A randomized first-in-human phase I trial of differentially adjuvanted Pfs48/45 malaria vaccines in Burkinabé adults

BACKGROUNDMalaria transmission-blocking vaccines aim to interrupt the transmission of malaria from one person to another.METHODSThe candidates R0.6C and ProC6C share the 6C domain of the Plasmodium falciparum sexual-stage antigen Pfs48/45. R0.6C utilizes the glutamate-rich protein (GLURP) as a carrier, and ProC6C includes a second domain (Pfs230-Pro) and a short 36-amino acid circumsporozoite protein (CSP) sequence. Healthy adults (n = 125) from a malaria-endemic area of Burkina Faso were immunized with 3 intramuscular injections, 4 weeks apart, of 30 μg or 100 μg R0.6C or ProC6C each adsorbed to Alhydrogel (AlOH) adjuvant alone or in combination with Matrix-M (15 μg or 50 μg, respectively). The allocation was random and double-blind for this phase I trial.RESULTSThe vaccines were safe and well tolerated with no vaccine-related serious adverse events. A total of 7 adverse events, mild to moderate in intensity and considered possibly related to the study vaccines, were recorded. Vaccine-specific antibodies were highest in volunteers immunized with 100 μg ProC6C-AlOH with Matrix-M, and 13 of 20 (65%) individuals in the group showed greater than 80% transmission-reducing activity (TRA) when evaluated in the standard membrane feeding assay at 15 mg/mL IgG. In contrast, R0.6C induced sporadic TRA.CONCLUSIONAll formulations were safe and well tolerated in a malaria-endemic area of Africa in healthy adults. The ProC6C-AlOH/Matrix-M vaccine elicited the highest levels of functional antibodies, meriting further investigation.TRIAL REGISTRATIONPan-African Clinical Trials Registry (https://pactr.samrc.ac.za) PACTR202201848463189.FUNDINGThe study was funded by the European and Developing Countries Clinical Trials Partnership (grant RIA2018SV-2311).

A randomized controlled trial showing safety and efficacy of a whole sporozoite vaccine against endemic malaria

A highly effective malaria vaccine remains elusive despite decades of research. Plasmodium falciparum sporozoite vaccine (PfSPZ Vaccine), a metabolically active, nonreplicating, whole parasite vaccine demonstrated safety and vaccine efficacy (VE) against endemic P. falciparum for 6 months in Malian adults receiving a five-dose regimen. Safety, immunogenicity, and VE of a three-dose regimen were assessed in adults in Balonghin, Burkina Faso in a two-component study: an open-label dose escalation trial with 32 participants followed by a double-blind, randomized, placebo-controlled trial (RCT) with 80 participants randomized to receive three doses of 2.7 × 10⁶ PfSPZ (N = 39) or normal saline (N = 41) just before malaria season. To clear parasitemia, artesunate monotherapy was administered before first and last vaccinations. Thick blood smear microscopy was performed on samples collected during illness and every 4 weeks for 72 weeks after last vaccinations, including two 6-month malaria transmission seasons. Safety outcomes were assessed in all 80 participants who received at least one dose and VE for 79 participants who received three vaccinations. Myalgia was the only symptom that differed between groups. VE (1 - risk ratio; primary VE endpoint) was 38% at 6 months (P = 0.017) and 15% at 18 months (0.078). VE (1 - hazard ratio) was 48% and 46% at 6 and 18 months (P = 0.061 and 0.018). Two weeks after the last dose, antibodies to P. falciparum circumsporozoite protein and PfSPZ were higher in protected versus unprotected vaccinees. A three-dose regimen of PfSPZ Vaccine demonstrated safety and efficacy against malaria infection in malaria-experienced adults.

567 The Ever-Present Costs of Cosmetic Surgery Tourism; A 5-Year Observational Study

Introduction

Cosmetic surgery tourism is an ever-growing industry. An increasing number of patients are presenting to NHS services with complications from their surgery. This study aims to evaluate the current presentation patterns for complications in cosmetic surgery tourism, as well as the financial burden to a single UK level one trauma centre in Birmingham, UK.

Method

Between 2015 and 2020, all patients presenting to the department of plastic surgery with complications of cosmetic surgery performed outside of the UK were included. A cost analysis was performed for each patient using published ‘National Schedule of NHS Costs.’

Results

A total of 26 patients presented to our hospital within the study period. 32 cosmetic procedures were undertaken, with the majority performed in Turkey (n = 14). Abdominoplasty was the most common procedure, followed by gluteal enhancement surgery. The total financial cost to our hospital from all cosmetic surgery-related complications was £152,946, with an average cost per patient of £5,882.54 (range £362 - £26,585).

Conclusions

Patients seek out medical tourism for multiple reasons. The costs displayed should predominantly be viewed as a reflection of the detrimental effect these complications can have on patients’ lives. Global governing bodies should focus efforts on educating patients and raising awareness on this ever-prevalent issue.

Abstract SP059: Toxicities of breast cancer treatment

Advances in screening and treatment of breast cancer have led to reductions in breast cancer recurrence and mortality. However, systemic therapies can cause long-term and late effects that negatively impact the quality of life of patients with breast cancer. It is important for patients to be aware of the potential risks, and for providers to be knowledgeable about symptom management options. For example, taxane chemotherapies reduce the risk of disease recurrence but can cause long-lasting neuropathy that interferes with activities of daily living. Unfortunately, few effective interventions for preventing or treating neuropathy have thus far been identified. Similarly, endocrine therapies significantly reduce the risk of recurrence of hormone receptor positive breast cancer. However, tamoxifen and the aromatase inhibitors can cause menopausal symptoms and arthralgias that affect survivors of breast cancer of all ages. Interventions that can effectively treat these symptoms in some, but not all, patients have been identified. In this educational session, prevention and treatment approaches for key long-term and late effects in patients with breast cancer will be discussed.

Citation Format: N Henry. Toxicities of breast cancer treatment [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr SP059.

Does the use of health technology assessment have an impact on the utilisation of health care resources? Evidence from two European countries

OBJECTIVES

A centralised approach to health technology assessment (HTA) may facilitate optimal use of HTA resources. A regional approach may increase the chances of local implementation of recommendations. This study aimed to compare assessment procedures in England (centralised HTA approach) with Spain (regional HTA approach) discussing key challenges and opportunities from both approaches.

METHODS

We compared technology assessments of anticancer medicines in the two jurisdictions from 2008 to 2015. To assess the implementation of HTA recommendations, we assessed trends in medicine usage using regression methods. We used IQVIA data, from 2011 to 2016, for a sample of 11 medicines. We used CatSalut data from Catalonia to assess the implementation of local recommendations.

RESULTS

In England, 66 assessments were undertaken by the National Institute for Health and Care Excellence (NICE), using a standardised methodology. In Spain, there were 79 reports undertaken by a range of bodies using a shared process and coordinated through the GENESIS collaboration; the assessment methods used varied substantially. Overall, the recommendations in the two jurisdictions were similar. Regression analyses indicate that where there is a positive recommendation by HTA bodies, the usage of the medicine responds most strongly (p < 0.001) in Catalonia (4.892), followed by England (3.120) and Spain (1.693).

CONCLUSIONS

This study suggests that medicine utilisation does respond to the positive recommendations of HTA bodies. However, if HTA capacity is organised primarily regionally, considerable effort may be required in coordination, to ensure consistent and rigorous assessments and adequate implementation of HTA findings.

Scoring Cercospora Leaf Spot on Sugar Beet: Comparison of UGV and UAV Phenotyping Systems

Selection of sugar beet (Beta vulgaris L.) cultivars that are resistant to Cercospora Leaf Spot (CLS) disease is critical to increase yield. Such selection requires an automatic, fast, and objective method to assess CLS severity on thousands of cultivars in the field. For this purpose, we compare the use of submillimeter scale RGB imagery acquired from an Unmanned Ground Vehicle (UGV) under active illumination and centimeter scale multispectral imagery acquired from an Unmanned Aerial Vehicle (UAV) under passive illumination. Several variables are extracted from the images (spot density and spot size for UGV, green fraction for UGV and UAV) and related to visual scores assessed by an expert. Results show that spot density and green fraction are critical variables to assess low and high CLS severities, respectively, which emphasizes the importance of having submillimeter images to early detect CLS in field conditions. Genotype sensitivity to CLS can then be accurately retrieved based on time integrals of UGV- and UAV-derived scores. While UGV shows the best estimation performance, UAV can show accurate estimates of cultivar sensitivity if the data are properly acquired. Advantages and limitations of UGV, UAV, and visual scoring methods are finally discussed in the perspective of high-throughput phenotyping.

Static electricity sparks household cleaning agent causing facial burn

Static electricity is the build up of an electrical charge secondary to the redistribution of electrons between two non-conducting materials as they rub against one another. In the domestic setting, a static discharge rarely causes significant injury, as although the voltage can be higher than normal domestic voltage (240V), the current is relatively low. However, in cases where highly flammable substances are used, the risk of a static charge causing a flash is much greater. Our institution presents the first documented case of static electrical ignition of a substance causing facial burns. While cleaning a large plastic bin sprayed with 'Ambersil', a highly flammable mould-removing aerosol spray that can be purchased for domestic use, the 60-year-old female patient placed her face inside the bin to reach the bottom and received a large flash burn to her face and right arm that was 2.5% TBSA (total body surface area) and superficial dermal in nature. She was treated conservatively and discharged. Despite advances in electrical safety in the domestic and industrial settings, there are still real risks of significant burn injuries, which manufacturers, employers and the general public should be made aware of.

Frey's syndrome following a facial burn treated with botulinum toxin

Frey's syndrome occurs as a result of damage to the auriculotemporal nerve, which causes inappropriate regeneration of damaged parasympathetic fibres to salivary glands to innervate the sympathetic receptors of sweat glands in the face. The symptoms are pathological flushing and sweating with gustatory stimuli. It most commonly occurs following parotid surgery and has not previously been reported following burn injury. We present a 50-year-old man who sustained 1% TBSA full thickness burn to the right side of his face as a child. This was excised and reconstructed with skin grafts as well as further revision procedures in his adult life. He incidentally reported copious amounts of gustatory sweating over his right temple region that had been present since his initial injury, occurring prior to any reconstruction, consistent with Frey's syndrome. This was confirmed with a starch iodine test, and successfully treated with Botulinum toxin injections post reconstruction. This case is the first report of Frey's syndrome following burn injury. We highlight the potential development of Frey's syndrome following facial burns, even in the reconstructed area. Botulinum toxin treatment remains effective.

Synthesis and structural characterization of the first neptunium based metal–organic frameworks incorporating {Np6O8} hexanuclear clusters

The synthesis of the first transuranium Metal–Organic Frameworks (TRU-MOFs) is reported here.

Pressure resistance of cold-shocked Escherichia coli O157:H7 in ground beef, beef gravy and peptone water

AIMS

(i) To study the effects of cold shock on Escherichia coli O157:H7 cells. (ii) To determine if cold-shocked E. coli O157:H7 cells at stationary and exponential phases are more pressure-resistant than their non-cold-shocked counterparts. (iii) To investigate the baro-protective role of growth media (0·1% peptone water, beef gravy and ground beef).

METHODS AND RESULTS

Quantitative estimates of lethality and sublethal injury were made using the differential plating method. There were no significant differences (P > 0·05) in the number of cells killed; cold-shocked or non-cold-shocked. Cells grown in ground beef (stationary and exponential phases) experienced lowest death compared with peptone water and beef gravy. Cold-shock treatment increased the sublethal injury to cells cultured in peptone water (stationary and exponential phases) and ground beef (exponential phase), but decreased the sublethal injury to cells in beef gravy (stationary phase).

CONCLUSIONS

Cold shock did not confer greater resistance to stationary or exponential phase cells pressurized in peptone water, beef gravy or ground beef. Ground beef had the greatest baro-protective effect.

SIGNIFICANCE AND IMPACT OF THE STUDY

Real food systems should be used in establishing food safety parameters for high-pressure treatments; micro-organisms are less resistant in model food systems, the use of which may underestimate the organisms' resistance.

Synthesis of a molecularly imprinted polymer to isolate glucosamine from plant extracts by an ionic-non-covalent dual approach

OBJECTIVE

The objective of this study was to synthesize a novel glucosamine-imprinted sorbent based on ionic and non-covalent dual approach to purify glucosamine from chicory root extracts.

METHODS

The synthesis of the molecularly imprinted polymer was optimized in terms of choice of monomers, porogen, cross-linker and initiator to have the best recognition as possible for targeted molecule. The sorbent obtained was characterized by nitrogen sorption (BET), scanning electron microscopy (SEM) and solid-phase extraction (SPE) to plot adsorption isotherms. The selectivity of polymer between glucosamine and interfering salt as ammonium sulphate was calculated. Extraction procedure was optimized in terms of loading, washing and elution solvents, to have the best recovery of glucosamine. Compounds were analysed by HPLC-UV after chemical derivatization.

RESULTS

The results showed that the optimal conditions of extracting glucosamine on this new type of sorbent were as follows: percolation of plant extract in EtOH/aqueous HCl pH 3, washing of cartridge with water and elution of compound of interest with aqueous acetic acid solution at 5%. The recoveries of glucosamine were around 53% and 70%, from aqueous standard solution and aqueous chicory roots extracts, respectively, on the molecularly imprinted polymer. And, only 11% and 7% of the ammonium sulphate were recovered from standard solution and chicory roots extract, respectively.

CONCLUSION

The use of the MIP as solid-phase extraction sorbent was able to extract preferentially glucosamine from structural analogues and ammonium salt. Assays on chicory roots extracts were carried out, and the MIP showed good results allowing the transfer methodology at semi-industrial scale for cosmetic companies. The optimized protocol of extraction of glucosamine allowed using only eco-friendly solvents, as ethanol, water and acetic acid.

Simple separation and characterization of lanthanide–polyaminocarboxylic acid complexes by HILIC ESI-MS

Lanthanide complexes with EDTA and DTPA ligands were separated and characterized by HILIC ESI-MS for the first time.

A Single Nucleotide Polymorphism in Steroid Receptor Coactivator-1 Diminishes the Coactivation of ERα

Estrogen signaling is critical in the progression of a large fraction of breast cancers as well as in the maintenance of bone mineral density. Generally speaking, Tamoxifen, a selective estrogen receptor modulator (SERM), blocks estrogen signaling in the breast by acting as an antagonist at the same time as promoting estrogen signaling in the bone by acting as an agonist. This tissue specific action characteristic of SERMs is thought to be maintained by the balance of levels and/or activities of estrogen receptor (ER) coregulators. Because of this critical role, single nucleotide polymorphisms (SNPs) in ER coregulators could have a dramatic effect on tamoxifen action.Previous studies have implicated steroid receptor coactivator-1 (SRC-1) as a critical coregulator for the mixed antagonist-agonist specificity of tamoxifen. By using an ERE-Tk-Luciferase transient transfection assay, we have shown that a SNP causing the amino acid change P1272S in SRC-1 dramatically reduces its ability to coactivate ERα.To assess the impact of this SNP on tamoxifen action in breast cancer we decided to genotype the SRC-1 P1272S SNP in a breast tumor DNA bank. This bank was generated from archived tumors from individuals either exclusively receiving adjuvant tamoxifen or not receiving any adjuvant therapy following surgical resection. Currently, the bank is composed of 1000 samples divided equally among the two groups. Genotyping for the SRC-1 P1272S SNP is currently underway.Since SRC-1 has also been shown to be important in proper maintenance of bone mineral density (BMD) and in the agonist action of tamoxifen in certain tissues, we also assessed the impact of the P1272S SNP in bone following tamoxifen therapy. We genotyped breast cancer patients exclusively receiving tamoxifen therapy (i.e. no chemotherapy, no radiation) who had lumbar (n=113) and/or hip (n=108) BMD scans before and after 12 months of tamoxifen therapy. We observed a significant association between the SNP and bone loss; women harboring the P1272S SNP lost 6.4% of their lumbar BMD, while women with the WT version lost only 1.3% of their lumbar BMD.These findings illustrate the critical role of SRC-1 in tamoxifen action in bone, and potentially other hormone responsive tissues. Studies are ongoing to decipher the mechanism for decreased coactivation activity of the SNP, and also to extend the clinical association studies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 66.

Association of Aromatase Inhibitor-Associated Musculoskeletal Symptoms with Ultrasonographic Changes at the Wrist

Background: About 40% of aromatase inhibitor (AI)-treated women develop AI-associated musculoskeletal symptoms (AIMSS) such as arthralgias, but the etiology is unclear. Tendon sheath fluid and tenosynovial changes have been demonstrated by imaging in symptomatic AI-treated patients. It is unclear if these changes correlate with development of AIMSS.Methods: Thirty consecutive patients (pts) initiating therapy with letrozole or exemestane on a prospective clinical trial were enrolled to this substudy. Pts with prior wrist trauma or who declined to provide informed consent were excluded. Pts underwent high resolution ultrasonography (US) of the wrists bilaterally and completed the Health Assessment Questionnaire (HAQ), pain Visual Analog Scale (VAS), and Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire at baseline (BL) and after 3 mo of AI. AIMSS was defined as increase in HAQ or pain VAS score during AI therapy that exceeded a predefined cutoff. Analysis of US images was performed in a blinded manner. Imaging abnormalities included the following: presence of fluid, synovitis, and/or hyperemia in the tendon sheath or joint recess. Statistical analysis was performed using univariate chi-square tests and logistic regression analyses.Results: Of the 30 enrolled subjects, 25 completed both BL and 3 mo assessments. Eight of 30 (27%) discontinued therapy because of AIMSS (2 before and 6 after the 3 mo timepoint), and 3 patients discontinued therapy for unrelated reasons. All patients have been followed for at least 6 mo. We observed a significant association between early treatment discontinuation and change in HAQ (Odds Ratio (OR) 1.525, p=0.0006) and VAS (OR 1.307, p=0.0096) but not DASH (OR 1.001, p=0.96) scores between BL and 3 mo. The proportion of pts with abnormalities on US at BL or that developed during therapy is given in tables 1 and 2, respectively. We did not observe a statistically significant correlation between objective abnormalities on US at BL or following initiation of AI therapy and the development of AIMSS or early treatment discontinuation because of AIMSS.Conclusions: Clinically relevant musculoskeletal symptoms develop in AI-treated women, leading to treatment discontinuation in a substantial percentage. However, patient-reported symptoms were not associated with inflammatory changes visible on wrist US in this pilot study.Proportion of pts with US abnormalities at BL # with abnl/total ptsof pts with AIMSS, # with US abnlof pts without AIMSS, # with US abnlof pts who d/c AI b/c AIMSS, # with US abnlof pts who continued AI, # with US abnlAny anatomic site27/30 (90%)9/10 (90%)18/20 (90%)7/8 (88%)20/22 (91%)--Tendon sheath14/30 (47%)7/10 (70%)7/20 (35%)5/8 (63%)9/22 (41%)--Joint recess24/30 (80%)6/10 (60%)18/20 (90%)6/8 (75%)18/22 (82%) Proportion of pts who developed new abnormalities on US during AI therapy # with abnl/total ptsof pts with AIMSS, # with US abnlof pts without AIMSS, # with US abnlof pts who d/c AI, # with US abnlof pts who continued AI, # with US abnlAny anatomic site13/25 (52%)5/9 (56%)7/16 (44%)4/6 (67%)7/19 (37%)--Tendon sheath5/25 (20%)2/9 (22%)3/16 (19%)0/6 (0%)5/19 (26%)--Joint recess12/25 (48%)5/9 (56%)6/16 (38%)4/6 (67%)6/19 (32%) 

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 802.

Bone Mineral Density (BMD) Changes at 1 Year in Postmenopausal Women Who Are Not Receiving Adjuvant Endocrine Therapy for Breast Cancer (BCA)

Background: Adjuvant therapy for breast cancer (BCA) may be associated with an increased risk for osteoporosis. This prospective, observational study evaluates BMD changes in postmenopausal women undergoing adjuvant chemotherapy (CTX) for early stage BCA, in the absence of endocrine therapy.Methods: Women who have been postmenopausal for at least 5 years, and who were recently diagnosed with Stage 0-III BCA were eligible to undergo serial BMD if adjuvant endocrine therapy was not recommended. Study BMDs were performed at baseline, 1 and 2 years. All patients (pts) were counseled on calcium, vitamin D and weight bearing exercise. This study was designed to assess serial changes in BMD in the individual and to compare changes in those treated with CTX to those who received no systemic therapy (observation). The study was closed prior to reaching target sample size due to slow accrual.Results: Sixteen pts enrolled. Eleven pts received CTX with a dose dense anthracycline and taxane containing regimen and 5 pts received no systemic adjuvant therapy. Twelve pts, median age 63 (range 52-80), have completed the 1 year assessment and are reported here. Two pts treated with CTX and 1 pt on observation were on bisphosphonates at study entry. Baseline BMD mean in gm/cm2 at the lumbar spine (LS) was 1.112 (range 0.807-1.389) and total hip (TH) was 0.989 (range 0.760-1.213). At 1 year, mean BMD at LS was 1.078 (range 0.767-1.347) and TH was 0.956 (range 0.753-1.210). For all 12 pts at 1 year, the individual BMD changes in LS & TH BMD ranged from 10% loss to 2% gain, with 8 of the 9 CTX treated pts losing 1-10% of BMD and the 3 pts on observation staying within 2% of baseline. The mean dosage of dexamethasone used during CTX by the 9 CTX pts was 230 mg (range 156-288mg). The 3 observation pts had no exposure to steroids during the parallel time period.Conclusions: This prospective, observational study supports the hypothesis that adjuvant CTX, and/or its supportive medications, may be associated with acute changes in BMD in postmenopausal women. Patient follow up continues.Funded by Susan G. Komen for the Cure POP0402593

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1066.

[Management of premature ejaculation in adults]

Premature ejaculation is a very frequent form of sexual dysfunction characterized by loss of control of ejaculation, inducing performance anxiety and, consequently, impaired quality of life of patients and their partners. The pathophysiology of this symptom is often both psychogenic and organic. The various organic causes must be systematically investigated. Several drug treatments are used with varying degrees of efficacy and their adverse effects must be taken into account when choosing a molecule. Psychological management is an essential complement to drug treatment.

Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus

All patients positive for methicillin-resistant Staphylococcus aureus (MRSA) at the University Hospitals of Geneva, Switzerland, between 1989 and 1997 (N = 1771) were included in a cohort study to evaluate the consequences of delayed containment of a hospital-wide outbreak occurring during a 4-year absence of MRSA control measures. The effects of efforts to control both the MRSA reservoir and the number of bacteraemic patients were assessed. Intensive infection control measures were initiated in 1993 and included patient screening, on-site surveillance, contact isolation, a computerized alert system, and hospital-wide promotion of hand hygiene. An increase in the rate of new MRSA-infected or -colonized patients was observed between 1989 and 1994 (from 0.05 to 0.60 cases per 100 admissions), which subsequently decreased to 0.24 cases in 1997 (P<0.001). However, the proportion of laboratory-documented methicillin-resistant isolates among all S. aureus showed little variation in the years from 1993 onwards (range, 19-24%), reflecting the result of an increase in the number of screening cultures. The annual number of patients with MRSA bacteraemia strongly correlated with the hospital-wide prevalence of MRSA patients (R(2)= 0.60; P = 0.01) and the rate of new MRSA patients (R(2)= 0.97; P<0.001). Consequently, the attack rate of nosocomial MRSA bacteraemia served as an excellent marker for the MRSA patient reservoir. In conclusion, despite delayed implementation, infection control measures had a substantial impact on both the reservoir of MRSA patients and the attack rate of MRSA bacteraemia.

[Prevalence of nosocomial infections in a university hospital: distribution, predisposing factors and diagnostic indices]

Nosocomial infections are a major challenge for modern medicine and contribute to increased resource use in health care systems. The first hospital-wide prevalence survey of nosocomial infections was conducted at the University of Geneva Hospitals in 1994. At the time of the study, 16.9% of admitted patients had nosocomial infections (168/994). Leading infection sites were: urinary tract (30%), respiratory tract (17%), surgical wounds (12%) and bloodstream (9.6%). Rates of infection varied between hospital wards: intensive care (21%), surgery (19%), rehabilitation (18%), internal medicine (13%). However, the distribution of nosocomial infections varied according to surveillance and attribution rules. Optimal detection of nosocomial infections requires ward surveillance, including revision of microbiology, nursing (Kardex) and medical records; the combination of fever above 38 degrees C, prescription of antimicrobial agent(s), and positive microbiological records suggested the diagnosis of nosocomial infections in 95% of situations. Priorities for infection control were derived from these results.

Comparison of agar dilution, broth dilution, disk diffusion, and the E-test for susceptibility testing of penicillin-susceptible and penicillin-resistant Streptococcus pneumoniae

An evaluation to determine the optimal methods for the in vitro susceptibility testing of 41 clinical isolates and the ATCC 49619 strain of Streptococcus pneumoniae to penicillin was undertaken. No very major or major interpretive errors were observed with the following test methods and media: agar dilution using either Mueller-Hinton medium with lysed horse blood or Haemophilus test medium; broth dilution using cation-adjusted Mueller-Hinton medium with lysed horse blood, Haemophilus test medium, or Todd-Hewitt medium; and the epsilo-meter test (E-test) using agar containing Mueller-Hinton medium and 5% sheep blood. The disk diffusion method using agar containing Mueller-Hinton medium and 5% sheep blood agar was an effective screening method, requiring confirmation by a dilution susceptibility test method.

Pancreatitis in human immunodeficiency virus-infected children receiving dideoxyinosine

To define predictive or contributory risk factors for pancreatitis in human immunodeficiency virus-infected children receiving dideoxyinosine (ddI), the authors evaluated 95 children, 3 months to 18 years of age, who had received ddI at 60 to 540 mg/m2 per day for a mean of 56 weeks. Pancreatitis developed in 7 patients (7%) but resolved in all upon withdrawal of ddI. Neither age, sex, nor CD4 count at study entry was predictive of pancreatitis, but pancreatitis appeared more likely to develop in hemophiliacs than in other patients (4 of 23 vs 3 of 72). Pancreatitis developed only in patients who received ddI at the highest dose levels (7 of 60 patients who received ddI at a dose > or = 360 mg/m2 per day vs 0 of 35 patients who received < or = 270 mg/m2 per day). Patients in whom pancreatitis developed had received a higher mean daily dose of ddI than patients with normal amylase and lipase levels throughout the study (348 mg/m2 vs 282 mg/m2), but no relationship with the cumulative dose or the duration of ddI therapy was observed. Although a statistically significant relationship between ddI plasma concentration (area under the curve) and pancreatitis was not conclusively demonstrated, as the number of patients in whom pancreatitis actually developed was small, such a relationship may have been obscured.(ABSTRACT TRUNCATED AT 250 WORDS)

Phenoxymethyl penicillin potassium as an in-feed medication for pigs with streptococcal meningitis

In two separate studies involving 2500 weaner pigs, strategic infeed medication with phenoxymethyl penicillin potassium significantly reduced the incidence of streptococcal meningitis.

Factors influencing antibiotic use in acute respiratory tract infections in family practice

The authors of this paper assessed the effect of psychosocial and biomedical factors on the prescription rate for upper respiratory infections. Their study, using written clinical vignettes mailed to a random sample of Ontario family practitioners, achieved a 69% response rate. Family practitioners most often used physical signs and symptoms in forming their decision to prescribe antibiotics. Psychosocial data, when present in the vignettes, significantly modified the prescription rate, often overriding the biomedical factors alone. The study is another step in exploring a complex decision-making process.

Ciprofloxacin therapy of experimental endocarditis caused by methicillin-susceptible or methicillin-resistant Staphylococcus aureus

Ciprofloxacin was more effective (P less than 0.01) than either imipenem or nafcillin therapy of experimental methicillin-susceptible Staphylococcus aureus endocarditis in rabbits after 2 or 3 days of treatment. There was no significant difference between results of treatment of methicillin-susceptible S. aureus experimental endocarditis with ciprofloxacin and results with the combination of nafcillin and gentamicin. Ciprofloxacin was more effective (P less than 0.01) than vancomycin therapy of experimental methicillin-resistant S. aureus endocarditis after 3 days of treatment. After 5 days of treatment, there was no significant difference between the results of treatment of experimental methicillin-resistant S. aureus endocarditis with ciprofloxacin and results with vancomycin.

Synergistic incorporation of daunorubicin in erythrocytes in the presence of polyene antibiotics. Role of the membrane potential

The synergistic incorporation into red blood cells of the antitumor compound daunorubicin, in the presence of the polyene antibiotics amphotericin B and vacidin A, depended on the composition of the external medium. Synergism was observed only for concentrations of polyene antibiotics that induce cation permeability. The same synergistic effect was observed with the K+ selective carrier, valinomycin, but this had a different dependence on the external medium composition. By using the membrane probe 3,3'-dipropylthiadicarbocyanine (diS-C3-(5], the synergistic effect was shown to occur under conditions where addition of the ionophores leads to hyperpolarization of the membrane.

Interaction of adriamycin with negatively charged model membranes: evidence of two types of binding sites

The interaction of the antitumor compound adriamycin with negatively charged unilamellar phospholipid vesicles was studied. The negative charges were provided by cardiolipin or phosphatidic acid. By analyzing the changes in the circular dichroism spectrum of adriamycin, we demonstrated the presence of two different spectral patterns corresponding to two different binding sites (I and II) on the vesicles. In site I, the amino sugar of adriamycin is bound to the ionized phosphate of either cardiolipin or phosphatidic acid, and the dihydroxyanthraquinone lies outside the bilayer. In site II, the amino sugar is still bound to the phosphate, but the dihydroxyanthraquinone moiety is embedded in the bilayer. This has been shown by measuring spectroscopically the binding of the aglycon part to an external probe and by measuring the susceptibility of bound adriamycin to reduction by NADH dehydrogenase.

Collagen degradation by metastatic variants of Lewis lung carcinoma: cooperation between tumor cells and macrophages

Interactions between cancer cells and host macrophages might have important regulatory roles in controlling the expression of the metastatic phenotype, particularly by regulating the production of proteases necessary for tissue invasion. To investigate that possibility, mouse macrophages and Lewis lung carcinoma (LLC) cells from four clonal subpopulations with either low or high metastatic ability were cultured on [14C]collagen (type l)-coated plates. They did not degrade collagen when they were cultured independently on that substrate, but they were induced to do so when macrophages and cancer cells were cultured together. An increased production of neutral collagenase and other neutral protease activities was observed simultaneously. The degree of stimulation of collagen degradation varied according to the cancer cell subpopulation present in the cocultures. For a given LLC cell subpopulation, similar degrees of stimulation of collagen degradation were achieved with either bone marrow-derived or resident peritoneal macrophages, either syngeneic (from C57BL/6 mice) or allogeneic; lower stimulations were obtained with thioglycolate-elicited peritoneal macrophages. Macrophage-conditioned culture media could be substituted for living macrophages to stimulate collagen degradation or collagenase secretion by LLC cells, but LLC cell-conditioned media did not stimulate collagen degradation by macrophages. This suggests that, in the cocultures, collagen degradation is achieved mainly by the cancer cells, not by the macrophages, and that it is induced by a soluble factor, a monokine, produced by the macrophages. That factor might be identical to a recently identified rabbit monokine that stimulates fibroblasts or synovial cells to degrade collagen and proteoglycan and to activate plasminogen, because rabbit macrophage-conditioned media containing that monokine also stimulated collagen degradation by LLC cells.

Metastatic heterogeneity of cells from Lewis lung carcinoma

To allow investigations of the role of tumor cell proteases in invasion and metastasis, an attempt was made to obtain well-defined homogeneous populations of Lewis Lung carcinoma cells differing widely in their metastatic potential. From a single Lewis lung carcinoma, a parental line of cells was established and subsequently cloned so as to provide 18 clonal tumor cell lines. These clones differed in their ability to produce spontaneous, macroscopically visible metastases in the lung after i.m. inoculation into syngeneic C57BL/6 mice. Several of them were less metastatic than the parental line. The parental line expressed a metastatic behavior close to that of the high-metastatic cell subpopulations that it contained. There was, within certain limits, a good correlation between the potential for spontaneous lung metastases arising from a primary tumor and that for "artificial" lung colonies obtained after i.v. injection of the Lewis lung carcinoma cells. Although positively correlated with the growth rate of the tumor cells, the metastatic ability of the clones could not be considered as a mere reflection of the proliferation rates of the cells constituting the primary tumors. Differences in metastatic behavior observed among clones persisted in several cases after the cells had been maintained in culture for prolonged periods. However, this stability of the clones in vitro was not absolute. Indeed, some subclones isolated from the low-metastatic clone H122 displayed metastatic abilities which were lower than that of the parent clone. Furthermore, a significant increase in metastatic potential was once observed after a prolonged culture period of that same clone, H122. Thus, new metastatic phenotypes can emerged under in vitro culture conditions. However, the relative rarity of this event suggests that some metastatic heterogeneity already preexisted in vivo among the tumor cells.

Co-operation between metastatic tumor cells and macrophages in the degradation of basement membrane (type IV) collagen

The co-culture of mouse peritoneal macrophages and Lewis lung carcinoma cells induces the release of a metal-dependent type IV collagen-degrading proteinase which is not produced in detectable amounts by either cell type cultivated alone. Conditioned media of the co-cultures degrade both pepsin-extracted type IV collagen from human placenta and mouse type IV procollagen. Thus macrophages can interact with tumor cells to degrade basement membrane type IV collagen: this might be of importance to allow cancer invasion and metastasis.