The progress of small cell lung cancer management using irinotecan plus cisplatin chemotherapy

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Background: Etoposide/cisplatin (EP) is the most widely used regimen resulting in a median survival of 8–10 mos and 17–20 mos respectively for patients (pts) with extensive-disease (ED) and limited-disease (LD). Encouraged by a phase III trial result that showed better survival outcome after Irinotecan/cisplatin (IP) combination as compared with EP, we previously reported promising activity of IP regimen for LD-SCLC and also for ED-SCLC. To further evaluate the role of IP in SCLC pts, we conducted two additional phase II studies. Methods: Between May 2003 and June 2006, a total of 196 SCLC pts (ED: 120, LD: 76) were enrolled in two separate trials. All pts were chemo-naive and ECOG PS of 0–2. Pts with ED-SCLC received irinotecan 60 mg/m2 intravenously (IV) and cisplatin 30 mg/m2 IV on days 1 and 8 every 21 days for 8 cycles followed by 6 cycles of irinotecan maintenance or observation. Treatment for LD-SCLC consisted of two 28-day cycles of cisplatin 30 mg/m2 IV on days 1 and 8 plus irinotecan 60 mg/m2 IV on days 1, 8, and 15, followed by two 21-day cycles of cisplatin 60 mg/m2 IV on day 1, plus etoposide 100 mg/m2 IV on days 1 to 3 with concurrent twice-daily thoracic radiation of total 45 Gy. Hoping to modify the treatment-related toxicity, 36 pts were given epoietin and 20 were given amifostine while 15 received neither during the concurrent chemo-radiation therapy. Results: For ED- SCLC, overall response rate was 92.6% with CR rate of 11.1%. The median survival was 13.8 mos (95% CI, 12.2 to15.3) with 1-and 2-year survival rates of 58.6% and 18.9%. The median progression-free survival (PFS) was 7.3 mos with 1-and 2-year PFS rates of 18.1% and 5.4%. Irinotecan maintenance did not affect the outcome, however. For LD-SCLC, the response rate was 97.1% with CR rate of 44.9%. The median survival was 24.9 mos (95% CI, 18.5 to 31.3) with 1-and 2-year survival rates of 75.2% and 51.4%. The median PFS was 11.0 mos (95% CI, 7.8–14.2) with 1-year PFS rates of 46.8%. The most common toxicity associated with IP treatment was grade 3 or 4 neutropenia (64.6% for ED, 45.3% for LD). Grade 3 diarrhea was developed in 12.4% for ED and 4% for LD pts. Conclusion: Significant antitumor activity of IP chemotherapy as shown suggests further progress in SCLC therapy.

No significant financial relationships to disclose.

Foreign material erosion after laparoscopic Roux-en-Y gastric bypass: findings and treatment

BACKGROUND

Patients after laparoscopic Roux-en-Y gastric bypass (LRYGB) can have nonspecific, upper gastrointestinal (UGI) complaints. During postoperative endoscopy, we have noted the erosion of nondissolvable material, such as Peri-Strips or silk sutures, into the gastric pouch. This study reports the incidence and presentation of foreign material erosion into the gastric pouch after a LRYGB and the outcome after therapeutic endoscopy.

METHODS

From a prospective LRYGB database, postoperative endoscopies from February 2002 to June 2005 that found foreign material in the gastric pouch were reviewed. Presenting symptoms, time until endoscopy, and patient outcomes were evaluated. A therapeutic endoscopy was performed by using endo-shears and biopsy forceps to remove the foreign material.

RESULTS

A total of 23 patients underwent 29 therapeutic endoscopies. From February 2002 to November 2004, 208 LRYGB were performed using silk suture for the outer layer of the gastrojejunostomy, and 21 patients (10%) had silk suture found on endoscopy. Peri-Strips were used from February 2002 to December 2003 (n = 153) and 6 patients (4%) had erosions. Since converting to Vicryl suture and Seamguard, we have had 173 and 228 patients, respectively, without pouch erosion. The most common presenting symptom was abdominal pain (n = 15, 65%). Other symptoms included nausea (n = 13, 57%), vomiting (n = 12, 52%), dysphagia (n = 5, 22%), and melena (n = 3, 13%). Foreign material was found by a mean of 34 weeks. Of 29 therapeutic endoscopies, 20 resulted in resolution of symptoms (69%), 4 led to improvements (14%), and 5 had no effect (17%). There were no endoscopic complications and no anastomotic leaks.

CONCLUSIONS

Nonabsorbable material used during a LRYGB can migrate into the gastric pouch and cause UGI complaints. A therapeutic endoscopy will resolve most UGI symptoms. Using absorbable material in the creation of the gastric pouch and the gastrojejunostomy will avoid foreign material erosion.

Characterization of a neocentric supernumerary marker chromosome originating from the Xp distal region by FISH, CENP-C staining, and array CGH

A small supernumerary marker chromosome (SMC) was observed in a girl with severe developmental delay. Her dysmorphism included prominent forehead, hypertelorism, down-slanting palpebral fissures, low-set/large ears, and flat nasal bridge with anteverted nares. This case also presented hypotonia, hypermobility of joints, congenital heart defect, umbilical hernia, failure to thrive, and seizures. The SMC originated from the distal region of Xp as identified by FISH with multiple DNA probes. Staining with antibodies to Centromere Protein C (CENP-C) demonstrated a neocentromere, while FISH with an alpha-satellite DNA probe showed no hybridization to the SMC. A karyotype was described as 47,XX,+neo(X)(pter-->p22.31::p22.31-->pter), indicating a partial tetrasomy of Xp22.31-->pter. This karyotype represents a functional trisomy for Xp22.31-->pter and a functional tetrasomy for the pseudoautosomal region given that there is no X-inactivation center in the marker chromosome. The SMC was further characterized by microarray-based comparative genomic hybridization (array CGH) as a duplicated DNA fragment of approximately 13 megabase pairs containing about 100 genes. We have described here a new neocentromere with discussion of its clinical significance.

Extensive nuclear localization of alpha-synuclein in normal rat brain neurons revealed by a novel monoclonal antibody

Synuclein was initially named for its localization in both presynaptic nerve terminals and portions of nuclear envelope. However, subsequent studies only confirmed the presynaptic localization of this protein in the brain; its nuclear localization in the neurons remained elusive. Here, two new monoclonal antibodies against alpha-synuclein (alpha-SYN) were produced. Epitope mapping using phage peptide display showed that the epitopes of the two antibodies were localized in two distinct specific sequences of the C-terminal domain of alpha-SYN. One antibody named 3D5 recognized amino acids 115-121 of alpha-SYN and the other antibody named 2E3 identified the amino acids 134-138 of the protein. Western blot analysis demonstrated that both 2E3 and 3D5 detected a 19 kD protein from rat and human brain homogenates, which was identical to the molecular size of recombinant alpha-SYN. However, immunohistochemical staining on normal adult rat brain sections showed that the two antibodies revealed distinct patterns of subcellular localization of alpha-SYN immunoreactivity. Both 3D5 and 2E3 detected the presynaptic alpha-SYN but only 3D5 detected the nuclear alpha-SYN. The nuclear localization of alpha-SYN was further confirmed by Western blot analysis in isolated nuclear fraction where the same size of alpha-SYN was detected, and by immunoelectron microscopy using colloidal gold probes where gold particles were specifically localized in portions of peri- and intra-nucleus. The nuclear positive neurons were distributed extensively in almost all the brain regions. This is the first report well characterizing the extensive localization of alpha-SYN in the neuronal nuclei throughout the brain in normal conditions. This finding indicates an important physiological function of this molecule in the nuclei of brain neurons, which deserves further investigations.

Depo-medroxyprogesterone in women on antiretroviral therapy: effective contraception and lack of clinically significant interactions

We conducted an open-label, steady-state pharmacokinetic (PK) study of drug interactions among HIV-infected women treated with depo-medroxyprogesterone acetate (DMPA) while on nucleoside analogues plus nelfinavir (N=21), efavirenz (N=17), or nevirapine (N=16); or nucleosides only or no antiretroviral therapy as a control group (N=16). PK parameters were estimated using non-compartmental analysis, with between-group comparisons of medroxyprogesterone acetate (MPA) PKs and within-subject comparisons of ARV PKs before and 4 weeks after DMPA dosing. Plasma progesterone levels were measured at baseline and at 2, 4, 6, 8, 10, and 12 weeks after DMPA dosing. There were no significant changes in MPA area under the concentration curve, peak or trough concentrations, or apparent clearance in the nelfinavir, efavirenz, or nevirapine groups compared to the control group. Minor changes in nelfinavir and nevirapine drug exposure were seen after DMPA, but were not considered clinically significant. Suppression of ovulation was maintained.

Optical node with time-space-and-wavelength domain contention resolution, deflection and dropping capability

We experimentally demonstrate an optical node with time-space-and- wavelength domain contention resolution, deflection and dropping capability. The node is composed of an optical buffer based on an optical crossconnect and a wavelength converter. Although the experimental results are shown at 10 Gbit/s the bitrate can be increased substantially. Bit-error rate measurements are shown, sustaining only 3.5 dB power penalty after 10mus of optical buffering and agile wavelength conversion over 18nm span.

Porcine circovirus type 2 (PCV2) distribution and replication in tissues and immune cells in early infected pigs

Replication of porcine circovirus type 2 (PCV2) in pigs, as measured by spliced capsid mRNA (Cap mRNA) and viral DNA, was investigated following experimental infection. Peripheral blood mononuclear cells (PBMCs), and tissue from bronchial lymph nodes (BLN), inguinal lymph nodes (ILN), tonsils, lungs, liver, kidneys, spleen and thymus from infected pigs on different days post-infection (DPI) were assessed. PCV2 replication differed dramatically between tissues from the same infected pig. The virus actively replicated in most tested tissues at 14DPI in association with increased PCV2 associated lesions and PCV2 antigen levels, although no clinical signs correlated with PCV2 associated disease were observed in infected pigs during the course of the study. The PCV2 Cap mRNA was detected only at 13DPI in PBMCs from infected pigs, suggesting replication of the virus in circulating blood is transient and not a major site for PCV2 replication in vivo. Evaluation of the Cap mRNA and viral DNA synthesis in T and B lymphocyte and monocyte populations from PBMCs and BLN at various intervals post-inoculation revealed replication of PCV2 in all cell subpopulations; however, viral replication in B lymphocytes was greater than observed in mononuclear cells isolated from BLN at 14DPI indicating that B lymphocytes may be an important cell population for PCV2 replication. These findings further our understanding of the cell types permissive for PCV2 replication and the pathogenesis of PCV2 infection in vivo.

Expression and bioactivity of recombinant human lysozyme in the milk of transgenic mice

Human milk lysozyme is an important protein for innate immunity, but human breast milk is a fairly poor source for commercial production of this enzyme. Research on the expression of recombinant human lysozyme (rHlys) is therefore potentially valuable to the dairy industry. In this study, 2 different kinds of transgenic mice, PBC-hLY and PBC-sighLY, were generated and used as system models to express rHlys. Six lines of PBC-hLY transgenic mice with human lysozyme genomic DNA-based constructs were generated, and a maximum expression level of rHlys approaching 0.154 mg/mL was achieved. Antibacterial activity of the whey from PBC-hLY female transgenic mice was determined by a turbidimetric assay. Results showed that antibacterial activity of the whey was strongly enhanced, and confirmed that rHlys retained full activity. For rHlys to be secreted efficiently into the milk of transgenic mice, 5 lines of mice were also generated, in which the signal peptide DNA of bovine beta-casein was substituted for that of lysozyme in PBC-hLY transgenic mice. Compared with PBC-hLY transgenic mice, both the expression levels of rHlys and the antibacterial activity of the whey were much higher in the PBC-sighLY transgenic mice. The concentration of rHlys in one of these mice amounted to 1.405 mg/mL-3 times higher than the level in human whey. The antibacterial activity of the whey was also 3 times higher than that of human whey. The rHlys from both PBC-hLY and PBC-sighLY transgenic mice had the same antibacterial activity as human milk lysozyme. The effect of the signal peptide and copy numbers of the transgene on expression of rHlys was also evaluated. This work will certainly permit a better understanding of how mammary gland bioreactor systems can be applied to produce rHlys in other mammals, such as cattle.

A new molecular mechanism for severe myoclonic epilepsy of infancy: Exonic deletions in SCN1A

We examined cases of severe myoclonic epilepsy of infancy (SMEI) for exon deletions or duplications within the sodium channel SCN1A gene by multiplex ligation-dependent probe amplification. Two of 13 patients (15%) who fulfilled the strict clinical definition of SMEI but without SCN1A coding or splicing mutations had exonic deletions of SCN1A.

Synthesis of monodisperse iron oxide and iron/iron oxide core/shell nanoparticles via iron-oleylamine complex

Monodisperse magnetic nanoparticles are of great scientific and technical interests. This paper reports a single-step synthesis of monodisperse magnetite nanoparticles with particle size of 8 nm. Iron/maghaemite core/shell nanoparticles with particle size of 11 nm were obtained by reducing the concentration of oleylamine. TEM and in-situ FTIR results suggested that iron-oleylamine intermediate was generated in-situ and decomposed at higher temperature. Oleylamine was also found on the surface of nanoparticles, indicating its role as capping agent which provided steric protection of as-synthesized nanoparticles from agglomeration. Both magnetite and iron/maghaemite core/shell nanoparticles were superparamagnetic at room temperature with a blocking temperature at 80 K and 67 K, respectively.

Genes associated with neuronal differentiation of precursors from human brain

Aiming to gain insights into the mechanisms of neuronal differentiation, we describe the first differential expression profiles of purified homogenous neural precursors (CD133+ cells from human fetal brain) with those of differentiated neurons from human fetal brain. The purity of the two populations of cells was verified by flow cytometry and immunocytochemistry, and cells were then processed for DNA microarray analysis. We confirmed the expression of several previously reported genes (e.g. cell cycle-, DNA replication- and apoptosis-related genes). In addition, we identified, and confirmed by reverse transcription-polymerase chain reaction and in situ hybridization, significant differential expression of platelet-derived growth factor receptor-alpha and insulin-like growth factor binding protein 4, indicating these factors as potential pro-neuronal differentiation factors. In summary, by using the microarray technique to perform a comparative analysis of the genes involved in the differentiation of neural precursors, enriched from the human fetus, we have identified hitherto unknown candidate genes and related signaling pathways that might play an essential role in neuronal differentiation.

Multicenter, randomized trial comparing a combined gemcitabine and cisplatin 3-week regimen with a 4-week regimen in non-small cell lung cancer (NSCLC) patients

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Background: This multicenter, randomized Phase II study (B9E-GH-JHSE) was aimed to compare the efficacy and safety of a gemcitabine-cisplatin combination over a 3-week schedule versus a 4-week schedule as first line treatment for Chinese patients with advanced NSCLC. Methods: Patients (pts) with pathologically or histologically confirmed stage IIIB/IV NSCLC not amenable to curative surgery, and presenting at least one measurable lesion were eligible for this study. Pts were randomized to receive cisplatin (cis) 75 mg/m2 on Day 1 plus either gemcitabine (gem) 1250 mg/m2 on Day 1 and 8 of a 21-day cycle (3-week arm) or gem 1000 mg/m2 on Day 1, 8, and 15 of a 28-day cycle (4-week arm). Patients received up to 6 cycles of treatment during this study. The primary endpoint was WHO objective response rate (ORR) and secondary endpoints included time to progression (TTP), CTC toxicity, and overall survival. Results: Of the 100 pts who were randomized to treatment, there were 51 pts in the 3-week arm: 14 females; mean age 59±8 yrs; 37% stage IIIB, 63% stage IV. In the 4-week arm, there were 49 pts: 24 females; mean age 56 ± 13 yrs; 33% stage IIIB, 67% stage IV. In the 3-week arm the overall response rate (complete response or partial response) was 24%, compared to 27% in the 4-week arm (Odds ratio: 1.17, 95% CI 0.47– 2.9, p = .819). There were no statistically significant differences between the two treatment arms in median overall survival time (3-week: 12.1 mths, 4-week: 13.8 mths; Hazard ratio (HR): 1.19, 95% CI 0.68–2.1, p = .54) and TTP (3-week: 4.9 mths, 4-week: 6.9 mths; HR: 1.33, 95% CI 0.85–2.1, p = .21). The difference in grade 3/4 hematological toxicities did not reach statistical significance (3-week: 37%, 4-week: 57%, p = .07), while grade 3/4 non-hematological toxicities were statistically significantly reduced in the 3-week arm (33% vs. 63%, p = .005). Grade 3/4 study drug related neutropenia (3-week: 27%, 4-week: 51%, p = .02) and thrombocytopenia (3-week: 8%, 4-week: 31%, p = .005) were reduced in the 3-week arm. Conclusions: While all efficacy endpoints were numerically superior in the 4-week arm, the difference was not statistically significant. However, grade 3/4 toxicities were reduced in the 3-week arm.

[Table: see text]

Primary hair growth in dogs depends on dietary selenium concentrations

Selenium (Se) plays an important role in hair growth. The objective of this study was to investigate the effect of dietary selenium concentration on hair growth in dogs. Thirty-six beagles were stratified into six groups based on age, gender and body condition score. The dogs were fed a torula yeast-based canned food for 3 weeks. Then the dogs were fed varying amounts of selenium supplied as selenomethionine for an additional 24 weeks. Analysed selenium concentrations in the experimental foods for the six groups were 0.04, 0.09, 0.12, 0.54, 1.03 and 5.04 mg/kg dry matter respectively. Body weight and food intake were not affected by the selenium treatments. Serum selenium concentration was similar initially but was significantly different at the end of the study among groups. Dietary selenium concentration below 0.12 mg/kg diet may be marginal for an adult dog. Dietary treatment had no effect on serum total thyroxine (TT(4)), free thyroxine (FT(4)), and free 3,3',5-triiodothyronine (FT(3)). There was a significant diet and time interaction (p = 0.038) for total 3,3',5 triiodothyronine (TT(3)). Hair growth was similar among groups initially but significantly reduced in dogs fed diets containing 0.04, 0.09 or 5.04 mg Se/kg when compared with 0.12, 0.54 and 1.03 mg Se/kg at week 11 (p < 0.05) and week 22 (p = 0.061). These results demonstrated that both low and high selenium diets reduce hair growth in adult dogs.

Measurement of bottom-quark hadron masses in exclusive J/psi decays with the CDF detector

We measure the masses of b hadrons in exclusively reconstructed final states containing a J/psi --> mu-mu+ decay using 220 pb(-1) of data collected by the CDF II experiment. We find: m(B+) = 5279.10 +/- 0.41(stat.) +/- 0.36(sys.) MeV/c2, m(B0) = 5279.63 +/- 0.53(stat.) +/- 0.33(sys.) MeV/c2, m(B(s)0) = 5366.01 +/- 0.73(stat.) +/- 0.33(sys.) MeV/c2, m(lambda(b)0) = 5619.7 +/- 1.2(stat.) +/- 1.2(sys.) MeV/c2. m(B+) - m(B0) = -0.53 +/- 0.67(stat.) +/- 0.14(sys.) MeV/c2, m(B(s)0) - m(B0) = 86.38 +/- 0.90(stat.) +/- 0.06(sys.) MeV/c2, m(lambda(b)0) - m(B0) = 339.2 +/- 1.4(stat.) +/- 0.1(sys.) MeV/c2. The measurements of the B(s)0, lambda(b)0 mass, m(B(s)0) - m(B0) and m(lambda(b)0) - m(B0) mass difference are of better precision than the current world averages.

Functional degradation of extrastriate visual cortex in senescent rhesus monkeys

The receptive field properties of striate cortical (V1) cells degrade in senescent macaque monkeys. We have now carried out extracellular single unit studies of the receptive field properties of cells in extrastriate visual cortex (area V2) in very old rhesus (Macaca mulatta) monkeys. This study provides evidence that both the orientation and direction selectivities of V2 cells in old monkeys degrade significantly. Decreased selectivity is accompanied by increased visually driven and spontaneous responses. As a result, V2 cells in old animals exhibit markedly decreased signal-to-noise ratios. A significant degradation of neural function in extrastriate cortex may underlie the declines in higher order visual function that accompany normal aging.