Mapping the European cancer prevention research landscape: A case for more prevention research funding

Despite the strong evidence of prevention as a prime defence against the disease, the majority of cancer research investment continues to be made in basic science and clinical translational research. Little quantitative data is available to guide decisions on the choice of research priorities or the allocation of research resources. The primary aim of the mapping of the European cancer prevention research landscape presented in this paper is to provide the evidence-base to inform future investments in cancer research. Using bibliometric data to identify funders that are active in prevention research in Europe and in the world, we have identified that 14% of cancer research papers had a focus on prevention research and those were funded by 16% of all the European cancer research funders. An important finding of our study is the lack of research on primary prevention with primary prevention funders accounting for 25% of European cancer prevention funders, meaning that less than 4% of all European cancer research funders identified show an interest in primary prevention. An additional analysis revealed that 7% of European cancer prevention research papers are categorised as implementation projects, meaning that only 1% of all cancer research publications are implementation research in cancer prevention. This paper highlights that the narrow focus on biology and treatment in Europe needs to be widened to include such areas as primary prevention and secondary prevention and a larger concentration on implementation research. These data can help support a more policy-focused cancer research agenda for individual European governments and charitable and philanthropic organisations and stimulate joining efforts across Europe to create a more systematic and structured approach to cancer prevention.

Application of Rupantaran software to Sri Lankan hospitals: an innovative tool developed to merge population-based cancer registry data into CanReg5

The purpose of a population-based cancer registry is to provide information on the disease burden for cancer control planning and is essential in studies on assessing the effectiveness of prevention, early detection, screening and cancer care interventions, where implemented. Sri Lanka is one of the Member States of the World Health Organisation's South-East Asia Region and receives technical support for cancer registration from the International Agency for Research on Cancer (IARC), and the IARC Regional Hub based at the Tata Memorial Centre in Mumbai, India. For data management of cancer registry records, Sri Lanka National Cancer Registry (SLNCR) uses the open-source registry software tool, CanReg5, as developed by IARC. The SLNCR has received data from 25 centres located across the country. Inputted data from the respective centres was then exported from various CanReg5 systems to the main centre in Colombo. As the import to the central CanReg5 system held in the capital is manual, the records were manually modified to avoid any duplicate entries, and the quality of data was compromised. To overcome this issue, a new software tool, Rupantaran, has been created and developed by IARC Regional Hub, Mumbai to help merge the records from different centres. Rupantaran was tested and implemented successfully at the SLNCR with 47,402 merged records. The Rupantaran software has proven beneficial in maintaining the quality of cancer registry data by avoiding manual errors, thus enabling rapid analysis and dissemination, a limiting factor previously.

Mapping the Global Cancer Research Funding Landscape

BACKGROUND

Global investment in research on noncommunicable diseases is on the rise. Cancer as primus inter pares draws particular interest from a wide spectrum of research funders. Next to the private, governmental, and academic sectors, philanthropy has carved out a sizeable area in the funding landscape over the last 25 years. Previous reports describing cancer research funding have looked at the volume of investment in cancer research but have paid little attention to building strategic intelligence on funders. Moreover, these efforts have focused primarily on well-resourced organizations, neglecting a large number of players with less-developed finances.

METHODS

In this article, we combined gnostic data acquisition with agnostic bibliometrics to establish a comprehensive map of the global cancer research funding landscape. The analysis of funding acknowledgments from cancer research papers used in this exercise is a "bottom-up" method that provides a broader perspective on the variety of actors involved. It does not rely on a priori knowledge, nor does it require funders' support for access to the data.

RESULTS

Using this approach, we have identified a total of 4693 organizations from 107 countries engaged in funding cancer research today.

CONCLUSIONS

This is the largest mapping exercise performed to date and should serve as a knowledge base for future analyses and comparisons aimed at understanding the dynamics and priorities of global cancer research funding.

Essential TNM: a registry tool to reduce gaps in cancer staging information

Accurate information on the extent of disease around the time of diagnosis is an important component of cancer care, in defining disease prognosis, and evaluating national and international cancer control policies. However, the collection of stage data by population-based cancer registries remains a challenge in both high-income and low and middle-income countries. We emphasise the lack of availability and comparability of staging information in many population-based cancer registries and propose Essential TNM, a simplified staging system for cancer registries when information on full Tumour, Node, Metastasis (TNM) is absent. Essential TNM aims at staging cancer in its most advanced disease form by summarising the extent of disease in the order of distant metastasis (M), regional lymph node involvement (N), and tumour size or extension, or both (T). Flowcharts and rules have been developed for coding these elements in breast, cervix, prostate, and colon cancers, and combining them into stage groups (I-IV) that correspond to those obtained by full TNM staging. Essential TNM is comparable to the Union for International Cancer Control TNM stage groups and is an alternative to providing staging information by the population-based cancer registries that complies with the objectives of the Global Initiative for Cancer Registry Development.

Determination of low levels of poly(ethylene glycol) 400 in plasma and urine by capillary gas chromatography-selected ion-monitoring mass spectrometry after solid-phase extraction

A convenient and sensitive method for the quantitative determination of poly(ethylene glycol) 400 in plasma and urine with capillary gas chromatography-mass spectrometry has been developed. The sample preparation involves solid-phase extraction with subsequent derivatization with heptafluorobutyric anhydride, which proved to give the most stable derivative. The derivatization procedure was optimized using experimental design, and different solid-phase extraction columns were evaluated. The limit of quantitation was 1 micromol/l (0.4 microg/ml) for both plasma and urine.

Central nervous and systemic kinetics of ramipril and ramiprilat in the conscious dog

The central nervous and systemic kinetics of ramipril, an angiotensin-converting enzyme inhibitor prodrug, and its active metabolite ramiprilat were studied in conscious beagle dogs after sampling of cerebrospinal fluid (CSF) and blood during chronic drug administration. The cardiovascular effect of angiotensin-converting enzyme inhibitors have been suggested to be mediated partly by central action. Ramiprilat and ramipril were determined in CSF and plasma by a gas chromatographic-mass spectrometric assay method. After 10 mg/kg of ramipril, given orally to four dogs once daily for 7 days, significant concentrations of ramiprilat were measured in CSF over the 24-h period after both the 1st and 7th day of treatment. The CSF/plasma (unbound) ratios of ramiprilat on day 7 were (mean +/- S.D.): 0.01 +/- 0.003 (2 h after dose), 0.18 +/- 0.05 (12 h after dose) and 0.32 +/- 0.11 (24 h after dose). Measurable concentrations of ramipril were recorded in plasma after oral dosing (bioavailability approximately 45%), whereas in CSF the prodrug concentration was below the minimal determinable levels in most cases. In a second set of experiments, ramiprilat (3 mg/kg) or ramipril (3 mg/kg) were given i.v. to three dogs once daily for 7 days. Ramipril was rapidly cleared from the plasma, clearance being approximately 140 ml/min/kg and half-life about 0.5 h on day 7. The corresponding values for ramiprilat were 8 ml/min/kg and 0.75 h. The CSF/plasma ratios for ramiprilat were essentially the same after i.v. administration of ramiprilat and ramipril and, furthermore, the ratios did not differ significantly from the ratios observed after oral administration of the prodrug.(ABSTRACT TRUNCATED AT 250 WORDS)

Pronounced accumulation of metoprolol in ischemic myocardium after coronary venous retroinfusion

The myocardial availability of the beta 1-selective blocker metoprolol was compared following standard intravenous (i.v.) administration and after coronary venous retroinfusion. Thirteen open-chest farm pigs were subjected to 90-min occlusion of the left anterior descending coronary artery. In six of these pigs, metoprolol was administered as an i.v. injection while 7 pigs received the drug retrogradely into the coronary vein. The time of administration was 5 min. In both groups, metoprolol was administered after 30 min of coronary artery occlusion. Metoprolol did not influence heart rate (HR) or blood pressure (BP) whether administered i.v. or into the coronary vein. At the end of administration, plasma metoprolol was significantly higher when administered i.v. (2,955 +/- 543 nmol/L) than after coronary venous infusion (1,213 +/- 464 nmol/L; p less than 0.05). At 30 and 60 min after injection, plasma metoprolol did not differ significantly between the two groups. Myocardial tissue concentration of metoprolol in nonischemic myocardium was approximately 480 pmol/g for both groups and similar in the subendocardial, midmyocardial, and subepicardial layers of the myocardium. After i.v. administration, myocardial Metoprolol concentration in the ischemic zone was less than that in the nonischemic zone, averaging 150-300 pmol/g tissue. In contrast, coronary venous retroinfusion of metoprolol resulted in a substantial accumulation of the drug in the ischemic zone, as exemplified by a subendocardial concentration of 2,002 +/- 689; a midmyocardial concentration of 26,643 +/- 8,813 and a subepicardial concentration of 98,571 +/- 58,930 pmol/g, respectively (mean +/- SE). Coronary venous retroinfusion of metoprolol resulted in a pronounced accumulation of drug in the ischemic myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between methylphenidate and placebo as adjuvant in care and rehabilitation of geriatric patients

The aim of the present study was to establish to what extent a short-term treatment with methylphenidate would have such practical clinical effects that possibilities for medical rehabilitation would be improved. Other purposes of the investigation were to certify therapeutically acceptable plasma concentrations in the elderly, and to study possible mental and physical effects of the suddenly improved and greatly extended daily attention given to the patient during the course of the study. 24 fatigued, elderly patients (70-93 years) were treated with methylphenidate/placebo for 9 days. The study was carried out as a double-blind test. Although a significant effect on heart rate and blood pressure was recorded when the full dose (20 mg) had been reached, no difference in mental or physical performance was observed between the two groups.

Comparison of high-selectivity gas chromatographic methods, including column switching, for the determination of felodipine in plasma

The selectivity required for the determination of low concentrations of felodipine in plasma was achieved by either mass-selective detection, optimization of stationary phase selectivity or column-switching gas chromatography (GC) with a dual-oven chromatograph, the latter two with electron-capture detection. The three approaches were evaluated in terms of selectivity, detectability, precision and suitability for routine applications with automated injection. Using mass-selective detection, the detectability in plasma samples was limited by the performance of the mass spectrometer. The detection limit (signal-to-noise ratio = 3) was 4.7 pmol (1.8 pg) of felodipine. Pre-concentration of extracts permitted quantitation in plasma down to 0.2 nmol/1. Using electron-capture detection, the detectability was determined by the selectivity and bleeding characteristics of the columns. For single-column separation, a 35% phenyl phase was selected. The detection limit was 3.0 fmol (1.2 pg). The limit of quantitation in plasma was 1 nmol/1. In column-switching GC, bleeding products from the first column will separate on the second column and may interfere in separations for trace analysis. Bleeding products from a 50% phenyl phase (DB-17) were characterised by GC-mass spectrometry. With a dual-column system, employing a DB-17 (50% phenyl) column for selective introduction on to a CP-Sil 5 (0% phenyl) column, the signal-to-noise ratio was limited by the low-bleeding second column, provided that the bleeding products from the first column were adequately separated from felodipine. The detection limit in this instance was significantly lower 0.35 fmol (0.13 pg). Direct injection of plasma extracts permitted quantitation down to 0.4 nmol/l. All three methods were well suited for use with autosamplers.

Drug level monitoring: cardiovascular drugs

Methods for the determination of cardiovascular drugs in blood and plasma are critically reviewed with emphasis on gas and liquid chromatographic techniques. The importance of the various procedures is discussed, in particular sample work-up where the conditions for isolation and derivatization of the compounds are decisive for the accuracy and precision of the methods. Compared with other assay techniques chromatographic methods are generally to be preferred owing to their better selectivity. In the review the following groups are discussed: digitalis glycosides, antiarrhythmic agents, beta-adrenoceptor antagonists, vasodilating agents, antihypertensive compounds, and diuretics.

Assay of prenalterol in plasma and urine by gas chromatography-mass spectrometry

A sensitive and selective method for the quantitative analysis of prenalterol in plasma and urine is described. Prenalterol and the internal standard, deuterated prenalterol, are extracted with diethyl ether at pH 9.9 under salting-out conditions. Derivatization is performed by means of pentafluoropropionic anhydride in toluene before separation in the gas chromatograph. Detection and quantification of the triacyl derivatives are done by mass spectrometry in the selected ion monitoring mode. The method allows determination of concentrations down to 5 nmol/l (1 ng/ml) in 1 ml of sample, with a relative standard deviation below 10%.

Pharmacokinetics of metoprolol in patients with hepatic cirrhosis

The selective beta 1-adrenoceptor antagonist metoprolol is eliminated primarily by hepatic metabolism and usually less than 5% of an oral dose is excreted unchanged in the urine. The effects of impaired liver function on the pharmacokinetics of metoprolol were studied in 10 patients with hepatic cirrhosis. All subjects were given single doses of 20mg intravenously and 50mg orally on separate days. The mean fraction of the drug available systematically was 84 +/- 10% in patients and 50 +/- 11% in a control group of 6 healthy subjects (p less than 0.05). The total body clearance of metoprolol in the cirrhotics was 0.61 +/- 0.13L/min and in the controls 0.80 +/- 0.11L/min. These values correspond to elimination half-lives of 7.2 +/- 1.2 and 4.2 +/- 1.1 hours, respectively. The differences were not statistically significant. Impaired liver function had no effect on the volume of distribution of metoprolol. Total clearance was weakly but linearly related to galactose clearance (r2 = 0.52; p less than 0.05), and the half-life was related to serum bilirubin (r2 = 0.74; p less than 0.01).

Selected ion monitoring of metoprolol and two metabolites in plasma and urine using deuterated internal standards

A highly sensitive and specific quantitative assay for metoprolol and two of its metabolites, containing an unchanged 2-hydroxy-4-isopropylaminopropoxy sidechain, has been developed. The compounds are isolated from the alkalized sample (plasma or urine) by extraction with dichloromethane, and converted to trifluoroacetyl derivatives by reaction with methyl-bis-(trifluoroacetamide). The reaction mixture is gas chromatographed on an OV-17 column and each substance is assayed by electron impact mass spectrometry using selected ion monitoring, and quantified by comparing the intensity of fragment ion m/z 266 with the intensities of corresponding fragment ions from the deuterated internal standards (m/z 270 and 271). It is possible to determine concentrations as low as 1 nmol l-1 (0.3 ng ml-1) in 1 ml of sample with relative standard deviation of less than 10%.

Determination of prenalterol in plasma and in urine by gas-liquid chromatography

A description is given of a gas-liquid chromatographic method for the quantitative determination of unchanged prenalterol in plasma and for the total (free and conjugated) prenalterol in urine. After addition of an adequate internal standard, prenalterol together with the internal standard, is extracted with diethyl ether and derivatized with heptafluorobutyric anhydride-pyridine to form a tri-heptafluorobutyric derivative. This derivative has favourable properties for its estimation by gas-liquid chromatography using electron-capture detection. A large percentage of prenalterol is excreted as sulfate conjugate in man. Thus a hydrolysis step is added to the urine assay. The sensitivity of the method is about 2ng/ml.

Electron-capture-gas chromatographic determination of atenolol in plasma and urine, using a simplified procedure with improved selectivity

A sensitive gas chromatographic method for the quantitative analysis of atenolol in human plasma and urine is described. Atenolol is extracted with dichloromethane containing heptafluorobutanol to improve the extraction ability. Derivatization with trifluoroacetic anhydride in diethyl ether gives a bistrifluoroacetyl derivative which is more selectively detected by an electron-capture detector than is the corresponding heptafluorobutyryl derivative. The method allows determination down to 20 nmol/l (5 ng/ml) in 1 ml of sample with a relative standard deviation below 10%.

The effect of impaired renal function on the plasma concentration and urinary excretion of metoprolol metabolites

Plasma concentration and urinary excretion of total and 2 active metabolites of metoprolol have been studied in patients with varying degrees of renal impairment and in healthy subjects after intravenous and oral administration of 20 and 50 mg of 3H-metoprolol tartrate respectively. Renal clearance of total metabolites correlated directly with 51Cr-EDTA clearance (r = 0.95, p less than 0.001). A reduction of glomerular filtration rate (GFR) by 70 to 80% increased the elimination half-life of total metabolites and of the active metabolite alpha-hydroxymetoprolol about 3-fold. Significant accumulation was, however, only observed in the patients with a GFR of about 5 ml/min. Even in these patients, the contribution of alpha-hydroxymetoprolol to the beta-adrenoceptor blocking effect of metoprolol will be negligible. The second active metabolite studied is eliminated via biotransformation, and the urinary excretion as well as the plasma concentration of this metabolite were extremely low in comparison with those of the parent drug.