Minimal residual disease and imaging-guided consolidation strategies in newly diagnosed and relapsed refractory multiple myeloma

Measurement of minimal residual disease (MRD) by next-generation flow cytometry (NGF) is an important tool to define deep responses in multiple myeloma (MM). However, little is known about the value of combining NGF with functional imaging and its role for MRD-based consolidation strategies in clinical routine. In the present study, we report our experience investigating these issues with 102 patients with newly diagnosed (n = 57) and relapsed/refractory MM (n = 45). Imaging was performed using either positron emission tomography or diffusion-weighted magnetic resonance imaging. In all, 45% of patients achieved MRD-negativity on both NGF and imaging (double-negativity), and 8% and 40% of patients were negative on either NGF or imaging respectively. Thus, in a minority of patients imaging was the only technique to detect residual disease. Imaging-positivity despite negativity on NGF was more common in heavily pretreated disease (four or more previous lines) compared to newly diagnosed MM (p < 0.01). Among the 29 patients undergoing MRD-triggered consolidation, 51% responded with MRD conversion and 21% with improved serological response. MRD-triggered consolidation led to superior progression-free survival (PFS) when compared to standard treatment (p = 0.04). In conclusion, we show that combining NGF with imaging is helpful particularly in patients with heavily pretreated MM, and that MRD-based consolidation could lead to improved PFS.

Mesenteric Lymph Node Transplantation in Mice to Study Immune Responses of the Gastrointestinal Tract

Mesenteric lymph nodes (mLNs) are sentinel sites of enteral immunosurveillance and immune homeostasis. Immune cells from the gastrointestinal tract (GIT) are constantly recruited to the mLNs in steady-state and under inflammatory conditions resulting in the induction of tolerance and immune cells activation, respectively. Surgical dissection and transplantation of lymph nodes (LN) is a technique that has supported seminal work to study LN function and is useful to investigate resident stromal and endothelial cell biology and their cellular interactions in experimental disease models. Here, we provide a detailed protocol of syngeneic mLN transplantation and report assays to analyze effective mLN engraftment in congenic recipients. Transplanted mLNs allow to study T cell activation and proliferation in preclinical mouse models. Donor mLNs proved viable and functional after surgical transplantation and regenerated blood and lymphatic vessels. Immune cells from the host completely colonized the transplanted mLNs within 7-8 weeks after the surgical intervention. After allogeneic hematopoietic cell transplantation (allo-HCT), adoptively transferred allogeneic CD4+ T cells from FVB/N (H-2q) mice homed to the transplanted mLNs in C57BL/6 (H-2b) recipients during the initiation phase of acute graft-versus-host disease (aGvHD). These CD4+ T cells retained full proliferative capacity and upregulated effector and gut homing molecules comparable to those in mLNs from unmanipulated wild-type recipients. Wild type mLNs transplanted into MHCII deficient syngeneic hosts sufficed to activate alloreactive T cells upon allogeneic hematopoietic cell transplantation, even in the absence of MHCII+ CD11c+ myeloid cells. These data support that orthotopically transplanted mLNs maintain physiological functions after transplantation. The technique of LN transplantation can be applied to study migratory and resident cell compartment interactions in mLNs as well as immune reactions from and to the gut under inflammatory and non-inflammatory conditions.

HeartCycle: advanced sensors for telehealth applications

Current treatment of Cardiovascular Disease (CVD)--the most frequent cause of hospitalization for people over 65--involves changes of diet and lifestyle, requiring in addition physical exercise to support these. Nowadays, patients receive sporadic feedback at doctor visits, or later on, when facing symptoms. The HeartCycle project aimed at providing 1) daily monitoring, 2) close follow up, 3) help on treatment routine and 4) decreasing non-compliance to treatment regimes. The present paper illustrates a new toolbox of advanced sensors developed within the HeartCycle project. Ongoing clinical studies support these developments.

[Invasive electrophysiology: complications, nightmares and their management]

Most minor side effects of ablation in the right atrium and right ventricle relate to femoral venous catheterization but there is a small risk of severe complications including atrioventricular (AV) block, damage of surrounding structures and thromboembolic events. Impairment of AV conduction can occur during ablation of atrioventricular re-entrant tachycardia, ablation of anteroseptal, mid-septal and parahisian accessory pathways, ablation of ectopic atrial tachycardia originating from the vicinity of the atrioventricular node and when ablating the septal isthmus for typical atrial flutter. Damage of the right coronary artery is a very rare complication after inferior isthmus ablation with high energy. The thromboembolic risk during and after cardioversion and ablation of atrial flutter is higher than previously recognized and anticoagulation therapy decreases this risk. The risk of perforation and tamponade during ablation in the right atrium and right ventricle is very low but particular caution is necessary in thin-walled structures such as the coronary sinus and the upper right ventricular outflow tract. Phrenic nerve injury can be avoided by pacing from the mapping electrode before application of radiofrequency energy at the right atrial free wall. Limitation of power output depending on the site of ablation and titration of energy application with continuous control of temperature and impedance should be considered to minimize the risk of complications.

[The efficacy of a combination herbal medicine in the treatment of functional dyspepsia. Meta-analysis of randomized double-blind studies on the basis of a valid gastrointestinal symptom profile]

BACKGROUND AND AIM

Functional dyspepsia is a heterogeneous clinical entity of incompletely known etiology. Overall, four randomized double-blind studies from the nineteen-nineties investigating acute treatment of this condition with the combination herbal medicine Iberogast, are available. A meta-analysis of the studieswas carried out to evaluate the overall therapeutic effect.

PATIENTS AND METHODS

In all four, triple-arm, controlled multicentre studies, the efficacy of 4 weeks of treatment with 3 x 20 drops daily, applied after a washout phase, was investigated, the primary efficacy parameter being a specific gastrointestinal symptom score. Of the 592 participants in the studies, 196 were treated with Iberogast, 131 with placebo, and 61 with cisapride as positive control. The remaining 204 patients, who were treated with an experimental herbal preparation of similar composition, were not admitted to the final analysis.

RESULTS

While overall appreciable improvement of the clinically relevant symptoms of moderate severity was seen under treatment with the combination herbal preparation, the individual studies differed in terms of the statistical significance of the results obtained. The meta-analysis of studies revealed a clear therapeutic effect for the herbal medicine (p < 0.0001).

CONCLUSION

The clinical experience with the combination preparation for the treatment of functional dyspepsia was confirmed by the meta-analysis of the modern double-blind studies.

An arm phantom: a digital simulation system for testing sphygmomanometers

An arm phantom for testing non-invasive blood pressure measuring instruments under reproducible and real conditions has been developed. Signal records, recorded on patients and validated by a reference method, are played into the instruments to be tested using a combination of an electro-pneumatic and an electro-acoustic converter. For each of 90 patients a database contains records of at least three different kinds of signal: cuff pressure oscillations, Korotkoff sounds (except in neonates) and cuff pressure. As the inflation and deflation rate varies between different sphygmomanometers the control and synchronization of the signal output are ensured as a function of the instantaneous cuff pressure, measured continuously by the system. A segmented output procedure synchronizes the data flow during the test procedure. The records of blood pressure signals are separated in different signal groups, containing only one pressure oscillation and Korotkoff sound respectively, whereas the instantaneous cuff pressure determines the signal group to be selected. Suitable interfaces to the sphygmomanometers under test consist of two specifically developed signal converters, an electro-pneumatic converter and an electro-acoustic converter. The system generates both cuff pressure oscillations and Korotkoff sounds from real data earlier recorded on human subjects. It allows any inflation and deflation rate of the cuff pressure to be applied, considers the variability of the pulse rate occurring in the same data record and finally it allows the superposition of artefacts. The arm phantom can replace clinical trials. The possibility of testing the limits of the performance of sphygmomanometers has been considerably extended.

[The content of ascorbic acid in plasma and in 14 tissues of lambs of different ages during normal feeding and feeding restricted from time to time during the suckling period]

In normally fed lambs (group 1) the content of ascorbic acid (AA) in the plasma on day 8, 18, 28, 38, 48, 60 and 100 after birth was the same as in lambs, that were fed on days 8 to 17 (group 2), 8 to 26 (group 3) and 8 to 35 (group 4) on the maintenance level. The restrictive feeding induced for a certain time a decrease in the glucose content of the plasma. In the lambs of group 2 and 3 there was no differences in the content of AA in 14 tissues compared to group 1. In the lambs of group 4 the body weight on the 35th day was only 54 and the mass of the hypophysis 60, of the lung 55.9, of the liver 51, of the heart 47.2, of the spleen 44.7 and of the kidney 38% of that of group 1; there was a tendency to a lower content of AA in most tissues. With increasing age the content of AA in the cerebrum, in the cerebellum, in the brain stem and in the testicles decreased; the highest content in the hypophysis was determined on day 180. The regulation of the synthesis of AA in the liver under normal and pathological conditions is discussed.

[The use of a hydrolysis residue from lysine production in a straw concentrate mixture for fattening lambs]

The validity of residues from hydrolysis of soya bean meal for production of lysine was tested in a growth experiment with 2 groups of 25 cross breeding lambs as well as in a N-balance trial with 5 lambs. The animals in the growth experiment started with an average body weight of 25 kg. An industrially produced concentrate for lamb fattening was given to the animals of the control group. To the second group a straw-concentrate mixture was given, containing 30% straw, 52% barley, 5% soya bean meal, 5% dried beet pulp and 5% of hydrolysis residue. The mixture included 10.71 MJ ME resp. 5.51 MJ net-energy fat (cattle) and 166 g digestible crude protein per kg dry matter. The lambs of group 2 showed an 8% lower intake of DM, connected with a 26% intake of energy and 32% lower intake of DCP in comparison to the control group. The average daily body weight gain was 374 g for the control group and 241 g for group 2 respectively, the difference being statistically significant. The feed/gain ratio was in group 2 = 14% higher for energy and 6% higher for DCP than in the control group. The N-balance trial resulted in a N-retention of 25 percent of the N-intake. The results approved the possible use of 5% of the hydrolysis residue product for 2% crude protein in straw-concentrate mixtures for ruminants.

[The reliability of the measurement of non-invasive oscillometric blood pressure instruments]

METHODS

The performance of five oscillometric blood pressure monitors was tested by means of a simulator. The oscillometric signals of two healthy patients were replayed. These signals were superimposed by sinusoidal artefacts with increasing amplitude, to examine the influence of artefacts on the accuracy of the measurement. Each measurement was repeated 15 times.

RESULTS

The artefacts taken for this examination did affect the scattering of each single measurement rather than the mean value of the repeated measurements. The results did get worse with decreasing signal-to-artefact ratio. However, some monitors are able to handle these artefacts better than others.

CONCLUSION

It is obvious that the implemented software for the artefact treatment and the determination of blood pressure values differs from manufacturer to manufacturer. Some devices were able to separate relevant signals from artefacts better than others. The most critical point of the oscillometric method is the correct determination of the maximum amplitude of the oscillations, because it directly influences the accuracy of the displayed blood pressure values. The availability of a simulator to test automated sphygmomanometers has shown to be a good tool to examine the performance of these devices.

[The content of Hb in the blood and of different constituents in the plasma of lambs with low and normal increase in body mass]

In lambs with a very restricted intake of nutrients and an increase of the body mass of less than 60 g per day (group A) and in those with an increase of more than 220 g/day (group B), analyses of components of the blood and the plasma were performed at certain intervals. In the lambs of group A an anemia developed in the course of 77 days. The concentrations of alpha-amino-N, non-protein-N, urea, glucose and insulin as well as the activity of the alkaline phosphatase of the plasma of the lambs of group A were always lower than those of group B. The beta-hydroxybutyrate concentration of the lambs of group A on the 7th and 21st day of the experiment was higher than that of group B. The concentrations of inorganic phosphate and iron in the plasma of group A at most points during the study were lower than that in group B.

[The effect of a restriction of the feed intake on the composition of the blood and on the development and composition of different tissues of sheep during growth. 2. The development of different tissues and the concentration of protein, DNA and RNA]

The concentration of protein in the cerebrum of sheep after a period of feed restriction (group 2) was lower (94.5 +/- 10.2) than in normally fed sheep of group 4 (101.4 +/- 9.4 mg/g wet weight). In the group 2 the concentration of protein in the M. longissimus dorsi and in the M. semimembranosus was also smaller. A high DNA-concentration was determined in the intestinal lymph nodes, in the spleen and in the lung. The DNA-concentration of the testes of group 2 (7.17 +/- 2.92) was higher than that of the group 4 (4.46 +/- 1.70 mg/g w. w.), also that of the renal fat tissue (0.39 +/- 0.18 resp. 0.20 +/- 0.09). The highest protein: DNA-relation in group 4 was found in the fat tissue (203.5: 1) and the lowest in the spleen (15.3: 1). A high RNA-concentration was analysed in the lymph nodes, in the spleen and in the lung. The RNA-concentration in the fat tissue of group 2 (0.34 +/- 0.13) was higher that that in group 4 (0.15 +/- 0.08 mg/g w. w.).

[The effect of a restriction of nutrient intake on the composition of the blood and on the development and composition of different tissues of sheep during growth. 1. The level of the hematocrit and hemoglobin in the blood, that of protein, alpha amino-N, remaining N, glucose, FFA, insulin, beta-hydroxybutyrate, Na, K, Ca, Mg, Pa, Fe, iron-binding capacity, Cu and Zn and the activities of ALT, AST, LDH, GGT and AP in plasma at slaughter]

In lambs after weaning with a body weight of 16.3 +/- 1.5 kg (group 1) and in sheep after a period of fattening with an increase of the body weight of 72.2 +/- 13.6 (group 2), of 184.4 +/- 12.2 (group 3) respectively of 302.1 +/- 24.3 g per day (group 4) the concentration of the components mentioned in the title was analysed in blood and plasma. The hematocrit, the concentration of Hb in the blood and that of total protein, of nonprotein-N, of Na, of Ca, of the iron-binding capacity and of Zn as well as the activity of the 5 enzymes in the plasma of the sheep of group 4 were higher than that of the group 2. Stress by the transport and stunning increased the concentration of free fatty acids in the plasma. The significance of the results for the clinical-chemical diagnosis is discussed.

[Relationship between wool yield and cyst(e)ine level in blood plasma]

Publications from Williams were the stimulation to study the relations between wool yield and cyst(e)ine concentration in blood plasma. Methodical experiments were carried out and the two methods used each provided clear results. At the same time the reversible binding of a part of the free cystine in the plasma with the plasma proteins and its effect on the analysis results might be considered. After an interpretation of the two methods their use is described taking into consideration the factors influencing the results of the analysis. It is concluded that the two methods are usable for the planned purpose.

[The nitrate content in milk]

Analytical possibilities for nitrate determination in milk on the base of photometric methods are discussed. An automated method, similar to Nijhuis u. a. (1979), is proposed using flow stream analyser ADM 300. Natrium nitrate (5 g and 10 g/kg live weight resp.) was given to two dairy cows after morning feeding on the 1st and on the 3rd day of experiment. The increase of nitrate content in the milk was very quick, maximal concentrations after 2 h were found as 5.6 mg/l (animal 1) and 3.2 mg nitrate-N/l (animal 2). But nitrate also disappeared relatively quickly, after 24 h there only values were observed corresponding to normal range of 1 mg/l.

[The effect of energy concentration and source on the use of feed protein and NPN in lambs. 3. Allantoin excretion and microbial protein synthesis]

In an N balance experiment with male crossbreeding lambs at an age of 3 ... 4 months four different rations were given differing in energy concentration (high greater than 700 EFU cattle/kg DM and low less than 650 EFU cattle/kg DM) and in the energy source (sugar, starch or crude fibre) with crude protein intake being almost equal. The rations contained 2% urea. Microbial protein synthesis in the rumen was assessed according to ROTH and KIRCHGESSNER (1978) (1), RYS et al. (1975) (2) and BICKEL-BAUMANN and LANDIS (1986) (3) on the basis of allantoin excretion in urine. The highest ruminal protein synthesis quotas were 868 ... 921 mg protein N per kg LW0.75 in (2). In (3) 723 ... 766 mg protein N/kg LW0.75 were synthesized. From the 15N labelling of the supplemented urea and the excreted allantoin it could be calculated that 26 ... 40% of the microbial protein resulted from the urea-N of the ration. Despite a high crude protein content of the ration of between 16 and 17% in the DM and a relation of NPN: pure protein of 0.95 the utilization of the NPN in the ration was relatively high but slightly lower than the utilization of pure protein. The variants with higher energy concentration showed as a tendency higher allantoin excretion in spite of slightly lower dry matter intake and a slightly higher NPN utilization than the variants with lower energy concentration.

[Influence of energy concentration and source on the utilization of feed protein and NPN in lambs. 2. 15N balance and utilization of pure protein and NPN]

In an experiment 12 lambs of the merino species were divided into 4 groups. The variants HE received 740 or 718 EFU cattle/kg DM and the variants NE 689 or 671 EFU cattle/kg DM. The different energy concentrations resulted from differentiated quotas of dried sugar beet chips and wheat starch supplements. Within the variants, sub-variants with (HESZ, NESZ) or without (HES, NES) sugar supplements were formed. Due to varied DM intake, the average energy intake in all groups was 42 EFU cattle/kg LW0.75. N balance experiments using 15N-labelled urea were carried out, and 15N accumulation of N excretion was projected to a steady state. The partial utilization of pure protein and NPN in the ration was ascertained with the help of a 3-pool compartment model of N utilization in ruminants. In the non-amino acid N pool HE utilized 84% of NPN and NE 77% for the synthesis of amino and nucleic acids. The efficiency of protein synthesis in the amino acid N-pool were in HESZ 64%, HES 70%, NESZ 70% and NES 73%, resp. The total utilization of NPN is the sum of the partial utilization in the two pools, whereas the total utilization of pure protein is calculated from the true digestibility and the efficiency of the utilization in the AA-N pool. The total utilization of NPN for the synthesis of protein for the protein pool amounted to 40/35/41/33% and that of pure protein to 54/51/49/50%. Energy intake being identical, energy concentration did not have an influence on the utilization of pure protein and NPN, whereas NPN utilization was better in rations containing sugar. The pure protein in the ration was by 19 ... 52% better utilized than NPN.

[Urea utilization in growing lambs. 7. NPN- and pure protein-N-utilization at various ages]

The utilization quota of NPN and pure feed protein for body protein synthesis was calculated on the basis of N balance experiments with 15N labelled urea with the help of model concepts of a 3-pool model and its mathematical usage. In lambs weighing 13 kg, the efficiency of amino acid and nucleic acid synthesis in the non-amino acid N pool was 64%. This results in a total utilization quota for NPN and pure protein in the ration of 40% and 60%, resp. Lambs weighing 27 kg showed an efficiency in amino acid and nucleic acid synthesis in the non-AA N pool of 77% and in the AA N pool of 60%. The total utilization quota of NPN was 47% and that of pure protein 56%. The pure protein in the ration was thus about twice as well utilized for total protein synthesis and for protein synthesis for crude protein retention as the NPN compounds in the ration.

[Comparison of lard-tallow mixture and bone fat in digestion and growth experiments in calves]

Male calves between 15 and 26 days old and with a live weight between 45 and 46 kg received dried skim milk dissolved in water plus fat concentration from lard--suet mixtures made with a synthetic emulsifier of the type ethoxylated partial ester with and without soybean lecithin supplement. One group received bone fat with an emulsifier as sole fat component. In the course of 9 experiment weeks the calves of the lard--suet group without lecithin reached an average daily weight gain of 710 g, which was not significantly better than the gains of 689 g of the lard--suet group with lecithin and of 674 g of the bone fat group. The calves of the lard--suet group with lecithin did not digest the feed fat significantly better than the calves in the other two groups. The quota of fatty acids in the feed distinctly influenced the composition of the fatty acids in the intestines, the kidneys and the hypodermis. With the example of suet the general relationship between the fatty acid patterns of the feed and body fats are recognizable, with the fatty acids C 16:0, C 18:2 and C 18:3 having a lower and C 16:1, C 18:0 and C 18:1 having a higher quota in the suet than in the feed fat. Due to the application of high amounts of bone fat, vegetable oil or sea animal fat there are deviations from this rule. There is a higher quota of linolenic acid in the suet of the calves than in butter fat but a lower quota than in foreign fat.

[Influence of emulsifiers and fat mixtures on the digestibility and sedimentation of fatty acids in calves]

In a digestibility experiment with 4 X 4 calves the animals received 100 g mixture for calves, 50 g dried green fodder and either 656 g dried whole milk and 164 g dried skim milk (VM) or 656 g dried whole milk and 164 g added fat. The added fat consisted of a mixture of tallow and lard in a 1:1 ratio plus 10% emulgator ES 20 (FE) or 8% ES 20 and 2% soybean lecithin (FL) or 25% lard, 25% tallow, 40% rape/sunflower oil with 10% ES 20 (FO). The apparent digestibility of the fat amounted to 91% in group VM and in groups FE/FL/FO to 66/70/67% resp. The composition of fatty acids and the use of an unsuitable charge of dried skim milk are considered to be the causes of the low apparent digestibility. The apparent digestibility of the fatty acids decreased with their growing chain length. The higher digestibility of the unsaturated fatty acids is largely caused by changes due to bacterial activity in these fatty acids in the intestines and by the influence of metabolically changed faecal fat. The combination of the synthetic emulgator with lecithin did not improve fat digestion but diminished the total fat content in the blood.

[Urea utilization by growing lambs. 5. N-balance with half synthetic rations]

In experiment with 14-week-old lambs a combination of semisynthetic rations containing 1.2% or 0.7% resp. native crude protein an intraruminal infusion of urea clearly influenced the biologic processes in the rumen. The molar quotas of butyric and valeric acid in comparison with acetic were high. The lambs could cope with infused amounts of 0.67 g urea/kg body weight if they received the daily amount of 1.35 g/kg body weight in two parts. When more than 1.9 g/kg body weight were applied, feed intake decreased even though the daily amount was distributed over 4 doses. In 10 out of 16 lambs N retention was, in dependence on the urea amounts infused, higher than the N amount retained from native crude protein. The result indicates that urea is utilized by 14-week-old lambs. Growing energy and N intake had a positive influence on the N balance.

[Urea utilization in growing lambs. 4. N balances with unprocessed rations]

N balance experiments were carried out with lambs of the ages of 8, 12 and 15 weeks fed with wheat rations with and without 2% urea supplement (N 1 and N 2) as well as with 3% urea and 20% straw (N 3) or with a soya bean meal supplement (N 4). There were no significant differences in the digestibility of the crude nutrients and in per cent of N retention between the individual ages. The straw supplement decreased the digestibility of organic matter, crude protein, crude fibre and NfE. The supplements of soya bean meal or urea increased the crude protein content in comparison to the wheat ration without supplements by 6% in the dry matter and resulted in N intakes 55 ... 60% higher and in 23 ... 38% higher N retention, which was, however, lower in relation to N intake. There were no significant differences with regard to N retention between N 2, N 3 and N 4. Consequently urea supplement to the feed mixture with 14% native crude protein resulted in increased N retention, which was not lower than with a soya bean meal supplement.

[Urea utilization in growing lambs. 3. Effect of urea and straw on carcass composition]

Subsequent to a growth experiment with intensively fattened lambs the value of the carcasses of 4 animals each from 7 groups was determined. The control groups with mixed fattening feed for lambs and the groups with wheat and barley mixtures containing urea showed higher carcass yields, net gains, fat percentage and padding, dry matter and fat content of the carcass and lower quotas of important cuts as well as a lower crude protein content in the carcass than groups with grain without urea and groups with straw. This is due to the higher weight gains of the first-mentioned groups. There were no significant differences in the carcass characteristics between the animals of the control group and the grain-urea groups. The carcass quality of the male lambs was better than that of the female ones.

[Urea utilization of growing lambs. 2. Growth experiments]

In two growth experiments with 30 lambs per group the influence of urea (1-2% of the ration) and straw (20-30% of the ration) on the performance was studied under conditions of intensive fattening. The content of native crude protein in the rations varied between 10.1 and 18.4% of the DM. In experiment 1 the lambs of the two groups which received mixed feed for fattening lambs without urea on average consumed with 1.02 and 1.11 kg DM resp., 696 and 757 EFUcattle resp. and 173 and 189 g crude protein resp. per animal and day. The groups with wheat or barley and urea consumed 1.06 and 0.96 kg DM resp., 714 and 627 EFUcattle resp. and 209 and 155 g crude protein resp. Their weight gain of 247 g/animal and day was 24% and that of 230 g resp. 26% higher than that in the control groups without urea. The lowest dry matter intake (0.91 and 0.82 kg resp.) was shown by the animals of the groups which received wheat or barley without urea. In the second experiment the control group achieved an average daily weight gain of 327 g at an expenditure of 2.24 kEFUcattle/kg weight gain. Despite a partly higher dry matter intake, the daily EFUcattle intake was between 12.2 and 24.5% lower in the straw groups and energy expenditure increased between 12.0 and 27.8%. Urea supplements of between 1 and 2% improved dry matter, EFUcattle and crude protein intake and thus weight gain.

Determination of the number of exponential functions in pharmacokinetic models on the basis of concentration-time data by MUCOM1

MUCOM1 is a new BASIC computer program which has been developed for automatically deriving the function terms of a pharmacokinetic model, operating on the best-approximation principle. The parameters of a poly-exponential model and their confidence intervals are computed from any available concentration-time data. The user neither needs to make an initial estimate of the number of terms, nor to find first approximations to the coefficients of the exponential functions. The approximation procedure is iterative, and is based on the RIP routine. MUCOM1 can be used on desk computers.

[Clinical death-cap (Amanita phalloides) poisoning: prognostic factors and therapeutic measures. Analysis of 205 cases]

205 cases of clinical poisoning with the mushroom Amanita phalloides (death cap) in the period 1971 to 1980 have been studied retrospectively. The lethality was 22.4%. Age and latency between the ingestion of the mushrooms and the first clinical symptoms were of prognostic significance. The death rate was 51.3% in children below 10 years of age but only 16.5% in patients older than 10 years. The average latency period was 10.3 hours for the fatal cases and 12.6 hours for the surviving patients. Country, year, sex and time of hospitalization did not influence lethality. Prognostic relevance could also be attributed to the thromboplastin time (Quick). 84% of the patients with values below 10% died, while all patients with minimal values of more than 40% survived. The correlation with the outcome was weaker for the serum transaminases and nil for creatinine. The patients underwent on the average 8 therapeutic measures, but up to 20 therapies could be administered to the same patient. Eight of the 30 recorded treatments involved general support, 7 toxin elimination and the remaining 14 could be classified as pharmacotherapy. With the aid of multiple regression analysis taking into account age, latency period and the effects of all the other measures, penicillin and hyperbaric oxygenation were found to contribute independently to a higher survival rate. As compared to penicillin, the combination of penicillin with silybin was associated with still further increased survival. On the other hand, several measures, including exchange transfusion, thiocytic acid, sulfamethoxazole, plasma expanders, haemodialysis, treatment of the hemorrhagic diathesis and THAM/sodium bicarbonate were administered more often to patients who did not survive. For the remaining 20 therapeutic measures our analysis revealed neither a positive nor a negative correlation with the clinical outcome.

[Pancreatic lipase activity in growing sheep]

The development of the activity of pancreas lipase was observed at lambs reared with and without ewes from their birth to an age of four weeks and in a second series between five and 18 weeks. A statistically significant influence of the age on the level of activity of pancreas lipase could be observed. It was also influenced by the feeding regime, that is, the lambs reared without ewes which were fed restrictively with milk replacer showed a significantly higher activity of pancreas lipase on comparison with lambs reared with milk replacer ad libitum or those reared by ewes. 8-week-old lambs after a suckling period of four weeks and the subsequent sole feeding with pelleted mixed feed reached approximately the same activity of pancreas lipase as adult wethers.

[Activity of disaccharidases in growing sheep. 3. Fattening lambs 5 to 18 weeks of age]

Lambs at an age between 4 and 18 weeks were kept on perforated floor and received pelleted fattening feed for lambs as sole feed ad libitum. After the maltase activity in the duodenal mucosa resp. the contents of the duodenum at an age of 5 weeks was low, it amounted to 6.98 resp. 5.31 units per 0.1 g fresh weight at the end of the eighth week and in the duodenal mucosa it remained on this level to the age of 18 weeks. In the contents of the duodenum it decreased to 3.25 units in this period. The lactase activity in the duodenal mucosa resp. the contents of the duodenum decreased continuously from 30.5 resp. 25.7 to 13.6 resp. 14.8 units in the period investigated. The maltase activity in the pancreas remained constant in the period investigated (4 units per 0.1 g fresh weight). Saccharase activity could not be detected in both duodenal mucosa and contents of the duodenum.

[Studies of the activity of disaccharides in growing sheep. 2. The influence of the feeding regime on the activity of disaccharidases in lambs up to the age of 4 weeks under various rearing conditions]

In two groups of 16 animals each lambs were fed restrictively resp. ad libitum withour ewes with a milk replacer up to the age of four weeks. Maltase activity in the contents of the duodenum and the pancreas homogenate increased with the increasing age of the lambs. The maltase activity of the restrictively fed lambs was higher. The maltase activity in the duodenal mucosa was not influenced by the age. Lactase activity in the duodenal mucosa showed a decreasing tendency up to the end of the four week of life; an increase of lactase activity in the contents of the duodenum could be ascertained up to the fourth week. In comparison with the suckling lambs reared by ewes (cf. 1.) the maltase activity in the duodenal mucosa of the lambs reared without ewes was lower and that in the contents of the duodenum was higher. Concerning lactase activity, there were not significant differences between the rearing and feeding regimens up to the age of three weeks. At the end of their fourth week of life the lactase activity in the suckling lambs was significantly lower than that in the lambs reared without ewes. The total maltase activity (= sum of the activities in the duodenal mucosa, the contents of the duodenum and in the pancreas) showed the highest values for the lambs reared without ewes and fed restrictively in the first three weeks of life. Saccharase activities in the duodenal mucosa or the contents of the duodenum could not be detected in any case.

[Investigations of the activity of disaccharidases in growing sheep. 1. Suckling lambs from birth to an age of 4 weeks]

Investigations of the course disaccharidases take in duodenum and pancreas were made with 20 suckling lambs (straw litter, supplementary feed from 3rd week onwards) at an age between 1 and 30 days. In the first week of the Lambs' lives the activity of lactase in the duodenal mucosa was highest. In the following weeks there was a slightly falling tendency. During the first four weeks of the lambs' lives there were no statistically significant differences concerning the maltase activities in the duodenal mucosa. At the beginning of the first and at the end of the fourth week of the lambs' lives the activity of lactase in the content of the duodenum was significantly lower than at the end of the first and up to the third week. The maltase in the contents of the duodenum showed a significantly higher activity at the end of the fourth week of life. Enzyme activities in the contents of the duodenum were significantly lower then those in the mucosa. After maltase activity in the pancreas had shown high values in the first two days of life, it decreased distinctly toward the end of the first week and than increased again up to the fourth week of life. In the period investigated, saccharase activity in the duodenal mucosa and in the contents of the duodenum could not be detected in any lamb.

[Glucose content of lambs' blood. 2. Blood glucose content during several hours after feeding]

During a 16-hour fasting period, the development of the blood glucose level of ewelessly reared lambs of 4 to 30 days of age was analysed. While the blood glucose level of lambs during their first week of life reacted with a considerable increase and a relatively quick decrease on the administration of milk substitutes, the course of this curve became smoother with increasing age. After a five-hour fasting period, the blood glucose level--after 4 days of the lambs' life--amounted to 101 mg, after 9 days to 96 mg, after 16 days to 91 mg, after 23 days to 64 mg, after 30 days to 71 mg per 100 ml blood. The significance of these results for the establishment of a suitable drinking technology is being discussed.