Enabling late-stage drug diversification by high-throughput experimentation with geometric deep learning

Late-stage functionalization is an economical approach to optimize the properties of drug candidates. However, the chemical complexity of drug molecules often makes late-stage diversification challenging. To address this problem, a late-stage functionalization platform based on geometric deep learning and high-throughput reaction screening was developed. Considering borylation as a critical step in late-stage functionalization, the computational model predicted reaction yields for diverse reaction conditions with a mean absolute error margin of 4-5%, while the reactivity of novel reactions with known and unknown substrates was classified with a balanced accuracy of 92% and 67%, respectively. The regioselectivity of the major products was accurately captured with a classifier F-score of 67%. When applied to 23 diverse commercial drug molecules, the platform successfully identified numerous opportunities for structural diversification. The influence of steric and electronic information on model performance was quantified, and a comprehensive simple user-friendly reaction format was introduced that proved to be a key enabler for seamlessly integrating deep learning and high-throughput experimentation for late-stage functionalization.

A parsimonious approach to predict regions affected by sewer-borne contaminants in urban aquifers

Leaky urban drainage networks (UDNs) exfiltrating wastewater can contaminate aquifers. Detailed knowledge on spatiotemporal distributions of water-dissolved, sewer-borne contaminants in groundwater is essential to protect urban aquifers and to optimize monitoring systems. We evaluated the effect of UDN layouts on the spreading of sewer-borne contaminants in groundwater using a parsimonious approach. Due to the UDN's long-term leakage behavior and the existence of non-degradable sewer-borne contaminants (equivalent to a conservative and constant contaminant source), we employed a concept of horizontal line sources to mimic the UDN layout. This does not require the consideration of bio-degradation processes or temporal delay and effectively bypasses the vadose zone, thus reducing computational requirements associated with a full simulation of leakages. We used a set of synthetic leakage scenarios which were generated using fractals and are based on a real-world UDN layout. We investigated the effects of typical leakage rates, varying groundwater flow directions, and UDN's layouts on the shape of the contaminant plume, disregarding the resulted concentration. Leakage rates showed minimal effects on the total covered plume area, whereas 89% of the variance of the plume's geometry is explained by both the UDN's layout (e.g., length and level of complexity) and groundwater flow direction. We demonstrated the potential of applying this approach to identify possible locations of groundwater observation wells using a real UDN layout. This straightforward and parsimonious method can serve as an initial step to strategically identify optimal monitoring systems locations within urban aquifers, and to improve sewer asset management at city scale.

Identifying opportunities for late-stage C-H alkylation with high-throughput experimentation and in silico reaction screening

Enhancing the properties of advanced drug candidates is aided by the direct incorporation of specific chemical groups, avoiding the need to construct the entire compound from the ground up. Nevertheless, their chemical intricacy often poses challenges in predicting reactivity for C-H activation reactions and planning their synthesis. We adopted a reaction screening approach that combines high-throughput experimentation (HTE) at a nanomolar scale with computational graph neural networks (GNNs). This approach aims to identify suitable substrates for late-stage C-H alkylation using Minisci-type chemistry. GNNs were trained using experimentally generated reactions derived from in-house HTE and literature data. These trained models were then used to predict, in a forward-looking manner, the coupling of 3180 advanced heterocyclic building blocks with a diverse set of sp3-rich carboxylic acids. This predictive approach aimed to explore the substrate landscape for Minisci-type alkylations. Promising candidates were chosen, their production was scaled up, and they were subsequently isolated and characterized. This process led to the creation of 30 novel, functionally modified molecules that hold potential for further refinement. These results positively advocate the application of HTE-based machine learning to virtual reaction screening.

A self-supervised deep learning method for data-efficient training in genomics

Deep learning in bioinformatics is often limited to problems where extensive amounts of labeled data are available for supervised classification. By exploiting unlabeled data, self-supervised learning techniques can improve the performance of machine learning models in the presence of limited labeled data. Although many self-supervised learning methods have been suggested before, they have failed to exploit the unique characteristics of genomic data. Therefore, we introduce Self-GenomeNet, a self-supervised learning technique that is custom-tailored for genomic data. Self-GenomeNet leverages reverse-complement sequences and effectively learns short- and long-term dependencies by predicting targets of different lengths. Self-GenomeNet performs better than other self-supervised methods in data-scarce genomic tasks and outperforms standard supervised training with ~10 times fewer labeled training data. Furthermore, the learned representations generalize well to new datasets and tasks. These findings suggest that Self-GenomeNet is well suited for large-scale, unlabeled genomic datasets and could substantially improve the performance of genomic models.

Mass Balance of the IDO Inhibitor in Rats and Dogs: Unexpected Cyanide Release from Imidazo[5,1-a]isoindole and Species Differences in Glucuronidation

Navoximod (GDC-0919) is a small molecule inhibitor of indoleamine 2,3-dioxygenase 1 (IDO1), developed to reduce T cell immunosuppression associated with cancer. This study describes the absorption, metabolism, and excretion (AME) of navoximod in rats and dogs following a single oral dose of [¹⁴C]-navoximod. An unexpected thiocyanate metabolite M1 and a chiral inversion metabolite M51 were captured as the major circulating metabolites in rats, accounting for 30% and 18% of 0-24 hr exposure, respectively. These two metabolites combined had much lower systemic exposure in dogs and humans (<6% and <1%). The novel cyanide release is proposed to occur via 4,5-epoxidation on the fused imidazole ring, leading to ring opening and rearrangement along with the release of cyanide. The decyanated metabolites were identified and confirmed by synthetic standards, which supported the proposed mechanism. In dogs, glucuronidation to M19 was the major clearance mechanism, representing 59% of the dose in the bile of bile duct-cannulated (BDC) dogs and 19% of the dose in the urine of intact dogs. Additionally, M19 also represented 52% of drug related exposure in circulation in dogs. In comparison, in humans, navoximod was mainly cleared through glucuronidation to M28 and excreted in urine (60% of the dose). The differences in the metabolism and elimination observed in vivo were qualitatively recapitulated in vitro with liver microsomes, suspended hepatocytes and co-cultured primary hepatocytes. The striking species differences in regioselective glucuronidation is likely explained by the species differences in UGT1A9, which was mainly responsible for M28 formation in humans. Significance Statement The results from this study demonstrated significant species differences in metabolism (especially glucuronidation) and elimination of navoximod among rats, dogs, and humans. The study also illustrated the mechanism of a novel cyanide release metabolism from the fused imidazo[5,1-a]isoindole ring. Such biotransformation should be kept in mind when working with imidazole containing new chemical entities (NCE) in drug discovery and development.

Adverse impact of a high CD4/CD8 ratio in the allograft may be overcome by methotrexate- but not mycophenolate- or posttransplant cyclophosphamide-based graft versus host disease prophylaxis

INTRODUCTION

A high CD4/CD8 T cell ratio in hematopoietic stem cell transplant (HSCT) allografts was observed to predict graft-versus-host disease (GVHD) and non-relapse mortality (NRM) but has not been comparatively examined in settings of various GVHD-prophylaxis regimens.

METHODS

This retrospective monocentric study included all consecutive HSCT performed with peripheral blood stem cells (PBSC) between January 2000 and June 2021. The impact of the graft CD4/CD8 ratio was analyzed in three cohorts with different GVHD-prophylaxis platforms.

RESULTS

In the cyclosporine/mycophenolate-mofetil (CSA/MMF) cohort (n = 294, HLA-matched HSCT), a high (> 75^th percentile) CD4/CD8 ratio was associated with increased overall mortality (HR 1.56; P=0.01), increased NRM (HR 1.85; P=0.01) and GVHD-associated mortality (HR 2.13; P=0.005). In the post-transplant cyclophosphamide (PTCy)/tacrolimus/MMF cohort (n = 113, haploidentical-related or mismatched-unrelated HSCT), a high CD4/CD8 ratio was associated with increased overall mortality (HR 2.07; P=0.04) and aGVHD3-4 (HR 2.24; P=0.02). By contrast, in the CSA/methotrexate (CSA/MTX) cohort (n = 185, HLA-matched HSCT) the CD4/CD8 ratio had no significant impact on any of the investigated endpoints.

CONCLUSION

A high CD4/CD8 ratio in the allograft has an adverse impact on GVHD and survival in CSA/MMF- and PTCy-based HSCT, while MTX-based prophylaxis may largely alleviate this important risk factor.

Pre-activated antiviral innate immunity in the upper airways controls early SARS-CoV-2 infection in children

Children have reduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection rates and a substantially lower risk for developing severe coronavirus disease 2019 compared with adults. However, the molecular mechanisms underlying protection in younger age groups remain unknown. Here we characterize the single-cell transcriptional landscape in the upper airways of SARS-CoV-2-negative (n = 18) and age-matched SARS-CoV-2-positive (n = 24) children and corresponding samples from adults (n = 44), covering an age range of 4 weeks to 77 years. Children displayed higher basal expression of relevant pattern recognition receptors such as MDA5 (IFIH1) and RIG-I (DDX58) in upper airway epithelial cells, macrophages and dendritic cells, resulting in stronger innate antiviral responses upon SARS-CoV-2 infection than in adults. We further detected distinct immune cell subpopulations including KLRC1 (NKG2A)+ cytotoxic T cells and a CD8+ T cell population with a memory phenotype occurring predominantly in children. Our study provides evidence that the airway immune cells of children are primed for virus sensing, resulting in a stronger early innate antiviral response to SARS-CoV-2 infection than in adults.

Determining the impact of flow velocities on reactive processes associated with Enterococcus faecalis JH2-2

This study focuses on the impact of infiltration rates on colloidal transport and reactive processes associated with Enterococcus faecalis JH2-2 using water-saturated sediment columns. The infiltration rates influence the physical transport of bacteria by controlling the mean flow velocity. This, in turn, impacts biological processes in pore water owing to the higher or lower residence time of the bacteria in the column. In the present study, continuous injection of E. faecalis (suspended in saline water with varying conditions of dissolved oxygen and nutrient concentrations) into a lab-scale sediment column was performed at flow velocities of 0.02 cm min^-1 and 0.078 cm min^-1, i.e., at residence times of 1-5 hours. The impact of residence times on reactive processes is significant for field scale setups. A process-based model with a first-order rate coefficient for each biological process was fitted for each obtained condition-specific dataset from the experimental observations (breakthrough curves). The coefficients were converted to a dimensionless form to facilitate the comparison of biological processes. These results indicate that the processes of attachment and growth were flow-dependent. The growth process in the absence of dissolved oxygen was the most dominant process, with a Damkoehler number of approximately 48.

Biological and Physical Clogging in Infiltration Wells: Effects of Well Diameter and Gravel Pack

Gravity-driven infiltration into the shallow subsurface via small-diameter wells (SDWs), i.e., wells with an inner diameter smaller than 7.5 cm (3 inches) and no gravel pack) has proven to be a cost-efficient and flexible tool for managed aquifer recharge (MAR), as it provides relatively high recharge rates with minimal construction effort. SDWs have a significantly smaller open filter area than larger diameter wells with gravel pack, making the infiltration of low-quality waters through these wells more at risk clogging. To investigate their susceptibility for biological and physical clogging, 24 physical models with different well setups were evaluated by infiltrating either nutrient-poor but turbid water or nutrient-rich but clear water. The experiments showed that smaller diameters and the lack of a gravel pack increase the well's susceptibility to both kinds of clogging. However, this effect was observed to be much more pronounced for physical than for biological clogging. Our conclusion is that SDWs show severe disadvantages with respect to the infiltration of highly turbid waters in comparison to large diameter wells with a gravel pack. Nevertheless, this disadvantage is much less severe when it comes to the infiltration of clear but nutrient-rich waters (e.g., treated wastewater). Depending on the economic and geological circumstances of a MAR-project, this disadvantage could be outweighed by the significantly lower construction costs of SDWs.

Reactive-transport modelling of Enterococcus faecalis JH2-2 passage through water saturated sediment columns

The reuse of treated wastewater (e.g. for irrigation) is a common practice to combat water scarcity problems world-wide. However, the potential spread of opportunistic pathogens and fecal contaminants like Enterococci within the subsoil could pose serious health hazards. Additional sources (e.g., leaky sewer systems, livestock farming) aggravate this situation. This study contributes to an understanding of pathogen spread in the environment, using a combined modelling and experimental approach. The impact of quartz sediment and certain wastewater characteristics on the dissemination of Enterococcus faecalis JH2-2 is investigated. The transport processes of advection-dispersion and straining were studied by injecting conservative saline tracer and fluorescent microspheres through sediment packed columns, and evaluating resulting breakthrough curves using models. Similarly, simultaneously occurring reactive processes of microbial attachment, decay, respiration and growth were studied by injecting Enterococcus faecalis JH2-2 suspended in water with or without dissolved oxygen (DO) and nutrients through sediment, and evaluating resulting inlet and outlet concentration curves. The processes of straining, microbial decay and growth, were important when DO was absent. Irreversible attachment was important when DO was present. Sensitivity analysis of each parameter was conducted, and field scale behavior of the processes was predicted, to facilitate future work.

Identification and Preclinical Development of a 2,5,6-Trisubstituted Fluorinated Pyridine Derivative as a Radioligand for the Positron Emission Tomography Imaging of Cannabinoid Type 2 Receptors

Despite the broad implications of the cannabinoid type 2 receptor (CB2) in neuroinflammatory processes, a suitable CB2-targeted probe is currently lacking in clinical routine. In this work, we synthesized 15 fluorinated pyridine derivatives and tested their binding affinities toward CB2 and CB1. With a sub-nanomolar affinity (K_i for CB2) of 0.8 nM and a remarkable selectivity factor of >12,000 over CB1, RoSMA-18-d₆ exhibited outstanding in vitro performance characteristics and was radiofluorinated with an average radiochemical yield of 10.6 ± 3.8% (n = 16) and molar activities ranging from 52 to 65 GBq/μmol (radiochemical purity > 99%). [¹⁸F]RoSMA-18-d₆ showed exceptional CB2 attributes as demonstrated by in vitro autoradiography, ex vivo biodistribution, and positron emission tomography (PET). Further, [¹⁸F]RoSMA-18-d₆ was used to detect CB2 upregulation on postmortem human ALS spinal cord tissues. Overall, these results suggest that [¹⁸F]RoSMA-18-d₆ is a promising CB2 PET radioligand for clinical translation.

101 Dothideomycetes genomes: A test case for predicting lifestyles and emergence of pathogens

Dothideomycetes is the largest class of kingdom Fungi and comprises an incredible diversity of lifestyles, many of which have evolved multiple times. Plant pathogens represent a major ecological niche of the class Dothideomycetes and they are known to infect most major food crops and feedstocks for biomass and biofuel production. Studying the ecology and evolution of Dothideomycetes has significant implications for our fundamental understanding of fungal evolution, their adaptation to stress and host specificity, and practical implications with regard to the effects of climate change and on the food, feed, and livestock elements of the agro-economy. In this study, we present the first large-scale, whole-genome comparison of 101 Dothideomycetes introducing 55 newly sequenced species. The availability of whole-genome data produced a high-confidence phylogeny leading to reclassification of 25 organisms, provided a clearer picture of the relationships among the various families, and indicated that pathogenicity evolved multiple times within this class. We also identified gene family expansions and contractions across the Dothideomycetes phylogeny linked to ecological niches providing insights into genome evolution and adaptation across this group. Using machine-learning methods we classified fungi into lifestyle classes with >95 % accuracy and identified a small number of gene families that positively correlated with these distinctions. This can become a valuable tool for genome-based prediction of species lifestyle, especially for rarely seen and poorly studied species.

Collected Rain Water as Cost-Efficient Source for Aquifer Tracer Testing

Locally collected precipitation water can be actively used as a groundwater tracer solution based on four inherent tracer signals: electrical conductivity, stable isotopic signatures of deuterium [δ² H], oxygen-18 [δ¹⁸ O], and heat, which all may strongly differ from the corresponding background values in the tested groundwater. In hydrogeological practice, a tracer test is one of the most important methods for determining subsurface connections or field parameters, such as porosity, dispersivity, diffusion coefficient, groundwater flow velocity, or flow direction. A common problem is the choice of tracer and the corresponding permission by the appropriate authorities. This problem intensifies where tracer tests are conducted in vulnerable conservation or water protection areas (e.g., around drinking water wells). The use of (if required treated) precipitation as an elemental groundwater tracer is a practical solution for this problem, as it does not introduce foreign matters into the aquifer system, which may contribute positively to the permission delivery. Before tracer application, the natural variations of the participating end members' tracer signals have to be evaluated locally. To obtain a sufficient volume of tracer solution, precipitation can be collected as rain using a detached, large-scale rain collector, which will be independent from possibly existing surfaces like roofs or drained areas. The collected precipitation is then stored prior to a tracer experiment.

The fate of DNAPL contaminants in non-consolidated subsurface systems - Discussion on the relevance of effective source zone geometries for plume propagation

Dense non-aqueous phase liquids, i.e., DNAPLs and the evolving contaminant plumes in aquifers provide significant potential to pose hazards affecting both environment and human health. Therefore, a proper assessment of contaminant spreading within the subsurface is critical. This includes a sufficient characterization of governing parameters describing both the subsurface and the contaminant itself. Thereby, knowledge on the contaminant source zone and especially the source zone geometry, i.e., SZG is critically required, yet very uncertain. This study identifies current limitations and open research questions in the formation and shape determination of source zone geometry, as well as its relevance for contaminant plumes. Our literature review reveals that existing characterization methods are subject to data interpretation uncertainties, while the application of these methods on field scale is limited by technical demands and accompanied efforts. In a next step, methods to implement increased source zone information into calculation methods are discussed. By means of an exemplary application of selected assessment tools, i.e., plume response models, results clearly proof the relevance of SZGs for site assessment. However, existing plume response models consider over-simplified geometries that may compromise their suitability. Our findings identify the demand for improved characterization of complex SZGs and the need to better evaluate the dependency of DNAPL migration on system properties and external influences. With emphasized knowledge on the most relevant SZG features, the delineation of "effective" SZGs allowing for straightforward implementation into plume response models and an adaption of the latter to incorporate more information on SZGs should be possible.

Functionally Distinctive Ptch Receptors Establish Multimodal Hedgehog Signaling in the Tooth Epithelial Stem Cell Niche

Continuous growth of the mouse incisor teeth is due to the life-long maintenance of epithelial stem cells (SCs) in their niche called cervical loop (CL). Several signaling factors regulate SC maintenance and/or their differentiation to achieve organ homeostasis. Previous studies indicated that Hedgehog signaling is crucial for both the maintenance of the SCs in the niche, as well as for their differentiation. How Hedgehog signaling regulates these two opposing cellular behaviors within the confinement of the CL remains elusive. In this study, we used in vitro organ and cell cultures to pharmacologically attenuate Hedgehog signaling. We analyzed expression of various genes expressed in the SC niche to determine the effect of altered Hedgehog signaling on the cellular hierarchy within the niche. These genes include markers of SCs (Sox2 and Lgr5) and transit-amplifying cells (P-cadherin, Sonic Hedgehog, and Yap). Our results show that Hedgehog signaling is a critical survival factor for SCs in the niche, and that the architecture and the diversity of the SC niche are regulated by multiple Hedgehog ligands. We demonstrated the presence of an additional Hedgehog ligand, nerve-derived Desert Hedgehog, secreted in the proximity of the CL. In addition, we provide evidence that Hedgehog receptors Ptch1 and Ptch2 elicit independent responses, which enable multimodal Hedgehog signaling to simultaneously regulate SC maintenance and differentiation. Our study indicates that the cellular hierarchy in the continuously growing incisor is a result of complex interplay of two Hedgehog ligands with functionally distinct Ptch receptors. Stem Cells 2019;37:1238-1248.

Smile or die: Can subjective well-being increase survival in the face of substantive health impairments?

A robust relationship between subjective well-being and mortality has been established in the literature, but few studies address how subjective well-being interacts with the impact of concrete diseases on survival. In addition, issues of endogeneity between bad health and subjective well-being are ignored when it comes to survival. We assess both for the British Household Panel Survey (BHPS; 1991-2008) and specifically analyze whether subjective well-being predicts better chances of surviving diseases such as cancer or heart conditions. We find that several of the studied diseases consistently decrease survival chances in our sample (e.g. hazard ratio 3.47 for cancer), also when controlling for the severity of health problems. But our results do not suggest that well-being mitigates the effect these diseases have on mortality. Life satisfaction also does not predict longer survival in the data set if we control for the endogeneity of subjective well-being.

Behandlung der oberflächlichen Thrombophlebitis

Die oberflächliche Thrombophlebitis ist eine häufige Erkrankung, von der Frauen aufgrund ihrer Risikofaktoren stärker betroffen sind als Männer. Diagnostisch sollte eine eventuell gleichzeitig vorkommende tiefe Venenthrombose mit bildgebenden Verfahren abgegrenzt werden. In der Therapie sind Heparin bzw. niedermolekulare Heparine indiziert, wenn tiefe Venenthrombosen vorliegen bzw. ein Risiko hierfür besteht. Im akuten Stadium können nichtsteroidale Antiphlogistika oral genommen werden, um Schmerz und Entzündung zu lindern. Liegt gleichzeitig eine chronisch venöse Insuffizienz vor, unterstützen so genannte Ödemprotektiva (z.B. Rosskastaniensamenextrakt und flavonoidhaltige Präparate) die Behandlung.

Bei entzündlichen Veränderungen relativ kurzer oberflächlicher Venenabschnitte ohne Beteiligung des tiefen Venensystems ist die Beschränkung auf lokale Behandlungsmaßnahmen möglich. Neben der Kompressionstherapie sind mehrmalige tägliche Anwendungen heparin- und heparinoidhaltiger Salben bzw. Gele üblich.

Bewährt hat sich insbesondere die Anwendung von topischen Präparaten, die Mukopolysaccharidpolyschwefelsäureester (MPS) enthalten.

Die Problematik, die Wirksamkeit topischer Präparate bei der Behandlung der oberflächlichen Thrombophlebitis unter den gegenwärtig strengen Kautelen unserer Aufsichtsbehörde nachzuweisen und neue Produkte zu entwickeln, wird diskutiert.

Hypertrophic osteoarthropathy in a young adult male from Berber, Sudan (2nd-3rd century CE)

Hypertrophic osteoarthropathy (HOA) is a pathological condition characterised by extensive periosteal new bone formation (NBF) on the diaphyses of the long bones, metacarpal and metatarsal bones. In modern clinical contexts, the secondary form of the disease is common and most often occurs secondary to intra-thoracic cancer and other forms of chronic pulmonary disease. Paleopathological evidence for HOA on the other hand has only occasionally been reported. Here we report a young adult male from the Meriotic cemetery at Berber in Sudan (2nd-3rd century CE) displaying widespread NBF on the diaphyses of the upper and lower limb bones, metacarpal and metatarsal bones, as well as the pelvis and scapulae. While several pathological conditions have to be considered as differential diagnostic options for NBF in the post-cranial skeleton, HOA is the most likely diagnosis, based on the distribution of the changes observed in this individual, as well as their macroscopic and radiographic characteristics. A chronic pulmonary condition as indicated by NBF on the visceral side of the ribs may represent the underlying cause for the HOA. This individual represents the first paleopathological case of HOA reported from an archaeological site in Africa.

Metabolites of alectinib in human: their identification and pharmacological activity

Two metabolites (M4 and M1b) in plasma and four metabolites (M4, M6, M1a and M1b) in faeces were detected through the human ADME study following a single oral administration of [¹⁴C]alectinib, a small-molecule anaplastic lymphoma kinase inhibitor, to healthy subjects. In the present study, M1a and M1b, which chemical structures had not been identified prior to the human ADME study, were identified as isomers of a carboxylate metabolite oxidatively cleaved at the morpholine ring. In faeces, M4 and M1b were the main metabolites, which shows that the biotransformation to M4 and M1b represents two main metabolic pathways for alectinib. In plasma, M4 was a major metabolite and M1b was a minor metabolite. The contribution to in vivo pharmacological activity of these circulating metabolites was assessed from their in vitro pharmacological activity and plasma protein binding. M4 had a similar cancer cell growth inhibitory activity and plasma protein binding to that of alectinib, suggesting its contribution to the antitumor activity of alectinib, whereas the pharmacological activity of M1b was insignificant.

High-dose chemotherapy with autologous haematopoietic stem cell support for relapsed or refractory primary CNS lymphoma: a prospective multicentre trial by the German Cooperative PCNSL study group

To investigate safety and efficacy of high-dose chemotherapy followed by autologous stem cell transplantation (HCT-ASCT) in relapsed/refractory (r/r) primary central nervous system lymphoma (PCNSL), we conducted a single-arm multicentre study for immunocompetent patients (<66 years) with PCNSL failing high-dose methotrexate)-based chemotherapy. Induction consisted of two courses of rituximab (375 mg/m²), high-dose cytarabine (2 × 3 g/m²) and thiotepa (40 mg/m²) with collection of stem cells in between. Conditioning for HCT-ASCT consisted of rituximab 375 mg/m², carmustine 400 mg/m² and thiotepa (4 × 5 mg/kg). Patients commenced HCT-ASCT irrespective of response after induction. Patients not achieving complete remission (CR) after HCT-ASCT received whole-brain radiotherapy. Primary end point was CR after HCT-ASCT. We enrolled 39 patients; median age and Karnofsky performance score are 57 years and 90%, respectively. About 28 patients had relapsed and 8 refractory disease. About 22 patients responded to induction and 32 patients commenced HCT-ASCT. About 22 patients (56.4%) achieved CR after HCT-ASCT. Respective 2-year progression-free survival (PFS) and overall survival (OS) rates were 46.0% (median PFS 12.4 months) and 56.4%; median OS not reached. We recorded four treatment-related deaths. Thiotepa-based HCT-ASCT is an effective treatment option in eligible patients with r/r PCNSL. Comparative studies are needed to further scrutinise the role of HCT-ASCT in the salvage setting.

Oesophageal lichen planus: the efficacy of topical steroid-based therapies

BACKGROUND

Oesophageal lichen planus is an idiopathic inflammatory disorder characterized by significant oesophageal stricturing. Oesophageal lichen planus is a rare, difficult to diagnose, and likely an under recognized disease. As a result, there is no standardized approach to therapy and treatment strategies vary.

AIM

To examine the utility of topical steroid therapy (fluticasone or budesonide) in the management of oesophageal lichen planus.

METHODS

A retrospective chart review was conducted of patients diagnosed with oesophageal lichen planus who underwent baseline and follow up endoscopy pre and post topical steroid therapy between 1995 and 2016 at Mayo Clinic, Rochester MN. Average time between upper GI endoscopy was 3.2 months (0.7-11.7). Swallowed steroid preparations included fluticasone 880 μg twice daily or budesonide 3 mg twice daily. Patients were reviewed for symptomatic response to therapy using the Dakkak-Bennett dysphagia score (0-4, no dysphagia to total aphagia). Pre- and post-endoscopic findings were assessed. Additional baseline demographic, endoscopic, and histologic data were also obtained.

RESULTS

We identified 40 patients who met the inclusion criteria. A significant reduction in median dysphagia score from 1 (0-4) to 0 (0-3) after steroid therapy (P < 0.001) was noted. 62% of patients reported resolution of their dysphagia after receiving topical corticosteroids. 72.5% had an endoscopic response to steroid therapy.

CONCLUSION

Topical swallowed budesonide or fluticasone appear to effective treatment for oesophageal lichen planus.

A Straightforward Random Walk Model for Fast Push-Pull Tracer Test Evaluation

In this article, we present a straightforward random walk model for fast evaluation of push-pull tracer tests. By developing an adaptive algorithm, we overcome the problem of manually defining how many particles have to be used to simulate the transport problem. Beside this, we validate the random walk model by evaluating a push-pull tracer test with drift phase and confirm the results with MT3DMS. The random walk model took less than 1% of computational time of MT3DMS, thus allowing a remarkable faster evaluation of push-pull tracer tests.

fMRI Study of Sentence Generation by Early Bilinguals Differing in Proficiency Level

The aim of this study was to identify the functional anatomy of the cerebral speech regions involved in speaking in native and foreign language in the same subject using functional magnetic resonance imaging.

Experimental design consisted of two activation runs. Each of them included two kinds of tasks arranged in series of five blocks lasting for 30s. In the experimental condition of the first run subjects were required to speak in their native language and in the second run the task was to speak in the foreign language. In both runs, baseline condition was the same and subjects were supposed to lie silently inside the bore. We observed the influence of proficiency on brain activation. In subjects with equal proficiency in the first and the second language, differences were not observed. In the subjects with unequal proficiency in the first and the second language we observed two main effects.

First was difference in the strength and extension of activation, the second effect was activation of new regions for the second language, in which proficiency was lower.

Environmental impact of using specialty feed ingredients in swine and poultry production: A life cycle assessment

Livestock production has a variety of environmental impacts such as greenhouse gas emissions, water pollution, acidification, and primary energy consumption. The demand for livestock products is expected to grow substantially, creating even more environmental pressure. The use of specialty feed ingredients (SFI) such as supplemented AA and phytase can reduce nutrient input into the system without compromising productivity and consequently can reduce emissions. The global change impact of using SFI in pig and broiler production systems in Europe and North and South America was studied. A life cycle assessment according to international standards (ISO 14040/44) analyzed contributions from producing SFI and animals to global change. Three different alternatives were analyzed. In addition, partial sensitivity analysis was conducted using 5 scenarios for each region for both production systems. Specialty feed ingredient supplementation in pig and broiler diets reduced greenhouse gas emissions (cradle to farm gate) by 56% and 54% in Europe, 17% and 15% in North America, and 33% and 19% in South America, respectively, compared to an unsupplemented diet. A total of 136 Mt CO equivalent (CO eq) was saved in 2012, rising to 146 Mt CO eq in 2050 on the basis of United Nations population projections. Considerable benefits of supplementation with SFI were apparent in European and South American diets when direct land use change was considered because of the reduced demand for soybean meal. The eutrophication potential of unsupplemented diets was reduced by up to 35% in pig and 49% in broiler production systems compared to supplemented alternatives. The acidification potential of supplemented strategies was reduced by up to 30% in pig and 79% in broiler production systems. The primary energy demand was similar in all alternatives, and this could be an area where the SFI industry can improve. Overall, SFI supplementation substantially reduced the global warming, eutrophication, and acidification potentials in all regions studied.

Pharmacological insight into the anti-inflammatory activity of sesquiterpene lactones from Neurolaena lobata (L.) R.Br. ex Cass

PURPOSE

Neurolaena lobata is a Caribbean medicinal plant used for the treatment of several conditions including inflammation. Recent data regarding potent anti-inflammatory activity of the plant and isolated sesquiterpene lactones raised our interest in further pharmacological studies. The present work aimed at providing a mechanistic insight into the anti-inflammatory activity of N. lobata and eight isolated sesquiterpene lactones, as well as a structure-activity relationship and in vivo anti-inflammatory data.

METHODS

The effect of the extract and its compounds on the generation of pro-inflammatory proteins was assessed in vitro in endothelial and monocytic cells by enzyme-linked immunosorbent assay. Their potential to modulate the expression of inflammatory genes was further studied at the mRNA level. In vivo anti-inflammatory activity of the chemically characterized extract was evaluated using carrageenan-induced paw edema model in rats.

RESULTS

The compounds and extract inhibited LPS- and TNF-α-induced upregulation of the pro-inflammatory molecules E-selectin and interleukin-8 in HUVECtert and THP-1 cells. LPS-induced elevation of mRNA encoding for E-selectin and interleukin-8 was also suppressed. Furthermore, the extract inhibited the development of acute inflammation in rats.

CONCLUSIONS

Sesquiterpene lactones from N. lobata interfered with the induction of inflammatory cell adhesion molecules and chemokines in cells stimulated with bacterial products and cytokines. Structure-activity analysis revealed the importance of the double bond at C-4-C-5 and C-2-C-3 and the acetyl group at C-9 for the anti-inflammatory activity. The effect was confirmed in vivo, which raises further interest in the therapeutic potential of the compounds for the treatment of inflammatory diseases.

Role of Growth arrest-specific gene 6-Mer axis in multiple myeloma

Multiple myeloma is a mostly incurable malignancy characterized by the expansion of a malignant plasma cell (PC) clone in the human bone marrow (BM). Myeloma cells closely interact with the BM stroma, which secretes soluble factors that foster myeloma progression and therapy resistance. Growth arrest-specific gene 6 (Gas6) is produced by BM-derived stroma cells and can promote malignancy. However, the role of Gas6 and its receptors Axl, Tyro3 and Mer (TAM receptors) in myeloma is unknown. We therefore investigated their expression in myeloma cell lines and in the BM of myeloma patients and healthy donors. Gas6 showed increased expression in sorted BMPCs of myeloma patients compared with healthy controls. The fraction of Mer(+) BMPCs was increased in myeloma patients in comparison with healthy controls whereas Axl and Tyro3 were not expressed by BMPCs in the majority of patients. Downregulation of Gas6 and Mer inhibited the proliferation of different myeloma cell lines, whereas knocking down Axl or Tyro3 had no effect. Inhibition of the Gas6 receptor Mer or therapeutic targeting of Gas6 by warfarin reduced myeloma burden and improved survival in a systemic model of myeloma. Thus, the Gas6-Mer axis represents a novel candidate for therapeutic intervention in this incurable malignancy.

Resilience in patients and spouses faced with malignant melanoma. A qualitative longitudinal study

Life-threatening diseases like malignant tumours are associated with considerable existential distress. Little is known about the factors that promote resilience within these individuals. This longitudinal qualitative partner study aimed to analyse resilience as per Antonovsky's sense of coherence. Eight patients with malignant melanoma and their partners were interviewed. They were asked about their coping strategies, attitudes towards the meaning of life and their cancer, and comprehension of what is happening to them. The questions were asked shortly after their diagnosis was made and 6 months later. All interviews were audio-taped and later transcribed and analysed according to the method of qualitative content analysis described by P. Mayring. At baseline, the majority of statements made (261; patients = 141/spouses = 120) related to coping/manageability of disease, with only 26 statements (patients = 15/spouses = 11) related to meaning and 127 (patients = 64/spouses = 63) to comprehension. There were no significant differences between the responses of patients and their partners and no significant changes in the number of statements during the 6-month interview. The most significant theme that emerged was manageability of disease, with distraction the most commonly utilised coping skill. The comprehension and meaning themes were far less prevalent. Hence, support should focus on disease and situational manageability.

Alternaria redefined

Alternaria is a ubiquitous fungal genus that includes saprobic, endophytic and pathogenic species associated with a wide variety of substrates. In recent years, DNA-based studies revealed multiple non-monophyletic genera within the Alternaria complex, and Alternaria species clades that do not always correlate to species-groups based on morphological characteristics. The Alternaria complex currently comprises nine genera and eight Alternaria sections. The aim of this study was to delineate phylogenetic lineages within Alternaria and allied genera based on nucleotide sequence data of parts of the 18S nrDNA, 28S nrDNA, ITS, GAPDH, RPB2 and TEF1-alpha gene regions. Our data reveal a Pleospora/Stemphylium clade sister to Embellisia annulata, and a well-supported Alternaria clade. The Alternaria clade contains 24 internal clades and six monotypic lineages, the assemblage of which we recognise as Alternaria. This puts the genera Allewia, Brachycladium, Chalastospora, Chmelia, Crivellia, Embellisia, Lewia, Nimbya, Sinomyces, Teretispora, Ulocladium, Undifilum and Ybotromyces in synonymy with Alternaria. In this study, we treat the 24 internal clades in the Alternaria complex as sections, which is a continuation of a recent proposal for the taxonomic treatment of lineages in Alternaria. Embellisia annulata is synonymised with Dendryphiella salina, and together with Dendryphiella arenariae, are placed in the new genus Paradendryphiella. The sexual genera Clathrospora and Comoclathris, which were previously associated with Alternaria, cluster within the Pleosporaceae, outside Alternaria s. str., whereas Alternariaster, a genus formerly seen as part of Alternaria, clusters within the Leptosphaeriaceae. Paradendryphiella is newly described, the generic circumscription of Alternaria is emended, and 32 new combinations and 10 new names are proposed. A further 10 names are resurrected, while descriptions are provided for 16 new Alternaria sections.

"I'm afraid I have bad news for you…" Estimating the impact of different health impairments on subjective well-being

Bad health decreases individuals' happiness, but few studies measure the impact of specific illnesses. We apply matching estimators to examine how changes in different (objective) conditions of bad health affect subjective well-being for a sample of 100,265 observations from the British Household Panel Survey (BHPS) database (1996-2006). The strongest effect is for alcohol and drug abuse, followed by anxiety, depression and other mental illnesses, stroke and cancer. Adaptation to health impairments varies across health impairments. There is also a puzzling asymmetry: strong adverse reactions to deteriorations in health appear alongside weak increases in well-being after health improvements. In conclusion, our analysis offers a more detailed account of how bad health influences happiness than accounts focusing on how bad self-assessed health affects individual well-being.

Electrophysiological correlates of attentional processes in patients with liver cirrhosis without minimal or clinically-overt hepatic encephalopathy

Liver cirrhosis is often accompanied by a spectrum of cognitive deficits, labelled hepatic encephalopathy (HE). The precise specification of cognitive impairment associated with HE has not been yet elucidated. The aim of this study was an attempt to examine cortical function in cirrhotic patients using EEG event-related potentials during a demanding task involving selective attention. We compared group of 30 patients with liver cirrhosis without minimal or overt HE with education-, age- and sex-matched 29 non-cirrhotic controls. Both groups performed an attentional blink (AB) task, which requires detecting and identifying two target characters in a longer series of rapidly and sequentially presented characters. EEG signals from 32 electrodes were measured and then analyzed in the paradigm of event-related potentials (ERP). Though the groups did not differ in the detection rate of the target stimuli, ERP waveforms revealed two group differences of component amplitudes. The first difference was related to the waveform amplitude within the 200-400 ms after first target in the right frontal region (frontocentral N2 component). Moreover, in patient group this amplitude positively correlated with the blood plasma level of alkaline phosphatase and gamma-glutamyl transpeptidase. The second amplitude difference was observed in the midline parieto-occipital regions within the 400-600 ms after the first target (P3b component). The AB task and ERP analysis allowed to find differences in cortical functioning in cirrhotic patients even without overt cognitive deficits. Our finding demonstrates that liver dysfunction can influence cortical processing associated with detecting and categorizing stimulus change.

Cognitive evoked response potentials in patients with liver cirrhosis without diagnosis of minimal or overt hepatic encephalopathy. A pilot study

Liver cirrhosis is often accompanied by cognitive deficits called minimal hepatic encephalopathy (MHE) when it is observed to a moderate extent. In the present study, brain activity and cognitive functioning were examined in patients with liver cirrhosis without MHE or overt clinical hepatic encephalopathy. A battery of neuropsychological tests and event related potentials (ERPs) were used. Moreover, an additional n-back task was administered with two difficulty levels (1- and 2-back). This task was designed to engage cognitive processes of storage and manipulation of information in working memory. The participants have to decide whether the letter shown was the same as a target (congruence condition). No significant differences were found in the performance of either the neuropsychological tests or the n-back task. However, the expected effects of decreased performance as well as a decrease in P3 amplitude with difficulty level were identified. The interaction of group x congruence condition was also observed in the P2 component time window. These results may indicate group differences manifesting in early stages of information processing in working memory. It confirms that the patients whose neuropsychological performance is within the normal range can still reveal subtle changes in CNS functioning visible in ERP research. The study confirms the usability of the ERP method in diagnosis of neurocognitive functions in patients with liver cirrhosis, which seems to be more sensitive than neuropsychological tests.

Rituximab monotherapy for primary cutaneous B-cell lymphoma: response and follow-up in 16 patients

BACKGROUND

We have carried out a retrospective analysis to evaluate the therapeutic value of the anti-CD20 antibody rituximab in 16 consecutive patients with primary cutaneous CD20+ B-cell lymphomas.

PATIENTS AND METHODS

Sixteen patients (4 females, 12 males) with a median age of 54 years received systemic therapy with rituximab 375 mg/m(2) once weekly for four or six consecutive weeks. Eleven patients had primary cutaneous follicle center cell lymphoma and five patients had a primary cutaneous marginal zone B-cell lymphoma.

RESULTS

Of the 16 patients with PCBCL, 14 patients (87.5%) achieved complete remission (CR). In two patients, partial remission was obtained and additional focal radiotherapy was applied, which resulted in final CR. Five to 14 (35%) patients with CR relapsed, in an interval between 6 and 37 months. There were no severe side-effects.

CONCLUSIONS

On the basis of our results, single-agent treatment with i.v. rituximab appears to be feasible and safe and results in a high rate of durable remissions. Judging from our data, it appears to be an attractive treatment option and should be directly compared with local radiotherapy.

[An unusual cause of severe abdominal pain]

A 33-year-old previously healthy man was admitted to the hospital with a 6-day history of diffuse abdominal pain and constipation. He was afebrile, looked unwell with a pale skin and displayed an elevated blood pressure. He had no peritoneal sign, and bowel sounds were normal. Blood tests were remarkable for a hematocrit of 26 % and mean cell volume of 83 fl, bilirubin levels were slightly elevated. Abdominal radiographs, abdominal ultrasound and computed tomography showed stool throughout the colon with a non-specific bowel gas pattern. Moreover, colonoscopy and gastroscopy provided no information on the underlying cause of the patient's severe pain. He was treated with fluids and spasmolytic drugs until the result of the urinary porphyrin level was received, which showed an elevated concentration of 1608 microg/d. Consequently, the plasma lead concentration was determined showing an elevated level of 92.3 microg/d. The examination of blood slides revealed erythrocytes with basophile stippling. On physical examination, a bluish discoloration could be seen along the gums. After starting the detoxication therapy with DMPS - 1800 mg p. o. for the first two days followed by 600 mg DMPS daily - the complaints disappeared. In spite of an extensive anamnestic exploration the source of the lead intoxication could not be found until now.