Visual and Proprioceptive Cue Weighting in Children with Developmental Coordination Disorder, Autism Spectrum Disorder and Typical Development

Accurate movement of the body and the perception of the body's position in space usually rely on both visual and proprioceptive cues. These cues are weighted differently depending on task, visual conditions and neurological factors. Children with Developmental Coordination Disorder (DCD) and often also children with Autism Spectrum Disorder (ASD) have movement deficits, and there is evidence that cue weightings may differ between these groups. It is often reported that ASD is linked to an increased reliance on proprioceptive information at the expense of visual information (Haswell et al, 2009; Gepner et al, 1995). The inverse appears to be true for DCD (Wann et al, 1998; Biancotto et al, 2011). I will report experiments comparing, for the first time, relative weightings of visual and proprioceptive information in children aged 8-14 with ASD, DCD and typical development. Children completed the Movement Assessment Battery for Children (MABC-II) to assess motor ability and a visual-proprioceptive matching task to assess relative cue weighting. Results from the movement battery provided evidence for movement deficits in ASD similar to those in DCD. Cue weightings in the matching task did not differentiate the clinical groups, however those children with ASD with relatively spared movement skills tended to weight visual cues less heavily than those with DCD-like movement deficits. These findings will be discussed with reference to previous DSM-IV diagnostic criteria and also relevant revisions in the DSM-V.

Efficacy of Milbemax (milbemycin oxime + praziquantel) in the treatment of dogs experimentally infected with Crenosoma vulpis

Crenosoma vulpis, the fox lungworm, infects wild and domestic canids and is a cause of chronic respiratory disease in dogs in North America and Europe. The objective of this study was to determine the efficacy of milbemycin oxime (0.5mg/kg)/praziquantel (5mg/kg) (Milbemax; Novartis Animal Health, Inc.) against C. vulpis infection in a randomized, blinded, placebo-controlled study using experimentally infected dogs. Sixteen beagles (8 males, 8 females) were each given 100 infective third-stage larvae of C. vulpis. Fecal samples were examined for first-stage larvae by quantitative Baermann examination pre-exposure and at days 21, 28, 35, 42 and 49 post-infection (PI). All of the dogs were shedding larvae in the feces at 21 days PI. The dogs were randomly assigned to one of two groups. At 28 days PI, Group 1 (4 males, 4 females) received placebo only while Group 2 (4 males, 4 females) received a single treatment of milbemycin oxime (0.5mg/kg) and praziquantel (5mg/kg). The 16 dogs were euthanized and necropsied at 49 days PI. Lungs were removed, assessed for gross lesions (graded on a subjective scale 0-3 with 0 being normal) and C. vulpis were collected by lung-flush and counted. Samples of lung tissue were preserved for evaluation of histopathology and the lesions graded on a subjective scale (0-3 with 0 being normal). Gross and histopathology lesions were detected in all 8 untreated Group 1 dogs with mean subjective lesion scores of 1.8 ± 0.7 (range 1-3) and 3.0 ± 0.0 (range 3), respectively. Gross lesions were observed in 3/8 and histopathology lesions in all 8 of the treated Group 2 dogs with mean subjective lesion scores of 0.4 ± 0.5 (range 0-1) and 1.3 ± 0.4 (range 1-2), respectively. The mean (geometric) number for adult C. vulpis recovered in untreated dogs was 48.3 (range 25-70) compared with 0.65 (range 0-2) in animals treated with Milbemax. The resulting efficacy against C. vulpis was 98.7%. The number of C. vulpis was significantly lower for treated dogs than the burden in the untreated group (p=0.0002). A single dose of Milbemax (milbemycin oxime 0.5mg/kg+praziquantel 5mg/kg) was highly effective for the treatment of patent C. vulpis infection in dogs. A dosing interval for the prevention of clinical disease in dogs exposed to natural infections has not been established.

Evaluation of the effects of reflexology on quality of life and symptomatic relief in multiple sclerosis patients with moderate to severe disability; a pilot study

Objective:

To examine the feasibility of delivering reflexology to people moderately to severely affected by multiple sclerosis and to investigate the effect on a range of symptoms.

Methods:

A pilot single-blind randomized placebo controlled trial.

Setting:

An outpatient multiple sclerosis rehabilitation centre.

Subjects:

Twenty people moderately to severely affected by multiple sclerosis were randomized into one of two groups receiving either reflexology or sham reflexology.

Intervention:

Each participant received 8 weeks, 1 hour per week of either reflexology or sham reflexology.

Main measures:

Primary outcome measure was the Multiple Sclerosis Impact Scale (MSIS29). Secondary measures assessed a range of symptoms at baseline, 8 weeks and 16 weeks.

Results:

There were no statistically significant differences between the two groups at either 8 ( P = 0.538) or 16 ( P = 0.112) weeks for the primary outcome measure; however, both groups demonstrated small improvements from 92.3 (SD 20.9) to 75.6 (SD 3.3) with reflexology, and 91.3 (SD 29.9) to 81.5 (±18.5) with sham reflexology group after 8 weeks of treatment. Small improvements were noted in most of the secondary outcome measures at 8 weeks. There was no difference between the groups at 8 weeks except for bladder function ( P = 0.003) and most scores returned to baseline at follow-up.

Conclusions:

The results do not support the use of reflexology for symptom relief in a more disabled multiple sclerosis population and are strongly suggestive of a placebo response. This study demonstrates, however, that reflexology can be delivered and is well tolerated by people who are moderately to severely affected by multiple sclerosis.

Country adaptation of the 2010 World Health Organization recommendations for the prevention of mother-to-child transmission of HIV

The World Health Organization (WHO) revised its global recommendations on treating pregnant women infected with the human immunodeficiency virus (HIV) with antiretrovirals and preventing mother-to-child transmission (PMTCT) of HIV. Initial draft recommendations issued in November 2009 were followed by a full revised guideline in July 2010. The 2010 recommendations on PMTCT have important implications in terms of planning, human capacity and resources. Ministries of health therefore had to adapt their national guidelines to reflect the 2010 PMTCT recommendations, and the Elizabeth Glaser Pediatric AIDS Foundation tracked the adaptation process in the 14 countries where it provides technical support. In doing so it sought to understand common issues, challenges, and the decisions reached and to properly target its technical assistance.In 2010, countries revised their national guidelines in accordance with WHO's most recent PMTCT recommendations faster than in 2006; all 14 countries included in this analysis formally conducted the revision within 15 months of the 2010 PMTCT recommendations' release. Governments used various processes and fora to make decisions throughout the adaptation process; they considered factors such as feasibility, health delivery infrastructure, compatibility with 2006 WHO guidelines, equity and cost. Challenges arose; in some cases the new recommendations were implemented before being formally adapted into national guidelines and no direct guidance was available in various technical areas. As future PMTCT guidelines are developed, WHO, implementing partners and other stakeholders can use the information in this paper to plan their support to ministries of health.

A qualitative exploration of the impact of a 12-week group exercise class for those moderately affected with multiple sclerosis

PURPOSE

The evidence base to support therapeutic exercise for people with multiple sclerosis (MS) is improving; however few studies have considered the patients' perspective. This study aimed to explore the experiences and views of people moderately affected with MS following participation in a 12-week exercise programme.

METHOD

Twenty people with MS participated in a group exercise class. Subsequently, four men and ten women took part in one of two focus groups. Semi-structured questions were used to elicit participants' views on the exercise class, outcomes from exercise and the exercise class and any perceived facilitators or barriers to exercise. Data were analysed using a general inductive method.

RESULTS

Benefits to participating in exercise for those with MS included social support and symptom improvement. Psychosocial factors, symptoms and lack of service emerged as exercise barriers. Three inter-related themes emerged; (1) The exercise class developed as a bridge to allow participants to realise, (2) the benefits of the class, helping them to overcome and (3) barriers to exercise.

CONCLUSION

Taking part in an exercise class was a positive experience for people with MS. Healthcare professionals should work with exercise professionals to provide feasible exercise opportunities to help those with MS benefit from therapeutic exercise.

Diagnostic accuracy of rapid phIGFBP-I assay for predicting preterm labor in symptomatic patients

OBJECTIVE

To estimate sensitivity, specificity, positive and negative predictive values (PPV, NPV) of insulin-like growth factor binding protein-1 (phIGFBP-1) test in predicting preterm delivery in women with symptoms of preterm labor. Secondary objectives were to compare test characteristics of the phIGFBP-1 and fetal fibronectin (fFN) tests.

STUDY DESIGN

Labor and delivery units in two Calgary hospitals. Subjects were 349 women with suspected labor between 24 and 35 weeks gestational age (GA). Women had cervical phIGFBP-1 test +/- and fFN testing. Sensitivity, specificity, PPV and NPV were estimated. Primary outcome was birth <37 weeks GA.

RESULT

Sensitivity of phIGFBP-1 test for delivery <37 weeks was 0.39; specificity, 0.76; PPV, 0.24; NPV, 0.86. NPV of phIGFBP-1 did not differ greatly from that of fFN testing (0.88).

CONCLUSION

NPV did not differ between phIGFBP-1 and fFN for delivery <37 weeks. Neither test improves on pretest probability of delivery <37 weeks, so clinicians must decide whether the use of either test is justified.

Strategies to defeat ketamine-induced neonatal brain injury

Studies using animal models have shown that general anesthetics such as ketamine trigger widespread and robust apoptosis in the infant rodent brain. Recent clinical evidence suggests that the use of general anesthetics on young children (at ages equivalent to those used in rodent studies) can promote learning deficits as they mature. Thus, there is a growing need to develop strategies to prevent this injury. In this study, we describe a number of independent approaches to address therapeutic intervention. Postnatal day 7 (P7) rats were injected with vehicle (sterile PBS) or the NMDAR antagonist ketamine (20 mg/kg). After 8 h, we prepared brains for immunohistochemical detection of the pro-apoptotic enzyme activated caspase-3 (AC3). Focusing on the somatosensory cortex, AC3-positive cells were then counted in a non-biased stereological manner. We found AC3 levels were markedly increased in ketamine-treated animals. In one study, microarray analysis of the somatosensory cortex from ketamine-treated P7 pups revealed that expression of activity dependent neuroprotective protein (ADNP) was enhanced. Thus, we injected P7 animals with the ADNP peptide fragment NAPVSIPQ (NAP) 15 min before ketamine administration and found we could dose-dependently reverse the injury. In separate studies, pretreatment of P6 animals with 20 mg/kg vitamin D(3) or a nontoxic dose of ketamine (5 mg/kg) also prevented ketamine-induced apoptosis at P7. In contrast, pretreatment of P7 animals with aspirin (30 mg/kg) 15 min before ketamine administration actually increased AC3 counts in some regions. These data show that a number of unique approaches can be taken to address anesthesia-induced neurotoxicity in the infant brain, thus providing MDs with a variety of alternative strategies that enhance therapeutic flexibility.

The effects of a 12-week leisure centre-based, group exercise intervention for people moderately affected with multiple sclerosis: a randomized controlled pilot study

OBJECTIVE

To establish the effects of a 12-week, community-based group exercise intervention for people moderately affected with multiple sclerosis.

DESIGN

Randomized controlled pilot trial.

SETTING

Two community leisure centres.

PARTICIPANTS

Thirty-two participants with multiple sclerosis randomized into intervention or control groups.

INTERVENTION

The intervention group received 12 weeks of twice weekly, 60-minute group exercise sessions, including mobility, balance and resistance exercises. The control group received usual care.

MAIN OUTCOME MEASURES

An assessor blinded to group allocation assessed participants at baseline, after eight weeks and after 12 weeks. The primary outcome measure was 25-foot (7.6 m) walk time, secondary outcomes assessed walking endurance, balance, physical function, leg strength, body mass index, activity levels, fatigue, anxiety and depression, quality of life and goal attainment.

RESULTS

The intervention made no statistically significant difference to the results of participants' 25-foot walk time. However the intervention led to many improvements. In the intervention group levels of physical activity improved statistically between baseline and week 8 (P < 0.001) and baseline and week 12 (P = 0.005). Balance confidence results showed a significant difference between baseline and week 12 (P = 0.013). Good effect sizes were found for dynamic balance (d = 0.80), leg strength (d = 1.33), activity levels (d = 1.05) and perceived balance (d = 0.94).

CONCLUSION

The results of the study suggest that community-based group exercise classes are a feasible option for people moderately affected with multiple sclerosis, and offer benefits such as improved physical activity levels, balance and leg strength.

Evaluation of a home-based physiotherapy programme for those with moderate to severe multiple sclerosis: a randomized controlled pilot study

OBJECTIVE

To investigate the effect of an eight-week home-based physiotherapy programme in reducing physical impairment, disability and psychological distress for people with moderate to severe multiple sclerosis (MS).

DESIGN

Pilot randomized controlled trial.

SETTING

Community; subjects' homes.

SUBJECTS

Thirty people moderately to severely affected by MS (Extended Disability Status Score, EDSS, 6.5-8) were randomized to an intervention or control group.

INTERVENTION

The intervention group received twice weekly, home-based physiotherapy for eight weeks and the control group received usual care.

MAIN MEASURES

The following outcome measures were recorded at baseline, post-intervention (Week 8) and at follow-up (Week 16). Primary outcome measure; Multiple Sclerosis Impact Scale (MSIS29) and secondary outcome measures assessed physical impairment, MS symptoms, quality of life, mood, and disability.

RESULTS

Although the Group * Time interaction failed to reach statistical significance with MSIS29 (p = 0.925), MS - related symptom checklist (MS-RS) (p = 0.627) and for lower limb strength, right knee extension (p = 0.375) and right knee flexion (p = 0.794), there is more evidence of altered levels in the treatment group than in the control group.

CONCLUSION

A minimum of 58 subjects per group are required to achieve a power of 80% at the 5% level of significance based on the MSIS29. A larger scale study is required.

How ethical is your clinical trial?

Is Institutional Review Board (IRB) approval and a rigorous informed consent process enough? It is our view that this is no longer the case. Conventional research ethics emphasise the importance of weighing the risks and benefits for prospective participants as one of the key determinants of deeming a clinical trial ethical. We support the notion that ethical obligations of research should include considerations not only at the individual level, but also at the community level (1 ,2 ).

Summation of responding maintained by fixed-interval schedules

A light and tone were separately correlated with responding maintained by fixed-interval schedules, in which the level of responding varied continuously throughout the duration of the interval. Responding during the presence of the single stimuli and their compound was compared during the successive segments of the interval. The following results were obtained: (1) more responses were emitted during compounding than were emitted during either stimulus alone in all segments of the interval; (2) increases in the number of responses across the interval during compounding paralleled increases during single-stimulus presentations. The sum of the responses emitted during the single stimuli was similar to the number of responses emitted during compounding, suggesting that the response tendencies correlated with the single stimuli combined in a summative or additive fashion.

Compounding of discriminative stimuli that maintain responding on separate response levers

In Experiment 1, rats' responses were reinforced on a fixed-interval 30-sec schedule in the presence of either a light or a tone and were not reinforced in their absence. Each stimulus was correlated with its own response lever, with only one lever present during a session. When light and tone were compounded in the presence of the tone-correlated lever, no change in responding occurred. However, when tone was compounded with light in the presence of the light-correlated lever, level of responding was greater than to light alone (response summation). Summation was also found when each stimulus was correlated with the same lever. Next, light and tone were again correlated with separate levers, but both levers were always simultaneously present. Compounding produced both summation and emission of most responses on the light-correlated lever. This prepotency of light was reduced (1) by leaving a houselight on throughout the session; and (2) by correlating each stimulus with a different schedule (either fixed-interval 4.7-sec or fixed-interval 30-sec). With a medium- and high-intensity houselight and with the different reinforcement schedules, similar results were obtained during compounding, regardless of whether compounding occurred in the presence of the light- or tone-correlated lever.

Compounding of pre-aversive stimuli

When two discriminative stimuli, each capable of maintaining a response, are combined, their compound will maintain a frequency of response greater than the frequencies maintained by the individual stimuli. This has been called additive summation. The present experiments extended the investigation of this phenomenon to a converse situation in which two pre-aversive stimuli were combined. Each pre-aversive stimulus was capable of reducing the frequency of an ongoing response. The combination of these stimuli reduced the relative frequency of response below that resulting from either stimulus. Furthermore, the compounding of two highly suppressive stimuli produced more suppression than the compounding of two less-suppressive stimuli. Evidence was also presented to suggest that the compound continued to reduce responding even when the single stimuli were no longer effective. A fourth experiment demonstrated that summation of response tendencies could not be accounted for in terms of stimulus intensity or sensory interaction.

Nerve cuff stimulation and the effect of fascicular organization for hand grasp in nonhuman primates

The overall goal of this work is to introduce nerve cuff electrodes into upper extremity hand grasp systems. The first challenge is to develop a nerve cuff electrode that can selectively activate multiple hand functions from common upper extremity peripheral nerves. The Flat Interface Nerve Electrode (FINE) has shown selective stimulation capability in animal trials. The FINE wraps around the nerve and gently reshapes the nerve and aligns the fascicles within the nerve. Our hypothesis is that the FINE can selectively stimulate multi-fascicular nerves in the human upper extremity resulting in selective hand function. To assess the ability of the FINE to produce control of a hand with many degrees of freedom, we have tested the FINE in nonhuman primates. Fascicular organization and fascicle count are important factors to consider when determining electrode placement. The proximal nerve is an attractive electrode location to access both extrinsic and intrinsic muscles in the upper extremity. A challenge with the nonhuman primate model is that the nonhuman primate median and ulnar nerves both have uni-fascicular regions proximally. The human proximal median and ulnar nerves have an encouraging anatomy of multi-fasciculated nerves with redundant fascicles that may result in more selective hand function than is capable in the nonhuman primate.

Clinical predictors of achalasia

Limited access to esophageal manometry (EM) may delay identification and treatment of patients with achalasia. In order to assess predictors to fast-track patients for manometric confirmation of achalasia, we compared the clinical, radiographic, and endoscopic characteristics of achalasia patients to patients with functional dysphagia without manometric features of achalasia (controls). Patients referred for esophageal manometry to assess functional dysphagia prospectively identified over a 12-month period were asked to participate in this study. The Achalasia Symptom Questionnaire (ASQ), a structured 11-question survey (score: 0-best, 67-worst), was completed by all consenting patients. ASQ scores, esophago-gastro-duodenoscopy and upper gastro-intestinal (UGI) contrast study findings were compared between patents with subsequently confirmed achalasia and those in whom achalasia was excluded by EM. Univariate logistic regression identified predictors that were tested by multivariate logistic regression to generate the model. Of the 803 EM performed over this 12-month period, 95 patients were referred specifically to assess functional dysphagia. Of these, 50 were confirmed to have achalasia, and 45 had dysphagia without manometric evidence for achalasia and hence comprised the control group. ASQ scores were higher in achalasia patients (37+/-13 versus 23+/-10). Endoscopy and/or contrast esophagogram reports were available in 92% achalasia patients and 80% controls. Significant predictors for achalasia identified on univariate logistic regression included ASQ score, abnormal findings on endoscopy, and contrast UGI study. Using multivariate logistic regression, we were able to accurately predict the probability of achalasia to be P where P=ey/(1+ey) and y=5.6+(0.089xASQ)+(2.088xEGD)+(3.083xUGI), e=exponential constant 2.7182, esophagogastroduodenoscopy (EGD) and UGI=0 if normal and 1 if abnormal. Dropping the predictor ASQ, the formula changes to y=-2.7+(1.987xEGD)+(2.861xUGI). Using only noninvasive investigations (i.e. eliminating EGD), the formula changes to y=-4.9653+(0.0951xASQ)+(3.4312xUGI). The probability of achalasia can be calculated in patients with functional dysphagia based on clinical, endoscopic, and radiographic findings allowing for a prioritization of EM studies.

Distinctive Expression of Cancer/Testis-X Antigens in a Subset of ER Negative Breast Carcinomas

Background: Cancer/testis-X antigens are a multigene family that are predominantly expressed in human germ line cells, with little or no expression in somatic adult tissues, but become aberrantly activated in various malignancies. Some such CT-X antigens represent ideal targets for cancer immunotherapy and have already been used in clinical testing. In contrast to melanomas, bladder, lung, ovarian and hepatocellular carcinomas which show higher levels of CT-X antigen expression, the reports in breast cancers have been inconclusive to date and a comprehensive gene expression and clinicopathological analysis has yet to be performed.Material and Methods: Using sequencing data as well as nine publicly available gene expression data sets, we analyzed the expression of Cancer/testis-X antigens in more than 1900 primary breast cancers. Complementary analysis was performed on three tissue microarrays comprising a total of 201 primary breast carcinomas and 53 brain metastases. Clinical information on the ER-, PR-, HER2, Ki67, p53, EGFR and basal markers was available for statistical analysis.Results: A significantly higher expression of Cancer/testis-X antigens was found in ER negative breast carcinomas over different data sets with a concordant gene expression pattern of several Cancer/testis-X antigens. Members of the MAGEA family and NY-ESO-1/CTAG1B were consistently the most prevalent. Immunohistochemical analyses confirmed a significant correlation of MAGEA family and NY-ESO-1/CTAG1B with ER negative (pValue &lt; 0.0001), PR negative (pValue &lt; 0.01) and Ki67 staining (pValue &lt; 0.0001). Many of these tumors were also positive for basal markers.Discussion: Previous studies of Cancer/testis-X antigens in breast have focused on ER positive cancers, in smaller subsets and provided inconclusive results. Using comprehensive gene expression data sets and tissue microarrays, we have demonstrated a significant association of MAGEA family and NY-ESO-1/CTAG1B with ER/PR negative breast cancer. Since these cancers represent a subgroup for which less therapeutic modalities are available, we propose the use of MAGEA and NY-ESO-1/CTAG1B cancer vaccines in the adjuvant setting as an approach to restricting tumor growth and metastases. Clinical trails using MAGEA and NY-ESO-1/CTAG1B are warranted.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3139.

PTC299, a Novel Regulator of Tumor VEGF Expression, Is Well Tolerated and Achieves Target Plasma Concentrations: Dose-Ranging Results of a Phase 1b Study in Women with Metastatic Breast Cancer

Background: Current anti-angiogenic drugs interfere with the vascular endothelial growth factor (VEGF) signaling pathway. PTC299 is an orally delivered, small-molecule investigational drug designed to inhibit the expression of VEGF and other angiogenic cytokines within tumors. PTC299 also induces a parallel interruption of tumor cell division at the G1/S phase of the cell cycle, offering several potential mechanisms of action. In multiple models of human cancers grown as xenografts in mice, including breast cancer, single-agent PTC299 decreases tumor and plasma VEGF levels and results in significant tumor regression or delay of tumor growth. Data from Phase 1a testing in healthy volunteers supported initiation of this Phase 1b, 2-stage, open-label, dose-ranging, escalating-dose, safety, pharmacokinetic (PK), and pharmacodynamic study evaluating PTC299 monotherapy and PTC299 combination therapy with hormonal agents in adult women with metastatic breast cancer.Materials and Methods: In Stage 1, patients have received PTC299 monotherapy in repeated 6-week cycles, each comprising a 4-week course of PTC299 administered on a twice daily (BID) schedule, followed by a 2-week washout period. The study was designed to enroll 3 successive cohorts of 3 to 6 patients at progressively higher dose levels of 0.3 mg/kg/dose BID, 0.6 mg/kg/dose BID, or 1.2 mg/kg/dose BID, with treatment given until disease progression or unacceptable toxicity. Safety, PK, and antitumor activity have been assessed.Results: Stage 1 enrolled 9 subjects (3 at each dose level) with a median [range] of 53 [31-76] years old and an Eastern Cooperative Oncology Group (ECOG) performance status of 0 (n=1) or 1 (n=8). Patients were extensively pretreated with hormonal (patient n=3), chemotherapy (n=9), and/or antiangiogenic agents (n=6). No dose-limiting toxicity was observed. Adverse events have generally been infrequent, low-grade, and do not appear to be PTC299-related. No hypertension, bleeding, thromboembolism, or proteinuria has been seen. Drug plasma concentrations have exceeded the maximally active plasma trough level identified in nude mouse xenograft models. Disease stabilization through multiple cycles (∼6 months and ∼4.5 months, respectively) has been observed in 2 subjects at the highest PTC299 dose level (1.2 mg/kg/dose BID). In these subjects, improvements in tumor-related markers of angiogenesis/inflammation have been observed.Discussion: PTC299 may offer safety, efficacy, and convenience advantages relative to current anti-angiogenic drugs. In Stage 1 of this Phase 1b study, PTC299 has been well tolerated, has achieved target plasma concentrations, and has shown suggestions of antitumor and pharmacodynamic activity. Accrual to Stage 2, in which subjects receive PTC299 combination therapy with hormonal agents, is ongoing.Supported by a translational breast cancer research grant award from the Congressionally Directed Medical Research Programs of the Department of Defense

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6092.