COMPARATIVE PHARMACOKINETICS OF PAMAM-OH DENDRIMERS AND HPMA COPOLYMERS IN OVARIAN-TUMOR-BEARING MICE

The purpose of this study was to model data from a head to head comparison of the in vivo fate of hyper-branched PAMAM dendrimers with linear HPMA copolymers in order to understand the influence of molecular weight (MW), hydrodynamic size (Rh) and polymer architecture on biodistribution in tumor-bearing mice using compartmental pharmacokinetic analysis. Plasma concentration data was modeled by two-compartment analysis using Winnonlin® to obtain elimination clearance (E.CL) and plasma exposure (AUC_plasma). Renal clearance (CL_R) was calculated from urine data collected over 1 week. A plasma-tumor link model was fitted to experimental plasma and tumor data by varying the tumor extravasation (K₄, K₆) and elimination (K₅) rate constants using multivariable constrained optimization solver in Matlab®. Tumor exposures (AUC_tumor) were computed from area under the tumor concentration time profile curve by the linear trapezoidal method. Along with MW and Rh, polymer architecture was critical in affecting the blood and tumor pharmacokinetics of the PAMAM-OH dendrimers and HPMA copolymers. Elimination clearance decreased more rapidly with increase in hydrodynamic size for PAMAM-OH dendrimers as compared to HPMA copolymers. HPMA copolymers were eliminated renally to a higher extent than PAMAM-OH dendrimers. These results are suggestive of a difference in extravasation of polymers of varying architecture through the glomerular basement membrane. While the linear HPMA copolymers can potentially reptate through a pore smaller in size than their hydrodynamic radii in a random coil conformation, PAMAM dendrimers have to deform in order to permeate across the pores. With increase in molecular weight or generation, the deforming capacity of PAMAM-OH dendrimers is known to decrease, making it harder for higher generation PAMAM-OH dendrimers to sieve through the glomerulus as compared to HPMA copolymers of comparable molecular weights. PAMAM-OH dendrimer had greater tumor extravsation rate constants and higher tumor to plasma exposure ratios than HPMA copolymers of comparable molecular weights which indicated that in the size range studied, when in circulation, PAMAM-OH dendrimers had a higher affinity to accumulate in the tumor than the HPMA copolymers.

Status of epidermal growth factor receptors family in hormone-dependent carcinomas of the breast and prostate with reference to serum lipids and lipoproteins

There are numerous growing evidences of resemblance between carcinomas of the breast and prostate. A total of 45 cases of these two hormone-dependent cancers along with appropriate controls were subjected for status of epidermal growth factor receptors as well as serum lipid profile. Paraffin embedded tissue sections from aforesald tumours were analysed by immunohistochemical staining for epidermal growth factor receptor (EGF-R), c-erbB-2 oncoprotein, estrogen receptor (ER) and progesterone receptor (PgR). Sera from same individuals were studied for serum lipid profile analysis. The study revealed that immunoexpression of all receptor proteins (EGF-R). c-erbB-2 was significantly higher in breast carcinoma. In addition, mean levels of triglycerides, total cholesterol, LDL-cholesterol were found to be significantly elevated while the level of HDL-cholesterol was observed to be lower among patients with breast cancer as compared to matched controls. Further, ER-positive breast cancer cases have significantly higher mean level of HDL-cholesterol when compared with ER-negative breast cancer patients. Contrary to this, no alteration in different serum lipid fractions was noticed among the patients with prostate cancer. However, a positive relationship was noticed between immunoexpressions of EGF-R and c-erbB-2 in prostate cancer.

Breast and prostate cancer

There are interesting similarities between carcinomas of the breast and prostate. Both genetic and exogenous factors are probably important in the development of breast and prostate cancers. Since there is an alarming increasing trend in the incidence of both cancers worldwide including India, high level of apprehension/awareness has been created among the general educated population. Furthermore, both cancers are strongly linked with the expression of the c-erbB-2 oncogene which has been the focus of basic research in the recent past. This gene belongs to the family of growth factor receptors and it has important implication in diagnosis and future treatment modalities.

Statistical Mechanics-Inspired Modeling of Heterogeneous Packet Transmission in Communication Networks

This paper presents the qualitative nature of communication network operations as abstraction of typical thermodynamic parameters (e.g., order parameter, temperature, and pressure). Specifically, statistical mechanics-inspired models of critical phenomena (e.g., phase transitions and size scaling) for heterogeneous packet transmission are developed in terms of multiple intensive parameters, namely, the external packet load on the network system and the packet transmission probabilities of heterogeneous packet types. Network phase diagrams are constructed based on these traffic parameters, and decision and control strategies are formulated for heterogeneous packet transmission in the network system. In this context, decision functions and control objectives are derived in closed forms, and the pertinent results of test and validation on a simulated network system are presented.

The transition strength from solid to liquid colloidal dipolar clusters in precessing magnetic fields

We report on the rotation of colloidal clusters of diamagnetic beads and of mixtures of paramagnetic and diamagnetic beads in a ferrofluid in a precessing external magnetic field. The precession angle of the external field is a control parameter determining the stability of the cluster. Clusters become locally unstable when the local precession angle reaches the magic angle. Cluster shape dependent depolarization fields lead to a deviation of the local from the external precession angle such that close to the external magic angle different cluster shapes might coexist. For this reason cluster transitions are weakly or strongly first-order transitions. If the transition is weakly first order a critical speeding up of the cluster rotation is observed. No speeding up occurs for strongly first-order cluster transitions with hysteresis. The strength of the first-order transition is controlled by the size of the core of the cluster.

Injuries associated with traumatic anterior glenohumeral dislocations

BACKGROUND

A number of shoulder girdle injuries are associated with acute anterior glenohumeral dislocations. In the present study we evaluated the prevalence of neurological deficits, greater tuberosity fractures, and rotator cuff injuries in a population of unselected patients who presented with a traumatic anterior glenohumeral dislocation.

METHODS

A prospective trauma database was used to record the demographic details on 3633 consecutive patients (2250 male patients and 1383 female patients with a mean age of 47.6 years) who had sustained a traumatic anterior glenohumeral dislocation between 1995 and 2009. On the basis of these data, we assessed the prevalence of and risk factors for ultrasound-proven rotator cuff tears, tuberosity fractures, and neurological deficits occurring in association with the dislocation.

RESULTS

Of the 3633 patients who had a dislocation, 492 patients (13.5%) had a neurological deficit following reduction and 1215 patients (33.4%) had either a rotator cuff tear or a greater tuberosity fracture. A dislocation with a neurological deficit alone was found in 210 patients (5.8%), a dislocation with a rotator cuff tear or a greater tuberosity fracture was found in 933 patients (25.7%), and a combined injury pattern was found in 282 patients (7.8%). Female patients with an age of sixty years or older who were injured in low-energy falls were more likely to have a rotator cuff tear or a greater tuberosity fracture. The likelihood of a neurological deficit after an anterior glenohumeral dislocation was significantly increased for patients who had a rotator cuff tear or a greater tuberosity fracture (relative risk, 1.9 [95% confidence interval, 1.7 to 2.1]; p < 0.001).

CONCLUSIONS

The prevalence of rotator cuff tear, greater tuberosity fracture, or neurological deficit following primary anterior glenohumeral dislocation is greater than previously appreciated. These associated injuries may occur alone or in combined patterns. Dislocations associated with axillary nerve palsy have similar demographic features to isolated dislocations. Injuries associated with a rotator cuff tear, greater tuberosity fracture, or complex neurological deficit are more common in patients sixty years of age or older. Careful evaluation of rotator cuff function is required for any patient with a dislocation associated with a neurological deficit, and vice versa.

Ameloblastoma in children: should we be radical?

Ameloblastoma is the most common aggressive benign odontogenic tumor of the jaws. The tumor is often asymptomatic, presenting as a slowly enlarging facial swelling. The physical presence of the tumor may cause symptoms such as pain, ulceration, loosening of teeth, or malocclusion. Ameloblastoma is a locally destructive tumor with a propensity for recurrence if not entirely excised. It is seen in all age groups, but the lesion is most commonly diagnosed in the third and fourth decades. The tumor is considered a rarity in the young age group. The treatment of ameloblastoma is still controversial and presents some special problems in children like the growth of the jaw, the different incidence, behavior and prognosis of the tumor in children, which make the surgical considerations different from adults. Some reports have encouraged conservative treatment for ameloblastoma in children.

Chronic portal vein thrombosis due to combined deficiency of protein C and protein S

Portal vein thrombosis (PVT) is a rare disorder that is associated with a variety of underlying condition of which liver cirrhosis, malignancy and myeloproliferative disorders are the most common. It is of two types, acute and chronic portal vein thrombosis. Anticoagulation therapy is recommended for all patients with acute portal vein thrombosis. Chronic portal vein thrombosis is characterised by the development o f portal hypertension. Bleeding from ruptured varices is the main complication. In the absence of bleeding, continuous anticoagulation therapy should be considered for chronic portal vein thrombosis in whom an underlying prothrombotic factor is to be identified. Here in this report a 13-year-old girl presented with haematemesis. The spleen was hugely enlarged. Her Hb was 8.38 g/dl. Grade III oesophageal varices were found in oesophagogastroduodenostomy. CT abdomen showed portal cavernoma formation with increased splenic collateral. Protein C activity was 45% and protein S activity was 40%. She was treated with beta-blocker, endoscopic variceal ligation followed by low molecular weight heparin and warfarin.

Kinase domain mutations confer resistance to novel inhibitors targeting JAK2V617F in myeloproliferative neoplasms

The transforming JAK2V617F kinase is frequently associated with myeloproliferative neoplasms and thought to be instrumental for the overproduction of myeloid lineage cells. Several small molecule drugs targeting JAK2 are currently in clinical development for treatment in these diseases. We performed a high-throughput in vitro screen to identify point mutations in JAK2V617F that would be predicted to have potential clinical relevance and associated with drug resistance to the JAK2 inhibitor ruxolitinib (INCB018424). Seven libraries of mutagenized JAK2V617F cDNA were screened to specifically identify mutations in the predicted drug-binding region that would confer resistance to ruxolitinib, using a BaF3 cell-based assay. We identified five different non-synonymous point mutations that conferred drug resistance. Cells containing mutations had a 9- to 33-fold higher EC(50) for ruxolitinib compared with native JAK2V617F. Our results further indicated that these mutations also conferred cross-resistance to all JAK2 kinase inhibitors tested, including AZD1480, TG101348, lestaurtinib (CEP-701) and CYT-387. Surprisingly, introduction of the 'gatekeeper' mutation (M929I) in JAK2V617F affected only ruxolitinib sensitivity (fourfold increase in EC(50)). These results suggest that JAK2 inhibitors currently in clinical trials may be prone to resistance as a result of point mutations and caution should be exercised when administering these drugs.

Photophysical and theoretical insights on non-covalently linked fullerene-zinc phthalocyanine complexes

The photo-physical aspects of non-covalently linked assemblies of a series of fullerenes, namely, C60, C70, tert-butyl-(1,2-methanofullerene)-61-carboxylate (1) and [6,6]-phenyl C70 butyric acid methyl ester (2) with a designed zinc phthalocyanine (ZnPc), viz., zinc-1,4,8,11,15,18,22,25-octabutoxy-29H,31H-phthalocyanine (3) in toluene medium are studied employing absorption spectrophotometric, steady state and time resolved fluorescence spectroscopic measurements. Of central interest in these investigations is the preferential binding of various fullerenes with ZnPc in toluene. The ground state interaction between fullerenes and 3 is first evidenced from UV-Vis measurements. Steady state fluorescence experiment reveals efficient quenching of the excited singlet state of 3 in presence of both underivatized and derivatized fullerenes. K values for the complexes of C60, C70, 1 and 2 with 3 are determined to be 6500, 22,230, 47,800 and 54,770 dm3 mol(-1), respectively. The magnitude of K suggests that 3 preferentially binds C70 and derivatized C70 in comparison to C60 and 1. Time resolved emission measurements establish that C(70)-3 and 2-3 complexes are stabilized much more in comparison to C(60)-3 and 1-3 systems in terms of charge separation process. Semi empirical calculations employing third parametric method substantiate the strong binding of C70 and its derivative with 3 in terms of heat of formation values of the respective complexes, and at the same time, determine the orientation of bound guest (here fullerenes) with the molecular plane of 3.

Continuous electrical stimulation decreases retinal excitability but does not alter retinal morphology

Retinal prostheses aim to provide visual perception through electrical stimulation of the retina. Hence they have to operate between threshold charge density and maximum safe charge density. To date most studies in the retina have concentrated on understanding the threshold, while stimulation safety has predominantly been studied in structures other than the retina. Toward this end, the present study focuses on determining the effect of continuous electrical stimulation of the retina both on retinal morphology and on the electrically evoked responses in the superior colliculus in a rodent model. The results demonstrate that the retina is able to tolerate 1 h long stimulation with only minor changes evident in retinal histology when examined three to 14 days later, even at charge densities (0.68 mC cm(-2)) above the safe limit of platinum delivered at high stimulus frequency (300 Hz). However, this continuous electrical stimulation causes an elevation in the threshold of the electrically evoked response in the superior colliculus, indicating some form of adaptation to continuous stimulation.

Spectroscopic and Molecular Weight Studies of Polytoluidines

Poly(o-toluidine) and poly(m-toluidine) in base form have been characterized by infrared and lH NMR spectroscopy. Assignments of the proton NMR signals have been facilitated by the use of model compounds. The distinction between benzenoid and quinoid methyl resonances in the NMR permits a semi-quantitative estimation of the oxidation states of the polytoluidines. Infrared studies are consistent with a polyaniline-type backbone having pendant methyl groups. Field desorption mass spectrometry (FD-MS) was employed for estimation of the molecular weight of poly(o-toluidine). Gel-permeation chromatography of the same sample showed a bimodal elution pattern, suggesting that the FD-MS technique detects only the lower molecular weight fraction of the polymer. Despite this inherent limitation, FD-MS yields the interesting information that the polymer contains chains of both odd and even numbers of repeat units, necessitating the coexistence of different oxidation states in the base form of the polymer.

Comparative biodistribution of PAMAM dendrimers and HPMA copolymers in ovarian-tumor-bearing mice

The biodistribution profile of a series of linear N-(2-hydroxylpropyl)methacrylamide (HPMA) copolymers was compared with that of branched poly(amido amine) dendrimers containing surface hydroxyl groups (PAMAM-OH) in orthotopic ovarian-tumor-bearing mice. Below an average molecular weight (MW) of 29 kDa, the HPMA copolymers were smaller than the PAMAM-OH dendrimers of comparable molecular weight. In addition to molecular weight, hydrodynamic size and polymer architecture affected the biodistribution of these constructs. Biodistribution studies were performed by dosing mice with (125)iodine-labeled polymers and collecting all major organ systems, carcass, and excreta at defined time points. Radiolabeled polymers were detected in organ systems by measuring gamma emission of the (125)iodine radiolabel. The hyperbranched PAMAM dendrimer, hydroxyl-terminated, generation 5 (G5.0-OH), was retained in the kidney over 1 week, whereas the linear HPMA copolymer of comparable molecular weight was excreted into the urine and did not show persistent renal accumulation. PAMAM dendrimer, hydroxyl-terminated, generation 6.0 (G6.0-OH), was taken up by the liver to a higher extent, whereas the HPMA copolymer of comparable molecular weight was observed to have a plasma exposure three times that of this dendrimer. Tumor accumulation and plasma exposure were correlated with the hydrodynamic sizes of the polymers. PAMAM dendrimer, hydroxyl-terminated, generation 7.0 (G7.0-OH), showed extended plasma circulation, enhanced tumor accumulation, and prolonged retention with the highest tumor/blood ratio for the polymers under study. Head-to-head comparative study of HPMA copolymers and PAMAM dendrimers can guide the rational design and development of carriers based on these systems for the delivery of bioactive and imaging agents.

Geometry and surface characteristics of gold nanoparticles influence their biodistribution and uptake by macrophages

Spherical and rod-shaped gold nanoparticles with surface poly(ethylene glycol) (PEG) chains were characterized for size, shape, charge, poly dispersity and surface plasmon resonance. The nanoparticles were injected intravenously to 6-8-week-old female nu/nu mice bearing orthotopic ovarian tumors, and their biodistribution in vital organs was compared. Gold nanorods were taken up to a lesser extent by the liver, had longer circulation time in the blood, and higher accumulation in the tumors, compared with their spherical counterparts. The cellular uptake of PEGylated gold nanoparticles by a murine macrophage-like cell line as a function of geometry was examined. Compared to nanospheres, PEGylated gold nanorods were taken up to a lesser extent by macrophages. These studies point to the importance of gold nanoparticle geometry and surface properties on transport across biological barriers.

Clinicopathological profile of renal changes in systemic lupus erythematosus

A study was done on 30 patients admitted in the department of medicine, RG Kar MCH to know the incidence and prevalence of systemic lupus erythematosus (SLE) patients and among them whether there were any cases of renal involvement, time of onset of clinicopathological features of renal involvement and renal changes if already been started in them who had no renal problem clinically. The cases were selected on the basic of revised ARA criteria. Total clinical examination and biochemical tests were done followed by renal biopsy in 28 cases. In rest 2 case, renal biopsy could not be performed because one case presented with severe azotaemia and another case presented with end stage renal disease with severe pallor. There were 28 females and 2 males in the present study presenting chiefly with joint pain and fever. Although renal symptoms were not very common in their presentation, in the present study, some form of renal abnormality (either on urine analysis or histology) was found in 26 patient. Among renal involvement, type IV diffuse proliferative lupus nephritis was more common. Incidence and prevalence of SLE was more common in this part of the world. When worldwise incidence of SLE is considered, renal involvement was quite high (96%) in the present study, type IV diffuse proliferative lupus nephritis was commonest type and in severe form.

AE9C90CB: a novel, bladder-selective muscarinic receptor antagonist for the treatment of overactive bladder

BACKGROUND AND PURPOSE

AE9C90CB (N- [(1R, 5S, 6R)-3-azabicyclo [3.1.0] hex-6-ylmethyl]-2-hydroxy-N-methyl-2, 2-diphenylacetamide), a novel muscarinic receptor antagonist, was synthesized for the treatment of overactive bladder. Here we describe the in vitro and in vivo profiles of AE9C90CB for action in bladder over salivary gland and compare it with four agents already in clinical use (tolterodine, oxybutynin, solifenacin and darifenacin).

EXPERIMENTAL APPROACH

Radioligand binding assay and isolated tissue-based functional assay were used to evaluate affinity, potency, and receptor subtype selectivity of compounds. Inhibition of carbachol-induced increase in intravesicular pressure and salivary secretion were measured in anaesthetized rabbits to assess the functional selectivity.

KEY RESULTS

In vitro radioligand binding study using human recombinant muscarinic receptors showed that AE9C90CB had greater affinity for M(3) muscarinic receptors with pKi of 9.90 +/- 0.11 and was 20-fold more selective for M(3) than for M(2) muscarinic receptors. AE9C90CB exhibited an unsurmountable antagonism on rat bladder strips (pK(B), 9.13 +/- 0.12). In anaesthetized rabbits after intravenous administration, AE9C90CB dose dependently inhibited carbachol-induced increase in intravesicular pressure and salivary secretion, and exhibited functional selectivity for urinary bladder over salivary gland which was ninefold better than that of oxybutynin.

CONCLUSIONS AND IMPLICATIONS

We have identified AE9C90CB, a compound exhibiting moderate selectivity for M(3) over M(2) receptors but greater selectivity for urinary bladder over salivary gland than oxybutynin, tolterodine, solifenacin and darifenacin. Therefore, AE9C90CB may be a promising compound for the treatment of overactive bladder with reduced potential to cause dry mouth than currently available antimuscarinic drugs.

Smac mimetics: implications for enhancement of targeted therapies in leukemia

Drug resistance is a growing concern with clinical use of tyrosine kinase inhibitors. Utilizing in vitro models of intrinsic drug resistance and stromal-mediated chemoresistance, as well as functional mouse models of progressive and residual disease, we attempted to develop a potential therapeutic approach designed to suppress leukemia recurrence following treatment with selective kinase inhibitors. The novel IAP inhibitor, LCL161, [corrected] was observed to potentiate the effects of tyrosine kinase inhibition against leukemic disease both in the absence and presence of a stromal-protected [corrected] environment. LCL161 enhanced the proapoptotic effects of nilotinib and PKC412, against leukemic disease in vitro and potentiated the activity of both kinase inhibitors against leukemic disease in vivo. In addition, LCL161 synergized in vivo with nilotinib to reduce leukemia burden significantly below the baseline level suppression exhibited by a moderate-to-high dose of nilotinib. Finally, LCL161 displayed antiproliferative effects against cells characterized by intrinsic resistance to tyrosine kinase inhibitors as a result of expression of point mutations in the protein targets of drug inhibition. These results support the idea of using IAP inhibitors in conjunction with targeted tyrosine kinase inhibition to override drug resistance and suppress or eradicate residual disease.

Detection of influenza virus induced ultrastructural changes and DNA damage

The influenza virus generally causes damage to epithelial cells of respiratory tract and infection of cells with this virus often results in cell death with apoptotic characteristics. Reports are available implicating influenza virus as a causative agent of chromosomal aberrations in cells and culture. The objective of this study was to analyze the process of cell death caused by influenza virus (A/Udorn/317/72, H3N2) infection in cultured HeLa cells by electron microscopy and comet assay. The apoptotic study was performed using light microscopy electron microscopy and comet assay to observe the changes in cell morphology and DNA fragmentation. HeLa cells, infected with influenza virus were harvested at various time periods to observe the ultrastructural changes. This infection gave rise to nuclear fragmentation and chromatin condensation accompanied by chromosomal DNA fragmentation into oligonucleosomes. The pattern of comet assay revealed that the apoptosis occurred due to fragmentation of the DNA of the cells which reached the maximum level at 36 h post infection. Ultrastructural study showed extensive chromatin condensation and nuclear fragmentation which are the characteristic features of apoptosis.

Dynamics of self-assembly of flower-shaped magnetic colloidal clusters

In a static magnetic field paramagnetic and nonmagnetic colloids immersed in a ferrofluid self-assemble into fluctuating colloidal flowers. Adsorption and desorption of nonmagnetic petals to larger paramagnetic cores and changes in the petal conformation around the paramagnetic core induce a fluctuating dynamics. We track the motion of colloidal petals on the paramagnetic core. Adsorption and desorption of petals occur on a larger time scale than the rotational diffusion of the petals. Magnetic dipole interactions split the motion of the petals into different modes of rotational diffusion. Modes of rotational diffusion that change the petal conformation are suppressed compared to the conformation invariant rotational diffusion of all petals. The suppression of higher modes of rotational diffusion results in a subdiffusive dynamics of the individual petals.

Cysteinyl leukotrienes and their receptors: molecular and functional characteristics

The cysteinyl leukotrienes (CysLTs) are a family of potent inflammatory lipid mediators synthesized from arachidonic acid by a variety of cells including mast cells, eosinophils, basophils and macrophages. The family includes leukotriene C(4) (LTC(4)), leukotriene D(4) (LTD(4)) and leukotriene E(4) (LTE(4)), which are potent biological mediators in the pathophysiology of inflammatory diseases and trigger contractile and inflammatory processes through the specific interaction with cell surface receptors, belonging to the superfamily of G-protein-coupled receptor. Pharmacological characterizations have suggested the existence of at least 2 types of CysLT receptors based on potency of agonist and antagonist, designated as CysLT(1) and CysLT(2). The CysLT(1) receptors are mostly expressed in lung smooth muscle cells, interstitial lung macrophages and the spleen, and it has been studied a lot elucidating its role in the etiology of airway inflammation and asthma. On the other hand, CysLT(2) receptors are present in the heart, brain and adrenal glands. This review discusses the role of CysLTs and their receptor in the pathophysiology of various inflammatory disorders. The understanding of CysLTs and their receptors in allergic airway disease is currently limited to CysLT(1)-receptor-mediated effects, and the role of the CysLT(2) receptors is pharmacologically less well defined, as there is no specific antagonist available yet. Specific CysLT(2)-receptor-selective antagonists would be very helpful to identify the precise role of CysLT and their receptors. Some recent evidence indicates the existence of additional receptor subtypes and requires further investigation for a better understanding of the role of the CysLT receptors. This review is an effort to summarize the localization, regulation and expression pattern along with the molecular and functional pharmacology of the CysLT receptors and to discuss their role in the pathophysiology of different diseases along with the recent update.

Open reduction and endobutton fixation of displaced fractures of the lateral end of the clavicle in younger patients

Displaced fractures of the lateral end of the clavicle in young patients have a high incidence of nonunion and a poor functional outcome after conservative management. Operative treatment is therefore usually recommended. However, current techniques may be associated with complications which require removal of the fixation device. We have evaluated the functional and radiological outcomes using a novel technique of open reduction and internal fixation. A series of 16 patients under 60 years of age with displaced fractures of the lateral end were treated by open reduction and fixation using a twin coracoclavicular endobutton technique. They were followed up for the first year after their injury.

At one year the mean Constant score was 87.1 and the median Disabilities of the Arm, Shoulder and Hand score was 3.3. All fractures had united, except in one patient who developed an asymptomatic fibrous union. One patient had post-traumatic stiffness of the shoulder, which resolved with physiotherapy. None required re-operation.

This technique produces good functional and radiological outcomes with a low prevalence of complications and routine implant removal is not necessary.

The CCN family proteins in carcinogenesis

The CCN (Cyr61 (cysteine-rich protein 61), CTGF (connective tissue growth factor), Nov (nephroblastoma overexpressed)) family consists of six members that belong to matricellular proteins of extracellular matrix (ECM). Like other matricellular proteins, CCN members do not primarily have a structural role; however, they modulate cell-ECM interactions. In general, CCN proteins are formed by four characteristic domain structures and thought to participate in various biological phenomena such as organ development, wound healing, angiogenesis, fibrosis, etc. In cancer, CCN proteins family expresses aberrantly; probably depending on the sites and types, expressions of different CCN proteins have been documented to be linked with either progression or inhibition of the pathological processes of cancer. Through various mechanisms like cell survival, apoptosis, inflammation, cell adhesion and migration and connection with several cytokines, CCN proteins perhaps influence the disease course including tumor metastasis. A majority of the above-mentioned effects are believed to be mediated by binding with integrins, a class of receptors that mediate cell-cell and cell-ECM interactions. Furthermore, the members of CCN family modulate the functions of several important growth factors and related pathways such as insulin-like growth factor (IGF), transforming growth factor-beta (TGF-beta) and Wnt signaling. Interestingly, a variety of factors/proteins linked with these signaling systems are reported to be associated with the carcinogenic process. Nevertheless, a precise knowledge about the pathophysiological activities including signaling pathways of CCN proteins would be helpful to identify molecular targets in order to design therapeutic strategies in the management of cancer.

Effect of Obesity on Breast Cancer Development

In recent years, obesity has been identified as a risk factor for the development of breast cancer in postmenopausal women, and it has been associated with a poor outcome. Many factors appear to be important in the mechanism of this increased risk, including estrogen, estrogen receptors, and the adipokines leptin and adiponectin. Estrogen, a potent mitogen for mammary cells, has long been implicated in the development of mammary tumors. Because adipose-associated aromatase activity increases the conversion of androgen to estrogen, mammary adipose tissue is thought to be an important source of local estrogen production. Leptin, which increases in the circulation in proportion to body fat stores, has been demonstrated in vitro to promote breast cancer cell growth. Animal models have also identified leptin as an important factor for the development of mammary tumors. In contrast to leptin, serum adiponectin concentrations are inversely related to body fat stores, and the addition of adiponectin to human breast cancer cells reduces cell proliferation and enhances apoptosis. This review explores the relationship between these factors and the development of mammary cancer in humans and mouse models.

Accuracy of carotid plaque detection and intima-media thickness measurement with ultrasonography in routine clinical practice

BACKGROUND

Current guidelines in cardiovascular disease prevention advocate the use of carotid ultrasound measurements for risk stratification. Carotid abnormalities (plaques or increased intima-media thickness (IMT)) are associated with high risk of coronary and peripheral artery disease. An office-based measurement by clinicians would considerably broaden the clinical applicability of carotid ultrasound. In the present study we have assessed the accuracy of ultrasound detection of carotid plaques and intima-media thickness by trained internists in a routine outpatient setting.

METHODS AND RESULTS

Carotid ultrasound was performed in 112 vascular outpatients by internists, after a six-week training period. The internists' results were independently compared to the reference standard, consisting of carotid ultrasound performed in a specialized vascular laboratory. Sensitivity and specificity were calculated for plaque detection and IMT determination. The mean time required to perform the scans on the outpatient department was 7.3 min (range 4.5 to 16.7 min). A high level of accuracy for detecting plaques (sensitivity 78.5%; specificity 93.6%) was achieved. Identifying abnormal IMT had lower sensitivity but adequate specificity of 46.7% and 87.6%, respectively.

CONCLUSIONS

In conclusion, our findings demonstrate that clinicians can be trained well enough in six weeks to accurately and efficiently detect carotid plaques in an outpatient setting. IMT abnormalities were less accurately detected in the office-based approach and may require a specialized vascular laboratory.