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.

Influence of Root Post Materials and Aging on Fracture Strength and Marginal Gap Quality of Ceramic Crowns-An In Vitro Study

The design of and materials for prosthodontic abutments and posts have significant influences on the fracture resistance of restored teeth. This in vitro study compared the fracture strength and marginal quality of full-ceramic crowns as a function of the inserted root posts via simulation of a five-year period of use. Test specimens were prepared from 60 extracted maxillary incisors using titanium L9 (A), glass-fiber L9 (B), and glass-fiber L6 (C) root posts. The circular marginal gap behavior, linear loading capacity, and material fatigue after artificial aging were investigated. The marginal gap behavior and material fatigue were analyzed using electron microscopy. The linear loading capacity of the specimens was investigated using the Zwick Z005 universal testing machine. None of the tested root post materials showed statistically significant differences in marginal width values (p = 0.921), except in the case of marginal gap location. For Group A, there was a statistically significant difference from the labial to the distal (p = 0.012), mesial (p = 0.000), and palatinal (p = 0.005). Similarly, Group B showed a statistically significant difference from the labial to the distal (p = 0.003), mesial (p = 0.000), and palatinal (p = 0.003). Group C showed a statistically significant difference from the labial to the distal (p = 0.001) and mesial (p = 0.009). Linear load capacity reached mean values of 455.8-537.7 N, and micro-cracks occurred after artificial aging, predominantly in Groups B and C. Through the chosen experimental design, it was shown that the root post material and root post length had no influence on the fracture strength of the test teeth before or after artificial aging. However, the marginal gap location depends on the root post material and its length, which is wider mesially and distally and also tends to be greater palatinally than labially.

HOW TO IDENTIFY SUBGROUPS IN LONGITUDINAL CLINICAL DATA: TREATMENT RESPONSE PATTERNS IN PATIENTS WITH A SHORTENED DENTAL ARCH

BACKGROUND

When dental patients seek care, treatments are not always successful,that is patients' oral health problems are not always eliminated or substantially reduced. Identifying these patients (treatment non-responders) is essential for clinical decision-making. Group-based trajectory modeling (GBTM) is rarely used in dentistry, but a promising statistical technique to identify non-responders in particular and clinical distinct patient groups in general in longitudinal data sets.

AIM

Using group-based trajectory modeling, this study aimed to demonstrate how to identify oral health-related quality of life (OHRQoL) treatment response patterns by the example of patients with a shortened dental arch (SDA).

METHODS

This paper is a secondary data analysis of a randomized controlled clinical trial. In this trial SDA patients received partial removable dental prostheses replacing missing teeth up to the first molars (N = 79) either or the dental arch ended with the second premolar that was present or replaced by a cantilever fixed dental prosthesis (N = 71). Up to ten follow-up examinations (1-2, 6, 12, 24, 36, 48, 60, 96, 120, and 180 months post-treatment) continued for 15 years. The outcome OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). Exploratory GBTM was performed to identify treatment response patterns.

RESULTS

Two response patterns could be identified - "responders" and "non-responders." Responders' OHRQoL improved substantially and stayed primarily stable over the 15 years. Non-responders' OHRQoL did not improve considerably over time or worsened. While the SDA treatments were not related to the 2 response patterns, higher levels of functional, pain-related, psychological impairment in particular, and severely impaired OHRQoL in general predicted a non-responding OHRQoL pattern after treatment. Supplementary, a 3 pattern approach has been evaluated.

CONCLUSIONS

Clustering patients according to certain longitudinal characteristics after treatment is generally important, but specifically identifying treatment in non-responders is central. With the increasing availability of OHRQoL data in clinical research and regular patient care, GBTM has become a powerful tool to investigate which dental treatment works for which patients.

IMPACT OF SHORTENED DENTAL ARCH ON ORAL HEALTH-RELATED QUALITY OF LIFE

BACKGROUND

A shortened dental arch (SDA) is an established treatment concept for patients with missing molars. However, little is known regarding long-term course of oral health-related quality of life (OHRQoL) in patients with SDA and the benefits from replacement of missing molars.

OBJECTIVE

Purpose of this multi-center randomized clinical trial was to assess OHRQoL over a period of 15 years in patients with molar replacement by a removable partial denture (RPD) compared to patients with a restored SDA without molar replacement.

METHODS

Patients at least 35 years of age with all molars missing in 1 jaw and at least the canine and one premolar present on each side were included. Patients received either a precision attachment-retained, RPD for replacement of missing molars (n = 79), or the dental arch ended with the second premolar (SDA) that had to be present or replaced by a cantilever fixed dental prosthesis (n = 71). Follow-up examinations continued for 15 years. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP). OHIP summary and dimension scores were longitudinally modeled in the statistical analyses to assess course of OHRQoL over time applying an intention-to-treat approach. In addition, scores for the OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were analyzed.

RESULTS

After an initial improvement in OHRQoL indicated by a mean decrease of 20.0 OHIP points with an effect size of 0.61 in the entire study population, OHRQoL stayed relatively constant over the entire follow-up period. Assuming a constant time and treatment effects over the study period, OHRQoL did not differ statistically significant between the 2 treatments (0.4 OHIP points; 95%-CI: 7.1 - 6.2). OHRQoL after treatment did not change notably over 15 years and was statistically nonsignificant as well (P = .872). Similar findings were observed in all 4 OHRQoL dimensions.

CONCLUSIONS

In patients, missing all molars in one jaw OHRQoL improved providing RPD or restoring SDA to a clinically relevant degree. Treatment-related improvement remained mostly stable over a period of at least 15 years. Therefore, patients can be informed that both treatment concepts are equivalent concerning long-term OHRQoL. Accordingly, patients' preferences regarding treatment options should be granted priority in treatment decision making with the SDA treatment option being the default.

Rehabilitation of shortened dental arches: A fifteen-year randomised trial

BACKGROUND

Few long-term studies on treatments in the shortened dental arch (SDA) are available.

OBJECTIVE

The objective of this trial was to analyse the long-term success of two different treatment concepts.

METHODS

Patients over 35 years of age with missing molars in one jaw and at least the canine and one premolar present on both sides were eligible. In the partial removable dental prosthesis (PRDP) group (N = 81), molars and missing second premolars were replaced by a precision attachment retained prosthesis. In the SDA group (N = 71), the dental arch ended with the second premolar that had to be present or replaced by a cantilever fixed dental prosthesis. Follow-up examinations were carried out over 15 years.

RESULTS

A comprehensive outcome variable comprised four failure categories for which Kaplan-Meier survival (success) analyses were conducted. Half of the patients exhibited a continuous preservation of the per protocol prosthetic status that remained totally unaffected by complications for more than 10 years. The event-free success rates for moderate or worse failure implied a loss of the per protocol prosthetic status. The respective survival rates fell below 50% at 14.2 years in the PRDP group and 14.3 years in the SDA group. In none of the analyses, a significant group difference was found.

CONCLUSIONS

In patients with an SDA condition, changes in the prosthetic status have to be expected. The affected proportion increases almost linearly from shortly after treatment and comprises the majority after 15 years. The influence of the examined treatments on success appears to be low.

Periodontal health in shortened dental arches: A 10-year RCT

PURPOSE

This analysis focused on periodontal health in shortened dental arches (SDAs).

METHODS

In a randomized controlled clinical trial, patients with missing molars in one jaw and at least one premolar and canine on both sides were eligible for participation. In the partial removable dental prosthesis (PRDP) group (n = 79), molars were replaced with a precision attachment retained PRDP. In the SDA group (n == 71), the SDA up to the second premolars was either left as is or restored with fixed dental prostheses. Outcome variables were vertical clinical attachment loss (CAL-V), pocket probing depth (PPD), bleeding on probing (BOP) and plaque index (PLI). For CAL-V and PPD, the changes at six measuring points per tooth were analyzed. For BOP and PLI, patient related rates were calculated for each point in time. Statistical methods included linear regression analyses.

RESULTS

In the intention-to-treat (ITT) analysis for CAL-V in the study jaw, the 10 year patient related mean changes were 0.66 mm in the PRDP group and -0.13 mm in the SDA group. The resulting mean patient related group difference of 0.79 mm (95% CI: 0.20 mm-1.38 mm) was significant (p = 0.01). There were no significant differences in the ITT analyses for PPD. For BOP and PLI, significant group differences with more favorable results for the SDA group were found.

CONCLUSIONS

In view of lacking substantial differences for CAL-V and PPD, the overall differences were considered of minor clinical relevance. The results add confirmatory evidence to the shortened dental arch concept and its clinical viability (controlled-trials.com ISRCTN97265367).

Impact of shortened dental arch on oral health-related quality of life over a period of 10 years - A randomized controlled trial

OBJECTIVES

To compare oral health-related quality of life (OHRQoL) in patients with either molar replacement by partial removable dental prostheses (PRDP) or with restored shortened dental arches (SDA) over a period of 10 years.

METHODS

In this multi-center RCT, a consecutive sample of 215 patients with bilateral molar loss in at least one jaw was initially recruited in 14 prosthodontic departments. Of those patients, 150 could be randomly allocated to the treatment groups (SDA: n = 71; PRDP: n = 79), received the allocated treatment, and were available for follow-up assessments. OHRQoL was assessed using the 49-item version of the Oral Health Impact Profile (OHIP) before treatment (baseline) and at follow-ups after treatment (4-8 weeks and 6, 12, 24, 36, 48, 60, 96, and 120 months). To investigate the course of OHRQoL over time, we longitudinally modelled treatment and time effects using mixed-effects models.

RESULTS

OHRQoL substantially improved from baseline to first follow-up in both groups indicated by a mean decrease in OHIP scores of 20.0 points (95%-CI: 12.5-27.5). When compared to the SDA group, OHRQoL in the PRDP group was not significantly different (-0.6 OHIP points; 95%-CI: -7.1 to 5.9) during the study period when assuming a constant time effect. OHRQoL remained stable over the 10 years with a statistically insignificant time effect (p = 0.848).

CONCLUSIONS

For patients requesting prosthodontic treatment for their lost molars, treatments with SDA or PRDP improve clinically relevantly OHRQoL and maintain it over a period of 10 years with no option being superior to the other.

CLINICAL SIGNIFICANCE

Since there was no significant difference between the two treatment options over the observation period of 10 years, and since results have stayed stable over time, patients can be informed that both treatment concepts are equivalent concerning OHRQoL.

Wirkung und Nebenwirkungen von Ibuprofen

Ibuprofen ist ein weit verbreitetes nichtsteroidales Antiphlogistikum (NSAID). Es hemmt durch Blockade des aktiven Zentrums die Cyclooxygenase 1 und 2 (COX-1 und COX-2) reversibel. In höheren Konzentrationen als die zur Hemmung der COX-1 und COX-2 notwendig sind, zeigt es Antitumor-Aktivität. In OTC-Dosierung (over the counter) (<1200 mg/d) ist das Risiko zur Entstehung von gastrointestinalen Blutungen geringer als bei Diclofenac, Naproxen, Piroxicam oder Indomethacin. Mit Erhöhung der Dosis (2400–3200 mg/d) und Verlängerung der Therapiedauer steigt das Risiko für gastrointestinale Nebenwirkungen. Bei höheren Dosierungen und schon eingeschränkter Nierenfunktion kann Ibuprofen zu einem akuten Nierenversagen führen. Eine Kontrolle der Nierenfunktion ist in diesen Fällen angezeigt. Bei Kindern bis zu 12 Jahren, bei Schwangeren und auch älteren Patienten sollte Paracetamol der Vorzug gegeben werden. Patienten mit Hypertonie, welche mit ACE-Hemmern, Angiotensin-II-Rezeptorenblockern oder Thiazid-Diuretika behandelt werden, sollten Ibuprofen nicht über einen längeren Zeitraum einnehmen. Bei gleichzeitiger Einnahme von Ibuprofen und Acetylsalicylsäure wird die irreversible Hemmung von ASS auf die COX-1 vermindert, da Ibuprofen eine höhere Affinität zum aktiven Zentrum der COX-1 besitzt.

Eine kurzzeitige Behandlung mit Ibuprofen ist meist unproblematisch. Bei längerfristiger Therapie und höherer Dosierung muss zwischen niedrigem und hohem gastrointestinalem und kardiovaskulärem Risiko differenziert werden.

The randomized shortened dental arch study: influence of two different treatments on interdental spacing over 5 years

OBJECTIVES

Being a secondary outcome in a multicenter randomized controlled trial, the present analysis focused on interdental spacing in the shortened dental arch (SDA). The aim was to evaluate changes in interdental spacing in dependence of two different treatments after an observation period of up to 5 years.

MATERIAL AND METHODS

Patients were either treated with a partial removable dental prosthesis (PRDP) for molar replacement (PRDP group) or according to the SDA concept aiming at a premolar occlusion (SDA group) in a randomized manner. Interdental spacing in the anterior region was measured with gauges and categorized as "0" (<0.1 mm), "1" (<0.5 mm), "2" (0.5-1 mm), and "3" (>1 mm). The statistical analysis was performed with analysis of variance models followed by linear contrast.

RESULTS

Ninety-one patients (SDA n = 41, PRDP n = 50) were included. Changes of interdental spacing were detected in 70.7 % of all cases. A significant difference between the mean score changes was found in the mandible comparing the PRDP group and the SDA group. The respective mean score changes from baseline to 5 years were 0.23 (SD 0.49) for the PRDP group and 0.02 (SD 0.30) for the SDA group (p = 0.023).

CONCLUSIONS

Major interdental spacing could be observed in neither of the groups. The SDA concept resulted in a slightly better outcome.

CLINICAL RELEVANCE

When deciding whether to replace missing molars, the present results give further support to the SDA concept.

Modeling Interoperable Information Systems with 3LGM² and IHE

BACKGROUND

Strategic planning of information systems (IS) in healthcare requires descriptions of the current and the future IS state. Enterprise architecture planning (EAP) tools like the 3LGM² tool help to build up and to analyze IS models. A model of the planned architecture can be derived from an analysis of current state IS models. Building an interoperable IS, i. e. an IS consisting of interoperable components, can be considered a relevant strategic information management goal for many IS in healthcare. Integrating the healthcare enterprise (IHE) is an initiative which targets interoperability by using established standards.

OBJECTIVES

To link IHE concepts to 3LGM² concepts within the 3LGM² tool. To describe how an information manager can be supported in handling the complex IHE world and planning interoperable IS using 3LGM² models. To describe how developers or maintainers of IHE profiles can be supported by the representation of IHE concepts in 3LGM².

METHODS

Conceptualization and concept mapping methods are used to assign IHE concepts such as domains, integration profiles actors and transactions to the concepts of the three-layer graph-based meta-model (3LGM²).

RESULTS

IHE concepts were successfully linked to 3LGM² concepts. An IHE-master-model, i. e. an abstract model for IHE concepts, was modeled with the help of 3LGM² tool. Two IHE domains were modeled in detail (ITI, QRPH). We describe two use cases for the representation of IHE concepts and IHE domains as 3LGM² models. Information managers can use the IHE-master-model as reference model for modeling interoperable IS based on IHE profiles during EAP activities. IHE developers are supported in analyzing consistency of IHE concepts with the help of the IHE-master-model and functions of the 3LGM² tool

CONCLUSION

The complex relations between IHE concepts can be modeled by using the EAP method 3LGM². 3LGM² tool offers visualization and analysis features which are now available for the IHE-master-model. Thus information managers and IHE developers can use or develop IHE profiles systematically. In order to improve the usability and handling of the IHE-master-model and its usage as a reference model, some further refinements have to be done. Evaluating the use of the IHE-master-model by information managers and IHE developers is subject to further research.

Recent developments in the prevention of chemotherapy-induced nausea and vomiting (CINV): a comprehensive review

The prevention of chemotherapy-induced nausea and vomiting (CINV) has been revolutionized over the past 25 years. Guideline-based treatment means that vomiting can be prevented in the majority, but not in all patients. Therefore, antiemetic research continues with the goal of optimizing CINV control for all patients. This comprehensive review summarizes the research efforts in this field over the past few years. Emerging from this research are two new antiemetic agents, netupitant/palonosetron, the first antiemetic combination agent and rolapitant, a new NK1RA. In addition, studies have evaluated the benefits of olanzapine and ginger, explored optimal combinations of agents for delayed CINV prevention, confirmed that dexamethasone-sparing regimens are effective, and demonstrated the value of NK1RAs in high-dose chemotherapy settings as well as with certain moderately emetogenic chemotherapies such as carboplatin. Research has also validated the correlation between antiemetic guideline adherence and improved CINV control. Finally, regulatory authorities have utilized extreme caution in retiring some 5-HT3RAs or decreasing their maximum dose.

Treatment of adolescents and young adults (AYA) with cancer in a multidisciplinary setting: on the way to a highly specialized AYA unit

Further survival improvements of adolescents and young adults (AYA) with cancer are clearly affected by biological characteristics of the malignancies and age-specific needs. Multidisciplinary teams drawing expertice from both pediatric and adult cancer teams as well as clinical trials are required to meet the age specific needs of AYA patients with cancer. In 2011, the first AYA unit was established at the University Hospital Halle (Saale), where patients with newly-diagnosed cancer aged 15-25 are treated interdisciplinary by pediatric and adult oncologists. The enrollment into pediatric or adult clinical trials is controlled by age 18. Over the last 2 years, 19 AYA with cancer have been treated at the unit; and, in turn patients and their relatives reflected a high satisfaction with the offered novel health care approach. In the scope of the future Comprehensive Cancer Center at the University Hospital Halle (Saale), a complete ward is planned for all admitted AYA up to 25 years with cancer. The patients will be treated by a tumor-specialized multidisciplinary team of adult or pediatric oncologists and oncological surgeons. Therefore, we intend to establish a special teaching curriculum for physicians, nurses and psychosocial health care staff. Rather than age, cancer biology of a malignancy, surveillance data of late side effects as well as the age-specific needs of AYA patients will be crucial for best treatment options.

The Randomized Shortened Dental Arch Study

The evidence concerning the management of shortened dental arch (SDA) cases is sparse. This multi-center study was aimed at generating data on outcomes and survival rates for two common treatments, removable dental prostheses (RDP) for molar replacement or no replacement (SDA). The hypothesis was that the treatments lead to different incidences of tooth loss. We included 215 patients with complete molar loss in one jaw. Molars were either replaced by RDP or not replaced, according to the SDA concept. First tooth loss after treatment was the primary outcome measure. This event occurred in 13 patients in the RDP group and nine patients in the SDA group. The respective Kaplan-Meier survival rates at 38 months were 0.83 (95% CI: 0.74-0.91) in the RDP group and 0.86 (95% CI: 0.78-0.95) in the SDA group, the difference being non-significant.

The Randomized Shortened Dental Arch study (RaSDA): design and protocol

BACKGROUND

Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials.

METHODS/DESIGN

This 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5).

DISCUSSION

The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof.

TRIAL REGISTRATION

The trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).

Comparing a Japanese and a German hospital information system

OBJECTIVES

To examine the architectural differences and similarities of a Japanese and German hospital information system (HIS) in a case study. This cross-cultural comparison, which focuses on structural quality characteristics, offers the chance to get new insights into different HIS architectures, which possibly cannot be obtained by inner-country comparisons.

METHODS

A reference model for the domain layer of hospital information systems containing the typical enterprise functions of a hospital provides the basis of comparison for the two different hospital information systems. 3LGM(2) models, which describe the two HISs and which are based on that reference model, are used to assess several structural quality criteria. Four of these criteria are introduced in detail.

RESULTS

The two examined HISs are different in terms of the four structural quality criteria examined. Whereas the centralized architecture of the hospital information system at Chiba University Hospital causes only few functional redundancies and leads to a low implementation of communication standards, the hospital information system at the University Hospital of Leipzig, having a decentralized architecture, exhibits more functional redundancies and a higher use of communication standards.

CONCLUSIONS

Using a model-based comparison, it was possible to detect remarkable differences between the observed hospital information systems of completely different cultural areas. However, the usability of 3LGM(2) models for comparisons has to be improved in order to apply key figures and to assess or benchmark the structural quality of health information systems architectures more thoroughly.

Effects of prosthetic treatment for shortened dental arches on oral health-related quality of life, self-reports of pain and jaw disability: results from the pilot-phase of a randomized multicentre trial

A multi-centre randomized clinical trial is under way at 14 university dental schools in Germany to compare prosthodontic treatments for the shortened dental arch (SDA). One of the aims of this pilot-study was to measure the effect of two treatment options of the SDA on oral health-related quality of life and on the Research Diagnostic Criteria (RDC) for temporomandibular disorders (TMD). Thirty-four patients participated in the pilot-study. Inclusion criteria were: all molars were missing and the presence of at least both canines and one premolar in each quadrant. Participants were randomly assigned to receive either removable partial dentures including molar replacement (RPD_group) or retain a premolar occlusion (PROC_group). The Oral Health Impact Profile (OHIP-49) and the RDC for TMD were completed by participants before treatment (pre-treatment), 6 weeks (6 wks), 6 months (6m) and 12 months (12 m) after treatment. At the 12-month follow up, data of 10 women and 11 men (mean age: 62 +/- 10 years) were available. Medians of the OHIP total-scores were as follows: RPD (n = 10), 43.5 (pre-treatment), 18.2 (6 wks), 13.3 (6m), 14.7 (12 m). PROC (n = 11): 31.8 (pre-treatment), 27.1 (6 wks), 8.8 (6m), 8.3 (12 m). Significant differences were shown for RPD_group between pre-treatment and 6m/12 m and for PROC_group between pre-treatment and 6m. There were no significant differences between treatment groups at any time. Within each group, an improvement of life-quality was observed. No significant difference could be reported between the two therapy concepts. This may be due to the low sample size within the pilot study.

Influence of 2-acetylaminofluorene (2-AAF) on biotransformation and lipid peroxidation in salivary glands and liver from male rats

Salivary glands proved to be active in biotransformation. In microsomes of rat salivary glands 7-ethoxyresorufin O-deethylation (EROD) and 7-pentoxyresorufin O-depentylation (PEROD) were detectable, but with much lower activities than in the liver. Beside the well-known induction of EROD or PEROD in the liver by beta-naphthoflavone (BNF) or phenobarbital (PB), respectively, a marked rise in EROD rate of salivary glands was observed after BNF treatment. Administration of 2-AAF caused an increase in EROD rates in liver microsomes, but a decrease in microsomes of salivary glands. This decrease in EROD rate was accompanied by selective cytotoxic damages in the convoluted granulated tubules of the submandibular glands. No cytotoxic damage occurred in the submandibular glands after a combined administration of the inducer BNF and 2-AAF. This indicates relations between these toxic effects of 2-AAF and changes of 2-AAF-metabolism in BNF-induced rats, maybe in the liver and/or in the submandibular glands themselves.

Age dependent different influence of carbon tetrachloride on biotransformation of xenobiotics, glutathione content, lipid peroxidation and histopathology of rat liver

15- and 60-day-old male rats were treated with different doses of CCl4 orally. 24 h later cytochrome P-450 (P450) concentration, 7-ethoxyresorufin O-deethylation (EROD) and 7-pentoxy-resorufin O-deethylation (PEROD) activities were determined. Whereas P450 and EROD are lowered to the same extent in both ages, PEROD shows a more pronounced inhibition in the livers of younger rats. The formation of endogenous lipid peroxides (measured as thiobarbituric acid reactive substances) is drastically increased only in the livers of young rats. The hepatic glutathione (GSH) content was unaffected by CCl4 treatment whereas oxidized glutathione is more increased in the livers of adult rats. This can be caused by a higher activity of GSH-peroxidase in the livers of adult rats. The changes in NADPH-induced lipid peroxidation and chemiluminescence correlate partially with the changes in P450 and biotransformation reactions. Histopathologically the liver damage is more extensive in suckling rats. The necrosis is localized predominantly in the perivenous tissue, which has normally the highest activities of toxification and detoxification enzymes.

[Contamination of breast milk with organochlorine compounds in comparison with cow's milk and selected milk products in the new federal districts]

400 human milk, 280 cowmilk, 56 milkpowder and 305 butter samples were examined concerning there content of chloroorganic compounds. In human milk the highest concentration had DDE, followed by PCB, DDT and HCB, the lowest values were measured for HCH. Only total DDT in human milk but no compound in the milk product samples was above the maximal tolerated limit. There is a strong reduction in comparison to the values measured in 1979 (ten times for total HCH, one half for total DDT and to one sixth for HCB) but the PCB concentration didn't change.

Nephrotoxic effects of diethylene glycol (DEG) in rats

Diethylene glycol (DEG) is a widely used substance with various risks of intoxication. In adult rats influences of DEG on functional parameters are characterized, indicating early signs of nephrotoxicity. A dose dependent proteinuria, an oliguric effect, an increased excretion of free hydrogen ions and a compensated impairment of renal tubular transport processes can be stated (0.25, 0.5 and 0.75 ml DEG/100 g b.m. i.p.). Following a single dose of 0.5 ml DEG/100 g b.m. i.p. the maximally expressed nephrotoxic effect is measurable 4 to 8 days after administration.

Influence of prenatal administration of cadmium on postnatal development and inducibility of hepatic monooxygenases in rats

Cadmium inhibits hepatic monooxygenases in rats of different ages. But also in the offspring of dams which had received cadmium during pregnancy changes in biotransformation activities and their inducibilities could be observed. In the 30- and 60-day-old offspring a decrease in the inducibility of ethoxyresorufin O-deethylation by the specific inducer beta-naphthoflavone could be demonstrated, whereas cytochrome P-450 concentration, ethylmorphine N-demethylation and ethoxycoumarin O-deethylation were not influenced.

Chlorinated drinking water is mutagenic and causes 3-methylcholanthrene type induction of hepatic monooxygenase

Acid/neutral fractions of 4 chlorinated drinking water samples were tested for mutagenicity in the Ames' test and injected intraperitoneally to 10- and 20-day-old Wistar rats at doses of 200 and 100 liters of water/kg body weight. Cytochrome P-450 mediated enzyme activities of ethylmorphine-N-demethylase (EMND), 7-ethoxycoumarin-O-deethylase (ECOD), 7-ethoxyresorufin-O-deethylase (EROD) and 7-pentoxyresorufin-O-dealkylase (PEROD) were determined in the 9000 g supernatant fraction of liver homogenate. EROD was introduced by the concentrates. The induction was related to the mutagenic activity. About 4-fold increase in activity was observed with the most mutagenic sample. PEROD was also slightly enhanced. EMND and ECOD activities were not affected by the lower dose, but the higher dose caused inhibition of 30-40%. Although the extracts were not toxic to bacteria, they were unexpectedly toxic to rats. It is concluded that the samples contained 3-methylcholanthrene (3-MC) type inducer(s).

Hemodynamic parameters and renal blood flow following stimulation of renal tubular transport processes by treatment with thyroid hormones

In adult rats, renal excretion of p-aminohippurate (PAH) can be stimulated by repeated administration of thyroid hormones. Data on renal cortical slices show clearly that a stimulation of active, carrier-mediated tubular transport processes is the most important cause. In vivo experiments also show an influence of treatment with thyroid hormones on various hemodynamic parameters. The diminution of vascular resistance in cortical and medullary regions of the kidney might contribute to the increased PAH excretion in thyroid hormone-treated rats.

Effect of cadmium in vitro on benzphetamine-N-demethylation and ethoxyresorufin-O-deethylation in rats of different age

The in vitro influence of CdSO4 on the liver microsomal benzphetamine-N-demethylation and ethoxyresorufin-O-deethylation activities in male Wistar rats/age 10, 30, 60 and 240 days/as well as the type of inhibition were studied after phenobarbital or beta-naphthoflavone pretreatment. Both reactions were inhibited by CdSO4 in dependence on concentration in all age groups. After phenobarbital pretreatment the inhibition of N-demethylation was slightly pronounced in 10-day old rats. In 10 and 30-days old rats the type of inhibition was competitive while in 60 and 240-days old rats a non-competitive type of inhibition was observed. O-deethylation of ethoxyresorufin was inhibited also in 10-day old rats, the inhibition type was non-competitive in all age groups. After beta-naphthoflavone pretreatment N-demethylation was inhibited competitively in all age groups. The inhibition of O-deethylation was more pronounced in 30-day old rats, in other age groups the inhibition was weak but concentration dependent. The type of inhibition was noncompetitive for all age groups studied.

Influence of age on in vitro effect of cadmium on rat liver cytochrome P-450 concentration and monooxygenases activity

Cadmium++ added in vitro destroys rat liver cytochrome P-450 (cyt. P-450) with increasing age by 25-50%. Ethylmorphine N-demethylation is inhibited only in rats 30-days old and thereafter. Ethoxycoumarin 0-deethylation is inhibited even in newborn rats, and the maximal inhibition appears to increase with age. It is concluded that in all age groups cadmium resistant cyt. P-450 subspecies are present. Ethoxycoumarin 0-deethylase activity possibly indicates the cadmium sensitive P-450 fraction.