Survival and response to pulmonary vasodilator therapies in patients with chronic obstructive pulmonary disease and pulmonary vascular phenotype

BACKGROUND

The aim of the study was to describe and investigate the effect of pulmonary arterial hypertension (PAH) therapies in a cohort of patients with severe precapillary pulmonary hypertension (PH) associated with chronic obstructive pulmonary disease (COPD; PH-COPD), and to assess factors predictive of treatment response and mortality.

MATERIAL AND METHODS

We retrospectively included patients with severe incident PH-COPD who received PAH therapy and underwent RHC at diagnosis and on treatment.

RESULTS

From 2015 to 2022, 35 severe PH-COPD patients, with clinical features of pulmonary vascular phenotype, were included. Seventeen (48.5%) patients were treated with combined PAH therapy. PAH therapy led to a significant improvement in hemodynamics (PVR -3.5 Wood Units (-39.3%); p < 0.0001), and in the simplified four-strata risk-assessment score, which improved by at least one category in 21 (60%) patients. This effect was more pronounced in patients on dual therapy. Kaplan-Meier estimated survival rates at 1, 3 and 5 years were 94%, 65% and 42% respectively. Univariate analysis showed a significant reduction in survival in patients with a higher simplified risk score at follow-up (Hazard ratio (HR) 2.88 [1.16-7.15]; p = 0.02). Hypoxemia <50 mmHg was correlated to mortality in multivariate analysis (HR 4.33 [1.08-17.42]; p = 0.04).

CONCLUSIONS

Our study confirms the poor prognosis of patients with COPD and a pulmonary vascular phenotype and the potential interest of combined PAH therapy in this population, with good tolerability and greater clinical and hemodynamic improvement than monotherapy. Using the simplified risk score during follow-up could be of interest in this population.

Collective Excitations of Exciton-Polariton Condensates in a Synthetic Gauge Field

Collective (elementary) excitations of quantum bosonic condensates, including condensates of exciton polaritons in semiconductor microcavities, are a sensitive probe of interparticle interactions. In anisotropic microcavities with momentum-dependent transverse-electric-transverse-magnetic splitting of the optical modes, the excitations' dispersions are predicted to be strongly anisotropic, which is a consequence of the synthetic magnetic gauge field of the cavity, as well as the interplay between different interaction strengths for polaritons in the singlet and triplet spin configurations. Here, by directly measuring the dispersion of the collective excitations in a high-density optically trapped exciton-polariton condensate, we observe excellent agreement with the theoretical predictions for spinor polariton excitations. We extract the interaction constants for polaritons of the same and opposite spin and map out the characteristic spin textures in an interacting spinor condensate of exciton polaritons.

Low-Energy Collective Oscillations and Bogoliubov Sound in an Exciton-Polariton Condensate

We report the observation of low-energy, low-momenta collective oscillations of an exciton-polariton condensate in a round "box" trap. The oscillations are dominated by the dipole and breathing modes, and the ratio of the frequencies of the two modes is consistent with that of a weakly interacting two-dimensional trapped Bose gas. The speed of sound extracted from the dipole oscillation frequency is smaller than the Bogoliubov sound, which can be partly explained by the influence of the incoherent reservoir. These results pave the way for understanding the effects of reservoir, dissipation, energy relaxation, and finite temperature on the superfluid properties of exciton-polariton condensates and other two-dimensional open-dissipative quantum fluids.

Chiral Modes at Exceptional Points in Exciton-Polariton Quantum Fluids

We demonstrate the generation of chiral modes-vortex flows with fixed handedness in exciton-polariton quantum fluids. The chiral modes arise in the vicinity of exceptional points (non-Hermitian spectral degeneracies) in an optically induced resonator for exciton polaritons. In particular, a vortex is generated by driving two dipole modes of the non-Hermitian ring resonator into degeneracy. Transition through the exceptional point in the space of the system's parameters is enabled by precise manipulation of real and imaginary parts of the closed-wall potential forming the resonator. As the system is driven to the vicinity of the exceptional point, we observe the formation of a vortex state with a fixed orbital angular momentum (topological charge). This method can be extended to generate higher-order orbital angular momentum states through coalescence of multiple non-Hermitian spectral degeneracies. Our Letter demonstrates the possibility of exploiting nontrivial and counterintuitive properties of waves near exceptional points in macroscopic quantum systems.

Fast-track development of an in vitro 3D lung/immune cell model to study Aspergillus infections

To study interactions of airborne pathogens, e.g. Aspergillus (A.) fumigatus with upper and lower respiratory tract epithelial and immune cells, we set up a perfused 3D human bronchial and small airway epithelial cell system. Culturing of normal human bronchial or small airway epithelial (NHBE, SAE) cells under air liquid interphase (ALI) and perfusion resulted in a significantly accelerated development of the lung epithelia associated with higher ciliogenesis, cilia movement, mucus-production and improved barrier function compared to growth under static conditions. Following the accelerated differentiation under perfusion, epithelial cells were transferred into static conditions and antigen-presenting cells (APCs) added to study their functionality upon infection with A. fumigatus. Fungi were efficiently sensed by apically applied macrophages or basolaterally adhered dendritic cells (DCs), as illustrated by phagocytosis, maturation and migration characteristics. We illustrate here that perfusion greatly improves differentiation of primary epithelial cells in vitro, which enables fast-track addition of primary immune cells and significant shortening of experimental procedures. Additionally, co-cultured primary DCs and macrophages were fully functional and fulfilled their tasks of sensing and sampling fungal pathogens present at the apical surface of epithelial cells, thereby promoting novel possibilities to study airborne infections under conditions mimicking the in vivo situation.

Systemic review: the pathogenesis and pharmacological treatment of hiccups

BACKGROUND

Hiccups are familiar to everyone, but remain poorly understood. Acute hiccups can often be terminated by physical manoeuvres. In contrast, persistent and intractable hiccups that continue for days or months are rare, but can be distressing and difficult to treat.

AIM

To review the management of hiccups, including a systematic review of reported efficacy and safety of pharmacological treatments.

METHODS

Available articles were identified using three electronic databases in addition to hand searching of published articles. Inclusion criteria were any reports of pharmaceutical therapy of 'hiccup(s)', 'hiccough(s)' or 'singultus' in English or German.

RESULTS

Treatment of 341 patients with persistent or intractable hiccups was reported in 15 published studies. Management was most effective when directed at the underlying condition. An empirical trial of anti-reflux therapy may be appropriate. If the underlying cause is not known or not treatable, then a range of pharmacological agents may provide benefit; however, systematic review revealed no adequately powered, well-designed trials of treatment. The use of baclofen and metoclopramide are supported by small randomised, placebo-controlled trials. Observational data suggest that gabapentin and chlorpromazine are also effective. Baclofen and gabapentin are less likely than standard neuroleptic agents to cause side effects during long-term therapy.

CONCLUSIONS

This systematic review revealed no high quality data on which to base treatment recommendations. Based on limited efficacy and safety data, baclofen and gabapentin may be considered as first line therapy for persistent and intractable hiccups, with metoclopramide and chlorpromazine in reserve.

Quantum information storage for over 180 s using donor spins in a 28Si "semiconductor vacuum"

A quantum computer requires systems that are isolated from their environment, but can be integrated into devices, and whose states can be measured with high accuracy. Nuclear spins in solids promise long coherence lifetimes, but they are difficult to initialize into known states and to detect with high sensitivity. We show how the distinctive optical properties of enriched (28)Si enable the use of hyperfine-resolved optical transitions, as previously applied to great effect for isolated atoms and ions in vacuum. Together with efficient Auger photoionization, these resolved hyperfine transitions permit rapid nuclear hyperpolarization and electrical spin-readout. We combine these techniques to detect nuclear magnetic resonance from dilute (31)P in the purest available sample of (28)Si, at concentrations inaccessible to conventional measurements, measuring a solid-state coherence time of over 180 seconds.

Hyperfine structure and nuclear hyperpolarization observed in the bound exciton luminescence of Bi donors in natural Si

As the deepest group-V donor in Si, Bi has by far the largest hyperfine interaction and also a large I = 9/2 nuclear spin. At zero field this splits the donor ground state into states having total spin 5 and 4, which are fully resolved in the photoluminescence spectrum of Bi donor bound excitons. Under a magnetic field, the 60 expected allowed transitions cannot be individually resolved, but the effects of the nuclear spin distribution, -9/2 < or = I(z) < or = 9/2, are clearly observed. A strong hyperpolarization of the nuclear spin towards I(z) = -9/2 is observed to result from the nonresonant optical excitation. This is very similar to the recently reported optical hyperpolarization of P donors observed by EPR at higher magnetic fields. We introduce a new model to explain this effect, and predict that it may be very fast.

Simultaneous subsecond hyperpolarization of the nuclear and electron spins of phosphorus in silicon by optical pumping of exciton transitions

We demonstrate a method which can hyperpolarize both the electron and nuclear spins of 31P donors in Si at low field, where both would be essentially unpolarized in equilibrium. It is based on the selective ionization of donors in a specific hyperfine state by optically pumping donor bound exciton hyperfine transitions, which can be spectrally resolved in 28Si. Electron and nuclear polarizations of 90% and 76%, respectively, are obtained in less than a second, providing an initialization mechanism for qubits based on these spins, and enabling further ESR and NMR studies on dilute 31P in 28Si.

Reduction of the linewidths of deep luminescence centers in 28Si reveals fingerprints of the isotope constituents

Dramatic reductions of the linewidths of well-known deep centers in 28Si reveal "isotopic fingerprints" of the constituents. The approximately 1014 meV Cu center, thought to be either a Cu pair or an isolated Cu, is shown to contain four Cu atoms, and the approximately 780 meV Ag center is shown to contain four Ag. The approximately 944 meV ;{*}Cu center, thought to be a different configuration of a Cu pair, in fact contains three Cu and one Ag, and a new two-Cu two-Ag center is found. The approximately 735 meV center, previously assigned to Fe, actually contains Au and three Cu. This suggests a family of four-atom (Cu, Ag, Au) centers.

Optical detection and ionization of donors in specific electronic and nuclear spin States

We resolve the remarkably sharp bound exciton transitions of highly enriched 28Si using a single-frequency laser and photoluminescence excitation spectroscopy, as well as photocurrent spectroscopy. Well-resolved doublets in the spectrum of the 31P donor reflect the hyperfine coupling of the electronic and nuclear donor spins. The optical detection of the nuclear spin state, and selective pumping and ionization of donors in specific electronic and nuclear spin states, suggests a number of new possibilities which could be useful for the realization of silicon-based quantum computers.

Solid- and solution-phase synthesis of highly-substituted-pyrrolidine libraries

Starting from a complex bicyclic beta-lactam scaffold we have demonstrated the possible production of libraries of a new class of drug-like, highly substituted pyrrolidines. The choice of the type of substitution was made by optimizing various synthetic routes. The selection of each compound is the result of a filtration of a large virtual combinatorial chemical space, using simple criteria. The access to these complex pyrrolidines needed only four to six synthetic steps.

Docetaxel for patients with paclitaxel-resistant Müllerian carcinoma

PURPOSE

To determine the efficacy and toxicity of docetaxel in patients with müllerian carcinoma resistant to paclitaxel.

PATIENTS AND METHODS

Thirty-two patients with epithelial ovarian cancer, fallopian tube cancer, or primary peritoneal cancer who failed paclitaxel-based chemotherapy received either 100 or 75 mg/m(2) of docetaxel every 3 weeks. Resistance to paclitaxel was defined as either progression of disease during treatment, failure to achieve regression of disease after at least four courses, or rapid recurrence (within 6 months) after completion of therapy.

RESULTS

Eighteen patients were treated on a formal protocol and fourteen with the commercially available docetaxel. Thirty were assessable for response. Toxicities were thoroughly evaluated in the 18 patients on protocol. Twenty-seven patients (85%) had epithelial ovarian cancer. The overall response rate was 23% (one complete and six partial responses), with a median survival time of 44 weeks (9.5 months). Nine patients had stable disease and 14 progressive disease. Among 19 patients who progressed during prior paclitaxel treatment, two (11%) responded to docetaxel, compared with five (45%) of 11 patients in other paclitaxel-resistance categories. The responders had a median taxane-free interval (ie, the time between the last paclitaxel and first docetaxel treatment) of 73 weeks, compared with 19 weeks for the nonresponder group. Toxic effects were as expected.

CONCLUSION

Docetaxel is an active chemotherapeutic agent in patients with müllerian carcinoma previously treated with paclitaxel-based chemotherapy, especially in the patients who had a long taxane-free interval after a previous short response to paclitaxel.

A phase II clinical and pharmacological study of oral 9-nitrocamptothecin in patients with refractory epithelial ovarian, tubal or peritoneal cancer

9-Nitrocamptothecin (9-NC) is a water-insoluble topoisomerase I inhibitor with a broad antitumor activity in animal models. A phase II study was performed in patients with heavily refractory ovarian, tubal or peritoneal cancer (median number of previous chemotherapy regimens > 3) to determine the activity of a daily oral dose of 9-NC. 9-NC dose was 1.5 mg/m2/day for four consecutive days every week. Increments of 0.25 mg/day were authorized in patients without significant side effects. Of 29 evaluable patients, a 7% remission rate was observed. Thirty-four percent of patients had stable disease. The median survival was 8 months. Toxicity was evaluated in 31 patients. Grade 3 or 4 hematologic toxicity consisted of anemia in 10 patients (32%), neutropenia in eight (26%) and thrombocytopenia in three (10%). Grade > or = 2 non-hematologic toxic effects were nausea and vomiting in 26 (84%), diarrhea in 12 (39%), weight loss in seven (22%), chemical cystitis in six (19%) and neutropenic sepsis in six (19%). 9-NC was tolerated for sustained periods of time in some patients (up to 47 weeks). The observed 8-month survival in such a refractory patient population is noteworthy. Further clinical research of prolonged exposure to less toxic analogs of 9-NC is warranted.

T-lymphocyte long-term cultures have a constant histone variant pattern during aging

Human peripheral long-term T-lymphocyte cell cultures show some characteristics similar to those of fibroblast cell lines, the latter of which have been used as in vitro systems for cellular aging studies for many years. Both show a limited in vitro life span, as well as a progressive prolongation of their cell cycle with increasing age. However, whereas T-cell cultures die from apoptosis at the end of their proliferative capacity, fibroblasts can be maintained for long periods of time in stationary cultures as postmitotic senescent cells. Previous studies analyzing the histone variant pattern of a human lung embryonic fibroblast cell line have shown that this pattern changes as a function of cumulative population doublings in a manner not unlike that found in terminally differentiating systems. In the present study the histone variant composition of long-term T-cell cultures was analyzed as a function of population doublings and compared to a human diploid fibroblast system. The results from this study provide a distinction at the molecular level among these two in vitro aging model systems, because it was found that long-term T-cell cultures show a constant histone variant constitution throughout their in vitro life, dissimilar to previous findings using the fibroblast cell system.

A phase I study of TNP-470 administered to patients with advanced squamous cell cancer of the cervix

A Phase I study of the novel angiogenesis inhibitor TNP-470 was performed. Patients with inoperable recurring or metastatic squamous cell cancer of the cervix with evaluable disease, no coagulopathy, and adequate renal, hepatic, and hematological function were eligible. One course of treatment consisted of an i.v. infusion of TNP-470 over 60 min every other day for 28 days, followed by a 14-day rest period. The starting dose was 9.3 mg/m2. Eighteen evaluable patients were treated, with a median age of 48 years (range 27-55) and performance status Zubrod 1 (range 0-2). Grade 3 neurotoxicities consisting of weakness, nystagmus, diplopia, and ataxia were encountered in two patients receiving the 71.2 mg/m2 dose. An intermediate dose level of 60 mg/m2 was evaluated and found to be well tolerated by three patients. Only one patient experienced grade 3 nausea on the 60 mg/m2 dose level. No myelosuppression, retinal hemorrhage, weight loss, or significant alopecia were observed. One patient had a complete response, which continues for 26 months, and three patients with initially progressive disease stage had stable disease for 5, 7.7, and 19+ months. Other Phase I studies, including over 200 patients, were performed concurrently with this study. Based on this experience, the dose of TNP-470 recommended for further studies is 60 mg/m2 as a 60-min i.v. infusion every Monday, Wednesday, and Friday. Neurotoxicity was dose limiting, but appears to be reversible. Otherwise, the treatment was well tolerated. The drug may be active in squamous cell cancer of the cervix. Further studies of TNP-470 in squamous cell cancer of the cervix are warranted.

Phase II study of irinotecan in prior chemotherapy-treated squamous cell carcinoma of the cervix

PURPOSE

A phase II study was performed to evaluate the antitumor activity and toxicity of irinotecan (CPT-11), a water-soluble derivative of camptothecin, in patients with prior chemotherapy-treated squamous cell cancer of the cervix.

PATIENTS AND METHODS

Forty-two patients were included in the study. The median age was 44 years (range, 24 to 59 years). The median Zubrod performance status was 1. All patients were refractory to first-line chemotherapy and 88% had received prior radiotherapy. The initial dose of CPT-11 was 125 mg/m2 given as a weekly 90-minute intravenous infusion for 4 weeks, every 6 weeks. Subsequent doses were unchanged, reduced, or omitted according to toxicity grade.

RESULTS

Forty-two patients were assessable for response. The overall response rate was 21%. The median time to response was 6 weeks and the median duration of response was 12 weeks. The overall median duration of survival was 6.4 months. A statistically significant survival advantage (median of 12.6 v 5.1 months) was found in patients whose disease responded to the treatment (P < .015). The major dose-limiting toxic effects (grade > or = 3) were nausea and vomiting (45%), diarrhea (24%), and granulocytopenia (36%). Grade > or = 3 anemia was encountered in 62% of patients and the incidence of thrombocytopenia was negligible. Less severe side effects were alopecia (48%), drug fever (43%), anorexia (33%), fatigue (33%), skin rash (21%), stomatitis (14%), and allergic reaction (9%). The gastrointestinal intolerance was dose-related. The incidence of bone marrow depression did not decrease with dose reduction, possibly because of a cumulative effect or hematologic intolerance by a subset of patients.

CONCLUSIONS

CPT-11 has significant activity in refractory cervical carcinoma. Gastrointestinal intolerance and hematologic toxicity must be monitored carefully. Further studies of alternative schedules may improve the tolerance and response rate.

Preliminary report of the activity of docetaxel in advanced or recurrent squamous cell cancer of the cervix

Eighteen patients with squamous cell cancer of the cervix were treated with i.v. docetaxel 100 mg/m2 over 1 h every 21 days. No patient received prior chemotherapy, except as a radiation sensitizer. Median age was 42 years (range 30-58) and Zubrod performance status was 1 (0-2). Ten (59%) patients had prior surgery and 11 (65%) had prior radiation therapy. Sixteen patients were evaluable for response. Two patients had a partial response (13%; 95% CI 0-32%) and eight (50%; 95% CI 23-77%) had stable disease. Dose reduction to 75 mg/m2 was required in 10 patients and to 55 mg/m2 in one patient. Granulocytopenia was the major hematopoietic toxicity (31% grade 3 and 44% grade 4). Docetaxel is active in patients with squamous cell cancer of the cervix and may be tolerable at this dose schedule.

[Recurrent renal vein thrombosis in a premature infant. Doppler ultrasound diagnosis and follow-up]

Renal vein thrombosis (RVT) is a rare disorder in neonates. Early diagnosis is mandatory since immediate thrombolytic therapy favours prognosis. Our case report describes RVT demonstrated by Duplex Doppler Ultrasound. A possibly characteristic sequence of changes in the echogenicity of the renal parenchyma and in the Duplex Doppler flow pattern of the renal arteries could be found.