A clinical approach strategy for the diagnosis, treatment and evaluation of external cervical resorption

AIM

To propose a clinical approach strategy on the diagnosis, treatment, and evaluation of external cervical tooth resorption (ECR) cases. To investigate and discuss the outcome of this approach.

METHODOLOGY

A clinical approach strategy on ECR was developed based on a retrospective observation study of 542 teeth. 47 teeth were excluded due to lack of clinical/radiographical information, and 182 were immediately extracted. This approach had three steps: diagnosis, treatment planning, and evaluation. During diagnosis, the medical, dental history and clinical/radiographical characteristics were evaluated. Depending on the resorption extent, ECR cases were categorized into four classes according to Heithersay's classification. During treatment planning, a treatment decision flowchart was prepared based on four main decisive criteria: probing feasibility, pain, location and extent of resorption (class), and existence of bonelike tissue. Three treatment options were applied: a) extraction, b) monitoring, or c) conservative treatment by external, internal, or combination of internal-external treatments. During evaluation, assessment of ECR progression, tooth survival and other factors like esthetics and periodontal attachment were performed. Descriptive statistical analysis of the outcome for up to ten years (for the overall clinical approach and for each individual treatment decision), was carried out with OriginLabs OriginPro 9 and Microsoft Excel 365.

RESULTS

A three-step strategy was developed on how to deal with ECR cases. Indicative examples of each treatment decision were presented and discussed. The overall survival rate of this strategy was 84.6% (3 years), 70.3% (5 years), 42.7% (8 years) and 28.6% (10 years). Higher survival rate was observed for external treatment decision than for internal. The success of each treatment decision depended on the extent of the resorption (class). The success of a treatment decision should be based on the long-term outcome, as a different evolution can be observed with time.

CONCLUSIONS

A clinical approach strategy was introduced on ECR pathosis. This strategy was not solely based on ECR class, as other important decisive criteria were considered. This step-wise approach, has a 70.3% survival rate with a mean of 5 years. This work will hopefully provide an incentive for a broader collaboration, to potentially establish a universally accepted ECR treatment strategy.

Anti-inflammatory activity of the sesquiterpene lactone diacethylpiptocarphol in dextransulfate sodium-induced colitis in mice

ETHNOPHARMACOLOGICAL RELEVANCE

Sesquiterpene lactones are organic compounds derived mainly from plants that exhibit anti-inflammatory and antitumor activities being one of the key mechanism of action of NF-kB pathway and synthesis of cytokines such as IL-1 and TNF- α.

AIM OF THE STUDY

The overall objective of the present study was to evaluate the anti-inflammatory action of a sesquiterpene lactone diacethylpiptocarphol (DPC) from Vernonia scorpioides (Lam.) Pers. and parthenolide (PTH) in Balb-c mice with DSS-induced colitis.

MATERIALS AND METHODS

The anti-inflammatory effects of Intraperitonial administration of DPC (5 mg/kg/day) were evaluated in Balb/c mice with DSS-induced colitis, and further the body weight measurement, TNF-α and TGF-β level was determined.

RESULTS

After intraperitoneal treatment for one week, DSS-induced colitis was significantly reduced in mice treated with either of both sesquiterpenes lactones, as witnessed by reduced cellular infiltration, tissue damage, TNF-α production, and enhanced production of TGF-β.

CONCLUSIONS

Sesquiterpene lactone DPC, isolated from Vernonia scorpioides showed anti-inflammatory activity, in this experimental model of colitis the sesquiterpene lactones DPC and PTH exhibit equal anti-inflammatory activity.

Cardiovascular, respiratory, gastrointestinal and behavioral effects of intravenous lidocaine in healthy, conscious horses and evaluation of the relationship with lidocaine and monoethylglycinexylidide serum concentrations

This study aimed to evaluate the relationship between the serum concentrations of lidocaine/ monoethylglycinexylidide (MEGX) and their effects on several systems in horses. Five healthy, conscious horses received a two-hour placebo intravenous infusion followed by a two-hour lidocaine infusion (bolus of 1.3 mg/kg over ten minutes followed by a continuous rate infusion of 0.05 mg/kg/min). Lidocaine and MEGX serum concentrations were sampled every ten to fifteen minutes during the experiment, and the presence of muscle fasciculations and loss of balance as well as the respiratory, digestive and cardiovascular systems of the five horses were evaluated by means of different non-invasive methods. During the lidocaine infusion, the mean (± SD) lidocaine and MEGX concentrations were respectively 768.88 ± 93.32ng/ml and 163.08 ± 108.98 ng/ml. The infusion of lidocaine significantly influenced the presence of fasciculations, caused a statistically but non-clinically significant decrease of systolic and diastolic blood pressures, which were both correlated with lidocaine and MEGX serum concentrations, and it increased the duodenal contractions frequency, which was correlated with the serum lidocaine concentration. In this study, mild hypotensive and prokinetic effects of short-term lidocaine infusion were observed.

Abstract P4-12-06: Quality of life, fatigue, and subjective cognitive functioning immediately and 6 months after adjuvant chemotherapy in breast cancer patients

Background

The aim of this study was to examine quality of life (QoL), fatigue, and subjective cognitive functioning (SCF) after chemotherapy in breast cancer (BC) patients.

Methods

BC patients were recruited before chemotherapy (3 FEC+3 Tax, BC-Chemo) and compared with disease-specific controls (i.e., BC patients not receiving chemotherapy, BC-Controls) and healthy controls (HC) matched for age and education.

All participants completed questionnaires assessing QoL (using the Functional Assessment of Cancer Therapy – General Population), fatigue (using the Functional Assessment of Chronic Illness Therapy-Fatigue), and SCF (with the Cognitive Failure Questionnaire) at recruitment and 6 months later (i.e., one month after the end of chemotherapy). Follow-up data (1 year after recruitment) were available for BC-Chemo and HC only.

Difference scores were computed for each participant (i.e., score after 6 months/ 1 year minus score at baseline) and transformed when necessary so that negative scores would reflect decline over time (i.e., decreased QOL, increased fatigue, and increased cognitive complaints). These difference scores were analysed using independent t-tests (BC-Chemo vs BC-Controls on one hand, and BC-Chemo vs HC on the other hand).

Results

Eighteen BC- Chemo, 19 BC-Controls, and 20 HC completed the study (mean age = 49, 58, and 44 years, resp., p = 0.001, BC-Controls being significantly older).

Statistical analyses showed that, after chemotherapy, BC- Chemo patients showed significantly lower QoL, more fatigue, and declined SCF than both groups of controls (see Table 1).

However, 6 months later, no statistically significant differences were found between BC- Chemo and HC with respect to QoL and fatigue. Only SCF remained significantly lower in BC- Chemo.

Table 1.Mean Scores (standard deviations) for Quality of Life (QoL), Fatigue, and Subjective Cognitive Functioning (SCF) in Breast Cancer Patients treated with Chemotherapy (BC-Chemo) or not (BC-Controls) and Healthy Controls 6 months and 1 Year After Baseline BC-ChemoBC-ControlsHealthy ControlsQoL (FACT-GP)   6 months after baseline-5.8 (8)1.1 (8.7)*-0.3 (4.7)*1 year after baseline-5.3 (11.8) 0.2 (9.4)Fatigue (FACIT-F)   6 months after baseline-6.1 (11.1)0 (7.3)*-0.1 (3.8)*1 year after baseline-3.6 (10.3) -2.1 (6.5)SCF (CFQ)   6 months after baseline-7.4 (9.4)0.3 (10.9)*1 (5)*1 year after baseline-10.4 (13) 1.2 (6)**p < 0.05 (two-tailed independent t-tests vs BC-Chemo). Note. FACT-GP: Functional Assessment of Cancer Therapy – General Population (higher scores = greater QoL). FACIT-F: Functional Assessment of Chronic Illness Therapy-Fatigue Scale (higher scores = low fatigue). CFQ: Cognitive Failure Questionnaire (higher scores = greater subjective cognitive problems). All difference scores reflect decline over time.

Conclusions

Shortly after chemotherapy (i.e., 6 months after baseline), breast cancer patients experienced diminished QoL and increased fatigue compared to both disease-specific and healthy controls, but these differences were no longer significant 6 months later. In contrast, group differences in SCF were significant at both timepoints, suggesting long-lasting cognitive decline for patients receiving chemotherapy.

Citation Format: Mebis J, Censabella S, Engels S, Van Marsenille C, Orye G, Marquette S, Vansteelant L, Luyten D, Maes A, Noé L, Bulens P. Quality of life, fatigue, and subjective cognitive functioning immediately and 6 months after adjuvant chemotherapy in breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-12-06.

Influence of mycotoxin binders on the oral bioavailability of tylosin, doxycycline, diclazuril, and salinomycin in fed broiler chickens

The presence of mycotoxins in broiler feed can have deleterious effects on the wellbeing of the animals and their performance. Mycotoxin binders are feed additives that aim to adsorb mycotoxins in the intestinal tract and thereby prevent the oral absorption of the mycotoxin. The simultaneous administration of coccidiostats and/or antimicrobials with mycotoxin binders might lead to a reduced oral bioavailability of these veterinary medicinal products. This paper describes the influence of 3 mycotoxin binders (i.e., clay 1 containing montmorillonite, mica, and feldspars; clay 2 containing montmorillonite and quartz; and yeast 1 being a modified glucomannan fraction of inactivated yeast cells) and activated carbon on the oral bioavailability and pharmacokinetic parameters of the antimicrobials doxycycline and tylosin, and the coccidiostats diclazuril and salinomycin. A feeding study with 40 15 day-old broilers was performed evaluating the effects of long-term feeding 2 g mycotoxin binder/kg of feed. The birds were randomly divided into 5 groups of 8 birds each, i.e., a control group receiving no binder and 4 test groups receiving either clay 1, clay 2, yeast 1, or activated carbon mixed in the feed. After 15 d of feeding, both the control and each test group were administered doxycycline, tylosin, diclazuril, and salinomycin, consecutively, respecting a wash-out period of 2 to 3 d between each administration. The 4 medicinal products were dosed using a single bolus administration directly in the crop. After each bolus administration, blood was collected for plasma analysis and calculation of the main pharmacokinetic parameters and relative oral bioavailability (F = area under the plasma concentration-time curve (AUC0-8 h) in the test groups/AUC0-8 h in the control group)*100). No effects were observed of any of the mycotoxin binders on the relative oral bioavailability of the coccidiostats (i.e., F between 82 and 101% and 79 and 93% for diclazuril and salinomycin, respectively). Also, no significant effects could be noticed of any of the mycotoxin binders on the relative oral bioavailability of the antimicrobials doxycycline and tylosin (i.e., F between 67 and 83% and between 43 and 104%, respectively).

CA 15.3 measurements for separating FDG PET/CT positive from negative findings in breast carcinoma recurrence

In breast cancer CA 15.3 is considered the tumour marker of choice. CA 15.3 is directly related to the disease extent and to hormone status (estrogen receptor ER+/ ER-, progesterone receptor PR+/PR-). This study was designed to assess the impact of disease extent, hormone receptor and HER2-status, and circulating blood volume on the area-under the ROC-curve of CA 15.3 to separate FDG PET positive from negative findings. Patients, methods: We retrospectively evaluated 379 FDG PET/CT examinations performed in 80 patients with breast cancer. Blood volumes were derived using the formulas by Nadler and multiplied by their corresponding CA 15.3 measurement. Results: ROC-curve analysis revealed an AUC of 0.695 (p = 0.0001) for CA 15.3 to separate FDG PET positive from negative findings. AUC measurements to separate normal scan find-ings from loco-regional disease and meta- static disease were 0.527 (p = 0.587) and 0.732 (p = 0.0001), respectively. AUC measurements for CA 15.3 to separate positive from negative FDG PET findings, in ER+ and ER- patients, were respectively 0.772 (p = 0.0001) and 0.596 (p = 0.143). AUC measurements for CA 15.3 to separate positive from negative FDG PET findings, in PR+ and PR- patients, were respectively 0.675 (p = 0.0001) and 0.694 (p = 0.0001). In HER2-positive and -negative patients, the AUC measurements were respectively 0.594 (p = 0.178) and 0.701 (p = 0.0001) to separate positive from negative FDG PET findings. Conclusion: The AUC for CA 15.3 measurements to separate FDG PET positive from negative findings in breast cancer patients with suspected recurrence proved to be directly related to the extent of the recurrent disease and hormone receptor status and inversely related to HER2-status. Correcting CA 15.3 measurements for blood volumes did not impact the AUC.

Protein S-nitrosylation in photosynthetic organisms: A comprehensive overview with future perspectives

BACKGROUND

The free radical nitric oxide (NO) and derivative reactive nitrogen species (RNS) play essential roles in cellular redox regulation mainly through protein S-nitrosylation, a redox post-translational modification in which specific cysteines are converted to nitrosothiols.

SCOPE OF VIEW

This review aims to discuss the current state of knowledge, as well as future perspectives, regarding protein S-nitrosylation in photosynthetic organisms.

MAJOR CONCLUSIONS

NO, synthesized by plants from different sources (nitrite, arginine), provides directly or indirectly the nitroso moiety of nitrosothiols. Biosynthesis, reactivity and scavenging systems of NO/RNS, determine the NO-based signaling including the rate of protein nitrosylation. Denitrosylation reactions compete with nitrosylation in setting the levels of nitrosylated proteins in vivo.

GENERAL SIGNIFICANCE

Based on a combination of proteomic, biochemical and genetic approaches, protein nitrosylation is emerging as a pervasive player in cell signaling networks. Specificity of protein nitrosylation and integration among different post-translational modifications are among the major challenges for future experimental studies in the redox biology field. This article is part of a Special Issue entitled: Plant Proteomics--a bridge between fundamental processes and crop production, edited by Dr. Hans-Peter Mock.

An accessory skull suture mimicking a skull fracture

This paper describes an investigation of the sudden and unexpected death of a five-and-a-half-month-old boy. As in every Dutch case of sudden unexpected death in infancy (SUDI), a multidisciplinary diagnostic approach was used. This included post-mortem radiography, showing a linear discontinuity of the parietal bone. Originally this was interpreted as a skull fracture, but autopsy indicated no signs of mechanical trauma. Instead the defect was defined as a unilateral accessory suture of the parietal bone. The initial erroneous diagnosis had severe adverse consequences and thus every health care professional or forensic specialist dealing with paediatric mechanical traumas should be cautious of this rare anomaly.

Reproducibility of FDG PET based metabolic tumor volume measurements and of their FDG distribution within

AIM

The aim of this study was to report on the reproducibility of F-18-fluorodeoxyglucose (FDG) PET MTV (metabolic tumor volume) 40% and MTV2.5, as well as on the intratumor reproducibility in patients, predominantly suffering from lung cancer and squamous cell carcinoma of the head and neck (SCCHN).

METHODS

Nineteen patients (14 men) who underwent a baseline staging FDG PET-CT examination and a second radiotherapy treatment planning FDG PET-CT examination prior to treatment initiation within 17 days (range: 7-37 days) from each other were included. Bland-Altman analysis was performed on MTV40% and MTVSUV2.5 values obtained of the primary tumor. For voxelwise comparison of the FDG distribution within tumors the transformation matrices, defined on the CT images, were applied to the corresponding FDG images. Accordingly, the MTV40% of the primary tumor volume was defined and copied on the second FDG image. The coordinates and SUV values of each pixel in the corresponding volumes in both FDG images were used for paired comparison.

RESULTS

The standard deviation of the percentage spread around the means of both measurements was respectively 32.5% for MTVSUV2.5 versus 18.8% for MTV40%. Using a cut-off value of 1.96 SD, differences exceeding 64% in MTVSUV2.5 and 37% in MTV40% may be considered to be clinically relevant. Correlation coefficients derived from the voxelwise paired comparison of SUV values within MTV40% volumes delineated on scan 1 and scan 2 ranged from 0.67 to 0.96 (mean: 0.83). Bland-Altman plots demonstrated a low reproducibility for low SUV values and a high(er) reproducibility for high SUV values (inverted triangular shape) in all tumor volumes under study.

CONCLUSION

The reproducibility of MTV40% proved better than that of MTVSUV2.5 with a cut-off of 37% (increase or decrease) in MTV allowing to define clinically significant changes. Furthermore, intratumoral voxelwise FDG distribution did not change significantly in most of the patients during the time interval studied.

Secondary non-Hodgkin lymphoma of the ethmoid sinus after temozolomide

The paranasal sinuses are rarely the site of malignancy, especially non-Hodgkin lymphoma. In such cases, the ethmoid sinus is the second most frequently involved paranasal sinus. Diagnosis of these malignancies is difficult because the early symptoms often mimic benign sinus pathology. Thus, most cases are diagnosed at an advanced stage, and their prognosis is poor. Here we describe the case of a 58-year-old man with a secondary high-grade B-cell non-Hodgkin lymphoma of the ethmoid sinus. This malignancy was diagnosed two years after the patient had received treatment with temozolomide for a glioblastoma multiforme. This case highlights that malignant tumours of the paranasal sinuses should always be included in the differential diagnosis of sinus disease. Additionally, patients treated with temozolomide should receive regular follow-up care including vigilant evaluation for secondary tumours, such as non-Hodgkin lymphoma.

Targeting monocytes and macrophages by means of SPECT and PET

Monocytes have been isolated from patient's blood and directly radiolabelled in vitro using a variety of radiopharmaceuticals such as 99mTc-HMPAO, 111In-oxine, 99mTc-colloids and 18F-FDG. Overall, the best labeling results were obtained using 99mTc-HMPAO. The wide availability of 99mTc and of the ligand HMPAO in kit-formulation makes it the most versatile procedure for imaging localized inflammation using in-vitro labeling. Injection of 99mTc-HMPAO labeled monocytes in adult patients has proven safe with an effective dose of 0.011 mSv/Mbq, equivalent to that of 99mTc-HMPAO labeled mixed white blood cells. Furthermore, in a proof of concept studies, in-vitro labeled monocytes were shown to specifically accumulate in the bowels of patients suffering from inflammatory bowel disease as well as in inflamed joints of rheumatoid arthritis patients. Inversely, the decrease in disease activity of inflamed joints of rheumatoid arthritis patients treated by Adalimumab could not be substantiated using 99mTc-HMPAO labelled monocytes suggesting this type of treatment does not reduce monocyte influx. In spite of their wide availability, in-vitro labeling procedures are cumbersome and time-consuming. Furthermore, cell activation may occur during the labeling process and it cannot be excluded that the radiopharmaceuticals used for labelling interfere with ongoing cellular processes. As such, various authors turned towards the development of radiopharmaceuticals for in-vivo labeling of both monocytes and more importantly macrophages, many of which were subsequently validated in animal models. Targets studied in this regard include amongst others the folate receptor, the mannose receptor, the peripheral benzodiazepine receptor as well as more general characteristics of macrophages such as phagocytosis. Various of these novel molecules appear promising and clinical studies using these radiopharmaceuticals are awaited in the near future. Some of these radiopharmaceuticals also reached the clinical stage, respectively the translocating protein targeting radiopharmaceutical 11C-PK11195 and the folate receptor targeting radiopharmaceutical 99mTc-EC20. Uptake of 11C-PK11195 in inflamed joints and sites of atherosclerosis in patients proved to be directly related to the number of peripheral benzodiazepine binding receptors available as well as to the severity of ongoing inflammation. Comparable results were obtained using 99mTc-EC20 in rheumatoid arthritis patients. In spite of these promising results, additional studies are warranted demonstrating that in vivo, quantitative visualization of monocyte trafficking and accumulation of M1 or M2 macrophage subtypes in sites of ongoing inflammation by means of SPECT and PET will contribute to a better understanding of human inflammatory diseases as well as to diagnosis, treatment planning and the development of targeted treatment strategies.

The value of post-mortem CT in neonaticide in case of severe decomposition: description of 12 cases

INTRODUCTION

In cases of neonaticide with delayed finding of the body, interpretation of autopsy results can be difficult because of decomposition. Postmortem computed tomography (PMCT) has become an increasingly popular tool in the (pediatric) forensic field. We performed a retrospective study to compare the outcome of PMCT with autopsy results in suspected neonaticide, in neonates found more than one week after their demise. We compared the performance of both methods on (1) determining gestational age, (2) differentiating between live birth and still birth and (3) determining cause of death.

METHOD

We selected all consecutive neonaticide cases with an estimated postmortem interval longer than one week, who underwent a forensic autopsy including a total body PMCT in the Netherlands Forensic Institute in the period 2008-2012. Both a pathologist and radiologist scored gestational age, signs of live birth and cause of death for each case.

RESULTS

22 cases of neonaticide were identified in the study period, of which 15 cases were estimated to be found more than 1 week after death. In 12 of these a total body PMCT was performed. In all cases, late postmortem changes were present. Gestational age could be assessed with PMCT in 100% of the cases and with autopsy in 58% of the cases. In all cases neither PMCT nor autopsy was able to assess live birth and cause of death.

CONCLUSION

PMCT is a better tool for estimating gestational age in case of suspected neonaticide with late postmortem changes compared to autopsy and should therefore be a standard part of the work-up. Signs of live birth and cause of death could not be determined with neither of the methods, an adjusted post mortem examination including limited autopsy for these cases might be developed.

Quantitative p retreatment VOI analysis of liver metastases. (99m)Tc-MAA SPECT/CT and FDG PET/CT in relation with treatment response to SIRT

Using quantitive VOI analysis, the percentage (99m)Tc-MAA uptake and SUVmax and mean values of liver metastases obtained prior to SIRT were related to treatment response using both a lesion-based and clinical dichotomous approach. Based on the VOI % of (99m)Tc-MAA activity, the estimated (90)Y-microspheres activity/cc (MBq/cc) was calculated from the effective dose injected. Baseline VOI FDG PET SUVmean and max values and estimated MBq/cc values were related to treatment response using a lesion-based approach (% change in SUVmean ≥  50%) and a clinical dichotomous approach. Fifteen treatment sessions were analyzed (13 patients). Using the lesion-based approach (12 treatment sessions) 40 lesions responded and 37 did not. SUVmax and mean values proved significantly different between non-responding and responding lesions; 18.6 (SD 10.8) versus 13.5 (SD 8.4 ) for SUVmax (p = 0.02) and 11.4 (SD 3.8) versus 6.3 (SD 4.5) for SUVmean (p = 0.002). Using the clinical dichotomous approach (15 treatment sessions / 11 responding), 91 lesions were analyzed; 57 responded. VOI volumes and estimated (90)Y-loaded glass microspheres activity (MBq/cc) did not differ between responders and non responders; 24 cc (SD 27) versus 21 cc (SD 21 cc) (p = 0.4) and 1.95 MBq/cc (SD 1.1 MBq/cc) versus 1.90 MB/cc (SD 2.7 MBq/cc) (p = 0.92). On the contrary, SUVmax and mean values proved significantly different between responders and non-responders; 23.7 (SD 9.8) versus 9.4 (SD 3.8 ) for SUVmax (p = 0.0001) and 13.1 (SD 8.1) versus 4.9 (SD 1.4) for SUVmean.

CONCLUSION

These findings suggest that in patients presenting with high baseline SUVmax and mean values, the administration of higher activities or alternatively, other potentially more useful treatment options might be considered.

Testing chemical agents with the cytokinesis-block micronucleus cytome assay

In order to evaluate the applicability of the cytokinesis-block micronucleus cytome assay in routine mutagenicity testing we investigated with this method different chemicals having different mechanisms of action: non-mutagens, direct-acting basealtering mutagens, direct-acting cross-linking mutagens, clastogens including a radiomimetic chemical, indirect-acting spindle poisons and indirect-acting enzyme inhibitors. We looked at the presence of micronuclei as biomarkers for either the loss of chromosome fragments (clastogen) or the loss of a whole chromosome (aneugen), nucleoplasmic bridges as biomarkers for complex rearrangements (e.g., dicentric chromosomes) and nuclear buds as biomarkers for gene amplification. The cytome assay proved to be a suitable tool to investigate genetic effects of environmental agents and to provide insight into their working mechanisms as all chemicals tested showed the expected response.

FDG uptake in lymph-nodes of HIV+ and tuberculosis patients: implications for cancer staging

AIM

The incidence of non-AIDS-related cancers (NADCs) in the AIDS-population has surpassed that of the general population. HIV significantly increases an individual's chances of reactivation of latent tuberculosis (TB) infection and progression to active TB disease. Both HIV, TB and CA present with increased FDG uptake in involved lymph nodes (LNs). The aim of this study was to assess the existence of quantitative differences in FDG uptake by lymph nodes in HIV+/TB-/CA- patients, TB+/HIV-/CA-, TB+/HIV+/CA- patients and HIV-/TB-/CA+ patients.

METHODS

Sixteen consecutive referred patients suffering from HIV-1, 21 suffering from HIV-1 and TB and 16 suffering from TB alone were prospectively included. In addition, 30 consecutively referred, previously untreated, HIV and TB negative cancer patients were included. All patients underwent FDG PET imaging. Mean standardized uptake values (SUV mean values) were obtained for involved lymph nodes using region growing and a threshold of 30% in all patients. Results obtained were compared using non-parametric statistics.

RESULTS

SUVmean values of involved LNs of HIV+/TB+/CA- patients were significantly higher than SUVmean values of involved LNs of HIV-/TB+/CA- patients and HIV+/TB-/CA patients (P<0.05). Also, SUVmean values of involved LNs of HIV-/TB-/CA+ patients were significantly higher than SUVmean values of involved LNs of HIV+/TB-/CA- patients. HIV+/TB+/CA- patients presented with a significantly higher number of sites of LN involvement when compared to the HIV+/TB-/CA- patient group.

CONCLUSION

FDG PET is not useful for assessing malignant lymph node involvement in HIV+, TB+ or HIV+/TB+ patients.

Collaborative study for the standardisation of the histamine sensitizing test in mice and the CHO cell-based assay for the residual toxicity testing of acellular pertussis vaccines

The European Pharmacopoeia (Ph. Eur.) and the World Health Organisation (WHO) require the performance of extensive quality and safety control testing before the release on the market of vaccine products for human use. Safety testing with regard to residual pertussis toxin (PT) in acellular pertussis combination vaccines is performed through assessment of fatal sensitisation of mice to histamine challenge by the vaccine product under test. Currently, use of different in-house procedures and no requirement for the inclusion of a standard reference in each assay render comparisons of results obtained for identical vaccine batches between different control laboratories very difficult. At the initiative of the European Directorate for the Quality of Medicines and HealthCare (EDQM), an international collaborative study was organised for the standardization of the Histamine Sensitizing Test (HIST) in mice and the Chinese Hamster Ovary (CHO)-cell-based assay (performed at the bulk product level) for the residual toxicity testing of acellular pertussis vaccines or acellular pertussis-based combination vaccines. The study was run under the aegis of the Biological Standardisation Programme, jointly supported by the Council of Europe and the European Commission under the project code BSP076. Ten (10) laboratories participated in the study and were requested to perform 3 independent Histamine Sensitizing Tests in mice and to report results of the lethal end-point measurement as prescribed by the Ph. Eur. monographs. Some of them also reported data from an in-house validated CHO-cell-based assay. In addition, some of the laboratories reported concomitantly data obtained by measurement of the drop in temperature induced after the histamine challenge, a method currently under investigation to be added as an alternative end-point for the HIST in the Ph. Eur. monographs for acellular pertussis-based combination vaccines in order to alleviate animal suffering (in application of the 3Rs principle). Based on the results of the collaborative study, a potency of 7500 IU/vial (International Units per vial) was assigned to the current Ph. Eur. Biological Reference Preparation (BRP) for PT. The results of the study also show that 1) intra- and inter-laboratory variations can be improved by the use of a validated standard operating procedure; 2) inclusion in each assay of a standard reference sample, calibrated in IU, can increase comparability of results among laboratories and thus help to reduce repeat testing; 3) a correlation between mortality data and temperature data was observed although, due to the limited number of data sets and the lack of a common method for the temperature end-point, further investigation of this point is required; 4) the CHO-cell-based assay did not yield comparable results and further standardisation of the assay procedure may be investigated in a follow-up project.

Evidence for the existence of Tc(IV) – humic substance species by X-ray absorption near-edge spectroscopy

The redox–sensitive fission product technetium–99 has been investigated in systems containing different reducing solid phases (pyrite, magnetite, ironsulphide and Gorleben sand) on the one hand and Gorleben groundwater, which contains a high amount of humic substances, on the other hand. Initially, technetium–99 was added to these systems as pertechnetate (Tc(VII)), which was reduced in presence and absence of humic substances with the aid of the different reducing surfaces (neutral to alkaline pH). Both in absence and presence of humic substances, Tc concentrations were observed which exceeded the TcO2solubility limit, whereby the presence of humic substances had a 100 fold higher Tc concentration compared to its absence. Using the La–precipitation method, it was shown that Tc(IV) inorganic colloids and organic colloids were quantitatively precipitated. It was demonstrated for the first time by a combination of chemical speciation methods (La–precipitation method and gel permeation chromatography) and XANES spectroscopy of the humic substance containing supernatant solutions, that Tc(IV) species were formed in these systems, indicating an association between Tc(IV) and humic substances.

Uranium release from boom clay in bicarbonate media

The release of natural uranium from Boom Clay was studied to better understand the mechanisms governing the solid-liquid partitioning of uranium. Batch leaching experiments suggested that the portion of natural uranium released from clay is associated with colloids at a low bicarbonate concentration prevailing in Boom Clay. At increased bicarbonate concentrations, uranium was present predominantly as dissolved species indicating a formation of uranium carbonate complexes. Thein situaqueous uranium concentration,i.e., the concentration in the pore waters collected by piezometers was found to be 2 to 3 orders of magnitudes lower than the one measured by the batch techniques. These results illustrated that the batch techniques may cause a remobilization of uranium containing colloids from clay surfaces into solution when clay is suspended, agitated, and mechanically perturbed. These colloids are attributed to artefacts and are not considered to existin situbecause of the high compaction of Boom Clay. Due to the presence of colloids, a laboratory derived solid-liquid partitioning coefficient is not equivalent to and cannot simply be converted to the distribution coefficientKdcurrently used in performance assessment calculations.

Humic colloid mediated transport of tetravalent actinides and technetium

The humic colloid mediated transport of tetravalent actinide and technetium ions is discussed. Numerous published and new results are used from comparable experimental systems and conditions. The results originate from investigations on two humic rich Gorleben groundwater/sediment systems under near-natural conditions. The conditioning time between groundwater and radionuclides vary from few minutes to four years. The migration time (residence time in the column) is varied from four hours to three days. The concentration of radionuclides added is varied between about 10-12 and 10-4mol/L. Humic colloids in natural groundwater contain trace metal ions in varying concentrations. In addition to studying the behavior of radionuclides added to the groundwater in the laboratory, the dissociation behavior of these natural tetravalent trace metal ions is studied by scavenging dissociating ions with a cation exchanger. The results show a kinetic behavior of the trace metal ion interaction as frequently reported in the literature, i.e. with increasing contact time, slow dissociation modes are progressively populated resulting in an enhanced radionuclide transport. The strong dependency of the radionuclide transport on the radionuclide concentration shows that humic colloid mediated transport may be overestimated if radionuclide concentrations used in laboratory studies are too high. Dissociation of the natural inventory of humic associated tetravalent trace metal ions proceeds with a kinetics comparable to the radionuclides added. This, however, is only observed for a small portion of the inventory and extrapolation beyond the observation range is not permissible. Therefore, the key question for application to predictive modeling of the mobility of tetravalent radionuclides in natural groundwater is if the behavior of the natural trace element inventory is applicable or the behavior of radionuclides added in laboratory studies.

New selenium solution speciation method by ion chromatography + gamma counting and its application to FeS2-controlled reducing conditions

Selenium is a redox sensitive element. In reducing conditions its solubility is controlled by the formation of metallic Se and in the presence of Fe2+ also by the precipitation of FeSe or FeSe2. However very few data concerning this species in geochemical reducing environments is found in literature, particularly due to insufficient measuring methods.

The assessment to what extent 79Se is a critical radionuclide for the geological disposal of High-Level Radioactive Waste, depends on its actual speciation in storage conditions. Therefore a new method based on ion chromatography of radiolabelled 75Se solutions followed by gamma-ray counting was developed to accurately measure selenium species with different degrees of oxidation (selenate (SeO4 2−) and selenite (SeO3 2−)) in solution.

This method was then tested in laboratory conditions which mimic the reducing environment in Boom Clay. Different amounts of ground pyrite (< 125 µm) were contacted with Synthetic Boom Clay Water (essentially 10−2 M NaHCO3) and spiked with different amounts of 75SeO3 2− and SeO4 2−. The batches were allowed to equilibrate over different time periods (up to two months) before analysing. The experiments were carried out in an oxygen-depleted glove box (99.6% N2, 0.4% CO2).

The kinetics of the redox reactions in the pyrite systems prevented the complete reduction of selenite (SeO3 2−) and especially selenate (SeO4 2−) on a limited time scale, probably due to the limited redox capacity of the studied systems.

FDG PET for monitoring response to local and locoregional therapy in HCC and liver metastases

Local ablative therapies and loco-regional therapies are being increasingly used for the purpose of providing local control of primary liver tumors and liver metastases while sparing normal liver tissue. In this manuscript, literature on the use of fluorodeoxyglucose positron emission tomography (FDG PET) to monitor local and loco-regional treatment for hepatocellular carcinoma (HCC) and liver metastases, mainly limited to radiofrequency ablation (RFA) and selective internal radiation therapy (SIRT) is reviewed. Available data obtained primarily in secondary liver tumors and to a lesser extent in HCC support the notion that FDG PET performed early after RFA provides additional information about the efficacy of local tumor ablation by differentiating post-treatment changes from residual or recurrent malignant tumor. In addition, FDG PET was shown to have an added value for the detection of tumor recurrence. Thus, FDG PET imaging may not only improve treatment evaluation but also provide an opportunity for early re-intervention following RFA. Potential problems that might occur when using FDG PET for the purpose of evaluation of RFA are false negative results due to partial volume effect when dealing with small lesions (<1 cm) or due to diabetes and false positive results due to abscess formation. Larger studies are warranted to confirm these promising

RESULTS

With regard to SIRT, several studies, almost exclusively performed in patients suffering from liver metastases, have addressed the feasibility of using FDG PET for the assessment and quantification of metabolic response of SIRT with (90)Y-microspheres. These studies consistently show that traditional morphological imaging, computed tomography/magnetic resonance imaging, is insensitive in monitoring response, owing to the presence of necrosis, edema, hemorrhage and cystic changes, when compared to metabolic imaging. Thus, in view of the lack of reliability of tumor markers and/or the potential for delineating the presence of extra-hepatic metastatic cancers in these patients, when confirmed by additional studies, FDG PET may prove to be an excellent adjunct for assessing response following SIRT of liver metastases.

The lanthanum precipitation method. Part 2: quantification of the conditional interaction constant between technetium(IV) and humic substances

The interaction between colloidal Tc(IV) species and colloidal Gorleben humic substances (HS) was quantified after application of the La-precipitation method on supernatant solutions obtained under various experimental conditions but at constant ionic strength of the Gorleben groundwater (0.04M). The determined interaction constant LogKHS (2.3+/-0.3) remained unchanged over a large range of Tc(IV) and HS concentrations and was independent of the pH of the original supernatant solution (pH range 6-10), Tc(IV)-HS loading (10(-3)-10(-6)molTcg(-1) HS) and the nature of the reducing surface (Magnetite, Pyrite and Gorleben sand) used for the pertechnetate reduction. The LogKHS value determined by the La-precipitation method is lower than the LogK value obtained from a previous study where the interaction between colloidal Tc(IV) species and Gorleben humic substances was quantified using a modified Schubert approach (2.6+/-0.3). The La-precipitation method allows to accurately determine the amount of Tc(IV) associated with HS but leads to a (small) overestimation of the free inorganic Tc(IV) species.

The lanthanum precipitation method. Part 1: a new method for technetium(IV) speciation in humic rich natural groundwater

A new and quick method for direct speciation of Tc(IV) in humic rich solutions, based on the induced aggregation of humic substances in the presence of the trivalent cation La3+, is presented. This method (the "La-precipitation method") allows flocculating all the humic substances and also the Tc(IV) associated with humic substances. The method is tested on solutions containing Tc(IV) and Gorleben humic substances. The influence of different parameters (humic substance concentration, Tc concentration, reaction time and pH) is investigated on the observed free Tc(IV) concentration after precipitation of all humic substances. None of these parameters had a (significant) influence on the observed Tc(IV) concentration in solution after addition of La3+ to Tc(IV)-HS containing solutions. It is therefore proposed that the method can be used to separate the Tc(IV) bound to humic substances from the free inorganic Tc species in solution.

XANES-EXAFS analysis of se solid-phase reaction products formed upon contacting Se(IV) with FeS2 and FeS

The solid-phase Se speciation after short-term (3 weeks) contact of selenite [Se(IV)] oxyanions with pyrite (FeS2) and troilite (FeS) was investigated using X-ray absorption spectroscopy (XAS; X-ray absorption near-edge spectroscopy-extended X-ray absorption fine structure (XANES-EXAFS)). It was found that the nature of the sulfide mineral dictates the final speciation since respectively Se(0) and FeSe(x) were formed, meaning that the reaction mechanism is different and that these phases cannot be regarded as geochemically similar. The experimental results support the previously proposed sorption/ reduction mechanism for the reaction of selenite with pyrite. In the presence of troilite the reduction proceeds through the intermediate formation of Se(0) by reduction of selenite with dissolved sulfide. XAS data recorded for the FeS2 and FeS were compared with different Se reference phases, ranging in oxidation state from -II to +IV, used for validation of the XAS analysis methodology. This methodology can in principle be used to analyze Se phases formed in "in situ" geochemical conditions such as high-level radioactive waste disposal facilities.

Cerebral arterial air embolism in a child after intraosseous infusion

Cerebral arterial air embolism (CAAE) has been reported as a rare complication of medical intervention. There has been one reported case of CAAE after the use of an intraosseous infusion (IO) system. We report on a case of CAAE after tibial IO infusion in a 7-month-old girl during resuscitation.

Autopsies following death due to traumatic injuries in The Netherlands: an evaluation of current practice

INTRODUCTION

Because of a steady decline in the number of autopsies following death due to traumatic injuries, valuable information concerning possible missed injuries and potential improvements in management is lost. This retrospective study describes current practice in the Amsterdam region of the Netherlands regarding such autopsies, and their rates.

METHOD

The current protocols for autopsies were reviewed. Data from government databases and hospitals for the year 2005 were collected. For all patients included that died an unnatural death due to traumatic injury, causes of death and recommendations for autopsy were reviewed. The number of clinical and medico-legal autopsies was determined.

RESULTS

Of 872 registered unnatural deaths, 414 were due to traumatic injuries; 63% of these died before reaching hospital and 37% died in hospital. There were more male deaths, and average age was 54 years. In 23% an autopsy was advised by the medical examiners, more often for pre-hospital deaths. The rate of autopsies was 46% when advice was given for a medico-legal autopsy.

CONCLUSION

The rates of both medico-legal and clinically desirable autopsies are very low. Currently, the system in Amsterdam focuses mainly on the former, and the latter with its attendant educational aspects is largely ignored. The role of the government should be expanded to optimise the autopsy system in unnatural deaths following traumatic injuries.

Determination of lidocaine and its two N-desethylated metabolites in dog and horse plasma by high-performance liquid chromatography combined with electrospray ionization tandem mass spectrometry

A sensitive method for the quantification of lidocaine and its metabolites, monoethylglycinexylidide (MEGX) and glycinexylidide (GX), in animal plasma using high-performance liquid chromatography combined with electrospray ionization mass spectrometry is described. The sample preparation includes a liquid-liquid extraction with methyl tert-butylmethyl ether after addition of 2M sodium hydroxide. Ethylmethylglycinexylidide (EMGX) is used as an internal standard. For chromatographic separation, an ODS Hypersil column was used. Isocratic elution was achieved with 0.01 M ammonium acetate and acetonitrile as mobile phases. Good linearity was observed in the range of 2.5-1000 ng ml(-1) for lidocaine in both dog and horse plasma. For MEGX, linear calibration curves were obtained in the range of 5-1000 ng ml(-1) and 20-1000 ng ml(-1) for dog and horse plasma, respectively. In dog and horse plasma good linearity was observed in the range of 200-1500 ng ml(-1) for GX. The limit of quantification (LOQ) in dog plasma for lidocaine, MEGX and GX was set at 2.5 ng ml(-1), 20 ng ml(-1) and 200 ng ml(-1), respectively. For horse plasma a limit of quantification of 2.5 ng ml(-1), 5 ng ml(-1) and 200 ng ml(-1) was achieved for lidocaine, MEGX and GX, respectively. In dog plasma, the limit of detection (LOD) was found to be 0.8 ng ml(-1), 2.3 ng ml(-1) and 55 ng ml(-1) for lidocaine, MEGX and GX, respectively. In horse plasma the LOD's found for lidocaine, MEGX and GX, were 1.1 ng ml(-1), 0.5 ng ml(-1) and 13 ng ml(-1), respectively. The method was shown to be of use in pharmacokinetic studies after application of a transdermal patch in dogs and after an intravenous infusion in horses.

Determination of cefquinome in pig plasma and bronchoalveolar lavage fluid by high-performance liquid chromatography combined with electrospray ionization mass spectrometry

The aim of this study was to develop a rapid and sensitive method for the quantification of cefquinome in animal plasma and bronchoalveolar lavage (BAL) fluid using high-performance liquid chromatography combined with electrospray tandem mass spectrometry (LC-ESI-MS/MS). Cefadroxil is used as internal standard. For plasma, the sample preparation includes a simple deproteinization step with a Microcon filter. This allows detecting the unbound cefquinome concentration, which is correlated with the concentration in other body fluids, such as BAL fluid. To be able to detect the total plasma concentration, deproteinization with acetonitrile, followed by a back-extraction of actonitrile with dichloromethane was performed. The BAL fluid is centrifuged to precipitate floating particles. Chromatographic separation is achieved on a PLRP-S column using 0.005% formic acid and methanol as mobile phase. For plasma, good linearity was observed in the range of 5-2500 ng ml(-1) for both the unbound and total concentration. The response in BAL fluid was linear in the range of 4-1000 ng ml(-1). The limit of quantification (LOQ) was set at 5.00 ng ml(-1) for plasma and at 4.00 ng ml(-1) for BAL fluid. The limit of detection (LOD) was 3.12 ng ml(-1) and 0.41 ng ml(-1) for the unbound and total concentration in plasma, respectively, and was 1.43 ng ml(-1) for BAL fluid. The method was shown to be of use in a pharmacokinetic study in pigs, where the correlation between cefquinome concentrations in plasma and BAL fluid of pigs was studied.

A battery of DNA effect biomarkers to evaluate environmental exposure of Flemish adolescents

The present paper deals with the evaluation of a battery of genotoxicity biomarkers in healthy Flemish adolescents and their relation with common pollutants occurring in their life environment. DNA damage as reflected by the comet assay appeared to be most sensitive to ozone (partial r(2) = 0.102, p < 0.00001), and to a lesser extent to ortho-cresol (partial r(2) = 0.055; p = 0.001) and 1-hydroxy-pyrene (1-OH-pyrene, partial r(2) = 0.031; p = 0.013). 8-hydroxy-deoxyguanosine (8-OHdG) was only related to ortho-cresol (r(2) = 0.069; p < 0.007). Interestingly, the comet assay results and urinary 8-OHdG concentrations were positively correlated with a Pearson r = 0.21 (p = 0.003, N = 200). Logistic regression models revealed significant relations between chromatid breaks and 1-OH-pyrene (relative risk (RR): 1.58; p = 0.008), and t,t-muconic acid (RR: 1.71; p = 0.014). There was no correlation between micronucleus formation or occurrence of chromosomal or chromatid breaks on the one hand and comet or 8-OHdG results on the other hand. Thus, in this study the comet assay on whole blood samples and urine 8-OHdG measurements especially appeared sensitive biomarkers for assessing the genetic effects of environmental pollutants to which adolescents may be exposed.

Investigation of co-genotoxic effects of radiofrequency electromagnetic fields in vivo

We investigated the possible combined genotoxic effects of radiofrequency (RF) electromagnetic fields (900 MHz, amplitude modulated at 217 Hz, mobile phone signal) with the drinking water mutagen and carcinogen 3-chloro-4-(dichloromethyl)-5-hydroxy-2(5H)-furanone (MX). Female rats were exposed to RF fields for a period of 2 years for 2 h per day, 5 days per week at average whole-body specific absorption rates of 0.3 or 0.9 W/kg. MX was given in the drinking water at a concentration of 19 microg/ml. Blood samples were taken at 3, 6 and 24 months of exposure and brain and liver samples were taken at the end of the study (24 months). DNA damage was assessed in all samples using the alkaline comet assay, and micronuclei were determined in erythrocytes. We did not find significant genotoxic activity of MX in blood and liver cells. However, MX induced DNA damage in rat brain. Co-exposures to MX and RF radiation did not significantly increase the response of blood, liver and brain cells compared to MX exposure only. In conclusion, this 2-year animal study involving long-term exposures to RF radiation and MX did not provide any evidence for enhanced genotoxicity in rats exposed to RF radiation.

Evaluation of the mutagenic and antimutagenic effects of South African plants

Dichloromethane and 90% methanol extracts of 42 South African plants were screened for mutagenicity and antimutagenicity using the Salmonella/microsome mutagenicity assay (Ames) against Salmonella typhimurium TA98 and TA100 bacterial strains in the presence and absence of metabolic activator S9. The methanol extracts from whole plants of Helichrysum simillimum, Helichrysum herbaceum and Helichrysum rugulosum indicated mutagenicity. These are the first reported tests on the mutagenicity of Helichrysum species. Six species indicated antimutagenic properties, all in the presence of S9: methanol leaf extract of Bauhinia galpinii, and dichloromethane leaf extracts of Bauhinia galpinii, Clerodendrum myricoides, Datura stramonium, Buddleja saligna, Millettia sutherlandii and Sutherlandia frutescens.

Determination of amiodarone and desethylamiodarone in horse plasma and urine by high-performance liquid chromatography combined with UV detection and electrospray ionization mass spectrometry

A rapid method for the quantification of amiodarone and desethylamiodarone in animal plasma using high-performance liquid chromatography combined with UV detection (HPLC-UV) is presented. The sample preparation includes a simple deproteinisation step with acetonitrile. In addition, a sensitive method for the quantification of amiodarone and desethylamiodarone in horse plasma and urine using high-performance liquid chromatography combined with electrospray ionization tandem mass spectrometry (LC-ESI-MS/MS) is described. The sample preparation includes a solid-phase extraction (SPE) with a SCX column. Tamoxifen is used as an internal standard for both chromatographic methods. Chromatographic separation is achieved on an ODS Hypersil column using isocratic elution with 0.01% diethylamine and acetonitrile as mobile phase for the HPLC-UV method and with 0.1% formic acid and acetonitrile as mobile phase for the LC-MS/MS method. For the HPLC-UV method, good linearity was observed in the range 0-5 microg ml(-1), and in the range 0-1 microg ml(-1) for the LC-MS/MS method. The limit of quantification (LOQ) was set at 50 and 5 ng ml(-1) for the HPLC-UV method and the LC-MS/MS method, respectively. For the UV method, the limit of detection (LOD) was 15 and 10 ng ml(-1) for amiodarone and desethylamiodarone, respectively. The LODs of the LC-MS/MS method in plasma were much lower, i.e. 0.10 and 0.04 ng ml(-1) for amiodarone and desethylamiodarone, respectively. The LODs obtained for the urine samples were 0.16 and 0.09 ng ml(-1) for amiodarone and desethylamiodarone, respectively. The methods were shown to be of use in horses. The rapid HPLC-UV method was used for therapeutic drug monitoring after amiodarone treatment, while the LC-MS/MS method showed its applicability for single dose pharmacokinetic studies.

Selenite reduction in Boom clay: Effect of FeS(2), clay minerals and dissolved organic matter

Several experiments were set up to study Se speciation and solubility in the reducing Boom clay environment, starting from oxidized Se species which were added in oversaturation with respect to the thermodynamic solubility of reduced Se solid phases. Upon introduction of SeO3(2-) to FeS(2)-containing samples, adsorption of SeO3(2-) occurred at the FeS2 surface, and led to a reduction and precipitation of a Se0 solid phase with a solubility of 3x10(-9) M (after 60 days). In the presence of humic substances, an association of Se with these humic substances was observed and the 3x10(-9) M solubility limit was not reached in the same time delay. Upon introduction of SeO3(2-) to Boom clay suspensions (equilibration up to 9 months), the initial adsorption of SeO3(2-) on the solid phase was increased with respect to systems containing only FeS2, due to the presence of (illite) clay minerals. This competing adsorption process, and the presence of humic substances, again decreased the kinetics of reduction with respect to FeS2 samples. Also, an association of Se with Boom clay humic substances was observed, and amounted up to approximately 10(-7) M in some samples after 9 months equilibration.

Column Precipitation Chromatography: An Approach to Quantitative Analysis of Eigencolloids

A new column precipitation chromatography (CPC) technique, capable of quantitatively measuring technetium eigencolloids in aqueous solutions, is presented. The CPC technique is based on the destabilization and precipitation of eigencolloids by polycations in a confined matrix. Tc(IV) colloids can be quantitatively determined from their precipitation onto the CPC column (separation step) and their subsequent elution upon oxidation to pertechnetate by peroxide (elution step). A clean-bed particle removal model was used to explain the experimental results.

[Sudden death at young age and the importance of molecular-pathologic investigation]

The autopsy of a 16-year-old boy who had died suddenly revealed hypertrophic cardiomyopathy (HCM). Molecular genetic investigation revealed mutations in the MYBPC3 gene. His surviving family members could then be examined and reassured that they did not carry the mutation. An 18-year-old boy who died suddenly turned out to have known HCM. No further investigations were done and no tissue was saved. Genetic investigation of his immediate family was impossible due to the lack of a known mutation in the family. Periodic examination in clinically unaffected family members was therefore advised. Sudden cardiac death at young age is not infrequently the first symptom of an inherited cardiac disease. Because these diseases usually inherit as an autosomal dominant trait, first-degree family members have a 50% chance of carrying the same genetic defect. Besides clinical cardiologic examination of the remaining family members, post-mortem molecular genetic investigation can be of value in reaching a diagnosis and in determining the subsequent therapeutic options for immediate relatives.

Single-dose pharmacokinetics and tolerability of alendronate 35- and 70-milligram tablets in children and adolescents with osteogenesis imperfecta type I

CONTEXT

Alendronate (ALN) is a bisphosphonate compound that can be administered orally and has potential use in pediatric osteoporotic conditions.

OBJECTIVE

The objective was to evaluate the pharmacokinetics and single-dose tolerability of ALN in children with osteogenesis imperfecta.

DESIGN

ALN was administered iv and orally in a two-period, randomized crossover study, with doses separated by a 2-wk washout and follow-up carried out within 2 wk after the last ALN dose.

SETTING

The study was conducted at the pediatric metabolic bone research unit at the Shriners Hospital for Children, Montréal, Canada.

PATIENTS

Twenty-four children (aged 4-16 yr; eight girls) with osteogenesis imperfecta type I participated.

INTERVENTIONS

All patients received iv ALN at a dose of 125 mug. In addition, patients weighing less than 40 kg received an oral dose of ALN 35 mg, whereas those weighing 40 kg or more received ALN 70 mg orally.

MAIN OUTCOME MEASURES

Total urinary excretion and oral bioavailability of ALN, blood and urine safety parameters, and adverse events were the main outcome measures.

RESULTS

The total urinary excretion of ALN after the iv dose was similar for both weight groups. The mean oral bioavailability (95% confidence interval) was 0.43% (0.28, 0.64%) for patients weighing less than 40 kg and 0.56% (0.36, 0.87%) for patients weighing 40 kg or more. Eighteen patients reported a total of 44 clinical adverse experiences, none of which were serious. The most common adverse experiences were mild to moderate headache (n = 7), nausea (n = 7), fever (n = 5), and abdominal pain (n = 6). Eighty percent of the adverse experiences (35 of 44) occurred within 48 h of medication administration, 91% (40 of 44) lasted less than 24 h, and 84% (37 of 44) were reported after oral dosing. Laboratory safety monitoring revealed a marginal decrease in absolute lymphocyte count and serum alkaline phosphatase after the study compared with baseline for both weight categories.

CONCLUSIONS

The mean oral bioavailability of 35- and 70-mg ALN tablets was less than 0.6%, comparable to adult studies. Adverse experiences from single-dose ALN were minor, and the drug was generally well-tolerated.