Relationships of emerging biomarkers of cancer cachexia with quality of life, appetite, and cachexia

PURPOSE

Quality of life (QoL), appetite, cachexia, and biomarkers [albumin, hemoglobin (Hb), neutrophils, lymphocytes, platelets, C-reactive protein (CRP), tumor necrosis factor alpha (TNFα), interleukin 6 (IL-6), interleukin 8 (IL-8), C-X-C motif chemokine ligand 5 (CXCL5) and citrullinated histoneH3 (H3Cit)] were compared for 40 cases with advanced cancer and 40 healthy controls. Baseline differences and significant relationships were explored for biomarkers with QoL, appetite, and cachexia.

METHODS

In a prospective case-control, age and sex matched study, the European Organisation for the Research and Treatment of Cancer Quality of Life-C30 questionnaire (EORTC-QLQ-C30) for QoL, the Functional Assessment of Anorexia and Cachexia Therapy assessment (FAACT A/CS-12) for appetite, and a five-factor cachexia assessment tool for cachexia assessment were performed. Routine hematological measurements and blood chemistry analyses together with ELISA procedures and a Multiplex® bead array platform, were used for biomarker analysis. Descriptive statistics and regression analyses were undertaken. P < 0.05 defined statistical significance.

RESULTS

Global health status (QL-G), functional scales (QL-FS), and symptom scales (QL-SS) differed for cases and controls (p < 0.01). In cases, differences were observed for QL-G (p < 0.01), QL-FS (p < 0.01), and QL-SS (p = 0.01) compared to standardized references values. FAACT A/CS-12 scores differed significantly between cases and controls (p < 0.01) and 30% of cases scored "poor" appetites. Cachexia was present in 60% of cases. Albumin, lymphocytes, platelets, Hb, platelet to lymphocyte ratio (PLR), systemic immune-inflammation index (SII), CRP, TNFα, all at p < 0.01, neutrophil to lymphocyte ratio (NLR) (p = 0.02), IL-6 (p < 0.04), and IL-8 (p = 0.02) differed significantly between cases and controls. No difference was found for CXCL5 or H3Cit. Albumin NLR, Hb, PLR, SII, TNFα, IL-8, and CRP showed significant relationships with all aspects of QoL. QL-FS was significantly related to CXCL5 (p = 0.04), significant relationships with FAACT A/CS-12 included: NLR (p = 0.002), Hb (p < 0.001), and PLR (p < 0.01). NLR, PLR, SII, TNFα, IL-6, IL-8, and CRP correlated positively to cachexia and albumin while Hb and lymphocyte count correlated negatively to cachexia.

CONCLUSION

CXCL5 and H3Cit were not reliable biomarkers for cancer cachexia, nor significantly related to QoL, appetite or cachexia. Albumin, NLR, Hb, PLR, SII, TNFα, IL-8, and CRP were reliable indicators of QoL, appetite, and cachexia. Future research should include other novel biomarkers namely growth differentiation factor-15 (GDF-15), fibroblast growth factor 21 (FGF-21), fractakline, interferon gamma (IFN-y), IL-16, macrophage colony stimulating factor (M-CSF), and macrophage procoagulant-inducing factor (MPIF).

Pain Intensity, Pain-Related Anxiety, and Hazardous Drinking Among Individuals With PTSD

OBJECTIVE

Evidence suggests that pain intensity may be indirectly linked to hazardous drinking and PTSD symptom severity via pain-related anxiety. The goal of this analysis was to test the hypotheses in a population with PTSD symptoms that pain intensity would be positively and indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via pain-related anxiety.

METHODS

Heavy drinkers with probable PTSD were recruited via Qualtrics panels (N = 371, 53% Female, Mage = 39.68, SD = 10.86). Linear regression and conditional process models were conducted to examine indirect associations between pain intensity and primary outcomes via pain-related anxiety.

RESULTS

Pain intensity was found to be indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via greater pain-related anxiety.

CONCLUSION

These initial findings suggest that pain-related anxiety may play an important role in relations between the experience of pain and hazardous patterns of alcohol consumption among individuals with probable PTSD. Future research is needed to determine the temporal nature of these associations and to examine the potential utility of treatments that address pain-related anxiety in the context of comorbid pain, PTSD, and hazardous drinking.

2023 MASCC and ESMO guideline update for the prevention of chemotherapy- and radiotherapy-induced nausea and vomiting

•Nausea and vomiting are considered amongst the most troublesome adverse events for patients receiving antineoplastics. •The guideline covers emetic risk classification, prevention and management of treatment-induced nausea and vomiting. •The Consensus Committee consisted of 34 multidisciplinary, health care professionals and three patient advocates. •Recommendations are based on evidence-based data (level of evidence) and the authors’ collective expert opinion (grade). •All recommendations are for the first course of antineoplastic therapy; modifications may be needed in subsequent courses.

Creation of a decellularized vaginal matrix from healthy human vaginal tissue for potential vagina reconstruction: experimental studies

BACKGROUND

When a disorder causes the absence of a healthy, full-size vagina, various neovaginal creation methods are available. Sometimes dilation or stretching of the vaginal cavity is sufficient, but intestinal or dermal flap tissue is generally required. However, different inherent tissue properties cause complications. Therefore, a lost body part should be replaced with a similar material. The use of organ-specific acellular vaginal tissue carries great potential, as its similar architecture and matrix composition make it suitable for vaginal regeneration.

METHODS

The authors developed an optimized protocol for decellularization of healthy human vaginal tissue. Resected colpectomy tissue from 12 healthy transgender patients was used. Successful decellularization was confirmed by applying acellular criteria from in-vivo remodeling reports. Suitability as a tissue-mimicking scaffold for vaginal reconstruction was determined by visible structural features, biocompatibility during stretching, and the presence of visible collagen, elastin, laminin, and fibronectin.

RESULTS

Histological examination confirmed the preservation of structural features, and minimal cellular residue was seen during fluorescence microscopy, DNA and RNA quantification, and fragment length examination. Biomechanical testing showed decreased peak load (55%, P <0.05), strain at rupture (23%, P <0.01), and ultimate tensile stress (55%, P <0.05) after decellularization, while the elastic modulus (68%) did not decrease significantly. Fluorescence microscopy revealed preserved Fibronectin-I/II/III and Laminin-I/II, while Collagen-I and Ficolin-2B were decreased but mostly retained.

CONCLUSIONS

The absence of cellular residue, moderately altered biomechanical extracellular matrix properties, and mostly preserved structural proteins appear to make our decellularized human vaginal matrix a suitable tissue-mimicking scaffold for vagina transplantation when tissue survival through vascularization and innervation are accomplished in the future.

Emerging markers of cancer cachexia and their relationship to sarcopenia

PURPOSE

Emerging biomarkers of cancer cachexia and their roles in sarcopenia and prognosis are poorly understood. Baseline assessments of anthropometrics, sarcopenia, cachexia status and biomarkers of cachexia were measured in patients with advanced cancer and healthy controls. Thereafter, relationships of the biomarkers with cachexia and sarcopenia were explored.

METHODS

A prospective case-control design was used, including 40 patients with advanced cancer and 40 gender, age-matched controls. Bioelectrical impedance [skeletal muscle index (SMI)] and hand dynamometry [hand grip strength (HGS)] assessed sarcopenia and a validated tool classified cancer cachexia. Albumin, lymphocyte and platelet counts, haemoglobin, C-reactive protein (CRP), pro-inflammatory cytokines/chemokines and citrullinated histone H3 (H3Cit) were measured.

RESULTS

Patients had significantly lower SMI (6.67 kg/m2 versus 7.67 kg/m2, p =  < 0.01) and HGS (24.42 kg versus 29.62 kg) compared to controls, with 43% being sarcopenic. Significant differences were found for albumin, lymphocyte and platelet counts, haemoglobin, CRP, and tumour necrosis factor α (TNFα), (p < 0.01). Interleukin (IL)-6 (p < 0.04), IL-8 (p = 0.02), neutrophil/lymphocyte ratio (NLR), p = 0.02, platelet/lymphocyte (PLR) ratio, p < 0.01 and systemic immune inflammatory index (SII), p < 0.01 differed significantly. No difference was observed for CXC motif chemokine ligand 5 [CXCL5 or epithelial neutrophil-activating peptide 78 (ENA78)] or H3Cit. Albumin and haemoglobin correlated negatively with total protein, skeletal muscle mass and SMI (all p < 0.01). The presence of sarcopenia associated significantly with albumin, haemoglobin and CRP.

CONCLUSION

Significant relationships and differences of haemoglobin, CRP and albumin supports future use of these biomarkers in cancer cachexia. CXCL5 and H3Cit as valuable biomarkers in cancer cachexia remains to be defined.

Findings from home-based HIV testing and facilitated linkage after scale-up of test and treat in rural South Africa: young people still missing

OBJECTIVES

The aim of the study was to estimate rates of linkage to HIV care and antiretroviral treatment (ART) initiation after the introduction of home-based HIV counselling and testing (HBHCT) and telephone-facilitated support for linkage in rural South Africa.

METHODS

A population-based prospective cohort study was carried out in KwaZulu Natal, South Africa. All residents aged ≥ 15 years were eligible for HBHCT. Those who tested positive and were not in care were referred for ART at one of 11 public-sector clinics. Individuals who did not attend the clinic within 2 weeks were sent a short message service (SMS) reminder; those who had not attended after a further 2 weeks were telephoned by a nurse counsellor, to discuss concerns and encourage linkage. Kaplan-Meier methods were used to estimate the proportion of newly diagnosed individuals linking to care and initiating ART.

RESULTS

Among 38 827 individuals visited, 26% accepted HBHCT. Uptake was higher in women than in men (30% versus 20%, respectively), but similar in people aged < 30 years and ≥ 30 years (28% versus 26%, respectively). A total of 784 (8%) tested HIV positive, of whom 427 (54%) were newly diagnosed. Within 6 months, 31% of women and 18% of men < 30 years old had linked to care, and 29% and 16%, respectively, had started ART. Among those ≥ 30 years, 41% of women and 38% of men had linked to care within 6 months, and 41% and 35%, respectively, had started ART.

CONCLUSIONS

Despite facilitated linkage, rates of timely linkage to care and ART initiation after HBHCT were very low, particularly among young men. Innovations are needed to provide effective HIV care and prevention interventions to young people, and thus maximize the benefits of universal test and treat.

Abstract P1-15-25: Prognostic factors associated with pathological complete response in early breast cancer patients undergoing neoadjuvant chemotherapy. The importance of Ki-67 and molecular subtype

Background: Ki-67 immunohistochemical determination is a widely used biomarker of cell proliferation in patients (pts) undergoing endocrine treatment for breast BC. The role of Ki-67 in pts undergoing neoadjuvant chemotherapy (NAC) for early BC remains controversial.

Methods: We analyzed retrospectively data on 137 patients undergoing taxane and/or anthracycline, transtuzumab based NAC. Luminal A was documented in 6 pts, Luminal B in 29 pts, Her-2 positive in 30 pts and triple negative breast cancers (TNBC) in 72 pts. Pathological complete response (pCR) was defined as the complete disappearance of the invasive cancer in the breast and absence of tumor in the axillary lymph nodes examined by axillary clearance.

Results: The pCR rate of the entire cohort was 41.6%. At 2 years 92% of pts who attained a pCR were disease free compared to 80% of pts who did not attain a pCR (log rank test p &lt; 0.0147).

On univariate analysis factors associated with higher pCR included primary tumor size (T1 68% vs. T2 41% vs. T3 or T4 0%, Chi2=20.05, p&lt;0.00017), nodal disease (N0 49% vs. N1 39% vs. N2 8%, p&lt;0.02948), ER receptor status (negative 59% vs. positive 14%, p&lt;0.00000), PR receptor status (negative 53% vs. positive 17%, p&lt;0.00002), molecular subtype (TNBC 53.4%, Her2=50% and Luminal A + B was 8.5%, p&lt;0.00002), Ki67 (&gt;40=55% vs. 15-39=34% vs. &lt;15=0%, p&lt;0.00060) and Stage (I= 85% vs. IIA=49% vs. IIB=36% vs. III=5%, p&lt;0.00006). Factors not associated with a higher pCR included age, menopausal status, extranodal spread and lympho-vascular invasion. In a logistic regression model Ki-67 as a continuous variable (p&lt;0.01203) and molecular subtype (p&lt;0.02228) retained its significance; while tumor size, stage of disease, nodal status, ER and PR loss significance.

Conclusion: Ki67 and molecular subtype (Her-2 positive disease and TNBC) are independent prognostic factors of pCR in pts with early BC undergoing NAC.

Citation Format: Rapoport BL, Barnard-Tide J, Smit T, Nayler S, Benn C-A. Prognostic factors associated with pathological complete response in early breast cancer patients undergoing neoadjuvant chemotherapy. The importance of Ki-67 and molecular subtype [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 P1-15-25.

Integrated safety analysis of rolapitant with coadministered drugs from phase II/III trials: an assessment of CYP2D6 or BCRP inhibition by rolapitant

BACKGROUND

Rolapitant, a long-acting neurokinin (NK)1 receptor antagonist (RA), has demonstrated efficacy in prevention of chemotherapy-induced nausea and vomiting in patients administered moderately or highly emetogenic chemotherapy. Unlike other NK1 RAs, rolapitant does not inhibit or induce cytochrome P450 (CYP) 3A4, but it does inhibit CYP2D6 and breast cancer resistance protein (BCRP). To analyze potential drug-drug interactions between rolapitant and concomitant medications, this integrated safety analysis of four double-blind, randomized phase II or III studies of rolapitant examined adverse events (AEs) by use versus non-use of drug substrates of CYP2D6 or BCRP.

PATIENTS AND METHODS

Patients were randomized to receive either 180 mg oral rolapitant or placebo ∼1-2 h before chemotherapy in combination with a 5-hydroxytryptamine type 3 RA and dexamethasone. Data for treatment-emergent AEs (TEAEs) and treatment-emergent serious AEs (TESAEs) during cycle 1 were pooled across the four studies and summarized in the overall population and by concomitant use/non-use of CYP2D6 or BCRP substrate drugs.

RESULTS

In the integrated safety population, 828 of 1294 patients (64%) in the rolapitant group and 840 of 1301 patients (65%) in the control group experienced at least one TEAE. Frequencies of common TEAEs were similar in the rolapitant and control populations. Overall, 53% of patients received CYP2D6 substrate drugs, none of which had a narrow therapeutic index (like thioridazine or pimozide), and 63% received BCRP substrate drugs. When grouped by concomitant use versus non-use of CYP2D6 or BCRP substrate drugs, TEAEs and TESAEs occurred with similar frequency in the rolapitant and control populations.

CONCLUSIONS

The results of this study support the safety of rolapitant as part of an antiemetic triple-drug regimen in patients receiving emetogenic chemotherapy, including those administered concomitant medications that are substrates of CYP2D6 or BCRP, such as ondansetron, docetaxel, or irinotecan.

Posterior lumbar interbody fusion using non resorbable poly-ether-ether-ketone versus resorbable poly-L-lactide-co-D,L-lactide fusion devices. Clinical outcome at a minimum of 2-year follow-up

Previous papers on resorbable poly-L-lactide-co-D,L-lactide (PLDLLA) cages in spinal fusion have failed to report adequately on patient-centred clinical outcome measures. Also comparison of PLDLLA cage with a traditionally applicable counterpart has not been previously reported. This is the first randomized prospective study that assesses clinical outcome of PLDLLA cage compared with a poly-ether-ether-ketone (PEEK) implant. Twenty-six patients were randomly assigned to undergo instrumented posterior lumbar interbody fusion (PLIF) whereby either a PEEK cage or a PLDLLA cage was implanted. Clinical outcome based on visual analogue scale scores for leg pain and back pain, as well as Oswestry Disability Index (ODI) and SF-36 questionnaires were documented and analysed. When compared with preoperative values, all clinical parameters have significantly improved in the PEEK group at 2 years after surgery with the exception of SF-36 general health, SF-36 mental health and SF-36 role emotional scores. No clinical parameter showed significant improvement at 2 years after surgery compared with preoperative values in the PLDLLA patient group. Only six patients (50%) in the PLDLLA group showed improvement in the VAS scores for leg and back pain as well as the ODI, as opposed to 10 patients (71%) in the PEEK group. One-third of the patients in the PLDLLA group actually reported worsening of their pain scores and ODI. Three cases of mild to moderate osteolysis were seen in the PLDLLA group. Following up on our preliminary report, these 2-year results confirm the superiority of the PEEK implant to the resorbable PLDLLA implant in aiding spinal fusion and alleviating symptoms following PLIF in patients with degenerative spondylolisthesis associated with either canal stenosis or foramen stenosis or both and emanating from a single lumbar segment.

Evaluation of cisplatin and a novel platinum polymer conjugate for drug toxicity and drug distribution in mice

The toxicity and distribution of cisplatin and two novel platinum (Pt) polymer conjugates (Pt-6 and Pt-7) were determined in serum and tissue of BALB/c mice at specific time points after i.p. administration of a drug bolus containing identical Pt concentrations. Pt concentrations were determined in serum, liver and kidney at 5 and 15 min, respectively, after drug administration by inductively coupled plasma mass spectrometry. It was found that the Pt polymer Pt-7 gave rise to a considerably lower Pt concentration in serum and considerably higher concentration in liver and kidney than cisplatin. LD25 measurements indicated that the Pt-7 polymer is considerably less toxic than cisplatin. In vitro experiments and determination of IC50 values in a variety of human tumor cell lines, normal lymphocytes and fibroblasts confirmed that Pt-6 and Pt-7 polymers are 40-500 times more toxic for tumor cells than for normal cells, perhaps reflecting preferential uptake. The toxicity of cisplatin was found to be only 1.6-40 times more effective in tumor cells. These inter-relationships are supported by the observation that the tumor enrichment factor (TEF) for cisplatin is only in the region of 6, and much lower than for Pt-6 and Pt-7, where TEFs are in the region of 40 and 150, respectively. These results demonstrate that the Pt polymer conjugates exhibit greater tumor specificity than cisplatin, killing tumor cells more effectively while being considerably less toxic for normal cells. It is concluded that the Pt polymer conjugates may be superior for cancer therapy and warrant further testing to assess their full clinical potential.

The use of vaccination in the control of bluetongue in southern Africa

The eradication of bluetongue virus (BTV) from endemic regions of Africa is virtually impossible due to the role played by widely distributed Culicoides spp. midge vectors and the ubiquitous distribution of vertebrate reservoir species. In endemic areas, attempts can only be made to limit the occurrence of bluetongue (BT) disease and its economic impact through vaccination. Despite several potential problems (teratogenicity, risk of reassortment, and reversion to virulence of the attenuated viral strains), the current live-attenuated vaccine, produced by Onderstepoort Biological Products (OBP), South Africa, has been used for decades in enzootic regions, and has been shown to provide a safe and efficacious means to control the disease in regions of southern Africa, as well as other areas of the world.

Vaccination in the control of bluetongue in endemic regions: the South African experience

The eradication of bluetongue virus (BTV) from endemic regions of Africa is virtually impossible due to the role played by the widely distributed Culicoides spp. of midge vectors and the ubiquitous distribution of reservoir species. In endemic areas attempts can only be made to limit the occurrence of bluetongue (BT) disease and its economic impact through vaccination. Despite several potential problems (teratogenicity, risk of reassortment and reversion to virulence of the attenuated viral strains), epidemiological and recent molecular data support the fact that the live attenuated vaccine that has been used for decades in enzootic regions, provides a safe and efficacious means to control the disease in regions of southern Africa, as well as other areas of the world.

Physiotherapists` knowledge of the transmission and prevention of communicable diseases

With the world-wide increase of communicable diseases, adequate knowledge by health professionals of the transmission and prevention of these diseases is essential to ensure effective protection.  The aim of this study was to determine whether practising physiotherapists’ knowledge of the transmission and prevention of tuberculosis, hepatitis A, hepatitis B, hepatitis C and HIV/AIDS was adequate to ensure effective protection.A descriptive study was conducted.  One hundred and forty six practising physiotherapists in the Free State received questionnaires on which they had to indicate the relevant transmission and preventative measures for each disease. One hundred and three (70.5%) questionnaires were returned.  Points were allocated for the knowledge of transmission and preventative measures.  The medians with respect to transmission were: tuberculosis 83%, hepatitis A 58%, hepatitis B 67%, hepatitis C 75% and HIV/AIDS 92%.  The medians with respect to preventative measures were: tuberculosis 57%, hepatitis A 58%, hepatitis B 77%, hepatitis C 67% and HIV/AIDS 71%.  The knowledge of transmission was better than the knowledge of preventative measures.  An increase in the knowledge of practising physiotherapists in the Free State is needed to ensure their maximal protection against communicable diseases.

Allelic frequencies of host genetic variants influencing susceptibility to HIV-1 infection and disease in South African populations

OBJECTIVES

Limited information is available on the prevalence in African populations of host genetic polymorphisms conferring resistance to HIV-1 infection and disease. The objective of this study was to determine the allelic frequencies in South African populations of the chemokine receptor gene variants CCR5delta32, CCR5m303 and CCR2b-641 and the CXCR4 ligand gene variant SDF1-3'A.

METHOD

Cross-sectional study to determine the prevalence of these gene variants in South African subjects of African and European descent.

RESULTS

The CCR5delta32 genetic variant is rare in individuals of African origin, having an allelic frequency of 0.1% (n = 1247) compared with 9.8% (n = 144) in Caucasians. The CCR5m303 mutation was not detected in Africans (n = 687), whereas an allelic frequency of 0.9% (n = 145) was identified in Caucasians. The frequency of CCR2b-641 allele was 13.1% (n = 180) in Africans, which was significantly higher that the 7.2% (n = 146) detected in Caucasians. Finally the allelic frequency of the SDF1-3'A gene variant was only 1.0% (n = 198) in Africans compared with 19.8% (n = 145) in Caucasians.

CONCLUSIONS

These results indicate that genetic polymorphisms conferring resistance to HIV-1 infection are rare in the South African Black population. Except for the CCR2b-641 gene variant, individuals of African origin also had a much lower prevalence of genetic variants associated with prolonged disease progression.

Transmission electron microscopy on simian immunodeficiency virus-infected cocultures of vervet monkeys

Healthy African green monkeys are the natural reservoirs for certain HIV-related SIVs. More research is now focused on these nonhuman primates that are asymptomatic, so as to answer questions of origins, pathogenesis and therapy with respect to HIV in man. The present study involves the isolation and subsequent co-cultivation of SIV variants from two healthy vervet monkeys (Cercopithecus aethiops pygerythrus). Western Blots (New LAV Blot 1 and New LAV Blot 2, Pasteur) revealed sero cross-reactivity of each monkey to major HIV-1 and HIV-2 antigens. Freshly isolated peripheral blood mononuclear cells of each monkey were co-cultivated with the CEMss and M4C8 T-cell lines. The cocultures were incubated in CO2 at 37 degrees C for 3-4 days, before refeeding with RPMI 1640, phytohaaemagglutinin and interleukin-2. Cytopathic effects in the cocultures were observed 14 days post-infection, with syncytia and enlarged, granular cells being predominant in both of the cell-lines used. The presence and morphology of viral-like particles were observed by transmission electron microscopy. Immunocytochemistry and in situ hybridization may help in characterization of the particles, as well as aid in determining localization and concentration in vitro.

Clinical presentation of Graves' ophthalmopathy

The eye findings of Graves' ophthalmopathy were prospectively recorded in 90 consecutive untreated patients (66 females, 24 males; mean age 44.5 years) according to the 1977 NOSPECS classification. Soft-tissue involvement was observed in 90%, proptosis greater than or equal to 23 mm in 30%, eye muscle involvement in 60%, corneal involvement in 9% and sight loss in 34%. No differences in the distribution of eye changes between right and left eye were found. Values for proptosis (mean +/- SD, 20.2 +/- 3.6 mm) had a near-normal distribution. Orbital computed tomography (CT) scanning (performed in 80 cases) demonstrated enlargement of inferior rectus in 60%, medial rectus in 50%, superior rectus in 40% and lateral rectus in 22%. Unilateral eye disease was present in 13 patients (14%); in 4 of these patients the CT scan showed eye muscle enlargement also in the fellow eye and in 2 patients bilateral eye disease subsequently developed. The distribution of age, sex and NOSPECS classes in patients with unilateral eye disease was similar to that in patients with bilateral eye disease, but the interval between the onset of thyroid and eye disease was much shorter in cases of unilateral than in cases of bilateral eye disease. Patients without clinically evident thyroid disease (n = 20, 22%) were not different from patients with thyroid disease in age, sex or ophthalmological presentation. The various data suggest: (1) the 1977 NOSPECS classification under-represents significant proptosis in 12% of cases; (2) the age and sex distribution of patients with Graves' ophthalmopathy is similar to that of cases with thyroidal Graves' disease, and (3) unilateral Graves' ophthalmopathy may represent an early stage of the disease, that as a rule already is or develops shortly afterwards into a bilateral disease.

Temporal relationship between onset of Graves' ophthalmopathy and onset of thyroidal Graves' disease

The temporal relationship between the onset of Graves' ophthalmopathy and the onset of thyroidal Graves' disease was evaluated in 125 consecutive patients with Graves' ophthalmopathy. Thyroidal Graves' disease--past or present--was clinically evident in 99 patients (79%): hyperthyroidism in 3 cases. Thyroid disease preceded the eye disease in 37 patients, it occurred simultaneously with the eye disease in 39 patients, and it developed after the eye disease in 23 patients (in 16 cases within one yr after the onset of eye disease). The age at the onset of thyroid disease (38.7 +/- 12.9 yr) was lower than the age at the onset of ophthalmopathy (41.8 +/- 12.5 yr; p less than 0.001). Among the 26 clinically euthyroid patients (21%) laboratory evidence of thyroidal Graves' disease was found in 14 cases (11%): abnormal TRH test, n = 9; normal TRH test but abnormal T3-suppression test, n = 4; normal TRH and T3-suppression tests but positive thyroid stimulating antibodies, n = 1). We conclude that Graves' ophthalmopathy as a rule develops at a time when thyroid autoimmunity also exists. This strongly suggests a common factor in the pathogenesis of thyroidal and ocular expressions of Graves' disease.

Therapeutic outcome of prednisone medication and of orbital irradiation in patients with Graves' ophthalmopathy

Response to treatment was evaluated prospectively in 58 patients with Graves' ophthalmopathy. Prednisone, administered to 44 patients, resulted in a favourable response in 29 patients (66%): excellent in 3, good in 10 and fair in 16 subjects; 15 patients (34%) did not respond. Orbital irradiation was administered to 39 patients of whom all except 4 had been treated previously with steroids. Six months later, 25 patients (64%) had responded favourably (excellent in 0, good in 9 and fair in 16 subjects) and 14 patients had not responded (36%). A favourable response to prednisone or irradiation was reflected in a general shift to lower grades in each of the classes 2-6 of the NOSPECS system. Responders were not different from non-responders with regard to age, sex, NOSPECS classification, ophthalmopathy index, interval between the onset of eye disease (or of thyroid disease if present) and the start of treatment, or the presence of thyroid disease. In conclusion, (1) the ratio of responders to non-responders is 2:1 for both prednisone treatment and orbital irradiation in Graves' ophthalmopathy, (2) the response is seen in all classes of the NOSPECS system, and (3) the response is not dependent on age, sex, severity or duration of eye disease, or the presence of thyroid disease.

Avian tuberculosis in wild birds in the Netherlands

Mycobacterium avium was isolated from 82 of 11,664 birds submitted for necropsy in The Netherlands. All isolated M. avium strains belonged to serotype 1, 2 or 3. The greatest number M. avium were from buzzards and falcons. The prevalence of tuberculosis in gulls is extremely low.

Drinking water vaccination against infectious laryngotracheitis

Chickens varying in age from ten days to five years were vaccinated with 10(1.3), 10(2.3) and 10(3.3) EID50 per bird of a commercial infectious laryngotracheitis drinking water vaccine. The vaccine gave no adverse reaction in the dose range tested. Five weeks after administration of 10(3.3) EID50 per bird 70% were protected against the intratracheal challenge with virulent infectious laryngotracheitis virus. Doses of 10(1.3) and 10(2.3) EID50 per bird did not give protection. No serological response could be detected by the neutralization test even in the group that had received 10(3.3) EID50 per bird. No contact spread of virus was detected from 14 days post-vaccination. Carriers of vaccine virus could not be demonstrated.

[Bird mortality and monitoring the environment (author's transl)]

Birds are useful parameters in studying toxicological contamination of the environment. Birds can be heard and seen, breeding results and feeding patterns being recorded on a rather extensive scale in the Netherlands. Since 1974, a working party was constituted to study normal and abnormal death of birds. This group consists of members of ornithological and veterinary institutes as well as local field workers, bird revalidation centres and bird preservation and protection groups. In 1979, approximately 2,000 birds were available for post-mortem and bacteriological, virological and toxicological studies. The cases of poisoning were classified into acute and chronic, accidental and crop-protecting effects. In the Laboratory of the Central Veterinary Institute, Poultry Department, the birds suspected of poisoning are screened by a biological-toxicological standard method using Lebistes and Daphnia. Pseudo-poisoning is caused in nature by Pasteurellosis, accidents, etc. Investigations are restricted by predation, the likelihood of finding of dead birds and retention of dead birds of prey for taxidermy. Acute poisoning in the Netherlands is mostly associated with protection of crops, nuisance caused by pigeons and other birds in gardens. Some cases of poisoning are due to quarrels between neighbours and people who poison game-birds out of revenge. Chronic poisoning is caused by metals such as lead pellets from cartridges. Chronic and acute poisoning continue to occur as a result of illegal use of prohibited insecticides.

Collyricloides massanae Vaucher, 1969, in a starling (Sturnus vulgaris L.) in the Netherlands

Collyricloides massanae (Trematoda: Collyriclidae) is described from cysts in the wall of the small intestine of a starling (Sturnus vulgaris L.) in the Netherlands. The original descriptin was from a yellow necked mouse, Apodemus flavicollis (Melchior), so this is the first record of the species in birds.

[Pasteurella multocida infections in birds following cat bites (author's transl)]

Infection with Pasteurella multocida caused by bites has been known for several decades. Cats are an important factor in Pasteurella multocida infection. Considerable numbers of victims are 'rescued' from the mouths of cats and submitted to bird reception centres for treatment. A number of bird shelters sent birds in this condition to the present authors for closer examination. The majority of birds caught by cats die. The mortality rates in shelters were reported to be 30, 90, 99 and one hundred per cent. Of the birds rescued alive from the mouths of cats, approximately 40 per cent died from the direct effects of the bites, and approximately 60 per cent died from Pasteurella multocida infection.

Local distribution of energy deposition in and around the follicles of a 125I contaminated thyroid

Iodine-125, which is used for the clinical diagnosis of the thyroid gland, has a high probability of decay by K-capture followed by the emission of low-energy electrons having ranges of up to 23 micrometer. Thus one has high local concentrations of energy deposition comparable in size to that of the smaller follicles. In this paper the local distribution of energy deposition inside and outside the follicles of the human thyroid gland is calculated for follicle sizes of 20--400 micrometer. Also the local dose rate at the position of the nuclei of the follicle cells is determined as a function of the follicle size. Possible dosimetric approaches to the problem of radiobiological effectiveness are discussed, at first in general and then for the example of the inactivation of follicle cells due to the incorporation of 125I.

[New Castle disease in imported birds. Cases observed and experimental vaccination (author's transl)]

An acute, highly virulent form of Newcastle disease is frequently observed in imported birds. Particularly parrots and, in some cases, pheasants are a potential source of danger. Diseased birds are imported from Asia as well as from South America. Outbreaks among birds imported from Africa have not so far been observed. The number of shipments in which Newcastle disease was found to be present in the birds is reviewed. Moreover, experimental vaccination is discussed.