Factors Leading to Gastrostomy Tube and Tracheostomy Requirements in Patients Treated Initially With Radiotherapy and Salvaged With Surgery and Free Flap Reconstruction

OBJECTIVE

Patients with recurrent oropharyngeal cancer can achieve survival benefits from surgical salvage, and often require simultaneous free-flap reconstruction. Resection and reconstruction can impact function, leading to tube dependence.

PRIMARY OBJECTIVE

describe rates of tracheostomy and gastrostomy tube dependence after oropharyngeal resection and free flap after prior radiation.

SECONDARY OBJECTIVE

evaluate patient, tumor, and treatment factors associated with tube dependence.

STUDY DESIGN

Retrospective, multi-institutional cohort study. Patients treated from 2003 to 2020. Average follow-up 21.4 months.

SETTING

Five tertiary care centers.

METHODS

Consecutive cohort of patients undergoing resection and simultaneous free-flap reconstruction for oropharyngeal squamous cell carcinoma after head and neck radiation.

PRIMARY OUTCOMES

gastrostomy tube dependence and tracheostomy or tracheostoma 1 year after surgery. Univariable and multivariable logistic regression were performed to identify factors associated with dependence.

RESULTS

89 patients underwent oropharyngectomy and free-flap reconstruction; 18 (20%) underwent total laryngectomy as part of tumor extirpation. After surgery, 51 patients (57%) lived 12 months. Among patients alive at 12 months, 22 (43%) were at least partially-dependent on gastrostomy tube, and 15 (29%) had either tracheostomy or tracheostoma. On multivariable analysis, extensive glossectomy (OR 16.6, 95% CI 1.83-389, p = 0.026) and total laryngectomy (OR 11.2, 95% CI 1.71-105, p = 0.018) were associated with long-term gastrostomy tube. No factors were associated with long-term tracheostomy on multivariable analysis.

CONCLUSION

Even among long-term survivors after salvage resection and free-flap reconstruction, rates of tube dependence are significant. This multi-institutional review is the largest such study to the date and may help inform shared decision-making.

LEVEL OF EVIDENCE

4 Laryngoscope, 133:2141-2147, 2023.

BepiColombo mission confirms stagnation region of Venus and reveals its large extent

The second Venus flyby of the BepiColombo mission offer a unique opportunity to make a complete tour of one of the few gas-dynamics dominated interaction regions between the supersonic solar wind and a Solar System object. The spacecraft pass through the full Venusian magnetosheath following the plasma streamlines, and cross the subsolar stagnation region during very stable solar wind conditions as observed upstream by the neighboring Solar Orbiter mission. These rare multipoint synergistic observations and stable conditions experimentally confirm what was previously predicted for the barely-explored stagnation region close to solar minimum. Here, we show that this region has a large extend, up to an altitude of 1900 km, and the estimated low energy transfer near the subsolar point confirm that the atmosphere of Venus, despite being non-magnetized and less conductive due to lower ultraviolet flux at solar minimum, is capable of withstanding the solar wind under low dynamic pressure.

Inner southern magnetosphere observation of Mercury via SERENA ion sensors in BepiColombo mission

Mercury's southern inner magnetosphere is an unexplored region as it was not observed by earlier space missions. In October 2021, BepiColombo mission has passed through this region during its first Mercury flyby. Here, we describe the observations of SERENA ion sensors nearby and inside Mercury's magnetosphere. An intermittent high-energy signal, possibly due to an interplanetary magnetic flux rope, has been observed downstream Mercury, together with low energy solar wind. Low energy ions, possibly due to satellite outgassing, were detected outside the magnetosphere. The dayside magnetopause and bow-shock crossing were much closer to the planet than expected, signature of a highly eroded magnetosphere. Different ion populations have been observed inside the magnetosphere, like low latitude boundary layer at magnetopause inbound and partial ring current at dawn close to the planet. These observations are important for understanding the weak magnetosphere behavior so close to the Sun, revealing details never reached before.

SERENA: Particle Instrument Suite for Determining the Sun-Mercury Interaction from BepiColombo

The ESA-JAXA BepiColombo mission to Mercury will provide simultaneous measurements from two spacecraft, offering an unprecedented opportunity to investigate magnetospheric and exospheric particle dynamics at Mercury as well as their interactions with solar wind, solar radiation, and interplanetary dust. The particle instrument suite SERENA (Search for Exospheric Refilling and Emitted Natural Abundances) is flying in space on-board the BepiColombo Mercury Planetary Orbiter (MPO) and is the only instrument for ion and neutral particle detection aboard the MPO. It comprises four independent sensors: ELENA for neutral particle flow detection, Strofio for neutral gas detection, PICAM for planetary ions observations, and MIPA, mostly for solar wind ion measurements. SERENA is managed by a System Control Unit located inside the ELENA box. In the present paper the scientific goals of this suite are described, and then the four units are detailed, as well as their major features and calibration results. Finally, the SERENA operational activities are shown during the orbital path around Mercury, with also some reference to the activities planned during the long cruise phase.

Nephrogenic fibrosing dermopathy in two patients with systemic lupus erythematosus

Nephrogenic fibrosing dermopathy (NFD) is a novel fibrosing disorder of the skin with characteristic histopathology. It affects patients with impaired renal function and appears to be independent from the type of kidney disease. Its aetiopathology is unknown and presently no standard therapy exists. We report a patient with systemic lupus erythematosus (SLE) and glomerulonephritis who developed diffuse indurated erythematous plaques covering nearly the entire legs and trunk. She had never received dialysis. The second patient suffered from SLE and antiphospholipid syndrome related thrombotic glomerulopathy. After 10 weeks of haemodialysis she developed the same skin condition. To the best of our knowledge, these are the first reports of NFD occurring in patients with SLE.

Effects of three amendments on extractability and fractionation of Pb, Cu, Ni and Sb in two shooting range soils

Contamination of shooting range soils with toxic trace elements, in particular Pb and Sb, is of increasing environmental concern worldwide. We studied the extractability of Sb, and other metals in two shooting range soils: a calcareous soil (pH 8) with low organic carbon (0.5%) and a non-calcareous soil (pH 6.3) with elevated organic carbon content (5%). Both soils contained total concentrations of around 500 mg kg(-1) Pb, 65 mg kg(-1) Cu, 100 mg kg(-1) Zn and 20 mg kg(-1) Sb. We tested the effects of Ca(OH)(2), phosphate and sodium humate amendments on metals and Sb extractability. Extracts with H(2)O and NaNO(3) contained 0.02-0.05% of the total Zn and Pb; 0.1-0.5% of total Ni and Cu and approximately 1% of total Sb. Sequential extraction procedure of Zeien and Brümmer resulted in similar percentages for the sum of the two most labile fractions (F1+F2) in two soils: 10% Pb, and 15-20% Sb. Water and NaNO(3)-extractable Sb concentrations increased after phosphate addition, but were not affected by the addition of sodium humate. The results show that leaching of Sb from shooting ranges into ground and surface waters may generate a serious environmental risk under widely different soils conditions.

Quantitative description of the state of awareness of patients in vegetative and minimally conscious state

Clinical scales represent the golden standard in characterizing awareness for patients in vegetative or in a minimally conscious state. Clinical scales suffer from problems of sensitivity, specificity, subjectivity, and inter-rater reliability. This leads to a misdiagnosis rate of up to 40% and consequences associated with inappropriate treatment decisions. In this study, objective measures including physiological and neurological signals are used to quantify the patient status. Using linear backward regression analysis, 13 variables (based on frequency analysis of the electrocardiogram, heart rate variability, amplitude and latency of the P300, skin conductance responses, changes in the blood pressure and respiration signal) were found to be sufficient to describe 74.7% of the variability of the scores. In this regression model, the P300, electrocardiogram and the blood pressure signal account for most of the variability. More patient data and additional measures will enable refinement of the methods. This new objective-measurement based model of the state of awareness will complement the clinical scales in order to increase the quality of diagnosis.

The ion-optical prototype of the low energy neutral atom sensor of the Interstellar Boundary Explorer Mission (IBEX)

The direct measurement of the energetic neutral atoms originating from the heliospheric termination shock and beyond as well as neutral interstellar gas penetrating into the heliosphere requires a very sensitive neutral particle imaging instrument in the energy range of 10-1000 eV. We present the development of the prototype of the low energy sensor for the Interstellar Boundary Explorer (IBEX) mission: IBEX-Lo is a neutral particle mass spectrometer dedicated to the measurement of energetic neutral atoms in this energy range. The response of the sensor to incident neutral hydrogen, helium, and oxygen atoms is discussed as well as the properties of the sensor's ion optics, the neutral-to-negative conversion surfaces, and other instrumental parameters.

The Effects of Systematic Resistance Training in the Elderly

The aim of the study was to examine the effects of a maximal resistance training following the principles of the most effective resistance training known from sport adapted to elderly people. Twenty-four subjects were randomly assigned into a training group (10 females and 4 males, age; 76.2 +/- 3.2 years) that underwent a training program and a control group (6 females and 4 males, age; 76.6 +/- 2.7 years) that did not participate in the training program. Before and after the training period, both groups were identically examined (blood and urine sample, spiroergometric testing, morphological measurements). The training group underwent a 12-week training program. Eight different exercises for the largest muscle groups of the largest joints were defined as one training circle. Training took place twice a week and commenced with two training circles per week (one circle per training session). After every four weeks, one training circle per week was added until four training circles per week were reached. Before, after every four weeks (changes in training amount) and after the training period, the maximum strength was measured. Data was analysed by the independent T-test and the analysis of variance, in case of significance, the dependent T-test and the Scheffé-test were used. In the resistance training group, the fat-free body mass was increased by approximately 2.9 +/- 0.5 kg, with no significant difference between females and males. Ergometrical fitness was increased by approximately 15 %, while the maximum oxygen uptake was increased by approximately 12 %. Maximum strength was increased between 26 % (bench pull) and 38 % (leg press). Resistance training that consisted of two training sessions per week was found to be at least as efficient as resistance training that included three training sessions per week, provided that the number of sets performed were equal. Seventy-five-year-old females were found to have a significantly higher body fat content than males of the same age (37 % versus 26 %, respectively). However, the decrease in body fat mass due to resistance training was found to be equal in both females and males (- 4 +/- 0.8 kg). Furthermore, there was almost no difference in muscle strength between the sexes for this age group (for example; leg press: females 86 kg versus males 82 kg).

Development of standardized cell culture conditions for tumor cells with potential clinical application

BACKGROUND

Tumor cell lines have enormous value for the study of different aspects of cancer biology and have also recently gained great importance in autologous cell-based anti-tumor therapies. However, the use of these cells is still limited because in vitro growth is hampered by suboptimal culture conditions and current media contain fetal bovine serum (FBS), which poses serious safety concerns regarding clinical application.

METHODS

To address this drawback, we aimed to develop a strategy for optimization of the culture medium for human medullary thyroid carcinoma (MTC) cell lines as a model system. We combined the general cell screening system (GCSS), which continuously measured the growth behavior of cells in a 96-well plate format, with statistically based experimental designs.

RESULTS

The results obtained clearly demonstrated that, just by changing the composition of the basal medium, a significantly enhanced growth rate could be observed, and by subsequent addition of several substances a serum-free cell culture medium could be developed. This medium allowed the propagation of two MTC cell lines comparable with conventionally used serum-supplemented medium.

DISCUSSION

We present a fast and easy way to screen for substances that are essential for tumor cell growth in vitro. Furthermore, these tumor cells can be adapted to culture conditions that allow the use of the cells in safe cell-based therapies. This is of utmost importance because of increasing regulatory requirements.

Establishment of human fibroma cell lines from a MEN1 patient by introduction of either hTERT or SV40 early region

Establishment of tumor cell lines as model systems for studying tumor biology or as a part of immunotherapeutic anti-cancer strategies is of high importance, whereby the highest possible preservation of the original tumor cell phenotype is a prerequisite for these aims. Since overexpression of the catalytic subunit of human telomerase (hTERT) is known to minimally alter the cellular phenotype, we focused on the establishment of cell lines derived from human fibroma from a MEN1 patient by ectopic expression of hTERT. Additionally, a cell line was generated by introduction of the early region of SV40 (SV40 ER). Both approaches resulted in continuous cell lines, and neither T1-LOHG (hTERT) nor SV1-LOHG (SV40 ER) showed a transformed phenotype. While SV40 ER-transfected cells underwent dramatic changes in morphology and growth characteristics, hTERT-expressing cells indeed retained a phenotype highly similar to the parental cells. Nevertheless, hTERT overexpression resulted in increased growth rates after about 70 population doublings (PD) and alterations of mRNA levels of genes associated with tumor pathogenesis. Thus, our data suggest that ectopic hTERT expression leads to immortalization of LOHG-F, sustaining many characteristics of the non-transfected counterparts, but continuous growth in vitro is associated with changes of the cellular phenotype.

Targeted inhibition of telomerase in human cancer: will it be a double-edged sword?

More than 80% of human malignancies express telomerase activity, while normal somatic tissues in general lack it. During each normal cell division, there is a constant loss of DNA sequences at chromosomal ends, which is due to the 'end-replication problem' of conventional DNA polymerase. Critical shortening of telomeres induces cell cycle arrest and eventually cell death. Telomerase, a ribonucleoprotein complex with a RNA (TR) and a catalytic subunit (TERT) as core components, is able to add reitineratedly telomeric repeat sequences to the very ends of chromosomes. It was suggested that activation of telomerase in tumor cells has a major impact on their continuous growth. Indeed, transfection of TERT constructs into various normal human cell types led to telomere elongation or stabilization and, most importantly, cellular immortalization. Conversely, inhibition of telomerase in tumor cell lines induced growth arrest, at least in first experimental settings. Such initial success implies that drug-mediated abrogation of telomerase action might be an ideal adjuvant treatment for cancer patients. There are, however, legitimate concerns about the generalization of such an approach.

Rapid identification of Staphylococcus epidermidis

During the collection of airborne bacteria in a museum in England some bacterial strains were isolated which due to their fatty acid profiles were clearly identified as members of the genus Staphylococcus. As fatty acid compositions of coagulase-negative staphylococci are very similar, differing only in quantities but not in qualities, further identification at the species level without a fatty acid database was not achieved. Investigation of the isolates using the Staph ID 32 API system resulted in an identification of the isolates as Staphylococcus epidermidis (probabilities of 79.7-95.5%). For further genotypic characterization of these isolates, some Staphylococcus epidermidis strains from different sources and the type strains of Staphylococcus aureus, Staphylococcus capitis, Staphylococcus epidermidis, Staphylococcus gallinarum, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus warneri and Staphylococcus xylosus were subjected to repetitive-sequence PCR, including enterobacterial repetitive intergenic consensus (ERIC) PCR, BOX-PCR and repetitive extragenic palindromic unit sequence (REP) PCR. ERIC- and BOX-PCR yielded a species-specific banding pattern for all Staphylococcus epidermidis strains. Furthermore, all staphylococcal reference strains investigated exhibited distinct banding patterns, clearly distinguishable from that of Staphylococcus epidermidis. No species-specific banding patterns could be observed after REP-PCR. As species identification of coagulase-negative staphylococci by fatty acid analyses and biochemical tests is known to be difficult ERIC- and BOX-PCR seem to be excellent tools for the identification of Staphylococcus epidermidis isolates.

Nitrilase of Rhodococcus rhodochrous J1. Conversion into the active form by subunit association

Nitrilase-containing resting cells of Rhodococcus rhodochrous J1 converted acrylonitrile and benzonitrile to the corresponding acids, but the purified nitrilase hydrolyzed only benzonitrile, and not acrylonitrile. The activity of the purified enzyme towards acrylonitrile was recovered by preincubation with 10 mM benzonitrile, but not by preincubation with aliphatic nitriles such as acrylonitrile. It was shown by light-scattering experiments, that preincubation with benzonitrile led to the assembly of the inactive, purified and homodimeric 80-kDa enzyme to its active 410-kDa aggregate, which was proposed to be a decamer. Furthermore, the association concomitant with the activation was reached after dialysis of the enzyme against various salts and organic solvents, with the highest recovery reached at 10% saturated ammonium sulfate and 50% (v/v) glycerol, and by preincubation at increased temperatures or enzyme concentrations.

Indoor air quality at the Correr Museum, Venice, Italy

Two multidisciplinary field surveys, one in winter and the other in summer have monitored the indoor microclimate, air pollution, deposition and origin of the suspended particulate matter and microorganisms of the Correr Museum, Venice. In addition, this study was focused to identify the problems caused by the heating and air conditioning system (HAC) and the effects due to the presence of carpets. Heating and air conditioning systems (HACs), when chiefly designed for human welfare, are not suitable for conservation and can cause dangerous temperature and humidity fluctuations. Improvements at the Correr Museum have been achieved with the assistance of environmental monitoring. The carpet has a negative influence as it retains particles and bacteria which are resuspended each time people walk on it. The indoor/outdoor pollutants ratio is greater in the summertime, when doors and windows are more frequently open to allow for better ventilation, illustrating that this ratio is mainly governed by the free exchange of the air masses. The chemical composition, size and origin of the suspended particulate matter have been identified, as well as the bacteria potentially dangerous to the paintings. Some general suggestions for improving indoor air quality are reported in the conclusions.

The indoor environment of a modern museum building, the Sainsbury Centre for Visual Arts, Norwich, UK

A multi-disciplinary approach was used to investigate the indoor environment of a modern museum building, and its suitability for the conservation of the collection therein. Climate, gaseous and particulate pollution and the concentrations of bacteria were measured in summer and winter campaigns. While the environment overall was found to be an acceptable one, a number of drawbacks were highlighted, the most serious of these being the large temperature and humidity fluctuations that occurred in the summer.

Agrococcus citreus sp. nov., isolated from a medieval wall painting of the chapel of Castle Herberstein (Austria)

A bacterial strain, D-1/1aT, isolated from a medieval wall painting of the chapel of Herberstein (Styria, Austria) was characterized by a polyphasic approach. Strain D-1/1aT shared 98.1% 16S rRNA sequence similarity to Agrococcus jenensis. The chemotaxonomic characteristics including polar lipid pattern, whole cell sugars, quinone system, polyamine pattern, cell wall composition and fatty acid profile were in good agreement with those of Agrococcus jenensis. The G+C content of the DNA was determined to be 74 mol%. The value of 47% DNA reassociation obtained after DNA-DNA hybridization between DNA of Agrococcus jenensis and strain D-1/1aT as well as differences in the amino acid composition of the peptidoglycan and in physiological characteristics demonstrate that the isolate represents a new species of the genus Agrococcus. The name Agrococcus citreus sp. nov. is proposed for the new species harbouring isolate D-1/1aT. The type strain is DSM 12453T.

Microbial synthesis of coniferyl alcohol by the fungus Byssochlamys fulva V107

Coniferyl alcohol (123 mM = 21.9 g/l) was synthesized from eugenol with a yield of 94.6% in a 36 h fed-batch bioconversion using resting cells of the fungus Byssochlamys fulva V107.

Purification, characterization and gene cloning of 6-hydroxynicotinate 3-monooxygenase from Pseudomonas fluorescens TN5

6-Hydroxynicotinate 3-monooxygenase, a membrane-bound, 42-kDa monomeric enzyme from Pseudomonas fluorescens TN5 was purified and characterized. The enzyme catalyzes the oxidative decarboxylation of 6-hydroxynicotinate and depends on O2, NADH and FAD with the holoenzyme containing 1 M of FAD per 1 M of enzyme. The isolated enzyme was used for the synthesis of 2,5-dihydroxypyridine, a precursor for the chemical synthesis of 5-aminolevulinic acid, which is applied as a plant growth hormone, a herbicide and in cancer therapy. A 1.8-kbp DNA fragment, which contains the ORF encoding 6-hydroxynicotinic acid 3-monooxygenase, was cloned, sequenced and expressed in Escherichia coli. The deduced 385 amino acid sequence of the cloned ORF is in agreement with the enzyme molecular mass, amino acid sequence of an internal peptide, contains a putative FAD-binding site and is homologous to similar flavoproteins such as salicylate 1-monoxygenase.

Purification and characterization of vanillyl-alcohol oxidase from Byssochlamys fulva V107

Vanillyl-alcohol oxidase from Byssochlamys fulva V107 was purified to apparent homogeneity as shown by SDS-PAGE and gel-permeation HPLC. The enzyme is a homodimeric flavoenzyme consisting of two 58 kDa subunits. It catalyzes the dehydrogenation of different 4-hydroxybenzylic structures, including the conversion of 4-hydroxybenzyl alcohols such as vanillyl alcohol to the corresponding aldehydes, eugenol to coniferyl alcohol, and 4-alkylphenols to 1-(4-hydroxyphenyl)alcohols. The latter reaction was S-stereospecific and was used for the synthesis of S-1-(4-hydroxyphenyl)ethanol and -propanol with enantiomeric excesses of 81.9 and 86.0%, respectively. The catalytic and structural similarities to a Penicillium vanillyl-alcohol oxidase and Pseudomonas 4-alkylphenol methylhydroxylases are discussed.

Carbon dioxide fixation by reversible pyrrole-2-carboxylate decarboxylase from Bacillus megaterium PYR2910

Pyrrole-2-carboxylate decarboxylase from Bacillus megaterium PYR2910 attains a balanced reaction equilibrium with an equilibrium constant of 0.3-0.4 M. Therefore, the enzyme catalyzes the reverse carboxylation of pyrrole after addition of bicarbonate. For the synthesis of pyrrole-2-carboxylate, the reverse reaction was optimized and the equilibrium was shifted towards the carboxylate. The product yield was 230 mM (25.5 g/l) pyrrole-2-carboxylate from 300 mM pyrrole in a batch reaction and 325 mM (36.1 g/l) from 400 mM pyrrole in a fed-batch reaction, using both whole cells and the purified enzyme in a pH 8.0 reaction mixture with bicarbonate saturation of 1.9 M. Kinetic studies indicated, that bicarbonate is the reactive species used by this carbon dioxide-fixation enzyme.

Pyrrole-2-carboxylate decarboxylase from Bacillus megaterium PYR2910, an organic-acid-requiring enzyme

Inducible pyrrole-2-carboxylate decarboxylase, which catalyzes the decarboxylation of pyrrole-2-carboxylate to pyrrole and CO2 in stoichiometric amounts, was purified from Bacillus megaterium PYR2910. The purity of the enzyme was shown by SDS/PAGE and gel-permeation HLPC. The enzyme has a molecular mass of approximately 98 kDa and consists of two identical subunits. It is highly specific for pyrrole-2-carboxylate, and also catalyzes the reverse reaction, the carboxylation of pyrrole. A unique feature of this enzyme is its requirement of an organic acid, such as acetate, propionate, butyrate or pimelate. A possible catalytic mechanism including a cofactor function of organic acid is discussed.

Purification and characterization of 2,4,6-trichlorophenol-4-monooxygenase, a dehalogenating enzyme from Azotobacter sp. strain GP1

The enzyme which catalyzes the dehalogenation of 2,4,6-trichlorophenol (TCP) was purified to apparent homogeneity from an extract of TCP-induced cells of Azotobacter sp. strain GP1. The initial step of TCP degradation in this bacterium is inducible by TCP; no activity was found in succinate-grown cells or in phenol-induced cells. NADH, flavin adenine dinucleotide, and O2 are required as cofactors. As reaction products, 2,6-dichlorohydroquinone and Cl- ions were identified. Studies of the stoichiometry revealed the consumption of 2 mol of NADH plus 1 mol of O2 per mol of TCP and the formation of 1 mol of Cl- ions. No evidence for membrane association or for a multicomponent system was obtained. Molecular masses of 240 kDa for the native enzyme and 60 kDa for the subunit were determined, indicating a homotetrameric structure. Cross-linking studies with dimethylsuberimidate were consistent with this finding. TCP was the best substrate for 2,4,6-trichlorophenol-4-monooxygenase (TCP-4-monooxygenase). The majority of other chlorophenols converted by the enzyme bear a chloro substituent in the 4-position. 2,6-Dichlorophenol, also accepted as a substrate, was hydroxylated in the 4-position to 2,6-dichlorohydroquinone in a nondehalogenating reaction. NADH and O2 were consumed by the pure enzyme also in the absence of TCP with simultaneous production of H2O2. The NH2-terminal amino acid sequence of TCP-4-monooxygenase from Azotobacter sp. strain GP1 revealed complete identity with the nucleotide-derived sequence from the analogous enzyme from Pseudomonas pickettii and a high degree of homology with two nondehalogenating monooxygenases. The similarity in enzyme properties and the possible evolutionary relatedness of dehalogenating and nondehalogenating monooxygenases are discussed.

Metabolism of 4-chlorophenol by Azotobacter sp. GP1: structure of the meta cleavage product of 4-chlorocatechol

A mutant strain of Azotobacter sp. GP1 converted 4-chlorophenol to 4-chlorocatechol under cometabolic conditions. Under the same conditions the wild-type strain accumulated a yellow compound, which by chemical and spectroscopic methods was identified as 5-chloro-2-hydroxy-6-oxohexadienoic acid (5-chloro-2-hydroxy-muconic semialdehyde). The structure of this compound indicates a meta-proximal cleavage of 4-chlorocatechol.

Effect of granulocyte-macrophage colony-stimulating factor on neutropenia and related morbidity induced by myelotoxic chemotherapy

PURPOSE

A phase Ib/II clinical study was undertaken to assess the efficacy of recombinant human (rh) granulocyte-macrophage colony-stimulating (GM-CSF) factor in attenuating neutropenia and associated morbidity caused by high-dose anticancer chemotherapy administered in the presence or absence of autologous bone marrow support.

PATIENTS AND METHODS

Twenty-two patients with various solid tumors and lymphoid neoplasias were treated with a single daily subcutaneous dose of rh GM-CSF (250 micrograms/m2) 48 hours after receiving a second cycle of highly myelotoxic chemotherapy for a period of 10 days. Within-subject comparisons on neutropenia-related clinical and laboratory variables were made with data obtained from the same patients after they received the first neutropenia-inducing cycle of identical chemotherapy in the absence of GM-CSF.

RESULTS

GM-CSF was active in neutropenic patients because it significantly increased the neutrophilic nadir, reduced the time of relevant neutropenia, and reduced the duration of a patient's hospital stay and the necessity for parenteral antibiotics. No significant toxicity was encountered with subcutaneous GM-CSF treatment.

CONCLUSION

Although GM-CSF was shown to significantly reduce chemotherapy-associated morbidity in patients receiving myelotoxic cancer chemotherapy, additional studies are needed to assess whether the use of GM-CSF in anticancer chemotherapy will allow an increase in the dosage level, leading to improved response rates and survival among cancer patients.

Effect of granulocyte-macrophage colony-stimulating factor on neutropenia and related morbidity induced by myelotoxic chemotherapy

A phase Ib/II clinical study was undertaken to assess the efficacy of recombinant human granulocyte-macrophage colony-stimulating factor (GM-CSF) to attenuate neutropenia and associated morbidity caused by high-dose anticancer chemotherapy administered in the presence or absence of autologous bone marrow support. We treated 22 patients with various solid tumors and lymphoid neoplasias with a single daily subcutaneous dose of GM-CSF (250 micrograms/m2) 48 h after a second cycle of highly myelotoxic chemotherapy for a period of 10 days and compared intraindividually neutropenia-related clinical and laboratory variables with data obtained from the same patients having previously received a first neutropenia-inducing cycle of identical chemotherapy in the absence of GM-CSF. We show that GM-CSF is active in neutropenic patients by significantly increasing the neutrophil nadir, reducing the time of relevant neutropenia, and reducing the duration of the patient's hospital stay and necessity for parenteral antibiotics. No significant toxicity was encountered with subcutaneous GM-CSF treatment.

Hyperextension spinal fracture

Hyperextension thoracolumbar spinal fractures are unusual and occur primarily in patients with ankylosed spines. Early diagnosis to avoid neurologic deterioration requires a high index of suspicion, given the paucity of radiographic findings. The biomechanics of the fracture and its treatment differ from more typical spinal fractures in several important aspects.

Interleukin-4 induces secretion of CSF for granulocytes and CSF for macrophages by peripheral blood monocytes

T cells are known to interact cooperatively with monocytes to produce Colony-Stimulating Factors (CSF), although T cell-mediated signals leading to CSF secretion by monocytes are not completely understood. We have made use of Northern blot hybridization and specific bioassays to study the effects of the T cell product interleukin-4 (IL-4) on monocyte CSF expression. The results suggest a previously unrecognized role of IL-4 as a CSF inducer since exposure of monocytes to IL-4 resulted in accumulation of transcripts for granulocyte-CSF (G-CSF) and macrophage-CSF (M-CSF). Consequently, IL-4-activated monocytes released factors in their culture supernatants biologically and antigenically indistinguishable from G- and M-CSF.

Experimental lipidosis of the inner ear. Morphological and functional results

Chronic administration of chlorphentermine in young rats induces an accumulation of lysosomes containing phospholipids in the inner ear. The inner hair cells, the dark cells of the stria vascularis, the perikarya of the spiral ganglion and some supporting cells are those most affected, whereas the outer hair cells always remain free. Most of the nerve fibres coursing radially to the inner hair cells as well as some tunnel crossing and outer spiral fibres are swollen, filled with osmiophilic material and vacuoles and sometimes degenerated. After discontinuing the treatment the changes remain, though to a lesser degree. The inclusions lead to changes in the cochlear compound action potential. The threshold, the latency of the first component and the time difference of the individual components are clearly changed at higher sound levels. After stopping chlorphentermine feeding the hearing ability improves but it does not become normal. Since the inclusions are found mainly in the inner hair cells and nerve fibres, we assume that the lipid turnover in these structures is especially high.

The influence of a chronic vitamin A deficiency on the rat cochlea

Rats were fed a vitamin-A-free diet and the cochleas of these animals were studied under the light and electron microscope. The cochlear function was tested by means of the electrocochleography. No pathologic changes could be found in the organ of Corti; the stria vascularis and the cochleas showed normal development. The recordings of the deficient rats are identical in configuration to controls, but they are shifted to higher intensities due to an otitis media found in the tested animals. These findings suggest that vitamin A does not have an important function in the inner ear.

The long-term period measurement, an instrumental method in phoniatry

With the help of an Analog to Digital Converter we are able to perform serial and statistical analysis in the time domain. The difficulty in those long-term period measurements consists in the correct extraction of the periodicity in human voice. A simple method is the electroglottography, which, however, is not applicable in all cases. The analysis of the acoustic wave (translated via microphone) demands a lot of electronics if to be precise. Our investigation consists of a compromise between precision and amount of instrumentation, and we only took one parameter as a criterion. The possible error is negligible. We present the results of this measurement type using the patterns of one normal voice and eight different kinds of voice disorders.

[Swiss Institute for the Prevention of Alcohol Problems]

The interest in preventive measures of self-destructing behaviours is increasing considerably. However, it seems hardly possible to apply the traditional public-health model to the prevention of alcohol problems because this is influenced too much by clinical thinking. When trying to prevent alcohol-related disabilities, one has in fact to establish behaviourial standards. Preventive measures will yield success only if compulsive and persuasive strategies are combined. The Swiss institute for the prevention of alcohol problems tries to adapt its activities (research, media department, education department, alcohol policy) to the necessaries of a comprehensive concept of prevention.

[Acoustic transmission characteristics of the human thorax at various frequencies (author's transl)]

The acoustic transmission characteristics of the human thorax in the frequency range of 100 to 2000 c.p.s. were studied in nine corpses. Using a logarithmic scale for frequency, the sound pressure level measured on the chest wall showed a linear attenuation between 100 and 1000 c.p.s. with a mean reduction in sound pressure level of 77 dB.

[A female mutational falsetto? (author's transl)]

This paper reports about a female mutational falsetto, that means an unusual high (309 Hz base frequency) fundamental frequency of the speaking voice in a 19-year-old girl. The psychological background and the epicrisis as well as the practical negative result of the hormon- and metabolism examination allow the diagnosis of this rare disturbance of the voice, the formal classification of which would on the other hand also allow the statement of a phononeurosis with a too high fundamental frequency of the speaking voice because the behavior of the voice from the menarche (12 years) up to the first examination does not seem assured definately. The individual median fundamental frequency of the speaking voice has inally been obtained at 270 Hz. Energy range of the speaking voice has been measured, glottography and sonagraphy has been carried out, all of which show the course of treatment clearly. It has been remarked critically that there has to be found a method to better reproduce the hearing impression in a figure. Investigations according to this have been made.