Abstract 4334: Clever-1/PD-L1 ratio predicts response to Bexmarilimab, a novel macrophage-guided immunotherapy, in immune deprived cancers

Introduction: Clever-1 is an immunosuppressive scavenger receptor expressed on tumor associated macrophages. High levels of Clever-1 are associated with poor survival, T-cell exclusion and dysfunction, and immunotherapy resistance. Bexmarilimab (FP-1305) is a novel humanized anti-Clever-1 IgG4-antibody capable of promoting an immune switch, potentially leading to intratumoral proinflammatory responses in patients. In a first-in-human all-comer single agent Phase I/II study in advanced solid tumors (NCT03733990) approximately 30% of patients in hepatocellular carcinoma, cutaneous melanoma and cholangiocarcinoma achieved immune activation, characterized by an IFNg response, which led to a survival benefit (ASCO 2022). Here, we show that patients getting a therapy benefit have immunologically cold tumors with low PD-L1 staining and high Clever-1 staining.

Methods: Pre-treatment tumor samples were immunohistochemically stained for Clever-1 (4G9, Santa Cruz) using Ventana platform and scored by % of intratumoral positive cells out of all viable cells and PD-L1 (22C3, Agilent) with combined positivity scoring (CPS). Ratio (PD-L1/Clever-1) at baseline was compared using non-parametric Wilcoxon-test according to clinical benefit.

Results: 23 successful baseline biopsies and stainings were obtained, 6 per cutaneous melanoma, 11 per cholangiocarcinoma and 1 per hepatocellular carcinoma, from patients treated with bexmarilimab. Patients had received an average of three previous lines of therapy. At baseline, patients that saw a clinical benefit (CBR) from bexmarilimab had average PD-L1/Clever-1 ratio of 0.2 compared to 4.4 (p=0.042, Wilcoxon nonparametric test) in patients that did not respond to the treatment.

Conclusion: PD-L1/Clever-1 IHC staining ratio may be used to predict bexmarilimab responding patients. These patients have a low PD-L1 staining and low IFNg levels as reported previously, and are often refractory to checkpoint inhibitors and other T cell activating agents. Bexmarilimab provides a novel therapy option for a tumor group that is otherwise poorly responsive to immune therapies.

Citation Format: Mari L. Björkman, Elisa M. Vuorinen, Juho Jalkanen, Marie-Louise Fjällskog, Jussi Koivunen, Teppo Huttunen, Maija Hollmén, Petri Bono. Clever-1/PD-L1 ratio predicts response to Bexmarilimab, a novel macrophage-guided immunotherapy, in immune deprived cancers. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4334.

Feasibility and patient acceptability of a commercially available wearable and a smart phone application in identification of motor states in parkinson's disease

In the quantification of symptoms of Parkinson's disease (PD), healthcare professional assessments, patient reported outcomes (PRO), and medical device grade wearables are currently used. Recently, also commercially available smartphones and wearable devices have been actively researched in the detection of PD symptoms. The continuous, longitudinal, and automated detection of motor and especially non-motor symptoms with these devices is still a challenge that requires more research. The data collected from everyday life can be noisy and frequently contains artefacts, and novel detection methods and algorithms are therefore needed. 42 PD patients and 23 control subjects were monitored with Garmin Vivosmart 4 wearable device and asked to fill a symptom and medication diary with a mobile application, at home, for about four weeks. Subsequent analyses are based on continuous accelerometer data from the device. Accelerometer data from the Levodopa Response Study (MJFFd) were reanalyzed, with symptoms quantified with linear spectral models trained on expert evaluations present in the data. Variational autoencoders (VAE) were trained on both our study accelerometer data and on MJFFd to detect movement states (e.g., walking, standing). A total of 7590 self-reported symptoms were recorded during the study. 88.9% (32/36) of PD patients, 80.0% (4/5) of DBS PD patients and 95.5% (21/22) of control subjects reported that using the wearable device was very easy or easy. Recording a symptom at the time of the event was assessed as very easy or easy by 70.1% (29/41) of subjects with PD. Aggregated spectrograms of the collected accelerometer data show relative attenuation of low (<5Hz) frequencies in patients. Similar spectral patterns also separate symptom periods from immediately adjacent non-symptomatic periods. Discriminative power of linear models to separate symptoms from adjacent periods is weak, but aggregates show partial separability of patients vs. controls. The analysis reveals differential symptom detectability across movement tasks, motivating the third part of the study. VAEs trained on either dataset produced embedding from which movement states in MJFFd could be predicted. A VAE model was able to detect the movement states. Thus, a pre-detection of these states with a VAE from accelerometer data with good S/N ratio, and subsequent quantification of PD symptoms is a feasible strategy. The usability of the data collection method is important to enable the collection of self-reported symptom data by PD patients. Finally, the usability of the data collection method is important to enable the collection of self-reported symptom data by PD patients.

Polymorphism in interferon alpha/beta receptor contributes to glucocorticoid response and outcome of ARDS and COVID-19

BACKGROUND

The use of glucocorticoids has given contradictory results for treating acute respiratory distress syndrome (ARDS). The use of intravenous Interferon beta (IFN β) for the treatment of ARDS was recently tested in a phase III ARDS trial (INTEREST), in which more than half of the patients simultaneously received glucocorticoids. Trial results showed deleterious effects of glucocorticoids when administered together with IFN β, and therefore, we aimed at finding the reason behind this.

METHODS

We first sequenced the genes encoding the IFN α/β receptor of the patients, who participated in the INTEREST study (ClinicalTrials.gov Identifier:  NCT02622724 , November 24, 2015) in which the patients were randomized to receive an intravenous injection of IFN β-1a (144 patients) or placebo (152 patients). Genetic background was analyzed against clinical outcome, concomitant medication, and pro-inflammatory cytokine levels. Thereafter, we tested the influence of the genetic background on IFN α/β receptor expression in lung organ cultures and whether, it has any effect on transcription factors STAT1 and STAT2 involved in IFN signaling.

RESULTS

We found a novel disease association of a SNP rs9984273, which is situated in the interferon α/β receptor subunit 2 (IFNAR2) gene in an area corresponding to a binding motif of the glucocorticoid receptor (GR). The minor allele of SNP rs9984273 associates with higher IFNAR expression, more rapid decrease of IFN γ and interleukin-6 (IL-6) levels and better outcome in IFN β treated patients with ARDS, while the major allele associates with a poor outcome especially under concomitant IFN β and glucocorticoid treatment. Moreover, the minor allele of rs9984273 associates with a less severe form of coronavirus diseases (COVID-19) according to the COVID-19 Host Genetics Initiative database.

CONCLUSIONS

The distribution of this SNP within clinical study arms may explain the contradictory results of multiple ARDS studies and outcomes in COVID-19 concerning type I IFN signaling and glucocorticoids.

Body movement as a biomarker for use in chronic pain rehabilitation: An embedded analysis of an RCT of a virtual reality solution for adults with chronic pain

Introduction

Chronic low back pain (CLBP) is a major public health problem. Reliably measuring the effects of chronic pain on movement and activity, and any changes due to treatment, is a healthcare challenge. A recently published paper demonstrated that a novel digital therapeutic (DTxP) was efficacious in reducing fear of movement and increasing the quality of life of adult patients with moderate to severe CLBP. In this paper, we report a study of how data from wearable devices collected in this study could be used as a digital measure for use in studies of chronic low back pain.

Methods

Movement, electrodermal recording, general activity and clinical assessment data were collected in a clinical trial of a novel digital therapeutic intervention (DTxP) by using the sensors in commercial Garmin Vivosmart 4, Empatica Embrace2 and Oculus Quest wearables. Wearable data were collected during and between the study interventions (frequent treatment sessions of DTxP). Data were analyzed using exploratory statistical analysis.

Results

A pattern of increased longitudinal velocity in the movement data collected with right-hand, left-hand, and head sensors was observed in the study population. Correlations were observed with the changes in clinical scales (Tampa Scale of Kinesiophobia, EQ5D Overall health VAS, and EQ5D QoL score). The strongest correlation was observed with the increased velocity of head and right-hand sensors (Spearman correlation with increasing head sensor velocity and Tampa Scale of Kinesiophobia -0.45, Overall health VAS +0.67 and EQ5D QoL score -0.66). The sample size limited interpretation of electrodermal and general activity data.

Discussion/Conclusion

We found a novel digital signal for use in monitoring the efficacy of a digital therapeutics (DTxP) in adults with CLBP. We discuss the potential use of such movement based digital markers as surrogate or additional endpoints in studies of chronic musculoskeletal pain.

Clinical Trial Registration

https://clinicaltrials.gov/ct2/show/NCT04225884?cond=NCT04225884&draw=2&rank=1, identifier: NCT04225884.

Modelling treatment benefit for bexmarilimab (an anti-Clever-1 antibody and a novel macrophage reprogrammer) using phase I/II first-in-man trial data

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Background: Bexmarilimab, an investigational immunotherapeutic antibody targeting Clever-1, is currently investigated in phase I/II MATINS study (NCT03733990) for advanced solid tumors. Machine learning (ML) based models combining extensive data could be generated to predict treatment responses to this first-in-class macrophage checkpoint inhibitor. Methods: 52 baseline features from 138 patients included in the part 1/2 of phase I/II MATINS trial were included in ML modelling. 19 patients were classified as benefitting from the therapy by RECIST 1.1 defined clinical benefit rate (DCR) at cycle 4. Initial feature selection was done using both domain knowledge and removal of features with several missing values resulting in 44 features from 102 patients. The remaining data was standardized and feature selection using variance analysis (ANOVA) based on F-values between response and features was performed. With this approach, and by removing features with high multicollinearity, the number of features could be further reduced, and used sample size increased by removing features with missing values, until only the most important features were included in the data. Feature selection resulted in nine baseline features from 127 patients, of which 18 with DCR, to be used for ML model selection and training Several ML models were trained, and prediction performance evaluated using leave-one-out cross-validation (LOOCV). In LOOCV a ML model is trained as many times as there are samples in the data (127 times in this case), each time leaving one sample out from the training set as a test set. Finally, the out-of-sample test results are aggregated to form an overall view of the model performance with unseen data. Regularized Extreme gradient boosting (XGBoost) was found out to be the best performing prediction model. Results: Nine baseline features were associated with bexmarilimab treatment benefit, and the best ML prediction performance was obtained with five features. CBR was associated with low TNFalpha and neutrophils, and high Eotaxin, CK, and T-regs. ML model trained with these five features performed well in LOOCV as 15/18 (83%) DCR and 101/109 (93%) non-DCR were classified correctly, and all considered classification performance metrics were excellent. In feature importance analysis, high baseline T-regs and Eotaxin, and low TNFalpha were characterized as the most important predictors for treatment benefit with relative importances of 0.34, 0.25, and 0.24 (out of 1). Conclusions: This study highlights possibility of using ML models in predicting treatment benefit for novel cancer drugs such as bexmarilimab and boost the clinical development. The findings are in line with expected novel immune activating mode-of-action of bexmarilimab. Clinical trial information: NCT03733990.

Health-related Quality of Life in Intermediate- or High-risk Patients Treated With Radical External Radiotherapy and Adjuvant Docetaxel for Localized Prostate Cancer: A Randomized, Phase III SPCG-13 Study

BACKGROUND/AIM

The goal of this study was to investigate whether health-related quality of life (HRQoL) was affected in patients with high- or intermediate-risk localized prostate cancer treated with docetaxel following radiation therapy (RT).

PATIENTS AND METHODS

A total of 376 patients treated with RT and androgen deprivation were randomized to receive 6 cycles of docetaxel 75 mg/m² (N=188, Arm A) or surveillance (N=188, Arm B). FACT-P HRQoL questionnaires were gathered at baseline, six months and 1, 2 and 4 years after randomization. The data were analysed using analysis of covariance.

RESULTS

FACT-P scores decreased in Arm A at the end of treatment and remained unchanged in Arm B (p<0.0001). The HRQoL scores in Arm A matched Arm B in the 1-year follow-up (p=0.0528) and remained similar in further follow-up.

CONCLUSION

Docetaxel transiently decreased HRQoL during chemotherapy but not after treatment for up to four years of follow-up.

Effect of Bifidobacterium animalis spp. lactis Bl-04 on Rhinovirus-Induced Colds: A Randomized, Placebo-Controlled, Single-Center, Phase II Trial in Healthy Volunteers

BACKGROUND

This study was designed to assess the efficacy of Bifidobacterium animalis ssp. lactis (Bl-04) for prevention of rhinovirus colds and to explore the interactions between the probiotic, the viral infection, the host response and the host microbiome.

METHODS

The effect of ingestion of the probiotic Bl-04 was evaluated in a randomized, double-blinded rhinovirus (RV) challenge study. Healthy volunteers recruited from a university community in USA were randomized 1:1 using a computer generated code to ingest either Bl-04 (n=165) or placebo (n=169) for 28 days and were then challenged with RV-A39, and followed for 14 days. All study interactions and sample collection occurred in dedicated clinical research space. The primary analysis was the effect of the probiotic on the incidence of RV-associated illness. (Trial registration: NCT02679807, study complete).

FINDINGS

The first cohort of volunteers was randomized on March 14, 2016 and the last (5^th) cohort was randomized on March 12, 2018. Sixty-three (56%, 95% CI [47%; 66%]) of the 112 subjects in the active group and 60 (50%,95% CI [41%; 59%]) of the 120 subjects in the placebo group had a protocol-defined rhinovirus-associated illness (χ²=0·91, p=0·34). The point estimate of the difference in illness (active-placebo) is 6.3% (95% CI -6.7;19.1). There were no adverse events that were judged as definitely or probably related to the study product.

INTERPRETATION

In this study there was no effect of orally administered Bl-04 on the occurrence of RV-associated illness.

FUNDING

Danisco Sweeteners Oy (now IFF Health & Biosciences).

Biweekly Cabazitaxel Is a Safe Treatment Option for Metastatic Castration-resistant Prostate Cancer (mCRPC) Patients After Docetaxel - A Final Analysis of the Prosty II Trial

BACKGROUND/AIM

Our phase III trial showed that biweekly docetaxel (D) is better tolerated than triweekly D in metastatic castration-resistant prostate cancer (mCRPC). The safety of biweekly cabazitaxel (CBZ) post-docetaxel was studied in mCRPC.

PATIENTS AND METHODS

Altogether, 60 patients received CBZ 16 mg/m² i.v. on day 1 and day 14 of a 4-week cycle. The mean serum PSA levels were 305 ng/ml, and the mean age 67 years. The primary endpoint was safety according to CTCAEv4.0.

RESULTS

A total of 255 4-week cycles of CBZ were administered. The most common grade 3/4 adverse events were neutropenia (16.7%), pain (13.3%), fatigue (10.0%), anemia (5.0%) and non-neutropenic infection (10.0%). PSA responses occurred in 10 patients (16.7%). Clinical benefit rate was 38.3% and median survival 10 months.

CONCLUSION

Biweekly CBZ is a well-tolerated treatment resulting in meaningful benefits for heavily pretreated mCRPC patients.

Quantification of tremor using consumer product accelerometry is feasible in patients with essential tremor and Parkinson's disease: a comparative study

Background

To quantify pharmacological effects on tremor in patients with essential tremor (ET) or Parkinson’s Disease (PD), laboratory-grade accelerometers have previously been used. Over the last years, consumer products such as smartphones and smartwatches have been increasingly applied to measure tremor in an easy way. However, it is unknown how the technical performance of these consumer product accelerometers (CPAs) compares to laboratory-grade accelerometers (LGA). This study was performed to compare the technical performance of CPAs with LGA to measure tremor in patients with Parkinson’s Disease (PD) and essential tremor (ET).

Methods

In ten patients with PD and ten with ET, tremor peak frequency and corresponding amplitude were measured with 7 different CPAs (Apple iPhone 7, Apple iPod Touch 5, Apple watch 2, Huawei Nexus 6P, Huawei watch, mbientlabMetaWear (MW) watch, mbientlab MW clip) and compared to a LGA (Biometrics ACL300) in resting and extended arm position.

Results

Both in PD and ET patients, the peak frequency of CPAs did not significantly differ from the LGA in terms of limits of agreement. For the amplitude at peak frequency, only the iPhone and MW watch performed comparable to the LGA in ET patients, while in PD patients all methods performed comparable except for the iPod Touch and Huawei Nexus. Amplitude was higher when measured with distally-located CPAs (Clip, iPhone, iPod) compared with proximally-located CPAs (all watches). The variability between subjects was higher than within subjects for frequency (25.1% vs. 13.4%) and amplitude measurement (331% vs. 53.6%). Resting arm position resulted in lower intra-individual variability for frequency and amplitude (13.4 and 53.5%) compared to extended arm position (17.8 and 58.1%).

Conclusions

Peak frequencies of tremor could be measured with all tested CPAs, with similar performance as LGA. The amplitude measurements appeared to be driven by anatomical location of the device and can therefore not be compared. Our results show that the tested consumer products can be used for tremography, allowing at-home measurements, in particular in studies with a cross-over or intra-individual comparison design using the resting arm position.

Trial registration

This trial was registered in the Dutch Competent Authority (CCMO) database with number NL60672.058.17 on May 30th 2017.

A randomized phase III trial between adjuvant docetaxel and surveillance after radical radiotherapy (RT) for intermediate and high-risk prostate cancer (PC): Quality-of-life results (QoL) in SPCG-13 trial

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Background: Six docetaxel cycles did not improve PSA relapse free survival as an adjuvant treatment after radical RT (Kellokumpu-Lehtinen EURURO-8532). Here we report SPCG-13 trials QoL results. Methods: A total of 376 PC patients (T2 with Gleason score (GS) 4+3, PSA>10; T2, GS 8-10 any PSA; or any T3) were randomised to receive either 6 cycles of docetaxel 75mg/m2 every 3 weeks (Arm A, n=188) or surveillance (Arm B, n=188) after radical RT NTC006653848. Neoadjuvant/adjuvant ADT was mandatory. Primary end-point was a rising PSA > 2 ng/ml above the nadir. Patients were followed for 5 years with PSA every 3 months for two years and thereafter every 6 month. FACT-P QoL questionnaires were used at baseline, during and after docetaxel treatment and in the follow-ups (at 1 year, 2 years and 4 years after treatment) in both groups, and analysed using analysis of variance (ANOVA) models. Results: Median follow-up was 59.4 months (range 1 to 111 months). 147 (78.2%) patients completed all six cycles in arm A. Mean age was 66.2 years in Arm A and 66.4 years in Arm B. The total QoL scores at baseline did not differ between the Arms (mean 119.0, SD±18.9, n=177 vs 118.2, SD±18.1, n=180). In Arm A the total score declined to 116.3 (SD+15.2), at 24 weeks and was 118.5 (SD±21.3) after chemotherapy. In Arm B at 24 weeks the QoL score had increased to 123.3 (SD±19.2) and was significantly higher than in Arm A (estimated difference of 8.2 with p<0.0001, ANOVA model adjusted for baseline). However, in the first follow-up (1 year) the QoL score was same in both Arms (123.7 vs 123.6, respectively, p=0.344, ANOVA model adjusted for baseline) and remained at the same level during further follow-ups. The decline in QoL scores during the docetaxel treatment were seen only in two sub-scores; functional and physical. Conclusions: Adjuvant docetaxel did decrease the QoL of patients during the treatment. However, in the later follow-ups it increased to the same level as those patients without docetaxel treatment. These results further support our conclusions of showing no benefit from docetaxel as adjuvant treatment in this patient group after radical curative treatment. Clinical trial information: RT NTC006653848.

Effect of Adjuvant Trastuzumab for a Duration of 9 Weeks vs 1 Year With Concomitant Chemotherapy for Early Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: The SOLD Randomized Clinical Trial

Importance

Trastuzumab plus chemotherapy is the standard adjuvant treatment for patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer. While the standard duration of trastuzumab treatment is 12 months, the benefits and harms of trastuzumab continued beyond the chemotherapy are unclear.

Objective

To evaluate the efficacy and safety of adjuvant trastuzumab continued beyond chemotherapy in women treated with up-front chemotherapy containing a taxane and trastuzumab.

Design, Setting, and Participants

Open-label, randomized (1:1) clinical trial including women with HER2-positive breast cancer. Chemotherapy was identical in the 2 groups, consisting of 3 cycles of 3-weekly docetaxel (either 80 or 100 mg/m2) plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide. Thereafter, no trastuzumab was administered in the 9-week group, whereas controls received trastuzumab to complete 1 year of administration. Disease-free survival (DFS) was compared between the groups using a Cox model and the noninferiority approach. The estimated sample size was 2168 patients (1-sided testing, with a relative noninferiority margin of 1.3). From January 3, 2008, to December 16, 2014, 2176 patients were accrued from 7 countries.

Intervention

Docetaxel plus trastuzumab for 9 weeks, followed by 3 cycles of fluorouracil, epirubicin, and cyclophosphamide in both groups. Controls continued trastuzumab to 1 year.

Main Outcomes and Measures

The primary objective was DFS; secondary objectives included distant disease-free survival, overall survival, cardiac DFS, and safety.

Results

In the 2174 women analyzed, median age was 56 (interquartile range [IQR], 48-64) years. The median follow-up was 5.2 (IQR, 3.8-6.7) years. Noninferiority of the 9-week treatment could not be demonstrated for DFS (hazard ratio, 1.39; 2-sided 90% CI, 1.12-1.72). Distant disease-free survival and overall survival did not differ substantially between the groups. Thirty-six (3%) and 21 (2%) patients in the 1-year and the 9-week groups, respectively, had cardiac failure; the left ventricle ejection fraction was better maintained in the 9-week group. An interaction was detected between the docetaxel dose and DFS; patients in the 9-week group treated with 80 mg/m2 had inferior and those treated with 100 mg/m2 had similar DFS as patients in the 1-year group.

Conclusions and Relevance

Nine weeks of trastuzumab was not noninferior to 1 year of trastuzumab when given with similar chemotherapy. Cardiac safety was better in the 9-week group. The docetaxel dosing with trastuzumab requires further study.

Trial Registration

ClinicalTrials.gov Identifier: NCT00593697.

The effect of a probiotic blend on gastrointestinal symptoms in constipated patients: a double blind, randomised, placebo controlled 2-week trial

Selected strains of lactobacilli and bifidobacteria are known to ameliorate constipation-related symptoms and have previously shown efficacy on digestive health. In this clinical trial, the safety and effectiveness of a probiotic blend containing lactobacilli and bifidobacteria were evaluated in adults with self-reported bloating and functional constipation. Constipation was diagnosed by the Rome III criteria. A total of 156 adults were randomised into this double-blind and placebo-controlled trial. Participants consumed the combination of Lactobacillus acidophilus NCFM (10¹⁰ cfu), Lactobacillus paracasei Lpc-37 (2.5×10⁹ cfu), Bifidobacterium animalis subsp. lactis strains Bl-04 (2.5×10⁹ cfu), Bi-07 (2.5×10⁹ cfu) and HN019 (10¹⁰ cfu) (n=78), or placebo (microcrystalline cellulose) (n=78) for two weeks. After treatment the following were measured: primary outcome of bloating and secondary outcomes of colonic transit time, bowel movement frequency, stool consistency, other gastrointestinal symptoms (flatulence, abdominal pain, and burbling), constipation-related questionnaires (PAC-SYM and PAC-QoL) and product satisfaction. Faecal recovery of consumed strains was determined. The enrolled population was defined as constipated, however, the initial bloating severity was lower than in previous similar studies. No clinically significant observations related to the safety of the product were reported. Product efficacy was not shown in the primary analysis for bloating nor for the secondary efficacy analyses. The placebo functioned similarly as the probiotic product. In post-hoc analysis, a statistically significant decrease in flatulence in favour of the probiotic group was observed; day 7 (intention-to-treat (ITT): P=0.0313; per-protocol (PP): 0.0253) and on day 14 (ITT: P=0.0116; PP: P=0.0102) as measured by area under the curve (AUC) analysis. The mean AUC of all symptoms decreased in favour of the probiotic group, indicating less digestive discomfort. The study was registered at the ISRCTN registry (ISRCTN41607808).

Deterministic and statistical characterization of rigid frame porous materials from impedance tube measurements

A method to characterize macroscopically homogeneous rigid frame porous media from impedance tube measurements by deterministic and statistical inversion is presented. Equivalent density and bulk modulus of the samples are reconstructed with the scattering matrix formalism, and are then linked to its physical parameters via the Johnson-Champoux-Allard-Lafarge model. The model includes six parameters, namely the porosity, tortuosity, viscous and characteristic lengths, and static flow and thermal permeabilities. The parameters are estimated from the measurements in two ways. The first one is a deterministic procedure that finds the model parameters by minimizing a cost function in the least squares sense. The second approach is based on statistical inversion. It can be used to assess the validity of the least squares estimate, but also presents several advantages since it provides valuable information on the uncertainty and correlation between the parameters. Five porous samples with a range of pore properties are tested, and the pore parameter estimates given by the proposed inversion processes are compared to those given by other characterization methods. Joint parameter distributions are shown to demonstrate the correlations. Results show that the proposed methods find reliable parameter and uncertainty estimates to the six pore parameters quickly with minimal user input.

Irritable bowel syndrome symptom severity improves equally with probiotic and placebo

AIM

To determine the effects of Lactobacillus acidophilus NCFM on irritable bowel syndrome (IBS) symptoms and quality of life (QoL).

METHODS

In this randomized triple-blind trial, adult IBS volunteers who were recruited according to Rome III criteria received 10⁹ or 10¹⁰ colony-forming units of NCFM or placebo daily for 12 wk. IBS Symptom Severity Score (IBS-SSS), which constituted the primary outcome, and secondary outcomes, including individual IBS symptoms, IBS-related QoL questionnaire, anxiety and depression, defecation frequency, and stool consistency, were assessed at baseline at the end of the 8-wk run-in period, after 4 and 12 wk of intervention, and after a 4-wk washout.

RESULTS

A total of 340 of 391 randomized volunteers completed the trial. IBS-SSS improved over 12 wk of treatment in all treatment groups, decreasing by a mean ± SD of 44.0 ± 80.2, 50.8 ± 82.4, and 48.3 ± 72.2 in the placebo, active low-dose, and active high-dose groups, respectively. Similarly, secondary outcomes did not differ between treatment groups. However, in a post hoc analysis of volunteers with moderate to severe abdominal pain at baseline (VAS > 35/100), the treatment significantly reduced the sensation of abdominal pain. Pain scores fell by 20.8 ± 22.8, 29.4 ± 17.9, and 31.2 ± 21.9 in the placebo, active low-dose, and active high-dose groups, respectively (P value for placebo vs combined active doses = 0.0460).

CONCLUSION

NCFM alleviates moderate to severe abdominal pain, consistent with earlier observations of this strain mitigating visceral pain through increased analgesic receptor expression.

Fixed-dose combination of tafluprost and timolol in the treatment of open-angle glaucoma and ocular hypertension: comparison with other fixed-combination products

A new preservative-free fixed-dose combination of 0.0015% tafluprost, a prostaglandin F_2α analog, and 0.5% timolol (TAF/TIM; Santen Oy, Tampere, Finland), a beta-adrenergic antagonist has recently been developed. The intraocular pressure (IOP) reduction with TAF/TIM in open-angle glaucoma and ocular hypertension is similar to that of other prostaglandin–timolol fixed-combination products. Patients with high IOP responded well to TAF/TIM with reductions of up to 40% (>13 mmHg) and beyond. Compared to previous controlled and double-masked clinical trials with DuoTrav^® (Alcon, Fort Worth, USA) and Ganfort^® (Allergan, Irvine, USA), TAF/TIM caused less superficial ocular side effects and less conjunctival hyperemia. Plausible explanations for the differences in side effects between the fixed-combination products are discussed.

Childbearing, the desire to have children, and awareness about the impact of age on female fertility among Finnish university students

OBJECTIVE

To describe Finnish university students' childbearing histories, desires concerning childbearing, and awareness regarding the impact of age on female fertility.

METHODS

A national survey of Finnish university students in 2008. A questionnaire was sent to 9,967 Finnish undergraduate university students aged less than 35 years. Altogether, the questionnaire was answered by 1,864 men and 3,222 women. The overall response rate was 51% (42% for men and 59% for women). Students were asked about their number of children, desired childbearing, and awareness of the effect of age on female fertility.

RESULTS

Of the respondents, 8.25% had children, and 94.0% wanted to have children in the future. Female students were more aware of the impact of age on female fertility than were male students. Over half of the men and approximately one-third of the women thought that the marked decrease in female fertility begins after the age of 45 years.

CONCLUSIONS

A vast majority of Finnish university students wanted to have children in the future. Their awareness of the natural, age-related decline in female fertility was insufficient. Sexual health education in schools and health care personnel's family planning counselling, for both men and women, should include information about the age-related drop in fertility.

Violence victimization among Finnish university students: prevalence, symptoms and healthcare usage

The present study examined the prevalence of various forms of violence victimization among university students in Finland. Violence victimization was analyzed in relation to physical and mental health symptoms, and the use of student healthcare services. A cross-sectional Student Health Survey was performed as a national postal survey for Finnish university students in 2004. In the next phase of the study, an additional postal survey regarding violence victimization was sent to those who had answered the original survey, which resulted in a sample of 905 students. It was found that violence victimization and violence-related health issues were markedly prevalent among Finnish university students. The students reported multiple forms of violence and injury demonstrating the diversity of violence victimization. Male and female victims differed both in the amount and type of symptoms, and in their relationship to the abuser/offender. Violence victimization and gender had a significant main effect on specific symptoms, while no interaction effect was found. The data also showed that violence victimization is overrepresented among frequent healthcare users. These findings have implications for clinical practice and public policy. The present findings provide useful information for policy makers and healthcare professionals concerning the health effects of violence in accordance with the use of healthcare services. More specifically, this information should be taken into consideration when planning student healthcare and could serve as a guideline for student healthcare management.

Users and non-users of web-based health advice service among Finnish university students - chronic conditions and self-reported health status (a cross-sectional study)

Background

The Internet is increasingly used by citizens as source of health information. Young, highly educated adults use the Internet frequently to search for health-related information. Our study explores whether reported chronic conditions or self-reported health status differed among Finnish university students using the Finnish Student Health Services web-based health advice service compared with those not using the service.

Methods

Cross-sectional study performed by a national postal survey in 2004. Material: A random sample (n = 5 030) of a population of 101 805 undergraduate Finnish university students aged 19–35. The response rate: 63% (n = 3 153). Main outcome measures: Proportion of university students reporting use a of web-based health advice service, diagnosed chronic conditions, and self-reported health status of users and non-users of a web-based health advice service. Statistical methods: Data were presented with frequency distributions and cross-tabulations and the χ² test was used.

Results

12% (n = 370) of Finnish undergraduate students had used the web-based health advice service and were identified as 'users'. The proportion of male students reporting allergic rhinitis or conjunctivitis was greater among users than non-users (24%, n = 22 vs. 15%, n = 154, χ², P = .03). The proportion of female students reporting chronic mental health problems was greater among users than non-users (12%, n = 34 vs. 8%, n = 140, χ², P = .03). There was no statistical significance between the group differences of male or female users and non-users in self-reported health status (good or fairly good, average, rather poor or poor).

Conclusion

Among young, highly educated adults the use of a web-based health advice service is not associated with self-reported health status. However, a web-based health advice service could offer support for managing several specific chronic conditions. More research data is needed to evaluate the role of web-based health advice services that supplement traditional forms of health services.

Risk of serious upper gastrointestinal events with concurrent use of NSAIDs and SSRIs: a case-control study in the general population

OBJECTIVES

To study the risk of serious upper gastrointestinal (GI) events associated with the concurrent use of selective serotonin re-uptake inhibitors (SSRIs) and different types of non-steroidal anti-inflammatory drugs (NSAIDs).

METHODS

This was a nationwide, register-based matched case-control study on non-institutionalized residents of Finland during the period 2000-2004. Patient-cases with serious upper GI events (n=9191) were drawn from the Hospital Discharge Register, and individually matched controls (n=41,780) were drawn from the Population Register. Logistic regression was applied in the data analysis, and adjustments were made for various co-morbidities and the use of other drugs associated with the risk of serious upper GI event.

RESULTS

The adjusted odds ratio (AOR) of serious upper GI events for SSRI use compared to non-use of SSRIs or NSAIDs was 1.30 [95% confidence interval (95%CI: 1.13-1.50)], and the AOR for concurrent SSRI and NSAID use compared to the non-use of either drug was 4.19 (95%CI: 3.30-5.31). The AOR of upper GI events for the concurrent use of SSRIs with NSAIDs compared to patients using NSAIDs only was 1.57 (95%CI: 1.24-1.99). The respective AOR for traditional, non-selective NSAIDs was 1.77 (95%CI: 1.31-2.38), for semi-selective NSAIDs (nimesulide, nabumetone, meloxicam, and etodolac) 1.30 (95%CI: 0.76-2.24) and for COX-2 selective NSAIDs 1.33 (95%CI: 0.70-2.50).

CONCLUSIONS

The concurrent use of SSRIs and NSAIDs is associated with a moderate excess relative risk of a serious upper GI event when compared with NSAID use alone.

Childbearing and the desire to have children among university students in Finland

BACKGROUND

The fertility rate in Europe is low and there is concern over the low birth rate in relation to the aging population. The age of childbearing women has increased and infertility is a growing problem. Highly educated women in Finland suffer from childlessness more often than less educated women. The aim of this study was to establish Finnish university students' actual and desired number of children, and compare the economic and educational situations of students with and without children.

METHODS

The study population consisted of Finnish undergraduate students under 35 years of age. The randomly selected sample was 5,030 subjects. The data were collected by postal questionnaire, the response rate being 62.7%. Frequency distributions, cross-tabulations, and descriptive statistics were used. Categorical variables were tested by the Cochran-Mantel-Haenzel test.

RESULTS

7.5% of students had children. Almost 90% desired to have children. Parenthood did not correlate negatively with satisfaction with financial situation or completed studies.

CONCLUSION

University students are seldom parents, though they are at the ideal age for childbearing and the majority desire to have children. The risk of unintended childlessness exists, when pregnancies are postponed because of unfinished studies.

Obstetric risk factors for early-onset schizophrenia in a Finnish birth cohort

OBJECTIVE

Although case-control investigations have shown an association between obstetric complications and schizophrenia, particularly among patients with early onsets, cohort studies have mostly failed to confirm this effect. The authors examined whether a history of fetal hypoxia and other obstetric complications elevated risk for early-onset schizophrenia in a 1955 Helsinki birth cohort.

METHOD

The subjects were 80 randomly selected patients with schizophrenia (36 with early and 44 with later onsets) representative of all available probands in the cohort, 61 of their nonschizophrenic siblings, and 56 demographically matched nonpsychiatric comparison subjects. Psychiatric diagnoses were obtained from structured clinical interviews, and obstetric data were taken from standardized, prospectively ascertained obstetric records. A score for hypoxia-associated obstetric complications was entered into logistic regression models, along with measures of prenatal infection and fetal growth retardation.

RESULTS

Hypoxia-associated obstetric complications significantly increased the odds of early-onset schizophrenia but not of later-onset schizophrenia or unaffected sibling status, after prenatal infection and fetal growth retardation were taken into account.

CONCLUSIONS

These findings support an association between obstetric complications and increased risk for early-onset schizophrenia. The authors advance a model whereby the neurotoxic effects of fetal hypoxia may lead to an early onset of schizophrenia due to premature cortical synaptic pruning.

School performance in Finnish children and later development of schizophrenia: a population-based longitudinal study

BACKGROUND

We examined whether children who are diagnosed as having schizophrenia in adulthood could be distinguished from their peers on performance in elementary school.

METHODS

We used a case-control study design nested within a population-based birth cohort of all individuals born in Helsinki, Finland, between January 1, 1951, and December 31, 1960. Case ascertainment was from 3 national health care registers. Elementary school records were obtained for 400 children who were diagnosed as having schizophrenia in adulthood and for 408 controls. Results were analyzed for the 4 years of schooling (ages 7-11 years) that were common to all pupils. School subjects were entered into a principal components analysis and produced 3 factors: academic, nonacademic, and behavioral. These factors were compared between cases and controls after adjusting for sex and social group. Eligibility for high school and progression to high school were investigated among cases and controls.

RESULTS

Cases performed significantly worse than controls only on the nonacademic factor (which loaded sports and handicrafts). There were no differences between the groups on the academic or behavioral factors, and there were no significant clinical correlates of factor scores. Cases were significantly less likely than controls to progress to high school, despite similar eligibility.

CONCLUSIONS

Poor performance in sports and handicrafts during elementary school, which may indicate a motor coordination deficit, appears to be a risk factor for later schizophrenia. Poor academic performance in elementary school was not a risk factor for schizophrenia in this study. Lack of expected progression to high school among cases, despite good academic grades, provides evidence for deteriorating premorbid functional adjustment in schizophrenia.

Quantitation of the relationship between tester cell number inoculated and SOS-inducing potency of 4-nitroquinoline-1-oxide (4-NQO) in an automated version of the SOS chromotest

The SOS chromotest is a simple quantitative short-term bacterial assay for the detection of genotoxic activity of pure compounds or complex samples. On the basis of consecutive experiments aimed at demonstrating the relationship between the inoculum size and the outcome of the test using 4-nitroquinoline-1-oxide (4-NQO) as model genotoxin. It is shown that within the suitable range of the cell number there is a negative correlation between the number of tester cells and test sensitivity. Moreover, it could be demonstrated that the peak of the dose response curve, i.e., the maximal induction factor, is systematically influenced by the actual value of the ratio of beta-galactosidase to alkaline phosphatase enzyme activities at a 4-NQO concentration of zero. Last but not least, some simple statistical data describing the performance of the automated version of the SOS chromotest are also given.

Some aspects of murine experimental listeriosis

A set of experiments was carried out in order to approach the complex nature of L. monocytogenes infections from different aspects. Experiment 1 showed that Listeria are able to gain admission to body by numerous ways and both subcutaneous and oral entry can lead to fatal septicemia. It also gave slight support to the theory of direct neural transmission of Listeria to the brain and indicated the possibility that intestinal absorption after oral exposition at least partly occurs via lymphatic vessels. No inflammatory reaction could be caused to mice by ocular flushing with Listeria suspension.

The second trial proved that there are vast differences in the animal pathogenecity of Listeria strains — even among those of the same serotype. In experiment 3A the abolishing effect of dextran sulfate on the early resistance of mice to Listeria was confirmed and it turned out that cortisone at a therapeutic dose level did not bring about that phenomenon. Levamisole granted no conspicuous enhancement of resistance in this acute challenge; however, the results of the immunity test (3B) suggested that levamisole may be beneficial during the induction phase. On the other hand, starvation appeared to impair long-term immunity. Likewise, in experiment 4 starved mice were quite susceptible to acute challenge with Listeria. Raised ambient temperature, on the contrary, prominently increased the survival rate of the animals.

Owing to the fairly small number of animals these results should be regarded as preliminary starting points to further studies.

A microassay of O2 concentrations based on oxygen-induced chemiluminescence in anaerobic lipoxygenase reactions

The preparation of chemiluminescence probes for assaying O2 concentrations in microsamples is described. This probe is based on an anaerobic lipoxygenase-linoleate system continuously generating reactive intermediates which in a spontaneous reaction with added O2 yield an excited species. The resulting chemiluminescence signals are highly reproducible upon repeated sample application and unaffected by even large variations in the contents of lipoxygenase-1 and linoleic acid. The linear assay range is between 0.25 and 25 nmol of O2. The assay system described is stable for 90 +/- 10 min, irrespective of the number of samples added, and the probe can be regenerated thereafter by adding linoleic acid.