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Aim: Report the final analysis from ASTRIS, the largest real-world study of second-/later-line osimertinib in advanced/metastatic EGFR T790M non-small-cell lung cancer (NSCLC). Methods: Patients with advanced/metastatic EGFR T790M NSCLC and prior EGFR-TKI treatment, received once-daily osimertinib 80 mg. Primary end point: overall survival (OS); secondary end points: progression-free survival (PFS), time-to-treatment discontinuation (TTD) and response rate. Safety was also recorded. Results: In 3014 patients, median OS: 22.8 months (21.6-23.8), median PFS: 11.1 months (11.0-12.0), median TTD: 13.5 months (12.6-13.9), and response rate: 57.3% (55.5-59.2). All end points reported with 95% CIs. Numerically longer median OS was observed in patients with baseline WHO performance status <2 versus 2 (24.0 vs 11.1 months) and those without versus with brain/leptomeningeal metastases (25.4 vs 18.0 months). No new safety signals were identified. Conclusion: Second-/later-line osimertinib demonstrated real-world clinical benefit and safety in advanced/metastatic EGFR T790M NSCLC. Clinical Trial Registration: NCT02474355 (ClinicalTrials.gov).

Background: Monitoring of sensitization may become a non-invasive marker of impaired epithelial barrier function related to changing environmental conditions., Objective: To longitudinally evaluate the prevalence and associated factors for positive skin prick tests (SPT) in a general population cohort., Methods: Baseline and 4-year follow-up data from the longitudinal LEAD study are used for the current analyses. Risk factors for SPT were analyzed by multivariate binary logistic regression analyses, including residence (urban/rural), sex, socioeconomic status (SES), allergic and/or respiratory diseases, lung function testing, blood eosinophils, body composition, lifestyle habits, family history, pets in household, and exposure to tobacco smoke in childhood/adolescence (6-18 years) and adulthood (≥19 years)., Results: In total, 1439 children/adolescents and 9844 adults with valid SPTs were included in these analyses. The prevalence of sensitization at baseline was 37.6% and was higher in males in every age group, except 10-<15 years. Individuals with doctor´s diagnosed allergy, asthma or parental allergy were more likely to have a positive SPT; in adulthood, sensitization was more common in those with a high SES. A lower occurrence of sensitization was associated with the presence of a dog in the household in childhood/adolescence and with smoking in adulthood. The prevalence and intensity (number of positive SPT reactions) increased after a 4-year follow-up, especially in children/adolescents., Conclusion: Sensitization is common in the general Austrian population and more likely in males than females. Longitudinal monitoring of sensitization in children/adolescents may identify environmental triggers related to changes in urbanization, industrialization and domestic lifestyle. ClinicalTrials.gov NCT01727518., Competing Interests: Prof. Dr. Sylvia Hartl reports grants from GSK, Roche, Menarini, Böhringer, Astra Zeneca, MSD, Sanofi, and Novartis for advisory board members and speakers honorarium. Prof. Dr. Wolfgang Pohl reports grants and/or personal fees from Meda, Novartis, Roche, Sanova, Astra Zeneca, Boehringer Ingelheim, Chiesi, GSK, and MedImmune, outside the submitted work. The authors declare that they have no other conflicts of interest in this work., (© 2022 Kölli et al.)

Background: The prevalences of obstructive and restrictive spirometric phenotypes, and their relation to early-life risk factors from childhood to young adulthood remain poorly understood. The aim was to explore these phenotypes and associations with well-known respiratory risk factors across ages and populations in European cohorts., Methods: We studied 49 334 participants from 14 population-based cohorts in different age groups (≤10, >10-15, >15-20, >20-25 years, and overall, 5-25 years). The obstructive phenotype was defined as forced expiratory volume in 1 s (FEV 1 )/forced vital capacity (FVC) z-score less than the lower limit of normal (LLN), whereas the restrictive phenotype was defined as FEV 1 /FVC z-score ≥LLN, and FVC z-score -2 increase in BMI, respectively). Current smoking was associated with the obstructive phenotype in participants older than 10 years (aOR=1.24, 95% CI 1.05-1.46)., Conclusion: Obstructive and restrictive phenotypes were found to be relatively prevalent during childhood, which supports the early origins concept. Several well-known respiratory risk factors were associated with the obstructive phenotype, whereas only low BMI was associated with the restrictive phenotype, suggesting different underlying pathobiology of these two phenotypes., Competing Interests: Conflict of interest: G. Wang has nothing to disclose. Conflict of interest: J. Hallberg reports receiving payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from AstraZeneca AB, outside the submitted work. Conflict of interest: D. Charalampopoulos has nothing to disclose. Conflict of interest: M. Casas Sanahuja has nothing to disclose. Conflict of interest: R. Breyer-Kohansal has nothing to disclose. Conflict of interest: A. Langhammer has nothing to disclose. Conflict of interest: R. Granell has nothing to disclose. Conflict of interest: J.M. Vonk has nothing to disclose. Conflict of interest: A. Mian reports that this study was funded by the Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; and ATHLETE, grant agreement number 874583). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. Consulting fees received for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: N. Olvera reports funding for salary payment for the current manuscript from Centro de Investigación Biomédica en Red (Instituto de Salud Carlos III). Conflict of interest: L.M. Laustsen has nothing to disclose. Conflict of interest: E. Rönmark has nothing to disclose. Conflict of interest: A. Abellan has nothing to disclose. Conflict of interest: A. Agusti has nothing to disclose. Conflict of interest: S.H. Arshad has nothing to disclose. Conflict of interest: A. Bergström has nothing to disclose. Conflict of interest: H.M. Boezen has nothing to disclose. Conflict of interest: M-K. Breyer has nothing to disclose. Conflict of interest: O. Burghuber has nothing to disclose. Conflict of interest: A.C. Bolund has nothing to disclose. Conflict of interest: A. Custovic reports grants or contracts from the Medical Research Council and Wellcome Trust, outside the submitted work; personal consulting fees from Philips and Stallergenes Greer, outside the submitted work; speaker's fees from Thermo Fisher Scientific, Sanofi, Stallergenes Greer, AstraZeneca and GSK, outside the submitted work; and is on the Board of Directors of the WAO and BSACI council, outside the submitted work. Conflict of interest: G. Devereux has nothing to disclose. Conflict of interest: G.C. Donaldson reports payment or honoraria for serving as a statistical editor for the American Journal of Respiratory and Critical Care Medicine from the American Thoracic Society), for reviewing grants for FWO and EOS (Belgium); and for participation on data safety monitoring or advisory boards for Novartis and AstraZeneca, outside the submitted work. Conflict of interest: L. Duijts reports this study was funded by The Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; and ATHLETE, grant agreement number 874583. The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. She also reports consulting fees for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: A. Esplugues has nothing to disclose. Conflict of interest: R. Faner reports that during the planning of this work, she was supported by the Spanish National Health System Research Contrat Miguel Sevet (CP16/00039); grants from Menarini, GSK and AZ, outside this work; and consulting fees as well as payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GSK and Chiesi, outside the submitted work. Conflict of interest: F. Ballester has nothing to disclose. Conflict of interest: J. Garcia-Aymerich has nothing to disclose. Conflict of interest: U. Gehring has nothing to disclose. Conflict of interest: S. Haider has nothing to disclose. Conflict of interest: S. Hartl reports grants from GSK, Böhringer, Menarini, Chiesi, AstraZeneca, MSD, Novartis, Air Liquide, Vivisol, Pfizer and TEVA; and personal fees from GSK, Böhringer, Menarini, Chiesi, AstraZeneca, MSD, Novartis, Roche, Abbvie, TEVA and Takeda, outside the submitted work. Conflict of interest: H. Backman has nothing to disclose. Conflict of interest: J.W. Holloway has nothing to disclose. Conflict of interest: G.H. Koppelman reports support for the current manuscript from the Lung Foundation of the Netherlands, payment made to his institution; grants or contracts paid to institution from H2020, Vertex, the Ubbo Emmius Foundation, TEVA the Netherlands and GSK, outside the submitted work; consulting fees paid to his institution from PURE IMS and GSK, outside the submitted work; and unpaid membership of the board of the Stichting Astma Bestrijding, outside the submitted work. Conflict of interest: A. Lertxundi has nothing to disclose. Conflict of interest: T.L. Holmen has nothing to disclose. Conflict of interest: L. Lowe has nothing to disclose. Conflict of interest: S.M. Mensink-Bout reports that this study was funded by The Erasmus Medical Centre, Rotterdam; the Erasmus University Rotterdam; and the Netherlands Organization for Health Research and Development. The project received funding from the European Union's Horizon 2020 research and innovation programme (LIFECYCLE, grant agreement number 733206, 2016; EUCAN-Connect grant agreement number 824989; ATHLETE, grant agreement number 874583). The researchers are independent from the funders. The study sponsors had no role in the study design, data analysis, interpretation of data, or writing of this report. She also reports consulting fees received for an opponent PhD defence committee at Copenhagen University, outside the submitted work. Conflict of interest: C.S. Murray reports grants or contracts from Asthma UK, MRC, the Moulton Charitable Foundation and the NIHR, outside the submitted work; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GlaxoSmithKline, Novartis, AstraZeneca and ThermoFisher, outside the submitted work; and participation on a data safety monitoring or advisory board for Boehringer Ingelheim, outside the submitted work. Conflict of interest: G. Roberts has nothing to disclose. Conflict of interest: L. Hedman has nothing to disclose. Conflict of interest: V. Schlünssen has nothing to disclose. Conflict of interest: T. Sigsgaard has nothing to disclose. Conflict of interest: A. Simpson reports a grant from UK Medical Research Council, outside the submitted work. Conflict of interest: J. Sunyer has nothing to disclose. Conflict of interest: M. Torrent has nothing to disclose. Conflict of interest: S. Turner has nothing to disclose. Conflict of interest: M. van den Berge reports grants from GlaxoSmithKline, AstraZeneca, Sanofi and Novartis, outside the submitted work. Conflict of interest: R.C.H. Vermeulen has nothing to disclose. Conflict of interest: S.A.A. Vikjord reports payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from AstraZeneca and Boehringer Ingelheim, outside the submitted work. Conflict of interest: J.A Wedzicha reports grants or contracts from GSK, AstraZeneca, Boehringer, Chiesi, Novartis and Greentech, outside the submitted work. Conflict of interest: A.H. Maitland-van der Zee reports grants or contracts from Vertex, Boehringer Ingelheim and Health Holland, outside the submitted work; consulting fees paid to her institution received from AstraZeneca and Boehringer Ingelheim, outside the submitted work; payment or honoraria for lectures, presentations, speaker bureaus, manuscript writing or educational events from GSK, outside the submitted work; and leadership or fiduciary roles in FIGON and EASYM, outside the submitted work. Conflict of interest: E. Melén has nothing to disclose., (Copyright ©The authors 2021.)

Lessons Learned: Conventional medicine and homeopathy work well together. Quality of life improves with additive homeopathy in patients with non-small cell lung cancer (NSCLC). Survival improves with additive homeopathy in patients with NSCLC., Background: Patients with advanced non-small cell lung cancer (NSCLC) have limited treatment options. Alongside conventional anticancer treatment, additive homeopathy might help to alleviate side effects of conventional therapy. The aim of the present study was to investigate whether additive homeopathy might influence quality of life (QoL) and survival in patients with NSCLC., Methods: In this prospective, randomized, placebo-controlled, double-blind, three-arm, multicenter, phase III study, we evaluated the possible effects of additive homeopathic treatment compared with placebo in patients with stage IV NSCLC, with respect to QoL in the two randomized groups and survival time in all three groups. Treated patients visited the outpatients' centers every 9 weeks: 150 patients with stage IV NSCLC were included in the study; 98 received either individualized homeopathic remedies (n = 51) or placebo (n = 47) in a double-blinded fashion; and 52 control patients without any homeopathic treatment were observed for survival only. The constituents of the different homeopathic remedies were mainly of plant, mineral, or animal origin. The remedies were manufactured by stepwise dilution and succussion, thereby preparing stable Good Manufacturing Practice grade formulations., Results: QoL as well as functional and symptom scales showed significant improvement in the homeopathy group when compared with placebo after 9 and 18 weeks of homeopathic treatment (p < .001). Median survival time was significantly longer in the homeopathy group (435 days) versus placebo (257 days; p = .010) as well as versus control (228 days; p < .001). Survival rate in the homeopathy group differed significantly from placebo (p = .020) and from control (p < .001)., Conclusion: QoL improved significantly in the homeopathy group compared with placebo. In addition, survival was significantly longer in the homeopathy group versus placebo and control. A higher QoL might have contributed to the prolonged survival. The study suggests that homeopathy positively influences not only QoL but also survival. Further studies including other tumor entities are warranted., (© 2020 The Authors. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.)

In Europe, lung cancer ranks third among the most common cancers, remaining the biggest killer. Since the publication of the first European Society of Radiology and European Respiratory Society joint white paper on lung cancer screening (LCS) in 2015, many new findings have been published and discussions have increased considerably. Thus, this updated expert opinion represents a narrative, non-systematic review of the evidence from LCS trials and description of the current practice of LCS as well as aspects that have not received adequate attention until now. Reaching out to the potential participants (persons at high risk), optimal communication and shared decision-making will be key starting points. Furthermore, standards for infrastructure, pathways and quality assurance are pivotal, including promoting tobacco cessation, benefits and harms, overdiagnosis, quality, minimum radiation exposure, definition of management of positive screen results and incidental findings linked to respective actions as well as cost-effectiveness. This requires a multidisciplinary team with experts from pulmonology and radiology as well as thoracic oncologists, thoracic surgeons, pathologists, family doctors, patient representatives and others. The ESR and ERS agree that Europe's health systems need to adapt to allow citizens to benefit from organised pathways, rather than unsupervised initiatives, to allow early diagnosis of lung cancer and reduce the mortality rate. Now is the time to set up and conduct demonstration programmes focusing, among other points, on methodology, standardisation, tobacco cessation, education on healthy lifestyle, cost-effectiveness and a central registry.Key Points• Pulmonologists and radiologists both have key roles in the set up of multidisciplinary LCS teams with experts from many other fields.• Pulmonologists identify people eligible for LCS, reach out to family doctors, share the decision-making process and promote tobacco cessation.• Radiologists ensure appropriate image quality, minimum dose and a standardised reading/reporting algorithm, together with a clear definition of a "positive screen".• Strict algorithms define the exact management of screen-detected nodules and incidental findings.• For LCS to be (cost-)effective, it has to target a population defined by risk prediction models.

Background: A minority of European countries have participated in international comparisons with high level data on lung cancer. However, the nature and extent of data collection across the continent is simply unknown, and without accurate data collection it is not possible to compare practice and set benchmarks to which lung cancer services can aspire., Methods: Using an established network of lung cancer specialists in 37 European countries, a survey was distributed in December 2014. The results relate to current practice in each country at the time, early 2015. The results were compiled and then verified with co-authors over the following months., Results: Thirty-five completed surveys were received which describe a range of current practice for lung cancer data collection. Thirty countries have data collection at the national level, but this is not so in Albania, Bosnia-Herzegovina, Italy, Spain and Switzerland. Data collection varied from paper records with no survival analysis, to well-established electronic databases with links to census data and survival analyses., Conclusion: Using a network of committed clinicians, we have gathered validated comparative data reporting an observed difference in data collection mechanisms across Europe. We have identified the need to develop a well-designed dataset, whilst acknowledging what is feasible within each country, and aspiring to collect high quality data for clinical research.

This document is a revision of the guideline for diagnosis and treatment of COPD that replaces the version from 2007. A multitude of recent reports regarding risk factors, diagnosis, assessment, prevention and pharmacological as well as non-pharmacological treatment options made a major revision mandatory. The new guideline is based on the GOLD document taking into account specifics in Germany and Austria., Competing Interests: Eine Übersicht der Interessenkonflikte findet sich im Internet unter http://www.awmf.org; AWMF-Registernummer 020-006., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background: Maintenance therapy (MT) with pemetrexed has been shown to improve overall and progression-free survival of patients with non-squamous non-small cell lung cancer (NSCLC), without impairing patients' health-related quality of life (HRQOL) substantially. Comprehensive data on HRQOL under real-life conditions are necessary to enable informed decision-making. This study aims to (1) assess HRQOL during first-line chemotherapy and subsequent MT and (2) record patients' and physicians' reasons leading to clinical decisions on MT., Methods: Patients treated for NSCLC at three Austrian medical centres were included. HRQOL was assessed at every chemotherapy cycle using the EORTC QLQ-C30/+LC13 questionnaire. Semi-structured interviews were conducted before MT initiation and at the time of discontinuation to evaluate patients' and physicians' reasons for treatment decisions. Longitudinal QOL analysis was based on linear mixed models., Results: Sixty-one (73%) out of 84 patients were considered for MT. Thirty-six patients (43%) received MT and 29 (35%) discontinued therapy. Decisions on MT initiation (in 20 cases by the physician vs 4 by the patient) and discontinuation (19 vs 10) were mainly voiced by the physician. Treatment toxicity of first-line chemotherapy was the main reason for rejection of MT in patients with stable disease and was more often indicated by patients than clinicians. HRQOL data were collected from 83 patients at 422 assessment time points and indicated significantly lower symptom severity during MT compared with first-line therapy for nausea and vomiting (p = 0.006), sleep disturbances (p < 0.001), appetite loss (p = 0.043), constipation (p = 0.017) and chest pain (p = 0.022), and a deterioration in emotional functioning (p = 0.023) and cognitive functioning (p = 0.044) during MT., Conclusions: Our results indicate that HRQOL and symptom burden improve between first-line treatment to MT in some respects, although some late toxicity persists. Discrepancies between patients' and physicians' perception of reasons for rejecting MT were evident. Thus, the integration of patient-reported outcomes, such as HRQOL, is required to enable shared decision-making and personalised healthcare based on mutual understanding of treatment objectives.

Ex vivo expansion of circulating tumor cells (CTCs) of small cell lung cancer (SCLC) patients enabled systematic screening of secreted cytokines. Permanent CTC cultures of different patients shared secretion of chitinase-3-like-1 (CHI3L1)/YKL-40, known to be upregulated in a range of tumor entities and to be associated with increased metastasis and decreased survival. This protein lacks enzymatic activity and its mechanism of promoting tumor dissemination has not been resolved. Results from SCLC CTC cultures suggest CHI3L1 as marker and important effector of tumor cell dissemination in the peripheral blood. Furthermore, this protein may link chronic inflammation of the lung, chronic obstructive pulmonary disease (COPD) and lung cancer.

Introduction: For a subpopulation of NSCLC patients genetic rearrangement of the anaplastic lymphoma kinase (ALK) was found as driver mutation, which can be targeted by the selective inhibitor crizotinib., Areas Covered: This article presents an overview of the clinical studies that provided the characterization of the pharmacokinetic parameters for the administration of crizotinib to cancer patients and the factors influencing the clinical profiles of this drug., Expert Opinion: Crizotinib is administered orally as a capsule and clinical studies indicated 250 mg crizotinib BID continuously as the maximal tolerated dose in cancer patients. Bioavailability is ∼ 40% and pharmacokinetic parameters are influenced by food only to a minor degree. This dose of the drug corresponds to a significant inhibition of the mutated ALK, retards tumor growth and achieves clinical responses in the majority of patients. Crizotinib lactam is the single metabolite with minor inhibitory activity for the ALK fusion protein. Metabolization is executed mainly by CYP3A4/5 and is modulated by other drugs interacting with this cytochrome oxidase. Despite the one-fits-all approach in administration of crizotinib at a fixed dose the pharmacokinetic parameters indicate a stable steady state upon continuous administration, which achieves sufficient inhibition of the ALK drug target.

The National Lung Screening Trial (NLST) could demonstrate, for the first time, in a prospective randomized trial, that low-dose CT screening (LD-CT) may decrease lung cancer mortality. At the moment, it is unclear how these results will be applicable to Austria. Specifically, the definition of the population at an increased risk for lung cancer and management of the high rate of false-positive results are problematic. As a consequence, lung cancer screening in Austria is recommended following the guidelines of the Austrian Society of Radiology and the Austrian Society of Pneumology. The recommendations suggest that only individuals with a significantly increased risk for lung cancer should be screened (age > 55 years, 30 pack-years, active or former smokers since < 15 years). The screened individuals must be informed about the high probability of false-positive screening results and the necessity for additional follow-up examinations or invasive examinations. The screened individuals must be informed that a CT screening may not prevent them from developing an inoperable lung cancer. In addition, CT screening examinations should be performed with a low-dose CT technique for at least three years at yearly intervals. In view of the high probability of false-positive findings, the evaluation of detected pulmonary nodules should be performed according to an already established standardized protocol.

Active oxygen species can cause lung injury. Although a direct action on endothelial cells is proposed, the possibility exists that they might cause injury via mediators. We considered that active oxygen species would stimulate the generation of cyclooxygenase metabolites, which then alter pulmonary vasoreactivity and cause edema. We chemically produced hydrogen peroxide by adding glucose oxidase to a plasma- and cell-free, but beta-D-glucose-containing, solution, which perfused isolated rat lungs. Addition of glucose oxidase to the perfusate caused a marked decrease in pulmonary vasoreactivity, accompanied by an increase in the concentrations of prostacyclin, thromboxane A2, and prostaglandin F2 alpha. Pretreatment with catalase, a specific scavenger of hydrogen peroxide, preserved pulmonary vasoreactivity, inhibited the increase of the concentration of the measured prostaglandins, and prevented edema formation. Indomethacin effectively blocked lung prostaglandin production but neither prevented the decrease in vasoreactivity nor inhibited edema formation. From these data we conclude that hydrogen peroxide impaired pulmonary vasoreactivity and subsequently caused edema. Despite the fact that hydrogen peroxide stimulated lung prostaglandin production, cyclooxygenase-derived products neither caused the decrease in vasoreactivity nor the development of edema.

The effects of standardized blood loss on the platelets, as well as on coagulation, fibrinolysis and complement parameters were studied in the pig. A simultaneous fall in arterial and venous platelet counts was demonstrated during the initial phase of blood loss, with a concomitat rise in pulmonary vascular resistance. After exsanguination to the extent of about 40% of the blood volume, the arterial platelet counts increased significantly, whilst the pulmonary vascular resistance, which was negatively correlated with the arterial platelet counts throughout the experiment, fell. Venous platelet counts, on the other hand, remained low during this experimental period and were correlated with cardiac output, but not with pulmonary vascular resistance.

8 healthy male volunteers performed jogging (as an example of an aerobic metabolic condition) and squash (as an example of an intermittently anaerobic metabolic condition). The platelets sensitivity to prostacyclin (PGI2) decreased after jogging. After squash, a statistically significant (p 0,001) decrease in the sensitivity of the platelets could be seen. Our findings suggest that an early alteration of platelet sensitivity might play a key role in maintaining the hemostatic balance and could be of greater importance than the vascular wall PGI2-synthesis, as the sensitivity changes immediately, whereas the PGI2-formation change is a long-term process.

After inhalation of prostaglandin I2 minimal effects on lung function and the cardiovascular system could be observed in healthy volunteers. Platelet function, however, decreased significantly. In the future the application of the prostaglandin I2 may be a new approach in the treatment of thromboembolic disorders in man.

The soluble brain protein 14-3-2 first described by Moore and McGregor in 1965 is now known to be a cell specific isoenzyme of the glycolytic enzyme enolase (EC 4.2.1.11), designated neuron specific enolase (NSE). It is not only a marker for all types of neurons, but also for all neuroendocrine or paraneuronal cells. The appearance of NSE is a late event in neural differentiation, thus making NSE a useful index of neural maturation. The demonstration that tumors of the nervous system and of neuroendocrine origin contain NSE has promoted the study of NSE as a possible tumor marker. Immunocytochemistry has been used to identify NSE in cytologic preparations from several types of tumors, offering useful indications for differential diagnosis. NSE levels in serum from tumor patients are not useful in the diagnosis of early stage disease. However, serum NSE levels have been shown to be helpful in the identification of advanced small cell lung cancer, neuroblastoma and several other neoplasms. The main use of serum NSE is the monitoring of chemotherapy and the detection of a relapse in these cases.

A 78 year old woman developed non-fatal pure red cell aplasia after taking Indomethacin for a long period. We gave the patient red cell transfusions and treated her with Methylprednisolon. Approximately 3 months after discontinuation of Indomethacin the patient felt well and blood picture was normal.

Right ventricular pump performances were assessed in 14 patients with chronic obstructive pulmonary disease by means of radionuclide angiocardiography using krypton-81m as a tracer. Right ventricular ejection fraction (RVEF) was significantly lower in the patients than in normal volunteers. Additionally there was a striking difference in RVEF between patients with normal pulmonary artery pressure (PAP) and those with pathologically elevated PAP. A linear negative correlation between RVEF and mean PAP could be demonstrated. From this data we suggest that radionuclide angiocardiography using krypton-81m allows non invasive assessment of right heart afterload and thus indirectly PAP.