods A series of novel cationic copolymers with various charge density were designed and synthesized by grafting different kinds of oligoethylenimine (OEI) onto a determinate multi-armed poly(L-glutamic acid) backbone. The molecular structures of multi-armed poly(L-glutamic acid)-graft-OEI (MP-g-OEI) copolymers were characterized using nuclear magnetic resonance, viscosimetry and gel permeation chromatography. Moreover, the MP-g-OEI/DNA complexes were measured by a gel retardation assay, dynamic light scattering and atomic force microscopy to determine DNA binding ability, particle size, zeta potential, complex formation and shape, respectively. MP-g-OEI copolymers were also evaluated in Chinese hamster ovary and human embryonic kidney-293 cells for their cytotoxicity and transfection efficiency.

Syntheses and crystalline structures of clusters Co-3(CO)(7)(mu(3)-S)(mu, eta(2)-SCNR2)

Through the reaction of Co-2(CO)(8) with four thiuram [R2NC(S)S](2), four new sulfur-capped trinuclear cobalt carbonyl clusters Co-3 (CO)(7) (mu(3)-S) (mu, eta(2)-S* C* NR2) ( I : R = Me; I : R = Et; II : R = i-Pr; IV : NR= -N [GRAPHICS] were prepared and characterized by elementary analysis, IR,H-1 NMR and MS spectroscopy. The crystal structure of the cluster Co-3(CO)(7)(mu(3)-S)[mu, eta(2)-S*C*N (i-Pr)(2)]( III) was determined by X-ray single crystal diffraction method. The crystal of m is monoclinic, belonging to space group P2(1)/n, and the cell parameters are as follows: a = 1, 145 2(2) nm, b = 1. 502 8(3) nm, c = 1, 214 4(2) nmj alpha = 90 degrees, beta = 92, 15(3)degrees, gamma = 90 degrees; V = 2. 088 5(7) nm(3) , Z = 4, F (000) = 1 096, D-c = 1. 747 mg . m(-3), mu = 2. 588 mm(-1), R=0. 040 7, R-w=0. 062 4, The structural analysis shows that cluster II has a pyrimidal Co3S framework and contains a heterocylic bridging bidentate ligand [mu, eta(2)-S* C* N (i-Pr)(2)] linked to the Co2 and Co3 atoms of the cluster by a cobalt-carbon and a cobalt-sulfur bond respectively.

三碘-氯化四-(4-三甲基苯胺基)卟啉-羟基-水合锰水合物的合成与晶体结构

报道了标题化合物([Mn(Ⅲ)OH·H_2O·TMAP]·I_3·Cl·9H_2O)的合成和晶体结构。晶体属P2_(1/a)空间群,a=1.8502(1)nm,b=1.2738(1)nm,c=3.0458(2)nm,β=104.52(4)°,Z=4,R=0.096,R_w=0.087.用顺磁和光谱电化学证明卟啉配合物中心锰为三价,确定了锰卟啉轴向两个配位氧原子,一个属水分子,另一个属氢氧根。讨论了锰卟啉的稳定氧化态。

电感耦合等离子体原子发射光谱测定混合稀土铜合金中稀土和非稀土元素

本文提出了用电感耦合等离子体原子发射光谱(ICP—AES)法直接测定混合稀土铜合金中13个非稀土和稀土元素。选用了合适的分析线对及ICP光源的工作参数。探讨了观察高度、功率、酸度、载气和基体量的变化对被测元素谱线强度的影响。不用化学分离,可一次同时测定La、Ce、pr、Nd、Sm、Sn、Zn、Fe、Al、Ni、Pb,Mg和Mn。测定范围(％):La_2O_3:0.096～6.4;CeO_2:0.24～16;Pr_6O_(11):0.0384～2.56;Nd_2O_3:0.096～6.4;Sn:0.096～3.2;Mg、Mn、Fe,Sm_2O_3:0.024～1.6;Zn:0.396～6.7;Pb:0.092～6.4;Ni:0.096～3.2;Al:0.0384～1.28。相对标准偏差±3.0～9.1％;回收率85～116％满足冶炼上的要求,得到了满意的结果。

Complete mitochondrial genome of the sea cucumber Apostichopus japonicus (Echinodermata: Holothuroidea): The first representative from the subclass Aspidochirotacea with the echinoderm ground pattern

Complete mitochondrial genome plays an important role in the accurate revelation of phylogenetic relationships among metazoans. Here we present the complete mitochondrial genome sequence from a sea cucumber Apostichopus japonicus (Echinodermata: Holothuroidea), which is the first representative from the subclass Aspidochirotacea. The mitochondrial genome of A. japonicus is 16,096 bp in length. The heavy strand consists of 31.8% A, 20.2% C, 17.9% G, and 30.1% T bases (AT skew = 0.027: GC skew = 0.062). It contains thirteen protein-coding genes (PCGs), twenty-two transfer RNA genes, and two ribosomal RNA genes. There are a total of 3793 codons in all thirteen mitochondrial PCGs, excluding incomplete termination codons. The most frequently used amino acid is Leu (15.77%), followed by Set (9.73%), Met (8.62%), Phe (7.94%), and Ala (7.28%). Intergenetic regions in the mitochondrial genome of A. japonicus are 839 bp in total, with three relatively large regions of Unassigned Sequences (UAS) greater than 100 bp. The gene order of A. japonicus is identical to that observed in the five studied sea urchins, which confirms that the gene order shared by the two classes (Holothuroidea and Echinoidea) is a ground pattern of echinoderm mitochondrial genomes. Bayesian tree based on the cob gene supports the following relationship: (outgroup, (Crinoids, (Asteroids, Ophiuroids, (Echinoids, Holothuroids)))). (C) 2009 Elsevier B.V. All rights reserved.

贵州凉风洞石笋的古气侯记录与古生态环境意义

自20世纪60年代以来，探索全球性气候变化规律和环境变迁史的研究工作在世界各国广泛开展。大规模的深海岩芯的研究、中国北方黄土的系统研究、大型湖泊沉积岩芯的研究及对树木年轮、泥炭、珊瑚、冰芯等“自然环境历史档案”开展的研究工作，都为重建古气候和古生态环境提供了大量的资料。洞穴化学沉积物（石笋）由于其特有的微层结构及其内的稳定氧、碳同位素和微量元素所蕴含的古气候与古生态环境信息，并且具有分布广、时间长、信息保存完整等特点，因此，它是研究地球环境变化很好的自然环境历史档案。本论文通过对凉风洞洞穴体系的综合研究和对凉风洞石笋（微层）生长特征及石笋的碳、氧稳定同位素组成的研究，系统探讨了贵州凉风洞石笋的古气候记录和古生态环境意义，得出以下主要结论：1，地表植被的类型及生物量等信息可综合反映于洞穴体系的不同组．分（气样、土样、水样）中。而洞穴的水动力条件也能很好的被洞穴滴水中所含微量（常量）元素记录。根据分析，洞穴综合体系对外界气候与生态环境的响应关系存在一定规律性。通过对比说明，我们所选的凉风洞基岩的溶蚀和缓冲对水体中的信息影响不大，即洞穴滴水较好的继承了土壤水所携带的地表气候与生态环境信息，是理想的研究对象。2．凉风洞石笋具有多个沉积旋回，不同沉积旋回的纹层组合及纹层结构存在一定的差异，指示不同的沉积环境。根据年龄数据判断，旋回①至旋回⑧之间年龄跨度为1570-8000 aBP，以呈缓平顶（柱）对称叠复状的沉积形态组合为主，示洞顶滴水量较大，滴水点相对稳定，且均匀，与全新世较为稳定的气候与环境变化的主旋律相一致。旋回⑧以下至底部石葡萄状沉积物之上部分之间年龄跨度为8000-14220 aBP，期间经历末次冰期晚期向全新世大暖期过渡，受诸如新仙女木事件（Younger Dryas）等的影响，气候变化幅度大，且经历多次反复，石笋生长的沉积学特征表现为斜锥（柱）、尖顶锥不对称叠复纹层组合，示洞顶滴水水量较小但变化较大，且洞穴滴水不稳（固）定。与此时间段内不稳定的气候与环境变化的主旋律也相一致。3．凉风洞石笋上段微层具有典型南方石笋微层发育的特性：微层发育较差，层面多弯曲，层间界面模糊等。下段因为沉积间断较多、风化层面厚及受到若干时段内碳酸钙重结晶而导致晶体穿插层位生长的影响，尽管在某些层位有微层发育，但无法对石笋微层作连续观察记录。根据高精度的石笋TIMS、ICP-MS测年数据和在显微镜下所数石笋微层数量的对比，扣除若干个沉积间断及风化层导致的微层缺失，以及显微镜下肉眼对细小微层计数的误差，我们认为，凉风洞石笋微层是年生长层的可能性较大。4，由于部分测年数据仍在测试中，目前无法精确控制石笋中沉积间断的存在导致的信息缺失，因此，我们仅仅根据部分石笋测年数据，建立了凉风洞石笋在不同时段的生长速率。全新世以来石笋的生长速率在22μm／yr-51μm／yr之间，明显高于末次冰期晚期向全新世过渡这一时间段内的石笋生长速率（16μm／yr）。这些数据间接印证了石笋生长响应于外界气候，尤其是降雨的变化。5．通过对洞穴体系的综合分析对比，我们判断凉风洞洞穴综合体系相对完整，洞穴化学沉积物的6先值较为直接的响应了土壤c压的61t值变化，即反映了地表的植被（c3植物和c；植物）的组成状况。贵州地区降雨80％集中在5-10月份，在此期间，基本受西南季风和东亚季风所控制。西南季风盛行时贵州各地的降雨频繁，是一年中雨量最集中的时期，在东亚季风影响时期，贵州多晴少雨，往往形成干早的天气。又西南季风控制区大气降雨创的值的加权平均值明显低于东亚季风控制区大气降雨δ18O值的加权平均值。因此，贵州地区年均降雨量和年均降雨δ18O值主要取决于西南（印度洋）季风的强弱：西南季风加强，降雨量增加，年均降雨剐、值偏负；西南季风减弱，降雨量减少，年均降雨δ18O值偏正。洞穴滴水的6旧O值变化基本继承了大气降水的别勿值变化。因此，对地处我国西南地区贵州南部的凉风洞，源于洞穴滴水的凉风洞石笋的别勺值变化直接响应了外界的大气降雨量的变化和西南季风与东亚季风相互的强弱交替。6．对凉风洞石笋碳、氧同位素组成的时间序列曲线作20点移动平均，发现，特别是进入全新世后，石笋的引3c值和扩、值几乎具有完全一致的同步变化，只是在变化幅度上在某些时段存在差异。说明在凉风洞石笋反映的14220-1570 aBP时间段内，尤其是10500-1570 aBP期间，本区域气候具有雨热（或干冷）同期的气候特征：在气温较高时间段，西南季风增强，气候湿润多雨，更有利于地表。植物的生长。气温降低时，随着东亚季风增强，西南季风减弱，气候干旱少雨，地表C；植物的生长占有一定的比例。据此重建和恢复了本地区14220-1570 aBP期间的古气候和古生态环境：（1）．14220-10500aBP，处于末次冰期晚期，气温较低。凉风洞石笋此时段的司、值都大于-9.8‰，最小值为-9.31‰，最大值达-7.290‰，平均值为-8.552‰。说明凉风洞洞穴地表的生长植被。植物占有一定的组分，石笋的δ18C值受C3植物和C4植物的共同影响。此时段内石笋6、值也存在一定的波动（-5.651‰－6.942‰），考虑到末次冰期晚期先全新世过渡期间气温变幅较大，O'Neil等（1969）所建立的氧同位素平衡分馏方程中的温度变化已不能忽略，并且大气降雨的温度效应作用也比较明显，因此我们对此时段的季风和大气降雨量的变化不作讨论。（2）. 10500-9300 aBP，新仙女木事件结束，进入全新世，气温逐渐回升。凉风洞石笋此时段的扩3c值大都小于-9.8‰，最小值为-10.377‰，最大值为-9.267‰，平均值为-9.910‰。凉风洞洞穴地表植被已逐渐由C3植物占主导。此时段石笋δ18C值明显卜降，最小值为-7.420‰，最大值为-6.077‰，平均值为-6.854‰。反映在全新世早期夏季风盛行，降雨量较大，西南季风对本地区全年降雨贡献率大。（3）．9300-8300 aBP，经历一段明显温度波动变化。仟3c值在-9.8‰上下波动，最小值为-10.155‰，最大值为-9.096‰，平均值为-9.712‰。凉风洞洞穴地表植被C4植物所占比例存在反复。此时段石笋岁a0值变化幅度不是很大，最小值为-6.796‰，最大值为-6.260‰，平均值为-6.490‰。受冬季风影响，夏季风有一定的减弱，总体降雨量一般，东亚季风对本地区全年降雨贡献率比全新世初期有所增大。（4）．8300-3l000BP，俗称全新世大暖期，此时段全球气温明显回升，石笋δ18C值总体逐渐降低，最小值为-n．926编，平均值为-10.496‰。凉风洞洞穴地表植被基本由C3植物所控制。但在扩飞值总体逐渐降低的趋势一F，也存在若干扩3c值明显增大时段，如7700-6700 aBP时段，61七值最大值达-8.110‰，地表C4植物所占比例已不能忽略。此时段石笋6150值变化幅度较大，最小值为-7.373‰，最大值为-5.047‰，平均值为-6.261‰。反映在全新世大暖期的大背景下西南季风和东亚季风的交替以及大气降雨量的变化存在较大的波动，说明了季风气候的不稳定性。（5）．3100-1570 aBP，在3100aBP前后，凉风洞石笋的δ18C值和δ18O值均急剧上升，标志进入晚全新世。此时段气温变幅很大，δ18C值总体虽然仍偏低，平均值为-10.275‰，但刻畜介于-6.495-12.097‰之间；δ18C值平均值为-6.184‰，变幅介于-4.677-8.65‰之间，均超过以往任何时段。此时段凉风洞洞穴地表植被基本上仍然由C。植物所控制，始于3100 aBP的急速降温事件使得在全新世晚期开始时段C4植物所占比例有一定的上升。此时段内西南季风和东亚季风反复多次交替，大气降雨量存在较大幅度的变化，说明了季风气候在此时段的很不稳定性。对于169于巧70 oBP百年时间段内石笋的δ18C值和司、值巨大幅度的急剧升高，有待进一步研究，也不排除石笋表层长期裸露受外界污染所致。

Nitrogen uptake of phytoplankton assemblages under contrasting upwelling and downwelling conditions: The Ría de Vigo, NW Iberia

Regenerated production (including organic nitrogen) is shown here to be important in the Ria de Vigo (Galicia, NW Iberia) in supporting both harmful algal bloom communities during the downwelling season, but also (to a lesser extent) diatom communities during stratified periods of weak to moderate upwelling. The Galician Rias, situated in the Iberian upwelling system, are regularly affected by blooms of toxic dinoflagellates, which pose serious threats to the local mussel farming industry. These tend to occur towards the end of summer, during the transition from upwelling to downwelling favourable seasons, when cold bottom shelf waters in the rias are replaced by warm surface shelf waters. Nitrate, ammonium and urea uptake rates were measured in the Ria de Vigo during a downwelling event in September 2006 and during an upwelling event in June 2007. In September the ria was well mixed, with a downwelling front observed towards the middle of the ria and relatively high nutrient concentrations (1.0-2.6 mu mol L-1 nitrate; 1.0-5.6 mu mol L-1 ammonium; 0.1-0.8 mu mol L-1 phosphate; 2.0-9.0 mu mol L-1 silicic acid) were present throughout the water column. Ammonium represented more than 80% of the nitrogenous nutrients, and the phytoplankton assemblage was dominated by dinoflagellates and small flagellates. In June the water column was stratified, with nutrient-rich, upwelled water below the thermocline and warm, nutrient-depleted water in the surface. At this time, nitrate represented more than 80% of the nitrogenous nutrients, and a mixed diatom assemblage was present. Primary phytoplankton production during both events was mainly sustained by regenerated nitrogen, with ammonium uptake rates of 0.035-0.063 mu mol N L-1 h(-1) in September and 0.078-0.188 mu mol N L-1 h(-1) in June. Although f-ratios were generally low (<0.2) in both June and September, a maximum of 0.61 was reached in June due to higher nitrate uptake (0.225 mu mol N L-1 h(-1)). Total nitrogen uptake was also higher during the upwelling event (0.153-0.366 in June and 0.053-0.096 mu mol N L-1 h(-1) in September). Nitrogen uptake kinetics demonstrated a strong preference for ammonium and urea over nitrate in June.

SDSS J150722.30+523039.8: a cataclysmic variable formed directly from a detached white dwarf/brown dwarf binary?

We present high-speed, three-colour photometry of the eclipsing cataclysmic variable SDSS J150722.30+523039.8 (hereafter SDSS J1507). This system has an orbital period of 66.61 min, placing it below the observed `period minimum' for cataclysmic variables. We determine the system parameters via a parametrized model of the eclipse fitted to the observed lightcurve by ?2 minimization. We obtain a mass ratio of q = 0.0623 +/- 0.0007 and an orbital inclination . The primary mass is Mw = 0.90 +/- 0.01Msolar. The secondary mass and radius are found to be Mr = 0.056 +/- 0.001Msolar and Rr = 0.096 +/- 0.001Rsolar, respectively. We find a distance to the system of 160 +/- 10pc. The secondary star in SDSS J1507 has a mass substantially below the hydrogen burning limit, making it the second confirmed substellar donor in a cataclysmic variable. The very short orbital period of SDSS J1507 is readily explained if the secondary star is nuclearly evolved, or if SDSS J1507 formed directly from a detached white dwarf/brown dwarf binary. Given the lack of any visible contribution from the secondary star, the very low secondary mass and the low HeI ?6678/Ha emission-line ratio, we argue that SDSS J1507 probably formed directly from a detached white dwarf/brown dwarf binary. If confirmed, SDSS J1507 will be the first such system identified. The implications for binary star evolution, the brown dwarf desert and the common envelope phase are discussed.

Clinical Utility of Microarray-Based Gene Expression Profiling in the Diagnosis and Subclassification of Leukemia: Report From the International Microarray Innovations in Leukemia Study Group

The Microarray Innovations in Leukemia study assessed the clinical utility of gene expression profiling as a single test to subtype leukemias into conventional categories of myeloid and lymphoid malignancies. METHODS: The investigation was performed in 11 laboratories across three continents and included 3,334 patients. An exploratory retrospective stage I study was designed for biomarker discovery and generated whole-genome expression profiles from 2,143 patients with leukemias and myelodysplastic syndromes. The gene expression profiling-based diagnostic accuracy was further validated in a prospective second study stage of an independent cohort of 1,191 patients. RESULTS: On the basis of 2,096 samples, the stage I study achieved 92.2% classification accuracy for all 18 distinct classes investigated (median specificity of 99.7%). In a second cohort of 1,152 prospectively collected patients, a classification scheme reached 95.6% median sensitivity and 99.8% median specificity for 14 standard subtypes of acute leukemia (eight acute lymphoblastic leukemia and six acute myeloid leukemia classes, n = 693). In 29 (57%) of 51 discrepant cases, the microarray results had outperformed routine diagnostic methods. CONCLUSION: Gene expression profiling is a robust technology for the diagnosis of hematologic malignancies with high accuracy. It may complement current diagnostic algorithms and could offer a reliable platform for patients who lack access to today's state-of-the-art diagnostic work-up. Our comprehensive gene expression data set will be submitted to the public domain to foster research focusing on the molecular understanding of leukemias

The addition of cetuximab to oxaliplatin-based first-line combination chemotherapy for advanced colorectal cancer: results of the MRC COIN trial.

Background: In the Medical Research Council (MRC) COIN trial, the epidermal growth factor receptor (EGFR)-targeted antibody cetuximab was added to standard chemotherapy in first-line treatment of advanced colorectal cancer with the aim of assessing effect on overall survival.
Methods: In this randomised controlled trial, patients who were fit for but had not received previous chemotherapy for advanced colorectal cancer were randomly assigned to oxaliplatin and fluoropyrimidine chemotherapy (arm A), the same combination plus cetuximab (arm B), or intermittent chemotherapy (arm C). The choice of fluoropyrimidine therapy (capecitabine or infused fluouroracil plus leucovorin) was decided before randomisation. 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 C is described in a companion paper. Here, we present the comparison of arm A and B, for which the primary outcome was overall survival in patients with KRAS wild-type tumours. Analysis was by intention to treat. Further analyses with respect to NRAS, BRAF, and EGFR status were done. The trial is registered, ISRCTN27286448.
Findings: 1630 patients were randomly assigned to treatment groups (815 to standard therapy and 815 to addition of cetuximab). Tumour samples from 1316 (81%) patients were used for somatic molecular analyses; 565 (43%) had KRAS mutations. In patients with KRAS wild-type tumours (arm A, n=367; arm B, n=362), overall survival did not differ between treatment groups (median survival 17·9 months [IQR 10·3—29·2] in the control group vs 17·0 months [9·4—30·1] in the cetuximab group; HR 1·04, 95% CI 0·87—1·23, p=0·67). Similarly, there was no effect on progression-free survival (8·6 months [IQR 5·0—12·5] in the control group vs 8·6 months [5·1—13·8] in the cetuximab group; HR 0·96, 0·82—1·12, p=0·60). Overall response rate increased from 57% (n=209) with chemotherapy alone to 64% (n=232) with addition of cetuximab (p=0·049). Grade 3 and higher skin and gastrointestinal toxic effects were increased with cetuximab (14 vs 114 and 67 vs 97 patients in the control group vs the cetuximab group with KRAS wild-type tumours, respectively). Overall survival differs by somatic mutation status irrespective of treatment received: BRAF mutant, 8·8 months (IQR 4·5—27·4); KRAS mutant, 14·4 months (8·5—24·0); all wild-type, 20·1 months (11·5—31·7).
Interpretation: This trial has not confirmed a benefit of addition of cetuximab to oxaliplatin-based chemotherapy in first-line treatment of patients with advanced colorectal cancer. Cetuximab increases response rate, with no evidence of benefit in progression-free or overall survival in KRAS wild-type patients or even in patients selected by additional mutational analysis of their tumours. The use of cetuximab in combination with oxaliplatin and capecitabine in first-line chemotherapy in patients with widespread metastases cannot be recommended.

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.

Prospective, Randomized Assessment of Transfer of Training (ToT) and Transfer Effectiveness Ratio (TER) of Virtual Reality Simulation Training for Laparoscopic Skill Acquisition

OBJECTIVES:: We assessed the effectiveness of ToT from VR laparoscopic simulation training in 2 studies. In a second study, we also assessed the TER. ToT is a detectable performance improvement between equivalent groups, and TER is the observed percentage performance differences between 2 matched groups carrying out the same task but with 1 group pretrained on VR simulation. Concordance between simulated and in-vivo procedure performance was also assessed. DESIGN:: Prospective, randomized, and blinded. PARTICIPANTS:: In Study 1, experienced laparoscopic surgeons (n = 195) and in Study 2 laparoscopic novices (n = 30) were randomized to either train on VR simulation before completing an equivalent real-world task or complete the real-world task only. RESULTS:: Experienced laparoscopic surgeons and novices who trained on the simulator performed significantly better than their controls, thus demonstrating ToT. Their performance showed a TER between 7% and 42% from the virtual to the real tasks. Simulation training impacted most on procedural error reduction in both studies (32- 42%). The correlation observed between the VR and real-world task performance was r > 0·96 (Study 2). CONCLUSIONS:: VR simulation training offers a powerful and effective platform for training safer skills.

Common variation near CDKN1A, POLD3 and SHROOM2 influences colorectal cancer risk.

We performed a meta-analysis of five genome-wide association studies to identify common variants influencing colorectal cancer (CRC) risk comprising 8,682 cases and 9,649 controls. Replication analysis was performed in case-control sets totaling 21,096 cases and 19,555 controls. We identified three new CRC risk loci at 6p21 (rs1321311, near CDKN1A; P = 1.14 × 10(-10)), 11q13.4 (rs3824999, intronic to POLD3; P = 3.65 × 10(-10)) and Xp22.2 (rs5934683, near SHROOM2; P = 7.30 × 10(-10)) This brings the number of independent loci associated with CRC risk to 20 and provides further insight into the genetic architecture of inherited susceptibility to CRC.