Serine metabolism is crucial for cGAS-STING signaling and viral defense control in the gut

Inflammatory bowel diseases are characterized by the chronic relapsing inflammation of the gastrointestinal tract. While the molecular causality between endoplasmic reticulum (ER) stress and intestinal inflammation is widely accepted, the metabolic consequences of chronic ER stress on the pathophysiology of IBD remain unclear. By using in vitro, in vivo models, and patient datasets, we identified a distinct polarization of the mitochondrial one-carbon metabolism and a fine-tuning of the amino acid uptake in intestinal epithelial cells tailored to support GSH and NADPH metabolism upon ER stress. This metabolic phenotype strongly correlates with IBD severity and therapy response. Mechanistically, we uncover that both chronic ER stress and serine limitation disrupt cGAS-STING signaling, impairing the epithelial response against viral and bacterial infection and fueling experimental enteritis. Consequently, the antioxidant treatment restores STING function and virus control. Collectively, our data highlight the importance of serine metabolism to allow proper cGAS-STING signaling and innate immune responses upon gut inflammation.

Telomerase RNA component lncRNA as potential diagnostic biomarker promotes CRC cellular migration and apoptosis evasion via modulation of β-catenin protein level

Aim

Long non-coding RNA (LncRNA) telomerase RNA component (TERC) has telomerase-dependent and independent activity in numerous cancer types. The present study purposes to demonstrate the role of lncRNA TERC as a diagnostic serum biomarker in colorectal cancer (CRC) patients and the molecular mechanism of lncRNA TERC in inducing tumor in CRC cell lines.

Materials and methods

PCR array was performed to examine lncRNAs dysregulated in CRC. LncRNA TERC expression level was evaluated in 70 CRC patients and 35 control subjects using RT-qPCR. Then transfection was performed to build down-expression models of lncRNA TERC. ROC curve analysis was applied to assess the diagnostic value of serum LncRNA CRC. In addition, RT-qPCR was used to detect expression level of lncRNA TERC and β-catenin mRNA. Moreover, ELISA and Western blot were used to detect the level of β-catenin protein in sera of CRC patients and cell lines. The biological functions such as cell growth and migration of CRC cells were assessed using a wound healing assay. Cell cycle analysis and apoptosis analysis were performed using flow cytometry.

Results

The lncRNA TERC is overexpressed in the sera of CRC patients with high diagnostic and stage discrimination accuracy. Furthermore, lncRNA TERC expression was upregulated in CRC cell lines and lncRNA TERC silencing induced cell arrest and apoptosis and inhibited cell migration. Furthermore, inhibition of lncRNA TERC reduces β-catenin protein levels.

Conclusion

The lncRNA TERC could be considered as an early stages CRC diagnostic biomarker with a good ability to discriminate between CRC stages. lncRNA TERC induces CRC by promoting cell migration and evading apoptosis by elevating the level of β-catenin protein.

Materials Perspectives of Integrated Plasmonic Biosensors

With the growing need for portable, compact, low-cost, and efficient biosensors, plasmonic materials hold the promise to meet this need owing to their label-free sensitivity and deep light-matter interaction that can go beyond the diffraction limit of light. In this review, we shed light on the main physical aspects of plasmonic interactions, highlight mainstream and future plasmonic materials including their merits and shortcomings, describe the backbone substrates for building plasmonic biosensors, and conclude with a brief discussion of the factors affecting plasmonic biosensing mechanisms. To do so, we first observe that 2D materials such as graphene and transition metal dichalcogenides play a major role in enhancing the sensitivity of nanoparticle-based plasmonic biosensors. Then, we identify that titanium nitride is a promising candidate for integrated applications with performance comparable to that of gold. Our study highlights the emerging role of polymer substrates in the design of future wearable and point-of-care devices. Finally, we summarize some technical and economic challenges that should be addressed for the mass adoption of plasmonic biosensors. We believe this review will be a guide in advancing the implementation of plasmonics-based integrated biosensors.

Tularemia: The Resurgence of a Diagnostic Challenge and Clinical Dilemma in the United States

Tularemia is a rare, life-threatening zoonotic infection with low, naturally occurring transmission rates in the United States. Classified as a Category A bioterrorism agent, this disease is highly infectious and has the potential to be fatal if left untreated. Making the diagnosis is difficult due to the non-specific symptomatology patients present with. Considering the increase in the prevalence of this diagnosis over the past two decades, this condition has the potential to become a public health crisis. This case report details a pediatric patient who was found to have fever, ulceration, and lymphadenopathy on hospital admission. After a prolonged and protracted course of illness, tularemia was diagnosed with laboratory testing. The purpose of this case report is to increase awareness of tularemia as a potential cause of non-specific flu-like symptoms, especially during the summer months. Moreover, our goal is to propose suggestions for healthcare professionals who encounter patients with clinical suspicion of tularemia.

An Overlooked Link between IgA Nephropathy and Lithium Toxicity: A Case Report

Lithium is one of the first-line agents for treating bipolar disorder. Although this agent is highly effective in treating mood disorders, renal toxicity is a frequent side effect. Lithium metabolism is affected by sodium-lithium counter-transporter (SLC-T) in erythrocytes. The high activity of SLC-T can result in decreased urinary lithium clearance and may lead to accumulation of lithium in the distal renal tubular cells, causing lithium toxicity. SLC-T is a genetic marker in primary hypertension (HTN), HTN in pregnancy, diabetic nephropathy, and IgA nephropathy (IgA-N) with HTN. Patients with IgA-N have been reported to have enhanced SLC-T activity and are likely to have considerably lower renal fractional clearance of lithium. Therefore, patients taking lithium for bipolar disorder with coexisting IgA-N can have severe lithium-induced nephropathy and nephrotoxicity even at therapeutic serum levels. Serum lithium levels reflect only extracellular lithium concentration. However, lithium exerts its effects once it has moved to the intracellular compartment. This phenomenon illustrates the reason why patients with significantly elevated serum levels might be asymptomatic. Creatinine clearance is inversely related to the duration of lithium therapy. The degree of interstitial fibrosis on renal biopsy has been known to be associated with the duration of lithium therapy and cumulative dose. We present a case with a past medical history of bipolar disorder treated with lithium for almost 20 years. His family history was significant for HTN. The patient was diagnosed with renal insufficiency of unknown causes, for which he underwent renal biopsy. The renal biopsy showed a typical lithium-induced tubulointerstitial nephritis and a coincidental finding of IgA-N. We suspect a high activity of SLC-T seen in IgA-N, and the adverse effects of lithium on SLC-T activity might cause reduction of urinary lithium clearance and accumulation of lithium in distal renal tubular cells, contributing to nephrotoxicity. There is a lack of the literature on the coexistence of IgA-N and lithium nephrotoxicity. We recommend in patients with concomitant IgA-N, taking lithium, more frequent monitoring of renal functions, and dose adjustments may reduce the risk of lithium-induced nephrotoxicity.

Neurolymphomatosis of the median nerve, optic nerve, L4 spinal nerve root and cauda equina in patients with B-cell malignancies: a case series

BACKGROUND

Neurolymphomatosis is rare. Neoplastic lymphocytes are seen to invade nerves (cranial or peripheral), nerve roots or other related structures in patients with hematological malignancy. It is a separate entity from central nervous system lymphoma. Neurolymphomatosis has most commonly been described in association with B-cell non-Hodgkin lymphoma. Neurolymphomatosis in the context of Burkitt lymphoma and the post-renal transplant setting has not been described before.

CASE REPORTS

We report for the first time in the Arabian Gulf countries and nearby Arab states four cases of neurolymphomatosis (one Asian, and the other 3 are from Arabic nationals) occurring between 2012 and 2017 involving the median nerve, optic nerve, nerve root and cauda equina in patients with Burkitt lymphoma, Philadelphia chromosome-positive B-cell acute lymphoblastic leukemia and diffuse large B-cell lymphoma.

CONCLUSIONS

Neurolymphomatosis is rare and can be difficult to diagnose by biopsy but reliably confirmed by a combined imaging approach. Prior treatment with high-dose dexamethasone might suppress 18F-fluorodeoxyglucose (FDG) activity and decrease the sensitivity of positron emission tomography/computed tomography (PET/CT). The prognosis is generally poor but using high-dose methotrexate as well as high-dose chemotherapy and autologous stem cell transplantation may be an effective way to treat neurolymphomatosis.

Wide-angle, wide-band, polarization-insensitive metamaterial absorber for thermal energy harvesting

We propose a wide-band metamaterial perfect absorber (MPA), using the coupling in the near-field of a quadruple split-ring resonator concentric with crossed ellipses. We designed the MPA with a metal–insulator-metal (MIM) structure for use in thermal energy harvesting. A gradient-based optimization approach was carried out to maximize the absorption of infrared (IR) radiation around 10 μm. Owing to the near-field coupling of resonators with optimal design parameters, the peaks of the absorption responses approach each other, thus broadening the overall bandwidth with almost unity absorptivity. The proposed design has a resonance at 10 μm resulting from magnetic polaritons (MPs) and thus maintains high absorption above 99% up to a range of incident-angles greater than 60° and exhibits a polarization-free behavior due to symmetry. When the optimal design was numerically examined to fabrication tolerances, it showed negligible sensitivities in the absorptivity with respect to design parameters. The strong electric field enhancement inside the split-ring gaps and between the ends of the cross arms and the surrounding ring enables designing MIM diodes to rectify the harvested thermal radiations at 288 K. MIM diodes can be built by the deposition of thin insulators to sit in these gaps. The MIM diode and MPA work together to harvest and rectify the incident IR radiation in a manner similar to the operation of rectennas. The MPA outperforms the traditional nano-antennas in impedance matching efficiency because of its higher resistance. Also, its dual-polarization reception capability doubles the rectenna efficiency. Our proposed MPA retained absorptivity more than 99% when coupled with MIM diodes whose resistances are in the range of 500 Ω–1 MΩ.

Synthesis and photoluminescence characteristics of Dy incorporated MoO3 phosphor: Suppression concentration quenching

A series of MoO₃:Dy³⁺ phosphors have been synthesized via the gel-combustion method. The X-ray and photoluminescence (PL) emission spectra were employed to characterize the obtained phosphors. The prepared samples were characterized through XRD measurements and exhibited that Dy³⁺ ions can be successfully incorporated into the host material. The PL emission bands of Dy³⁺ doped MoO₃ were observed at 486 nm, 574 nm and 666 nm which are assigned to the transitions of ⁴F_9/2 → ⁶H_15/2, ⁴F_9/2 → ⁶H_13/2 and ⁴F_9/2 → ⁶H_11/2, respectively. Concentration quenching were largely taken into consideration as one of the crucial aspects limiting the application range of phosphors in today's modern world. An abnormal thermal quenching dependence was reported when Dy³⁺ ions were incorporated into MoO₃ host matrix. In order to understand the origin of this beneficial behaviour, energy transfer processes occurring via radiative and nonradiative mechanisms were investigated to elucidate this suppression of the concentration quenching.

Safety and Efficacy of Emergency Ureteroscopy with Intracorporeal Lithotripsy in Patients Presented with Urinary Tract Infection with Mild Sepsis

Objective: To assess safety and efficacy of emergency ureteroscopy (URS) with intracorporeal lithotripsy for management of distal ureteral stones in highly selected cases presented with urinary tract infection (UTI) with mild sepsis. Patients and Methods: Patients presenting with a solitary distal ureteral stone ≤20 mm with UTI with mild sepsis at two tertiary care centers between January 2016 and December 2018 were included. Patients were randomly assigned into one of two groups; Group I (GI) managed by direct emergency definitive URS and Group II (GII) managed by Double-J ureteral stent insertion. Both groups were compared regarding operative time, time to normalization of leukocytosis and temperature, analgesic consumption, length of hospital stay, and any perioperative complications. Stone-free status was defined as complete stone removal or residual nonobstruction fragments of ≤2 mm. Results: A total of 124 patients were included; 55 in GI and 69 in GII. Both groups were comparable regarding demographic and baseline data, length of hospital stay (2.0 ± 0.14 vs 1.99 ± 0.12 days, p = 0.78), time to normalization of total leukocytic count and body temperature, and analgesic consumption. Patients in GII had significantly lower operative time, compared to those in GI (22.2 ± 6.7 vs 44.6 ± 8.7 minutes, p < 0.001). Stone-free rate in GI was 98.1%. Both groups were comparable in postoperative adverse events [5 (9.1%) vs 8 (11.6%), p = 0.76], respectively, in GI and GII. Most complications were low grade, without reported mortality rate. Conclusion: Emergency URS with intracorporeal lithotripsy seems to be safe and efficient definitive alternative to temporary ureteral stenting in highly selected patients presenting with UTI with mild sepsis secondary to obstructing distal ureteral stones.

Indicators of Risk for Dental Caries in Children: A Holistic Approach

BACKGROUND

Dental caries in children is a major public health problem worldwide, with a multitude of determinants acting upon children to different degrees in different communities. The objective of this study was to determine maternal, environmental, and intraoral indicators of dental caries experience in a sample of 6- to 7-y-old children in South East Queensland, Australia.

METHODS

A total of 174 mother-child dyads were recruited for this cross-sectional study from the Griffith University Environments for Healthy Living birth cohort study. Maternal education, employment status, and prepregnancy body mass index were maternal indicators, and annual household income was taken as a proxy for environmental indicators. These were collected as baseline data of the study. Clinical data on children's dental caries experience, saliva characteristics of buffering capacity, stimulated flow rate, and colony-forming units per milliliter of salivary mutans streptococci were collected for the oral health substudy. Univariate analysis was performed with 1-way analysis of variance and chi-square tests. Caries experience was the outcome, which was classified into 4 categories based on the number of carious tooth surfaces. Ordinal logistic regression was used to explore the association of risk indicators with caries experience.

RESULTS

Age (P = 0.021), low salivary buffering capacity (P = 0.001), reduced levels of salivary flow rate (P = 0.011), past caries experience (P = 0.001), low annual household income; <$30,000 (P = 0.050) and <$60,000 (P = 0.033) and maternal employment status (P = 0.043) were associated with high levels of dental caries.

CONCLUSION

These data support the evidence of associations between maternal, environmental, and children's intraoral characteristics and caries experience among children in a typical Western industrialized country. All of these need to be considered in preventative strategies within families and communities.

KNOWLEDGE TRANSFER STATEMENT

The results of this study can be used by clinicians, epidemiologists, and policy makers to identify children who are at risk of developing dental caries. With consideration of costs for treatment for the disease, this information could be used to plan cost-effective and patient-centered preventive care.

Recognizing Obesity in Adult Hospitalized Patients: A Retrospective Cohort Study Assessing Rates of Documentation and Prevalence of Obesity

Background: While obesity is a chronic condition that predisposes patients to other more serious disorders, the prevalence and the documentation of obesity as diagnosis has not been extensively studied in hospitalized patients. We conducted a retrospective chart review to investigate the prevalence and documentation of obesity as a diagnosis among patients admitted to our medical center. Method: IRB approval was obtained for this retrospective study. Body mass index (BMI) as per CDC, admission and discharge diagnosis of obesity and common comorbidities (hypertension, diabetes, hyperlipidemia, coronary artery disease, congestive heart disease, chronic kidney disease and chronic obstructive pulmonary disease) were recorded. The length of stay in the hospital was also calculated. We also investigated whether counselling was provided to the obese patients for weight loss. Results: A total of 540 consecutive patients were reviewed with a mean age was 66 ± 6 years. Out of 540 patients only 182 (34%) had normal weight, 188 (35%) of the patients were overweight and 170 (31%) patients were obese. Of the obese group, 55% were female and 45% were male.100 (59%) had class I obesity, 43 (25%) had class II obesity and 27 (16%) class III obesity. Of the obese patients 40/170 (23.5%) patients had obesity documented on the admission problem list and only 21 (12%) had obesity documented as a discharge diagnosis. Only 3 (2%) patients were given appropriate counseling and referral for obesity management during the hospitalization. Comorbidities and their prevalence included, hypertension (68%), diabetes mellitus (35%), hyperlipidemia (36%), coronary artery disease (18%), chronic kidney disease (17%), congestive heart failure (18%) and COPD (24%). The average length of stay in normal weight, overweight and obese patients was similar for all three groups (4.5 ± 0.5 days). Conclusion: A significant number of hospitalized patients were overweight and obese. An overwhelming percentage never had weight status documented. Hospitalization offers health care providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.

Reduced intensity conditioning is effective for hematopoietic SCT in dyskeratosis congenita-related BM failure

BM failure (BMF) is a major and frequent complication of dyskeratosis congenita (DKC). Allogeneic hematopoietic SCT (allo-HSCT) represents the only curative treatment for BMF associated with this condition. Transplant-related morbidity/mortality is common especially after myeloablative conditioning regimens. Herein, we report nine cases of patients with DKC who received an allo-SCT at five different member centers within the Eastern Mediterranean Blood and Marrow Transplantation Registry. Between October 1992 and February 2011, nine DKC patients (male, 7 and female, 2), with a median age at transplantation of 19.1 (4.9-31.1) years, underwent an allo-HSCT from HLA-matched, morphologically normal-related donors (100%). Preparative regimens varied according to different centers, but was reduced intensity conditioning (RIC) in eight patients. Graft source was unstimulated BM in five cases (56%) and G-CSF-mobilized PBSCs in four (44%) cases. The median stem cell dose was 6.79 (2.06-12.4) × 10(6) cells/kg body weight. GVHD prophylaxis consisted of CsA in all nine cases; MTX or mycophenolate mofetil were added in five (56%) and two (22%) cases, respectively. Anti-thymocyte globulin was administered at various doses and scheduled in four (44%) cases. Median time-to-neutrophil engraftment was 21 (17-27) days. In one case, late graft failure was noted at 10.4 months post allo-HSCT. Only one patient developed grade II acute GVHD (11%). Extensive chronic GVHD was reported in one case, whereas limited chronic GVHD occurred in another four cases. At a median follow-up of 61 (0.8-212) months, seven (78%) patients were still alive and transfusion independent. One patient died of metastatic gastric adenocarcinoma and graft failure was the cause of death in another patient. This study suggests that RIC preparative regimens are successful in inducing hematopoietic cell engraftment in patients with BMF from DKC. Owing to the limited sample size, the use of registry data and heterogeneity of preparative as well as GVHD prophylaxis regimens reported in this series, we are unable to recommend a particular regimen to be considered as the standard for patients with this disease.

Long-range transfer of electron-phonon coupling in oxide superlattices

The electron-phonon interaction is of central importance for the electrical and thermal properties of solids, and its influence on superconductivity, colossal magnetoresistance and other many-body phenomena in correlated-electron materials is the subject of intense research at present. However, the non-local nature of the interactions between valence electrons and lattice ions, often compounded by a plethora of vibrational modes, presents formidable challenges for attempts to experimentally control and theoretically describe the physical properties of complex materials. Here we report a Raman scattering study of the lattice dynamics in superlattices of the high-temperature superconductor YBa(2)Cu(3)O(7) (YBCO) and the colossal-magnetoresistance compound La(2/3)Ca(1/3)MnO(3) that suggests a new approach to this problem. We find that a rotational mode of the MnO(6) octahedra in La(2/3)Ca(1/3)MnO(3) experiences pronounced superconductivity-induced line-shape anomalies, which scale linearly with the thickness of the YBCO layers over a remarkably long range of several tens of nanometres. The transfer of the electron-phonon coupling between superlattice layers can be understood as a consequence of long-range Coulomb forces in conjunction with an orbital reconstruction at the interface. The superlattice geometry thus provides new opportunities for controlled modification of the electron-phonon interaction in complex materials.

Feedback effect on high-energy magnetic fluctuations in the model high-temperature superconductor HgBa2CuO(4+δ) observed by electronic Raman scattering

We use electronic Raman scattering to study the model single-layer cuprate superconductor HgBa(2)CuO(4+δ). In an overdoped sample, we observe a pronounced amplitude enhancement of a high-energy peak related to two-magnon excitations in insulating cuprates upon cooling below the critical temperature T(c). This effect is accompanied by the appearance of the superconducting gap and a pairing peak above the gap in the Raman spectrum, and it can be understood as a hitherto-undetected feedback effect on the high-energy magnetic fluctuations due to the Cooper pairing interaction. This implies a direct involvement of the high-energy magnetic fluctuations in the pairing mechanism. All of these effects occur already above T(c) in two underdoped samples, demonstrating a related feedback mechanism associated with the pseudogap.

Road traffic injuries and data systems in Egypt: addressing the challenges

OBJECTIVE

Road traffic injuries (RTIs) are a major cause of global mortality and morbidity, killing approximately 1.3 million people and injuring 20 to 50 million each year. The significance of this public health threat is most pronounced in low- and middle-income countries where 90 percent of the world's road traffic-related fatalities take place. Current estimates for Egypt show a road traffic fatality rate of 42 deaths per 100,000 population-one of the highest in the Eastern Mediterranean Region. RTIs are also responsible for 1.8 percent of all deaths and 2.4 percent of all disability-adjusted life years (DALYs) lost in the country. Despite this, studies surrounding this topic are scarce, and reliable data are limited. The overall goal of this article is to define the health impact of RTIs in Egypt and to identify the strengths and weaknesses of each data source for the purpose of improving the current RTI data systems.

METHODS

A 2-pronged approach was undertaken to assess the burden of RTIs in Egypt. First, a thorough literature review was performed using PubMed, Embase, ISIS Web of Knowledge, and Scopus databases. Articles pertaining to Egypt and road traffic injuries were selected for screening. With assistance from Egyptian colleagues, a comprehensive exploration of data sources pertaining to RTIs in Egypt was undertaken and secondary data from these sources were procured for analysis.

RESULTS

The literature review yielded a total of 20 studies, of which 6 were multi-country and 5 were hospital-based studies. None examined risk factors such as speeding, alcohol, or seat belt use. Secondary data sources were acquired from national hospital-based injury surveillance; a community-based health survey; pre-hospital injury surveillance; the Ministry of Transport; the General Authority for Roads, Bridges and Land Transport; death certificates; and the central agency for public motorization and statistics. Risk factor data are also limited from these sources.

CONCLUSION

The results of this article clearly highlight the significant burden that road traffic injuries pose on the health of the Egyptian population. The hospital-based injury surveillance system that has been established in the country and the use of International Classification of Diseases (ICD-10) coding brings the system very closely in line with international guidelines. There is, however, some considerable room for improvement, including the need to extend the coverage of the surveillance system, the inclusion of injury severity scores and disability indicators, and standardization of the sometimes rather disparate sources from various sectors in order to maximally capture the true burden of RTIs.

Highly anisotropic anomaly in the dispersion of the copper-oxygen bond-bending phonon in superconducting YBa2Cu3O7 from inelastic neutron scattering

Motivated by predictions of a substantial contribution of the "buckling" vibration of the CuO(2) layers to d-wave superconductivity in the cuprates, we have performed an inelastic neutron scattering study of this phonon in an array of untwinned crystals of YBa(2)Cu(3)O(7). The data reveal a pronounced softening of the phonon at the in-plane wave vector q=(0,0.3) upon cooling below ~105 K, but no corresponding anomaly at q=(0.3,0). Based on the observed in-plane anisotropy, we argue that the electron-phonon interaction responsible for this anomaly supports an electronic instability associated with a uniaxial charge-density modulation and does not mediate d-wave superconductivity.

Is cisplatin required for the treatment of non-small-cell lung cancer? Experience and preliminary results of a phase I/II trial with topotecan and vinorelbine

Platinum-based chemotherapy is considered standard treatment for advanced non-small-cell lung cancer (NSCLC). However, toxicity of most platinum-based regimens is substantial and requires close monitoring and supportive care. Over the past decade, paclitaxel, docetaxel, vinorelbine, gemcitabine, irinotecan, and topotecan have been introduced into the clinic. These newer agents have shown promising activity against NSCLC with a favorable toxicity profile as single agents. For patients with metastatic NSCLC, palliation is the main goal of therapy. Therefore, treatment should be easy to administer on an outpatient basis. We explored a novel combination therapy avoiding platinum. Patients with recurrent or metastatic NSCLC were treated with intravenous (i.v.) topotecan (0.5-1.0 mg/m(2)/day x 5) and i.v. vinorelbine (20-30 mg/m(2)/day on day 1 and day 5) in 21-day cycles. Dose-limiting toxicity (DLT) was defined separately with or without the addition of granulocyte colony-stimulating factor (G-CSF) support. Twenty-nine patients have been enrolled to date. At i.v. topotecan doses of 0.75-1.0 mg/m(2)/day and i.v. vinorelbine of 25 mg/m(2)/day, neutropenia was frequent but of short duration (<7 days). The DLT of i.v. topotecan (0.85 mg/m(2)) in the absence of G-CSF support was based on myelosuppression with neutropenic fever. With the addition of G-CSF, a DLT has not been reached. Nonhematologic toxicities included mild to moderate fatigue and constipation. An overall clinical response rate of 42% was achieved, with responses noted at all dose levels. At a short median follow-up of 15 months, the median survival for all patients is 13 months. In conclusion, the combination regimen of topotecan and vinorelbine is feasible for outpatient administration and is well tolerated with less toxicity than platinum-based regimens. Preliminary response data demonstrate good tumor activity, suggesting that this regimen could make an excellent palliative treatment for advanced NSCLC.