Discussion Brefeldin A Platelet activating factor plays an important role in the initiation and/or maintenance of mucosal inflammation and intestinal injury [10]. Although PAF has been implicated in numerous diseases involving mucosal inflammation, such as asthma [35], [36], peptic ulcer[37], Crohn’s disease [38], and ulcerative colitis [39], its pathogenic role is best established in neonatal necrotizing enterocolitis (NEC). We have shown that PAFR inhibition reduced the risk of NEC in a neonatal animal model using clinical risk factors for NEC (bacterial colonization, intestinal ischemia, and formula feeding) [5]. We have also shown that giving the PAF-degrading enzyme PAF-acetylhydrolase (PAF-AH) with enteral feedings prevents the initiation of experimental NEC in this rat model [7].

The intestine, particularly the distal small bowel, is at increased risk for PAF-induced inflammatory injury, since PAF-receptor gene is constitutively expressed at the highest level in the ileum compared to other organs [40]. Our previous studies have shown that the development of NEC in a rodent model is preceded and underlined by exaggerated enterocyte apoptosis [41] and that PAF is a potent inducer of enterocyte apoptosis in tissue culture [42]. However, while the role of PAF has been established in this NEC neonatal rat model, the mechanisms by which PAF contributes to NEC are not completely understood. TLRs are important in the protection of the host. They initiate the innate immune response modulate the adaptive immune response to bacteria and viruses.

TLRs recognize PAMPs that may derive either from bacteria, viruses or fungi and initiate signaling that results in expression and release of inflammatory cytokines. We and Cilengitide others [20], [22], [34], [43], [44] have shown that IEC of the mature, healthy small and large intestine express low levels of TLR4 and MD-2 and respond poorly to LPS, but TLR4 and MD-2 are abnormally upregulated in inflammatory bowel disease [34]. The very low level of expression of and subdued signaling via TLRs may represent an adaptation of IEC to prevent collateral tissue damage from an unnecessary inflammatory response to commensal organisms. Ongoing signaling between commensals and TLRs has an important beneficial effect on the maintenance of normal barriers in the intestine and enhances protection and repair from injury [45]. We have also demonstrated in an animal model of acute colitis using dextran sulfate sodium that TLR4, through the adapter protein MyD88, is important in the intestinal response to epithelial injury and limiting bacterial translocation [46]. We know that TLRs are expressed on fetal enterocytes [47].


This most result indicated that 11a does not have obvious agonistic effects towards PNR. Because PNR was the least activated among the four nuclear receptors tested at the indicated range of 11a concentrations (Figure 1C), our results indicate that the specificity of 11a towards PNR is low and the agonism of 11a is probably not a direct effect, as shown in the NCOR release study where 11a also inhibited TR��-NCOR and RAR��-NCOR interactions [32]. Figure 1 The effect of 11a on PNR, TLX, COUP-TFI and COUP-TFII activation of the DR2-luciferase reporter. Because 11a activated PNR-related nuclear receptors COUP-TFI and COUP-TFII in the DR2 luciferase assay at the relatively low concentration of 30 nM (Figure 1) and only COUP-TFII could be detected in all breast cancer cell lines [40], we examined whether 11a could alter the expression of COUP-TFII downstream target genes in MCF7 and T47D, two ER�� positive breast cancer cell lines.

COUP-TFII has been implicated in various cancers for both oncogenic and tumor suppressive effects [41]. In breast cancer cells, RARB2 [42,43] and NGFI-A [44,45] are two well-characterized direct targets up-regulated by COUP-TFII. All-trans retinoic acid (atRA) was previously shown to increase COUP-TFII mRNA level as well as enhancing COUP-TFII downstream target gene expression [46]. Indeed, 1 ��M atRA was found to increase COUP-TFII mRNA level by about 1.5- and 2.5-fold in MCF7 and T47D cells, respectively (Figure S3). Interestingly, although 11a did not increase COUP-TFII mRNA levels in the two cell lines, 11a treatment resulted in up-regulation of COUP-TFII target genes.

In the MCF7 cell line, 0.1 ��M 11a induced NGFI-A gene expression to a similar level as 1 ��M atRA. 1 ��M 11a induced NGFI-A expression ~5 fold over that of 1 ��M atRA (Figure S3A). Because NGFI-A expression is too low to be detected in T47D cells, we measured another COUP-TFII target gene, RARB2. In T47D cells, atRA robustly increased RARB2 mRNA level by 30-fold. Although 11a also increased RARB2 expression in a dose-dependent manner, the magnitude of activation was not comparable to atRA (Figure S3B). These results indicated that 11a possibly regulates COUP-TFII activity in a gene- and cell-specific manner. Since 11a induced cell death in HEK293T cells at higher concentrations and PNR was shown to induce apoptosis in several cell types [28], we further investigated whether 11a-induced cytotoxicity was PNR-mediated.

Because PNR is undetectable by western blotting in breast cancer cell lines, several stable PNR overexpression breast cancer cell lines, MCF7, MDA-MB-231, LM2 [34] and MDA-MB-468 cells, were generated (Figure 2A). MTT cell proliferation assays were then used to determine the IC50 values for 11a in GFP-expressing control cell lines and PNR-overexpressing cell Anacetrapib lines.

Neither of these genes appeared to respond to infection or to be

Neither of these genes appeared to respond to infection or to be differentially expressed, although Ptp4a1 selleck compound was highly expressed throughout the infection (not shown). Other Epo responsive genes did appear to respond to infection: Eif1a (Eukaryotic translation initiation factor) and Kif3a (kinesin family member 3A) were up regulated in all three mouse strains at day 7 and 9 respectively (Fig 6). However, since these genes participate in multiple signal transduction pathways, their up-regulation may be related to inflammation rather than erythropoiesis [32]. Figure 6 EPO responsive genes. Erythropoietin primarily acts through the erythropoietin receptor (Epor) that is exclusively expressed on cells from the erythroid lineage. So the level of expression of Epor may be related to the number of erythroid cells in the tissues.

In uninfected mice, Epor transcription was highest in A/J mice. After infection C57BL/6 mice tended to have lower levels of expression than either A/J or BALB/c mice although this was only significant if the expression levels were compared over the whole time course (p=0.00003 with respect to BALB/c mice and p=0.043 with respect to A/J mice). This was consistent with lower erythropoiesis and haemoglobin titre in C57BL/6 mice. However, given the small difference in expression and the lack of evidence for changes in Epo response genes this may not be an important mechanism driving anaemia after T. congolense infection. Interferon gamma (Ifng) down regulates Kit ligand (Kitl) and Epor and may be an important contributor to anaemia of infection [33].

Kit (CD117) is a receptor for Kitl (SCF or Stem Cell Factor), which acts synergistically with Epo in the promotion of erythropoeisis [33]. Ifng expression Carfilzomib increased approximately 8-fold after infection in all mouse strains and then declined fastest in BALB/c and remained highest in C57BL/6 consistent with the observed haemoglobin titres (Fig 7). Consistent with the inhibitory activity of IFN-��, the expression of Kit and Epor all declined somewhat at day 7 pi and C57BL/6 had the lowest levels of expression after day three (Fig 7). Higher levels of Kitl may be indicative of higher levels of erythropoiesis. In the spleen Kitl expression was highest in A/J and lowest in C57BL/6 from day 3 to 9 (Fig 7). Figure 7 Genes that mediate haematopoiesis. Insulin like growth factor (Igf1) appears to be more important than Epo for regulation of erythropoiesis in some anaemic patients [34], [35], [36]. Expression of Igf1 declined in C57BL/6 mice till day 7 pi, while it increased in A/J mice and was more than twice as high as in C57BL/6 on day 7 (Fig 7). However, differences at other days were small and no correlations with anaemia could be made.

However, the pattern of cigarette smoking over the course of preg

However, the pattern of cigarette smoking over the course of pregnancy in these women, including those treated with opioid agonists, has not been fully examined. Given that pregnancy is a time of high motivation to change for many women, it is possible that those opioid-dependent pregnant patients Y-27632 solubility who smoke may be a group particularly interested and willing to stop smoking. There are two main medications used to treat opioid dependence: methadone and buprenorphine. Studies of various nonpregnant agonist-treated samples suggest that both methadone and buprenorphine can interact with nicotine. Work conducted over 25 years ago suggests that opioid use, including heroin, methadone, and buprenorphine, is associated with increased smoking (Chait, & Griffiths, 1984; Mello, Lukas, & Mendelson, 1985; Mello, Mendelson, Sellers, & Kuehnle, 1980).

More recent research has demonstrated that concurrent nicotine use enhances methadone��s effect on opioid-withdrawal scores in methadone-maintained patients (Elkader, Brands, Selby, & Sproule, 2009), and buprenorphine increases the number of cigarettes smoked per day (CPD) (Mutschler, Stephen, Teoh, Mendelson, & Mello, 2002). Findings of interactions between nicotine and methadone, and nicotine and buprenorphine, suggest that there may be important clinical implications to substance use and its treatment in persons with opioid dependence who smoke cigarettes. However, direct comparisons of smoking among individuals on methadone and buprenorphine have received little attention. One recent study (Pajusco et al.

, 2012) compared smoking behavior in patients treated with methadone versus buprenorphine and confirmed high rates of smoking and cigarette use patterns among the two groups with no apparent difference between medications. To the authors�� knowledge, no other studies have directly compared cigarette smoking behavior associated with buprenorphine and methadone medication treatment, in either general or pregnant opioid-dependent populations. Given that buprenorphine is increasingly prescribed during pregnancy (Jones et al., 2010; Lacroix et al., 2011) and that the potential public health risks associated with even a small increase in cigarette smoking during pregnancy are great, there is a need to probe for any differences in cigarette smoking behavior among opioid-dependent pregnant patients treated with buprenorphine and methadone.

Because there are signals that suggest methadone and buprenorphine each can interact with smoking and because pregnancy represents a prime opportunity to study the time course of smoking cessation (given women��s motivation to stop), these analyses were conducted to see if there were differential effects Dacomitinib by opioid treatment agent��either in overall cessation rates of smoking or in the time course of changes in smoking. The Maternal Opioid Treatment: Human Experimental Research (MOTHER) study (Jones et al.

, 2000) Despite the success of these initiatives, national monit

, 2000). Despite the success of these initiatives, national monitoring surveys have shown that decreases in smoking prevalence have slowed in recent years (Nelson et al., 2008). It is estimated that 21% of adults in the United States currently smoke and that of current smokers, 78% smoke Brefeldin A ATPase daily (CDC, 2010b). As the primary contributor to the establishment and maintenance of chronic smoking (Berrettini & Lerman, 2005; Hu, Davies, & Kandel, 2006), nicotine dependence has been characterized by both physiological adaptations (e.g., tolerance and withdrawal) and other accommodating behaviors (e.g., time spent in activities necessary to obtain/use nicotine and recover from its effects and the forfeiting or reduction of important social, occupational, or recreational activities).

Although traditional descriptions of the development of nicotine dependence have suggested the need for both heavy and long-term smoking, an emerging body of research based on separate cohorts of novice adolescent smokers has demonstrated that symptoms of nicotine dependence can occur soon after smoking initiation (DiFranza, Savageau, Rigotti, et al., 2002; Gervais, O��Loughlin, Meshefedjian, Bancej, & Tremblay, 2006; Kandel, Hu, Griesler, & Schaffran, 2007), at relatively low levels of smoking exposure (Caraballo, Novak, & Asman, 2009; Gervais et al., 2006; Scragg, Wellman, Laugesen, & DiFranza, 2008) and before the establishment of daily smoking habits (DiFranza et al., 2007; Gervais et al., 2006).

For example, in a cohort of seventh graders sampled from Montreal secondary schools, 30% and 20% developed mental and physical symptoms of dependence, respectively, within 3 months of reporting their first puff (Gervais et al., 2006). Similarly, based on a cohort of 6th to 10th graders drawn from Chicago public schools, 25% of new adolescent smokers were found to experience Batimastat symptoms of dependence within 5 months of smoking onset (Kandel et al., 2007). Furthermore, in the Montreal study, it took much less time to develop symptoms of nicotine dependence (e.g., mental addiction, physical addition, cravings, withdrawal symptoms, and tolerance) compared with reaching lifetime consumption of 100 cigarettes and daily smoking (Gervais et al., 2006), indicating that symptoms of nicotine dependence in adolescents can occur before the emergence of established smoking patterns.

We believe these findings warrant larger, adequately powered (and

We believe these findings warrant larger, adequately powered (and controlled) clinical trials within older adolescent smokers. Interpretation of findings should be tempered by study limitations, most notably the lack of power within the small sample to comprehensively assess safety, tolerability, and efficacy of these medications. While the double-blind sellectchem nature of the randomized treatment was a methodological strength, inclusion of a placebo treatment group would have allowed for additional comparisons. Another concern is poor participant retention, a pervasive challenge in adolescent smoking cessation studies that undermines the ability to detect effects over time. For this reason, we caution readers not to over-interpret abstinence outcomes (Table 2), which are provided for descriptive purposes only.

To address attrition, future studies should incorporate innovative techniques, such as retention-targeted contingency management (Carroll et al., 2006; Festinger, Marlowe, Dugosh, Croft, & Arabia, 2008; Ledgerwood, Alessi, Hanson, Godley, & Petry, 2008; Sinha, Easton, Renee-Aubin, & Caroll, 2003), and should be conservatively powered in anticipation of elevated dropout rates compared with adult studies. Despite these limitations, findings provide a novel addition to the nascent older adolescent smoking cessation pharmacotherapy literature. Varenicline and bupropion XL, never before investigated as cessation treatments in young smokers, appear to be viable candidates for further study based on the present results.

Future studies to comprehensively evaluate their safety, tolerability, and efficacy in older adolescents should incorporate a fully powered sample, a longer course of treatment (12 weeks), and posttreatment follow-up over several months to allow for more direct comparison with the well-established adult smoking cessation pharmacotherapy literature. One would expect, based on findings to date, lower absolute rates of abstinence among older adolescents versus adults, but it is unclear how effect sizes (odds ratios) would compare between these two age groups. What is clear is that, given the prevalence and significant public health impact of older adolescent smoking, as well as the limits of the current cessation evidence base, further studies of Dacomitinib pharmacotherapy for older adolescent smoking cessation will be critical contributions to the field. Funding Medical University of South Carolina Hollings Cancer Center Pilot Research Program and the National Institutes of Health (K12DA000357, K23DA020482, R25DA020537, and UL1RR029882). Declaration of Interests Dr. Upadhyaya is an employee and stockholder of Eli Lilly and Company. The other authors do not have potential conflicts to declare.

Cases (n = 50) were matched with two randomly selected controls (

Cases (n = 50) were matched with two randomly selected controls (n = 100). Conditional logistic regression models were used to investigate the associations between pre-diagnostic levels of hs-CRP, adiponectin, leptin, soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intercellular sellectchem adhesion molecule-1, E-selectin, monocyte chemoattractant protein-1 and colorectal cancer risk. Area under the receiver operating curves (AUC) and relative integrated discrimination improvement (RIDI) statistics were used to assess the discriminatory potential of the models. RESULTS: Plasma adiponectin level was associated with decreased colorectal cancer risk (P for linear trend = 0.03). Quartiles of sVCAM-1 were associated with increased colorectal cancer risk (P for linear trend = 0.02).

No association was observed with any of the other biomarkers. Compared to standard models with known risk factors, those including both adiponectin and sVCAM-1 had substantially improved performance for colorectal cancer risk prediction (P for AUC improvement = 0.01, RIDI = 26.5%). CONCLUSION: These results suggest that pre-diagnostic plasma adiponectin and sVCAM-1 levels are associated with decreased and increased colorectal cancer risk, respectively. These relationships must be confirmed in large validation studies. Keywords: Colorectal cancer, Adiponectin, Soluble vascular cell adhesion molecule-1, Nested case-control study, Prospective study INTRODUCTION Colorectal cancer is the third most frequently diagnosed cancer worldwide, accounting for more than one million cases and 600 000 deaths every year[1].

The identification of pre-diagnostic biomarkers associated with subsequent colorectal cancer risk is a key challenge. Markers of adiposity, endothelial adhesion, and inflammation may be suitable candidates[2-5]. Adipose tissue is an endocrine organ that produces adipokines and plays a critical role in the regulation of inflammatory processes[6]. Leptin reflects body fat storage and acts as a pro-inflammatory adipokine. Conversely, adiponectin production is decreased in obesity and generally has anti-inflammatory properties. Adhesion molecules such as E-selectin, intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and the chemokine monocyte chemoattractant protein-1 (MCP-1) are important in cell-cell and cell-basement membrane interactions.

They are also intimately involved in inflammatory reactions[7]. C-reactive protein (CRP) is a widely used systemic biomarker for diagnosing acute and chronic inflammation[8]. Previous cross-sectional studies suggest the potential involvement of these biomarkers in colorectal carcinogenesis, with higher blood levels of CRP[9], leptin[10], soluble adhesion AV-951 molecules[11,12], and lower levels of adiponectin[10,13] observed in patients with colorectal cancer compared to controls.

Here we report the use of structural data from the pre-fusion den

Here we report the use of structural data from the pre-fusion dengue virus-2 (DENV-2) E protein as a model for a computational approach to the design of new peptide inhibitors of DENV-2 entry. This approach makes use of a residue-specific all-atom probability discriminatory function (RAPDF) score to identify in situ amino acid sequences that are likely to have high structural or and binding stability [23], [24]. Out of seven computationally designed peptides that were synthesized and tested, two were identified as possessing fifty percent in vitro inhibitory activity (IC50) below 10 ��M and another with IC50 activity below 40 ��M. Two of the inhibitors (DN57opt and DN81opt) are binding optimized variants of peptides originally designed from DENV inhibitory peptide sequences located in domain II near the domain I/domain II hinge region [9].

The other (1OAN1) is an entirely novel peptide designed from an extended beta sheet region comprising the first connection between domains I and II. We show that the two peptides with the highest inhibitory activity interfere with virus:cell binding, cause structural changes to the surface of DENV-2 virions, and bind specifically to purified DENV-2 E protein. The causative agent of dengue fever, dengue hemorrhagic fever and dengue shock syndrome, DENV has emerged in the past several decades as the most important mosquito borne viral disease with an estimated 2.5 billion people living in areas at risk for epidemic transmission and 50�C100 million people infected annually [25], [26].

Complicating this situation, the four distinct serotypes of DENV generate only low level immunological cross protection, allowing for repeated epidemic outbreaks in the same populations [27], [28]. The phenomenon of antibody dependent enhancement has been shown to result in more severe disease in individuals who have been previously infected with a different serotype [29]�C[33]. With no specific treatment or prevention available other than vector control, DENV is an important target for the development of antivirals and vaccines. The results presented here indicate that the DENV E glycoprotein has multiple accessible surfaces that can be targeted by distinct inhibitors and is an amenable target for rational inhibitor design.

Materials and Methods Computational optimization of hinge region inhibitory peptides Peptide inhibitors were designed to have improved in situ binding compared to naturally occurring sequences using the residue-specific all-atom probability discriminatory function (RAPDF) [24]. The x-ray diffraction structure of DENV-2 envelope protein (Protein Data Bank identifier 1OAN) was used as a template for creating mutant structures from which the peptides were derived [14]. For each peptide, we randomly selected a residue Drug_discovery side chain and substituted it with a new side chain.

A Bonferroni correction for multiple comparisons was performed T

A Bonferroni correction for multiple comparisons was performed. To maintain an overall type I error rate of 0.05, each test selleck chem Pacritinib of association with complete pathologic response was considered significant if P<0.005. All variables significant in univariate analysis were entered into a multiple logistic regression model. Statistical interactions between significant variables were tested. All analyses were carried out with SAS V9 (The SAS Institute, Cary, NC, USA). RESULTS Clinicopathological features Patient characteristics are summarised in Table 1. Thirty-three (31.7%) patients had a complete pathologic tumour response to preoperative HDREB. Seventy-one (68.3%) were found to have residual carcinoma, including 35 patients (34.3%) who were considered as partial responders due to the presence of microfoci of residual carcinoma.

Ninety-six (94.1%) patients were preoperatively staged as cT3. pT stage was available for 80 patients, of which 31 (38.8%) were pT0, 12 (15.0%) were downstaged to pT1, 17 (21.3%) were pT2 and 20 cases (25.0%) were pT3. Table 1 Clinicopathological characteristics of rectal cancer patients treated with high-dose-rate brachytherapy Selection of cut-off scores based on ROC curve analysis Cut-off scores were determined to be 50% for p53, 20% for VEGF, Bcl-2 and EGFR and 10% for APAF-1. Tumours with scores above the obtained cut-off values were considered positive for the expression of the protein. The corresponding AUCs (95% CI) are listed in Table 2. AUCs were the largest for EGFR (0.66 (0.54�C0.78)) and VEGF (0.64 (0.51�C0.

77) indicating that the discriminatory power for complete response was the greatest for these two markers. Table 2 ROC curve-derived cut-off scores, area under the curve (AUC) and association of protein expression with complete pathologic response Univariate analysis The association of protein expression with complete pathologic response (Table 2) demonstrated that negative VEGF expression (P-value=0.004, OR (95% CI)=0.23 (0.09�C0.63)) and EGFR positivity (P-value=0.003, OR (95% CI)=5.78 (1.85�C18.07)) were significantly associated with complete tumour response after correction for multiple comparisons while p53, APAF-1 and Bcl-2 demonstrated no predictive ability for the outcome. Loss of VEGF expression was associated with more than a 4.3 times greater chance of complete tumour response compared with VEGF-positive tumours, while EGFR positivity resulted in a 5.

78 times increased odds of complete tumour regression. Representative immunostains of VEGF and EGFR are illustrated in Figure 1. Figure 1 Representative immunostains of VEGF (A) and EGFR (B) from pretreatment rectal tumour biopsies. Multivariable analysis VEGF and Cilengitide EGFR were entered into multivariable analysis. Eighty-eight tumours could be evaluated, of which 27 (31%) had a complete pathologic response. Loss of VEGF (P-value=0.009; OR (95% CI)=0.24 (0.08�C0.69)) and positive EGFR (P-value=0.

R interpreted the results of the experiments; L E N , R J V , an

R. interpreted the results of the experiments; L.E.N., R.J.V., and M.-S.G. prepared the figures; L.E.N. drafted the manuscript; L.E.N., R.J.V., J.M.C., M.-S.G., Y.I., and N.B.R. approved the final http://www.selleckchem.com/products/BI6727-Volasertib.html version of the manuscript; R.J.V., J.M.C., M.-S.G., Y.I., and N.B.R. edited and revised the manuscript. ACKNOWLEDGMENTS We thank Pere Puigserver for experimental suggestions and for reviewing the manuscript. Present address of M.-S. Gauthier: Montreal Diabetes Research Center, University of Montreal, Montreal, QC, Canada H1W 4A4. Footnotes 1This article is the topic of an Editorial Focus by Mary C. Sugden and Mark J. Holness (49a).
Pancreatic adenocarcinoma is the fifth leading cause of death due to solid tumors in Western industrialized countries.

Because pancreatic adenocarcinoma is often difficult to detect in early stages, most patients are diagnosed with advanced or metastatic disease at first presentation [1,2]. The median survival of patients with locally advanced disease is 6 to 10 months, compared to 3 to 6 months for patients with metastatic disease [3]. Gemcitabine (Gemzar?; 2′,2′-difluorodeoxycytidine) is a pyrimidine antimetabolite and a specific analogue of deoxycytidine. At present, gemcitabine monotherapy remains the standard care for patients with locally advanced and metastatic pancreatic adenocarcinoma (LA/MPC) [4]. However, patients who receive this therapy have a median overall survival (OS) of only 5.65 months [5]. In an effort to increase the objective response rate (RR) and survival of LA/MPC patients, many trials have been carried out in the last ten years to evaluate gemcitabine monotherapy or combination therapy regimens.

Currently, the National Comprehensive Cancer Network (NCCN) guidelines indicate that gemcitabine combined with one other agent is the optimal treatment for LA/MPC patients with evidence of category 2B disease (recommendation based on lower-level evidence). It is unclear whether this regimen is the ideal treatment for LA/MPC or whether it should be reevaluated. Therefore, we undertook a systematic review and quantitative meta-analysis to evaluate the available evidence from relevant randomized trials. This review will summarize the various trials of gemcitabine-based chemotherapy regimens in LA/MPC and discuss how these results should affect clinical practice.

Methods Search strategy We carried out a comprehensive search of the literature for randomized controlled trials in Pubmed using the terms “chemotherapy,” “gemcitabine,” AV-951 “trials,” and “pancreatic cancer” (no limitation for language). In addition to full publications, abstracts presented at the annual meetings of the American Society of Clinical Oncology (ASCO) and the European Cancer Conference (ECCO) were included. Selection criteria To be eligible for inclusion, trials were required to be prospective, properly randomized and well designed, which we defined as matched for age, stage and performance status (PS) or Karnofsky performance status (KPS).