COP Group Research Articles

A new trend to reduce adverse events in patients undergoing transcatheter aortic valve implantation: cusp overlap technique: a cross sectional study.

Transcatheter aortic valve implantation (TAVI) is currently the treatment of choice for the majority of patients at moderate or high surgical risk. However, some complications occur frequently with this procedure. In this study, we aimed to assess whether the cusp-overlap view (COP) technique may be associated with a reduced incidence of some of these complications compared with the classical three-cusp view (TCV) technique. In this single-center, retrospective study we investigated; technical success, postprocedural permanent pacemaker implantation (PPMI), new-onset stroke, pericardial tamponade, arrhythmia development, acute renal failure, major bleeding, major vascular complications, procedure-related coronary obstruction, new-onset left bundle branch block (LBBB), paravalvular leak, peri-procedural myocardial infarction (MI), day of hospitalization, death, and major adverse cardiac and cerebrovascular events (MACCE) were determined as the clinical endpoints. A total of 281 consecutive patients who met the study criteria and underwent elective or emergency transfemoral TAVI using the self-expandable CoreValve Evolut valve were included. 176 consecutive patients implanted with the classical TCV technique and 105 consecutive patients implanted with the COP technique were compared. Compared with the TCV group, patients in the COP group had lower PPMI (3.8% vs. 10.8%, p = 0.039), in-hospital mortality (1.9% vs. 8.5%, p = 0.018), and 1-year death (4.8% versus 18.8%, p = 0.001), and MACCE rates (12.4% vs 31.3%, p < 0.001). The COP technique may help to reduce the conduction disturbances, PPMI requirement and complication rates that may develop following TAVI. In addition, it is an interesting result that it reduces mortality and MACCE rates in long-term follow-ups.

Microarchitecture of medication-related osteonecrosis of the jaw (MRONJ); a retrospective micro-CT and morphometric analysis

Medication-related osteonecrosis of the jaw (MRONJ) is a severe side effect of antiresorptive (AR) drugs such as bisphosphonates (BP) and denosumab (Dmab). Although several risk factors are described, the etiology of MRONJ is still not fully elucidated. Bone-strengthening is the primary aim of antiresorptive therapy; however, overly increased bone mass and microcrack accumulation are also discussed in MRONJ etiologies. The aim of this study is to evaluate the microarchitecture of jaw bones with micro−computed tomography (micro-CT) in AR-treated patients with or without MRONJ.Human jaw bone samples of AR-treated patients were separated into 11 groups by AR treatment bisphosphonate (BP), denosumab (Dmab), both (M) and control groups. Subgroups were divided according to the clinical localization as AR-exposed vital jaw bone (BPexp, Dmabexp, Mexp), osteonecrosis–margin of a sequestrum (BPOmar, DmabOmar, MOmar) and osteonecrosis–sequestrum (BPOseq, DmabOseq, MOseq). Healthy jaw bone (CHB) and osteoporotic jaw bone (COP) represent control groups. Samples underwent retrospective micro-CT and morphometric analysis in representative units by bone volume fraction (BV/TV), bone surface density (BS/BV), trabecular thickness (Tr.Th.), trabecular number (Tr.N.), trabecular space (Tr.Sp.), Euler characteristic for bone connectivity, bone mineral density (BMD) and tissue mineral density (TMD).A total of 141 samples from 78 patients were analyzed. BV/TV of Mexp group (mean: 0.46 ± 0.27) was significantly higher than in the COP group (mean: 0.14 ± 0.05; p = 0.0053). Tr.Th. differed significantly between the BPexp group (mean: 0.32 ± 0.15) and the Mexp group (mean: 0.57 ± 0.20; p = 0.0452) as well as between the BPOseq group (mean: 0.25 ± 0.10) and the MOseq group (mean: 0.39 ± 0.18; p = 0.0417). Signs of trabecular thickening and unorganized trabecular microarchitecture from AR-exposed- to sequestrum groups, were analyzed in 3D reconstructions. However, BS/BV, Tr.N., and Tr.Sp. showed no significant differences. Euler characteristic of the BPOseq group (median: 7.46) doubled compared to that of the BPexp group (median: 14.97; p = 0.0064). Mineralization parameters BMD and TMD were similar in all groups.Findings show evidence of enhanced bone mass and suspect microarchitecture in some AR-treated jaw bone compared to osteoporotic jaw bone. Despite increased bone mass, some MRONJ samples showed decreased trabecular connectivity by Euler characteristic compared to AR-treated jaw bone. These samples may indicate extensive ossification and ineffective bone mass with superficially higher bone mass without existing or even reduced mechanical stability, indicated by connectivity loss. This result might also suggest a high risk to microcrack accumulation. At some point, possibly some kind of over-ossification could lead to under-nourishment and microarchitectural weakness, creating instability, subsequently increasing vulnerability to MRONJ.

Management of Cervical Cancer in Pregnant Women: A Multi-Center Retrospective Study in China.

Background: This retrospective multi-center study aimed to describe the epidemiological characteristics, clinical features, and management of patients with cervical cancer in pregnancy (CCIP) and evaluate maternal and infant outcomes.Methods: The data of patients with CCIP were retrospectively collected from those diagnosed and treated in 17 hospitals in 12 provinces in China between January 2009 and November 2017. The information retrieved included patients' age, clinical features of the tumor, medical management (during pregnancy or postpartum), obstetrical indicators (i.e., gestational age at diagnosis, delivery mode, and birth weight), and maternal and neonatal outcomes. Survival analyses were performed using Kaplan–Meier survival curves and log-rank tests that estimated the overall survival of patients.Results: One-hundred and five women diagnosed with CCIP (median age = 35 years) were identified from ~45,600 cervical cancer patients (0.23%) and 525,000 pregnant women (0.020%). The median gestational age at cancer diagnosis was 20.0 weeks. The clinical-stage of 93.3% of the patients with CCIP was IB1, 81.9% visited the clinic because of vaginal bleeding during pregnancy, and 72.4% had not been screened for cervical cancer in more than 5 years. To analyze cancer treatments during pregnancy, patients were grouped into two groups, termination of pregnancy (TOP, n = 67) and continuation of pregnancy (COP, n = 38). Analyses suggested that the TOP group was more likely to be diagnosed at an earlier gestational stage than the COP group (14.8 vs. 30.8 weeks, p < 0.001). The unadjusted hazard ratio for the COP group's overall survival was 1.063 times that of the TOP group (95% confidence interval = 0.24, 4.71). There were no significant differences between the TOP and COP groups in maternal survival (p = 0.964). Thirty-three of the infants of patients with CCIP were healthy at the end of the follow-up period, with a median age of 18 ± 2.8 months.Conclusions: Most patients with CCIP had not been screened for cervical cancer in over 5 years. The oncologic outcomes of the TOP and COP groups were similar. A platinum-based neoadjuvant chemotherapy regimen could be a favorable choice for the management of CCIP during the second and third trimesters of pregnancy.

Differences in small airway lesions in patients with different types of idiopathic interstitial pneumonia

Objective: To investigate the differences in small airway lesions in patients with different types of idiopathic interstitial pneumonia (IIPs). Methods: A total of 46 patients with IIPs confirmed by video assisted thoracoscopic or open lung biopsy, hospitalized in the Respiratory and Critical Care Medicine of Beijing Chao-Yang Hospital, from Dec. 1998 through Nov. 2007 were studied, including 19 patients with idiopathic pulmonary fibrosis (IPF group), 14 with nonspecific interstitial pneumonia (NSIP group), and 13 cryptogenic organizing pneumonia (COP group). Pulmonary function and high resolution CT (HRCT) of the patients were examined before lung biopsy, and lung biopsy tissue were stained with hematoxylin-eosin. The abnormality of small airways in pathology, pulmonary function and HRCT were compared among these patients with IIPs. Results: Small airway inflammatory cell infiltration score (53.8±17.7) was significantly higher in the COP group than in the IPF group (38.8±9.7) (P<0.01). The fibrous tissue proliferation score in small airways (42.9±12.1) in the IPF group was significantly higher than that in the NSIP group (31.4±10.5) and the COP group (26.7±16.3) (both P<0.05). In the IPF group, NSIP group and COP group, the small airway function index was significantly reduced, and the maximum expiratory flow rate (V(25%), V(50%)) at 25% and 50% of the lung capacity was<80% predicted, the incidences of small airway dysfunction in the three groups were 63.2%, 69.2%, and 63.6%, respectively. There was no significant difference among the groups (P>0.05). Small airway inflammatory cell infiltration was negatively correlated with V(50%) of small airway function (r=-0.305, P=0.049). The bronchodilation rate in the HRCT of the IPF group (100%) was significantly higher than that of the NSIP group (50.0%) and the COP group (53.8%) (both P<0.01). Conclusion: The patients with IPF, NSIP and COP have abnormal pathologic, physiological and imaging changes of small airways, moreover have different characteristics.

Cessation of pacing in super-responders of cardiac resynchronization therapy: A randomized controlled trial.

The consequence of cessation of biventricular pacing in super-responders of cardiac resynchronization therapy (CRT) has not been fully investigated. In this prospective, single-blinded clinical trial, 21 super-responders were randomly assigned to the ceased pacing (CeP, 11 patients) group or the continued pacing (CoP, 10 patients) group. Patients randomized to the CeP group underwent cessation of biventricular pacing. New York Heart Association (NYHA) class, quality of life (QOL) assessed with Minnesota questionnaire, 6-minute walking distance (6MWD), left ventricular end systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), and left ventricular ejection fraction (LVEF) were compared between groups at 3- and 6-month follow-up. No significant difference was observed between the CeP and CoP groups regarding NYHA class, QOL, 6MWD, LVESV, LVEDV, or LVEF after 3 months (all P > 0.05). After 6 months, there existed no significant difference between the CeP and CoP groups with regard to NYHA class, QOL, 6MWD, LVESV, and LVEDV (all P > 0.05); however, LVEF was significantly lower in the CeP group than that of the CoP group (0.49 ± 0.10 vs 0.60 ± 0.11, P = 0.04), and LVEF was significantly reduced in the CeP group compared with the baseline value at randomization (0.49 ± 0.10 vs 0.54 ± 0.06, P = 0.04). LVEF was significantly reduced in super-responders of CRT 6 months after cessation of pacing. Super-responders to CRT should receive continued, long-term pacing to preserve recovered LV function.

Effect of copulation on estrus duration, LH response, and ovulation in Boer goats

The objectives of this investigation were to determine the effect of copulation on estrus duration, LH response and ovulation in Boer goats. A controlled randomized study, with two replicates, in which does were divided at each replicate in treatment (COP; n = 12) and control (CON; n = 12) groups was performed. All the does were pluriparous and estrus synchronized with CIDR (progesterone 300 mg) maintained in the vagina for seven days, and received 50 μg of GnRH at device insertion and 5 mg of natural prostaglandin F-2α im at CIDR removal. The COP group received two copulas within the first 4 h of estrus onset, and the CON group was only permitted to be mounted. Estrus was detected twice a day during the first 24 h after pessary removal and then every 4 h by using bucks with canvas apron as teasers, led by leash for 96 h. Blood was collected during all the estrus period after each estrus detection and analyzed for LH by radioimmunoassay (RIA). In addition, at the second replicate ovulation time and number of ovulations were also monitored by transrectal ultrasonography using a linear 7.5 MHz probe beginning 24 h after estrus onset and repeated every 4 h until all the preovulatory follicles disappeared. Estrus onset was 36.7 ± 10.5 h and 35.5 ± 13.6 h for CON and COP groups, respectively (P = 0.82). Estrus duration for the same groups was 40.3 ± 9.9 h and 28.3 ± 4.7 h, respectively (P = 0.001). The LH peak time for the CON group was 17.7 ± 6.3 h, and for the COP group, it was 10.9 ± 2.6 h (P = 0.004). The LH peak magnitude for the same groups was 31.5 ± 16.2 ng/mL and 34.9 ± 20.7 ng/mL, respectively (P = 0.34). The LH peak duration was not different between groups (CON: 7.3 ± 1.6 h versus COP: 7.2 ± 2.4 h; P = 0.94). The first ovulation time for CON and COP groups was 33.7 ± 3.9 h and 29.1 ± 3.2 h (P = 0.05), and the last ovulation time for the same groups was 37.7 ± 3.9 h and 32.6 ± 2.5 h, respectively (P = 0.02). The overall time from LH peak to ovulation was 18.6 ± 4.8 h without differences between groups (CON: 16.3 ± 5.6 h versus COP: 20.6 ± 3.3 h; P = 0.15). The number of ovulations for the CON group was 2.2 ± 0.4, and for COP group, it was 2.1 ± 0.4 (P = 0.96). It was concluded that copulation reduced estrus duration and hastened LH peak and ovulation in Boer goats.

Control and autonomy irony in communities of practice from a power-based perspective

PurposeThe extant literature provides evidence that control measures employed in communities of practice (CoPs) have undergone significant changes with the evolution of the concept. When it started as a self-organized group, its members had the freedom to pursue their own interests. Now, CoPs are moving closer toward bureaucratic form of control. The purpose of this paper is to discuss that although it might still be difficult to locate the power base in a CoP, undercurrents suggest that they have a strong affinity for managements’ interests.Design/methodology/approachThis approach taken in this paper is to present a historical background, contrast characteristics of present CoPs with its earlier versions and develop propositions highlighting a power-based perspective on leadership, sponsorship and objectives for CoPs within an existing organization.FindingsThe authors have found that power in a CoP has undergone tremendous changes from the time when it was introduced by Lave and Wenger (1991). When it started as a self-organized group, control exerted was null and void, as the members were given freedom to pursue their interests. The paper shows that CoPs can be formed intentionally, which is quite contrary to the common belief that they emerge naturally. Now, CoPs are moving closer toward bureaucratic form of control with the setting up of governance committees. This has serious repercussions for their autonomy, as envisaged by the early proponents of CoP, who believed that closely knit informal groups would enhance situational learning.Originality/valueThere is a general feeling that the word “autonomy” is a misnomer for CoP today. The power that once rested with the CoP group has been taken over by management in the form of sponsorship, goal congruency, etc. What appears as powerful in a CoP today is the sponsor and the CoP has ceased to exist as they used to be. This paper makes it clear that a CoP approach can provide value to the modern organization. However, if the issues discussed herein with regard to organizational power are not appropriately accounted for, CoP may fall short of expectations.

Studio clinico sull’efficacia del polishing nelle sedute di mantenimento

Objectives Scaling and polishing are commonly used to maintain periodontal health. The aim of this study was to evaluate the efficacy of different instruments for this purpose 3 months after treatment. Materials and methods The study included 49 participants. The following parameters were evaluated before (T0) and 3 months after (T3) treatment: clinical attachment level (CAL), percentage of sites with plaque (full-mouth plaque score, FMPS), and percentage of sites with bleeding (full-mouth bleeding score, FMBS). All subjects received instructions for maintaining good oral hygiene. In 9 subjects dental polishing was not done (controls, cc group). Twenty-five subjects were treated with dental polishing using a professional polishing cup ( cop) (n = 13) or a professional polishing brush ( spaz) (n = 12). Statistical analysis t-test and ANOVA. Results and conclusions At T3, the FMPS was decreased in all groups. The FMBS showed no change in the cc group, whereas mean reductions of 3.18 and 5.38 were observed in the cop and spaz groups, respectively. Analysis of the CAL showed losses in the cc (0.46) and spaz (0.19) groups and a gain of 0.57 in the cop group. Further studies are needed.

THA With Delta Ceramic on Ceramic: Results of a Multicenter Investigational Device Exemption Trial

Although the published studies on the outcomes of total hip arthroplasty (THA) performed with currently available ceramic components show high survivorship and low bearing wear at midterm followup, concern over ceramic fracture and squeaking persist. For these reasons, the use of ceramic is limited. Recently, a new alumina matrix composite material (Delta ceramic) with improved material properties was developed to address these concerns. We report the early outcomes and complications of a prospective, randomized, multicenter trial of 263 patients (264 hips) at eight centers, comparing a Delta ceramic-on-ceramic (COC) articulation with a Delta ceramic head-crosslinked polyethylene bearing combination (COP). There were 177 COC hips and 87 COP hips. Complications were reported for all patients, whereas clinical and radiographic results were provided for the 233 patients with minimum 2-year followup (average, 31.2 months; range, 21-49 months). The Harris hip scores and clinical, radiographic, and survivorship outcomes were similar in both groups. There were four (2%) revisions in the COC group and two (2%) in the COP group. We encountered three intraoperative ceramic liner-related events. In addition, one patient receiving the COC underwent revision for chipping of the ceramic liner, and a second had ceramic fragmentation on followup radiographs but has not undergone revision. These liner related complications remain a concern. No patient reported squeaking in either group; this leaves us hopeful the new material will lessen the frequency of squeaking. In the short term, the Delta COC articulation provided similar functional scores and survivorship and complication rates with the ceramic head mated with crosslinked polyethylene. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Use of communities of practice in business and health care sectors: A systematic review

BackgroundSince being identified as a concept for understanding knowledge sharing, management, and creation, communities of practice (CoPs) have become increasingly popular within the health sector. The CoP concept has been used in the business sector for over 20 years, but the use of CoPs in the health sector has been limited in comparison.ObjectivesFirst, we examined how CoPs were defined and used in these two sectors. Second, we evaluated the evidence of effectiveness on the health sector CoPs for improving the uptake of best practices and mentoring new practitioners.MethodsWe conducted a search of electronic databases in the business, health, and education sectors, and a hand search of key journals for primary studies on CoP groups. Our research synthesis for the first objective focused on three areas: the authors' interpretations of the CoP concept, the key characteristics of CoP groups, and the common elements of CoP groups. To examine the evidence on the effectiveness of CoPs in the health sector, we identified articles that evaluated CoPs for improving health professional performance, health care organizational performance, professional mentoring, and/or patient outcome; and used experimental, quasi-experimental, or observational designs.ResultsThe structure of CoP groups varied greatly, ranging from voluntary informal networks to work-supported formal education sessions, and from apprentice training to multidisciplinary, multi-site project teams. Four characteristics were identified from CoP groups: social interaction among members, knowledge sharing, knowledge creation, and identity building; however, these were not consistently present in all CoPs. There was also a lack of clarity in the responsibilities of CoP facilitators and how power dynamics should be handled within a CoP group. We did not find any paper in the health sector that met the eligibility criteria for the quantitative analysis, and so the effectiveness of CoP in this sector remained unclear.ConclusionThere is no dominant trend in how the CoP concept is operationalized in the business and health sectors; hence, it is challenging to define the parameters of CoP groups. This may be one of the reasons for the lack of studies on the effectiveness of CoPs in the health sector. In order to improve the usefulness of the CoP concept in the development of groups and teams, further research will be needed to clarify the extent to which the four characteristics of CoPs are present in the mature and emergent groups, the expectations of facilitators and other participants, and the power relationship within CoPs.

Comparison of Two Regimens for the Treatment of Meningoencephalomyelitis of Unknown Etiology

The optimal treatment for meningoencephalomyelitis of unknown etiology (MUE) remains unknown, despite the widespread use of a variety of immunosuppressive drugs. To compare the efficacy of prednisolone combined with either vincristine and cyclophosphamide (COP group; n= 10) or with cytosine arabinoside (AraC group; n= 9). Nineteen dogs with neurological deficits, neuroimaging, and cerebrospinal fluid abnormalities consistent with a diagnosis of MUE. Prospective, blinded, and randomized clinical trial. Dogs fulfilling the inclusion criteria were randomly allocated to receive 1 drug regimen. Four of 10 dogs in the COP group and 5/9 in the AraC group survived > 12 months but neither the survival time nor the time-to-treatment failure differed between the 2 groups. Treatment with COP resulted in an unacceptable incidence of adverse effects. The adverse effects of COP make it an unsuitable treatment for MUE. Although survival of animals treated with AraC was broadly similar to that reported in recently published studies describing this treatment, it remains unclear whether it confers any benefit over using prednisolone alone.

Assessment of head wear more than ten years after total hip arthroplasty: 22-mm zirconia vs. metal heads.

The present retrospective study assessed radiographs to determine socket wear in total hip arthroplasty (THA) with 22-mm zirconia or COP (Cobalt-Chrome alloy rich in Cobalt and Phosphorous) heads, and in cemented stems at more than 10 years after operation. Sockets of ultra high molecular weight polyethylene were used in each of two THA groups (13 hips each) in a clinical trial in our hospital between 1989 and 1990. Three observers carried out masked assessments of the radiographs. Upon final examination, there was no remarkable loosening in the zirconia or COP group, and no case had required revision surgery as of 2005. There was a statistically significant difference between the 2 groups in average annual linear wear, at 0.093 mm/year and 0.046 mm/year in the zirconia and COP groups, respectively. Volume wear and average annual volume wear were also significantly greater in the zirconia group despite its superior mechanical strength and toughness in vitro. Our present findings do not confirm early expectations of lower wear in long-term results of 22-mm zirconia femoral heads used in THA.

Treatment of thyroid-associated ophthalmopathy: comparative study between prednisone and COP therapy

To evaluate the efficacy of two therapies, high-dose prednisone and COP in the treatment of patients with active thyroid-associated ophthalmopathy (TAO). According to severity and compliance, the patients admitted in Peking Union Medical College Hospital from August 2000 to July 2003 were divided into two groups. Thirteen patients with active TAO were treated with high-dose prednisone. The initial dosage was 1.5-2.0 mg.kg(-1).d(-1) (maximal dosage 200 mg), tapering gradually, and shifting to alternate-day treatment. Fourteen patients in the COP group were treated with cyclophosphamide (CTX), oncovin (VCR) and prednisone. This therapy was modified from CHOP in the treatment of patients with non-Hodgkin's lymphoma: CTX 600 mg/m(2), VCR 1.1 mg/m(2) were administrated by intravenous infusion every 2-4 weeks, prednisone was given orally at 1 mg.kg(-1).d(-1) for seven days after each infusion. The duration of treatment for both groups was approximately 10 months. The parameters including clinical activity score (CAS), thickness of extra-ocular muscle as well as 24 h urinary GAG were used to evaluate the efficacy of treatment in both groups. There was no significant difference in age and sex between two groups. However the patients in the COP group were more severe than that in prednisone group (P < 0.05). CAS in the patients treated with prednisone before and after treatment were 4.4 +/- 1.8, 1.6 +/- 1.1 respectively, that in patients treated with COP were 6.5 +/- 1.6, 1.9 +/- 1.3 respectively. All these changes were highly significant (P < 0.01). The thickness of extra-ocular muscles in the patients treated with prednisone decreased from (6.5 +/- 1.5) mm to (5.8 +/- 1.1) mm, that in patients treated with COP decreased from (6.8 +/- 1.7) mm to (5.3 +/- 1.1) mm. Both changes were highly significant (P < 0.01). Comparative study of the changes in the thickness of extra-ocular muscle by percentage between two groups demonstrated that the muscle thickness in patients treated with COP was decreased by (23.7 +/- 4.3)%, that in patients treated with prednisone was by (13.3 +/- 4.6)%. The difference between the two groups was highly significant (P < 0.01). The 24 h urinary GAG level in patients treated by prednisone decreased from (33.6 +/- 6.6) mg/24 h before treatment to (16.7 +/- 2.5) mg/24 h after treatment. Those in COP group were (40.6 +/- 10.1) mg/24 h and (15.7 +/- 5.1) mg/24 h respectively. The difference was significant (P < 0.01) in each group. There were no serious complications during treatment. Both the prednisone and COP therapy are effective in the treatment of patients with active TAO. The preliminary results indicate that COP is more effective than prednisone, it suggests that COP might be feasible for treating patients with progressive and severe TAO.

Rapid Determination of Substrate Specificity of Clostridium histolyticum β-Collagenase Using an Immobilized Peptide Library

The molecular basis of the substrate specificity of Clostridium histolyticum beta-collagenase was investigated using a combinatorial method. An immobilized positional peptide library, which contains 24,000 sequences, was constructed with a 7-hydroxycoumarin-4-propanoyl (Cop) fluorescent group attached at the N terminus of each sequence. This immobilized peptide library was incubated with C. histolyticum beta-collagenase, releasing fluorogenic fragments in the solution phase. The relative substrate specificity (k(cat)/K(m)) for each member of the library was determined by measuring fluorescence intensity in the solution phase. Edman sequencing was used to assign structure to subsites of active substrate mixtures. Collectively, the substrate preference for subsites (P(3)-P(4)') of C. histolyticum beta-collagenase was determined. The last position on the C-terminal side in which the identity of the amino acids affects the activity of the enzyme is P(4)', and an aromatic side chain is preferred in this position. The optimal P(1)'-P(3)' extended substrate sequence is P(1)'-Gly/Ala, P(2)'-Pro/Xaa, and P(3)'-Lys/Arg/Pro/Thr/Ser. The Cop group in either the P(2) or P(3) position is required for a high substrate activity with C. histolyticum beta-collagenase. S(2) and S(3) sites of the protease play a dominant role in fixing the substrate specificity. The immobilized peptide library proved to be a powerful approach for assessing the substrate specificity of C. histolyticum beta-collagenase, so it may be applied to the study of other proteases of interest.

A randomized clinical trial of chlorambucil versus COP in stage B chronic lymphocytic leukemia. The French Cooperative Group on Chronic Lymphocytic Leukemia

In 1980, the French Cooperative Group on Chronic Lymphocytic Leukemia started a randomized clinical trial in which intermediate prognosis patients (stage B) received either an indefinite course of chlorambucil (0.1 mg/kg/d) or 12 cycles of the COP regimen (vincristine, cyclophosphamide, and prednisone). We present the results of the third interim analysis based on 291 patients (151 in the chlorambucil group and 140 in the COP group) with a mean follow-up of 53 months at the reference date of June 1, 1987. At this date, 129 deaths were observed, 65 in the chlorambucil group and 64 in the COP group; there was no improvement in overall survival with the COP regimen (P = .44) even after adjusting for both prognostic and imbalanced factors (P = .24). The 3-year and 5-year overall survival rates were, respectively, 69% and 44% in the chlorambucil group as compared with 73% and 43% in the COP group. The median survival times were 58 months in the chlorambucil group and 57 months in the COP group. Moreover, no significant difference was observed between the two treatment groups in terms of either treatment response, 9-month status, time to disease progression to stage C, or causes of death.

A Randomized Clinical Trial of Chlorambucil Versus COP in Stage B Chronic Lymphocytic Leukemia

In 1980, the French Cooperative Group on Chronic Lymphocytic Leukemia started a randomized clinical trial in which intermediate prognosis patients (stage B) received either an indefinite course of chlorambucil (0.1 mg/kg/d) or 12 cycles of the COP regimen (vincristine, cyclophosphamide, and prednisone). We present the results of the third interim analysis based on 291 patients (151 in the chlorambucil group and 140 in the COP group) with a mean follow-up of 53 months at the reference date of June 1, 1987. At this date, 129 deaths were observed, 65 in the chlorambucil group and 64 in the COP group; there was no improvement in overall survival with the COP regimen (P = .44) even after adjusting for both prognostic and imbalanced factors (P = .24). The 3-year and 5-year overall survival rates were, respectively, 69% and 44% in the chlorambucil group as compared with 73% and 43% in the COP group. The median survival times were 58 months in the chlorambucil group and 57 months in the COP group. Moreover, no significant difference was observed between the two treatment groups in terms of either treatment response, 9-month status, time to disease progression to stage C, or causes of death.

Vibrational Spectra of Organophosphorus Compounds. IV. Infrared and Raman Spectra of CH3OPCl2 and CD3OPCl2

The infrared spectra of gaseous and liquid CH3OPCl2 and CD3OPCl2 have been recorded from 4000 to 33 cm− 1. The Raman spectra of the liquids have been recorded and depolarization values measured. No indication of a second conformer could be found in either the low-temperature Raman or infrared spectra. The interesting “methyl” torsion was observed at 127 cm− 1 for the hydrogen compound and 119 cm− 1 for the deuterium-containing molecule. Considerable mixing among the low-frequency skeletal modes and the torsional vibration was apparent. Assignment of the other fundamentals based on position, depolarization values, and isotopic shifts is given and discussed. It is shown that the band in the region of 1190-1170 cm− 1 which is characteristic of the CH3OP moiety results from a rocking motion of the methyl group rather than to a stretching motion of the COP group to which it is frequently assigned. The vibrations resulting from the COP group are better characterized as COP symmetric and COP antisymmetric stretching modes rather than C–O and P–O motions.