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Prevailing uncertainties regarding the therapeutic interchangeability of PD-1 and PD-L1 inhibitors affect both clinical decision making and health-care budgeting. This Personal View presents a comprehensive assessment of the fragmented regulatory landscape of PD-1 and PD-L1 inhibitors, highlighting the complex dynamics of market competition, pricing, and the effect on health-care budgets. Our paper explores the current state of clinical trials, uninformative trial designs, and the challenges they pose in evaluating the therapeutic interchangeability of these drugs. To address these challenges, research that will inform us of the extent of interchangeability of PD-1 and PD-L1 inhibitors is needed. We recommend head-to-head randomised controlled trials, standardised study designs for indirect comparisons, trials with monotherapy groups, post-approval trials funded from private or public sources, and adoption of a near-equivalence framework in both conducting and evaluating trials., Competing Interests: Declaration of interests RWFvL reports research grants (all paid to their institution) from Bristol Myers Squibb and Pfizer; received consulting fees from Bristol Myers Squibb, Roche, Pierre Fabre, AstraZeneca, and Pfizer; received speaker fees from AstraZeneca; and declares travel support from Ipsen, all outside the submitted work. SBvWvD-K reports a research grant (paid to their institution) for PRIME-ROSE (grant number 101104269); and received travel support from the European Medicines Agency, Nordic Precision Medicine Forum, Centre for Innovation in Regulatory Science, and Cancer Drug Development Forum, all outside the submitted work. RHJM reports unrestricted research grants (all paid to their institution) from Astellas, Bayer, Boehringer ngelheim, Cristal Therapeutics, Deuter Oncology, Novartis, Nordic Pharma, Pamgene, Pfizer, Roche, Sanofi, and Servier, all outside the submitted work. All other authors declare no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved, including those for text and data mining, AI training, and similar technologies.)

Objective: To identify patient-related characteristics considered to affect patient involvement in shared decision making (SDM) about treatment., Methods: We conducted a scoping review of qualitative studies. We searched for literature across seven databases until March 2022, and included qualitative studies that focused on associations between patient-related characteristics and SDM about treatment in adults. We analyzed studies using an inductive thematic approach., Results: The search yielded 5948 articles, of which 70 were included. We identified many different patient-related characteristics, which we grouped into four categories related to: (1) the individual who is facing the decision, (2) the decision, (3) the relationship between the patient and the clinician and others involved in the decision, and (4) the healthcare context., Conclusions: Studies report a variety of patient-related characteristics that may affect patient involvement in SDM. Amongst others, patients may need to feel informed, to understand their role in SDM, and be able to communicate. Involvement may be challenging with characteristics such as perceived time pressure, poor patient-clinician relationships, emotional distress, and severe illness., Practice Implications: In order to truly involve patients in SDM, we might need to focus on characteristics such as patient emotions and relationship building, besides information provision and values clarification., Competing Interests: Declaration of Competing Interest The authors report no competing interests., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Objectives: To identify what patient-related characteristics have been reported to be associated with the occurrence of shared decision-making (SDM) about treatment., Design: Scoping review., Eligibility Criteria: Peer-reviewed articles in English or Dutch reporting on associations between patient-related characteristics and the occurrence of SDM for actual treatment decisions., Information Sources: COCHRANE Library, Embase, MEDLINE, PsycInfo, PubMed and Web of Science were systematically searched for articles published until 25 March 2019., Results: The search yielded 5289 hits of which 53 were retained. Multiple categories of patient characteristics were identified: (1) sociodemographic characteristics (eg, gender), (2) general health and clinical characteristics (eg, symptom severity), (3) psychological characteristics and coping with illness (eg, self-efficacy) and (4) SDM style or preference. Many characteristics showed no association or unclear relationships with SDM occurrence. For example, for female gender positive, negative and, most frequently, non-significant associations were seen., Conclusions: A large variety of patient-related characteristics have been studied, but for many the association with SDM occurrence remains unclear. The results will caution often-made assumptions about associations and provide an important step to target effective interventions to foster SDM with all patients., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: Shared decision making calls for clinician communication strategies that aim to foster choice awareness and to present treatment options neutrally, such as by not showing a preference. Evidence for the effectiveness of these communication strategies to enhance patient involvement in treatment decision making is lacking. We tested the effects of 2 strategies in an online randomized video-vignettes experiment., Methods: We developed disease-specific video vignettes for rheumatic disease, cancer, and kidney disease showcasing a physician presenting 2 treatment options. We tested the strategies in a 2 (choice awareness communication present/absent) by 2 (physician preference communication present/absent) randomized between-subjects design. We asked patients and disease-naïve participants to view 1 video vignette while imagining being the patient and to report perceived room for involvement (primary outcome), understanding of treatment information, treatment preference, satisfaction with the consultation, and trust in the physician (secondary outcomes). Differences across experimental conditions were assessed using 2-way analyses of variance., Results: A total of 324 patients and 360 disease-naïve respondents participated (mean age, 52 ± 14.7 y, 54% female, 56% lower educated, mean health literacy, 12 ± 2.1 on a 3-15 scale). The results showed that choice awareness communication had a positive (M present = 5.2 v. M absent = 5.0, P = 0.042, η 2 partial = 0.006) and physician preference communication had no (M present = 5.0 v. M absent = 5.1, P = 0.144, η 2 partial = 0.003) significant effect on perceived room for involvement in decision making. Physician preference communication steered patients toward preferring that treatment option (M present = 4.7 v. M absent = 5.3, P = 0.006, η 2 partial = 0.011). The strategies had no significant effect on understanding, satisfaction, or trust., Conclusions: This is the first experimental evidence for a small effect of fostering choice awareness and no effect of physician preference on perceived room to participate in decision making. Physician preference steered patients toward preferring that option.

Competing Interests: EFS reports grants form AstraZeneca, Bristol Myers Squibb, Boehringer Ingelheim, Bayer, Merck Sharp & Dphme, Eli Lilly, Daiichi Sankyo, Roche, Novartis, Takeda, Pharmamar; received consulting fees from Eli Lilly; and received payments or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events for Boehringer Ingelheim, AstraZeneca, Daiichi Sankyo, and Novartis, all outside the submitted work. EEV reports grants from AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Clovis Oncology, GlaxoSmithKline, Merck Sharp & Dohme, Novartis , Pfizer, Roche, and Sanofi, all outside the submitted work. All other authors declare no competing interests. The DRUG Access Protocol is supported by all participating pharmaceutical companies: Bayer, Roche, and Sanofi. No company had a role in writing of the manuscript or decision to submit it for publication. EEV, HJB, and EFS led the DRUG Access Protocol trial as principal investigators. HG and HMWV functioned as co-principal investigators for the trial. LJZ and SBvWvD-K wrote the manuscript. LJZ, GFdW, and BSG coordinated the trial. SBvWvD-K and AAMGP-vR functioned as representatives on behalf of the health insurance companies during trial design. LT, THLT, and JEdB represented the Dutch National Health Care Institute during trial design. NB, ANMW, FALME, and EFS functioned as representatives of the Dutch Medical Societies for Oncology, Pulmonology and Haematology during trial design. LJZ and SBvWvD-K contributed equally as first authors.

Up until now the standard treatment for metastasized colorectal carcinoma has been fluorouracil (5-FU) in combination with folonic acid in low doses administered intravenously, even after the recent registration of a number of new intravenously administered cytostatics, such as irinotecan and oxaliplatin. Meanwhile there are oral alternatives for 5-FU: capecitabine and the combination of tegafur and uracil with folonic acid. In four randomised studies it was shown that these drugs were globally just as effective as the combination of 5-FU with folonic acid (in accordance with the 'Mayo Clinic' scheme). There was no survival advantage for the oral drugs compared to 5-FU with folonic acid. Compared to 5-FU and folonic acid the use of capecitabine or tegafur-uracil-folonic acid was associated with less toxic effects; however, there were differences in the side effects profile between the oral drugs and 5-FU (more hand-foot syndrome for capecitabine and less (symptomatic) leucopenia for tegafur-uracil-folonic acid). An examination of the serious side effects (grade 3 and 4) revealed that the total incidence was generally comparable. These data, together with the ease of oral administration, form the basis for the registration of capecitabine and tegafur-uracil-folonic acid. The definitive place of these drugs in the treatment of metastasized colorectal carcinoma is not yet clear.

The Central Medical Pharmaceutical Committee of the Health Insurance Council informs the medical profession annually about the effects of drugs through the Pharmacotherapeutical Compass. The 1998 edition now contains a chapter on pharmacokinetics as well. Compared with previous editions the main alterations of the contents concern an introduction and advice on the antidepressants, two protocols with respect to the medical treatment of patients suffering from epilepsy, advice with respect to oral drugs for the treatment of inflammatory bowel disease, an introduction and advice regarding the treatment of allergic rhinitis, the treatment of patients suffering from AIDS with antiretroviral drugs, the treatment of genital herpes, the taking of insulin lispro by patients with diabetes and the taking of bisphosphonates to prevent or to treat osteoporosis. Two corrections to the 1998 edition are given.

An invitational conference was held on September 11, 1996 by the Medical Advisory Commission to the Blood Transfusion Council of the Netherlands Red Cross, addressing the issues of 'maximal' versus 'optimal' safety measures for the blood supply. Invited were blood transfusion specialists, clinicians, representatives of patient interest groups, the Ministry and Inspectorate of Health and members of parliament. Transfusion experts and clinicians were found to advocate an optimal course, following strategies of evidence-based medicine, cost-benefit analyses and medical technology assessment. Patient groups depending on blood products, such as haemophilia patients would rather opt for maximal safety. Insurance companies would choose likewise, to exclude any risk if possible. Health care juridical advisers would advise to choose for optimal safety, but to reserve funds covering the differences with 'maximal safety' in case of litigation. Politicians and the general public would sooner choose for maximal rather than optimal security. The overall impression persists that however small the statistical risk may be, in the eyes of many it is unacceptable. This view is very stubborn.

The spectral changes caused by the addition of halides to myeloperoxidase (donor:hydrogen-peroxide oxidoreductase, EC 1.11.1.7) have been investigated and the dissociation constants of the enzyme-halide complexes have been determined. The pH dependence of the dissociation constants suggests that halide binding is associated with a protonation step in myeloperoxidase. Myeloperoxidase catalyzes the peroxidative chlorination and bromination of monochlorodimedone. It is shown that at low pH, chloride acts as a competitive inhibitor with respect to H2O2, whereas at higher pH, H2O2 inhibits the chlorination reaction. The dissociation constant (Kd) of the spectroscopically detectable complex and the Km for chloride are considerably smaller than the inhibition constant (Ki) for chloride. These halogenation reactions are strongly pH dependent, the logarithm of the Km for chloride varies linearly with pH. The position of the pH optimum of the chlorination and bromination reaction is a linear function of the logarithm of the [halide]/[H2O2] ratio. A mechanism of the chlorination and bromination reaction is suggested with substrate inhibition for both hydrogen peroxide and the halide.

1. We have constructed a physical map of the mtDNA of Tetrahymena pyriformis strain ST using the restriction endonucleases EcoRI, PstI, SacI, HindIII and HhaI. 2. Hybridization of mitochondrial 21 S and 14 S ribosomal RNA to restriction fragments of strain ST mtDNA shows that this DNA contains two 21-S and only one 14-S ribosomal RNA genes. By S1 nuclease treatment of briefly renatured single-stranded DNA the terminal duplication-inversion previously detected in this DNA (Arnberg et al. (1975) Biochim. Biophys. Acta 383, 359--369) has been isolated and shown to contain both 21-S ribosomal RNA genes. 14 S ribosomal RNA hybridizes to a region in the central part of the DNA, about 8000 nucleotides or 20% of the total DNA length apart from the nearest 21 S ribosomal RNA gene. 3. We have confirmed this position of the three ribosomal RNA genes by electron microscopical analysis of DNA . RNA hybrid molecules and R-loop molecules. 4. Hybridization of 21 S ribosomal RNA with duplex mtDNA digested either with phage lambda-induced exonuclease or exonuclease III of Escherichia coli, shows that the 21-S ribosomal RNA genes are located on the 5'-ends of each DNA strand. Electron microscopy of denaturated mtDNA hybridized with a mixture of 14-S and 21-S ribosomal RNAs show that the 14 S ribosomal RNA gene has the same polarity as the nearest 21 S ribosomal RNA gene. 5. Tetrahymena mtDNA is (after Saccharomyces mtDNA) the second mtDNA in which the two ribosomal RNA cistrons are far apart and the first mtDNA in which one of the ribosomal RNA cistrons is duplicated.

Comparison of the features of the Hepanosticon, micro-Hepanosticon and Auscell techniques. The serum of 17,000 blood donors of the Amsterdam Blood Bank were tested. Using the micro-Hepanosticon method, 4.5% were false positive with fresh serum, but only 1.5% when the sera were frozen and stored before testing. The authors conclude that the agar gel diffusion, the hemagglutination-inhibition and the Austria II techniques are the most specific, although 1.5% false-positive results must be accepted. The micro-Hepanosticon method offers the great advantage of being the most economical.

1. We have done cross-hybridizations between the mitochondrial ribosomal RNAs and DNAs from strains ST and PP of Tetrahymena pyriformis. DNA . ribosomal RNA hybrid formation can be completely prevented by an excess of the heterologous ribosomal RNA and the heterologous hybrids melt 6 degrees C below the homologous hybrids. This shows that the ribosomal RNA cistrons can account for the 5% cross-hybridization previously observed between the mtDNAs of strains PP and ST (Goldbach et al. (1977) Biochim. Biophys. Acta 477, 37--50). 2. By electron microscopy of DNA . ribosomal RNA hybrids we have determined the position of the ribosomal RNA cistrons on the mtDNA of strain GL, a mtDNA which we have shown to contain a sub-terminal 1 micron duplication-inversion and a terminal palindrome at one end which varies in length from 0 to 5 micron and which includes the 1 micron duplication-inversion (Arnberg et al. (1977) Biochim. Biophys. Acta 477, 51--69). The 21 S ribosomal RNA cistron overlaps the 1 micron duplication-inversion and as a result two or three cistrons are present, depending on the size of the terminal palindrome. Only one 14 S ribosomal RNA cistron is found, located about 10 000 base pairs away from the nearest 21 S cistron is found, located about 10 000 base pairs away from the nearest 21 S cistron and with the same polarity as this cistron. 3. We conclude from these results and those in the preceding paper that the sequence of the ribosomal RNAs and the position of the ribosomal RNA genes in the mtDNA is strongly conserved in Tetrahymena. Possible reasons for the duplication of 21-S ribosomal RNA genes and the terminal heterogeneity of Tetrahymena mtDNA are discussed.

Hepatitis B immunoglobulin (HBIg) was administered to 241 patients contaminated with HBAg positive material; 116 persons were followed up for 7 months after the HBIg injection. Only 4 (3.4%) cases of hepatitis B with jaundice and demonstrable HBAg occurred and 15 (12.9%) cases of subclinical hepatitis B were observed. HBIg is well tolerated. Passively transferred HBAb were demonstrable for 2-3 months and no chronic carriers of HBAg were seen after administration of HBIg.

A patient with nephrotic syndrome and an acquired factor XII deficiency associated with a factor XII-like procoagulant activity in the urine was investigated. The urinary protein with procoagulant activity was isolated and comparative investigations revealed similar properties to plasma factor XII. It is suggested that the acquired coagulation defect may result from an insufficient biosynthetic capacity to compensate for the loss of factor XII in the urine.

A portacaval shunt (PCS) model is frequently employed to study phenomena inherent in portal-systemic shunting of splanchnic blood. In many species, a PCS induces hepatic insufficiency, accompanied by encephalopathy. Rats operated on with a 'nonsuture' technique tolerate a PCS better and exhibit no or only slight encephalopathy. Age and environment seem to have a large impact on the ability to tolerate a PCS. This explains the discrepancies between the results of different investigators and the varying time periods reported between the PCS operation and the optimal time for experiments. To characterize the PCS model (button technique) in rats with respect to metabolic parameters in our field of interest, we studied three groups of male Sprague-Dawley rats--non-operated (n = 12); sham-operated (n = 12) and PCS (n = 13)--for 4 weeks following surgery. Body weight in the PCS group decreased for 1 week after surgery and then increased at about the same rate as in the control groups. Plasma immunoreactive insulin, plasma immunoreactive glucagon (IRG) and aromatic amino acid concentrations were highest 1 week after surgery and tended to normalize in the next weeks. Plasma branched-chain amino acid (BCAA) concentrations were decreased in the 1st, 2nd and 3rd week after surgery, after which normalization occurred. These data demonstrate that after 3-4 weeks, male Sprague-Dawley rats start to recover from the metabolic disturbances caused by PCS with regard to the parameters measured. Therefore, experiments in this area, especially those relating to BCAA metabolism, should be carried out 2-3 weeks after the shunt operation (button technique).

1. Electron micrographs of the linear mtDNA from Tetrahymena pyriformis strain GL show linear molecules with a duplex 'eye' of variable size in the middle. This indicates that replication of this DNA starts near the middle of the molecule and proceeds bidirectionally to the ends, as previously shown for the mtDNA of strain ST (Arnberg, A.C., Van Bruggen, E.F.J., Clegg, R.A., Upholt, W.B. and Borst, P. (1974) Biochim. Biophys. Acta 361, 266-276). The mtDNAs of these two strains have little base sequence homology beyond the ribosomal RNA cistron (Goldbach, R.W., Bollen-De Boer, J.E., Van Bruggen, E.F.J. and Borst, P. (1978) Biochim. Biophys. Acta 521, 187-197). 2. Electron micrographs of mtDNA from strain ST, spread under non-denaturing conditions, contain only molecules with fully duplex ends. mtDNA spread under conditions of early denaturation contains duplex loops on one end (40% of all molecules) or both ends (37%). The loops are stable to partial denaturation and vary in size from 0.15 to approximately 1.0 micron, most loops measuring 0.25--0.40 micron. No loops are formed with single-stranded DNA under analogous conditions and we conclude from this result that loop formation is based on the presence of straight, rather than inverted, duplications near the ends. 3. When full-length 3H-labelled mtDNA from strain ST, 32P-labelled at the 5'-termini with T4 polynucleotide kinase, was sedimented in alkaline sucrose gradients, greater than 70% of the 3H and less than 30% of the 32P cosedimented with full-length molecules; the remaining 32P sedimented heterogeneously and predominantly with the DNA less than 10% the size of intact single strands. Brief incubations of full-length mtDNA with DNA polymerase I from Escherichia coli and labelled dNTPs at 15 degrees C did not lead to preferential labelling of terminal EcoRI fragments of the DNA. From these results we infer that the DNA contains nicks or gaps near the termini and that these are not bordered by free 3'-OH groups. 4. A model is presented in which straight sequence repetitions at the termini of Tetrahymena pyriformis mtDNA are involved in the later stages of replication. This model can also account for the pronounced terminal heterogeneity previously observed in this DNA.