Radiological artificial intelligence - predicting personalized immunotherapy outcomes in lung cancer

Personalized medicine has revolutionized approaches to treatment in the field of lung cancer by enabling therapies to be specific to each patient. However, physicians encounter an immense number of challenges in providing the optimal treatment regimen for the individual given the sheer complexity of clinical aspects such as tumor molecular profile, tumor microenvironment, expected adverse events, acquired or inherent resistance mechanisms, the development of brain metastases, the limited availability of biomarkers and the choice of combination therapy. The integration of innovative next-generation technologies such as deep learning-a subset of machine learning-and radiomics has the potential to transform the field by supporting clinical decision making in cancer treatment and the delivery of precision therapies while integrating numerous clinical considerations. In this review, we present a brief explanation of the available technologies, the benefits of using these technologies in predicting immunotherapy response in lung cancer, and the expected future challenges in the context of precision medicine.

Osimertinib in advanced EGFR-mutant lung adenocarcinoma with asymptomatic brain metastases: an open-label, 3-arm, phase II pilot study

Background

Osimertinib is selective for both epidermal growth factor receptor (EGFR)-tyrosine-kinase inhibitor (TKI) sensitizing and Thr790Met mutations. While intracranial activity of osimertinib is documented in larger trials, a prospective study focusing exclusively on patients with asymptomatic brain metastases has not been reported.

Methods

In this nonrandomized, phase II, open-label, 3-arm prospective proof-of-concept pilot study, 48 patients with metastatic EGFR-mutant lung adenocarcinoma (LUAD) received osimertinib 80 mg daily. Patients were either treatment naive (arm A = 20) or previously treated with an EGFR-TKI and Thr790Met positive (arm B = 18) or negative (arm C = 10). In cases of isolated intracranial progression, osimertinib dose was escalated (160 mg). The primary endpoints were intracranial objective response rate (iORR) and intracranial disease control rate (iDCR). The secondary endpoint was intracranial progression-free survival (iPFS). This study is registered at Clinicaltrials.gov, NCT02736513.

Results

The iORRs were 84.2%, 66.7%, and 50% and the iDCRs were 94.7%, 94.4%, and 80% in arms A, B, and C, respectively. The median iPFS was 11.8 months (95% CI 7.7 to NA), 7.6 months (95% CI 5.3 to NA), and 6.3 months (95% CI 3.9 to NA) in arms A, B, and C, respectively. Following dose escalation, pooled iORR was 54% (arm A = 5, arm B = 4, arm C = 2). Adverse events were similar to those in previously published literature.

Conclusion

Osimertinib demonstrated high efficacy on brain metastases. All trial arms displayed a significant decrease in the number and diameter of target lesions. These findings indicate that osimertinib is effective for Thr790Met-positive and -negative LUAD patients with asymptomatic brain metastases. Therefore, osimertinib should be considered a viable option for EGFR-mutant patients with brain involvement regardless of their Thr790Met mutation status.

An Update on the Use of Exhaled Breath Analysis for the Early Detection of Lung Cancer

Lung cancer has historically been the main responsible for cancer associated deaths. Owing to this is our current inability to screen for and diagnose early pathological findings, preventing us from a timely intervention when cure is still achievable. Over the last decade, together with the extraordinary progress in therapeutical alternatives in the field, there has been an ongoing search for a biomarker that would allow for this. Numerous technologies have been developed but their clinical application is yet to come. In this review, we provide an update on volatile organic compounds, a non-invasive method that can hold the key for detecting early metabolic pathway changes in carcinogenesis. For its compilation, web-based search engines of scientific literature such as PubMed were explored and reviewed, using articles, research, and papers deemed meaningful by authors discretion. After a brief description, we depict how this technique can complement current methods and present the value of electronic noses in the identification of the “breathprint”. Lastly, we bring some of the latest updates in the field together with the current limitations and final remarks.

Rapid Response to the Combination of Lenvatinib and Pembrolizumab in Patients with Advanced Carcinomas (Lung Adenocarcinoma and Malignant Pleural Mesothelioma)

The new era of cancer treatments has made immune checkpoint inhibitors (ICIs) and emerging multikinase inhibitors (TKIs) the standards of care, thus drastically improving patient prognoses. Pembrolizumab is an anti-programmed cell death-1 antibody drug, and lenvatinib is a TKI with preferential antiangiogenic activity. We present, to our knowledge, the first reported series of cases consisting of patients with metastatic non-small cell lung cancer and malignant pleural mesothelioma who were treated with several types of chemotherapy combinations and ICIs followed by disease progression. They were subsequently treated with combined immunotherapy and TKI treatment, resulting in a near complete response within a very short time. Clinical responses were supported by in vitro testing of each patient's lymphocytic response to pembrolizumab after pre-exposure of target cancer cells to lenvatinib.

The impact of osimertinib' line on clonal evolution in EGFRm NSCLC through NGS-based liquid biopsy and overcoming strategies for resistance

BACKGROUND

Resistance mechanisms following 1st line therapy with osimertinib in EGFR + NSCLC have become focus of investigation. This retrospective study aims to deepen the understanding and clarify possible mechanisms of osimertinib 1st line resistance in comparison to the 2nd line by examining NGS results of 30 patients who developed resistance to osimertinib. Furthermore, we followed clinical outcomes of select patients who received combined therapy following EGFR resistance, a novel strategy not yet widely tested.

METHODS

Liquid biopsy technique (Guardant360) was used to monitor tumor dynamics in patients who were treated with osimertinib as 1st-line therapy (Group A, N = 15) and patients who received osimertinib as 2nd-line therapy (Group B, N = 15).

RESULTS

At the time of progression under osimertinib all but one patient preserved the primary EGFR mutation. While the C797S mutation was relatively common in the 2nd-line osimertinib setting (5/15), it did not develop in group A patients. TP53 was the most common detected mutation among all patients accounting for 11/15 in group A (73.33 %) and 10/15 in group B (66.67 %). In group A MET amplification was found in 3/15 patients (20 %) whereas MET mutation appeared in only one patient from group B. The outcomes of different treatment approaches post osimertinib resistance is reported including chemotherapy with/without osimertinib for maintaining control of brain metastases, drug combination such as osimertinib with crizotinib, chemo-immunotherapy and others. Overall survival in this cohort ranged from 12 to80 months.

CONCLUSIONS

Mechanisms of resistance to osimertinib as 1st-line therapy differ from those which develop in the 2nd-line setting and commonly include MET amplification. C797S is not a main resistance mechanism in the 1st-line setting, whereas it is more common in the 2nd-line setting. Combined therapy was effective and well tolerated, making it an acceptable choice in patients for whom there is a reasonable rationale for such treatment, however this approach deserves further investigation.

Dose escalation of osimertinib for intracranial progression in EGFR mutated non-small-cell lung cancer with brain metastases

Background

Osimertinib is a selective irreversible epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) with increased penetration across the blood-brain barrier compared with previous EGFR-TKIs, and thus, a 52% reduction in the risk of intracranial disease progression is seen when it is used as a first line of therapy compared with gefitinib and erlotinib. It is also efficient as second-line therapy for patients who developed the T790M resistance mutation following treatment with previous generation TKIs. Here, we report 11 patients who were treated by an increasing dose of osimertinib from 80 mg to 160 mg QD orally following intracranial progression in either first- or second-line setting.

Methods

This is a subcohort analysis from a larger nonrandomized, phase 2, open-label trial, evaluating the efficacy of osimertinib dose escalation from 80 mg to 160 mg in EGFR-mutated advanced non-small-cell lung cancer (NSCLC) patients with intracranial progression in either first- (arm A) or second-line setting (arm B for T790M+ and C for T790M-).

Results

Eleven patients, 5 in arm A, 4 in arm B, and 2 in arm C were reported in this study. The mPFS of osimertinib before dose escalation was 11.4 ± 8.9 (6.6-30.7) months for arm A, 8.7 ± 1.8 (6.3-11.2) for arm B, and 14.5 ± 7.8 (6.7-22.3) for arm C. Intracranial response rate to dose escalation was 54% (6 of 11) with 2 of 11 having intracranial stability. Median iPFS was 4.3 ± 7.4 (0.7-25.5) months; 3.8 ± 6.4 (1.8-18.9), 5.6 ± 9.7 (0.7-25.5), and 7.0 ± 2.7 (4.3-9.6) for arms A/B/C, respectively. Dose escalation was well tolerated with diarrhea and paronychia as the main dose-limiting symptoms.

Conclusions

Osimertinib 160 mg is feasible and may offer a therapeutic alternative for patients with isolated intracranial progression on osimertinib standard (80 mg) dose. Further studies on CNS osimertinib pharmacokinetics are needed to test this hypothesis.

Régulation médicale : mise au point 2018 et développements futurs

En 2018, les centrales de régulation d’urgences médicales devraient toutes être en mesure d’offrir certaines plus-values essentielles aux patients : une réanimation par téléphone avec accompagnement des témoins jusqu’à l’arrivée des secours, l’utilisation de réseaux de premiers répondants, ainsi que les défibrillateurs automatiques des domaines privés et publics via des applications Internet, l’assistance aux témoins pour réaliser des injections d’épinéphrine lors de réactions allergiques sévères ou de chlorhydrate de glucagon lors d’hypoglycémie. En complément, le bénéfice attendu des centrales d’urgences médicales visà-vis du système de soins dans son ensemble implique une meilleure efficience quant à l’engagement des moyens dont elles disposent. Cela ne peut se faire qu’en collectant les données liées à l’engagement des moyens (type, nombre, niveau de priorité) et en les corrélant avec la gravité de la situation observée sur site par les intervenants. Cette analyse permet d’estimer les taux de sur-triage et de sous-triage de la centrale lors de la décision d’envoi des moyens. L’utilisation appropriée des signaux prioritaires qui en découle permet également de réduire les risques des intervenants et de la population générale. Finalement, les fusions de centrales permettent de rationaliser certains coûts fixes, de faire face à des difficultés de recrutement et de formation, mais également d’augmenter la qualité de la régulation offerte à la population.

GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community

RATIONALE

This initiative is focused on building a global consensus around core diagnostic criteria for malnutrition in adults in clinical settings.

METHODS

In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) was convened by several of the major global clinical nutrition societies. GLIM appointed a core leadership committee and a supporting working group with representatives bringing additional global diversity and expertise. Empirical consensus was reached through a series of face-to-face meetings, telephone conferences, and e-mail communications.

RESULTS

A two-step approach for the malnutrition diagnosis was selected, i.e., first screening to identify "at risk" status by the use of any validated screening tool, and second, assessment for diagnosis and grading the severity of malnutrition. The malnutrition criteria for consideration were retrieved from existing approaches for screening and assessment. Potential criteria were subjected to a ballot among the GLIM core and supporting working group members. The top five ranked criteria included three phenotypic criteria (non-volitional weight loss, low body mass index, and reduced muscle mass) and two etiologic criteria (reduced food intake or assimilation, and inflammation or disease burden). To diagnose malnutrition at least one phenotypic criterion and one etiologic criterion should be present. Phenotypic metrics for grading severity as Stage 1 (moderate) and Stage 2 (severe) malnutrition are proposed. It is recommended that the etiologic criteria be used to guide intervention and anticipated outcomes. The recommended approach supports classification of malnutrition into four etiology-related diagnosis categories.

CONCLUSION

A consensus scheme for diagnosing malnutrition in adults in clinical settings on a global scale is proposed. Next steps are to secure further collaboration and endorsements from leading nutrition professional societies, to identify overlaps with syndromes like cachexia and sarcopenia, and to promote dissemination, validation studies, and feedback. The diagnostic construct should be re-considered every 3-5 years.

First results from EBW emission diagnostics on COMPASS

COMPASS tokamak shots at low magnetic field feature overdense plasmas during the extended current flat-top phase. The first harmonic of the electron cyclotron emission is completely cutoff for O and X modes and so the emission caused by electron Bernstein waves (EBWs) propagating obliquely with respect to the magnetic field and undergoing so called EBW-X-O conversion process can be observed. We perform an angular scan of the EBW emission during a set of comparable shots in order to determine the optimum antenna direction. A weak dependence of the radiative temperature on the antenna angles indicates an influence of multiple reflections from the vessel wall. The low temperature at the mode conversion region is responsible for the collisional damping of EBW, which can explain several times lower measured radiative temperature than the electron temperature measured by the Thomson scattering system.

[Impact of family support over food intake and depressive status in cervical cancer patients during hospitalization]

INTRODUCTION

Uterine cervical cancer represents a public health problem in Mexico; the patients suffer physical and psychological stress leading to depression and weight loss. Eating with a relative has positive effects in food ingestion and depressive status in hospitalized patients. In our society, food is the closest way that family members have to bring care and to show affection to the patient that has less appetite as disease goes on.

OBJECTIVE

To establish the relationship between presence of the family during the meals and depresion, food intake, and weight variation during hospitalization.

METHODOLOGY

106 women admitted to the Oncology Department at the General Hospital of Mexico with a diagnosis of CUCA clinical stage II and III were studied in order to improve their condition. Weight and height, diet by means of 24 hour recalls were assessed both at hospital admission and discharge, and Beck's depression inventory was applied; the frequency with which the relatives escorted the patient was recorded.

RESULTS

Patients were classified in two groups according to the frequency of family escorting; it was found that 43 patients (40.6%) were accompanied, and 63 patients (59.4%) were not. We did not find significant differences in age and days of hospital stay between the groups (p > 0.05). The escorted patients had more foods available during hospitalization (p < 0.05). Energy consumption (kcal) in escorted patients was higher by 12.7% as compared to non-escorted patients. 76.7% of the escorted patients were depressed, as compared to 55% in the non-escorted group. Significant differences were found with regards to clinical status and presence of depression (p < 0.05) between the study groups.

CONCLUSIONS

Family escorting does not have an influence on the amount of foods consumed during hospitalization or body weight variation; however, it does have an influence on the presence of depression.

[Nutritional status in hospitalized patients in a public hospital in Mexico City]

OBJECTIVE

To determine the frequency of malnutrition among hospitalized patients and to relate nutrition status with body mass index, fasting time, adequacy intake of protein and energy during hospitalization and length of stay. METHODS (STUDY POPULATION, SUBJECTS, INTERVENTION): We evaluated weight loss in the last 6 months prior to admission, body mass index (BMI), ideal and usual body weight percentages, days of hospitalization, energy and protein intake adequacy, fasting days and cause in hospitalized patients at different wards at Hospital General de Mexico. Patients were divided into groups according to their nutritional status (at risk/with malnutrition or normal) and data was assessed descriptively and comparatively by t-tests to determine mean differences.

RESULTS

We assessed 561 hospitalized patients. We found different frequencies of malnutrition according to various indicators: 21.17% according to BMI, 38.07% and 19.57% by percentages of habitual and ideal weights--respectively-- and a weight loss in 69.57% of the patients. Mean daily energy intake was found to be of 1,061+/-432.7 kcal, while mean protein intake was 42.1 + 22.7 g, representing only the 69.4% and 54.9% of the energy and protein requirements. We found statically significant differences among malnourished and normal patients in relation to BMI (p < 0.001), length of stay (p < 0.05), energy adequacy (p < 0.001) and protein intake (p < 0.05).

CONCLUSION

Malnutrition is common in hospitalized patients. An important factor in hospital malnutrition is the lack of compliance in the patient's requirements, preventing a fast recovery and increasing their length of stay. Thus, it is important to make changes and improvements in the institutional health system so that there is trained personnel in order to provide and adequate nutrition care attention to the critically ill patient, improving their condition and general prognosis.

[Effect of an intensive nutritional treatment in nutritional status of head and neck cancer patients in stages III and IV]

OBJECTIVE

Malnutrition and accelerated weight loss are frequent secondary diagnosis in patients with cancer. Head and neck cancer (H & N Cancer) affects nutritional status because of the tumor type and localization. The aim of the study was to assess the effect of an intensive nutritional treatment (INT) on nutritional status of H & N cancer patients, stages III and IV and to compare that with a historical control whose nutritional treatment was conventional (CT).

METHODS

All patients were nutritionally assessed before oncological treatment started (anthropometrical, biochemical, and dietetically). A nutritional feeding plan according to their nutritional personal need was calculated. In case it was impossible to cover all the nutritional requirements orally, a feeding tube was placed. Nutritional follow up was performed each 21 days, during their oncological treatment in four occasions. The results obtained were compared with those obtained from the patients who received the CT that consisted only in nutritional counseling by the attending physician; the statistical test used was Mann Whitney U test.

RESULTS

The INT was associated with maintenance of the nutritional status along their oncological treatment. The statistical significant parameters were: weight 55 to 47 kg in the CT group vs 59 a 58 kg in the INT group (p < 0.0001), and hemoglobin: from 13 to 11 g/dl in the CT group vs 14 to 13 g/dl in the INT group (p < 0.002) as the most important ones. In the rest of the data we can observe a clear tendency of increasing the nutrition parameters in patients the INT group, while in the CT group, they showed a persistent decrease.

CONCLUSION

We concluded that patients who received the INT as part of their oncological treatment deteriorated less their nutritional status than those who received a CT.

[An efficient example of a Swiss pre-hospital chain of survival: the state of Vaud model]

The state of Vaud model of the pre-hospital chain of survival is an example of an efficient way to deal with pre-hospital emergencies. It revolves around a centrally located dispatch center managing emergencies according to specific key words, allowing dispatchers to send out resources among which we find general practitioners, ambulances, physician staffed fast response cars or physician staffed helicopters and specific equipment. The Vaud pre-hospital chain of survival has been tailored according to geographical, demographical and political necessities. It undergoes constant reassessment and needs continuous adaptations to the ever changing demographics and epidemiology of pre-hospital medicine.

Discharges in the JET tokamak where the safety factor profile is identified as the critical factor for triggering internal transport barriers

Joint European Torus discharges which demonstrate the critical role the safety factor profile, q, can play in the formation of internal transport barriers (ITB) are examined. In these discharges, the target parameters, including the E x B flows, were kept virtually the same, except for the q profile. In a discharge with a nonmonotonic q, an ITB was triggered whereas a discharge with monotone q made no such transition. Thus, there is strong evidence that the q profile was the critical factor for the triggering of an ITB. Possible interpretations of this finding are discussed.

[Experiences with the STT (scapho-trapezio-trapezoid) arthrodesis. A retrospective evaluation]

From 1992 until 1998, 98 fusions of the scapho-trapezio-trapezoid joint on 97 patients were performed in our clinic. The indications were dissociation of the scapho-lunate joint (n = 32), necrosis of the lunate stage III/IV (Lichtman classification) (n = 39), and idiopathic arthrosis of the scapho-trapezio-trapezoid joint (n = 27). 87 patients with 88 procedures were reviewed after an average follow-up period of three years. The review included a clinical examination with determination of a traditional wrist-score and a DASH questionnaire, X-rays of the wrist and CT of the carpal bones. The results in the wristscore were on average 74 of maximal 100 points. The DASH-score was on average 29. The best results were in the group with arthrosis of the scapho-trapezio-trapezoid joint. The results in the groups with scapho-lunate dissociation and necrosis of the lunate were also good. The rate of non-union was within an acceptable level with 7.7%. In the examined group, five patients underwent fusion of the wrist for persisting pain after scapho-trapezio-trapezoid arthrodesis. The examination of the radiological investigations in the reviewed group demonstrated, that CT shows arthritic degeneration in patients where the conventional X-ray does not. In conclusion, scapho-trapezio-trapezoid arthrodesis is a valid therapeutic method in the above mentioned indications. However, the question how early arthritic degeneration will affect long-term results remains unanswered for the moment.

Background for studies on the treatment of male osteoporosis: state of the art

Male osteoporosis represents an important, although long underestimated, public health problem. Both in men and in women aging is accompanied by continuous bone loss and by an exponential increase in the incidence of osteoporotic fracture, with a female to male incidence ratio of about 2 to 3 to 1 in the elderly for hip and vertebral fractures. Morbidity after osteoporotic fractures appears to be more serious and mortality more common in men than in women. To date, no single treatment has been proved to be effective and safe in published prospective studies. The present report, based on a systematic search of the literature on male osteoporosis, summarises the state of the art on the clinical consequences of male osteoporosis and its risk factors, in relation to the present state of knowledge about female osteoporosis. This constitutes the background for the design of rational clinical development strategies for therapeutic interventions in male osteoporosis. From this review of the literature it is apparent that notwithstanding the existing sex differences in pathophysiology of osteoporosis and the difference in age-specific incidence of osteoporotic fractures, there are also important similarities between osteoporosis in women and men. The higher incidence of fracture in women than in men results from quantitative differences in risk factors rather than from different risk factors. Even though there are sex differences in bone geometry, incidence of fracture seems to be similar in men and women for a same absolute areal bone mineral density. However, the lack of data on the changes in fracture rates in men resulting from pharmacological intervention, leading to changes in bone mineral density or bone turnover, remains the main limitation for extrapolation of established treatment outcomes from women to men.

Feed contamination with Candida krusei as a probable source of mycotic mastitis in dairy cows

Over 3 months, yeasts were isolated in pure culture from milk samples obtained from 8 lactating cows with acute mastitis and from 1 cow with subacute mastitis. Eight of the isolates were identified as Candida krusei; 1 isolate was not submitted for identification. The affected cows were assigned to separate milking groups and had not been treated by intramammary administration of antibiotic before the outbreak. Remission of disease without treatment was observed, followed by shedding of the yeast in milk for 2 to 5 weeks. Median somatic cell counts in the affected cows before, during, and 2 months after the onset of clinical signs were 93,000; 1,793,000; and 135,000 cells/ml, respectively. Wheat silage was found to be the probable source of the infecting microorganism, whereas inadequate milking hygiene resulted in its persistence in the herd. Following replacement of the silage and improvement of the milking hygiene, the outbreak ceased. Candida krusei thus may cause mastitis in cattle not only following intramammary antibiotic treatment, but also in conditions of heavy environmental contamination, in conjunction with inadequate milking hygiene.

[The tolerance and residue accumulation of sodium-2,2-dichloropropionate (Dalapon) administered over 90 days to dairy cows]

The influence of the pesticide Sodium-2,2-dichlorpropionate (Na-DCP; Dalapon) was investigated on dairy cows concerning of its effect on ability and health condition. The investigations were carried out in practice using several parameters (feeding, efficiency, haematological and clinicochemical parameters, tests of the slaughtered organisms including their patho-histological examination). The arising of residues was controlled in milk, organs and tissue as well. The pesticide was daily applied orally with the feedstuff in 3 different dosages (2.5, 10, 30 mg/kg b. w./d). Feedstuff consumption, results of milk production and milk quality were not influenced by Na-DCP. The presented results can not verify with safety the insignificant alterations of some clinicochemical parameters (Creatinine, Bilirubin). Direct after the deposit of Dalapon in all samples of milk, organs and tissue residues of this pesticide could be observed. The maximum tolerable residue levels for animal in the ex-GDR were exceeded under these conditions.

Inhibition of human leukocyte elastase (HLE) by N-substituted peptidyl trifluoromethyl ketones

A series of tripeptides possessing trifluoromethyl or aryl ketone residues at P1 were prepared and evaluated both in vitro and in vivo as potential inhibitors of human leukocyte elastase (HLE). Tripeptides containing non naturally occurring N-substituted glycine residues at the P2-position have been demonstrated to be potent in vitro inhibitors of HLE, with IC50 values in the submicromolar range. Sterically demanding substituents on the P2-nitrogen have no detrimental effect on in vitro potency. The inhibition process presumably acts via hemiketal formation with the active site Ser195 of HLE, and is facilitated by the strongly electron withdrawing trifluoromethyl functionality. Deletion of the amino acid at the P3-subsite region affords inactive compounds. Valine is the preferred residue at the P1-position, whereas the corresponding glycine, alanine, alpha,alpha-dimethylglycine, or phenylalanine analogues are all inactive. The compounds described herein all confer a high degree of in vitro specificity when tested against representative cysteine, aspartyl, metallo, and other serine proteases. One of the most potent in vitro inhibitors is (3RS)-N-[4-[[[(4-chlorophenyl)sulfonyl]amino]carbonyl]phenyl] oxomethyl]-L-valyl-N-(2,3-dihydro-1H-inden-2-yl)glycine N-[3-(1,1,1-trifluoro-4-methyl-2-oxopentyl)]amide (20i; BI-RA-260) (IC50 = 0.084 microM). Compound 20i was also tested in hamsters in an elastase-induced pulmonary hemorrhage (EPH) model. In this model, intratracheal (it.) administration of 20i, 5 min prior to HLE challenge, effectively inhibited hemorrhage in a dose-dependent manner with an ED50 of 4.8 micrograms. The inhibitor 20i, 20 micrograms administered it. 24, 48, and 72 h prior to HLE challenge, exhibits significant inhibition against hemorrhage at all time points (97%, 64% and 49%, respectively). In a 21-day chronic model of emphysema in hamsters, 200 micrograms of HLE administered it. caused an elastase-induced emphysema in the lungs which can be quantitated histologically utilizing image analysis. In this assay, 20i significantly inhibited pulmonary lesions associated with septal destruction and increased alveolar spaces, when dosed at 20 micrograms it. 5 min prior to challenge with HLE.

[Parameters of non-specific immunity in umbilical cord blood in response to the stress of labor and surgery in healthy mothers and patients with late gestoses]

The authors investigated six proteins of the acute phase in the serum of mothers and in the umbilical blood of the foetus during spontaneous delivery and after Caesarean section in 40 women and their neonates. Half the women were in good health, half suffered from late gestoses. The patients' age, weeks of delivery and operation, the mean body weight of the neonates and evaluation of their condition after delivery by the Agpar score were comparable. The results were processed statistically. Mean levels of six proteins of the acute phase were assessed in the serum of the mother and the umbilical blood in all four groups of women and their neonates and percentage ratios of proteins in mother and foetus were assessed. On evaluation by the two-sample t-test in the umbilical blood of spontaneous deliveries in late gestoses significantly lower prealbumin values were found, and the same applied to Caesarean sections. Conversely a significant increase of A2MG levels and orosomucoid was found in the umbilical blood of children from mothers with late gestoses after Caesarean section. The values of the orosomucoid/prealbumin index according to Hollinshead were markedly elevated in late gestoses in the maternal blood as well as in the umbilical blood of the foetus.

[Acute phase proteins during labor and surgical stress in women with normal pregnancy and late gestoses]

The authors investigated within the framework of non-specific immunity reactions proteins of the acute phase during spontaneous delivery and Caesarean section up to the 5th day after delivery and on the 1st, 5th and 10th day after delivery in forty women, half of them healthy and half suffering from late gestoses. Half the women had spontaneous deliveries, half had deliveries by Caesarean section. The proteins of the acute phase reacted sensitively to the stress of childbirth during spontaneous delivery and their activation was inhibited by general anaesthesia in deliveries by Caesarean section. After spontaneous delivery the elevated proteins of the acute phase returned to baseline values by the 5th day, after operation their levels rose further up to the 5th day, orosomucoid to the 10th day after operation. In late gestoses with spontaneous delivery or by Caesarean section there were significantly elevated alpha-1-antitrypsin and alpha-2-macroglobulin and orosomucoid levels, whole in patients with late gestoses in the prealbumin levels were reduced. The elevated levels of proteinase inhibitors in late gestoses support the view on a possibly impaired coagulation equilibrium in late gestoses, and the high ceruloplasmin levels suggest an enhanced catecholamine breakdown during the stress alarm reaction.

[Activation of certain stress axes in spontaneous and surgical deliveries in healthy women and in women with late gestoses]

Within the framework of the stress theory the authors investigated total cortisol levels in the maternal serum during spontaneous delivery and 24 hours after delivery in 20 women half of whom had a non-complicated pregnancy and half had an EPH gestosis. They investigated also cortisol levels in 20 women during delivery by Caesarean section; half of them had a normal pregnancy and half had suffered from gestosis. At the onset of delivery and operation resp. women with gestosis had significantly elevated cortisol levels, as compared with healthy women. During spontaneous delivery the levels of this hormone had a rising trend with the peak during delivery of the foetus and return to pre-delivery values after 24 hours. During Caesarean section the cortisol levels rose only insignificantly and in gestoses they declined already at the end of the operation. In the discussion the authors draw attention to the activation of the stress axes during delivery and attempt to explain the elevated cortisol levels during delivery and in late gestoses.

Inhibition of human leukocyte elastase by N-substituted tripeptide trifluoromethyl ketones

Several tripeptide trifluoromethyl ketones containing non-naturally occurring N-substituted glycine residues at the P2-position are effective human leukocyte elastase (HLE) inhibitors in vitro and possess IC50 values in the submicromolar range. Deletion of the amino acid at the P3-subsite region affords inactive compounds. The trifluoromethyl ketone derivative of valine is the preferred residue at the P1-position; whereas, the corresponding glycine or alpha, alpha-dimethyl glycine analogs result in inactive compounds.

[The enteral absorption of iron (II) from humic acid-iron complexes in suckling piglets using radiolabeled iron (59Fe)]

Bioavailability of iron (II) bounded as a chelate to macromolecular humic acids was investigated in two different concentrations using retention rates of 59Fe in piglets (age: 24 h). Investigations period was from 3 hrs. to 21 days following application. 21 days after a single oral application of the humic-acid-iron-complexes, 25% of the total Fe was detected in the animal, distributed in the erythrocytes (80%), muscles and bones (8% respectively) and liver (4%). For the first time in veterinary medicine these results enable a combined therapy of enteric and iron-deficiency syndrome by using only one drug. Recommendation for dosing is provided.

Evaluation of zinc complexes on the replication of rhinovirus 2 in vitro

The effect of zinc salts and complexes were evaluated on the replication of rhinovirus 2 in vitro. Zinc chloride inhibited the replication of rhinovirus 2 at concentrations between 3 and 12 micrograms/ml. Influenza virus was not affected. A number of zinc complexes were tested and compared to zinc chloride. The results indicated that the activity and toxicity of all zinc complexes in the rhinovirus cytopathogenic effect (CPE) assay were directly related to the amount of unbound zinc available.

[Pharmacologic and toxicologic properties of humic acids and their activity profile for veterinary medicine therapy]

Humic acids derive from a class of natural substances in humic substances. The chemical properties of certain defined humic acid products enable their application in diseases of the digestive system of mammals when combined with metabolic disorders, especially in rearing age. The simple administration (via feed), their exceptional safety and the absence of side effects (e. g. allergy, resistance) as well as no residue formation in animal derived products allow a broad application of these substances in veterinary medicine, even when regarding ecotoxicological aspects.

The effect of ethanol and haloperidol on dopamine receptor (D2) density

The study was performed to investigate the influence of ethanol on haloperidol-induced changes of the dopamine (D2) receptors in rat striatal membrane preparations. Subchronic administration of the neuroleptic in the drinking water resulted in an increase of the number of binding sites in a dose-dependent manner. Simultaneous treatment with both haloperidol and ethanol prevented the rise of D2 receptors.

Diazepam attenuates the antagonism of haloperidol against apomorphine-induced stereotypic behavior after subchronic but not acute treatment in rats

Apomorphine-induced stereotypic behavior was investigated in rats treated with diazepam or haloperidol and with the combination of both drugs in a one day trial or subchronically. The drugs were administered via the drinking water. Diazepam dose-dependently reduced apomorphine stereotypies after the subchronic (6 days) but not after the acute treatment. Haloperidol suppressed apomorphine-induced stereotypic behavior dose-dependently after acute as well as after subchronic administration apparently without the development of tolerance. This discrepancy to other studies may be explained by the concomitant increase in maximum number of D2-receptors in the striatum. The apomorphine antagonistic effect of haloperidol was attenuated when the neuroleptic was administered subchronically in combination with the benzodiazepine. This finding was unexpected since both drugs reduced apomorphine-induced stereotypic behavior when administered alone. The further increase in maximum number of D2-receptors due to combined treatment with low doses of diazepam, suggesting a sort of "over adaptation", possibly explains the haloperidol-antagonistic action of diazepam in the behavioral experiments. Binding studies on dopamine (D1), 5-hydroxytryptamine (5-HT2) and benzodiazepine receptors revealed that modification of the apomorphine-induced stereotypies by the combined treatment with haloperidol and diazepam cannot be explained by interactions of the drugs at the level of the D1, 5-HT2 or benzodiazepine-receptors.

The influence of antihistamine compounds on the oral intake of different addictive drugs

The influence of two antihistamines on the oral intake of various drugs with addictive potency was investigated in rats. Under the chosen conditions neither tripelennamine nor diphenhydramine have reinforcing properties. The reinforcing potency of addictive drugs is not augmented by the both substances. On the contrary, in some cases they led to a decrease in oral intake of the drug solutions offered.

4-(Indolyl-3)-1-(benzimidazolonylalkyl)-piperidines, a novel group of potential antiallergy compounds

A group of indolyl-benzimidazolone-piperidines is described and the structure-activity with reference to the passive cutaneous anaphylaxis (PCA) in rats is discussed. Compound 7b, 4-(indolyl-3)-1-(benzimidazolonyl-propyl)-piperidine, which has the highest potency in this test, was studied in more detail with regard to antihistaminic and secretory cell stabilization properties.