Lack of activity of betulin-based Oleogel-S10 in the treatment of actinic keratoses: a randomized, multicentre, placebo-controlled double-blind phase II trial

BACKGROUND

Betulinic acid and other triterpenes have shown strong antitumour activity in vitro and in vivo. A triterpene extract of birch bark formed the base of Oleogel-S10 and allowed topical application. Two previous trials have shown efficacy and tolerability in the treatment of actinic keratoses (AKs) with betulin-based Oleogel-S10.

OBJECTIVES

To confirm the efficacy and tolerability/safety of Oleogel-S10 in the treatment of AKs in a multicentre placebo-controlled study.

METHODS

Patients (n = 165) were treated topically for 3 months in a four-arm parallel study design, randomly allocated to A (n = 53) Oleogel-S10 once daily, B (n = 51) Oleogel-S10 twice daily, or C (n = 25) or D (n = 28) placebo (petroleum jelly) once or twice daily, respectively. Clinical efficacy in this double-blind study was assessed by the investigators. Final and baseline biopsies were evaluated by central histopathology.

RESULTS

Complete clearance of the target lesions was seen in 4% of patients in group A and 7% in group B, but not in the placebo groups. A clearance rate of > 75% was seen for 15% and 18% of patients in groups A and B, respectively, and for 13% in the placebo groups. These differences were not statistically significant. Histopathologically, 43·9% of patients showed a downgrading or clearance of the marker AK with no significant differences between the groups. Treatment with Oleogel-S10 was well tolerated. The tolerability as assessed by the investigator was mostly 'very good' (78·8%), followed by 'good' (18·2%) and only 1·2% assessed it as 'intolerable'. Patient-assessed tolerability was graded mostly 'very good' (56·4%) or 'good' (34·5%).

CONCLUSIONS

Treatment with Oleogel-S10 was well tolerated during a treatment period of 3 months, yet was no better than placebo in terms of efficacy in the treatment of AKs.

Peak-bone-mass development in young adults: effects of study program related levels of occupational and leisure time physical activity and exercise. A prospective 5-year study

SUMMARY

Young adulthood is characterized by profound life-style changes. This study suggests that reduction of sport or exercise, induced by alteration of the occupational situation, negatively impacts generation/maintenance of peak bone mass. In order to compensate occupational-related reductions of physical activity, workplace exercise programs will be helpful.

INTRODUCTION

Only few studies have determined the effect of physical activity or physical exercise on bone mineral density (BMD) in the period of late skeletal maturation, i.e. around peak bone mass. The aim of this article was to determine the long-term effect of different levels of physical activity and exercise directly and indirectly derived by occupation during young adulthood.

METHODS

Sixty-one male and female dental students (DES) and 53 male and female sport students (SPS) 21±2 years old were accompanied over the course (4.8±0.5 years) of their study program. BMD at the lumbar spine (LS), hip, and whole body (WB) were determined using dual-energy X-ray absorptiometry.

RESULTS

Parameters of physical activity increased non-significantly in both groups with no relevant differences between the groups. Indices of exercise, however, increased significantly in the SPS group while a significant decrease was assessed for the DES group. Independent of gender, BMD of the SPS increased significantly (p≤0.007) at all skeletal sites (LS, 2.4±3.9%; hip, 1.6±3.5%; WB, 1.8±2.8%) while BMD of the DES remained unchanged at LS (-0.6±4.4%, p=0.432) and WB (0.5±1.9%, p=0.092) but decreased significantly at the hip (-1.9±4.3%, p=0.010). BMD-changes at LS, hip, and WB differ significantly between SPS and DES (p≤0.017). Results remained unchanged after adjusting for baseline BMD-values that differed (p=0.030 to p=0.082) in favor of the SPS group.

CONCLUSION

Changes of exercise levels directly or indirectly caused by occupational factors during young adulthood significantly affected generation and/or maintenance of peak bone mass. Compensatory exercise is thus highly relevant for bone health of young adults.

Enfermedad de Takayasu

La enfermedad de Takayasu o arteritis inespecífico de la mujer joven, fué considerada durante mucho tiempo como una afección propia de la raza asiática, concepto que se ha desvirtuado gracias a las publicaciones occidentales cada día más frecuentes. Desde el punto de vista clínico se considera fundamentalmente manifestadones neurológicas, cardiovasculares y oculares las que se analizan a propósito de un caso personal: enferma de 25 años de edad con probable antecedente de infección tuberculosa, quien presenta hace seis años un cuadro neurológico caracterizado por cefaleas paroxísticas, claudicación intermitente visual y muscular facio-braquial ; luego un ictus apopléctico con coma durante tres días y hemiparesia discreta derecha; días después un nuevo ictus apopléctico con coma vigil durante dos meses y medio, trastornos motores bilaterales, afasia mixta, persiste una hemiplejía derecha durante siete meses y luego una monopleiía con hipoestesia braquial a predominio distal hasta la actualidad. En el examen se encuentra ausencia de pulso en ambos miembros superiores y carótida izquierda, presión arterial ausente en miembros superiores e hipertensión en los inferiores. Se discute brevemente la fisiopatogenia del trastorno vascular, incidiendo fundamentalmente en la importancia de los sindromes del arco aórtico en los problemas de la circulación cerebral.

Comparing the biological washout of β+-activity induced in mice brain after 12C-ion and proton irradiation

In clinical ion beam therapy, protons as well as heavier ions such as carbon are used for treatment. For protons, β(+)-emitters are only induced by fragmentation reactions in the target (target fragmentation), whereas for heavy ions, they are additionally induced by fragmentations of the projectile (further referred to as autoactivation). An approach utilizing these processes for treatment verification, by comparing measured Positron Emission Tomography (PET) data to predictions from Monte Carlo simulations, has already been clinically implemented. For an accurate simulation, it is important to consider the biological washout of β(+)-emitters due to vital functions. To date, mathematical expressions for washout have mainly been determined by using radioactive beams of (10)C- and (11)C-ions, both β(+)-emitters, to enhance the counting statistics in the irradiated area. Still, the question of how the choice of projectile (autoactivating or non-autoactivating) influences the washout coefficients, has not been addressed. In this context, an experiment was carried out at the Heidelberg Ion Beam Therapy Center with the purpose of directly comparing irradiation-induced biological washout coefficients in mice for protons and (12)C-ions. To this aim, mice were irradiated in the brain region with protons and (12)C-ions and measured after irradiation with a PET/CT scanner (Siemens Biograph mCT). After an appropriate waiting time, the mice were sacrificed, then irradiated and measured again under similar conditions. The resulting data were processed and fitted numerically to deduce the main washout parameters. Despite the very low PET counting statistics, a consistent difference could be identified between (12)C-ion and proton irradiated mice, with the (12)C data being described best by a two component fit with a combined medium and slow washout fraction of 0.50 ± 0.05 and the proton mice data being described best by a one component fit with only one (slow) washout fraction of 0.73 ± 0.06.

Neuroprotection requires the functions of the RNA-binding protein HuR

Alterations in the functions of neuronal RNA-binding proteins (RBPs) can contribute to neurodegenerative diseases. However, neurons also express a set of widely distributed RBPs that may have developed specialized functions. Here, we show that the ubiquitous member of the otherwise neuronal Elavl/Hu family of RNA-binding proteins, Elavl1/HuR, has a neuroprotective role. Mice engineered to lack exclusively HuR in the hippocampal neurons of the central nervous system (CNS), maintain physiologic levels of neuronal Elavls and develop a partially diminished seizure response following strong glutamatergic excitation; however, they display an exacerbated neurodegenerative response subsequent to the initial excitotoxic event. This response was phenocopied in hippocampal cells devoid of ionotropic glutamate receptors in which the loss of HuR results in enhanced mitochondrial dysfunction, oxidative damage and programmed necrosis solely after glutamate challenge. The molecular dissection of HuR and nElavl mRNA targets revealed the existence of a HuR-restricted posttranscriptional regulon that failed in HuR-deficient neurons and is involved in cellular energetics and oxidation defense. Thus, HuR acts as a specialized controller of oxidative metabolism in neurons to confer protection from neurodegeneration.

Automation and uncertainty analysis of a method for in-vivo range verification in particle therapy

We introduce the automation of the range difference calculation deduced from particle-irradiation induced β(+)-activity distributions with the so-called most-likely-shift approach, and evaluate its reliability via the monitoring of algorithm- and patient-specific uncertainty factors. The calculation of the range deviation is based on the minimization of the absolute profile differences in the distal part of two activity depth profiles shifted against each other. Depending on the workflow of positron emission tomography (PET)-based range verification, the two profiles under evaluation can correspond to measured and simulated distributions, or only measured data from different treatment sessions. In comparison to previous work, the proposed approach includes an automated identification of the distal region of interest for each pair of PET depth profiles and under consideration of the planned dose distribution, resulting in the optimal shift distance. Moreover, it introduces an estimate of uncertainty associated to the identified shift, which is then used as weighting factor to 'red flag' problematic large range differences. Furthermore, additional patient-specific uncertainty factors are calculated using available computed tomography (CT) data to support the range analysis. The performance of the new method for in-vivo treatment verification in the clinical routine is investigated with in-room PET images for proton therapy as well as with offline PET images for proton and carbon ion therapy. The comparison between measured PET activity distributions and predictions obtained by Monte Carlo simulations or measurements from previous treatment fractions is performed. For this purpose, a total of 15 patient datasets were analyzed, which were acquired at Massachusetts General Hospital and Heidelberg Ion-Beam Therapy Center with in-room PET and offline PET/CT scanners, respectively. Calculated range differences between the compared activity distributions are reported in a 2D map in beam-eye-view. In comparison to previously proposed approaches, the new most-likely-shift method shows more robust results for assessing in-vivo the range from strongly varying PET distributions caused by differing patient geometry, ion beam species, beam delivery techniques, PET imaging concepts and counting statistics. The additional visualization of the uncertainties and the dedicated weighting strategy contribute to the understanding of the reliability of observed range differences and the complexity in the prediction of activity distributions. The proposed method promises to offer a feasible technique for clinical routine of PET-based range verification.

From infinite to two dimensions through the functional renormalization group

We present a novel scheme for an unbiased, nonperturbative treatment of strongly correlated fermions. The proposed approach combines two of the most successful many-body methods, the dynamical mean field theory and the functional renormalization group. Physically, this allows for a systematic inclusion of nonlocal correlations via the functional renormalization group flow equations, after the local correlations are taken into account nonperturbatively by the dynamical mean field theory. To demonstrate the feasibility of the approach, we present numerical results for the two-dimensional Hubbard model at half filling.

[Pain therapy in oncology: results of a nationwide survey]

BACKGROUND

Pain is one of the most prevalent and distressing symptoms of patients suffering from cancer. In the field of oncology comprehensive expertise is pursued not only with respect to the administration of anticancer treatment but to all fields that relate to the needs of cancer patients. However, the results of studies have revealed persisting and relevant deficits in pain therapy in the setting of oncology.

MATERIALS AND METHODS

An online survey was performed involving all members of the German Society for Hematology and Medical Oncology (DGHO) with respect to training and continuing education in pain therapy, the relevance for routine oncology and knowledge, to determine the level of expertise in pain therapy and the assessment of tumor-specific therapy.

RESULTS

A total of 183 out of 1,962 questionnaires could be evaluated. Oncologists are often engaged in pain therapy and 80 % of the respondents perceived themselves as being primarily responsible for pain control. Education and assessment were identified as barriers to sufficient pain therapy. Case vignettes revealed only few relevant therapeutic misinterpretations.

CONCLUSION

This first survey of German oncologists exploring expertise in cancer pain therapy, showed similar problems in education and pain assessment as previous international studies. Despite the claimed responsibility for pain management, there were a small but relevant number of oncologists who showed serious therapeutic misinterpretations in case studies.

A controlled trial on the effect of feeding dietary chestnut extract and glycerol monolaurate on liver function in newborn calves

Beginning in the fall of 2010, an increasing and alarming number of cases of calves suffering from liver dystrophy were reported in the south of Germany. An epidemiological investigation was carried out by the authors between November 2010 and July 2011, leading to the implication of a commercial dietary supplement as the potential cause for this outbreak. The components of this product were first tested in a cell culture model and two of them (dietary chestnut extract and glycerol monolaurate) showed a cytotoxic effect. The objective of this study was therefore to evaluate the effect of supplemental feeding of both components alone or in combination on liver function in newborn calves on a commercial dairy farm. Ten calves were enrolled in each of the three treatment groups and the control group (group O) following a blocked design. Treatment consisted of supplementation with chestnut extract at 0.02% of birth body mass (BM) (group C), supplementation with glycerol monolaurate at 0.006% of BM (group G) or a combined treatment (group CG) for five consecutive days. The effect of treatments on liver function was evaluated clinically and by measurement of glutamate dehydrogenase (GLDH) and aspartate aminotransferase (AST) activities as well as the determination of the concentrations of glucose, L‐lactate and total bilirubin in serum. There was a significant increase in GLDH and AST activities and a significant decrease in glucose concentration in treatment groups C and CG compared with the control group (p ≤ 0.035), whereas no difference was shown for group G. Survival was significantly decreased in groups C (p = 0.029) and CG (p = 0.001) compared with both group G and the control group. These results suggest that dietary chestnut extract in an amount of 0.02% of BM alone or in combination has a toxic effect on liver function in newborn calves.

[Stress and job satisfaction in the discipline of inpatient anesthesiology : results of a web-based survey]

BACKGROUND

How do physicians in the specialty of anesthesiology perceive the working conditions regarding stress and job satisfaction? The health system in Germany has been confronted with a rapidly changing framework over the last 20 years: For example, an increased influence of economic patterns on the workflow and the medical decision of physicians has been established forcing them to always take the economic aspects into account. Moreover, a new generation (generation Y) of physicians with other requirements of the work place, meaning mainly a demand for a better work-life balance, has gained a foothold in hospitals. These changes make it very important to investigate the status quo of current working conditions.

AIM

Working conditions in hospitals in the specialty of anesthesiology is the main issue investigated in this study.

METHODS

For this study 1,321 completed online-questionnaires from physicians in hospitals with the specialty of anesthesiology were analyzed. The questionnaire was based on the stress theory, the effort-reward-imbalance model (ERI) and the job-demand-control model (JDC).The items used in the questionnaire were taken from the ERI questionnaire and the short questionnaire on work analysis (KFZA). By calculating a certain ratio of several items (according to the stress theory), the prevalence of distress could be measured. In addition the overall job satisfaction in the field of anesthesiology was measured and analyzed.

RESULTS

In this study 47.0 % (95 %-CI: 44.3-49.7 %) of all respondents showed signs of distress. Simultaneously, 61.8 % (95 %-CI: 59.2-64.5 %) were very satisfied with the job situation. Regarding gender, female physicians perceived a lower control of the work situation whereas male physicians perceived a much higher decision level. This led to a higher prevalence of distress in the group of female physicians regarding the JDC model (odds ratio, OR: 1.54, 95 %-CI: 1.19-2.01). Regarding age, the prevalence of distress increased from 36.5 % in the respondents under 35 years old to 50.7 % in those 35-59 years old (OR: 1.79, 95 %-CI: 1.38-2.32). Looking at the different functional positions in the hospital, senior doctors showed a much higher prevalence of distress (52.8 %) than junior doctors (OR: 1.57, 95 %-CI: 1.21-2.05). Analyzing job satisfaction with respect to the functional position, the highest significant proportion was shown by senior doctors (65.8 %).

CONSEQUENCES

This study revealed a high prevalence of unfavorable working conditions for anesthetists in hospitals. Taking the forthcoming shortage of qualified physicians in German hospitals into account, these results have to be considered as a cause for concern. Constant unfavorable working conditions have a negative effect on the mental and physical health of employees. Sooner or later a migration of qualified physicians abroad could be the consequence. To prevent a future shortage of qualified physicians and to make the hospital work place more appealing, working conditions have to be adapted to current needs and expectations of employees. The focus should be put on balanced working conditions according to stress models shown in this study.

[Distress Among Surgeons - a Study in German Hospitals]

Background Stress with negative influence on health (distress) is highly prevalent among surgeons. Especially the physicians' own perception of working conditions plays an important role in an evaluation of the stress potential of working conditions. Thus, this study is intended to examine and evaluate the working conditions of surgeons in German hospitals. Material and Methods This web-based study is methodically based on the theoretical stress models of Siegrist (Effort-Reward-Imbalance Model) and Karasek (Job-Demand-Control Model). The questionnaire designed for this survey consists of items from two validated questionnaires. Thus it is possible to draw a conclusion about the job satisfaction and distress prevalence among surgeons concerning working conditions in German hospitals. Results In this study 58.2% (95% CI: 55.6 - 61.5) of respondents showed unfavourable working conditions (ER/JDC ratio > 1). Meanwhile 52.2% (95% CI: 49.3 - 55.1) were satisfied with their job. The distress prevalence among female surgeons was six percent points higher (95% CI: 0.1 - 12.0) at 62.4% with an odds ratio compared to male surgeons of 1.29 (95% CI: 1.01 - 1.65; p < 0.05). Chief residents, in comparison to functional positions, showed with 22.0% the lowest distress prevalence of all positions. The highest prevalence was shown by fellows with 66.7% (OR: 7.11; 95% CI: 3.26 - 15.48; p < 0.001). Furthermore 43.4% of fellows said that they were very satisfied with their job. Among attendings 61.5% stated this (OR: 2.08; 95% CI: 1.52 - 2.84; p < 0.001). Conclusions The outlined data emphasise a high stress-potential among surgeons in hospitals concerning working conditions. According to the ERI/JDC model emphasis should be put on the balance between effort and reward or, respectively, job demands and control.