Prevalence of prediabetes and type 2 diabetes in children with obesity and increased transaminases in European German-speaking countries. Analysis of the APV initiative

BACKGROUND

Non-alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood.

OBJECTIVES

The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases.

METHODS

Data from the observational multicentre (n = 51), cross-sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines.

RESULTS

The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0-12.8) and 1.4% (95% CI: 1.1-1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI-SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1-15.4) in the mild, 21.9% (95% CI: 18.8-25.1) in the advanced group, 10.7% (95% CI: 9.4-11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17-1.72, 2.26-fold; (1.78-2.86), respectively], the advanced group also for T2DM [2.39 (1.36-4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%).

CONCLUSIONS

Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM.

Comparative pathogenesis of Ebola virus and Reston virus infection in humanized mice

Filoviruses of the genus Ebolavirus include 6 species with marked differences in their ability to cause disease in humans. From the highly virulent Ebola virus to the seemingly nonpathogenic Reston virus, case fatality rates can range between 0% and 90%. In order to understand the molecular basis of these differences, it is imperative to establish disease models that recapitulate human disease as faithfully as possible. Nonhuman primates (NHPs) are the gold-standard models for filovirus pathogenesis, but comparative studies are skewed by the fact that Reston virus infection can be lethal for NHPs. Here we used HLA-A2-transgenic, NOD-scid-IL-2γ receptor-knockout (NSG-A2) mice reconstituted with human hematopoiesis to compare Ebola virus and Reston virus pathogenesis in a human-like environment. While markedly less pathogenic than Ebola virus, Reston virus killed 20% of infected mice, a finding that was linked to exacerbated inflammation and viral replication in the liver. In addition, the case fatality ratios of different Ebolavirus species in humans were recapitulated in the humanized mice. Our findings point to humanized mice as a putative model to test the pathogenicity of newly discovered filoviruses, and suggest that further investigations on Reston virus pathogenesis in humans are warranted.

Complement 3+-astrocytes are highly abundant in prion diseases, but their abolishment led to an accelerated disease course and early dysregulation of microglia

Astrogliosis and activation of microglia are hallmarks of prion diseases in humans and animals. Both were viewed to be rather independent events in disease pathophysiology, with proinflammatory microglia considered to be the potential neurotoxic species at late disease stages. Recent investigations have provided substantial evidence that a proinflammatory microglial cytokine cocktail containing TNF-α, IL-1α and C1qa reprograms a subset of astrocytes to change their expression profile and phenotype, thus becoming neurotoxic (designated as A1-astrocytes). Knockout or antibody blockage of the three cytokines abolish formation of A1-astrocytes, therefore, this pathway is of high therapeutic interest in neurodegenerative diseases. Since astrocyte polarization profiles have never been investigated in prion diseases, we performed several analyses and could show that C3⁺-PrP^Sc-reactive-astrocytes, which may represent a subtype of A1-astrocytes, are highly abundant in prion disease mouse models and human prion diseases. To investigate their impact on prion disease pathophysiology and to evaluate their potential therapeutic targeting, we infected TNF-α, IL-1α, and C1qa Triple-KO mice (TKO-mice), which do not transit astrocytes into A1, with prions. Although formation of C3⁺-astrocytes was significantly reduced in prion infected Triple-KO-mice, this did not affect the amount of PrP^Sc deposition or titers of infectious prions. Detailed characterization of the astrocyte activation signature in thalamus tissue showed that astrocytes in prion diseases are highly activated, showing a mixed phenotype that is distinct from other neurodegenerative diseases and were therefore termed C3⁺-PrP^Sc-reactive-astrocytes. Unexpectedly, Triple-KO led to a significant acceleration of prion disease course. While pan-astrocyte and -microglia marker upregulation was unchanged compared to WT-brains, microglial homeostatic markers were lost early in disease in TKO-mice, pointing towards important functions of different glia cell types in prion diseases.

Richtigstellung: Saphenofemorale Rezidive nach endovenöser thermischer Therapie und nach chirurgischer Therapie

Die Arbeitsgruppe Mumme, Mühlberger, Sidhwa und Hummel haben mit ihrer Arbeit „Alarmierend hohe Rate saphenofemoraler Rezidive nach endovenöser Lasertherapie“ (Phlebologie 2019;48:18–22) mehrere Behauptungen aufgestellt, die nochmals genauer beleuchtet werden müssen.

Abstract P4-02-12: Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients

Background

During the diagnostic work-up of breast carcinomas, immunohistochemistry (IHC) is the currently used method for assessing the expression of estrogen- (ER) and progesterone-receptors (PR), human epidermal growth factor receptor 2 (HER2) as well as of Ki-67 as a marker of tumor cell proliferation. In this study, we analyzed the concordance of these four breast cancer biomarkers between the RT-qPCR- and IHC-based (evaluated by three independent pathologists) determinations.

Methods

The expression of ER/ESR1, PR/PGR, HER2/ERBB2 and Ki-67/MKI67 was determined in 269 FFPE breast cancer samples with tumor content >20% from Chinese patients. For IHC, the samples were freshly cut, stained and assessed by three independent pathologists using the same scoring methods in a blinded fashion (positivity defined as: ER/PR ≥1%, HER2 >2+ and Ki-67 ≥20%). Measurement of the markers on the mRNA level was done on total RNA extracts prepared from whole tissue sections from the same FFPE blocks using the CE-marked RT-qPCR based IVD MammaTyper® on a Cobas® z480 qPCR cycler. IHC assessments of the three pathologists were compared to each other with regard to concordance of positive/negative results. Subsequently, agreement of RT-qPCR and IHC results for each marker and in samples in which the three pathologists had a consensus positive/negative IHC result was determined. Furthermore, we compared the MammaTyper® assessments from a subset of whole FFPE sections to data obtained from paired samples enriched for invasive carcinoma via macrodissection.

Results

From the 269 samples, 256 were available for final analysis. When excluding cases with discordant IHC callings between the three pathologists (6.0% for ER; 7.4% PR; 4.1% Her2; 17.1% Ki-67)) the concordance to the RT-qPCR determination and consensus IHC-based analysis displayed an excellent agreement for ER (OPA: 95.4%, PPA: 97.5%, NPA: 91.5%, Kappa: 0.897), PR (OPA: 91.1%, PPA: 89.6%, NPA: 93.1%, Kappa: 0.820) and HER2 (OPA: 97.1%, PPA: 91.9%, NPA: 100.0%, Kappa: 0.936). For cancer MKI67 mRNA and Ki-67 protein expression, a lower but still good concordance was found (OPA: 90.1%, PPA: 91.8%, NPA: 83.3%, Kappa: 0.707). In addition, we could demonstrate an excellent agreement of quantitative RT-qPCR measurements between whole surface and paired tumor-enriched samples in 99 Chinese breast cancer patients with R2 of 0.927 for ER, 0.926 for PR, 0.923 for HER2 and 0.908 for KI67. Even under highly standardized IHC scoring conditions, the discordance rates in the RT-qPCR marker callings with 0.0% for ESR1, 5.0% for PGR, 3.0% for ERBB2, 13.1% for MKI67 were lower than disagreements by three pathologists on the identical slide.

Conclusion

Standardized determination of the breast cancer biomarkers ER, PR, HER2 and Ki-67 on the mRNA level shows high concordance to a consensus IHC determined by three experienced pathologists indicating that RT-qPCR may be a valid alternative for determining the four breast cancer biomarkers. In line with previous research we could show on a large set of samples that macrodissection is not required for reliable assessment of the four breast cancer markers in clinical FFPE samples.

Citation Format: Teng X, Li X, Xu S, Zhang J, Hartmann K, Laible M, Hipfel R, Bai Y, Ba X, Wu Z, Wirtz RM, Liu S, Ugur S. Comparison of RT-qPCR with consensus immunohistochemistry by three pathologists for ER, PR, HER2 and Ki-67 in Chinese breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-02-12.

Abstract P2-07-08: Standardized prediction of Oncotype DX® risk classes by local RT-qPCR

Background: Recent results from the prospective validation of the Oncotype DX® recurrence score (RS) have underlined the clinical validity of the assay for the prediction of chemotherapy benefit in ER+/HER2- early stage breast cancer patients. Due to health economic restrictions, some patients have no easy access to the test. A pre-selection of tumor samples may help identify patients with a high likelihood to be spared chemotherapy. Histology and semi-quantitative IHC are hence used to select samples for Oncotype testing, but these suffer from intra- and inter-observer variability, especially for Ki-67 which is a main factor in most RS prediction algorithms. We have established and validated a tool for the prediction of RS risk classes (TAILORx cutoff RS ≤25) based on highly standardized, reproducible and locally performed RT-qPCR measurements of ERBB2, ESR1, PGR and MKI67 mRNA using the CE-marked IVD MammaTyper®.

Methods: Total RNA was extracted from whole surface 10μm sections from FFPE breast cancer samples with a known RS result and a tumor cell content ≥20%. ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR on a CFX96 qPCR cycler using the MammaTyper® kit. A prediction model for an RS ≤25 result was established using multivariable logistic regression. Based on this model and the training data two cutoffs for confident prediction of low chemotherapy benefit patients in a clinical setting were established at 95% and 97.5% specificity. The model and the cutoffs were then fixed and validated in a second, separate set of breast cancer samples. ROC analysis was used to characterize predictive power of the continuous values resulting from the prediction model. Positive and negative predictive values for detection of an RS ≤25 result were also determined on the validation samples using the two pre-defined cutoffs.

Results: The sample set for training of the prediction model encompassed 202 samples including 29 samples (14.4%) with an RS >25. In an initial multivariable model with all four markers, PGR and MKI67 were the strongest predictors while the influence of ESR in the model was lower, but still significant. ERBB2 was no significant predictor in this set of ERBB2 negative samples and was therefore excluded from the final model which was based on three markers only. This three marker model achieved an AUC of 0.920 (95% CI: 0.871-0.968) in the training samples. When applying the fixed model from the training dataset to a second separately collected set of 104 samples containing 20 samples (19.2%) with an RS >25, an AUC of 0.883 (95% CI: 0.810-0.955) was documented. When further applying the two predefined cutoffs established in the training set, 45 and 36 of the 104 validation samples (43.3% and 34.6%) had a predicted low chemotherapy benefit result (RS ≤25). Even with the less stringent cutoff, not a single one of the RS >25 cases from the validation cohort was falsely predicted as RS ≤25 sample.

Conclusion: We have established a highly reliable method for prediction of Oncotype DX® low chemotherapy benefit results based on local and cost effective mRNA measurements. This method enables local pathologies to pre-assess routine samples using a highly precise molecular tool and thereby reserve the Oncotype DX® test for cases with ambiguous cancer biology.

Citation Format: Lehr H-A, Aulmann S, Etzrodt A, Laible M, Hartmann K, Gürtler C, Wirtz RM, Sahin U, Varga Z. Standardized prediction of Oncotype DX® risk classes by local RT-qPCR [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-08.

Eine jugendpsychiafrische Befundkarfe für erziehungsschwierige Minderjährige

Es wird über eine jugendpsychiatrische Befundkaxte für verwahrlosungsgefährdete bzw. verwahrloste Minderjährige berichtet. Die Befundkarte ist auf männliche Minderjährige spezifiziert, aber mit sinngemäßen Abänderungen und Ergänzungen auch für weibliche Minderjährige zu verwenden. Sie soll sowohl der gutachtlichen Beurteilung des einzelnen Verwahrlosten als auch der statistischen Analyse größerer Verwahrlostenkollektive dienen.

Für die gutachterliche Beurteilung des einzelnen Verwahrlosten enthält die Befundkarte einen Katalog von Verwahrlosungsmerkmalen, auf welchem der Untersucher die jeweils erhobenen Befunde registrieren und ihre Anzahl und Valenz ablesen kann.

Für die statistische Analyse größerer Verwahrlostenkollektive ist die Befundkarte mit einer Lochkarte kombiniert, auf welcher alle ermittelten Befunde abgelocht und für statistische Berechnungen ausgezählt werden können.

Das methodische Prinzip der Befundkarte wird auch für die gutachtliche Beurteilung und statistische Analyse anderer psychopathologischer Syndrome empfohlen.

Abstract P1-06-11: Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper®

Background: Oncotype DX® recurrence score (RS) has emerged as a recommended risk classifier for patients with ER+/HER2- early-stage breast cancer. While RS is one of the most rigorously studied risk scores, it is also one of the most expensive tests, thus remaining beyond reach for a many patients.

The necessity for an affordable method for estimating risk of recurrence has motivated investigations on the correlation between RS and traditional parameters such as IHC for ER, PR and Ki67. However, semi-quantitative IHC lacks standardization across different laboratories especially for Ki67.

In this study we therefore investigated whether the standardized assessment of HER2, ER, PR, and Ki67 on mRNA level could better serve for prediction of low risk RS cases.

Methods: ERBB2, ESR1, PGR and MKI67 mRNA expression was measured by RT-qPCR in extracts from FFPE breast cancer samples using the MammaTyper® test. Complete data for RS, IHC, grading and mRNA measurement was available for 198 samples. Tumor subtypes according to St Gallen surrogate definition from 2013 were assigned based on binary mRNA marker classification (pos/neg) according to pre-defined cut-offs. Subtype results were compared to RS risk classes based on commercial and TAILORx-trial cut-offs. RS low risk classification (RS ≤25) based on four IHC markers and grading was estimated using the online tool breastrecurrenceestimator.onc.jhmi.edu and compared to observed RS classes.

Finally, the prediction of continuous RS values by mRNA or semi-quantitative IHC measurement was compared by linear regression and subsequent ROC analysis of prediction models.

Results: The distribution of RS risk classes in the set of samples with full data was 21% RS 0-10, 39% RS 11-17, 27% RS 18-25, 7% RS 26-30 and 7% RS >30. MammaTyper® called 38% (76) of the samples as Luminal A-like. From these samples 70% and 99% had RS values below 18 and 25 respectively. Only 1 MammaTyper® Luminal A-like sample had an RS >30.

Estimation of RS according to the online tool resulted in classification of 61% (121) of the samples as low risk (RS ≤25). Of these 74% and 98% of samples had observed RS values below 18 and between 18 and 25 respectively. 2 and 1 samples called as low risk by the online tool had an RS of 26-30 and >30 and, respectively.

In linear regression analysis of IHC against RS only PR and Ki67 were significant predictors (p-values <0.0001 and 0.0128) while when using mRNA values ESR1, PGR and MKI67 were found as predictors of RS in the multivariate model (all p-values <0.0001). On a training set (67% of samples) the IHC based prediction model was correlated to the observed RS with an R2 of 0.305 whereas the mRNA based model achieved an R2 of 0.489. When the models were applied to training and validation dataset (33% of samples) for prediction of an RS >25 result, the IHC based model had AUCs of 0.887 and 0.836, respectively, while the mRNA based model achieved AUCs of 0.909 and 0.899, respectively.

Conclusion: mRNA based prediction of RS was considerably better than prediction based on IHC. As Ki67 IHC standardization is reaching its limits, local gene expression measurements with their high degree of standardization could serve as a safer way for prediction of Oncotype low risk results.

Citation Format: Lehr H-A, Aulmann S, Laible M, Etzrodt A, Hartmann K, Gürtler C, Sahin U, Varga Z. Prediction of oncotype DX® results based on local gene expression measurements by MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-11.

Abstract P3-08-14: Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper®

Background:

Estrogen receptor (ER/ESR1), progesterone receptor (PR/PGR) and epidermal growth factor receptor 2 (HER2/ERBB2) are routinely assessed by immunohistochemistry (IHC) during workup of breast cancer samples. The routine use of Ki67 (MKI67) IHC assessment in the context of breast cancer subtyping, however, remains controversial, due to poor reproducibility and lack of standardization.

The MammaTyper® test is an in-vitro diagnostic (IVD) test which measures the expression status of the four breast cancer biomarkers ERBB2, ESR1, PGR and MKI67 on the mRNA level via reverse transcription-quantitative PCR (RT-qPCR) and has demonstrated a high degree of reproducibility in the assessment of the four markers.

In this retrospective analysis we assessed the prognostic power of molecular subtyping by MammaTyper® in archived samples from low risk early breast cancers treated with adjuvant endocrine therapy only.

Methods:

ER+/HER2- (according to initial diagnosis) FFPE breast cancer samples from patients treated with adjuvant endocrine therapy only were obtained from 6 different centers. Tumor cellularity was assessed by H&E staining and RNA was extracted from samples with a tumor cell content of ≥20% using a bead-based RNA purification kit (RNXtract®). Total RNA was then used as input for MammaTyper® RT-qPCR. Expression values were classified as positive or negative for each marker based on predefined cutoff values. Tumor subtypes were assigned to each sample based on the combination of binary (pos/neg) single marker expression status according the St Gallen surrogate subtype definition. Distant disease free survival of Luminal A-like samples vs. samples with other subtypes was assessed by Kaplan Meier analysis and Cox regression using SAS version 9.4.

Results:

The final analysis included 319 samples with sufficient tumor cellularity and RNA content for reliable analysis. The rate of distant recurrence in the analyzed set was 8.5%. Median follow up was 7.8 years. The MammaTyper® test called 60% (192) of samples as Luminal-A-like (4.7% (9) distant events), 37% (119) as Luminal B-like (HER2 negative) (13.4% (16) distant events), 1.3% (4) as Triple negative (ductal) (25% (1) distant events), 0.6% (2) as “not defined according to St Gallen” (ESR1-/PGR+) (50% (1) distant events) and 0.6% (2) as Luminal B-like (HER2 positive) (no distant events).

When comparing Luminal A-like samples with the samples of the other subtypes in survival analysis, Luminal A-like samples had a significantly better distant disease free survival when assessing samples from patients with pN0 status (278) (p=0.0177, HR=0.344 (95% CI 0.137-0.866), pN1 status (0-3 affected nodes) (314) (p=0.0153, HR=0.374 (95% CI 0.163-0.855) as well as for all samples (p=0.0032, HR=0.319 (95% CI 0.143-0.711).

Conclusion:

Determination of HER2, ER, PR and Ki67 mRNA levels allows molecular subtyping according to the St Gallen surrogate subtype definition. Low risk of distant recurrence could be confirmed for the MammaTyper® Luminal A-like samples suggesting that for this patient group endocrine treatment alone may be sufficient. The high degree of standardization of mRNA measurement may drive the use of the Ki67/MKI67 biomarker in routine breast cancer pathology.

Citation Format: Laible M, Hartmann K, Gürtler C, Anzeneder T, Weber S, Keller T, Sahin U. Prediction of distant recurrence in low risk early breast cancer by RT-qPCR based subtyping using MammaTyper® [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-08-14.

Akuter blutiger Durchfall als Vorstellungsgrund bei einem Hund mit primärem Hypoadrenokortizismus

Ein 7 Jahre alter, männlich-kastrierter Schäferhundmischling wurde wegen akuten blutigen Erbrechens und wässrig-blutigen Durchfalls vorgestellt. Aufgrund klinischer Präsentation, unspezifischer Laborwertveränderungen, unauffälliger Elektrolytwerte und schneller klinischer Besserung auf Infusionstherapie wurde die Diagnose “hämorrhagische Gastroenteritis” (HGE) gestellt. Bei erneuter Vorstellung des Hundes wegen Leistungsschwäche einen Monat später bestanden Elektrolytverschiebungen (Hyperkaliämie und Hyponatriämie), die charakteristisch für einen typischen Hypoadrenokortizismus sind. Mittels ACTH-Stimulationstest wurde eine Unterfunktion der Nebennierenrinde bestätigt. Dieser Fallbericht zeigt, dass sich Patienten in einer Addison-Krise mit akutem hämorrhagischem Durchfall präsentieren können. Durch Erbrechen und Durchfall kann es zu einem Kaliumverlust über den Gastrointestinaltrakt kommen, wodurch typische Elektrolytverschiebungen für einen Morbus Addison verschleiert werden. Im Zweifelsfall sollte bei jedem Patienten mit blutigem Durchfall zum Ausschluss eines Hypoadrenokortizismus eine Bestimmung der basalen Kortisolkonzentration erfolgen.

Feline lower urinary tract disease in a German cat population

Objective: To investigate epidemiologic data, clinical signs, results of urinalysis and causes of lower urinary tract disease in a German veterinary hospital population of cats and to determine if the demographic data, history, clinical signs and urinalysis results correlate with a particular etiology. Materials and methods: Cats presented with signs of feline lower urinary tract disease (FLUTD) with a documented history and physical examination, a complete urinalysis (urine specific gravity, urine dipstick and sediment, urine culture) of urine obtained by cystocentesis or catheterization, and diagnostic imaging of the urinary tract were included into the study. Cats that had received a previous treatment during the same episode of FLUTD were excluded. Results: A total of 302 cats were included into the study. Cats with FLUTD presented throughout the seasons with similar frequency. The most common diagnosis was feline idiopathic cystitis (FIC) (55.0%), followed by bacterial urinary tract infection (UTI) (18.9%), urethral plug (10.3%) and urolithiasis (7.0%). Urethral obstruction was significantly more frequent in cats with FIC than in cats with UTI. Cats with FIC and urethral plugs were significantly younger and had significantly higher body weights than cats with UTI and neoplasia. FIC and urethral plugs were significantly more common causes of FLUTD in cats younger than 10 years compared to cats that were 10 years or older (65.2% versus [vs.] 35.8% and 13.3% vs. 3.0%), while the incidences of UTI and neoplasia increased with age (12.9% vs. 41.8% and 1.0% vs. 13.4%). Conclusion and clinical relevance: FIC and UTI are the most common diagnoses in cats with FLUTD, with a significant age-related difference in incidence.

The Rivalta’s test as a diagnostic variable in feline effusions – evaluation of optimum reaction and storage conditions

Objective: The Rivalta’s test is used to diagnose feline infectious peritonitis (FIP) in cats with effusion. Only little information on the influence of sample storage and reaction conditions on test results is available, and diagnostic sensitivity and specificity to diagnose FIP vary considerably between few available studies. This study determined the influence of storage of effusion, modifications on reaction conditions, and inter-observer variation. Material and methods: The Rivalta’s test was repeated up to 21 days after storage at room temperature, in the refrigerator, or freezer. The test was performed by two independent, blinded investigators. It was also performed using different volumes of acetic acid, different acids, and different kinds of water. Results: Even after storage for 21 days, test results were comparable. While inter-observer variation revealed substantial disagreement, different modifications in performance showed no major influence on test outcome. Conclusion: The Rivalta’s test seems to be a very robust test concerning storage conditions. Modifications in reaction condition also do not substantially influence outcome. However, the test is subjective and depends on the evaluating person.

Comparison of auricular and rectal temperature measurement in normothermic, hypothermic, and hyperthermic dogs

Objective: Measurement of rectal temperature is the most common method and considered gold standard for obtaining body temperature in dogs. So far, no study has been performed comparing agreement between rectal and auricular measurements in a large case series. The purpose of the study was to assess agreement between rectal and auricular temperature measurement in normothermic, hypothermic, and hyperthermic dogs with consideration of different environmental conditions and ear conformations. Materials and methods: Reference values for both methods were established using 62 healthy dogs. Three hundred dogs with various diseases (220 normothermic, 32 hypothermic, 48 hyperthermic) were enrolled in this prospective study. Rectal temperature was compared to auricular temperature and differences in agreement with regard to environmental temperature, relative humidity, and different ear conformations (pendulous versus prick ears) were evaluated using Pearson’s correlation coefficient and Bland-Altman analysis. Results: Correlation between rectal and auricular temperature was significant (r: 0.892; p < 0.01). However, Bland-Altman plots showed an inacceptable variation of values (bias: 0.300 °C; limits of agreement: –0.606 to 1.206 °C). This variation was above a maximal clinical tolerance of 0.3 °C, which was established by experts’ opinion (n = 16). Relative humidity had a significant influence (p = 0.001), whereas environmental temperature did not. Conclusion: Variation between the two methods of measuring body temperature was clinically unacceptable. Clinical relevance: Although measurement of auricular temperature is fast, simple, and well tolerated, this method provides a clinically unacceptable difference to the rectal measurement.

Immune mediated destruction of platelets in dogs with heat stroke: A prospective study

Objective: Severe thrombocytopenia is a common sequelae to heat stroke in dogs. So far it has been hypothezised that it is due to disseminated intravascular coagulation. We hypothezised that it is due to immune mediated destruction via antiplatelet antibodies. Material and methods: Prospective evaluation of dogs with heat stroke from May 2005 to August 2008. Dogs that developed severe thrombocytopenia within 5 days of admission were included in the study. All dogs were treated with a standardized treatment protocol. In addition, they received either immunoglobulins or prednisolone. Results: Six dogs were presented with heat stroke during that time period. Four developed a severe thrombocytopenia. All four dogs tested positive for antiplatelet antibodies and did not have elevated D-Dimers at that time. Platelet count in three dogs recovered fully, one dog was euthanized due to liver and renal failure. Conclusion: In those cases thrombocytopenia was due to immune mediated destruction not due to DIC. Clinical rele-vance: Due to the severity of the thrombocytopenia and the high risk for bleeding in those patients, immunosuppressive therapy in addition to DIC prophylaxis should be discussed.

Fallbericht und Literaturübersicht kutaner Dirofilariose

Gegenstand und Ziel: Der Fallbericht erörtert das diagnostische Vorgehen und differenzialdiagnostische Überlegungen bei Patienten mit Mikrofilarämie und negativem Dirofilaria-immitis-Antigentest und diskutiert die Infektion mit Dirofilaria repens und deren Therapie. Material und Methode: Bei einem Hund aus Ungarn wurden im Blutausstrich Mikrofilarien gefunden. Die weitere Diagnostik zur Differenzierung der Mikrofilarien umfasste einen Dirofilaria-immitis-Antigentest, eine Polymerasekettenreaktion zum Nachweis von Dirofilaria immitis und Dipetalonema reconditum sowie eine Saure-Phosphatase-Reaktion zur Diagnose einer Infektion mit Dirofilaria repens. Ergebnisse: Mittels der Saure-Phosphatase-Reaktion konnte eine Infektion mit Dirofilaria repens diagnostiziert werden. Die Therapie gegen die Mikrofilarien erfolgte mit Selamectin. Schlussfolgerung und klinische Relevanz: Bei mikrofilarämischen Patienten muss differenzialdiagnostisch neben einer Infektion mit Dirofilaria immitis eine Infektion mit anderen, weniger pathogenen Parasiten in Betracht gezogen werden, da sich die Notwendigkeit einer Therapie und das Therapieregime je nach Infektion deutlich unterscheiden.

Messung der myokardialen Geschwindigkeit mittels Gewebe-Doppler beim gesunden Hund

Ziele der Studie waren die Evaluierung der myokardialen Gewebegeschwindigkeit mittels Gewebe-Doppler (Tissue Velocity Imaging, TVI) hinsichtlich der Reproduzierbarkeit sowie die Erstellung von Referenzwerten für die systolische und diastolische longitudinale Myokardbewegung. Weiterhin wurde der Einfluss von Geschlecht, Herzfrequenz, Alter, Gewicht und Rasse untersucht. Material und Methoden: Das Probandenkollektiv umfasste 199 gesunde Hunde. Systolische und diastolische longitudinale TVI wurden mittels Farb-Gewebe-Doppler im linksapikalen Vierkammerblick für rechte freie Wand, Septum und linke freie Wand einzeln aufgezeichnet und ausgewertet. Ergebnisse: Die Variationskoeffizienten für die Intrareader-Variabilität lagen alle unter 10%. Die Variationskoeffizienten für die Interreader-Variabilität unterschritten 12,4%. Das TVI wies eine heterogene Verteilung im Myokard mit einem apikobasalen Geschwindigkeitsgradienten für systolische und diastolische Parameter auf. Es zeigte keine Abhängigkeit vom Geschlecht. Dagegen beeinflussten Herzfrequenz, Alter, Gewicht und Rasse das TVI signifikant. Schlussfolgerung und klinische Relevanz: Das TVI stellt eine Technik mit guter Reproduzierbarkeit dar. Nachteil des Verfahrens ist die Abhängigkeit von Herzfrequenz, Alter, Gewicht und Rasse der Hunde. Die Studie belegt, dass das TVI beim Hund als neue Methode in der Echokardiographie eingesetzt werden kann. Diese Arbeit stellt eine Grundlage für weitere Studien auf dem Gebiet der Gewebe-Dopplertechnik dar und liefert für den klinischen Einsatz Referenzwerte für Hunde verschiedener Gewichtsgruppen.

A transatlantic perspective on the integration of immuno-oncology prognostic and predictive biomarkers in innovative clinical trial design

Immuno-therapeutics aim to activate the body's own immune system against cancer and are one of the most promising cancer treatment strategies, but currently limited by a variable response rate. Biomarkers may help to distinguish those patients most likely to respond to therapy; they may also help guide clinical decision making for combination therapies, dosing schedules, and determining progression versus relapse. However, there is a need to confirm such biomarkers in preferably prospective clinical trials before they can be used in practice. Accordingly, it is essential that clinical trials for immuno-therapeutics incorporate biomarkers. Here, focusing on the specific setting of immune therapies, we discuss both the scientific and logistical hurdles to identifying potential biomarkers and testing them in clinical trials.

Cutaneous ulcers following hydroxyurea therapy

Hydroxyurea (HU) is usually a well tolerated antineoplastic agent and is commonly used in the treatment of chronic myeloproliferative diseases. Dermatological side effects are frequently seen in patients receiving longterm HU therapy. Cutaneous ulcers have been reported occasionally.

We report on four patients with cutaneous ulcers whilst on long-term hydroxyurea therapy for myeloproliferative diseases. In all patients we were able to reduce the dose, or stop HU altogether and their ulcers markedly improved. Our observations suggest that cutaneous ulcers should be considered as possible side effect of long-term HU therapy and healing of the ulcers can be achieved not only by cessation of the HU treatment, but also by reducing the dose of hydroxyurea for a limited time.

Die Sklerotherapie mit Luft- oder CO2-O2-Schaum

Ziel und Durchführung: Die Wirksamkeit und Nebenwirkungen der ultraschallgeführten Polidocanol-Schaumsklerosierung (FS) wurde in dieser Anwendungsbeobachtung (AWB) für Luft-FS und CO2-O2-FS über ein internetbasiertes Protokoll dokumentiert.

Material und Methoden: An der AWB nahmen 11 Zentren teil, neun Zentren arbeiteten mit Luft-FS, zwei Zentren mit CO2-O2-FS. Verwendet wurden zugelassene Medikamente. In 553 Behandlungen wurde bei 376 Patienten für die Luft-FS Polidocanol (Aethoxysklerol®, Kreussler) mit 0,25 % bis 4 % verwendet. In 152 Behandlungen erfolgte bei 125 Patienten die CO2-O2-FS mit Polidocanol 1–3 %, mit CO2(Laparox®, Linde) und mit O2 (Conoxia®, Linde) im Verhältnis 70:30. Die Abfüllung bei der CO2-O2-FS erfolgte steril mittels der Massendurchfluss-Messtechnik. Eine klinische Ab-schlussuntersuchung und Ultraschallkontrolle erfolgte zirka 4–6 Wochen nach der letzten Therapie.

Ergebnisse: Krampfadern größer als 3 mm wurden bei Luft-FS im Durchschnitt mit 5,3 ml, bei der CO2-O2–FS mit 8,2 ml behandelt; der Unterschied war signifikant. Nebenwirkungen: Hyperpigmentierungen: Luft 23,3 %, CO2-O2 13,6 %; Hämatom: Luft 14,4 %, CO2-O2 2,5 %; Migräne: Luft 0,1 %, CO2-O2 keine; Matting: Luft 1,4 %, CO2-O2 kein; Brennen: Luft 11,7 %, CO2-O25,5 %; Thrombo-sen: Luft 1,1 %, CO2-O2 1,6 %; Sehstörungen: Luft 0,2 %, CO2-O2 2 %.

In beiden Gruppen ergab sich kein Unterschied in der Sicherheit bei durchschnittlich 5,3 ml Schaum in der Luft-FS und 8,2 ml Schaum in der CO2-O2-FS. Lokale Nebenwirkungen waren in der CO2-O2-Gruppe geringer; in dieser Gruppe war die Behandlung effektiver, da größere Vo-lumen sicher angewandt werden konnten. In beiden Gruppen traten keine zentralneurologischen Nebenwirkungen auf, alle Sehstörungen waren innerhalb von 20 Minuten ohne zusätzliche Therapie spontan reversibel.

Conclusio: Die hier publizierten Ergebnisse stimmen mit über 1 000 Behandlungen für CO2-O2-FS aus der Literatur überein. Unter CO2-O2-FS trat in diesen Arbeiten keine TIA oder Apoplexe auf. Die CO2-O2-FS erscheint ins-gesamt für größere Krampfadern wirksamer als die Luft-FS. Die Verwendung der physiologischen Gase CO2-O2 in der FS ist möglicherweise sicherer als die Luft-FS. Klare Beweise stehen hier noch aus und die mögliche Komplikation der iatrogenen Gasembolie muss immer be-rücksichtigt werden.

Sensitivity and specificity of an in-clinic point-of-care PCR test for the diagnosis of canine leishmaniasis

Canine leishmaniasis is an important infectious disease worldwide. Although commonly used, antibody tests are often falsely negative, and in such cases direct detection of the pathogen, such as PCR, is necessary. However, PCR is only performed in specialized laboratories and not available in all localities. The aim of this study was to compare the sensitivity and specificity of an in-clinic point-of-care (ICPOC) PCR for the diagnosis of canine Leishmania spp. infection to those of a well characterized reference real-time PCR. In this study, 515 samples from 251 dogs (201 EDTA blood samples, 244 conjunctival swabs, 19 lymph node aspirates, and 51 bone marrow aspirates) were collected prospectively and analysed for the presence of Leishmania DNA using an ICPOC test. The results were compared to those of a reference real-time PCR for identification of Leishmania kinetoplast minicircle DNA. Sensitivity and specificity with 95% confidence interval (CI 95%) were determined. Specificity was 100% for all samples examined. Sensitivity was 57.1% (CI 95%, 34.0-78.2) in bone marrow aspirates, 58.8% (CI 95%, 32.9-81.6) in lymph node aspirates, 46.9% (CI 95%, 32.5-61.7) in conjunctival swabs, and 10.0% (CI 95%, 3.3-21.8) in blood. The ICPOC PCR was easy to perform and was reliable in the case of positive test results. A negative result, however, did not exclude infection and therefore requires further diagnostics.

Midostaurin: a magic bullet that blocks mast cell expansion and activation

Clinically relevant features in patients with systemic mastocytosis (SM) include the cosmetic burden of lesional skin, mediator-related symptoms, and organ damage resulting from mast cell (MC) infiltration in advanced forms of SM. Regardless of the SM variant, expansion of neoplastic MC in the skin and other organs is triggered by mutant forms of KIT, the most prevalent being D816V. Activation of MC with subsequent release of chemical mediators is often caused by IgE-dependent mechanisms in these patients. Midostaurin, also known as PKC412, blocks the kinase activity of wild-type KIT and KIT D816V, counteracts KIT-dependent growth of neoplastic MC, and inhibits IgE-dependent mediator secretion. Based on this activity-profile, the drug has been used for treatment of patients with advanced SM. Indeed, encouraging results have been obtained with the drug in a recent multi-center phase II trial in patients with advanced SM, with an overall response rate of 60% and a substantial decrease in the burden of neoplastic MC in various organs. Moreover, midostaurin improved the overall survival and relapse-free survival in patients with advanced SM compared with historical controls. In addition, midostaurin was found to improve mediator-related symptoms and quality of life, suggesting that the drug may also be useful in patients with indolent SM suffering from mediator-related symptoms resistant to conventional therapies or those with MC activation syndromes. Ongoing and future studies will determine the actual value of midostaurin-induced MC depletion and MC deactivation in these additional indications.