An open label phase II trial of the Plk1 inhibitor BI 2536, in patients with sensitive relapse small cell lung cancer (SCLC)

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Background: BI 2536 is a potent, selective inhibitor of polo-like kinase 1 (Plk1), a regulator of mitotic progression. BI 2536 demonstrated favorable tolerability and antitumor activity in phase I trials. We investigated the antitumor efficacy, safety and PK of BI 2536 in patients (pts) with sensitive relapse SCLC. Methods: This open label single arm phase II study followed a Gehan two-stage design. Primary objective was to determine the antitumor efficacy of BI 2536 in SCLC pts with disease recurrence ≥60 days after completion of first-line chemotherapy. 18 pts had to complete 2 courses to be evaluable for stage 1 analysis. In case of ≥2 partial or complete antitumor responses (RECIST criteria), stage 2 accrual would continue until 40 pts were entered. Patients received 200 mg BI 2536 as a 1h i.v. infusion on Day 1 every 3 weeks. Dose escalation to 250 mg (cycle 3 onwards) was encouraged in pts with <Grade 2 drug related non-hematologic and <Grade 3 hematologic toxicity. Results: 23 pts (14 female, 9 male, 21 extensive disease, 2 limited disease), median age 60 yrs (range: 35–77) were treated. All patients had disease recurrence >60 days after completion of first-line therapy. Of 23 pts, no objective antitumor responses were observed, 7 had stable disease as best response, 14 had progression, 2 were not evaluable. A median of 2 courses were given, up to a maximum of 12 in 1 pt. The PFS rate at 3 months was 25%. Due to the lack of antitumor responses, trial accrual was terminated after stage 1. Overall, BI 2536 was well tolerated. Frequent AEs were neutropenia (48%), fatigue (39%), nausea (30%), anemia, vomiting, constipation (26% each), and thrombocytopenia (22%). Drug related grade 3/4 AEs were neutropenia (13%/26%), grade 3/4 thrombocytopenia (1 pt each), grade 3/4 anemia (1 pt each), grade 4 sepsis (1 pt), Grade 4 ARDS (1 pt) and Grade 3 fatigue (1 pt). PK analyses indicate that BI 2536 has high clearance (>1,000 mL/min) and quickly distributes in multiple compartments in a large volume of distribution (>1,000 L). Estimated elimination half-life was >25 h. Conclusions: BI 2536 was well tolerated in relapsed SCLC pts, but demonstrated no convincing antitumor efficacy after stage I of the study. Therefore, BI 2536 will not be assessed further as a single agent in SCLC.

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Evidence-based care and the curriculum

An evidence-based (EB) approach has been a significant driver in reforming healthcare over the past two decades. This change has extended across a broad range of health professions, including oral healthcare. A key element in achieving an EB approach to oral healthcare is educating our practitioners, both current and future. This involves providing opportunities integrated within simulated and actual clinical settings for practitioners to learn and apply the principles and processes of evidence-based oral healthcare (EBOHC). Therefore, the focus of this discussion will be on ways in which EBOHC and associated research activities can be implemented into curricula, with the aim of improving patient care. This paper will initially define the scope of EBOHC and research, what these involve, why they are important, and issues that we need to manage when implementing EBOHC. This will be followed by a discussion of factors that enable successful implementation of EBOHC and research into curricula. The paper concludes with suggestions on the future of EBOHC and research in curricula. Key recommendations related to curricula include strengthening of the culture of a scientific approach to education and oral healthcare provision; complete integration of EBOHC into the curriculum at all levels; and faculty development to implement EBOHC based on their needs and evidence of effective approaches. Key recommendations to support implementation and maintenance of EBOHC include recognition and funding for high-quality systematic reviews and development of associated methodologies relevant for global environments; building global capacity of EBOHC researchers; research into improving translation of effective interventions into education and healthcare practice, including patient-reported outcomes, safety and harms, understanding and incorporation of patient values into EB decision-making, economic evaluation research specific to oral healthcare and effective methods for changing practitioner (faculty) behaviours; and extend access to synthesized research in 'user friendly' formats and languages tailored to meet users' needs. Realizing these recommendations may help to improve access to effective healthcare as a basic human right.

Expression of the glucocorticoid-induced receptor mRNA in rat brain

The glucocorticoid-induced receptor (GIR) is an orphan G-protein-coupled receptor awaiting pharmacological characterization. GIR was originally identified in murine thymoma cells, and shows a widespread, yet not completely complementary distribution in mouse and human brain. Expression of the mouse GIR gene is modulated by dexamethasone in the brain and periphery, suggesting that GIR function is directly responsive to glucocorticoid signals. The rat GIR was cloned from rat prefrontal cortex by our group and was shown to be up-regulated following chronic amphetamine. The physiological role of GIR in the rat is not known at present. In order to gain a clearer understanding of the potential functions of GIR in the rat, we performed a detailed mapping of GIR mRNA expression in the rat brain. GIR mRNA showed widespread distribution in forebrain limbic and thalamic structures, and a more restricted distribution in hindbrain areas such as the spinal trigeminal nucleus and the median raphe nucleus. Areas with moderate to high levels of GIR include olfactory regions such as the nucleus of olfactory tract, hippocampus, various thalamic nuclei, cortical layers, and some hypothalamic nuclei. In comparison with previous studies, significant regional differences exist in GIR distribution in mouse and rat brain, particularly in the thalamus, striatum and in hippocampus at a cellular level. Overall, the expression of GIR in rat brain more closely approaches that seen previously in human than mouse, suggesting that rat models may be more informative for understanding the role of GIR in glucocorticoid physiology and glucocorticoid-related disease states. GIR mRNA distribution in the rat indicates a potential role of this receptor in the control of feeding and ingestive behavior, regulation of stress and emotional behavior, learning and memory, and, drug reinforcement and reward.

Enhancing human balance control with galvanic vestibular stimulation

With galvanic vestibular stimulation (GVS), electrical current is delivered transcutaneously to the vestibular afferents through electrodes placed over the mastoid bones. This serves to modulate the continuous firing levels of the vestibular afferents, and causes a standing subject to lean in different directions depending on the polarity of the current. Our objective in this study was to test the hypothesis that the sway response elicited by GVS can be used to reduce the postural sway resulting from a mechanical perturbation. Nine subjects were tested for their postural responses to both galvanic stimuli and support-surface translations. Transfer-function models were fit to these responses and used to calculate a galvanic stimulus that would act to counteract sway induced by a support-surface translation. The subjects' responses to support-surface translations, without and with the stabilizing galvanic stimulus, were then measured. With the stabilizing galvanic stimulus, all subjects showed significant reductions in both sway amplitude and sway latency. Thus, with GVS, subjects maintained a more erect stance and followed the support-surface displacement more closely. These findings suggest that GVS could possibly form the basis for a vestibular prosthesis by providing a means through which an individual's posture can be systematically controlled.

Skin care for patients receiving radiotherapy

Radiotherapy can cause significant skin reactions. Research suggests that skin care practices are diverse for patients receiving radiotherapy. Standardised practice enables nurses to evaluate interventions.

Characteristics of new referrals to twenty-seven lymphoedema treatment units

Lymphoedema affects 25-28% of patients who have undergone axillary surgery or radiotherapy in the treatment of cancer. The prevalence of primary lymphoedema or of lymphoedema secondary to non-cancer causes is unknown. In addition, basic demographic and disease characteristics of the lymphoedema population remain undocumented. We conducted a prospective survey to determine these characteristics. Lymphoedema treatment clinics in the UK were invited to participate at the British Lymphology Society 1996 Annual Conference. Twenty-seven clinics collected a standard data set for all new referrals in a 3-month period in 1997. The sample size was 603. The mean number of new referrals was 7.4 patients per unit per month. Eighty per cent of patients had cancer-related lymphoedema, and 86% of patients were female. Patients' mean age was 61.0 years. Thirty-seven per cent of the sample had suffered lymphoedema for less than 3 months, and 15% for 5 years or more. Patients with non-cancer related oedema had suffered the condition disproportionately longer than the cancer-related group (chi 2 = 102.2, P < 0.001). Sixty-six per cent of patients were reported as having lymphoedema at more than one site. Seventy-four per cent of all patients suffered unilateral limb oedema, and 23% bilateral limb oedema. Bilateral swelling was recorded for 67% of the non-cancer related group and 13% of the cancer related group (chi 2 = 153.4, P < 0.001). Median percentage excess volume (PCEV) for all patients with unilateral limb oedema was 16.4%. There was a positive relationship between PCEV and duration of the condition (H = 24.0, P < 0.001), and PCEV and non-cancer related lymphoedema (H = 10.5, P < 0.05). These results suggest that patients with non-cancer related lymphoedema and those with cancer-related lymphoedema form two distinct groups. The former present substantial management problems which are made more complex by late referral.

The MGDS examination: a systematic approach. 3. Part II of the examination: diagnosis, treatment planning, execution of treatment, maintenance and appraisal, writing-up log diaries

This paper is the third in a series of four which present a systematic approach to colleagues who are preparing for and sitting the examination for the Diploma of Membership in General Dental Surgery (MGDS) of The Royal College of Surgeons of England. Although some details may differ, the general principles set out in the four papers apply equally to the MGDS examinations of the other Royal Surgical Colleges.

The MGDS examination: a systematic approach. 2. Part II of the examination: log diary presentation, patient selection and assessment

This paper is the second in a series of four which present a systematic approach to colleagues who are preparing for and sitting the examination for the Diploma of Membership in General Dental Surgery (MGDS) of The Royal College of Surgeons of England. Although some details may differ, the general principles set out in the four papers apply equally to the MGDS examinations of the other Royal Surgical Colleges.

The MGDS examination: a systematic approach. 1. General preparation and Part I of the examination. Member in General Dental Surgery

This paper is the first in a series of four which present a systematic approach to colleagues who are preparing for and sitting the examination for the Diploma of Membership in General Dental Surgery (MGDS) of The Royal College of Surgeons of England. Although some details may differ, the general principles set out in the four papers apply equally to the MGDS examinations of the other Royal Surgical Colleges.

Porcine gastric mucosa associated lymphoid tissue (MALT): stimulation by colonization with the gastric bacterial pathogen, Helicobacter pylori

The presence and features of mucosa associated lymhoid tissue (MALT), analogous to Peyer's patches, in the cardia of the lesser curvature of the porcine stomach are described. The gastric mucosa associated lymphoid tissue (gastric-MALT) is histologically distinct from gastric inflammation associated with colonization by normal gastric microflora and experimental bacterial colonization with a human gastric bacterial pathogen, Helicobacter pylori. The gastric-MALT consists of well-demarcated encapsulated and organized lymphoid tissue, intimately associated with overlying gastric epithelium, centered below the muscularis mucosae and drained by efferent lymphatics. Gastric-MALT was identified in all piglets studied including microbially sterile uninfected gnotobiotes; these structures were enlarged with age and local (gastric) antigenic stimulation. Significant (P < 0.05) expansion of the gastric-MALT occurred in H. pylori-infected gnotobiotic piglets. These distinct morphologic features and location in the cardia suggest that lymphoid elements in the gastric-MALT are involved in gastric antigen processing and regional lymphoid maturation, differentiation and proliferation in the stomach.

Toxicity of chemotherapy

Because anticancer drugs are cytotoxic for normal as well as neoplastic cells, the range of unwanted effects that accompanies their use is broad. Many of the side effects are potentially life-threatening or seriously debilitating. Many are similar to, and readily confused with, direct or indirect (paraneoplastic) consequences of the cancer itself. Recognition of drug side effects is vital for optimal patient care, because early withdrawal of the offending agent and institution of appropriate treatment have the potential to significantly reduce the overall morbidity and mortality associated with the diagnosis of cancer.

Implementing corporate wellness programs: a business approach to program planning

1. Support of key decision makers is critical to the successful implementation of a corporate wellness program. Therefore, the program implementation plan must be communicated in a format and language readily understood by business people. 2. A business approach to corporate wellness program planning provides a standardized way to communicate the implementation plan. 3. A business approach incorporates the program planning components in a format that ranges from general to specific. This approach allows for flexibility and responsiveness to changes in program planning. 4. Components of the business approach are the executive summary, purpose, background, ground rules, approach, requirements, scope of work, schedule, and financials.

The total-contact cast for management of neuropathic plantar ulceration of the foot

Seventy-one neuropathic ulcers of the foot in sixty-six patients were treated with the use of a total-contact cast. The ulcers had been present for an average of five months (range, one to twenty-nine months) and were graded according to the Wagner classification; only patients who had grade-I or grade-II lesions were treated with a total-contact cast. The diameter of the ulcer averaged 3.5 centimeters (range, 1.5 to 15.5 centimeters). Sixty-four (90 per cent) of seventy-one ulcers were healed at a mean of five and one-half weeks (range, one to fourteen weeks). A deep infection developed in two patients during treatment. Twenty-two ulcers (31 per cent) recurred within eighteen months after initial healing; nineteen (86 per cent) of them healed after an average of two weeks in a second cast. Recurrent ulceration was usually associated with an underlying fixed deformity or osseous prominence. The total-contact cast provided safe, reliable, and cost-effective treatment for patients who had neuropathic ulcers of the foot.