Correlation between the in vitro ATP-based chemosensitivity assay and HER2/neu expression in women with breast cancer

Several in vitro chemosensitivity tests have been developed to predict the chemotherapeutic response of tumours prior to initiation of individualized treatment for breast cancer. This study investigated whether the in vitro chemosensitivity response of cell lines derived from breast cancer patients was affected by HER2/neu expression. We cultured breast cancer cell lines from 50 patients and the adenosine triphosphatebased chemotherapy response assay (ATPCRA) was performed with 5-fluorouracil, gemcitabine, docetaxel, doxorubicin, methotrexate, vinorelbine and paclitaxel. 5-fluorouracil combined a high median cell death rate (32.4%) with the narrowest range of cytotoxic effects (7.3-65.7%). In addition, gemcitabine showed significantly greater activity in HER2/neupositive patients. In contrast, docetaxel was significantly less effective in HER2/neu-positive patients. No significant correlation was found between the other agents and HER2/neu expression. The use of the ATP-CRA test for metastatic tissue from patients with recurrent disease might be a useful approach to determine the most effective chemotherapy regimen.

Osseointegration of anodized titanium implants under different current voltages: a rabbit study

The oxide layer that covers a titanium surface is extremely stable and appears to have excellent biocompatibility, which can result in successful osseointegration. The aim of this study was to analyse the characteristics of an oxide layer formed by anodic oxidation (anodization), and to evaluate the extent of bone healing around the anodized implant. The screw-type implants were made of commercially pure titanium (Grade 2). The Group 1 samples had a turned surface, and three other types of experimental specimens were anodized under constant voltages of 190 V (Group 2), 230 V (Group 3) and 270 V (Group 4). The surface characteristics of each sample type were inspected. Removal torque was measured after a 4-week healing period and the histomorphometric analysis was performed 6 weeks after implantation in rabbit tibiae. There was an increase in both the size and number of pores as the anodizing voltage increased. The Ra value of the Group 4 samples was higher than those in the Group 1 and 2 samples (P < 0.05). Group 3 showed a difference compared with Group 1 (P < 0.05). A thicker oxide layer, which contained crystalline (anatase) TiO(2) with the inclusion of some electrolytes (Ca, P), was formed at the higher anodizing voltage. Group 4 had higher removal torque values and percentages of bone-to-implant contact than the other groups (P < 0.05). The anodized titanium implants showed more intimate and stronger connections with peri-implant bone during early osseointegration than the turned titanium implants in this experimental model.

A giant malignant peripheral nerve sheath tumour of the breast: CT and pathological findings

Malignant peripheral nerve sheath tumour (MPNST) is a rare soft tissue sarcoma. In particular, primary MPNST of the breast is extremely rare. We report a case of a giant malignant peripheral nerve sheath tumour involving the entire right breast, which was not associated with neurofibromatosis type 1 (NF-1) or previous radiation therapy. A CT scan showed a huge heterogeneous soft tissue mass with well-enhanced nodules at its periphery and low-density internal necrosis, which was confirmed by modified radical mastectomy.

Photodetection of basal cell carcinoma using methyl 5-aminolaevulinate-induced protoporphyrin IX based on fluorescence image analysis

BACKGROUND

The preferential accumulation of 5-aminolaevulinic acid (ALA)-induced protoporphyrin IX (PpIX) in neoplastic cells supports its potential use in the photodetection of porphyrin fluorescence in tumour cells. Hence, epithelial tumours, including basal cell carcinoma (BCC), might be visualized using the fluorescence of selectively accumulated ALA-induced PpIX.

AIM

In this study, we evaluated the clinical efficacy of PpIX fluorescence images using fluorescence image analysis (FIA) to define the lateral border between the tumour and tumour-free areas of facial BCC.

METHODS

FIA was used to define the lateral border between the tumour and tumour-free areas on red fluorescence images induced by the topical application of methyl 5-aminolaevulinate (MAL) ointment. According to the FIA results, 50 tissue samples, obtained from 10 patients with BCC, were divided into three categories: tumour area (n = 10), suspected tumour area (n = 20) and suspected tumour-free area (n = 20). These tissue samples were evaluated by histopathological examination. The FIA tool marked out the PpIX fluorescence image for defining the lateral border between the BCC tumour and tumour-free areas.

RESULTS

The rate of tumour detection from BCC lesions using PpIX fluorescence with the FIA tool showed a sensitivity of 94.1% and specificity of 82.6%.

CONCLUSION

These results suggest that MAL-induced PpIX fluorescence imaging using FIA is quite sensitive and specific for detecting tumour and occult tumour in facial BCC lesions. This method of presurgical in vivo imaging is therefore proposed as a useful tool for defining the lateral border between BCC tumour and tumour-free areas.

Paraneoplastic pemphigus without an underlying neoplasm

We describe a 52-year-old man with paraneoplastic pemphigus (PNP) without any evidence of an underlying neoplasm over an 8-year follow-up period. He had a chronic relapsing vesiculobullous eruption for approximately 7 years (from April 1998 to May 2005). Initially, scattered flaccid vesicles with crusts developed on the face and trunk, which waxed and waned several times. Our patient was diagnosed as having PNP based on immunopathological criteria for PNP, i.e. histopathological, immunoblotting and immunoprecipitation analyses. However, physical and laboratory examinations including serial blood tests with peripheral blood smear, whole-body positron emission tomography/computed tomography and abdominal ultrasound were unable to detect any underlying neoplasm over an 8-year follow-up period.

Biological responses of anodized titanium implants under different current voltages

The oxide layer of a titanium surface is very stable, and seems to result in excellent biocompatibility and successful osseointegration. The purpose of this study was to investigate the effects of high anodic oxidation voltages on the surface characteristics of titanium implants and the biologic response of rabbit tibiae. Bone tissue responses were evaluated by removal torque tests and histomorphometric analysis. Screw-shaped implants with microthreads were made of commercially pure titanium (Grade II). We prepared anodized implants under 300 V (group I), 400 V (group II), 500 V (group III) and 550 V (group IV). The surface characteristics of specimens were inspected according to three categories: surface morphology, surface roughness and oxide layer thickness. The screw-shaped implants were installed in rabbit tibiae. The removal torque values were measured and histomorphometric analysis was done after 1- and 3-month healing periods. Data indicate that as anodic oxidation voltage increased above 300 V, oxide layer thickness increased rapidly and pore size also increased. The roughness values of the implants increased with voltage up to 500 V, but decreased at 550 V. In the removal torque test, group III showed higher values than groups I and II at a statistically significant level (P < 0.05) after a 1-month healing period. In histomorphometric analysis, groups III and IV, after a 3-month healing period, showed greater bone to implant contact ratios for the total implant surface than did group I (P < 0.05).

Multi-center prospective analysis of risk-reducing salpingo-oophorectomy to prevent BRCA-associated breast and ovarian cancer

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Background: Our groups previously reported on the efficacy of risk-reducing salpingo-oophorectomy (RRSO) for the prevention of BRCA-associated breast and ovarian cancer. (Kauff ND, et al. NEJM 2002; Rebbeck TR, et al. NEJM 2002) Limitations of those reports included relatively short prospective follow-up and lack of power to analyze the protection of RRSO when participants were stratified by BRCA1 vs. BRCA2. To address these limitations, we have pooled our updated datasets to provide robust estimates of the efficacy of RRSO. Methods: 886 women ≥ 30 years of age, with a deleterious mutation in BRCA1 or BRCA2 and ovaries in-situ at time of genetic test results, were enrolled on prospective follow-up studies at one of eleven centers from 11/1/1994 - 12/1/2004. Women chose to participate in either ovarian surveillance or undergo RRSO. Follow-up information was collected by questionnaire and medical record review. Follow-up time was counted from time of RRSO or from time of genetic test results for women who did not undergo RRSO. After excluding cancers diagnosed within the first 6 months of follow-up, the effect of RRSO on time to diagnosis of breast or BRCA-associated gynecologic cancer was analyzed using a Cox proportional-hazards model. Results: 559 (63%) participants underwent RRSO a median of 5 months after genetic test results. 12 occult ovarian or fallopian tube cancers were diagnosed at time of RRSO. During a mean 40 months follow-up, RRSO was associated with a 52% reduction in breast cancer risk and a 91% reduction in ovarian cancer risk (see Table ). When the cohort was stratified by mutation status, RRSO was associated with a reduced risk of BRCA1-associated ovarian cancer and BRCA2-associated breast cancer. Conclusions: The results confirm that RRSO is highly protective against BRCA-associated breast and ovarian cancer. These results also generate the hypothesis that the protection conferred by RRSO against specific cancers may differ between carriers of BRCA1 and BRCA2 mutations.

[Table: see text]

No significant financial relationships to disclose.

Sera from patients with toxic epidermal necrolysis contain autoantibodies to periplakin

BACKGROUND

The pathophysiological mechanism of toxic epidermal necrolysis (TEN) with extensive bullae that is induced suddenly by drugs is not well understood. The individual patterns and distribution of the widespread mucocutaneous reactions of TEN often show striking similarities with those of paraneoplastic pemphigus (PNP), which is known to involve autoantibodies (aAbs) to members of the plakin family.

OBJECTIVES

To investigate the existence of circulating aAbs to periplakin in the sera of patients with TEN.

METHODS

The presence of circulating aAbs to periplakin was examined using immunoblotting, immunoabsorption and indirect immunofluorescence (IF) analyses. Recombinant protein expression was used to determine the interaction between periplakin and aAbs in the sera of patients with TEN.

RESULTS

Indirect IF studies revealed circulating aAbs in the intercellular area in the epidermis. Interestingly, on rat bladder the staining pattern of the IgG deposits was similar to that observed in patients with PNP. Immunoblotting analysis of the epidermal extracts was used to identify the aAbs in the sera of patients with TEN. These contained circulating aAbs to a 190-kDa protein corresponding to periplakin. Recombinant periplakin and domains of periplakin were prepared in order to confirm the existence of aAbs to periplakin. Immunoblotting with these proteins demonstrated that the sera from patients with TEN reacted with each domain as well as with the full-length periplakin.

CONCLUSIONS

We found that circulating aAbs in the sera of patients with TEN target periplakin. These aAbs might play a role in the pathogenesis of TEN as a humoral autoimmune mechanism.

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment

Using a Kastle-Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication ("spinal") boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications.

Detection of coins ingested by children using a handheld metal detector: a systematic review

To determine if the use of a handheld metal detector (HHMD) can safely reduce the number of radiographs requested in cases of coins ingested by children, a search was performed to identify prospective studies of the ability of an HHMD to identify the presence or absence of ingested coin in children (17 years or younger). Outcome measures were presence or absence of coin on metal detector screening, and accuracy of coin localisation. Inclusion and exclusion criteria were defined. Mantel-Haenszel (fixed effect model) pooling with 95% confidence intervals (CI) was used to calculate overall sensitivities and specificities. In total, 11 studies met the inclusion criteria. The overall sensitivity of the HHMD at detecting the presence of coins was 99.4% (95% CI 98.0 to 99.9%) and accuracy at localisation was 99.8% (98.5 to 100.0%). The overall specificity of the HHMD was 100% (76.8 to 100%). Use of the HHMD is an accurate, radiation free, and cost effective method of identifying and localising coins ingested by children. An algorithm for investigating children with coin ingestion is proposed.

Scoring and staging systems using cox linear regression modeling and recursive partitioning

OBJECTIVES

Scoring and staging systems are used to determine the order and class of data according to predictors. Systems used for medical data, such as the Child-Turcotte-Pugh scoring and staging systems for ordering and classifying patients with liver disease, are often derived strictly from physicians' experience and intuition. We construct objective and data-based scoring/staging systems using statistical methods.

METHODS

We consider Cox linear regression modeling and recursive partitioning techniques for censored survival data. In particular, to obtain a target number of stages we propose cross-validation and amalgamation algorithms. We also propose an algorithm for constructing scoring and staging systems by integrating local Cox linear regression models into recursive partitioning, so that we can retain the merits of both methods such as superior predictive accuracy, ease of use, and detection of interactions between predictors. The staging system construction algorithms are compared by cross-validation evaluation of real data.

RESULTS

The data-based cross-validation comparison shows that Cox linear regression modeling is somewhat better than recursive partitioning when there are only continuous predictors, while recursive partitioning is better when there are significant categorical predictors. The proposed local Cox linear recursive partitioning has better predictive accuracy than Cox linear modeling and simple recursive partitioning.

CONCLUSIONS

This study indicates that integrating local linear modeling into recursive partitioning can significantly improve prediction accuracy in constructing scoring and staging systems.

Conservative treatment for closed fifth (small finger) metacarpal neck fractures

BACKGROUND

Subcapital fractures of the fifth metacarpal bone, meaning fractures just below the knuckle of the little finger, account for approximately 20% of all hand fractures. Currently, there is no consensus concerning the optimal management of these fractures. Traditionally, treatment consists of closed reduction and external splinting in a neutral position using plaster of Paris (POP), involving the metacarpal joint, the proximal interphalangeal joint and the carpo-metacarpal joint. An alternative treatment strategy is functional treatment using taping or bracing that does not restrict movement.

OBJECTIVES

To compare functional treatment with immobilization, and to compare different periods and types of immobilization, for the treatment of closed fifth metacarpal neck fractures in adults.

SEARCH STRATEGY

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialized Register (July 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004), OVID OldMEDLINE (1951 to 1965), OVID MEDLINE (1966 to July 2004), OVID MEDLINE In-Process (July 2004), EMBASE (1988 to 2004, week 29), the Internet, and reference lists of articles. No language restrictions were applied.

SELECTION CRITERIA

All randomized and quasi-randomized controlled trials which compare functional treatment with immobilization or different types of immobilization for closed fifth metacarpal neck fractures.

DATA COLLECTION AND ANALYSIS

Two review authors assessed abstracts of all studies identified by the initial search, identified studies meeting the selection criteria, independently assessed the quality of the trial reports, and extracted and analysed the data.

MAIN RESULTS

Five studies met the inclusion criteria including a total of 252 participants. Most studies were of poor quality. The primary outcome measure, function of the hand, was not used in any studies. There was no evidence that any of the treatment modalities was statistically significantly superior.

AUTHORS' CONCLUSIONS

No included studies reported our primary outcome measure of interest, validated hand function. There was heterogeneity between the studies, which were of limited quality and size. No single non-operative treatment regimen for fracture of the neck of the fifth metacarpal can be recommended as superior to another in result. Further research is definitely warranted.

Head injuries in airbag-equipped motor vehicles with special emphasis on AIS 1 and 2 facial and loss of consciousness injuries

OBJECTIVES

Safety of the airbag supplemental restraint system (airbag) is a well-known concern. Although many lives are saved each year through airbag use, injuries continue to occur, especially to the head. Airbag safety research has focused primarily on severe injuries, while minor and moderate injuries have been largely ignored.

METHODS

In this study, 205,977 injury cases from the 1995 to 2001 National Automotive Sampling System (NASS)/ Crashworthiness Data System (CDS) were surveyed to determine the prevalence of AIS 1 and 2 facial and brain loss of consciousness (LOC) injuries and determine if these injuries are a concern. The query was focused on frontal impacts in vehicles equipped with airbags. Only occupants wearing appropriate seatbelts were included in this study so that the airbag would provide occupant protection under optimal conditions. Of the 205,977 injury cases studied, 2.4% met this criterion.

RESULTS

From the data gathered, the trends seem to indicate an increase in these specific injuries, both in terms of the total number and the proportion to all injury cases. In 1995, AIS 1 and 2 head injuries accounted for 96.5% of all head injuries caused by airbags. By 2001, the percentage had risen 3.0% to 99.5%. Injuries occurring in vehicles equipped with first-generation versus second generation airbags were compared, and data seem to suggest that there is a higher rate of minor and moderate head injuries when occupants are in second-generation airbag-equipped vehicles, even when appropriate lap and shoulder belts are used.

CONCLUSIONS

The short timeframe surveyed prevents drawing meaningful conclusions about statistical significance, but the graphical representations of the data in this study underscore an urgent need for further investigation based on current trends in order to understand the issue of minor and moderate head injury prevention in regard to airbags.

Strain-rate dependent material properties of the porcine and human kidney capsule

This study was performed to characterize the mechanical properties of the kidney capsular membrane at strain-rates associated with blunt abdominal trauma. Uniaxial quasi-static and dynamic tensile experiments were performed on fresh, unfrozen porcine and human renal capsules at deformation rates ranging from 0.0001 to 7 m/s (strain-rates of 0.005-250 s(-1)). Single stroke, dynamic tests were performed on samples of porcine renal capsule at strain-rates of 0.005 s(-1) (n = 33), 0.05 s(-1) (n = 17), 0.5 s(-1) (n = 38), 2 s(-1) (n = 10), 4 s(-1) (n = 10), 50 s(-1) (n = 21), 100 s(-1) (n = 18), 150 s(-1) (n = 17), 200 s(-1) (n = 10), and 250 s(-1) (n = 17). Due to limited availability of human tissues, only quasi-static tests were performed (0.005 s(-1), n = 25). Porcine renal capsule properties were found to match the material properties of human capsular tissue sufficiently well such that porcine tissue material can be used as a human test surrogate. The apparent elastic modulus and breaking stress of the porcine renal capsule were observed to increase significantly with increasing strain-rate (p < 0.01). Breaking strain was inversely related to strain-rate (p < 0.01). The effect of increasing strain-rate on material properties diminished appreciably at rates exceeding 150 s(-1). Empirically derived mathematical models of constitutive behavior were developed using a hyperelastic/viscoelastic Ogden formulation, as well as a Cowper-Symonds law material curve multiplication.

An abutment screw loosening study of a Diamond Like Carbon-coated CP titanium implant

The aim of this study was to quantify the extent of abutment screw loosening and thus understand the role of frictional and wear factors in abutment screw loosening by using a cyclic loading device to compare Diamond Like Carbon (DLC)-coated and non-coated implants. The properties of DLC films, including hardness, wear resistance, chemical stability, and biocompatibility, are similar to those of real diamond materials. In this study, a 1-mum thick DLC film served to protect and lubricate a layer of commercially-pure titanium affixed to the top of a dental implant (external hexagon-shaped implant). A cyclic loading force was then applied to the top of the prosthetic portion of the implants in order to determine the difference in looseness of the titanium abutment screw between ten DLC-coated implants and ten non-coated implants. The abutment screw loosening tests were performed with 100 N of force at a frequency of 20 Hz. Data indicate that implants with a DLC coating are more resistant to an applied force (P = 0.002) than are those without the coating. We hope these results will be useful for preventing implant abutment screw loosening.

Microencapsulated ascorbic acid for milk fortification

The present study was designed to develop a microencapsulated L-ascorbic acid and iron that could be used to fortify milk and to determine the sensory properties of milk fortified with microencapuslation. Coating material was medium-chain triacylglycerol (MCT), and selected core material was ferric ammonium sulfate and L-ascorbic acid. The highest efficiency of microencapsulation was 95.0% in the ratio of 15:1 as coating to core material. Ascorbic acid release was increased sharply up to 5 d storage as 6.5%. TBA value was the lowest when both capsulated iron and ascorbic acid were added during 12 d storage, compared with other treatments. In sensory analysis, most aspects were not significantly different between control and capsulated ascorbic acid fortified milk at 5 d storage. The present study indicated that the use of microencapsulated ascorbic acid with MCT is effective for fortifying milk. In addition, these results suggest that acceptable milk products can be prepared with microencapsulated ascorbic acid and iron.

Enhanced expression of transglutaminase 2 in anterior polar cataracts and its induction by TGF-beta in vitro

BACKGROUND/AIMS

Transglutaminase activity has long been implicated in the cataract formation. However, the precise mechanism of how it is produced and involved in this process remains unclear. Here the authors sought to examine whether transglutaminase 2 (TGase 2) is expressed in lens epithelial cells from patients with anterior polar cataracts, to determine whether TGase 2 expression is induced by transforming growth factor (TGF-beta) in cultured lens epithelial cells, and to determine whether TGase 2 participates in the crosslinking of fibronectin in lens epithelial cells in vitro.

METHODS

Lens epithelial cells from anterior polar cataracts, nuclear cataracts, and non-cataractous clear lenses were examined for the expression of TGase 2 using reverse transcription-polymerase chain reaction, western blot analysis, and immunohistochemical analysis. The modulation of extracellular TGase 2 activity by TGF-beta was measured by the formation of fibronectin polymers and the incorporation of fluorescein cadaverine into extracellular matrix proteins. The effect of TGase 2 overexpression was analysed by immunofluorescence staining and western blot analysis of human lens epithelial (HLE) B-3 cells transiently transfected with TGase 2 gene.

RESULTS

The expression of TGase 2 mRNA and its protein was markedly enhanced in lens epithelial cells from patients with anterior polar cataracts. Treatment of HLE B-3 cells with TGF-beta caused an increase in TGase 2 protein, its extracellular activity, and the crosslinking of fibronectin. Transient transfection of HLE B-3 cells with the TGase 2 gene led to the increased production of fibronectin monomers and polymers.

CONCLUSIONS

This study shows that TGase 2 is overexpressed in lens epithelial cells from anterior polar cataracts and that TGF-beta may be a causative factor in the induction of TGase 2. The enhanced expression of TGase 2 might cause the accumulation and crosslinking of the extracellular matrix proteins and might play a part in anterior polar cataract development.

A novel mechanism for endocrine-disrupting effects of polychlorinated biphenyls: direct effects on gonadotropin-releasing hormone neurones

Polychlorinated biphenyls (PCBs) cause abnormal development and physiology of the reproductive system. We hypothesized that these effects may be mediated, at least in part, by neuroendocrine cells in the hypothalamus that integrate inputs to and outputs from the central nervous system and reproductive systems. The effects of two PCB mixtures, Aroclor 1221 and Aroclor 1254, were tested on the hypothalamic GT1-7 cells, which synthesize and secrete the key hypothalamic hormone, gonadotropin-releasing hormone (GnRH). GT1-7 cells were treated for 24 h in dose-response experiments and GnRH gene expression and release were quantified. Aroclor 1221 was stimulatory to GnRH gene expression, particularly at post-transcriptional levels (GnRH cytoplasmic mRNA), and increased GnRH peptide levels, suggesting a post-translational regulation of GnRH biosynthesis. It also caused a qualitative increase in GT1-7 neurite outgrowth and cell confluency. Aroclor 1254 had very different effects from Aroclor 1221. It inhibited GnRH nuclear mRNA levels at high dosages, and stimulated GnRH mRNA at low doses, suggesting a post-transcriptional mechanism of regulation. Aroclor 1254 did not alter GnRH peptide levels. Qualitatively, Aroclor 1254 caused a retraction of GT1-7 cell processes and neurotoxicity at high dosages. In order to gauge the involvement of the oestrogen receptor in these responses, the oestrogen receptor antagonist, ICI 182,780 (ICI) was coadministered in other studies with the PCBs. While effects of Aroclor 1221 on GnRH gene expression were not blocked by ICI, its effects on GnRH peptide levels were blocked by ICI, indicating that some but not all of the effects of Aroclor 1221 are mediated by the classical oestrogen receptor alpha and/or beta. The inhibitory effects of Aroclor 1254 on GnRH gene expression were not prevented by ICI, although ICI itself had stimulatory effects on GnRH gene expression that were blocked by cotreatment with Aroclor 1254. These results demonstrate a novel mechanism for effects of the two PCBs directly on GnRH gene expression, and indicate a hypothalamic level for endocrine disruption by these environmental toxicants.