Phase II study of oral platinum drug JM216 as first-line treatment in patients with small-cell lung cancer

PURPOSE

This multicenter phase II trial was performed to determine tumor efficacy and tolerance of the oral platinum drug JM216 in patients with small-cell lung cancer (SCLC).

PATIENTS AND METHODS

Patients with SCLC limited disease unfit for intensive chemotherapy or those with extensive disease received JM216 120 mg/m(2)/d for 5 consecutive days every 3 weeks. Individual dose escalation to 140 mg/m(2)/d was allowed if toxicity was </= grade 2 according to the National Cancer Institute Common Toxicity Criteria. Tumor response was evaluated according to World Health Organization criteria.

RESULTS

Twenty-seven patients were assessable for toxicity and 26 for tumor response. Eighty-eight cycles were administered. Common Toxicity Criteria grade 3 and 4 hematologic toxicities were neutropenia in 15.9% and 3.7%, lymphocytopenia in 47.6% and 17.1%, and thrombocytopenia in 19.5% and 10.3% of cycles, respectively. One patient suffered from neutropenic fever. Nausea, vomiting, and diarrhea were the most common nonhematologic toxicities. Except for grade 4 diarrhea in one patient, no grade 4 nonhematologic toxicity was observed. No severe neurotoxicity or nephrotoxicity was observed. Tumor response rate was 10 of 26 (38%; 95% confidence interval, 19% to 58%), excluding five unconfirmed partial responses. No complete responses were observed. Median overall time to progression was 110 days (range, 5 to 624 days). Median overall survival time was 210 days (range, 5 to 624 days).

CONCLUSION

Oral JM216 is active in previously untreated patients with SCLC and shows mild toxicities.

[Medical training therapy in lumbar syndromes]

Chronic low back pain can be considered to be one of the most frequently treated and most costly diseases in modern industrial societies. Dysfunctions and imbalances of the spine-supporting muscles increase the risk of low back pain. Consequently preventive treatment and rehabilitation have to aim at preserving and restoring the full capacity of the spine-supporting muscles as well as training coordination and spine-friendly behaviour. In addition to various measures of pain therapy, physiotherapeutic treatment including neuro-physiotherapy, physical treatment (eg electrotherapy), balneotherapy and supportive behavioural training, medical rehabilitation therapy (MRT) ranks among the most effective ways of treating low back pain. MRT applies guidelines and methods of exercise methodology within medically indicated programmes of preventive treatment and rehabilitation. Various objectives of MRT are outlined with special regard to the stages of MRT treatment, emphasizing positive adaptation of the neuro-muscular system in the course of rehabilitation. Physicians are responsible for MRT diagnosis and control. Taking into account the base disorder and the progress of therapy physiotherapists and the physicians in charge determine MRT objectives and treatment strategies.

Prostate biopsy schemes: 3-D visualization-based evaluation

We have developed a prostate needle biopsy visualization system for the evaluation and optimization of biopsy schemes. Three-dimensional (3-D) prostate surface models have been reconstructed from the digitized whole-mount radical prostetactomy specimens with localized cancers. We have conducted evaluation of five major biopsy schemes with a total of 201 3-D prostate models. These are sextant, 10-pattern, 12-pattern, 14-pattern, and the 5-region schemes. The 10- and 12-pattern biopsy schemes had a 99.0% detection rate, while the rate of traditional sextant biopsy scheme was only 72.6%. The 5-region biopsy scheme had a 90.5% detection rate and the 14-pattern, which includes all the biopsies used in the above schemes, added only one additional positive case (99.5%). Our results suggest that biopsy schemes that use laterally placed biopsies based on the five region anatomical model are superior to the routinely used sextant biopsy scheme. Significant correlation is found between the tumor volume and the positive needle core volume for each of these five schemes. The 10-pattern scheme is the best in cancer detection among these five biopsy schemes.

[In vitro evaluation of potentially effective gemcitabine combination therapy for exocrine pancreatic carcinoma]

The aim of the present study was to define potentially synergistic gemcitabine drug combinations for the treatment of pancreatic adenocarcinoma by using a tumour-specific in vitro screening system. The anticancer drug screening system used for these experiments consisted of four different established human pancreatic adenocarcinoma cell lines (BxPc-3, Panc-1, ASPC-1, Ca-pan-1) and the Microculture Tetrazolium (MTT) Assay for quantification of cytotoxic drug effects. To define single agent activities, dose-response curves, IC 50 values, and in order to validate the test system, in a first step gemcitabine and several conventional anticancer drugs including 5-FU, cisplatin, epirubicin, and mitomycin C were tested at 10 different concentrations ranging from 0.001 to 100 micrograms/ml. The effectiveness of various gemcitabine combinations was subsequently determined by using clinically relevant in vitro drug concentrations, and was rated as synergistic, additive or subadditive according to the criteria of Aapro. Overall, a heterogeneous chemosensitivity pattern was noted within the four tested cell lines. In agreement with the known chemotherapeutic refractoriness of pancreatic cancer, major cytotoxic effects were only seen with use of rather high drug concentrations. Investigation of various drug exposure times revealed a superior antiproliferative activity of gemcitabine and the other compounds in case of prolonged incubation. During subsequent drug combination experiments, gemcitabine + cisplatin and gemcitabine + epirubicin resulted in synergistic activity in 2/4 cell lines each. As opposed to the poor activity of single agents, a > 50% growth inhibition (in vitro response) was noted in 3 and 2 cell lines, respectively. Experimental data obtained with this pancreatic cancer specific in vitro screening system suggest that dose escalation or prolonged administration of gemcitabine, as well as the combination of this drug with cisplatin or epirubicin might result in improved therapeutic results. Encouraging preliminary results obtained in phase II studies seem to support the potential clinical relevance of the described disease-oriented screening system.

Principles underlying the organization of movement initiation from quiet stance

The purpose of this study was to determine common principles underlying the programming of movement initiation from quiet stance. Subjects were asked to initiate gait, step over a ruler, or to step over a 10 cm high obstacle at a self-paced speed and as fast as possible. The independent variables were initiation condition (gait initiation, stepping over a ruler or obstacle) and initiation speed (self-paced and as fast as possible). The dependent measures for the stance limb only were the latency between postural soleus (S(1)) EMG inhibition and tibialis anterior (TA) EMG onset, the duration of both TA and soleus (S(2)) activity following TA, duration and slope, impulse, and peak forces of the anterior-posterior (Fx) ground reaction force. Selected timing events were also monitored. Analysis of variance was used to determine main and interaction effects. The following results were obtained. (1) The interval from the inhibition of S(1) postural activity to the onset of TA remained invariant between all conditions. (2) The duration of TA increased and S(2) decreased with an increase in speed of initiation. There was no difference in TA and S(2) duration between the initiation conditions. (3) Time to heel-off remained invariant for all conditions. (4) Prior to heel-off all force variables increased with initiation speed but were similar between initiation conditions. After heel-off force variables were different between speeds and conditions being greater for fast speed and stepping over the obstacle. Two conclusions may be drawn from this study. First, the results indicate that gait initiation consists of two, highly coordinated motor programs. Heel-off of the stance limb is the division between these two programs. Second, our findings also suggest that gait initiation and stepping are governed by the same motor programs.

Simultaneous myocardial revascularization and aortic valve replacement: stentless versus stented bioprostheses

Implantation of stentless aortic valve prostheses is more time-consuming than implantation of conventional stented bioprostheses. Simultaneous myocardial revascularization can result in a considerably prolonged operation time. We reviewed our patients with regard to surgical aspects in the specific patient cohorts. From April 1996 to April 1999, 303 patients were operated for aortic valve disease with or without concomitant coronary artery revascularization. Mean age was 75 years, ranging between 36 and 90 years. Using the Medtronic Freestyle valve, the following techniques of implantation were used: subcoronary technique, 163 patients, 61.5%; root inclusion technique, 7 patients, 3.5%; total root replacement, 30 patients, 15%. Total hospital mortality rate was 5.6%, reflecting age and concomitant disease of these patients. For isolated aortic valve replacement, the mortality rate was 4.7% and 6.7% for combined procedures. Coronary artery patients who are not suitable for stentless valve implantation owing to extensive aortic root calcification have a higher perioperative mortality rate. Compared with the isolated valve replacement and despite more extensive surgery and prolonged operative time, simultaneous myocardial revascularization in patients with stentless prostheses implantation can be performed without an increased risk.

By-product formation during exposure of respiring Saccharomyces cerevisiae cultures to excess glucose is not caused by a limited capacity of pyruvate carboxylase

Upon exposure to excess glucose, respiring cultures of Saccharomyces cerevisiae produce substantial amounts of ethanol and acetate. A possible role of a limited anaplerotic capacity in this process was investigated by overexpressing pyruvate carboxylase and by replacing it with a heterologous enzyme (Escherichia coli phosphoenolpyruvate carboxylase). Compared to the wild-type, neither the pyruvate carboxylase (Pyc)-overexpressing nor the transgenic strain exhibited reduced by-product formation after glucose pulses to aerobic glucose-limited chemostat cultures. An increased intracellular malate concentration was observed in the two engineered strains. It is concluded that by-product formation in S. cerevisiae is not caused by a limited anaplerotic capacity.

Expression of cytochrome P450scc mRNA in the hippocampus of patients with temporal lobe epilepsy

The hippocampus is one of the target areas of neurosteroidal action. Expression of cytochrome P450scc (P450scc, CYP11A1), one of the key enzymes in steroid metabolism, results in de novo synthesis of the neurosteroid pregnenolone. We used a competitive RT-PCR assay to quantify the amount of P450scc mRNA in hippocampal tissue specimens obtained at neurosurgery from patients with temporal lobe epilepsy (TLE). P450scc mRNA is expressed approximately 200 times lower in the hippocampus than in adrenal tissue known for high P450scc expression. P450scc mRNA concentrations were significantly higher in the hippocampus of women (1.72 +/- 0.36 aU, arbitrary units; mean +/- s.e.m.) than of men (0.92 +/- 0.15 aU, p < 0.004). Our data show for the first time the sex-dependent expression of P450scc mRNA in the hippocampus of patients with TLE.

Phase I clinical and pharmacological study of oral methoxymorpholinyl doxorubicin (PNU 152243)

PURPOSE

The methoxymorpholinyl doxorubicin analogue PNU 152243 was brought into clinical studies because of preclinical observations of its non-cross-resistance in mdr tumor cells, dose-limiting neutropenia, lack of cardiotoxicity, and antitumor activity after oral administration.

METHODS

PNU 152243 was given orally every 4 weeks to 21 adults with a variety of solid tumors at doses ranging from 59 to 940 microg/m(2). Antiemetic prophylaxis with 5-HT3 antagonists and steroids, given i.v. on day 1 and orally on days 2-8, was required beginning with the dose of 118 microg/m(2). The plasma pharmacokinetics of PNU 152243 were determined by an HPLC method with fluorescence detection. The in vitro myelotoxic effects on granulocyte macrophage-colony forming cells (GM-CFC) of the plasma from 11 patients, obtained 4 and 6 h after treatment at all dose levels, were also assessed.

RESULTS

Neutropenia was the main hematologic toxic effect and the maximum tolerated dose (MTD) for myelotoxicity was 940 microg/m(2), with neutropenia grade 3-4 in two of three patients. Dose-dependent nausea and vomiting were dose-limiting and the MTD for gastrointestinal toxicity was fixed at 820 microg/m(2), with grade 4 vomiting in one of two patients. Other frequent toxic effects were diarrhea and fatigue. Peak levels of PNU 152243 were achieved 4 h after dosing. Dose-dependent Cmax and AUCExp, and significant interpatient variability of the main pharmacokinetic parameters were found. Very low levels of the 13-dihydrometabolite PNU 155051 were detected only at the highest doses. The hematotoxicity tests showed a <70% colony growth inhibition with no correlation between the growth inhibition effect and the degree of myelotoxicity in the same patient. Plasma concentrations of PNU 152243 were 1000 times lower than the concentration inhibiting the growth of 70% of colonies. No objective tumor responses were seen.

CONCLUSIONS

Owing to the occurrence of severe and prolonged nausea and vomiting, the clinical development of oral PNU 152243 was discontinued. The higher-than-expected neutropenia and its lack of relationship with plasma levels of PNU 152243 and its 13-dihydroderivative PNU 155051 might be related to the formation of potent cytotoxic metabolites present in human plasma at undetectable concentrations and with prolonged half-life, as suggested by hematotoxicity tests performed with plasma from patients in GM-CFC assays.

[Ulcerative stomatitis as clinical clue to inadvertent methotrexate overdose]

Gastrointestinal side effects and the development of toxic liver fibrosis are well-known side effects of low dose methotrexate therapy. A female patient receiving a long term low dose methotrexate therapy for a seronegative chronic polyarthritis developed an ulcerative stomatitis, as clinical clue to an inadvertently given methotrexate overdose. A summary of other side effects of methotrexate and of oral side effects of other cytostatic agents and immunosuppressive drugs is given.

The non-steroidal anti-inflammatory drug tepoxalin inhibits interleukin-6 and alpha1-anti-chymotrypsin synthesis in astrocytes by preventing degradation of IkappaB-alpha

Tepoxalin is a structurally and functionally novel non-steroidal anti-inflammatory drug (NSAID) with potent anti-inflammatory and analgesic properties. Apart from its inhibitory effect on cyclooxygenase activity, tepoxalin is able to inhibit production of cytokines in peripheral cells outside the CNS. No data, however, are available concerning the effects of this drug in the CNS. Since cytokines such as interleukin-1 (IL-1) or interleukin-6 (IL-6) as well as acute-phase proteins such as alpha1-anti-chymotrypsin (ACT) participate in the etiopathology of Alzheimer's disease (AD), we were interested whether tepoxalin is able to inhibit the synthesis of these immunomodulators in primary rat microglia and astrocytes as well as in the human astrocytoma cell line U373 MG. We found that tepoxalin markedly inhibits IL-1beta-induced IL-6 and ACT synthesis in astrocytes and the synthesis of IL-1beta and IL-6 in lipopolysaccharide (LPS)-stimulated microglial cells. Electrophoretic mobility shift and reporter gene assays revealed that tepoxalin exerts its inhibitory effect through the inhibition of nuclear factor kappaB (NF-kappaB), a transcription factor involved in the induction of IL-1, IL-6 and ACT gene expression. We show that inhibition of NF-kappaB activation by tepoxalin is mediated by preventing IkappaB-alpha degradation. Based on this inhibitory effect of tepoxalin on cytokine and ACT synthesis and the documented therapeutic efficacy of NSAIDs in AD, we conclude that tepoxalin may be of therapeutic benefit for the treatment of AD patients and should therefore be tested in clinical trials.

[Goal-oriented outcome measurement in inpatient or day care orthopedic-rheumatologic rehabilitation of patients with back pain]

The comparison of patient characteristics and effectiveness of inpatient rehabilitation (IPR) and outpatient rehabilitation (OPR) is of growing importance in terms of flexible and cost-effective structures in rehabilitation. The effectiveness of the treatment is measured applying a goaloriented approach based on the individual rehabilitation goals and the attainment of these goals at the end of the programme. The frequencies of rehabilitation goals chosen by patients in IPR and OPR are similar. Decrease of pain, improvement of muscular strength and improvement of the range of motion are the main goals of patients in IPR and OPR (92-56%). No relevant differences can be seen considering the effectiveness of IPR and OPR, except for the markedly higher improvement of vitality in IPR. Patients in need of rehabilitation whose primary rehabilitation goal is improvement of vitality should therefore preferentially be referred to an inpatient rehabilitation programme.

Quantification of conversion and degradation of circulating angiotensin in rats

The aim of the present study was to quantify with a uniform technique the rates of conversion of ANG I to ANG II in the lung and kidney and the degradation of both peptides to biologically inactive products in the pulmonary, renal, and systemic circulation. We infused the peptides intravenously, into the left ventricle, and into the left renal artery of rats and compared their effects on renal blood flow. The measured change in renal blood flow was used as a bioassay parameter to estimate the concentration of circulating ANG II. Mathematical analysis of our data allowed us to calculate conversion and degradation rates. Furthermore, the role of aminopeptidases A (EC 3.4.11.7) and N (EC 3.4.11.2) in the degradation of the peptides in the kidney was investigated by intrarenal infusion of the inhibitor amastatin. Our results show that the conversion rate of ANG I is 75% in the pulmonary and 21% in the renal circulation. Both peptides are degraded by 5% in the pulmonary, by 67% in the systemic, and by 93% in the renal circulation. Amastatin prevented 60% of the renal degradation of the peptides to inactive products, and this effect could be attributed to inhibition of aminopeptidase N. The results indicate that the converting capacity of the kidney is of minor importance for endocrine generation of ANG II but could be useful for the paracrine production.

Usefulness of spoligotyping To discriminate IS6110 low-copy-number Mycobacterium tuberculosis complex strains cultured in Denmark

Mycobacterium tuberculosis complex strains cultured in Denmark have been analyzed by IS6110 restriction fragment length polymorphism (RFLP) on a routine basis from 1992 and onwards. Due to the influx of immigrants with tuberculosis, the number of strains harboring only one to five copies of IS6110 has increased steadily. Since the discriminatory power of IS6110 fingerprinting for such strains is poor, we have performed additional genotyping of all low-copy-number strains by the recently described PCR-based method known as spoligotyping. A total of 311 clinical strains were typed: 14 Mycobacterium bovis BCG, 48 M. bovis, and 249 M. tuberculosis strains. Spoligotyping correctly differentiated M. bovis and M. bovis BCG from M. tuberculosis strains, but it did not differentiate M. bovis from M. bovis BCG. All M. bovis BCG strains exhibited identical spoligotype patterns. The discriminatory power of spoligotyping of low-copy-number M. tuberculosis strains was higher than that of IS6110 fingerprinting. Based on RFLP typing solely, 83% of the low-copy-number M. tuberculosis strains were found to form part of a cluster, and 75% were found to form a cluster on the basis of spoligotyping. When the two techniques were combined, the amount of clustering decreased to 55%. The combination of these two techniques might be valuable in studying the epidemiology of M. tuberculosis strains harboring few copies of the IS6110 element.

Validation of a malnutrition screening tool for patients receiving radiotherapy

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to validate a new malnutrition screening tool (MST) in cancer patients undergoing radiotherapy. The MST was compared with the subjective global assessment (SGA) of nutritional status. One hundred and six patients attending two cancer care centres in Australia were independently rated as well nourished or malnourished using SGA and at risk or not at risk of malnutrition using the MST. Convergent validity of the MST was established by determining the ability of the MST to predict SGA. According to SGA, 89% of the patients were well nourished and 11% were moderately malnourished. According to the MST, 28% of patients were at risk of malnutrition. The MST had a sensitivity of 100% and a specificity of 81%. The positive predictive value was 0.4 and the negative predictive value was 1.0. The MST is easy to use and is a strong predictor of nutritional status. The malnutrition screening tool is a simple, quick, valid tool that can be used to identify radiation oncology outpatients who are at risk of malnutrition.

ANG II- and TxA(2)-induced mesenteric vasoconstriction in rats is mediated by separate cell signaling pathways

Studies in vitro have demonstrated that vasoconstrictor agents increase intracellular Ca(2+) and activate protein kinase C (PKC) to elevate vascular tone. The aim of the present study was to determine the importance of these signaling pathways for angiotensin II (ANG II) and thromboxane A(2) (TxA(2)) in regulating mesenteric blood flow (MBF) in vivo. In anesthetized rats increasing doses of ANG II or the TxA(2) agonist U-46619 were administered into the superior mesenteric artery to reduce MBF. Intra-arterial infusion of inhibitors served to examine the contribution of different pathways: 8-(diethylamino)octyl 3,4,5-trimethoxybenoate hydrochloride (TMB-8) to inhibit intracellular Ca(2+) release, nifedipine to block transmembrane Ca(2+) influx through the L-type Ca(2+) channel, and staurosporine to inhibit PKC. Each of the inhibitors attenuated ANG II-induced reductions in MBF, and all dose-response curves were shifted to the right to an approximately threefold higher ANG II dose. Combinations of the inhibitors revealed that their effects were additive; together they abolished the vasoconstrictor action of ANG II completely. In contrast, the dose-response curve for U-46619 was not affected by any of the inhibitors infused either separately or together. The results demonstrate that a rise in intracellular Ca(2+) and activation of PKC are major mediators of the vasoconstrictor effect of ANG II in mesenteric circulation, but they play a subordinate role, if any, for the effects of TxA(2). Because TxA(2) plays a major role only under pathological conditions, the uncontrolled vasoconstriction appears to be associated with the recruitment of novel signal transduction pathways.

An international dermatological image atlas on the WWW: practical use for undergraduate and continuing medical education, patient education and epidemiological research

We describe the development of an image database DOIA (Dermatological OnlIne Atlas) and present several spin-off projects using images of the atlas, e.g. student education using the atlas including results of an questionnaire evaluating computer-literacy, prerequisites and interests of students for using computers and the World-Wide-Web (WWW), a patient information system and an experiment to collect epidemiological data from patients with dermatological diseases via WWW. The database, available on the WWW at http:@www.derma.med.uni-erlangen.de, contains about 3,000 clinical images covering more than 540 dermatological diagnoses. It is designed for worldwide use; international submissions are encouraged. One aim of the project is to compile an international reference for dermatological images, containing images of high educational quality and also covering conditions on different skin types and rare diagnoses which are not commonly illustrated in ordinary textbooks. All images were originally mapped to the Erlanger Diagnosis Code, which is a proprietary modified ICD-9 key, later also to the UMLS (Unified Medical Language System). In addition, images are described with keys for the location, physical attributes of the location and clinical and histopathological features of the lesion. In order to facilitate the integration of the atlas into other web-based medical resources and to allow easy access to additional information, the Erlanger Diagnosis Code was mapped to the CUIs (unique concept identifiers) of the UMLS Metathesaurus. One purpose of the UMLS is to allow conversion of terms from one controlled medical vocabulary to another, thus, mapping of our diagnosis code to the UMLS CUIs allows simultaneous search for a given diagnosis in a number of other databases and also access to our image database from other databases. Mapping was successful for 619 out of 1383 dermatological diagnosis terms. For images with these diagnoses we are able to provide a hyperlink to other databases available on the Internet, such as MEDLINE, PDQ and OMIM, with automatic retrieval using the preferred vocabulary of the respective database. By grouping all diagnoses into sets with similar morphologies we further integrated a differential diagnosis mode. In order to educate patients via the Internet, a separate patient information system has been developed, using images of the electronic atlas. As an experiment to explore the feasibility of the Internet to gather epidemiological data from patients, users are asked to complete an electronic questionnaire covering signs for atopy. We conclude that an online image atlas has multiple educational, clinical and research applications.

Epidemiology of tuberculosis in HIV-infected patients in Denmark

Denmark is an area of low incidence of HIV and tuberculosis (TB). The number of newly reported cases of HIV has been stable during the 1990s, whereas the number of TB cases has doubled in Denmark in the past decade, mainly due to immigration. However, among native Danes the incidence of TB has increased in the younger age groups, indicating more newly infected persons. This study was performed in order to assess the impact of the HIV epidemic and immigration on TB incidence among native Danes. The study was also designed to reveal transmission patterns of TB among HIV-positive patients. Data from HIV-TB co-infected patients identified in the national registers of TB and AIDS from 1992-95 were collected retrospectively from medical records. Restriction fragment length polymorphism (RFLP) analyses of TB isolates from co-infected patients were compared with all patterns registered in the nationwide Danish RFLP database (approximately 1,700 patients). Sixty-seven co-infected patients were identified, 26 Danes and 41 immigrants, representing only 4% of all TB cases during the study period. Danish co-infected patients were part of a cluster, i.e. they had a RFLP-pattern identical to a pattern in the national RFLP database, more often than immigrants (83% vs. 45%, p < 0.005). In only 2 cases were co-infected Danes and immigrants part of the same cluster. Danish HIV-TB co-infected patients were more often intravenous drug users than were co-infected immigrants (p < 0.0005). In conclusion, we found no evidence to suggest that the increase in TB incidence among young Danes was caused by the HIV-epidemic or transmission from immigrants. TB among HIV-positive Danes is most often due to recent infection. The patients often belong to a subpopulation living in Copenhagen characterized by intravenous drug use.

Transgenic Lewis rats overexpressing the proteolipid protein gene: myelin degeneration and its effect on T cell-mediated experimental autoimmune encephalomyelitis

Transgenic Lewis rats overexpressing proteolipid protein (PLP) genes in peripheral and central nervous myelin were produced by microinjecting murine genomic PLP sequences into fertilized eggs. The mouse PLP gene shares 98.7% homology in the nucleotide sequence with its rat counterpart, but both are fully identical on protein level. Homozygous rats show tremors early in postnatal life, eventually develop seizures, and die before they reach weaning age, while hemizygous animals are phenotypically normal and have a normal life expectancy. Transgene expression in the central nervous system (CNS) has profound consequences for myelin formation and maintenance: approximately twofold overexpression of PLP/DM-20, as seen in homozygotes, results in apoptosis of mature, and a developmental arrest of the remaining immature oligodendrocytes. Severe dysmyelination ensues, associated with reactive astrogliosis and microglia activation/proliferation. Activation of microglia is also prominent in hemizygous rats with low levels of transgene overexpression. In these animals, myelin sheaths remain intact, but there is low-grade myelin degeneration throughout life witnessed by myelin uptake and activation of microglia and astrocytes, in the absence of the expression of major histocompatibility complex class II gene products. There were no spontaneous lymphocytic infiltrates in areas of myelin degeneration. However, hemizygous LEW.PLP rats were more sensitive to experimental autoimmune encephalomyelitis mediated by T cells specific for PLP, but not another encephalitogenic myelin protein, MBP.

Apoptosis of T lymphocytes in acute disseminated encephalomyelitis

Apoptosis has been shown to be an efficient mechanism involved in clearance of T lymphocytes from the brains of animals with acute experimental autoimmune encephalomyelitis (EAE), an animal model for human multiple sclerosis. In this report we describe a case of acute disseminated encephalomyelitis following general measles infection. In this disease, which closely mimics the pathology of acute EAE we found a high percentage (30%) of apoptotic T cells. This indicates that in both rodent and human brain clearance of T cell-mediated inflammation follows similar mechanisms.

Development of a valid and reliable malnutrition screening tool for adult acute hospital patients

Nutrition screening identifies individuals who are malnourished or at risk of becoming malnourished and who may benefit from nutrition support. The aim of this study was to develop a simple, reliable and valid malnutrition screening tool that could be used at hospital admission to identify adult acute patients at risk of malnutrition. The sample population included 408 patients admitted to an Australian hospital, excluding pediatric, maternity, and psychiatric patients. The ability of various nutrition screening questions to predict subjective global assessment (SGA) were examined in contingency tables. The combination of nutrition screening questions with the highest sensitivity and specificity at predicting SGA was termed the malnutrition screening tool (MST), and consisted of two questions regarding appetite and recent unintentional weight loss. Subjects who were at risk of malnutrition according to the MST had significantly lower mean values for the objective nutrition parameters (except immunologic parameters) and longer length of stays than subjects who were not at risk of malnutrition. Therefore convergent and predictive validity of the MST was established. The interrater reliability of the malnutrition screening tool was high (93-97%). The MST is a simple, quick, valid, and reliable tool which can be used to identify patients at risk of malnutrition.