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Collaborative translational research leading to multicenter clinical trials in Duchenne muscular dystrophy: the Cooperative International Neuromuscular Research Group (CINRG).

Progress in the development of rationally based therapies for Duchenne muscular dystrophy has been accelerated by encouraging multidisciplinary, multi-institutional collaboration between basic science and clinical investigators in the Cooperative International Research Group. We combined existing research efforts in pathophysiology by a gene expression profiling laboratory with the efforts of animal facilities capable of conducting high-throughput drug screening and toxicity testing to identify safe and effective drug compounds that target different parts of the pathophysiologic cascade in a genome-wide drug discovery approach. Simultaneously, we developed a clinical trial coordinating center and an international network of collaborating physicians and clinics where those drugs could be tested in large-scale clinical trials. We hope that by bringing together investigators at these facilities and providing the infrastructure to support their research, we can rapidly move new bench discoveries through animal model screening and into therapeutic testing in humans in a safe, timely and cost-effective setting.

Animals↗

International cooperative study on the relationship between dietary factors and blood pressure: a report from the Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study.

To investigate the epidemiological relationship of dietary factors to blood pressure (BP) and major cardiovascular diseases, we carried out the International Cooperative Cardiovascular Diseases and Alimentary Comparison (CARDIAC) Study, which so far involves 45 centers in 20 countries. From each population, 100 men and 100 women aged 50-54 years were randomly selected for BP measurement, 24-h urine collection, and blood test. Various biological markers of diets from urine and blood were analyzed centrally in the Izumo CARDIAC center. In within-center multiple regression analyses, body mass index (BMI) was strongly positively and independently associated with BP. Urine magnesium (Mg) excretion was negatively and independently associated with BP. In cross-center simple regression analyses, systolic and diastolic BP showed significant correlations with BMI (p less than 0.01) and 24-h urinary sodium (Na) excretion (p less than 0.005) in men and significant inverse correlations with urinary 3-methylhistidine (3-MH) divided by creatinine (p less than 0.01 and p less than 0.005, respectively) in men, and were inversely correlated with urinary Mg in women (p less than 0.05). Therefore, Na and BMI adversely affect BP, whereas animal protein and Mg intakes may have beneficial influence on BP.

Amino Acids↗

Enhancing nuclear emergency response through international cooperation.

Nuclear and radiological emergencies may easily become severe international emergencies requiring substantial resources in several or many states for an adequate response, which in some cases may require resources exceeding national capabilities. Through the development of a consistent, coherent and sustainable joint programme for improved and more efficient international responses to nuclear and radiological emergencies, it is believed that we could achieve a better and more cost-effective response capability for nuclear and radiological emergencies. This requires, however, that we be willing and able to establish mechanisms of assistance where information and resources are globally shared and that standardised/harmonised procedures be developed and implemented. If we are willing to make this investment, we believe that, in the long term, there will be a significant benefit for all of us.

Decision Support Systems, Management↗

[Present status and perspectives in international cooperation in the Cochrane Collaboration].

The Cochrane Collaboration is an international organization that aims to help people make well-informed decisions about healthcare by preparing, maintaining and promoting the accessibility of systematic reviews of the effects of healthcare interventions. It is a non-profit organization. The main work of the Collaboration is done by about fifty Collaborative Review Groups, within which Cochrane Reviews are prepared and maintained. The members of these groups share an interest in generating reliable, up-to-date evidence relevant to the prevention, treatment and rehabilitation of particular health problems or groups of problems.

Databases, Bibliographic↗

International Cooperative Ataxia Rating Scale for pharmacological assessment of the cerebellar syndrome. The Ataxia Neuropharmacology Committee of the World Federation of Neurology.

Despite the involvement of cerebellar ataxia in a large variety of conditions and its frequent association with other neurological symptoms, the quantification of the specific core of the cerebellar syndrome is possible and useful in Neurology. Recent studies have shown that cerebellar ataxia might be sensitive to various types of pharmacological agents, but the scales used for assessment were all different. With the long-term goal of double-blind controlled trials-multicentric and international-an ad hoc Committee of the World Federation of Neurology has worked to propose a one-hundred-point semi-quantitative International Cooperative Ataxia Rating Scale (ICARS). The scale proposed involves a compartimentalized quantification of postural and stance disorders, limb ataxia, dysarthria and oculomotor disorders, in order that a subscore concerning these symptoms may be separately studied. The weight of each symptomatologic compartment has been carefully designed. The members of the Committee agreed upon precise definitions of the tests, to minimize interobserver variations. The validation of this scale is in progress.

Cerebellar Ataxia↗

Combined treatment of patients with lung carcinoma. (Preliminary results assembled in international cooperative investigation).

The authors submit information on the preliminary results of combined treatment of patients with carcinoma of the lungs (epidermoid, adenocarcinoma, large-cell and combined carcinoma). The patients were classified, consistents with the protocol of the study, into two basic groups, each of which was sub-divided at random into two sub-groups. In the first group of 25 patients 9 were subjected to preoperative radiotherapy--2 000 rad (Co60) and 16 patients were operated without previous radiotherapy. The second group was formed by 41 patients incl. 21 who were treated by radical Co60 therapy and 20 patients who in addition to Co60 therapy were given the cytostatic preparation Methotrexate and 5-Florouracil. The submitted work is part of an international cooperative study within the framework of the Council of Mutual Economic Assistance which was started in 1976 and the enlistment of patients will be completed in 1980.

Adenocarcinoma↗

Carrier detection in hemophilia A: a cooperative international study. I. The carrier phenotype.

Eight laboratories in six countries cooperated to clarify several issues concerning the phenotypes of heterozygous carriers of hemophilia "A." Plasma levels of factor VIII (F.VIII:C, formerly VIII:C) and von Willebrand factor (VWF:Ag, formerly VIIIR:Ag) of carriers and normal women were determined by various "in-house" methods; a single lyophilized plasma standard was used for all assays. Analysis of the collated data from 336 carriers (296 obligatory carriers and 40 sporadic carriers) and 137 normal women showed that there was no difference in the F.VIII:C levels of "paternal" carriers (women who had obtained the abnormal gene from their fathers) and "maternal" carriers. Neither was there a difference in the VWF:Ag levels of normal women and either type of carrier. Age was found to have a significant effect on both F.VIII:C and VWF:Ag, values being higher at very young and very old ages, the minima occurring in the 25- to 30-year range. ABO blood type had a striking effect. Women of types A, B, and AB (designated non-O in the study), both normals and carriers, had significantly higher levels of both factors than did women of type O. Analysis by laboratories showed that differences in mean levels of both factors between laboratories were highly significant. It was concluded that age, ABO blood type, and laboratory variation should be taken into account in carrier detection.

ABO Blood-Group System↗

[International cooperation on the detection of irradiated food].

A survey over recent international developments to detect the irradiation treatment of foods is given, in particular the programmes of "ADMIT" (FAO/IAEA) and of BCR (European Community). The need to detect radiation treatment by analysing the food itself is desirable to check compliance with existing regulations, such as the enforcement of labelling and control of prohibition, to enhance consumer confidence in the correct application of radiation processing, and to protect consumers' freedom of choice between irradiated or unirradiated food products. Some larger collaborative studies on an international scale have already taken place, e.g. ESR measurements of bones from chicken, pork, beef, frog legs and fish, thermoluminescence of insoluble minerals isolated from herbs and spices, gas chromatographic analysis of hydrocarbons and alkylcyclobutanones derived from the lipid fraction of chicken and the microbiological DEFT/APC procedure for spices. These methods could soon be implemented in international standard protocols.

Animals↗

International cooperation to collect obstetric data.

Reported are preliminary results of an international collection of data initiated by FIGO. Data of 33.000 deliveries in 19 countries, five countries each in South America, Africa, and Asia and four in Europe provided a good basis for comparison and called attention to shortcomings in each individual country and to the need for more progress in obstetric treatment. - Sociological and demographic items in a questionnaire bring into focus the importance of both family planning and sexual education. - The authors consider this data collection a preliminary study for modernisation of Tauffer Statistics.

Africa↗