International multicenter phase II study of the HDAC inhibitor (HDACi) depsipeptide (FK228) in cutaneous T-cell lymphoma (CTCL): Interim report

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Background: Depsipeptide, a unique bicyclic peptide histone deacetylase inhibitor (HDACi), has shown activity in a range of in vitro and in vivo tumor models and clinical activity in T-cell lymphomas and prostate cancer. This study seeks to confirm the CTCL activity previously reported by the NCI (Piekarz, et al., ASCO, 2004). Methods: Single-arm, open label study, in 25 centers in the UK, Germany, Poland and the US. Patients aged ≥18 years with biopsy-confirmed CTCL (centrally reviewed) who have failed at least one prior systemic treatment receive up to 6 cycles of depsipeptide as a 4-hour IV infusion on Days 1, 8 and 15 q 28 days. Eligibility criteria include: mycosis fungoides and Sézary syndrome plus variants, Stages IB - IVA, adequate organ function, ECOG PS ≤ 1. Patients with significant cardiovascular abnormalities are excluded in addition to those taking QTc-prolonging or CYP3A4-inhibiting drugs. The primary endpoint is overall reponse rate measured by a combination of imaging, circulating cell counts and a weighted skin average instrument, confirmed by standardized photography. A subset undergoes pharmacokinetic assessments. Correlative studies include acetylation status, apoptotic markers and proteomic analyses where possible. Target accrual is 76 to yield 64 evaluable patients. Results: 30 patients have received treatment with 17 evaluable for efficacy. Responses seen are 1 cCR, 4 PRs (duration 2+ to 6 months) 9 SD and 3 PD. 3 patients withdrew early for PD and 2 for other reasons. The remaining patients on study are too early to assess. Most frequent toxicities are: nausea/vomiting, fatigue, myelosuppression and asymptomatic ECG changes. No patient has withdrawn for toxicity and there have been no treatment-related deaths. Conclusions: The previously reported efficacy of depsipeptide in CTCL has also been seen in the present study. Duration of response is encouraging. Toxicity is manageable and the study continues to accrue.

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Distribution of Ca.LSU intron and acid protease production by Candida albicans strains isolated from gastrointestinal tract of diabetes children

The association between the presence of self-splicing intron Ca.LSU and proteolytic activity of Candida albicans isolates was tested. Study included 95 C. albicans strains isolated from gastrointestinal tract of diabetes children. The strains with the intron (genotype B) displayed a significantly higher proteolytic activity (385.2+/-192U/L) than did strains without intron (genotype A) (119+/-115U/L) (p = 0.0000048).

Characterization of new oxovanadium(IV) complexes of saccharides

Oxovanadium(IV) complexes of the monosaccharides D- and L-arabinose, D-galactose, D-mannose, D-lyxose, D-xylose and the disaccharide maltose were obtained in aqueous solutions at pH 13. Their sodium salts were precipitated with absolute ethanol and characterized by UV-vis spectroscopy (absorption and reflectance), thermo-analytical (TG and DTA) data, magnetic susceptibility measurements and IR-spectroscopy. All the complexes were found to be mononuclear, possessing the VO2+ moiety. The IR spectra were analyzed and discussed in detail allowing one to determine the characteristics of the metal-to-ligand interactions.

Short-term itraconazole versus terbinafine in the treatment of tinea pedis or manus

A total of 304 patients with a clinical diagnosis of palmar-type tinea pedis or manus and a positive mycologic examination were recruited into this double-blind, randomized, multicenter, phase III study. Patients were randomized to receive either oral itraconazole 200 mg twice daily (in the morning and evening) for 7 days, followed by placebo for 7 days (n = 153), or placebo in the morning and oral terbinafine 250 mg in the evening for 14 days (n = 151). At the first visit and 1, 2, and 6 weeks after the start of the study, signs and symptoms were assessed clinically, and scales were taken for mycologic assessments (microscopy and culture). At weeks 1, 2, and 6, the effectiveness of therapy was evaluated globally and given a rating of healed (absence of signs and symptoms), marked improvement (> or = 50% clinical improvement), considerable residual lesions (< 50% clinical improvement), no change, or worsened. The primary efficacy parameter was the mycologic cure rate at the follow-up end-point (week 6). The tolerability of the study medications was assessed at weeks 1 and 2. Adverse events were recorded at weeks 1, 2, and 6. Routine hematologic and biochemical tests were performed at the start of the study and after 1 week of treatment. No significant differences were seen in the baseline patient characteristics between the two groups. The rate of mycologic cure (negative microscopy and culture test result) was 79% in the itraconazole group and 80% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the treatment groups (-7.1, 5.4) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.013 and P = 0.029) showed the two treatments to be equivalent. The results of the global evaluations of the efficacy in the two treatment groups are shown in Table 1. The rate of clinical response (healed or markedly improved) was 93% in the itraconazole group and 91% in the terbinafine group at the follow-up end-point. The analysis of the 90% confidence interval for the difference between the two groups (-2.5, 5.7) and the outcome of the Blackwelder test (for two one-sided tests, P = 0.004 and P < 0.001) showed the two treatments to be equivalent. The severity of the clinical signs and symptoms decreased from the baseline to the treatment end-point and from the treatment end-point to the follow-up end-point in both groups. At the double-blind treatment period end-point (week 2), the tolerability of the study medication was rated as very good or good in more than 97% of patients. During treatment, 21 of 153 patients (14%) in the itraconazole group and 28 of 151 patients (19%) in the terbinafine group reported adverse events. During follow-up, one patient in the itraconazole group and two in the terbinafine group reported adverse events. The most frequent events were headache, abdominal pain, nausea, vomiting, and hypertriglyceridemia. Two patients in the itraconazole group and four in the terbinafine group withdrew because of adverse events. Severe adverse events were reported by one patient in the itraconazole group and five in the terbinafine group. Serious adverse events were reported by two patients in the terbinafine group, although these were probably not drug related. No clinically relevant changes in laboratory variables were observed.

Temporal patterns in a fish assemblage of a semiarid mangrove zone in Madagascar

Gillnet sampling was conducted for a year in a tropical mangrove creek (SW Madagascar), characterized by a limited freshwater influence, a high turbidity and a tidal range up to 3 m. Sixty species of juvenile fishes were caught, 44 species being of commercial interest. Catches were dominated by Gerreidae (27% of total abundance), Teraponidae (16%), Carangidae (13%) and Sparidae (12%). The temporary resident fishes in the mangrove zone represented 50% of the species and 97% of the total abundance, the other species being rare (less than five individuals). The species richness, abundance and biomass per netting were low in the middle of the cool season (July-August). Monthly changes in the fish assemblage were particularly complex, with three species groups displaying a clear seasonal pattern, some species succeeding one another in a rather unstructured way, and three species abundant throughout the year. There was no clear structuring effect of temperature, salinity and turbidity on the fish assemblage. However, tidal, lunar and diel effects on the composition of the fish assemblage were evident. The species overlap between the Sarodrano mangrove fauna and the adjacent coral reef fauna is particularly weak with six species in common and shows that the mangrove plays only a very limited nursery role for coral reef species.

The monitoring of cadmium, zinc and copper in the kidneys and liver of humans deceased in the region of Cracow (Poland)

Cadmium, zinc and copper levels were determined in the renal cortex and liver of 60 inhabitants of Cracow, Poland. Cadmium levels in the renal cortex were contained in broad limits of 5-176 μg/g, mean 50.6 μg/g (wet weight). Maximum levels were found in the age group of about 50-60 years. The levels were slightly higher in men (53 μg/g) than in women (45 μg/g), with no effect of location within the region. The levels in smokers (62 μg/g) were much higher than in non-smokers (32 μg/g). The above relations were less pronounced for cadmium levels in the liver. Whole body retention of cadmium followed the pattern of cadmium in renal cortex. The level of zinc in renal cortex reflected those of cadmium. A significant proportion of the population (54% in smokers, 9% in non-smokers) showed cadmium levels in renal cortex exceeding the reference level of 50 μg/g recently accepted for general population. In the view of the authors the exposure to cadmium of the population of Cracow is excessive and calls for attention.

[Level of beta 2-microglobulin in serum of patients with acute viral hepatitis types A, B and C]

Serum beta 2-microglobulin concentrations were assayed in 14 patients with acute hepatitis A, 16 with acute hepatitis B and 10 with hepatitis C. Serum samples were taken from each patient in the first and the second week of hospitalization and in the period of aminotransferase normalization. There was a significant increase of beta 2-microglobulin level in every type of hepatitis compared to the control group. A raised serum beta 2-microglobulin concentration persisted during convalescent period. It decreased gradually in type A and B of hepatitis. Serum beta 2-microglobulin level during convalescence in hepatitis C was similar to that of first weeks of hospitalization.

[Comparison of prolactin levels in first, second and multiple physiological pregnancy]

Serum prolactin level was estimated by radioimmunological method (RIA) in women during the first, the second and the multiple normal pregnancy. The value of prolactin was compared in the successive pregnancies and in the successive weeks of pregnancy. The dependence between concentration of prolactin and successive pregnancy was observed. A significant increase of prolactin was noted in the 4 week of multiple pregnancy. The increased level of prolactin was observed in the 10th, 12th, 14th, 40th and 42nd weeks of the first normal pregnancy.

Simultaneous operation for hydatid cyst of right lung and liver

Hydatid disease is endemic in many regions of Turkey. We observed 23 cases of simultaneous liver hydatid cyst in 344 patients having pulmonary hydatid cyst referred to our center. The simultaneous hydatid cysts were diagnosed by ultrasonography. In all cases complete resection was possible in a single operation. We performed thoracophrenotomy in 21 cases and thoracolaparotomy in two cases. Empyema was observed in three patients postoperatively. No mortality has occurred. Recurrence of a pulmonary cyst was observed in one patient 20 months postoperatively.

[Assessment of the phagocytosis and intracellular killing of Candida albicans by granulocytes of patients with atopic dermatitis]

Using morphological and radionuclide methods the ability of engulfing and intracellular killing of Candida albicans cells by granulocytes of patients with atopic dermatitis was tested. The patients had moderately intense lesions without secondary infections. The results obtained by the morphological method, that is the percent of phagocytizing granulocytes, the percent of C. albicans cells engulfed by the granulocytes and the percent of killed C. albicans cells in the group of 25 patients and in the group of 25 controls were not statistically significantly different. The radionuclide method with 51Cr labelling of Candida albicans failed to demonstrate differences between 15 patients and 25 controls in the intracellular killing of these cells. No significant effect of the serum of healthy subjects on the functions of the granulocytes and no effect of the serum of the patients on granulocyte functions of controls were noted.

["Tooth mortality" in a Marseille S.C.T.D. The effect of periodontal disease: comparison with some results of a national epidemiological study]

1,247 avulsions have been noted for a year in the S.C.T.D. (tooth, age and sex of the patient). 44.6% were caused by tooth decay. However periodontal disease was responsible for 39.5% of tooth avulsions. The tooth lost because of periodontal disease were in most part extracted after 40 years. A weakness of some type of teeth regarding tooth mortality may be quoted. A sexual dimorphism of tooth mortality was present in the studied population.

[Error in expert assessment]

On the basis of the statutory code of physicians' duties in Poland, the authors discuss a new category of professional error, namely "error in expert assessment." Expert assessment comprises: Issue of certificates stating temporary inability to work (L-4 forms); Issue of certificates allocating patients to appropriate disability categories; Issue of certificates entitling patients to special services; Issue of certificates for legal purposes According to regulation any physician can be required to provide an expert assessment, because institutions requesting such an opinion refer to persons or institutions so as to obtain special information. In certain cases physicians may request to be released from this obligation. Nevertheless, if they accept it and then pass an erroneous opinion they may be liable to a charge of malpractice. The authors have pointed out that errors in expert assessment usually result from: Inadequate professional knowledge; Examination of the records with no clinical examination; Failure to take account of information included in the patient's file; Illogical or unjustified conclusions about the cause and result relationship. The most common errors in the formulation of expert assessments are: "Overdiagnosis" of the results of an accident; Unjustified statements that death has resulted from an accident or from bad working conditions in cases of death from natural causes; Incorrect reconstruction of the events leading up to an accident or of the mechanism of injuries.(ABSTRACT TRUNCATED AT 250 WORDS)

[Zinc content of leukocytes and serum in psoriasis patients]

The mean zinc level in leucocytes from psoriasis patients was found to be decreased by a statistically significant amount, which was not the case in serum. On the basis of data from the literature and our own observations, the role of zinc is discussed in the development of immunologic events.