Molecular epidemiology identifies the expansion of the DENV2 epidemic lineage from the French Caribbean Islands to French Guiana and mainland France, 2023 to 2024

In 2023, dengue virus serotype 2 (DENV2) affected most French overseas territories. In the French Caribbean Islands, viral circulation continues with > 30,000 suspected infections by March 2024. Genome sequence analysis reveals that the epidemic lineage in the French Caribbean islands has also become established in French Guiana but not Réunion. It has moreover seeded autochthonous circulation events in mainland France. To guide prevention of further inter-territorial spread and DENV introduction in non-endemic settings, continued molecular surveillance and mosquito control are essential.

Opportunities for growth in the growing field of psychobiotics

There is growing interest in the field of psychobiotics, which are probiotics that confer a mental health benefit when ingested. As this field grows, it should pay particular attention to three areas within psychobiotics research that are currently under-studied - sex (and gender) representation, fungi and the mycobiome, and vagus nerve activity. Giving these three domains more attention is currently feasible without significant increased investment of time or money. We discuss these three domains briefly, why they are of particular relevance for psychobiotics research, and how psychobiotics research can easily integrate their perspectives. Our recommendations are summarised in the conclusion, but include equal sex representation at all phases of research (human and animal studies), investigating the relationship between psychobiotics and commensal fungi, and measuring the activity of the vagus nerve in psychobiotics studies.

Pilot study of an online intervention for young people with a first psychotic episode: Thinkapp

Introduction

Online interventions can be a complement to maintain the long-term effectiveness of psychosocial interventions in First Episode Psychosis (FEP) that have already demonstrated their efficacy in the short and medium term (Calvo et al., 2015).

Objectives

To test the effectiveness of a mobile app–based intervention (Thinkapp) to improve quality of life, functioning and symptomatology, and reduce days of admission and hospitalizations, in young people with FEP.

Methods

Fourteen patients with FEP, aged 14–30, recruited from Gregorio Marañón Hospital, Ramón y Cajal Hospital and AMAFE Foundation in Madrid (Spain) received treatment as usual plus a psychoeducational intervention through a mobile app. Changes in dependent variables over the course of the intervention were assessed by means of a battery of clinical tests at baseline, 3-month and 6-month follow-up using a Wilcoxon test.

Results

Of the fourteen patients included, 7 patients completed the 6-month follow-up and 8 completed the 3-month follow-up. There were significant differences in days of admission (p = 0.042) between baseline and 6-month follow-up. No significant results were observed in other clinical variables.

Conclusions

The study provides preliminary data potentially related to the reduction of days of admissions.

Disclosure

No significant relationships.

Trends and determinants of condomless sex in gonorrhoea patients diagnosed in France through the sentinel surveillance network ResIST, 2005-2014

Background

Gonorrhoea is increasing in France since its resurgence in the late 1990’s. Understanding trends of condomless sex is a requirement to tailor prevention toward most exposed individuals. This study aims to analyse trends and determinants of condomless penetrative sex (PS) in MSM and heterosexuals diagnosed with gonorrhoea in France.

Methods

A standardized self-administered questionnaire filled by 3453 patients was used to monitor condomless sex through the sentinel surveillance network ResIST between 2005 and 2014. Trends were used to describe consistent condom use for penetrative sex (PS). A logistic regression model analysed patients’ characteristics associated with condomless PS.

Results

Between 2005 and 2014, condomless PS increased regardless of sexual orientation. Condomless PS was particularly common among HIV positive men who have sex with men (MSM (65%)). People living in metropolitan regions outside Paris area (adjusted odds-ratio (AOR) [95% CI] =1.33[1.12–1.58]) were more likely to engage in condomless PS. Conversely, MSM (AOR [95% CI] =0.21 [0.16–0.29]), HIV seronegative patients (AOR [95% CI] =0.68 [0.51–0.89]), patients diagnosed in hospital (AOR [95% CI] = 0.66 [0.45–0.97]) and multi-partners (≥ 10 partners, AOR [95% CI] = 0.54 [0.40–0.74]) were more likely to use condoms.

Conclusions

These findings highlight a decreasing use of condom in MSM and heterosexuals diagnosed with gonorrhoea. Prevention strategies should take in account drivers of condomless sex in a context of uncontrolled STI epidemics.

AB0535 ARE THE NEUTROPHIL/LYMPHOCYTE RATIO (NLR) AND PLATELET/LYMPHOCYTE RATIO (PLR) USEFUL TO COMPARED WITH ACUTE PHASE REACTANTS (ESR/CRP) FOR DIAGNOSIS AND PROGNOSIS OF PATIENTS WITH ACTIVE TAKAYASU’S ARTERITIS (TAK)?: AN ANALYSIS BASED ON ROC AND KAPLAN-MEIER CURVES IN A LATIN AMERICAN POPULATION

Background:

The NIH criteria are the main measure to determine activity in TAK. NLR and PLR appear promising to predict disease activity(1). TAK is one of the most frequent vasculitis in Colombia with a prevalence of 13.3%; however, in more recent years the information is sparse about TAK clinical behavior in our region, which leads to a late diagnosis. Although survival has improved with immunosuppressive treatment, relapses remain high especially in the first year of diagnosis

Objectives:

Compare NLR and PLR with ESR/CRP to predict TAK activity

Show survival and relapse in patients with TAK followed to 7 y

Methods:

Retrospective cohort of 43 patients with TAK between 2011-2018 with prospective follow-up of relapses and mortality. 88% fulfilled the ACR 1990 criteria. The disease activity was determined according to NIH criteria: active disease (n=34) and inactive disease (n=9). Through bivariate analysis, we compared the clinical and radiologic characteristics between age groups (table 1) using the Pearson test and Wilcoxon range test. Value of p <0.05 was statistically significant. Survival and relapse analysis were performed using Kaplan-Meier plots. Sensitivity (Sn), specificity (Sp) and area under the curve (AUC) were determined for NLR, PLR, ESR and CRP by receiver-operating curves (ROC) compared to NIH criteria.

Table 1.

Comparison of Clinical Features in Patients with TAK

No (%) of PatientsAge at diagnosis≤40 y (n=32)Age at diagnosis≥40 y(n=11)P valueFemale30 (94)11 (100)0.39Age at symptom onset (years), median: (Interquartile range –IQR-)20 (17-25)52 (47-57)0.110Time from symptom onset to diagnosis (months) median (IQR)9.5 (2-15)36 (1.5-24)0.774Smoking2 (6)6 (54)0.002Dyslipidemia7 (22)6 (54)0.042ACR Criteria 1990Claudication of extremities14 (43)5 (45)0.922Upper extremities blood pressure discrepancy > 10 mmHg19 (59)6 (54)0.779Decreased brachial artery pulse24 (75)9 (82)0.644Subclavian artery or aorta bruit19 (59)6 (54)0.774Arteriographic abnormality27/27 (100)11/11 (100)1.0ESR (mm/h), median (IQR)56 (23-115)38 (33-76)0.011CRP (mg/dL), median (IQR)1.35 (0.4-3.4)3 (1.49-18.5)0.020Creatinine (mg/dL), median (IQR)0.72 (0.6-0.83)0.84 (0.75-1)0.007Hata-Numano classification I15%18% IIa6%9% IIb6% III6% IV3%9% V59%64%

Results:

41 patients were women (96%) with a median age at diagnosis of 22 y and an interval from the onset of disease to diagnosis of 12 months (IR:1-168 m). The population over 40 years had a greater comorbidities burden (54% had history of smoking and dyslipidemia) and a major interval between the onset of disease and the diagnosis (36 months vs 9.5 months). Most frequent vascular phenotypes were types V (62%) and I (16%). NLR and PLR showed poor performance to predict activity compared with CRP; NLR level of 1.74 showed to be the predictive cut-off value for active TAK (Sn: 85.3%, Sp: 37.5%, AUC = 0.563). PLR level of 112.5 was found to be the predictive cut-off value for active TAK (Sn: 76.5%, Sp: 50%, AUC = 0.517). The CRP was the most accurate biomarker (Sn: 79.4%, Sp: 75%, AUC = 0.761) while the ESR was lower to predict activity (Sn: 63.6%, Sp: 75%, AUC = 0.598) (figure 1). At 5 years, survival was 83% and 50% of patients had presented at least one relapse (figure 2)

Conclusion:

Our data does not support the use of NLR or PLR to differentiate relapse and remission in TAK. CRP had better diagnostic performance than ESR in the prediction of activity compared to NIH criteria. The 5-year survival in this cohort is below that reported after 1985 (reported survival: 90-96%)(2)

References :

[1]Pan L, et al. Platelet-to-lymphocyte ratio and neutrophil-to-lymphocyte ratio associated with disease activity in patients with Takayasu’s arteritis: a case-control study. BMJ Open 2017; 7: e014451

[2]Schmidt J, et al. Diagnostic features, treatment, and outcomes of Takayasu arteritis in a US cohort of 126 patients, Mayo Clin Proc. 2013; 88(8): 822-30

Disclosure of Interests:

None declared

AB1005 BULLOUS LUPUS (BSLE) AS THE FIRST MANIFESTATION OF SYSTEMIC LUPUS ERYTHEMATOSUS IN THE PEDIATRIC POPULATION (PSLE): A DIAGNOSTIC CHALLENGE IN DAILY PRACTICE

Background:

Cutaneous manifestations are observed in 59–85% of patients with SLE but less than 5% developed BSLE. In the GLADEL cohort, the prevalence is 0.41%. BSLE literature in children is scarce

Objectives:

to describe the clinical characteristics of the patients with BSLE

Methods:

series of cases between 2010-2019 of two reference centers. The cases met Camisa and Grimwood criteria for BSLE

Results:

5 cases had bullous lesions that resolved with residual hypopigmentation. One case had focal seizure and other patient had arthritis with leukopenia and thrombocytopenia. 2 patients had proteinuria <500 mg/24 hours. There were no cases of lupus nephritis. The median SLEDAI-2K score was 12 (IR: 8-17). All had ANAs in titers greater than 1:160 and four had anti-DNA (+). 5 patients had anti-RNP and 4 had anti-Sm. One case had anti-Ro/anti-La. All presented low C3 and 80% had low C4. 80% had ESR ≥20 mm/hour and CRP greater than 0.5 mg/dl in 60%. All presented clinical response with glucocorticoids and dapsone; one patient had methemoglobinemia that improved. At 3 months, the blisters did not recur in 4 patients except one case that presented relapse due to inadherence.

Histologically, the most common finding was subepidermal blisters with neutrophils in the papilar dermis. DIF showed linear deposits of Igs and complement in 4 cases and granular deposits in one case; IgG/IgM were in 5 of the samples. IgA was positive in 60% and C3 in 80%

Conclusion:

In this series, BSLE was associated with neuropsychiatric, joint and haematological involvement in 40% of patients, without lupus nephritis. Such abnormalities had a parallel course to skin involvement, without recurrences. BSLE tends to have a single-phase behavior and in children unlike adults, severe renal involvement is uncommon

References:

[1]Pons-Estel GJ, et al. Lupus 2018; 27(10): 1753-1754

Disclosure of Interests:

None declared

Epidemiology of Clostridioides difficile infections, France, 2010 to 2017

BackgroundClostridioides difficile is a leading cause of healthcare-associated diarrhoea in middle and high-income countries. Up to 2018, there has been no systematic, annual surveillance for C. difficile infections (CDI) in France.AimsTo provide an updated overview of the epidemiology of CDI in France between 2010 and 2017 based on five different data sources.MethodsThis is a descriptive study of retrospective surveillance and alerts data. Incidence of CDI cases was estimated through the CDI incidence survey (2016) and data from the French National Uniform Hospital Discharge Database (PMSI; 2010-16). Testing frequency for CDI was estimated through the CDI incidence survey and point prevalence studies on healthcare-associated infections (HAI; 2012 and 2017). The national early warning response system for HAI (HAI-EWRS, 2012-17) and National Reference Laboratory data (2012-17) were used to follow the number of severe CDI cases and/or outbreaks.ResultsIn 2016, CDI incidence in acute care was 3.6 cases per 10,000 patient days (PD). There was a statistically significant increase in CDI incidence between 2010 and 2016 (+ 14% annually) and testing frequency was 47.4 per 10,000 PD. The number of CDI HAI-EWRS notifications decreased between 2015 and 2017 with only a few large outbreaks reported.ConclusionThe CDI incidence estimate increased from 2010, but remained below the European average of 7 per 10,000 PD in 2014; there were fewer severe cases or clusters reported in France. The consistency between PMSI and laboratory-based estimated CDI incidence could allow for more routine monitoring of CDI incidence.

Time-to-Event Analysis of Polatuzumab Vedotin-Induced Peripheral Neuropathy to Assist in the Comparison of Clinical Dosing Regimens

Polatuzumab vedotin, an antibody-drug conjugate containing monomethyl auristatin E, was associated with an incidence of grade ≥2 peripheral neuropathy (PN) of 55-72% in patients with indolent non-Hodgkin lymphoma in a phase II study, when dosed 1.8-2.4 mg/kg every 3 weeks until progression or for a maximum of 17 cycles. To quantify the correlation of conjugate exposure and treatment duration with PN risk, a time-to-event model was developed using data from phase I and II studies. The model suggested that PN risk increased with conjugate exposure and treatment cycles, and a trend for increased risk with body weight and albumin concentration. When capping the treatment duration to six to eight cycles, the risk ratio of a dose of 2.4 mg/kg vs. 1.8 mg/kg was ≥1.29; the predicted incidence of grade ≥2 PN at 1.8-2.4 mg/kg dose levels was 17.8-37.2%, which is comparable with other antimicrotubule agents for lymphoma treatment.

Long-term drug survival of biological agents in patients with rheumatoid arthritis in clinical practice

OBJECTIVES

To assess and compare the long-term drug survival (time to drug discontinuation) of biological agents (BA) in patients with rheumatoid arthritis (RA) in clinical practice. Factors associated with discontinuation of BAs were also investigated.

METHOD

We conducted an observational longitudinal study of RA patients taking BAs from 1999 to 2013. The primary endpoint was BA discontinuation due to: adverse drug reactions (ADRs), inefficacy, and other causes. Incidence rates of discontinuation (IRs) per 100 patient-years were estimated using survival techniques. Comparisons between BA discontinuation rates and other associated factors were made using Cox regression models.

RESULTS

We included 851 courses of BA therapy (1869 patient-years). Adalimumab (33%) was the BA most frequently used, followed by etanercept (24.4%), infliximab, and rituximab. Treatment was suspended in 558 cases [IR 29.8, 95% confidence interval (CI) 27-32]. In the first year of therapy 68% continued on BAs, and after 10 years the retention rate did not exceed 10%. The IR due to inefficacy was 12.1 (95% CI 10.6-13.8) and the IR of ADRs was 13.6 (95% CI 12-15). The unadjusted IR was higher for rituximab than for tumour necrosis factor (TNF) antagonists. In multivariate analysis, infliximab was the BA with the highest risk of discontinuation, compared to adalimumab. Calendar period, taking subsequent courses of BAs, concomitant therapy, and specific comorbidities were also independent factors associated with discontinuation.

CONCLUSIONS

After several years of BA treatment in clinical practice, the survival rate was low, mainly as a result of ADRs and inefficacy. We also found differences between the discontinuation rates of BAs and other clinical factors that modify their survival.

A molecular view of the role of chirality in charge-driven polypeptide complexation

Polyelectrolyte molecules of opposite charge are known to form stable complexes in solution. Depending on the system conditions, such complexes can be solid or liquid. The latter are known as complex coacervates, and they appear as a second liquid phase in equilibrium with a polymer-dilute aqueous phase. This work considers the complexation between poly(glutamic acid) and poly(lysine), which is of particular interest because it enables examination of the role of chirality in ionic complexation, without changes to the overall chemical composition. Systematic atomic-level simulations are carried out for chains of poly(glutamic acid) and poly(lysine) with varying combinations of chirality along the backbone. Achiral chains form unstructured complexes. In contrast, homochiral chains lead to formation of stable β-sheets between molecules of opposite charge, and experiments indicate that β-sheet formation is correlated with the formation of solid precipitates. Changes in chirality along the peptide backbone are found to cause "kinks" in the β-sheets. These are energetically unfavorable and result in irregular structures that are more difficult to pack together. Taken together, these results provide new insights that may be of use for the development of simple yet strong bioinspired materials consisting of β-rich domains and amorphous regions.

Design-based inference in time-location sampling

Time-location sampling (TLS), also called time-space sampling or venue-based sampling is a sampling technique widely used in populations at high risk of infectious diseases. The principle is to reach individuals in places and at times where they gather. For example, men who have sex with men meet in gay venues at certain times of the day, and homeless people or drug users come together to take advantage of services provided to them (accommodation, care, meals). The statistical analysis of data coming from TLS surveys has been comprehensively discussed in the literature. Two issues of particular importance are the inclusion or not of sampling weights and how to deal with the frequency of venue attendance (FVA) of individuals during the course of the survey. The objective of this article is to present TLS in the context of sampling theory, to calculate sampling weights and to propose design-based inference taking into account the FVA. The properties of an estimator ignoring the FVA and of the design-based estimator are assessed and contrasted both through a simulation study and using real data from a recent cross-sectional survey conducted in France among drug users. We show that the estimators of prevalence or a total can be strongly biased if the FVA is ignored, while the design-based estimator taking FVA into account is unbiased even when declarative errors occur in the FVA.

Clinical outcomes in elderly patients with advanced non-small cell lung cancer: results from ARIES, a bevacizumab observational cohort study

AIMS

Retrospective analyses from first-line clinical studies in advanced non-small cell lung cancer (NSCLC) have reported conflicting results on progression-free survival (PFS) and overall survival benefits with the addition of bevacizumab to chemotherapy in elderly patients. Here we report effectiveness and safety outcomes by age subgroup for patients with NSCLC in the ARIES observational cohort study.

MATERIALS AND METHODS

ARIES enrolled patients with advanced non-squamous NSCLC who received first-line bevacizumab-containing treatment per physician's choice. Kaplan-Meier estimates were used to calculate medians and 95% confidence intervals for PFS and overall survival for patients aged <65, ≥65, <75 and ≥75 years.

RESULTS

In total, 1967 patients receiving first-line treatment with bevacizumab and chemotherapy were enrolled. The median PFS and overall survival values were 6.4 (95% confidence interval = 6.0-6.8) and 14.2 (95% confidence interval = 12.7-15.2) months for patients aged <65 years, respectively, and 6.8 (95% confidence interval = 6.3-7.0) and 12.1 (95% confidence interval = 11.4-13.1) months for patients ≥65 years, respectively. For patients <75 years, the median PFS and overall survival values were 6.6 (95% confidence interval = 6.3-6.9) and 13.5 (95% confidence interval = 12.6-14.5) months, respectively, and 6.6 (95% confidence interval = 5.9-7.1) and 11.6 (95% confidence interval = 10.0-12.5) months, respectively, for patients ≥75 years. Incidence proportions of bevacizumab-associated adverse events were generally similar across all age groups.

CONCLUSIONS

Data from the ARIES study suggest that treatment with bevacizumab in combination with chemotherapy is a viable first-line treatment option for elderly bevacizumab-eligible patients with advanced non-squamous NSCLC.

Chikungunya outbreak in the Caribbean region, December 2013 to March 2014, and the significance for Europe

On 6 December 2013, two laboratory-confirmed cases of chikungunya without a travel history were reported on the French part of the Caribbean island of Saint Martin, indicating the start of the first documented outbreak of chikungunya in the Americas. Since this report, the virus spread to several Caribbean islands and French Guiana, and between 6 December 2013 and 27 March 2014 more than 17,000 suspected and confirmed cases have been reported. Further spread and establishment of the disease in the Americas is likely, given the high number of people travelling between the affected and non-affected areas and the widespread occurrence of efficient vectors. Also, the likelihood of the introduction of the virus into Europe from the Americas and subsequent transmission should be considered especially in the context of the next mosquito season in Europe. Clinicians should be aware that, besides dengue, chikungunya should be carefully considered among travellers currently returning from the Caribbean region.

Long-term use of antimalarial drugs in rheumatic diseases

OBJECTIVES

To evaluate long-term use of antimalarial drugs and to analyse all causes of discontinuation.

METHODS

This is a retrospective study of a cohort of rheumatic diseases patients on antimalarials, during a maximum period of 17.5 years. Case was defined as antimalarial treatment discontinuation due to: a) lack of efficacy, b) adverse events, and c) other causes. Survival techniques were used to estimate the incidence rate (IR) per 1,000 patient-years with the 95% Confidence Interval (95% CI) of antimalarial treatment discontinuation. Cox regression models were conducted to evaluate possible associated factors to antimalarial discontinuation.

RESULTS

One thousand, two hundred and ninety-one medical records were reviewed, and 778 patients were included. Patients started 869 different courses of treatment, with a total follow-up of 2,263 person-years. The IR of global discontinuation was 204 (95% CI 186-224). Fifty-two per cent of the treatments stopped were related to adverse events, 14% to lack of efficacy; and 34% to other reasons (refusal to take medication, ocular comorbidity, remission, or pregnancy). Adverse events discontinuations were related to non-ophthalmologic reasons in 54.5% (gastrointestinal, neuro-psychiatric, skin problems), and to ophthalmologic adverse events in 45.5%. Nine patients suffered definite presence of antimalarial retinopathy (IR: 3.97 [IC 95%: 2.06-7.62]) and one of them irreversible loss of vision (IR: 0.44 [IC 95%: 0.06-3.12]). Women, increasing age, and chloroquine vs. hydroxychloroquine use, increased the risk of discontinuation due to ophthalmologic adverse events.

CONCLUSIONS

Results suggest that antimalarials have a good balance between benefit and risk. However, we noted a number of discontinuations due to both inefficacy and adverse events. The potential for an unusual but serious ophthalmologic toxicity emphasises the importance of close ophthalmologic monitoring.

Near-real-time simulations of biolelectric activity in small mammalian hearts using graphical processing units

Simulations of cardiac bioelectric phenomena remain a significant challenge despite continual advancements in computational machinery. Spanning large temporal and spatial ranges demands millions of nodes to accurately depict geometry, and a comparable number of timesteps to capture dynamics. This study explores a new hardware computing paradigm, the graphics processing unit (GPU), to accelerate cardiac models, and analyzes results in the context of simulating a small mammalian heart in real time. The ODEs associated with membrane ionic flow were computed on traditional CPU and compared to GPU performance, for one to four parallel processing units. The scalability of solving the PDE responsible for tissue coupling was examined on a cluster using up to 128 cores. Results indicate that the GPU implementation was between 9 and 17 times faster than the CPU implementation and scaled similarly. Solving the PDE was still 160 times slower than real time.

HIF expression and Max-SUV-18F-FDG-PET in non-small cell lung cancer (NSCLC) patients

e22010

Background: Tumor hipoxia induces the up-regulation of several genes via the hipoxia-inducible transcription factors (HIF) 1 and 2. HIF-2 alpha (HIF-2 α) and HIF-1 alpha (HIF-1α) are associated with the prognosis of operable NSCLC patients. We studied the immunohistochemical expression of HIF-1α and HIF-2 α in patients with NSCLC and the possible correlation with the maximum standardised uptake value (max SUV) of 18F-FDG as well as other biological parameters. Methods: We used a Tissue Arrayer device (Beecher Instruments. WI) to construct a TMA block, according to conventional protocols for the study of immunohistochemical expression of HIF-1α, HIF-2 α, EGFR, bcl-2, MIB1, p16, p63 and cyclins A, B1, D1 and D3. Sections were scored as positive if >10% of cells stained positively. Staining patterns were correlated to clinical variables. Results: HIF- 1α expression was observed in 84/96 patients (34/39 adenocarcinomas and 50/57 squamous cell carcinomas), however it did not correlate with clinical stage (I-II: 41/45 vs III-IV: 44/51). HIF-1α correlated positively with HIF-2 α (p:0,001) and EGFR (p:<0,001) expressions. The maxSUV values of 18F-FDG-PET were higher (p:0,039) in HIF-1α -positive (17,1±8,6) than in negative tumors (11,8±4,4). HIF-2 α expression was observed in 60/103 cases (27/42 adenocarcinomas and 33/61 squamous cell carcinomas) and it did not correlate with clinical stage ((I-II: 28/45 vs III-IV: 32/57). HIF-2 α correlated positively with HIF-1α (p:0,001), MIB1 (p:0,045) and EGFR (p:0,091) expressions. After multivariate analysis, only the clinical stage (RR: 2,2) was a prognostic factor. Conclusions: 1) HIF-1α and HIF-2 α expressions are frequent in patients with NSCLCs and it did not correlate with clinical stage; 2) maxSUVs FDG-PET values were higher in HIF1alpha positive than in HIF-1α negative patients; 3) HIF-1α was correlated with EGFR expression, while HIF-2 α was correlated with MIB1 expression.

No significant financial relationships to disclose.

Bevacizumab (B), cisplatin, and vinorelbine in chemotherapy-naive patients (p) with nonsquamous non-small cell lung cancer (NSCLC): A Galician Lung Cancer Group phase II study

e19089

Background: Bevacizumab, an anti-VEGF monoclonal antibody, improves response rates and prolongs survival in p with non squamous NSCLC when combined with carboplatin-paclitaxel or cisplatin-gemcitabine. This single-arm, open-labeled phase II trial aims to evaluate the efficacy and safety profile of B in combination with another widely used chemotherapy doublet for NSCLC: cisplatin and vinorelbine. Methods: Chemotherapy-naïve p diagnosed with stage IIIB or IV non squamous NSCLC received cisplatin (80 mg/m2), vinorelbine (25 mg/m2 IV days 1 and 8) and B (15 mg/kg IV) on day 1 every 3 weeks for up to 6 cycles followed by B 15 mg/kg alone every 3 weeks until disease progression. Main eligibility criteria were: PS 0–1, no brain metastases, no history of hemoptysis, stable cardiac condition and no full dose anticoagulation. Primary endpoint was progression-free survival and secondary endpoints were RR, duration of response, OS, 1-year survival and safety profile of the combination. Results: 38 p have been enrolled in the study and data of 27 p have been included in this analysis. P characteristics were: male 66.7%; median age 57 years (range 41–74); ECOG PS 0/1 (%) 33.3/66.7; adenocarcinoma/other (%) 74.1/25.9; stage IIIB/IV (%) 25.9/74.1. Median number of cycles for B/cisplatin/vinorelbine was 4.0 (range 1–6) and median number of cycles for B maintenance was 2 (range 1–4). 17 p were evaluable for response according to RECIST criteria: PR 29.4% and SD 41.2%. With a median follow-up of 3.9 months (range 0.7–11.1), median PFS was 4.6 months (95% CI: 2.6–6.6) and median OS has not been reached yet. Hematological toxicities were: 1 p gr. 3 anemia; 2 p gr. 3 and 2 p gr. 4 leucopenia; 10 p gr. 3, 1 p gr. 4 neutropenia and 3 p febrile neutropenia. Most common grade 3/4 non hematological toxicities were: vomiting (1p gr. 4), high blood pressure, asthenia and hyperglycemia. 1 p experienced gr. 4 abdominal pain, 1 p. gr. 4 constipation, 1 p. gr. 4 nausea and 1 p gr. 4 respiratory infection. No grade 3/4 hemoptysis were reported. Conclusions: This interim analysis shows that B in combination with cisplatin and vinorelbine is safe and well tolerated and has a promising activity in chemo-naïve p with non squamous NSCLC. Survival data will be updated.

[Table: see text]

[Use of tobacco smoke: approach and risk perception by middle-school students in Catania (Italy)]

The aim of this study was to investigate the approach and behaviour of middle school students in Catania, towards the risks associated with tobacco smoke. This study is part of a multicentric project evaluating the lifestyles of middle school students (grades 6-8), carried out by the Research and Health Education Group (GRES) and was performed during the 2006/2007 school year. In total 432 students participated in the study by completing a self-administered questionnaire. Data was analysed by using the Statistical Package for the Social Sciences (SPSS). Results show an increasing trend in the number of smokers from grades 6 to 8. In grades 6 and 8 most smokers are female while in grade 7 male smokers outnumber female smokers. Three percent of the student population reports smoking occasionally and 3% are regular smokers. In light of these results families, schools and institutions should take charge of programming and implementing health promotion interventions aimed at reducing risks and improving the quality of life of students in Catania.

In situ estrogen metabolism in proliferative endometria from untreated women with polycystic ovarian syndrome with and without endometrial hyperplasia

The aim of the present investigation was to study whether the endocrinological status of women bearing polycystic ovarian syndrome (PCOS) affects the endometrial in situ steroid metabolism. For this purpose, we evaluated the mRNA levels (RT-PCR), and the activity of steroid metabolic enzymes: P450 aromatase, steroid sulfatase (STS), estrogen sulfotransferase (EST) and 17beta-hydroxysteroid dehydrogenase (17beta-HSD) in 23 samples of normal endometria (CE), 18 PCOS endometria without treatment (PCOSE), 10 specimens from PCOS women with endometrial hyperplasia (HPCOSE), and 7 endometria from patients with endometrial hyperplasia not associated to PCOS (EH). The data showed lower levels of STS mRNA for PCOSE and HPCOSE (p<0.05, p<0.01, respectively) and of EST for HPCOSE and EH compared to control (p<0.05). However, higher levels for EST mRNA were obtained in PCOSE (p<0.05) versus CE. The mRNA and protein levels for P450 aromatase were undetectable in all analyzed endometria. The relationship between the activities of STS and EST was lower in PCOSE and HPCOSE (p<0.05) versus CE. The ratio between the mRNA from 17beta-HSD type 1/type 2 was higher in PCOSE (p<0.05), whereas, a diminution in the 17beta-HSD type 2 activity was observed in PCOSE (p<0.05). These results indicate that the activity of enzymes related to the steroid metabolism in analyzed PCOSE differ from those found in the CE. Consequently, PCOSE may present an in situ deregulation of the steroid metabolism.