Sniffin' Sticks Screening 12 test: Presentation of odours on filter paper improves the recognition rate

To the Editor: Monitoring of olfactory function and diagnosis of olfactory disorders using the pen-based "Sniffin' Sticks test" is problematic during the SARS-CoV-2 pandemic due to hygienic concerns. The aim of this study was to find out whether the results of olfactory testing obtained by presenting odours on a single-use filter paper is identical to performing the test by presenting the odour pens according to the manufacturer's manual.

Prevalence and risk factors of smell dysfunction - a comparison between five German population-based studies

BACKGROUND

The prevalence of olfactory impairment increases with age and is known to be an early sign of different neurodegenerative diseases. Only few population-based studies examined the prevalence of olfactory impairment and comparisons across studies are scarce. Aim of this analysis was to compare the prevalence and determinants of normosmia across five population based studies in Germany.

METHODOLOGY

Data from five population-based, cross-sectional studies were included. They were independently conducted and used the same test system (Sniffin' Sticks Screening 12) to measure olfactory function. This system consists of 12 odor-dispensing felt-tip pens; the task is a forced-choice selection among four alternative odors per pen. Sociodemographic information and comorbidities were assessed in face-to-face interviews. Univariate, descriptive statistics and multivariable logistic regression models stratified by study, were performed to determine risks, i.e. prevalence odds ratios, associated with olfactory function.

RESULTS

The prevalence of normosmic participants varied considerably across studies. Olfactory function was lower in men, decreased with age, and increased with higher education. Several individual comorbidities and a comorbidity index were associated with olfactory dysfunction. Recognition performance for three of the 12 pens was especially low in all studies.

CONCLUSION

Four factors, well known to describe population composition, contribute to explain differences in the prevalence of olfactory function between studies when the same test system is used. Our results indicate that comorbidities and educational level should always be considered when test systems based on smell recognition are used in population-based studies.

Attentional bias, craving and cannabis use in an inpatient sample of adolescents and young adults diagnosed with cannabis use disorder: The moderating role of cognitive control

Motivational processes like attentional bias and craving have been related to substance use. However, results are inconclusive. The present cross-sectional study was designed to replicate and extend previous research by investigating the relationships between attentional bias, craving, cognitive control and (severity of) cannabis use in a sample of inpatient adolescents and young adults (aged 18-30) diagnosed with CUD according to DSM-5. Contrary to expectations, our sample did not show attentional bias for cannabis words, neither did attentional bias correlate with craving, cognitive control or (severity of) cannabis use. In line with our hypotheses, however, increased session-induced craving was correlated to more daily cannabis use and reduced cognitive control. Furthermore, participants who displayed reduced cognitive control used more cannabis per day. A bootstrapped hierarchical regression model showed that, contrary to expectations, cognitive control did not modulate the relationships between attentional bias, craving and cannabis use. This study highlights the unique role of craving in relation to cannabis use and extends previous findings that cognitive control appears to have no moderating role regarding cannabis use disorder. Based on our results, it might well be that the underlying mechanisms of cannabis use disorder differ from those in other substance use disorders.

Abstract P5-08-09: Use of oral contraceptives and risk of breast cancer in BRCA1 and BRCA2 mutation carriers: An international prospective cohort study; for the studies of EMBRACE, GENEPSO, HEBON, kConFab and BCFR

This abstract was withdrawn by the authors.

Effects of pen bedding and feeding high crude protein diets on manure composition and greenhouse gas emissions from a feedlot pen surface

Greenhouse gas (GHG) emissions from concentrated animal feeding operations vary by stage of production and management practices. The objective of this research was to study the effect of two dietary crude protein levels (12 and 16%) fed to beef steers in pens with or without corn stover bedding. Manure characteristics and GHG emissions were measured from feedlot pen surfaces. Sixteen equal-sized feedlot pens (19 x 23 m) were used. Eight were bedded approximately twice a week with corn stover and the remaining eight feedlot pens were not bedded. Angus steers (n = 138) were blocked by live weights (lighter and heavier) with 7 to 10 animals per pen. The trial was a 2 x 2 factorial design with factors of two protein levels and two bedding types (bedding vs. non bedding), with four replicates. The study was conducted from June through September and consisted of four -28-day periods. Manure from each pen was scrapped once every 28 days and composite manure samples from each pen were collected. Air samples from pen surfaces were sampled in Tedlar bags using a Vac-U-Chamber coupled with a portable wind tunnel and analyzed with a greenhouse gas gas chromatograph within 24 hr of sampling. The manure samples were analyzed for crude protein (CP), total nitrogen (TN), ammonia (NH3), total volatile fatty acid (TVFA), total carbon (TC), total phosphorus (TP), and potassium (K). The air samples were analyzed for methane (CH4), carbon dioxide (CO2), and nitrous oxide (N2O) concentrations. The concentration of TN was significantly higher (p < 0.05) in manure from pens with cattle fed the high protein diets. The volatile fatty acids (VFAs) such as acetic, propionic, isobutyric, butyric, isovaleric, and valeric acids concentrations were similar across both treatments. There were no significant differences in pen surface GHG emissions across manure management and dietary crude protein levels.

Klinik und Genetik des familiären Brust- und Eierstockkrebses

Während mit der Entdeckung der Hochrisikogene „breast cancer 1“ (BRCA1) und „breast cancer 2“ (BRCA2) in den Jahren 1994/1995 die Erforschung des hereditären Mamma- und Ovarialkarzinoms zunächst beendet schien, belegen neuere Ergebnisse, dass das hereditäre Mamma- und Ovarialkarzinom eine extreme genetische Heterogenität aufweist. Die genetisch definierten Subtypen zeigen außerdem eine unterschiedliche phänotypische Ausprägung hinsichtlich der histopathologischen Charakteristika, des Krankheitsverlaufs und des Therapieansprechens. Dies erfordert eine Einbettung der Gendiagnostik in ein strukturiertes und standardisiertes Betreuungskonzept, das es erlaubt prospektive Daten zur Tumorinzidenz und zum Verlauf zu erfassen sowie in prospektiven Studien die Wertigkeit der verschiedenen diagnostischen, präventiven und neuen therapeutischen Optionen zu validieren. Das deutsche Konsortium widmet sich dieser Aufgabenstellung, um den betreffenden Familien effiziente Präventions- und Interventionsstrategien anbieten zu können. Dabei kommt der Zusammenarbeit mit der Selbsthilfe (http://www.BRCA-Netzwerk.de) mittlerweile eine große Bedeutung zu, die uns immer wieder vor Augen hält, wie wichtig es ist, den in diesem Artikel aufgeworfenen Fragestellungen nachzugehen.

Student tutors are able to teach basic sonographic anatomy effectively - a prospective randomized controlled trial

PURPOSE

Ultrasound is a widely used diagnostic tool. In medical education, it can be used to teach sonographic anatomy as well as the basics of ultrasound diagnostics. Some medical schools have begun implementing student tutor-led teaching sessions in sonographic abdominal anatomy in order to meet the growing demand in ultrasound teaching. However, while this teaching concept has proven to be feasible and well accepted, there is limited data regarding its effectiveness. We investigated whether student tutors teach sonographic anatomy as effectively as faculty staff sonographers.

MATERIALS AND METHODS

50 medical students were randomly assigned to one of two groups. 46 of these could be included in the analysis. One group was taught by student tutors (ST) and the other by a faculty staff sonographer (FS). Using a pre/post-test design, students were required to locate and label 15 different abdominal structures. They printed out three pictures in three minutes and subsequently labeled the structures they were able to identify. The pictures were then rated by two blinded faculty staff sonographers. A mean difference of one point in the improvement of correctly identified abdominal structures between the pre-test and post-test among the two groups was regarded as equivalent.

RESULTS

In the pre-test, the ST (FS) correctly identified 1.6 ± 1.0 (2.0 ± 1.1) structures. Both the ST and FS group showed improvement in the post-test, correctly identifying 7.8 ± 2.8 vs. 8.9 ± 2.9 structures, respectively (p < .0001 each). Comparing the improvement of the ST (6.2 ± 2.8 structures) versus the FS (6.9 ± 3.2) showed equivalent results between the two groups (p < .05 testing for equivalence).

CONCLUSION

Basic abdominal sonographic anatomy can be taught effectively by student tutors.

NOA-08 randomized phase III trial of 1-week-on/1-week-off temozolomide versus involved-field radiotherapy in elderly (older than age 65) patients with newly diagnosed anaplastic astrocytoma or glioblastoma (Methusalem)

LBA2001

Background: The median survival time for elderly patients (pts) with malignant gliomas is in the range of a few months. Radiotherapy (RT) is the standard treatment and superior to best supportive care both with respect to progression-free and overall survival. The benefit derived from surgery and RT is modest, and both treatments are less well tolerated in elderly pts than in the young. The availability of a potentially effective pharmacological agent, temozolomide (TMZ), for malignant glioma, which exhibits a favorable safety profile, necessitated a reconsideration of the widespread therapeutic nihilism with malignant glioma in the elderly.

Methods: The NOA-08 trial of the Neurooncology Working Group (NOA) of the German Cancer Society compared standard postsurgical involved-field RT to a dose of 54-60 Gy, in pts with anaplastic astrocytoma or glioblastoma > 65 ys with a Karnofsky performance score ≥ 60, to TMZ in an one week on/one week off schedule at 100 mg/m2 with dose modification in 25 mg steps in both directions. The primary endpoint was the median survival time (OS) during the follow-up in the 12 months after date of operation. The trial sought to demonstrate the non-inferiority of TMZ compared with RT. Regarding a maximal difference of 25% between both treatment arms in OS as being equivalent, 2 x 206 pts were randomized between May 15, 2005 and Nov 2, 2009 in 22 German and one Suisse sites to provide 80% power to achieve significance at a one-sided level of 0.05. Thirty-nine patients were excluded from the intention-to-treat (ITT) population because no therapy was applied (n=22) or withdrawal of informed consent (n=17).

Results: All histological diagnoses were centrally confirmed. Pts characteristics were balanced between arms in the ITT population (n=373) except for more resections and more anaplastic astrocytomas in the RT arm. The non-inferiority of TMZ was not shown. In contrast, pts in the TMZ arm had an increased risk of death (HR=1.24 [95% CI: 0.94-1.63]) compared to pts in the RT arm. The rate of adverse and serious adverse events was higher in the TMZ arm.

Conclusions: This trial fails to show the non-inferiority of dose-intensified TMZ alone compared with RT alone in the primary treatment of older pts with malignant glioma. Unlike anaplastic glioma in the younger patient population, RT cannot be safely deferred in the treatment of elderly patients with anaplastic astrocytoma or glioblastoma. Whether RT plus TMZ is superior to RT alone, is addressed in the ongoing companion trial conducted by NCIC, EORTC and TROG.

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Prevalence Rates of Pathogenic Mutations in the BRCA1 and BRCA2 Genes in Families with Different Disease Histories: Results from the German Consortium for Hereditary Breast and Ovarian Cancer

Introduction: In the German Consortium for Hereditary Breast and Ovarian Cancer (GC-HBOC), a large number of families with different histories of breast and ovarian cancers was screened for pathogenic mutations in the tumor-suppressor genes BRCA1/2. We here aimed to analyse the prevalence rates of pathogenic mutations for various familial disease histories.Methods: From 1997-2009 more than 6,000 families were screened for pathogenic mutations in BRCA1/2. Mutation analysis was performed by DHPLC (denaturing high-performance liquid chromatography) pre-screening, direct sequencing of suspect fragments and MLPA (multiplex ligation-dependant probe amplification) in at least one index case of these families. Complete pedigree information over three generations was used for the analysis. All lineages within a pedigree were traced and checked for the presence of several predefined disease histories.Results: Detailed mutation prevalence rates have been determined for a variety of familial risk situations. The highest mutation prevalence rate (78%, 95%CI 67-87%) was seen in families with at least two relatives affected by pre-menopausal breast cancer and at least two affected by ovarian cancer at any age. Importantly, the presence of a single woman affected by breast and ovarian cancer or bilateral breast cancer with first breast cancer under the age of 41 was associated with a BRCA1/2 mutation prevalence of 53% (95%CI 48-59%) and 34% (95%CI 23-47%) respectively. Interestingly, low mutation prevalence rates of &lt;10% were found in families with only one case of male breast cancer (9%, 95%CI 4-19%), and in families with three or more cases of postmenopausal breast cancer (7%, 95%CI 4-14%), the former being only BRCA2 mutations. Overall, the mutation prevalence was 27% (95% CI 26-29%) in the whole cohort.Conclusion: We provide comprehensive estimates for BRCA1/2 mutation prevalence rates that are based on a large number of families with comprehensive pedigree information. Such estimates can be used to develop cost effective screening strategies for public health care providers.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4073.

Evaluation of a candidate breast cancer associated SNP in ERCC4 as a risk modifier in BRCA1 and BRCA2 mutation carriers. Results from the Consortium of Investigators of Modifiers of BRCA1/BRCA2 (CIMBA)

Background:

In this study we aimed to evaluate the role of a SNP in intron 1 of the ERCC4 gene (rs744154), previously reported to be associated with a reduced risk of breast cancer in the general population, as a breast cancer risk modifier in BRCA1 and BRCA2 mutation carriers.

Methods:

We have genotyped rs744154 in 9408 BRCA1 and 5632 BRCA2 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA) and assessed its association with breast cancer risk using a retrospective weighted cohort approach.

Results:

We found no evidence of association with breast cancer risk for BRCA1 (per-allele HR: 0.98, 95% CI: 0.93–1.04, P=0.5) or BRCA2 (per-allele HR: 0.97, 95% CI: 0.89–1.06, P=0.5) mutation carriers.

Conclusion:

This SNP is not a significant modifier of breast cancer risk for mutation carriers, though weak associations cannot be ruled out.

Pharmacokinetic and pharmacodynamic modelling of the novel human granulocyte colony-stimulating factor derivative Maxy-G34 and pegfilgrastim in rats

OBJECTIVES

This study aims to compare pharmacokinetics and pharmacodynamics of pegfilgrastim, a pharmaceutical recombinant human granulocyte colony-stimulating factor (rhG-CSF), with that of a newly developed reagent, Maxy-G34. This comparison was performed using rat experiments and biomathematical modelling of granulopoiesis.

METHODS

Healthy rats and those with cyclophosphamide-induced neutropenia were treated with either pegfilgrastim or Maxy-G34 under various schedules. Time courses of absolute neutrophil count (ANC) and G-CSF serum level were measured and we constructed a combined pharmacokinetic/pharmacodynamic model of both drugs. Neutropenic episodes were assessed by experimental data and model simulations.

RESULTS

Both Pegfilgrastim and Maxy-G34 showed strong dose-dependent efficacy in reducing neutropenic episodes. However, time courses of ANC and G-CSF serum levels were markedly different. The biomathematical model showed good agreement with these data. We estimated that differences between the two drugs could be explained by lower bioavailability and reduced elimination of Maxy-G34. Based on the data and model interpolations, we estimated that Maxy-G34 is superior in reducing neutropenic episodes. Also, we predicted that G-CSF administration 48 h after cyclophosphamide would be superior to its administration after 2 or 24 h, for both derivatives.

CONCLUSION

Maxy-G34 is a highly potent drug for stimulation of neutrophil production in rats. By our modelling approach, we quantified differences between Maxy-G34 and pegfilgrastim, related to pharmacokinetic parameters. Model simulations can be used to estimate optimal dosing and timing options in the present preclinical rat model.

The TP53 Arg72Pro and MDM2 309G>T polymorphisms are not associated with breast cancer risk in BRCA1 and BRCA2 mutation carriers

Background:

The TP53 pathway, in which TP53 and its negative regulator MDM2 are the central elements, has an important role in carcinogenesis, particularly in BRCA1- and BRCA2-mediated carcinogenesis. A single nucleotide polymorphism (SNP) in the promoter region of MDM2 (309T>G, rs2279744) and a coding SNP of TP53 (Arg72Pro, rs1042522) have been shown to be of functional significance.

Methods:

To investigate whether these SNPs modify breast cancer risk for BRCA1 and BRCA2 mutation carriers, we pooled genotype data on the TP53 Arg72Pro SNP in 7011 mutation carriers and on the MDM2 309T>G SNP in 2222 mutation carriers from the Consortium of Investigators of Modifiers of BRCA1/2 (CIMBA). Data were analysed using a Cox proportional hazards model within a retrospective likelihood framework.

Results:

No association was found between these SNPs and breast cancer risk for BRCA1 (TP53: per-allele hazard ratio (HR)=1.01, 95% confidence interval (CI): 0.93–1.10, P_trend=0.77; MDM2: HR=0.96, 95%CI: 0.84–1.09, P_trend=0.54) or for BRCA2 mutation carriers (TP53: HR=0.99, 95%CI: 0.87–1.12, P_trend=0.83; MDM2: HR=0.98, 95%CI: 0.80–1.21, P_trend=0.88). We also evaluated the potential combined effects of both SNPs on breast cancer risk, however, none of their combined genotypes showed any evidence of association.

Conclusion:

There was no evidence that TP53 Arg72Pro or MDM2 309T>G, either singly or in combination, influence breast cancer risk in BRCA1 or BRCA2 mutation carriers.

A pharmacokinetic model of filgrastim and pegfilgrastim application in normal mice and those with cyclophosphamide-induced granulocytopaenia

OBJECTIVES

Recombinant human granulocyte colony-stimulating factor (rhG-CSF) is widely used as treatment for granulocytopaenia during cytotoxic chemotherapy; however, optimal scheduling of this pharmaceutical is unknown. Biomathematical models can help to pre-select optimal application schedules but precise pharmacokinetic properties of the pharmaceuticals are required at first. In this study, we have aimed to construct a pharmacokinetic model of G-CSF derivatives filgrastim and pegfilgrastim in mice.

METHODS

Healthy CD-1 mice and those with cyclophosphamide-induced granulocytopaenia were studied after administration of filgrastim and pegfilgrastim in different dosing and timing schedules. Close meshed time series of granulocytes and G-CSF plasma concentrations were determined. An ordinary differential equations model of pharmacokinetics was constructed on the basis of known mechanisms of drug distribution and degradation.

RESULTS

Predictions of the model fit well with all experimental data for both filgrastim and pegfilgrastim. We obtained a unique parameter setting for all experimental scenarios. Differences in pharmacokinetics between filgrastim and pegfilgrastim can be explained by different estimates of model parameters rather than by different model mechanisms. Parameter estimates with respect to distribution and clearance of the drug derivatives are in agreement with qualitative experimental results.

CONCLUSION

Dynamics of filgrastim and pegfilgrastim plasma levels can be explained by the same pharmacokinetic model but different model parameters. Beause of a strong clearance mechanism mediated by granulocytes, granulocytotic and granulocytopaenic conditions must be studied simultaneously to construct a reliable model. The pharmacokinetic model will be extended to a murine model of granulopoiesis under chemotherapy and G-CSF application.

Impact of BRCA mutation status on the clinical phenotype and survival of hereditary breast cancer

Abstract #3091

Background : In a multidisciplinary program supported by the German Cancer Aid in 1996-2006 a total of 3.408 women with a family history for breast and/or ovarian cancer were genetically counselled and tested for BRCA-1 and BRCA-2 mutations.&#x2028; Methods: The mutations were detected using DHPLC and direct sequencing. The family history of breast and/or ovarian cancer was proven by collecting medical reports of family members. The statistical analysis was done using standard procedures (Kaplan-Meier-analysis, t-test, chi-square-test).&#x2028; Results: Among the women with breast cancer 566 showed a deleterious BRCA1 and 313 a BRCA2 mutation. Four women were found to have mutations in both genes and 2.525 were BRCA-1/2 negative. In accordance with the literature we found the phenotype “hormone receptor negative and grade 3” as well as the medullary subtype significantly more often in BRCA1 associated breast cancers (74% vs. 24%, 63% vs. 42% and 10% vs. 5%). The median age of onset was significantly lower in BRCA1 mutation carriers (38 yrs) compared to BRCA2 mutation carriers (45 yrs) and women tested negative for BRCA1 and BRCA2 mutations (46 yrs) as well as sporadic breast cancer cases within these families (52 yrs). The median age of the 4 women with mutations in both genes was even lower (median age 33.5 yrs). Although BRCA2 associated breast carcinomas presented in more advanced stages (N+ in 44%[118/257] compared to BRCA-1 positive in 31%[166/519], p&lt;0.01) there was no difference in overall survival between BRCA1 and BRCA2 mutation carriers. However, BRCA1 and BRCA2 negative cases showed a significantly better survival rate compared to the women with mutations (p&lt;0.0001). Women from families with early onset breast cancer (&lt;35 yrs) or bilateral breast cancer (&lt;40 yrs) had a significantly better survival (p&lt;0.0001) than women from families with a later age of onset.&#x2028; Conclusions: The BRCA mutation status has a significant impact on the clinical phenotype of hereditary breast cancer which is important for the clinical management, counselling and prevention.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3091.