Advancing the use of new approach methodologies for assessing teratogenicity: Building a tiered approach.

Many New Approach Methodologies (NAMs) have been developed for the safety assessment of new ingredients. Research into reproductive toxicity and teratogenicity is a particularly high priority, especially given their mechanistic complexity. Forty-six non-teratogenic and 39 teratogenic chemicals were screened for teratogenic potential using the in silico DART model from the OECD QSAR Toolbox; the devTox quickPredict™ (devTox assay) test and the Zebrafish Embryotoxicity Test (ZET). The sensitivity and specificity were 94.7% and 84.1%, respectively, for the DART tree (83 chemicals), 86.1% and 35.6% for the devTox (81 chemicals) and 77.8% and 76.7% for the ZET (57 chemicals). Fifty-three chemicals were tested in all three assays and when results were combined and based on a "2 out of 3 rule", the sensitivity and specificity were 96.0% and 71.4%, respectively. The specificity of the devTox assay for a sub-set of 43 chemicals was increased from 26.1% to 82.6% by incorporating human plasma concentrations into the assay interpretation. When all 85 chemicals were assessed in a decision tree approach, there was an excellent predictivity and assay robustness of 90%. In conclusion, all three models exhibited a good sensitivity and specificity, especially when outcomes from all three were combined or used in "2 out of 3" or a tiered decision tree approach. The latter is an interesting predictive approach for evaluating the teratogenic potential of new chemicals. Future investigations will extend the number of chemicals tested, as well as explore ways to refine the results and obtain a robust Integrated Testing Strategy to evaluate teratogenic potential.

Evaluation of Clinical Trials in Onco-haematology: A New Method Based on Risk Analysis and Multidisciplinarity.

BACKGROUND: European member states are increasingly vying with one another to recruit patients for clinical trials (CTs). The French national agency for medicines (ANSM) now receives an ever-growing number of CTs, extending response times. The aim of the new methodology presented herein is to reduce assessment times below the national mandatory timeframe of 60 days and to improve patient safety. MATERIALS AND METHODS: Based on an analysis of the criteria defining CTs, 4 key points were identified (safety, fragile population, loss of opportunity, design complexity) to build a criticality score which would determine evaluation type. This score also determines the resources needed (complete evaluation, multidisciplinary advice, ad hoc evaluation) and the timeframe required for appropriate analysis. All post-phase I CTs were analysed from the implementation of the new assessment method, on 01/02/2018 through to 31/12/2019. RESULTS: 447 CTs were analysed (63% industry and 37% academic sponsors). Based on a criticality scale, 27% of the CTs received a type A evaluation (complete), 37% a type B (multidisciplinary evaluation), 23% a type C evaluation (ad hoc evaluation) and 13% a type D evaluation (fast evaluation). From 2014 to 2017, 37% of the CTs were analysed within the mandatory timeframe, with a mean of 68 days, reaching a maximum of 102 days in 2017. Using this new assessment method, 92% of CTs respected the mandatory timeframe in 2019; the mean time in 2018-2019 was 34 days; Grounds for Non-Acceptance (GNA) were raised for 66% of the CTs (69% from academic sponsors and 65% from industrial firms). 3 CTs were refused. CONCLUSION: Here, we demonstrate the feasibility of risk analysis and multidisciplinarity method, which resulted in a dramatic improvement of assessment times.

Autosomal dominant erythromelalgia.

We present a kindred of 29 persons affected with erythromelalgia (erythermalgia) in 5 generations. This paper updates the family reported by Burbank et al. [1966]. Patients have symptoms of intermittent intense burning limb pain related to increased skin temperature. No successful treatment has been identified, and the pathogenetic mechanism has not been established. Most affected individuals are female.

Biomagnetometers for unshielded and well shielded environments.

The paper describes magnetometers for operation in well shielded and unshielded environments. For unshielded environments, the noise cancellation is accomplished by spatial filtering using higher-order gradiometers which are formed in software. The theory of the software formation of high-order gradiometers has been successfully tested experimentally to the second-order gradient level, using a seven-channel prototype system. An unshielded, open environment system, designed to operate with third-order noise cancellation is presently under construction. It is a whole head system, consisting of a minimum of 64 sensing channels, and is expected to be operational by late 1991. In the opposite extreme, a magnetometer is being developed for operation in a well shielded environment of a whole body superconducting shield. The high temperature superconducting shield will operate in liquid nitrogen, while the magnetometer detection system will operate in liquid helium. The high level of shielding will allow detection of biomagnetic signals using magnetometers. The whole body high temperature superconducting shielded system is presently under development and a half scale working shield already exists. The complete whole body shielded system is expected to be operational in 1994/95.

The use of a squid third order spatial gradiometer to measure magnetic fields of the brain.

It appears to be clear from the results that the third order gradiometer is able to detect small biomagnetic signals from the brain which are related to evoked potentials and spontaneous electrical activity. The instrument operates reasonably well within a noisy environment, however further development is necessary to balance the first gradient. We intend to pursue this direction with software systems. Some of the data presented suggest that components of MEG evoked activity may change independently of EEG. One interpretation which may derive from this is that the same current dipoles are probably not responsible for the entire configuration of evoked fields. This interpretation is consistent with EEG evidence which indicates that analogous components in the evoked potential may vary independently as a function of stimulus parameters and information processing. Perhaps a model of magnetic dipoles due to small current loops would be more compatible with the electrophysiological data.

Internal mammary artery-to-pulmonary artery fistulas. Case report and review of the literature.

A case of internal mammary artery-to-pulmonary artery fistula is presented, and all previously reported cases are reviewed. This represents a rare cause of a continuous precordial murmur that may be confused clinically with a patent ductus arteriosus. Patients are usually asymptomatic, and routine diagnostic tests may be of little help in establishing a diagnosis. Selective internal mammary angiography is the procedure of choice for confirmation and localization. The question of advisability of surgery for these patients remains unanswered.