Impact of supplemental home enteral feeding postesophagectomy on nutrition, body composition, quality of life, and patient satisfaction.

The aim of this prospective cohort study is to analyze the impact of supplemental home enteral nutrition (HEN) post-esophageal cancer surgery on nutritional parameters, quality of life (QL), and patient satisfaction. A systematic review reported that over 60% of patients lose >10% of both body weight and BMI by 6 months after esophagectomy. Enteral feeding (EF) is increasingly a modern standard postoperatively; however, the impact of extended HEN postdischarge has not been systematically studied. One hundred forty-nine consecutive patients [mean age 62 ± 9, 80% male,76% adenocarcinoma, 66% on multimodal protocols, and 69% with BMI ≥ 25 kg/m2] were studied. Jejunal EF commenced day 1 postoperatively, and supplemental overnight HEN (764 kcal; 32g protein) continued on discharge for a planned further 4 weeks. Weight, BMI, and body composition analysis (bioimpedance analysis) were measured at baseline, preoperatively and at 1, 3, and 6 months, along with the EORTC QLQ-C30/OES18 QL measures. A patient satisfaction questionnaire addressed eight key items in relation to HEN (max score 100/item). Median (range) total duration of EF was 49 days (28-96). Overall compliance was 96%. At 6 months, compared with preoperatively, 58 (39%) patients lost >10% weight, with median (IQR) loss of 6.8 (4-9) kg, and 62 (41%) patients lost >10% BMI. Lean body mass and body fat were significantly (p < 0.001) decreased. Mean global QL decreased (p < 0.01) from 82 to 72. A high mean satisfaction score (>70 ± 11/100) was reported, >80 for practical training, activities of daily living, pain, anxiety, recovery and impact on caregivers, with lower scores for appetite (33 ± 24) and sleep (63 ± 30). Supplemental HEN for a minimum of one month postdischarge is associated with high compliance and patient satisfaction. Weight and BMI loss may still be substantial, however this may be less than published literature, in addition the impact on HR-QL may be attenuated. HEN has both subjective and objective rationale and merits further validation toward optimizing nutritional recovery and overall wellbeing.

Optimal sequencing of ibrutinib, idelalisib, and venetoclax in chronic lymphocytic leukemia: results from a multicenter study of 683 patients.

Background: Ibrutinib, idelalisib, and venetoclax are approved for treating CLL patients in the United States. However, there is no guidance as to their optimal sequence. Patients and methods: We conducted a multicenter, retrospective analysis of CLL patients treated with kinase inhibitors (KIs) or venetoclax. We examined demographics, discontinuation reasons, overall response rates (ORR), survival, and post-KI salvage strategies. Primary endpoint was progression-free survival (PFS). Results: A total of 683 patients were identified. Baseline characteristics were similar in the ibrutinib and idelalisib groups. ORR to ibrutinib and idelalisib as first KI was 69% and 81%, respectively. With a median follow-up of 17 months (range 1-60), median PFS and OS for the entire cohort were 35 months and not reached. Patients treated with ibrutinib (versus idelalisib) as first KI had a significantly better PFS in all settings; front-line [hazard ratios (HR) 2.8, CI 1.3-6.3, P = 0.01], relapsed-refractory (HR 2.8, CI 1.9-4.1, P < 0.001), del17p (HR 2.0, CI 1.2-3.4, P = 0.008), and complex karyotype (HR 2.5, CI 1.2-5.2, P = 0.02). At the time of initial KI failure, use of an alternate KI or venetoclax had a superior PFS when compared with chemoimmunotherapy. Furthermore, patients who discontinued ibrutinib due to progression or toxicity had marginally improved outcomes if they received venetoclax (ORR 79%) versus idelalisib (ORR 46%) (PFS HR .6, CI.3-1.0, P = 0.06). Conclusions: In the largest real-world experience of novel agents in CLL, ibrutinib appears superior to idelalisib as first KI. Furthermore, in the setting of KI failure, alternate KI or venetoclax therapy appear superior to chemoimmunotherapy combinations. The use of venetoclax upon ibrutinib failure might be superior to idelalisib. These data support the need for trials testing sequencing strategies to optimize treatment algorithms.

Image accuracy improvements in microwave tomographic thermometry: phantom experience.

Evaluation of a laboratory-scale microwave imaging system for non-invasive temperature monitoring has previously been reported with good results in terms of both spatial and temperature resolution. However, a new formulation of the reconstruction algorithm in terms of the log-magnitude and phase of the electric fields has dramatically improved the ability of the system to track the temperature-dependent electrical conductivity distribution. This algorithmic enhancement was originally implemented as a way of improving overall imaging capability in cases of large, high contrast permittivity scatterers, but has also proved to be sensitive to subtle conductivity changes as required in thermal imaging. Additional refinements in the regularization procedure have strengthened the reliability and robustness of image convergence. Imaging experiments were performed for a single heated target consisting of a 5.1 cm diameter PVC tube located within 15 and 25 cm diameter monopole antenna arrays, respectively. The performance of both log-magnitude/phase and complex-valued reconstructions when subjected to four different regularization schemes has been compared based on this experimental data. The results demonstrate a significant accuracy improvement (to 0.2 degrees C as compared with 1.6 degrees C for the previously published approach) in tracking thermal changes in phantoms where electrical properties vary linearly with temperature over a range relevant to hyperthermia cancer therapy.

Microwave thermal imaging: initial in vivo experience with a single heating zone.

The deployment of hyperthermia as a routine adjuvant to radiation or chemotherapy is limited largely by the inability to devise treatment plans which can be monitored through temperature distribution feedback during therapy. A non-invasive microwave tomographic thermal imaging system is currently being developed which has previously exhibited excellent correlation between the recovered electrical conductivity of a heated zone and its actual temperature change during phantom studies. To extend the validation of this approach in vivo, the imaging system has been re-configured for small animal experiments to operate within the bore of a CT scanner for anatomical and thermometry registration. A series of 5-7 day old pigs have been imaged during hyperthermia with a monopole antenna array submerged in a saline tank where a small plastic tube surgically inserted the length of the abdomen has been used to create a zone of heated saline at pre-selected temperatures. Tomographic microwave data over the frequency range of 300-1000 MHz of the pig abdomen in the plane perpendicular to the torso is collected at regular intervals after the tube saline temperatures have settled to the desired settings. Images are reconstructed over a range of operating frequencies. The tube location is clearly visible and the recovered saline conductivity varies linearly with the controlled temperature values. Difference images utilizing the baseline state prior to heating reinforces the linear relationship between temperature and imaged saline conductivity. Demonstration of in vivo temperature recovery and correlation with an independent monitoring device is an important milestone prior to clinical integration of this non-invasive imaging system with a thermal therapy device.

Effectiveness of GnRH plus prostaglandin F2alpha for estrus synchronization in cattle of Bos indicus breeding.

Postpartum and lactating crossbred cows containing a percentage of Bos indicus breeding at three locations were studied to determine the efficacy of GnRH + PGF2alpha combinations for synchronization of estrus and(or) ovulation. Cows were equally distributed to each of three treatments by body condition score at the start of the experiment (d 0). All cows received 100 microg of GnRH on d 0 and 25 mg of PGF2alpha 7 d later. The three insemination protocols included 1) AI 12 h after exhibiting estrus during d 7 to 12 of the experiment (Select-Synch; n = 197); 2) timed-AI + 100 microg of GnRH on d 9 of the experiment (CO-Synch; n = 193); 3) AI 12 h after exhibiting estrus during d 7 to 10 of the experiment. Cows not exhibiting estrus by d 10 were timed-AI and injected with 100 microg of GnRH on d 10 of the experiment (Hybrid-Synch; n = 200). The percentage of cows exhibiting estrus during d 7 to 12 of the experiment was lower (P < 0.05) for CO-Synch (17.6%) cows than for Select-Synch or Hybrid-Synch (45.2 and 33.0%, respectively) cows, which did not differ (P > 0.05). For the Select-Synch and Hybrid-Synch cows that exhibited estrus during d 7 to 10 of the experiment and were artificially inseminated, conception rates were similar across treatments (50.5%). Pregnancy rates were greater (P < 0.01) for CO-Synch and Hybrid-Synch (31.0 and 35.5%, respectively) cows than for Select-Synch (20.8%) cows. A greater (P < 0.01) percentage of cycling cows became pregnant (34.5%) than noncycling cows (25.9%) across all treatments. The CO-Synch and Hybrid-Synch synchronization protocols resulted in greater pregnancy rates compared with the Select-Synch protocol in postpartum and lactating crossbred cows containing a percentage of Bos indicus breeding.

A two-stage microwave image reconstruction procedure for improved internal feature extraction.

We have developed a two-stage Gauss-Newton reconstruction process with an automatic procedure for determining the regularization parameter. The combination is utilized by our microwave imaging system and has facilitated recovery of quantitatively improved images. The first stage employs a Levenberg-Marquardt regularization along with a spatial filtering technique for a few iterations to produce an intermediate image. In effect, the first set of iterative image reconstruction steps synthesizes a priori information from the measurement data versus actually requiring physical prior information on the interrogated object. Because of the interaction of the Levenberg-Marquardt regularization and spatial filtering at each iteration, the intermediate image produced from the first reconstruction stage represents an improvement in terms of the least squared error over the initial uniform guess; however, it has not completely converged in a least squared sense. The second stage involves using this distribution as a priori information in an iteratively regularized Gauss-Newton reconstruction with a weighted Euclidean distance penalty term. The penalized term restricts the final image to a vicinity (determined by the scale of the weighting parameter) about the intermediate image while allowing more flexibility in extracting internal object structures. The second stage makes use of an empirical Bayesian/random effects model that enables an optimal determination of the weighting parameter of the penalized term. The new approach demonstrates quantifiably improved images in simulation, phantom and in vivo experiments with particularly striking improvements with respect to the recovery of heterogeneities internal to large, high contrast scatterers such as encountered when imaging the human breast in a water-coupled configuration.

Non-invasive thermal assessment of tissue phantoms using an active near field microwave imaging technique.

An active microwave imaging system for non-invasive temperature sensing has been developed and evaluated. The system is designed to assess biological tissues undergoing thermal therapy. This paper presents results that demonstrate the imaging capabilities of the microwave method using simulated and experimental phantom materials. Results from both numerical studies and laboratory experiments have been analysed and are presented. The imaging system uses a 16 channel fixed monopole array transceiver unit operating over a bandwidth of 300-900 MHz. The annular array diameter is 14.75 cm and is immersed in a 0.9% saline solution. Standard heterodyning principles are used for signal detection leading to a dynamic range of the system of better than 115dB. Image formation is accomplished with a 2-D finite element based, near-field iterative technique. This allows the simultaneous reconstruction of both the real and imaginary components of the dielectric property distribution in tissue equivalent phantoms. Data acquisition currently captures 144 complex field measurements per image. Image reconstruction requires approximately 2 min per iteration with a typical convergence in less than 10 steps. Experiments performed to evaluate the temperature dependence of biological phantoms (saline with variable salt concentrations) are described. The numerical accuracy and precision of the reconstruction algorithm based upon these phantom studies are presented. Simple laboratory models of localized hyperthermia have been used to evaluate the experimental accuracy and precision of the imaging system. A numerical precision of 0.02 degrees C and an accuracy of 0.37 degrees C have been observed with the current algorithm. In laboratory experiments, images have been reconstructed at different target temperatures and target saline concentrations. The effect of placing high contrast biological phantoms (i.e. bone/fat simulants) along with the heated objects have also been studied. Localized heating of the biological phantom is achieved by pumping a saline solution of pre-selected concentration through enclosed ends of hollow dielectric cylinders having approximately 5cm inner diameter and 4 mm wall thickness. The temperature of the heated zone is preset and maintained to +/-0.2 degrees C by an external heater and circulator. The results currently show that a maximum temperature precision of 0.98 degrees C and maximum relative accuracy of 0.56 degrees C has been achieved in the laboratory using the current generation of the prototype system.

A germline TaqI restriction fragment length polymorphism in the progesterone receptor gene in ovarian carcinoma.

Clinical outcome in ovarian carcinoma is predicted by progesterone receptor status, indicating an endocrine aspect to this disease. Peripheral leucocyte genomic DNAs were obtained from 41 patients with primary ovarian carcinoma and 83 controls from Ireland, as well as from 26 primary ovarian carcinoma patients and 101 controls in Germany. Southern analysis using a human progesterone receptor (hPR) cDNA probe identified a germline TaqI restriction fragment length polymorphism (RFLP) defined by two alleles: T1, represented by a 2.7 kb fragment; and T2, represented by a 1.9 kb fragment and characterised by an additional TaqI restriction site with respect to T1. An over-representation of T2 in ovarian cancer patients compared with controls in the pooled Irish/German population (P < 0.025) was observed. A difference (P < 0.02) in the distribution of the RFLP genotypes between Irish and German control populations was also observed. The allele distributions could not be shown to differ significantly from Hardy-Weinberg distribution in any subgroup. Using hPR cDNA region-specific probes, the extra TaqI restriction site was mapped to intron G of the hPR gene.

Luteal function and reproductive response in suckled beef cows after metestrus administration of a norgestomet implant and injection of estradiol valerate with various dosages of injectable norgestomet.

In an experiment replicated over 2 yr, 149 suckled beef cows were administered Syncro-Mate-B (SMB), a 6-mg Norgestomet (NOR) ear implant (in situ 9 d) in conjunction with an i.m. injection of 5 mg of estradiol valerate (EV), and either 3.0, 4.5, or 6.0 mg of NOR, 2 d after estrus. All cows were artificially inseminated at 48 h (timed insemination; TI) after implant removal (IR) and cows were reinseminated at any estrus subsequent to 24 h of TI through 30 d. Blood samples collected before treatment, every 3 d through IR, and at TI were assayed for progesterone (P4). At TI, 44, 39, and 12% of cows treated with 3.0, 4.5, or 6.0 mg of NOR, respectively, had serum concentrations of P4 greater than 1 ng/mL (3.0 and 4.5 mg vs 6.0 mg, P less than .01). Fifty-eight, 63, and 84% of cows treated with 3.0, 4.5, or 6.0 mg of NOR, respectively, exhibited a synchronized (within 5 d of IR) estrus (3.0 and 4.5 mg vs 6.0 mg, P less than .05). Pregnancy rates for the 5-d synchronized period were 38, 45, and 66% for cows treated with 3.0, 4.5, or 6.0 mg of NOR, respectively (3.0 and 4.5 mg vs 6.0 mg, P less than .05). First-service pregnancy rates were 66, 71, and 79% for cows treated with 3.0, 4.5, or 6.0 mg of NOR, respectively (P greater than .10).(ABSTRACT TRUNCATED AT 250 WORDS)

Using serial observations to identify predictors of progression to AIDS in the Toronto Sexual Contact Study.

The Toronto Sexual Contact Study comprises a cohort of 249 male sexual contacts of men with HIV disease which has been followed every 3 months for almost 5 years. On enrollment 143 were seropositive and 16 seroconverted during the follow-up period. By 31 December 1989, 41 of the 159 seropositive cohort members had developed AIDS. Using Cox relative risk regression models, we investigated the association of a number of laboratory and clinical variables and progression to AIDS. Fixed covariate models examined laboratory variables from the enrollment visit of cohort members, with time calculated from this date. In models assessing time dependent covariates, time was calculated from the estimated date of HIV infection. In the univariate models of either fixed or time dependent covariates, many variables were significantly associated with risk of progression to AIDS (T4 cell count, T4/T8 ratio, blastogenic responses to phytohemagglutinin, concanavalin A, and pokeweed mitogen, serum IgA, appearance of p24 antigen, and the development of oral hairy leukoplakia, thrush, or herpes zoster). Appearance of persistent generalized lymphadenopathy was not associated with increased risk of progression. In the multivariate model which evaluated fixed laboratory covariates, T4/T8 ratio, IgA level, and PHA response at enrollment were significantly associated with elevated risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Detection of incident HIV infection by PCR compared to serology.

In order to determine the most sensitive method for the early detection of HIV infection, polymerase chain reaction (PCR) and serology were compared using matched peripheral blood mononuclear cells (PBMC) and serum samples taken sequentially at 3-month intervals on 17 HIV seroconverters. All samples from the time of enrollment in the study to the time of seroconversion were studied. [There were only two of the 17 cases where PCR and antigen positivity preceded EIA detectable seroconversion.] Initially, one of these cases was found to be PCR positive 11 months prior to seroconversion, however DNA fingerprinting techniques indicated that the early positive specimen did not belong to the subject in question. In a single subject, PCR was negative at the time of serologic evidence of infection but was positive at the next sampling 3 months later. In the remaining 14 cases, PCR was positive at the same sample time as full or partial seroconversion as determined by three EIA screening tests and Western blot. EIA antibody screen tests showed variability in detection of early HIV antibodies. We found no evidence for prolonged HIV infection prior to seroconversion. PCR offers little if any advantage over serology in the early detection of HIV infection in adults.

Canadian multicenter azidothymidine trial: AZT pharmacokinetics.

The study objective was to describe the pharmacokinetics of azidothymidine (AZT) in a large population of early, asymptomatic human immunodeficiency virus (HIV)-infected individuals. The study design was a multicenter, prospective, descriptive single-dose pharmacokinetic study. Each of 66 fasting, male, HIV-infected homosexuals older than 18 years of age and in CDC classifications II, III, and IVC2 received a single 400-mg oral dose of AZT with subsequent pharmacokinetic measurements performed during an 8-h period for AZT and its major metabolite, glucuronylazidothymidine (GAZT). Results were obtained in 65 patients (36 smokers, 29 nonsmokers), of whom 3 were noted to have hepatic dysfunction. In those with normal hepatic function, the following parameters were described: AZT, area under the curve (AUC) +/- SD, 9.9 +/- 5.7 microM.h, maximum concentration (Cmax) +/- SD, 7.3 +/- 4.7 microM; time to maximum concentration (Tmax) +/- SD, 0.93 +/- 0.42 h, and half-life (t1/2) +/- SD, 1.0 +/- 0.8 h. Corresponding values for GAZT were: AUC +/- SD 35.7 +/- 10.3 microM.h, Cmax +/- SD 21.3 +/- 7.3 microM, Tmax +/- SD 1.2 +/- 0.50 h, t1/2 +/- SD 0.98 +/- 0.62 h, No significant differences were found in comparisons of study site, CDC classification of disease, smokers versus nonsmokers, and in patients with hepatic dysfunction, although a higher AUC and earlier Cmax for AZT was noted in the latter group. It is concluded that AZT pharmacokinetics are similar in patients with early asymptomatic HIV disease when compared with previous reports in patients with later disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Cofactors of progression to acquired immunodeficiency syndrome in a cohort of male sexual contacts of men with human immunodeficiency virus disease.

In a cohort of 249 male sexual contacts of men with acquired immunodeficiency syndrome (AIDS) or an AIDS-related condition in Toronto, Ontario, Canada, 143 cohort members were seropositive on enrollment and 16 seroconverted between initial recruitment in July 1984 to July 1985 and December 1988. Data on age, smoking and drinking status, recreational drug use, and history of sexually transmitted diseases and other diseases were obtained from interviews at induction and during follow-up on the cohort members every 3 months. Cox relative risk regression models, in which time was calculated from estimated date of human immunodeficiency virus (HIV) infection for seroprevalent cohort members and from 90 days prior to the first positive test for seroconverters, examined the potential effect of use of a variety of recreational drugs and the occurrence of selected infections on the risk of development of AIDS. Thirty-five cohort members developed AIDS while under study. No significant association with risk of progression to AIDS was noted for use of various recreational drugs (singly or in combination), history of specific infections, age at enrollment, or smoking and drinking status at enrollment. Only estimated duration of HIV infection appeared to be associated with increasing risk of development of AIDS.

Kaposi's sarcoma and AIDS: a variable spectrum.

A cohort of 61 patients with Kaposi's sarcoma (KS) and AIDS was seen in the Oncology Unit of the Toronto General Hospital between 1982 and 1986. In an attempt to identify prognostic variables, laboratory and clinical parameters were examined using Kaplan-Meier estimates and the Cox Regression Model. All patients were male, median age 36 years (range 23-52). In 49 patients KS was diagnosed before any AIDS-associated opportunistic infection (OI). Three patients had concurrent KS and OI, and nine patients developed KS one or more months after an OI. Only 11 patients had stage I or II disease, 34 stage III, and 15 stage IV. Only 18 patients (30%) were asymptomatic. Twenty-six percent had fever, night sweats, or weight loss, 11% had minor opportunistic infections, and 33% had both symptom complexes. The median overall survival was 10.5 months. The survival of patients who received chemotherapy for their KS was not significantly different from the survival of non-treated patients (p = 0.7). Although significant differences in survival could not be seen between stages, patients with both systemic symptoms and minor opportunistic infections had significantly shorter survival (p = 0.03). Survival from the onset of KS was significantly shorter for patients who had experienced a previous OI, but their overall survival from the date of diagnosis of AIDS was not significantly different from those patients presenting with KS alone. When analyzed separately the laboratory parameters of hemoglobin (p less than 0.0001), absolute lymphocyte count (p = 0.03), platelet count (p = 0.04), and T4 level (p = 0.05) demonstrated a significant relationship with survival.(ABSTRACT TRUNCATED AT 250 WORDS)

Isolation of drug-resistant variants of HIV-1 from patients on long-term zidovudine therapy. Canadian Zidovudine Multi-Centre Study Group.

We determined whether drug-resistant variants of HIV-1 could be isolated from the peripheral blood mononuclear cells of 20 individuals with HIV infection (Centers for Disease Control groups II and III) on long-term zidovudine (AZT) therapy. Toward this end, zidovudine (10 microM) has been included in the tissue culture medium used to isolate HIV-1. Under these circumstances, virus with a zidovudine-resistant phenotype was successfully obtained in five out of 20 cases. This property of drug resistance appeared to be stable, and did not disappear upon extended replication of such virus in the absence of drug pressure. Drug-resistant virus could also be isolated from these subjects on subsequent occasions, but was not present in samples obtained prior to therapy. Replication of these zidovudine-resistant isolates in tissue culture was inhibited by each of four other nucleoside analogues. Thus, other drugs may be useful in controlling selective zidovudine-resistant variants of HIV-1.

Combination chemotherapy and alpha-interferon in the treatment of Kaposi's sarcoma associated with acquired immune deficiency syndrome.

Thirteen men with a median age of 37 (range 28 to 46) years who had extensive Kaposi's sarcoma associated with acquired immune deficiency syndrome (AIDS) were treated with combination chemotherapy and alpha-interferon. Four patients had stage III disease and nine had stage IV disease (one with pulmonary and eight with gastrointestinal involvement). Treatment consisted of monthly courses of actinomycin D, 1 mg/m2, and vinblastine sulfate, 6 mg/m2, given intravenously on day 1, bleomycin, 10 mg/m2 given intravenously on days 1 and 8, and human lymphoblastoid (alpha-) interferon, 10 million U/m2 given subcutaneously three times a week for six doses starting on day 14. Forty-one treatment cycles (median 3, range 1 to 12) were administered. The median granulocyte and platelet counts on day 14 before the start of interferon therapy were 600 X 10(9)/L and 134 X 10(9)/L respectively; the counts did not fall further during interferon therapy. There was no difference in T-cell subsets, 2',5'-oligoadenylate synthetase level or results of blastogenesis studies after interferon therapy. Four patients required admission to hospital for neutropenia-associated fever. A complete response (of 24 weeks' duration) was seen in one patient and a partial response (of 14 to 44 weeks' duration) in four. One patient had a mixed response, with regression of skin involvement but progression of pulmonary disease. The median length of survival was 48 (range 4 to 143) weeks. Eleven patients died of progressive Kaposi's sarcoma, one of lymphoma and one of Pneumocystis carinii pneumonia. The results suggest that this form of therapy is not appropriate for patients with Kaposi's sarcoma associated with AIDS.

Lack of biological significance of in vitro Brugia malayi microfilarial cytotoxicity mediated by Propionibacterium acnes ("Corynebacterium parvum")-and Mycobacterium bovis BCG-activated macrophages.

The effect of nonspecific activation of host macrophages by Propionibacterium acnes ("Corynebacterium parvum") or Mycobacterium bovis BCG on Brugia malayi microfilariae was determined by in vitro and in vivo studies. Intraperitoneal injection of C. parvum or BCG stimulated peritoneal exudate cells, which were toxic to microfilariae. Microfilariae were equally susceptible to damage by C57BL/6J or BALB/cJ peritoneal exudate cells. Furthermore, inhibitors of oxidative metabolism and arginine supplementation did not prevent this toxicity, suggesting that the mechanism of microfilarial damage differs from that seen with another multicellular helminth, Schistosoma mansoni. In vivo studies with both BCG and C parvum, however, did not confirm the importance of nonspecific immunity in resistance to B. malayi microfilaremia. Despite the lack of biologic relevance of this phenomenon, in vitro studies may yield important knowledge about the mechanisms of microfilarial damage.