Abstract PD2-10: Treatment with abemaciclib modulates the immune response in gene expression analysis of the neoMONARCH neoadjuvant study of abemaciclib in postmenopausal women with HR+, HER2 negative breast cancer

Background: Abemaciclib is a selective inhibitor of CDK4 & 6 approved on a continuous dosing schedule for the treatment of HR+, HER2- metastatic breast cancer (MBC) patients (pts) in combination with endocrine therapy or as monotherapy. Recent studies have demonstrated the potential for CDK4 & 6 inhibitors, including abemaciclib, to promote anti-tumor immunity. Schaer et al., (Cell Reports 2018) showed that abemaciclib monotherapy results in upregulation of antigen presentation on tumor cells and increases T-cell activation. These activities synergized with anti-PD-L1 therapy to further enhance immune activation leading to complete tumor rejection in murine tumor models (Schaer et al., Cell Reports 2018). In this exploratory analysis, we evaluated the early and late immune-modulating effects of abemaciclib in the neoadjuvant study neoMONARCH (NCT02441946).

Methods: NeoMONARCH is a Phase II trial in women with stage I-IIIB HR+, HER2- BC evaluating neoadjuvant treatment with 2 weeks of abemaciclib, alone or in combination with anastrozole (abemaciclib+ANZ), or ANZ alone. All patients received 14 weeks of abemaciclib +ANZ after the first 2 weeks of treatment. Serial biopsies were collected at 3 time points: Baseline (BL) - prior to treatment, Early - after 2 weeks of therapy with abemaciclib, ANZ, or abemaciclib+ANZ, and Late – after 2 weeks of initial therapy followed by 14 weeks of abemaciclib+ANZ. RNA was extracted from formalin fixed paraffin embedded (FFPE) tumor biopsies at each time point and subjected to whole transcriptome RNA sequencing. The curated data were subjected to statistical analysis using ANOVA tests followed by pathway analysis using Ingenuity Pathway Analysis (IPA) and Gene Set Enrichment Analysis (GSEA).

Results: Consistent with the known activity of abemaciclib to inhibit the cell cycle, we observed at the early and late time points a significant treatment induced downregulation of genes related to mitotic spindle organization, replication stress response, G2M checkpoint, and E2F targets. Abemaciclib treatment for 2 weeks, alone or in combination with ANZ, followed by 14 weeks of combination therapy was associated with upregulation of gene expression signatures related to T-cell immune response and antigen presentation. Importantly, this phenomenon was notobserved with 2 weeks of ANZ treatment alone followed by 14 weeks of combination therapy.

Conclusion: These data lend support that continuous inhibition of CDK4 & 6 signaling by abemaciclib treatment leads to prolonged cell cycle arrest resulting in tumor cell apoptosis & senescence, which then leads to an enhanced immune activation.

Citation Format: Hurvitz S, Martin M, Press M, Wijayawardana S, Brahmachary M, Ebert PJ, Young S, Jansen V, Slamon D. Treatment with abemaciclib modulates the immune response in gene expression analysis of the neoMONARCH neoadjuvant study of abemaciclib in postmenopausal women with HR+, HER2 negative breast cancer [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 PD2-10.

Abstract PD1-02: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Cortes J, Martin M, Pernas S, Gomez Pardo P, Lopez-Tarruella S, Gil-Martin M, Manso L, Ciruelos E, Perez-Fidalgo JA, Hernando C, Ademuyiwa FO, Weilbaecher K, Mayer I, Pluard TJ, Martinez Garcia M, Vahdat L, Wach A, Barker D, Romagnoli B, Kaufman PA. Withdrawn [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 PD1-02.

Abstract P3-10-08: Markers of response to CDK4 & 6 inhibition from neoMONARCH: A phase II neoadjuvant study of abemaciclib in postmenopausal women with hormone receptor positive, HER2 negative breast cancer

Background: Combination treatments of endocrine therapy (ET) with CDK4 & 6 inhibitors have improved outcomes in patients with HR+ advanced breast cancer, both as initial therapy and after progression on ET. Abemaciclib is a selective inhibitor of CDK4 & 6 approved on a continuous dosing schedule for the treatment of HR+, HER2- MBC patients (pts), alone or in combination with ET. However, biomarkers that predict benefit from this class of agents remain elusive. We previously reported in the phase II neoadjuvant neoMONARCH study (NCT02441946), after 2 weeks of treatment, abemaciclib, alone or in combination with anastrozole (ANZ), led to a significantly higher rate of complete cell cycle arrest (CCCA, defined as Ki67 ≤2.7%) compared to ANZ alone in early stage HR+, HER2- breast cancer (Martin et al. SABCS 2017). As an exploratory aim of this trial, we evaluated the gene expression analyses in order to determine markers of sensitivity and resistance to therapy.

Methods: Serial biopsies were collected at 3 time points: Baseline (BL) - prior to treatment, Early – after 2 weeks of therapy with abemaciclib, ANZ, or abemaciclib+ANZ, and Late – after 2 weeks of initial therapy followed by 14 weeks of abemaciclib+ANZ. RNA was extracted from FFPE tumor biopsies at each timepoint and subjected to a Cell Cycle Associated Gene (CCAG) expression panel using the Modaplex® platform and whole transcriptome RNA sequencing. Ki67 was measured at each time point by immunohistochemistry (IHC). Tumors were categorized by the post-treatment Ki67 expression as either sensitive (Ki67 ≤2.7) or resistant (Ki67 ≥7.4), based upon the IMPACT and POETIC studies. Additionally, tumors intrinsically resistant/sensitive to therapy were also identified.

Results: ANZ-treated tumors that did not achieve CCCA at 2 weeks (N= 8) displayed higher expression of the cell cycle associated genes FOXM1, E2F1, TOPO2A, and RRM2. The addition of abemaciclib to ANZ decreased gene expression in a majority of the tumors (N=5, 62.5%). Tumors intrinsically resistant to treatment with abemaciclib+ANZ displayed persistently elevated levels of cell cycle associated genes compared to sensitive tumors. Finally, gene expression signature of Rb loss-of-function (Rbsig) and RB1 gene expression levels were associated with sensitivity to abemaciclib.

Conclusion: On-treatment Ki67 indicated treatment sensitivity and correlated with cell cycle associated gene expression in sensitive and resistant tumors. These exploratory analyses suggest that gene expression analyses may identify genomic markers for abemaciclib and ET treatment sensitivity and may help inform in which tumors to use abemaciclib.

Citation Format: Hurvitz S, Martin M, Wijayawardana S, Brahmachary M, Ebert PJ, Young S, Jansen V, Slamon D. Markers of response to CDK4 & 6 inhibition from neoMONARCH: A phase II neoadjuvant study of abemaciclib in postmenopausal women with hormone receptor positive, HER2 negative breast cancer [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 P3-10-08.

Abstract P6-18-06: Ribociclib treatment benefit in patients with advanced breast cancer with ≥1 dose reduction: Data from the MONALEESA-2, -3, and -7 trials

Background: In the MONALEESA (ML) trials, addition of ribociclib (RIB; cyclin-dependent kinase 4/6 inhibitor) to endocrine therapy (ET) prolonged progression-free survival (PFS) in patients (pts) with hormone receptor-positive (HR+), HER2-negative (HER2–) advanced breast cancer (ABC). RIB was generally well tolerated, with adverse events (AEs) managed effectively by dose modifications. Here we present efficacy data for RIB-based regimens of interest for the proposed indication (i.e. with a non-steroidal aromatase inhibitor [NSAI] or fulvestrant [FUL]) from ML-2, -3, and -7 in pts who received no prior ET for ABC and who had ≥1 RIB dose reduction, to explore the efficacy of RIB in pts who need to dose reduce.

Methods: Pts included in this analysis were: postmenopausal women with HR+, HER2– ABC and no prior ET for ABC who received RIB (600 mg; 3-weeks-on/1-week-off) with letrozole (2.5 mg/day; ML-2 [NCT01958021]), or FUL (500 mg per label; ML-3 [NCT02422615]); and premenopausal women with no prior ET and ≤1 line of chemotherapy for ABC who received RIB with an NSAI (anastrozole: 1 mg/day; letrozole: 2.5 mg/day; ML-7 [NCT02278120]) plus goserelin (3.6 mg every 28 days). Dose reductions for RIB (600 to 400 to 200 mg) were permitted. Primary endpoint was PFS. Secondary endpoints included overall response rate (ORR), clinical benefit rate (CBR), and safety.

Results: In ML-2, -3, and -7, ≥1 RIB dose reduction occurred (n/N) in 169/334 (51%), 92/238 (39%), and 91/246 (37%) pts assigned to RIB, respectively. AEs were the main reason for dose reduction, with all-grade neutropenia the most common AE leading to dose reduction (ML-2 69%, ML-3 80%, ML-7 82%). Median PFS (months) was prolonged with RIB vs placebo in pts without a RIB dose reduction (ML-2: 27.7 vs 16.0; ML-3: not reached [NR] vs 18.3; ML-7: 23.8 vs 13.8); median PFS in pts with ≥1 RIB dose reduction was: ML-2 25.3, ML-3 NR, and ML-7 27.5 months. In pts with measurable disease and without a RIB dose reduction, ORR was 46% (ML-2), 43% (ML-3), and 48% (ML-7); CBR was 70%, 68%, and 79%, respectively. In pts with measurable disease and ≥1 RIB dose reduction, ORR was 62% (ML-2), 57% (ML-3), and 55% (ML-7); CBR was 88%, 85%, and 88%, respectively. The most common Grade 3/4 AEs in the RIB vs placebo groups (≥5% of pts in either ML trial, irrespective of causality or dose reduction) were neutropenia (ML-2: 62% vs 1%; ML-3: 55% vs 0; ML-7: 65% vs 4%), leukopenia (ML-2: 21% vs 1%; ML-3: 12% vs 0; ML-7: 16% vs 1%), hypertension (ML-2: 13% vs 13%; ML-3: 5% vs 5%; ML-7: 2% vs 3%), increased alanine aminotransferase (ML-2: 10% vs 1%; ML-3: 10% vs 0; ML-7: 5% vs 1%), and increased aspartate aminotransferase (ML-2: 6% vs 1%; ML-3: 6% vs 0; ML-7: 4% vs 1%).

Conclusions: Results from the ML-2, -3, and -7 trials suggest that pts who start on 600 mg of RIB and require dose reduction for the management of their AEs, or for other reasons, continue to derive clinical benefit.

Citation Format: Beck JT, Neven P, Sohn J, Chan A, Sonke GS, Bachelot T, Campos-Gomez S, Martin M, Bardia A, Alam J, Miller M, Diaz-Padilla I, Kong O, Hart L. Ribociclib treatment benefit in patients with advanced breast cancer with ≥1 dose reduction: Data from the MONALEESA-2, -3, and -7 trials [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 P6-18-06.

Measurement of the Charm-Mixing Parameter y_{CP}

A measurement of the charm-mixing parameter y_{CP} using D^{0}→K^{+}K^{-}, D^{0}→π^{+}π^{-}, and D^{0}→K^{-}π^{+} decays is reported. The D^{0} mesons are required to originate from semimuonic decays of B^{-} and B[over ¯]^{0} mesons. These decays are partially reconstructed in a data set of proton-proton collisions at center-of-mass energies of 7 and 8 TeV collected with the LHCb experiment and corresponding to an integrated luminosity of 3  fb^{-1}. The y_{CP} parameter is measured to be (0.57±0.13(stat)±0.09(syst))%, in agreement with, and as precise as, the current world-average value.

Observation of Two Resonances in the Λ_{b}^{0}π^{±} Systems and Precise Measurement of Σ_{b}^{±} and Σ_{b}^{*±} Properties

The first observation of two structures consistent with resonances in the final states Λ_{b}^{0}π^{-} and Λ_{b}^{0}π^{+} is reported using samples of pp collision data collected by the LHCb experiment at sqrt[s]=7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. The ground states Σ_{b}^{±} and Σ_{b}^{*±} are also confirmed and their masses and widths are precisely measured.

Evidence for an η c ( 1 S ) π - resonance in B 0 → η c ( 1 S ) K + π - decays

A Dalitz plot analysis of B 0 → η c ( 1 S ) K + π - decays is performed using data samples of pp collisions collected with the LHCb detector at centre-of-mass energies of s = 7 , 8 and 13 Te V , corresponding to a total integrated luminosity of 4.7 fb - 1 . A satisfactory description of the data is obtained when including a contribution representing an exotic η c ( 1 S ) π - resonant state. The significance of this exotic resonance is more than three standard deviations, while its mass and width are 4096 ± 20 - 22 + 18 Me V and 152 ± 58 - 35 + 60 Me V , respectively. The spin-parity assignments J P = 0 + and J P = 1 - are both consistent with the data. In addition, the first measurement of the B 0 → η c ( 1 S ) K + π - branching fraction is performed and gives B ( B 0 → η c ( 1 S ) K + π - ) = ( 5.73 ± 0.24 ± 0.13 ± 0.66 ) × 10 - 4 , where the first uncertainty is statistical, the second systematic, and the third is due to limited knowledge of external branching fractions.

Search for lepton-flavour-violating decays of Higgs-like bosons

A search is presented for a Higgs-like boson with mass in the range 45 to 195 GeV / c 2 decaying into a muon and a tau lepton. The dataset consists of proton-proton interactions at a centre-of-mass energy of 8 TeV , collected by the LHCb experiment, corresponding to an integrated luminosity of 2 fb - 1 . The tau leptons are reconstructed in both leptonic and hadronic decay channels. An upper limit on the production cross-section multiplied by the branching fraction at 95% confidence level is set and ranges from 22 pb for a boson mass of 45 GeV / c 2 to 4 pb for a mass of 195 GeV / c 2 .

Measurement of Antiproton Production in p-He Collisions at sqrt[s_{NN}]=110 GeV

The cross section for prompt antiproton production in collisions of protons with an energy of 6.5 TeV incident on helium nuclei at rest is measured with the LHCb experiment from a data set corresponding to an integrated luminosity of 0.5  nb^{-1}. The target is provided by injecting helium gas into the LHC beam line at the LHCb interaction point. The reported results, covering antiproton momenta between 12 and 110  GeV/c, represent the first direct determination of the antiproton production cross section in p-He collisions, and impact the interpretation of recent results on antiproton cosmic rays from space-borne experiments.

First Observation of the Doubly Charmed Baryon Decay Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+}

The doubly charmed baryon decay Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+} is observed for the first time, with a statistical significance of 5.9σ, confirming a recent observation of the baryon in the Λ_{c}^{+}K^{-}π^{+}π^{+} final state. The data sample used corresponds to an integrated luminosity of 1.7  fb^{-1}, collected by the LHCb experiment in pp collisions at a center-of-mass energy of 13 TeV. The Ξ_{cc}^{++} mass is measured to be 3620.6±1.5(stat)±0.4(syst)±0.3(Ξ_{c}^{+})  MeV/c^{2} and is consistent with the previous result. The ratio of branching fractions between the decay modes is measured to be [B(Ξ_{cc}^{++}→Ξ_{c}^{+}π^{+})×B(Ξ_{c}^{+}→pK^{-}π^{+})]/[B(Ξ_{cc}^{++}→Λ_{c}^{+}K^{-}π^{+}π^{+})×B(Λ_{c}^{+}→pK^{-}π^{+})]=0.035±0.009(stat)±0.003(syst).

Creating a personalized evaluation framework for patient-reported outcomes: an illustration using the EQ-5D visual analogue scale

BACKGROUND

This paper outlines the creation of an intuitive, personalized evaluation framework for Patient-Reported Outcomes, using the EQ-5D visual analog scale (VAS) as an illustration.

METHODS

A draft framework asked patients to divide and label the EQ-5D-VAS into different levels or categories of health. Comprehension of the framework and patient-defined health level labels, and how they map onto the EQ-5D-VAS, were tested through in-person, semi-structured interviews with individuals self-reporting cardiovascular disease. Interviews were conducted in three waves, with the framework revised between waves.

RESULTS

Analyses included 14 participants. Eight participants (57.1%) felt that four levels of health were appropriate and there was general agreement on the labels; Poor, Fair, Good, and Excellent. There was substantial variability in where patients drew lines to indicate the level boundaries; Poor ranged between 0 and 50; Fair 10-75; Good 40-91; Excellent 60-100. In wave 3, all participants demonstrated appropriate comprehension of the framework.

CONCLUSIONS

The framework was well understood. The wide range of margins and the extent of overlap between the levels provide strong evidence for the relevance of the personalized evaluation framework approach, and specifically a personalized EQ-5D-VAS evaluation framework, to better understand and interpret each individual's response to the item.

Measurement of Angular and CP Asymmetries in D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} Decays

The first measurements of the forward-backward asymmetry of the dimuon pair (A_{FB}), the triple-product asymmetry (A_{2ϕ}), and the charge-parity-conjugation asymmetry (A_{CP}), in D^{0}→π^{+}π^{-}μ^{+}μ^{-} and D^{0}→K^{+}K^{-}μ^{+}μ^{-} decays are reported. They are performed using data from proton-proton collisions collected with the LHCb experiment from 2011 to 2016, corresponding to a total integrated luminosity of 5  fb^{-1}. The asymmetries are measured to be A_{FB}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(3.3±3.7±0.6)%, A_{2ϕ}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(-0.6±3.7±0.6)%, A_{CP}(D^{0}→π^{+}π^{-}μ^{+}μ^{-})=(4.9±3.8±0.7)%, A_{FB}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, A_{2ϕ}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(9±11±1)%, A_{CP}(D^{0}→K^{+}K^{-}μ^{+}μ^{-})=(0±11±2)%, where the first uncertainty is statistical and the second systematic. The asymmetries are also measured as a function of the dimuon invariant mass. The results are consistent with the standard model predictions.

Measurement of the Ω_{c}^{0} Baryon Lifetime

We report a measurement of the lifetime of the Ω_{c}^{0} baryon using proton-proton collision data at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3.0  fb^{-1} collected by the LHCb experiment. The sample consists of about 1000  Ω_{b}^{-}→Ω_{c}^{0}μ^{-}ν[over ¯]_{μ}X signal decays, where the Ω_{c}^{0} baryon is detected in the pK^{-}K^{-}π^{+} final state and X represents possible additional undetected particles in the decay. The Ω_{c}^{0} lifetime is measured to be τ_{Ω_{c}^{0}}=268±24±10±2  fs, where the uncertainties are statistical, systematic, and from the uncertainty in the D^{+} lifetime, respectively. This value is nearly four times larger than, and inconsistent with, the current world-average value.

Observation of a New Ξ_{b}^{-} Resonance

From samples of pp collision data collected by the LHCb experiment at sqrt[s]=7, 8 and 13 TeV, corresponding to integrated luminosities of 1.0, 2.0 and 1.5  fb^{-1}, respectively, a peak in both the Λ_{b}^{0}K^{-} and Ξ_{b}^{0}π^{-} invariant mass spectra is observed. In the quark model, radially and orbitally excited Ξ_{b}^{-} resonances with quark content bds are expected. Referring to this peak as Ξ_{b}(6227)^{-}, the mass and natural width are measured to be m_{Ξ_{b}(6227)^{-}}=6226.9±2.0±0.3±0.2  MeV/c^{2} and Γ_{Ξ_{b}(6227)^{-}}=18.1±5.4±1.8  MeV/c^{2}, where the first uncertainty is statistical, the second is systematic, and the third, on m_{Ξ_{b}(6227)^{-}}, is due to the knowledge of the Λ_{b}^{0} baryon mass. Relative production rates of the Ξ_{b}(6227)^{-}→Λ_{b}^{0}K^{-} and Ξ_{b}(6227)^{-}→Ξ_{b}^{0}π^{-} decays are also reported.

Measurement of the Lifetime of the Doubly Charmed Baryon Ξ_{cc}^{++}

The first measurement of the lifetime of the doubly charmed baryon Ξ_{cc}^{++} is presented, with the signal reconstructed in the final state Λ_{c}^{+}K^{-}π^{+}π^{+}. The data sample used corresponds to an integrated luminosity of 1.7  fb^{-1}, collected by the LHCb experiment in proton-proton collisions at a center-of-mass energy of 13 TeV. The Ξ_{cc}^{++} lifetime is measured to be 0.256_{-0.022}^{+0.024}(stat)±0.014(syst)  ps.

On the Reliability of Plasminogen Measurement Employing the Proactivator-Activator Converting Method

A simple plasminogen determination method is presented. It is based upon the conversion of plasminogen into activator by large and constant amounts of streptokinase. The activator contained in a standard coagulum consisting of bovine fibrin, streptokinase, and a 1:40 dilution of human plasma converts the plasminogen adsorbed on bovine fibrin into plasmin. Lysis of the test coagulum is hereby induced. The speed of such lysis is limited by the concentration of the activator incorporated in the test coagulum. The variable component of the activator being human plasminogen, the speed of lysis is directly dependent upon the concentration of human plasminogen in the standard coagulum. Using the thromboelastograph according to Hartert in recording the test clot lysis times, this method of plasminogen determination was shown to be a simple and quick procedure. The standard deviation ranged from ± 13.2 to 68 %, depending upon the plasminogen value to be measured (lower rates of error were attached to high, and higher rates of error to low, plasminogen concentrations). The biological variation of plasminogen values in a group of 26 men aged from 40 to 65 years was calculated to be ±21 %. Both plasminogen and plasmin, its activated form, were exchangeable in the test, i.e. plasminogen determinations performed by activator assay did not differentiate between plasminogen and plasmin. There was no influence by varying anti-SK titers in the plasma up to a circulating antibody content of 2 million. Furthermore, plasma antiplasmins did not affect the plasminogen measuring system. Plasminogen tested by activator assay displayed values closely related to those achieved by immunochemical methods. Plasminogen measurements were performed in patients undergoing streptokinase and urokinase infusion treatment. 5,000 u streptokinase per hour, as well as 270,000 CTA-u urokinase per hour, infused over a period of 2 days produced a fall in plasminogen down to 30-60% of normal. In contrast, 100,000 u streptokinase per hour lowered the plasminogen concentration down to values of below 1%. The foregoing data indicate that plasminogen measurement, according to the principles outlined here (activator assay), may be regarded as a valuable and rehable method for the routine control of streptokinase and urokinase therapy.

Intravasale Thrombusbildung durch elektrischen Strom und Thrombolyse

1. Elektronenmikroskopische Befunde an Venenendothelien der Maus nach Einwirken von elektrischem Strom, der über eine Anode zugeführt wurde, ergaben eine schwere Zellschädigung bis zu völliger Zerstörung des Endothels. Das Endothel der kleinen Arterien reagierte abweichend mit Bildung großer Vakuolen, die sich gegen das Gefäßlumen vorwölbten, es weitgehend verlegten und damit eine Thrombolyse erschwerten oder sogar unmöglich machten.

2. Die Reaktion auf derartige Venenendothelschädigungen bestand von der Blutseite her in einer Aggregation von mehr oder weniger stark degranulierten Thrombozyten. Aggregierte Plättchen im Bereich des Gefäßlumens ohne Kontakt mit Endothel wurden nur selten beobachtet. Kam es zu einer so starken Stromschädigung, daß eine völlige Vernichtung des Endothels mit freier Kommunikation zwischen Blut und subendothelialem Bindegewebe die Folge war, wurde regelmäßig Fibrin in großen Mengen im Bereich der Gefäßwand abgeschieden.

3. Da Thrombozytenaggregation und Fibrinbildung nicht allein von der Stromeinwirkung, sondern im wesentlichen vom Grad der Endothelschädigung abhingen, und da in zusätzlichen In-vitro-Versuchen keine Abhängigkeit der Vollbhitgerinnung von der Zufuhr elektrischen Stroms nachgewiesen werden konnte, wird die Hypothese einer primär durch elektrostatische Vorgänge eingeleiteten Thromboseentstehung verworfen.

4. 24 h und 3 Tage nach Auflösung strominduzierter Thromben durch Streptokinase konnte Endothel als organisierter Bestandteil der Gefäßwand nicht mehr nachgewiesen werden. Die Funktion der Endothelzellen wurde in diesem Stadium von einer ein- bis mehrschichtigen Lage mäßig degranulierter Thrombozyten eingenommen, die untereinander durch Ausbildung von »regiones densae« und gegenseitige Verzahnung dem Blutstrom ein festes Widerlager boten. Die Bedeutung dieser bisher wenig beachteten Thrombozytenfunktion im Rahmen experimenteller Eingriffe an Blutgefäßen wird diskutiert.

Studies on Activator Formation in Human Plasma with Streptokinase

A new method is presented for estimating the activator (plasminogen-streptokinase complex) concentration in native plasma of patients undergoing streptokinase infusion. The principle of the method is based on clot lysis time as recorded by the thromboelastograph. The test clot constituents were bovine fibrinogen, bovine plasminogen, EDTA, human plasma (with unknown activator concentrations), and thrombin. In order to obtain a standardization line, urokinase dissolved in NaCl solution was substituted for patients’ plasma. Thus, each lysis time could easily be converted into urokinase equivalent (CTA-u/ml). Streptokinase and plasminogen molecules in undiluted patients’ plasma were found to exist both in an activator-bound (equimolar plasminogen-streptokinase complex) and in a freely circulating form. This result is in agreement with earlier findings where the activator complex was demonstrated to be a widely dissociated complex in highly diluted plasma of patients, thus displaying an ample proportion of free streptokinase and plasminogen molecules. Streptokinase treatment using dosage schemes of 100,000 u SK/h, 150,000 u/h, and 200,000 u/h were monitored by quantitative activator, streptokinase, and plasminogen measurements. An average activator concentration of 50–100 CTA-u/ml and a SK-concentration of 7–16 u/ml were recorded during streptokinase infusion. Plasminogen values averaged 0.25%, independent of the amount of streptokinase infused. Each drop in streptokinase was accompanied by a drop in activator during the infusion, and each rise in streptokinase by a rise in activator. There was a strong correlation between streptokinase and activator concentrations in that, on the average, 1 u streptokinase equalled 8.4 CTA-u/ml activator (correlation coefficient r = 0.9). It is concluded that the activator concentration in the plasma of patients undergoing fibrinolytic treatment can easily be adjusted by regulating the hourly streptokinase influx.

Streptokinase Stability Pattern during Storage in Various Solvents and at Different Temperatures

The activity drop of 5 u streptokinase was measured in 1 ml each of various solutions (0.9% NaCl solution, 5% glucose solution, 5% levulose solution, 10% dextran solution, gelatin solution, 3% albumin solution, Michaelis buffer, glucose (5%)-heparin (750 u/ml) solution) at different incubation temperatures (–20° c, 4° c, 20 c, 37 C), and over different observation periods (15 min, 30 min, 45 min, 60 min, 6 h, 12 h, 24 h, and 48 h). Solution media tested for streptokinase-protecting quality were broken down into three groups.

Group I: Solvents displaying excellent stabilizing properties (gelatin and albumin solutions).

Group II: Solvents displaying medium stabilizing properties (dextran and levulose solutions).

Group III: Solvents displaying poor stabilizing properties (NaCl and glucose solutions, Michaelis buffer).

In testing streptokinase concentrations as used for therapeutic purposes (1500 u/ml, 50,000 u/ml), no decay was found to take place over observation periods of up to 48 h, and no influence by different solvents (Group I, II or III) was traceable. Heparin stored with streptokinase at room temperature over a period of 48 h did not alter the streptokinase stability.

Some mechanisms concerning the stability pattern of streptokinase are discussed. It appears that low streptokinase concentrations need negatively charged colloids to keep the protein structure intact. The streptokinase-protecting macro-molecules tested so far were albumin, gelatin, and streptokinase. Obviously, streptokinase by itself was able to preserve its own stability provided its concentration was of a certain order of magnitude (1500 u/ml, 50,000 u/ml).

Indirect Measurement of Streptokinase Concentration in the Plasma of Patients Undergoing Fibrinolytic Treatment

A new method of determining streptokinase concentrations on a quantitative basis in the plasma of patients undergoing streptokinase infusion is demonstrated. The principle of this method is based on the clot lysis time recorded by the thrombo-elastograph. The test clot constituents were bovine fibrin, bovine plasminogen, human euglobulin, EDTA, human plasma (with unknown streptokinase quantity) and thrombin. As plasminogen (euglobulin) and fibrinogen were present in the test coagulum in rather high concentrations (fixed excess) no interference with changing plasminogen and fibrinogen levels of the patient’s plasma was observed. Further, due to high EDTA concentrations, no interaction with platelet functions and coagulation factors took place. The standard error of measuring 5 u of streptokinase in one ml of human plasma was determined at s = ±0.47 u/ml.

Eleven patients undergoing fibrinolytic treatment with streptokinase were monitored by streptokinase determination in the plasma. In this group of patients, streptokinase concentration values varying between 15 and 0.5 units/ml plasma were measured. One striking feature was the continuous decrease in streptokinase concentration in the plasma, in spite of unchanged streptokinase infusion rates. This observation was consistent in regimens with both large (100,000 u/h) and small (30,000 u/h) streptokinase infusion rates. No explanation is available for this observation up to now. A rise in circulating anti-streptokinase contents was precluded. Possibly, an accelerated streptokinase metabolism rate in the course of long-term streptokinase administration may be involved.

Amplitude Analysis of the Decay B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} and First Observation of the CP Asymmetry in B[over ¯]^{0}→K^{*}(892)^{-}π^{+}

The time-integrated untagged Dalitz plot of the three-body hadronic charmless decay B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} is studied using a pp collision data sample recorded with the LHCb detector, corresponding to an integrated luminosity of 3.0  fb^{-1}. The decay amplitude is described with an isobar model. Relative contributions of the isobar amplitudes to the B[over ¯]^{0}→K_{S}^{0}π^{+}π^{-} decay branching fraction and CP asymmetries of the flavor-specific amplitudes are measured. The CP asymmetry between the conjugate B[over ¯]^{0}→K^{*}(892)^{-}π^{+} and B^{0}→K^{*}(892)^{+}π^{-} decay rates is determined to be -0.308±0.062.

Semiquantitative Plasminogenbestimmung mit Hilfe des Thrombelastographen

1. Es wird eine einfach durchzuführende Plasminogenbestimmung mit Hilfe des Thrombelastographen mitgeteilt. Das Prinzip benutzt die durch hohe Streptokinase-mengen induzierte Aktivatorfunktion des menschlichen Plasminogens. Dieser Aktivator wandelt in einem Standardgerinnsel aus Rinderfibrin und verdünntem Humanplasma das dort adsorbierte bovine Plasminogen in Plasmin um, so daß eine Lyse des Testgerinnsels zustande kommt. Limitierend für die Geschwindigkeit der Lyse ist dabei die Höhe des Aktivatorspiegels. Da ein Bestandteil des Aktivators Human-plasminogen ist, steht die Geschwindigkeit der Lyse in direkter Abhängigkeit zum Gehalt des im Rinderfibrin-Standardgerinnsel inkorporierten menschlichen Plasminogens. Mit Hilfe einer vorher konstruierten Eichkurve, in der Lysezeiten und verschiedene Humanplasma(Plasminogen)-konzentrationen gegeneinander aufgetragen sind, kann zu jeder sich ergebenden Lysezeit des Testgerinnsels der zugehörige Plasminogen-gehalt des beigefügten Humanplasmas in Prozent der Norm abgelesen werden.

2. Die Standardabweichung so erhaltener und im Thrombelastographen geschriebener Lysezeiten bewegt sich zwischen i 10% bei annähernd normalen und ±50% bei extrem niedrigen (um 0.01 %) Plasminogenspiegeln.

3. An Hand einer Serie von 10 Langzeitlysen mit Streptokinase konnte die beschriebene Bestimmungsmethode erprobt werden. Es handelte sich um eine 3 Tage dauernde kombinierte Infusionsbehandlung von Streptokinase und Heparin. Die Therapie wurde durch Gabe der titrierten Initialdosis gestartet und mit stündlicher Gabe von 100000 E Streptokinase fortgesetzt. Hierbei kam es durchschnittlich bereits 4 Std. nach Behandlungsbeginn zu einem Abfall des Plasminogens unter die 1%-Grenze. Von der 16. Behandlungsstunde an lagen die Werte zwischen 1 und 0.05% der Norm. 16 Std. nach Absetzen der Streptokinase hatte sich das Plasminogen weitgehend restituiert und zeigte Plasmaspiegel zwischen 30 und 100%.

4. Für schnell durchzuführende Routinekontrollen während einer Streptokinase-thérapie wurden zwei Modifikationen der hier erprobten Plasminogenbestimmung vorgeschlagen. Die erste Abwandlung beruht auf Glättung der leicht biphasisch geformten Eichkurve, die damit zu einer Eichgeraden wird und von nur zwei Eich werten charakterisiert ist. Eine zweite Modifikation, die weitere Vereinfachungen zur Folge hat, wurde durch die Beobachtung, daß alle untersuchten Eichgeraden konstante, mit nur geringer Abweichung behaftete Neigungswinkel im doppelt-logarithmischen System aufwiesen, möglich. Hierdurch enthält die mathematische Formel, welche die Eichgerade beschreibt, nur noch zwei Variable, nämlich die Lysezeit des Standardgerinnsels mit 100% Humanplasminogen und jene mit unbekanntem Plasminogen-spiegel. Damit kann der gesuchte Plasminogengehalt durch eine einfache Rechenoperation und ohne Konstruktion von Eichgeraden oder -kurven unmittelbar in einer einmalig aufgestellten Tabelle abgelesen werden.

Prevalence and impact of asthma among school-aged students in Lima, Peru

SETTING AND OBJECTIVE

The International Study of Asthma and Allergies in Childhood (ISAAC) reported asthma prevalence in Peru to be among the highest in the world. We assessed the prevalence and morbidity of self-reported asthma in an underserved, peri-urban area of Lima, Peru, with limited medical access.

DESIGN

The study was conducted in the outskirts of Lima from March to May 2011. Five hundred children aged 6-18 years were selected through cluster sampling. Parents completed a modified version of the ISAAC questionnaire. Children underwent spirometry testing. Those with a forced expiratory volume in one second (FEV1% predicted) 80% were tested for reversibility using salbutamol.

RESULTS

Of the 500 children selected, 71% participated. The prevalence of asthma was 16.7%. Asthma symptoms were associated with self-reported asthma (P < 0.001); 52.5% of children with asthma had ever used an inhaler (P < 0.001), and 27.1% had never been to the doctor for respiratory problems (P < 0.001).

CONCLUSION

We found a high prevalence of self-reported asthma and high morbidity related to asthma symptoms in the previous 12 months among the study cohort. Symptoms were poorly controlled due to limited availability of medication and access to medical services.

Studies of the resonance structure in D 0 → K ∓ π ± π ± π ∓ decays

Amplitude models are constructed to describe the resonance structure of D 0 → K - π + π + π - and D 0 → K + π - π - π + decays using pp collision data collected at centre-of-mass energies of 7 and 8 TeV with the LHCb experiment, corresponding to an integrated luminosity of 3.0  f b - 1 . The largest contributions to both decay amplitudes are found to come from axial resonances, with decay modes D 0 → a 1 ( 1260 ) + K - and D 0 → K 1 ( 1270 / 1400 ) + π - being prominent in D 0 → K - π + π + π - and D 0 → K + π - π - π + , respectively. Precise measurements of the lineshape parameters and couplings of the a 1 ( 1260 ) + , K 1 ( 1270 ) - and K ( 1460 ) - resonances are made, and a quasi model-independent study of the K ( 1460 ) - resonance is performed. The coherence factor of the decays is calculated from the amplitude models to be R K 3 π = 0.459 ± 0.010 ( stat ) ± 0.012 ( syst ) ± 0.020 ( model ) , which is consistent with direct measurements. These models will be useful in future measurements of the unitary-triangle angle γ and studies of charm mixing and C P violation.

Evidence for the Rare Decay Σ^{+}→pμ^{+}μ^{-}

A search for the rare decay Σ^{+}→pμ^{+}μ^{-} is performed using pp collision data recorded by the LHCb experiment at center-of-mass energies sqrt[s]=7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. An excess of events is observed with respect to the background expectation, with a signal significance of 4.1 standard deviations. No significant structure is observed in the dimuon invariant mass distribution, in contrast with a previous result from the HyperCP experiment. The measured Σ^{+}→pμ^{+}μ^{-} branching fraction is (2.2_{-1.3}^{+1.8})×10^{-8}, where statistical and systematic uncertainties are included, which is consistent with the standard model prediction.

Review of parental activation interventions for parents of children with special health care needs

BACKGROUND

A large number of U.S. children are identified as having special health care needs (CSHCN). Despite parents' central role in managing their child's needs, many parents report difficulties in navigating service systems, finding information about their child's condition, and accessing health care and community resources. Therefore, there is a need for interventions that "activate" parents of children with special health care needs to increase their knowledge, skills, and confidence in managing, coordinating, and advocating for their child's needs. This study sought to review the existing literature and examine the effects of parent support interventions that focus on parental activation either in part or whole, on child, parent, or family outcomes. Specific aims included (a) summarizing the nature and content of interventions; (b) describing changes in relevant outcomes; (c) identifying limitations and making recommendations for future research.

METHODS

Following electronic databases were searched: MEDLINE, EMBASE, PsycINFO via ProQuest, PubMed, Cumulative Index to Nursing and Allied Health via EBSCO, Education Resources Information Center (ERIC) via ProQuest, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), and Google Scholar. Twenty-two studies were selected, data were extracted, and quality was assessed using standardized procedures.

RESULTS

Five intervention categories were identified: parent-to-parent supports, psycho-educational groups, content-specific groups, community health worker model, and self-management-based interventions. Although most studies showed positive effects of the intervention, evidence was inconsistent for parental outcomes such as self-efficacy, confidence, strain, depression, and perceived social support. Evidence was more consistent in showing improvement in parent coping and in use of community-based services and resources.

CONCLUSIONS

There is a need to boost active ingredients of interventions that specifically target enhancing parent skill sets relevant to areas of self-efficacy, confidence, and empowerment. Future studies must also adapt intervention and study design to recruit socioeconomically vulnerable families.

Measurement of the Ratio of the B^{0}→D^{*-}τ^{+}ν_{τ} and B^{0}→D^{*-}μ^{+}ν_{μ} Branching Fractions Using Three-Prong τ-Lepton Decays

The ratio of branching fractions R(D^{*-})≡B(B^{0}→D^{*-}τ^{+}ν_{τ})/B(B^{0}→D^{*-}μ^{+}ν_{μ}) is measured using a data sample of proton-proton collisions collected with the LHCb detector at center-of-mass energies of 7 and 8 TeV, corresponding to an integrated luminosity of 3  fb^{-1}. For the first time, R(D^{*-}) is determined using the τ-lepton decays with three charged pions in the final state. The B^{0}→D^{*-}τ^{+}ν_{τ} yield is normalized to that of the B^{0}→D^{*-}π^{+}π^{-}π^{+} mode, providing a measurement of B(B^{0}→D^{*-}τ^{+}ν_{τ})/B(B^{0}→D^{*-}π^{+}π^{-}π^{+})=1.97±0.13±0.18, where the first uncertainty is statistical and the second systematic. The value of B(B^{0}→D^{*-}τ^{+}ν_{τ})=(1.42±0.094±0.129±0.054)% is obtained, where the third uncertainty is due to the limited knowledge of the branching fraction of the normalization mode. Using the well-measured branching fraction of the B^{0}→D^{*-}μ^{+}ν_{μ} decay, a value of R(D^{*-})=0.291±0.019±0.026±0.013 is established, where the third uncertainty is due to the limited knowledge of the branching fractions of the normalization and B^{0}→D^{*-}μ^{+}ν_{μ} modes. This measurement is in agreement with the standard model prediction and with previous results.

[Sinusoidal obstruction syndrome after BeAM conditioning regiment for autologous stem cell transplantation: Imputability of bendamustine? Report of two cases and literature review]

INTRODUCTION

Sinusoidal obstruction syndrome is a rare complication of autologous hematopoietic stem cell transplantation. This syndrome is mainly described following conditioning regiment with busulfan, cyclophosphamide and/or total body irradiation.

CASE REPORTS

We report for the first time two cases of sinusoidal obstruction syndrome occurring lately after BeAM conditioning regiment (bendamustine, etoposide, aracytine, melphalan) for autologous stem cell transplantation in patients treated for malignant lymphoma.

CONCLUSION

Our observations highlight the difficulty to diagnose this complication with often non-specific clinical presentation and possible delayed occurrence after to transplantation, but also the therapeutic challenges, defibrotide being the only agent currently efficient. Physiopathology and potential responsibility of bendamustine in the sinusoidal obstruction syndrome occurrence will be discussed.

Clinical Profile of a New Monoclonal Antibody-Based Immunoassay for Tissue Polypeptide Antigen

Our preliminary evaluation of a new monoclonal antibody-based assay for tissue polypeptide antigen (TPA) has shown it to be clinically equivalent to the polyclonal antibody-based assay for TPA. The new assay (TPA-M) employs three monoclonal antibodies to epitopes on cytokeratins 8, 18 and 19. This multicenter, multinational study included 266 patients with newly diagnosed carcinomas of the lung, breast, large bowel and urinary bladder. TPA values from the two assays were compared with three other cytokeratin markers (TPS, CYFRA 21–1 and TPACyk) and with the established reference markers for these malignancies (CEA and NSE for lung, CA 15–3 for breast, CEA and CA 19–9 for colorectal tumors). Analysis of receiver operating characteristic (ROC) curves in lung, colorectal and bladder cancer showed similar sensitivities for the two assays, ranging from 50% to 80% with a specificity of 95%. In breast cancer all the markers studied showed poor sensitivity. However, TPA determination by either method could discriminate advanced stage (stages III and IV) from early stage disease (stages 0 to II). TPA showed similar discriminating ability in bladder cancer. On the basis of the results obtained in our patient series, it seems that of the cytokeratin markers studied, TPA and TPA-M are the most sensitive and offer a wide range of clinical applications.