TGM2 inhibition attenuates ID1 expression in CD44-high glioma-initiating cells

BACKGROUND

CD44 is a molecular marker associated with cancer stem cell populations and treatment resistance in glioma. More effective therapies will result from approaches aimed at targeting glioma cells high in CD44.

METHODS

Glioma-initiating cell lines were derived from fresh surgical glioblastoma samples. Expression of tissue transglutaminase 2 (TGM2) was attenuated through lentivirus-mediated short hairpin RNA knockdown. MTT assay [(3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] was used to evaluate the growth inhibition induced by TGM2 inhibitor. Terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling was used to evaluate cell apoptosis following TGM2 inhibition. CD44(+) glioma stem cells were sorted by flow cytometry. A nude mice orthotopic xenograft model was used to evaluate the in vivo effect of TGM2 inhibitor.

RESULTS

TGM2 was highly expressed in CD44-high glioblastoma tissues and tumor-derived glioma-initiating cell lines. TGM2 knockdown impaired cell proliferation and induced apoptosis in CD44-high glioma-initiating cell lines. Further studies indicated that expression of inhibitor of DNA binding 1 protein (ID1) is regulated by TGM2 and might be an important mediator for TGM2-regulated cell proliferation in CD44-high glioma-initiating cell lines. TGM2 inhibitor reduces ID1 expression, suppresses cell proliferation, and induces apoptosis in CD44-high glioma-initiating cell lines. Furthermore, TGM2 is highly expressed in CD44(+) glioma stem cells, while pharmacological inhibition of TGM2 activity preferentially eliminates CD44(+) glioma stem cells. Consistently, TGM2 inhibitor treatment reduced ID1 expression and induced apoptosis in our orthotopic mice xenograft model, which can be translated into prolonged median survival in tumor-bearing mice.

CONCLUSIONS

TGM2 regulates ID1 expression in glioma-initiating cell lines high in CD44. Targeting TGM2 could be an effective strategy to treat gliomas with high CD44 expression.

Temozolomide plus interferon-β for recurrent malignant glioma patients: Experience of 28 cases

e13037

Background: Previous studies showed that interferon-β may enhance chemosensitivity of temozolomide (TMZ) and nitrosoureas. The present study was to evaluate the efficiency and side effects of TMZ plus INF-β in recurrent malignant glioma patients. Methods: Patients (age≥18 years) with grade III-IV glioma that was progressive or recurrent after prior standard radiotherapy plus TMZ chemotherapy were eligible for the study. Patients were scheduled to receive INF-β 3MU subcutaneous injections on days 1, 3 and 5, while TMZ 200mg/m2orally on days 2 to 6, of a 4-week cycle until tumor progression or unacceptable toxicity. Tumor response was assessed by MRI every 8 weeks. The primary end point was objective response (complete response [CR] plus partial response [PR]) by Response Assessment in Neuro-Oncology Working Group (RANO) criterion. Secondary end points included progression free survival (PFS), overall survival (OS), and toxicity. Results: From July of 2010 to October of 2012, 28 patients were assessed (16 GBM and 12 grade III glioma). There were 22 males and 6 females, and the median age was 44.5 years (ranged from 22 to 73). The median KPS was 80 (70`100). Radiographic responses were noticed in 35.7% (10 of 28) of patients. There was none CR, but 10 PR, 14 stable disease (SD) and 4 progressive disease (PD). The median PFS was 6.0 months (95% CI 3.9-8.0),the median OS was not availability. The most common toxicities include grade±-2 neutropenia(4 cases), thrombocytopenia (3 cases), nausea and vomiting (3 case), fatigue (8 cases) and liver malfunction (3 cases). Grade III or ‡W toxicities were uncommon. Conclusions: Temozolomide plus INF-β has moderate efficacy for recurrent high grade glioma with acceptable toxicity, and thus worth further investigation.

The Stupp regimen preceded by early post-surgery temozolomide versus the Stupp regimen alone in the treatment of patients with newly diagnosed glioblastoma multiforme (GBM)

2022

Background: In treatment of newly diagnosed GBM with the Stupp chemo-radiotherapy regimen, following by adjuvant chemotherapy, patients were treated with temozolomide (TMZ) & combined radiotherapy 4-5 weeks after surgery. In the interval between surgery and chemo-radiotherapy, it is not known whether additional TMZ treatment will improve efficacy or safety. This trial evaluated the safety and efficacy of the Stupp regimen + early post-surgery TMZ chemotherapy in the treatment of patients with newly diagnosed GBM. Methods: The trial was a multi-center, randomized open-label study. 99 newly diagnosed GBM patients were enrolled and randomly assigned to the Stupp regimen + early post-surgery TMZ chemotherapy arm (experimental group, n = 52) or to Stupp regimen alone (control group, n = 47). Fourteen days after surgery, the patients in experiment group recieved TMZ orally at 75mg/m2/day for 14 days. The primary endpoint of the study was the overall survival (OS). The secondary endpoints included the progression-free survival (PFS), objective tumor assessment and adverse events (AEs). Results: The median OS time was 17.58 months (95% CI: 15.18 – 23.03 months) in the experiment group and 13.17 months (95% CI: 11.14 – 18.76 months) in the control group (log-rank test, p = 0.021). There is no significantly difference in the median PFS between experiment group and control group (8.74 months, 95% CI: 6.41-14.85 months vs 10.38 months, 95% CI: 8.18-15.44 months, p = 0.695). No statistically significant difference was detected as regards to the objective tumor assessments. There is no significance in OS or PFS between MGMT positive and MGMT negative groups. TMZ treatment was well tolerated in the study. AE types and rates were generally similar between the two groups. There were 22 SAEs in this study, with only 1 SAE (lung infection) in Stupp regimen group was possibly drug-related. Conclusions: The addition of early post-surgery TMZ chemotherapy to the Stupp regimen for newly diagnosed GBM resulted in a statistically significant survival benefit with minimal additional toxicity. Clinical trial information: NCT00686725.

R10K update: NGS of immune repertoire for biomarker discoveries (P3241)

The natural duty of the adaptive immune system is to detect any internal and external threats and mount specific and measured reactions accordingly. Therefore, the immune repertoire is rich in specific diagnostic markers. We have developed a novel multiplex PCR method, which can amplify the CDR3 regions from a sample inclusively and semi-quantitatively. The PCR products can be sequenced directly with different next generation sequencing platforms. A software package was developed to filter out amplification and sequencing errors, identify CDR3 sequences and perform routine repertoire analysis. The R10K project (www.R10K.org) is organized and supported by the HudsonAlpha Institute for Biotechnology, a nonprofit research institute specialized in genomic research. The project is an international collaborative effort to sequence 10,000 samples and study 100 diseases. Our pilot studies have demonstrated that disease specific repertoire changes can be detected. Quantitatively, the changes in repertoire diversity can be used as a biomarker for disease staging and measuring treatment response. Qualitatively, detection of disease specific CDR3s can be used for early diagnosis of diseases, including cancer, autoimmune diseases, inflammatory diseases, and infectious diseases. The R10K project is open to collaborators; the IP rights are shared among collaborators, participating institutions and companies. The data will be publicly available as each study is completed.

[Survival of newly diagnosed malignant glioma patients on combined modality therapy]

OBJECTIVE

To explore the survival of newly diagnosed malignant gliomas patients on combined modality therapy of surgery, radiotherapy and chemotherapy.

METHODS

The data of 122 newly diagnosed malignant glioma patients on combined modality therapy at our center between 2000 and 2010 were retrospectively reviewed and analyzed. The median age was 40 years old (range: 5 - 75) and median Karnofsky performance status score (KPS) 80 (range: 60 - 100). Combined modality therapy consisted of surgery (maximal safety tumor resection), followed by fractionated focal irradiation for a total dose of 54 - 60 Gy and then 4 - 6 cycles of adjuvant chemotherapy including temozolomide or nitrosourea-based regimens or other ones without temozolomide and nitrosourea. The overall and progression-free survivals were analyzed by the Kaplan-Meier method and the influencing factors screened by Cox proportional hazard model.

RESULTS

There were grade IV (n = 70) and grade III (n = 52). The median survival periods were 17.0 months for grade IV patients and 36.0 months for grade III ones. The 2, 3, 4 and 5-year survival rates were 32.0% vs 64.8%, 19.6% vs 47.8%, 11.8% vs 32.0% and 5.9% vs 25.4% (P < 0.01) for grades IV and III patients respectively. The median progression-free survivals were 9.0 vs 12.0 months and 1, 2 and 3-year progression-free survival rates 30.8% vs 50.0%, 12.3% vs 31.4% and 9.2% vs 17.7% (P < 0.01) respectively. Multivariate analysis revealed that histologic type was an independent prognostic factor.

CONCLUSION

Combined modality therapy of surgery, adjuvant radiotherapy and chemotherapy may improve the survival of patients with malignant gliomas.

Effect of interferon-α/β on temozolomide activity against MGMT-positive glioma stem-like cells in vitro and in vivo

e12503

Background: O6-methylguanine DNA methyltranferase (MGMT) is one of the main mechanisms of chemoresistance for alkylating agents in malignant gliomas. Recent studies have showed that glioma stem-like cells (GSCs) could be the main reason for tumor recurrence and chemoresistance. In this study, we aimed to explore the effects of interferon-α/β against MGMT-positive glioma stem-like cells, and to investigate whether interferon-α/β can enhance the efficiency of temozolomide (TMZ) and the possible mechanism Methods: The growth inhibition effect of TMZ, with interferon-α or interferon-β, against the MGMT-positive GSCs from human glioma cell lines U251 and SKMG-4 (U251G and SKMG-4G) was evaluated by using Cell Counting Kit-8 (CCK-8) assay in vitro, and in xenograft models. MGMT and NF-κB expression in the tumor samples were determined by RT-PCR and Western blot analysis. Results: Our results revealed that the anti-tumor activity of TMZ was significantly enhanced by combined using interferon-α/β in vitro. In xenograft models, the tumor growth inhibit rate (IR) of TMZ to SKMG-4G and U251G was 35.2%±2.28% and 16.7%±1.96%, respectively. When TMZ combined with interferon-α or interferon-β, the IR to SKMG-4G was 58.4%±4.34% and 63.4%±1.08%; and to U251G was 41.1%±8.66% and 44.5%±1.90%, respectively(P<0.05). The expression of NF-κB and MGMT in MGMT-positive GSCs decreased significantly in both mRNA and protein levels after using interferon-α/β. Conclusions: Our results indicate that IFN-α/β can enhance the sensitivity of TMZ, possibly through down-regulate NF-κB expression resulting in lower MGMT transcription expression.

Evaluation of three next generation sequencing platforms for immune repertoire sequencing (58.10)

The advent of next generation sequencing (NGS) techniques, combined with a semi-quantitative multiplex PCR method, enables us to comprehensively profile the lymphocyte receptor diversity (immune repertoire) of the entire collection of B or T cells from a particular sample. Different NGS platforms vary in read length, throughput, sequencing error rate and error pattern, hands-on time, turnaround time and price. Three popular NGS techniques (Illumina HiSeq, 454 FLX and Ion Torrent) were employed to sequence amplicons from T cell receptor clones generated with arm-PCR in order to evaluate the usage of those techniques on immune repertoire sequencing. The error pattern and rate of the three techniques in the context of T cell receptor sequences were profiled. Based on the differences of the three techniques, we discuss the usage of each NGS platform in the context of immune repertoire sequencing.

R10K: an international collaborative project for biomarker discovery (58.7)

The R10K Project is an international collaborative effort to sequence the immune repertoire (T and B cells) from 10,000 samples that cover 100 diseases. We have developed a novel multiplex PCR method, which can amplify targets from a complex genetic material, inclusively and semi-quantitatively. This easy-to-use technology has been successfully applied to amplify immune repertoire libraries from peripheral blood samples or other tissue samples. The natural duty of the adaptive immune system is to detect any internal and external threats and mount specific and measured reactions accordingly. Our pilot studies have demonstrated that immune repertoire sequencing can be used to measure this specific response and identify disease-related T cell CDR3s. Therefore, analyzing the immune repertoire of several disease states with high throughput sequencing may lead to the discovery of disease-specific biomarkers for diagnosis, prognosis, and treatment evaluations. The R10K project is organized and supported by the HudsonAlpha Institute for Biotechnology, a non-profit research institute specialized in genomic research. A Scientific Advisory Board has been established to help identify projects from online submitted proposals. The R10K data will be made public 6 months after it has been generated.

Identification and temporal monitoring of breast cancer-associated T cell receptors with high throughput sequencing (46.23)

Tumor-specific antigens may trigger an immune response that leads to T lymphocytes infiltrating the tumor tissue. We have developed a method to study the immune repertoire of a sample by utilizing a patented multiplex PCR amplification strategy, arm-PCR (Patent No. 7,999,092), coupled with high throughput sequencing (Wang et al., PNAS 2010). Using this method, we studied a patient’s surgically removed breast cancer tissue, the nearby normal tissue, and sorted peripheral blood. The patient’s sorted peripheral blood was also examined three months, six months, and one year post-surgery. Dominant T cell clones with specific CDR3 sequences were identified from the breast cancer tissue. Some of these same clones were found expressed at high levels in the nearby normal tissue and peripheral CD8+ cells. After treatment, dynamic changes in these cancer-associated clones were apparent, demonstrating the capability of the current technology to identify specific T cells associated with a patient’s cancer tissue. These specific T cells can serve as personalized biomarkers for prognosis, treatment evaluations, and early detection of recurrence. They can also be used to develop personalized treatment strategies. Currently, this study has been extended to examine 10 additional breast cancer patients.

[Correlation between TGF- β1 expression and Treg cell infiltration in glioma]

AIM

To investigate correlation between the expression of TGF-β1 and the amount of Treg cell in glioma, and evaluate their clinical values in predicting the prognosis of glioma.

METHODS

Double immunohistochemistry staining was used to detect the expression of TGF-β1, CD4 and Foxp3 in 135 specimens of human gliomas (WHO I 18, WHO II 45, WHO III 53, WHO IV 19) and 15 normal brain.

RESULTS

OF the 135 specimans of glioma, 58 showed low TGF-β1 expression and 77 (57.03%) showed high TGF-β1 expression while ws not expression in normal brain tissue. Average Treg cell density in glioma was 2. 031/HP, but there was no expression of Treg in normal brain tissue. Expression of TGF-β1 was positively correlated with the mount of Treg in glioma tissues (r = 0.294, P < 0.01). Compared with the low grade, The levels of TGF-β1 and the amount of Treg cells with significant higher in high-grade glioma, however the mount of Treg had no correlations with Sex, KPS score. The Laplan-Meier analysis showed that there wer significant difference in overall survival (OS) between the TGF-β1 high-expression and low-expression group (P < 0.001). Cox multivariate analysis showed that TGF-β1 and Treg were not independent prognostic factors (P > 0.05).

CONCLUSION

Intratumoral of TGF-β1 may relate to the infiltration of Treg cells in glioma tissues. The level of TGF-β1 was obviously increased in high grade. Glioma patients with TGF-β1 or Trg high expression have poorer prognosis, while TGF-β1 and Treg cannot serve as independent prognostic factors of glioma survival time.

High throughput sequencing identified specific T cells from breast cancer tissue and peripheral blood (48.37)

Tumor specific antigens may trigger an immune response that leads to T lymphocytes infiltrating the tumor tissue. We have developed methods using high throughput sequencing technology to study the immune repertoire within a sample (Wang et al., PNAS 2010). Using this method, we studied a patient’s surgically removed breast cancer tissue, the nearby normal tissue, and sorted peripheral blood. Dominant T cell clones with specific CDR3 sequences were identified from the breast cancer tissue. The same clones were found expressed at high levels in the nearby normal tissue and peripheral CD8+ cells. The clones were also expressed at low levels in other subsets of T cells in peripheral blood. Peripheral blood was collected after lumpectomy and radiation therapy from the same patient and subsets of T cells were sequenced. The study demonstrated the capability to identify specific T cells associated with a patient’s cancer tissue. These specific T cells can serve as personalized biomarkers for prognosis, treatment evaluations and early detection of recurrent tumors. Identification of these cancer specific T cells also make it possible to design personalized treatment strategies.

Development of an alternative method for the identification and production of antigen-specific monoclonal antibodies (65.16)

A critical step in the production of monoclonal antibodies (Abs) is the initial identification of the antigen-specific Abs, which is usually performed by multiple rounds of panning in both hybridoma and phage display. We have developed an alternative method that allows for the rapid and direct identification of antigen-specific Abs from peripheral blood via high-throughput immune repertoire sequencing and LC MS/MS peptide matching. Our B-cell repertoire technology combines novel amplicon rescued multiplex PCR (arm-PCR, patent pending) with high-throughput gene sequencing to access the sequence of a broad spectrum of heavy and light chain V-regions. As a proof of concept, we have sequenced the immune repertoire of 2 healthy individuals at various time points after administration of the 2009-2010 seasonal influenza vaccine. Antigen-specific Abs were purified directly from immune peripheral blood serum and identified using LC MS/MS peptide sequencing, exploiting the B-cell repertoire gene sequencing results as a database for identification. During our study, several unique peptides were successfully matched for each individual’s response to both Flu A strains in the vaccine. Future work includes the development of a method to rapidly clone and express these identified Abs in a human in vitro glycoexpression system. The recombinant Abs will then be tested for their ability to bind flu hemagglutinin, demonstrating the utility of our technology towards the production of mAbs.

Profiling the pattern of human immunoglobulin SHM and CSR in B memory cells via high-throughput sequencing (62.11)

One of the defining features of the adaptive immune system is that it adapts its response during an infection to improve its recognition of the pathogen. The adaptive feature is best embodied in the genetic alteration mechanism of somatic hypermutation (SHM) and class-switch recombination (CSR) as they are only activated to increase recognition to a previously encountered pathogen. Due to the limited number of sequence data, the hypermutation pattern such as mutation rate, and the distribution of mutation spots remains poorly understood. Using the combination of arm-PCR and high-throughput sequencing, we have determined about one million cDNA sequences of human immunoglobulin genes in B memory cells isolated from the peripheral blood from two subjects at various time points after administration of the 2009-2010 flu vaccine. We identified the location of the hypermutations, the distribution of mutation rate, mutation patterns of different classes of immunoglobulin, and the impact on primer design for immunoglobulin genes.

Immune repertoire high-throughput sequence analysis (IRAS) web service (65.20)

An immune repertoire is the sum of functionally diverse B and T cells, which is shaped by genetic polymorphism, antigen exposure history and regulation and modulation of the immune system. High-throughput sequencing techniques allow us to take a snapshot of the diversity of the immune repertoire, which is a fundamental determinant of the competence of the immune system. However, many researchers are overwhelmed by the task of managing and analyzing the flooding amount of sequence data generated by next-generation DNA sequencers. To make the immune repertoire high-throughput sequencing technology accessible to greater numbers of investigators, we have developed a web based immune repertoire sequence data analysis and management system (IRAS). IRAS is backed by a Linux cluster, where V, D, J germline sequences can be mapped onto reads using the Smith-Waterman algorithm in a high-throughput manner. Mapping results are loaded into a MySQL database and reads are annotated with CDR1, 2, 3 regions. We have developed a web portal to allow easy access to those data, where 2D-plot, 3D-plot, various summary tables, statistical results and mapping alignments can be generated on the fly. The IRAS is open to public and welcome to use. Users can submit their sequence data and relevant metadata through the web portal.

[Nimotuzumab in combination with chemotherapy for patients with malignant gliomas]

OBJECTIVE

Nimotuzumab is a humanized monoclonal antibody targeted against epidermal growth factor receptor (EGFR). Recent clinical studies show that patients with malignant gliomas could benefit from nimotuzumab treatment. The aim of the present study was to evaluate the efficacy and side effects of nimotuzumab in combination with chemotherapy for patients with malignant gliomas.

METHODS

The patients received 200 mg of nimotuzumab infusion intravenously over 60 minutes once weekly for the first eight weeks and then once every two weeks until unacceptable toxicity or tumor progression occurred. Individualized chemotherapy was administered based on O(6)-methylguanine-DNA methyltransferase (MGMT) expression and previous chemotherapy responses in combined with nimotuzumab.

RESULTS

Fourteen patients received a total of 122 times of nimotuzumab ranging from 2 to 20 (median 7.5 times). Combined chemotherapy regimens included: continuous 21-day temozolomide (10 cases), standard 5-day temozolomide (2 cases), teniposide plus cisplatin (1 case), and teniposide plus nimustine (1 case). Partial response (PR) and stable disease (SD) were found in 3 patients (21.4%)and 6 patients (42.9%), respectively. Disease control rate (PR + SD) was 64.3%. The median progression-free survival (PFS) was 4 months (95%CI: 0.7 - 7.3) and PFS at 6 months was 30.6%. The most common toxicities include grade I-II neutropenia (2 cases), thrombocytopenia (2 cases), lymphopenia (1 case), nausea and vomitting (3 case) and asymptomatic transaminase increase (1 case). One patient developed grade IV neutropenia and thrombocytopenia. One patient developed nimotuzumab-related acneiform rash.

CONCLUSIONS

Nimotuzumab in combination with chemotherapy has moderate activity in patients with malignant gliomas and the toxicities are well tolerable, therefore, worth further investigation.

Surgical management of radiation-induced temporal lobe necrosis in patients with nasopharyngeal carcinoma: report of 14 cases

BACKGROUND

Radiation-induced temporal lobe necrosis is a rare and serious late complication in irradiated patients with nasopharyngeal carcinoma (NPC). Treatment of radiation-induced temporal lobe necrosis with surgery has been seldom thoroughly investigated.

METHODS

We retrospectively analyzed the clinical data of 14 patients with radiation-induced temporal lobe necrosis treated with surgical intervention.

RESULTS

Radiation-induced temporal lobe necrosis presented as obvious cystic formation or as heterogeneous enhanced nodule on MRI. Among 3 patients with (18)F-fluorodeoxyglucose ((18)F-FDG) PET-CT scan, increased uptake of (18)F-FDG was observed in 2 cases. Four patients were anesthestized nasotracheally and 1 was through tracheostomy during surgery because of other radiation complications, including trismus and skull base osteoradionecrosis. The temporal approach was applied in all cases, with the removal of bone flap in 11 patients. During follow-up, 1 patient died of exhaustion.

CONCLUSIONS

Surgery benefits selected patients with NPC with radiation-induced temporal lobe necrosis. The goals of surgery are to relieve the increased intracranial pressure and to establish the accurate diagnosis.

Comprehensive and semi-quantitative TCR repertoire analysis with a novel multiplex PCR method and 454 sequencing (85.3)

CDR3 sequences, composed by V(D)J combination, form the center of the antigen binding site where they often play a critical role in defining the affinity and specificity of the receptor for individual peptide-MHC complexes of both the TCRα and TCRβ chains. The goal of our study was to produce comprehensive, unrestricted profiles of TCR diversity among key developmental and effector subsets of T cells isolated from the blood of a single, healthy donor at sequence-level resolution using a novel multiplex PCR method combined with Roche 454 Life Sciences high-throughput sequencing technology. From the sequence reads, about 1.48 million CDR3 intervals were identified, totaling 169,977 and 113,290 unique CDR3 intervals for TCRα and for TCRβ, respecitively. Our data also show numerous examples of identical CDR3 sequences shared by different T subsets. Using the compound Poisson process model, we estimated that the diversity of the TCRα and β chains expressed by our donor is around 0.47 x 106 and 0.35 x 106 unique CDR3 nucleotide sequences, respectively. Our comprehensive data demonstrates that our new method has overcome past challenges in studying the T cell immune repertoire and is highly sensitive, repeatable, and semi-quantitative. This approach provides a useful tool for assessing immune competence, tracking T cell expansion kinetics, assessing vaccine efficiency, and detecting antigen-specific T cell clones in patients with infection or cancer.

[Weekly Paclitaxel and Cisplatin in the Treatment of Elderly Advanced Non-small Cell Lung Cancer.]

BACKGROUND

Lung cancer is one of the most common cancers in the world. The number of elderly lung cancer patients is expected to rapidly increase. Therefore, the management of elderly lung cancer patients is becoming a major challenge in the field of oncology. This study was to evaluate the efficacy and safety of weekly paclitaxel (PTX) and cisplatin (DDP) as the first-line chemotherapy on advanced NSCLC patients of more than 70 years old.

METHODS

Fifty chemotherapy-naive patients with advanced NSCLC more than 70 years old were administrated weekly paclitaxel and pisplatin regiment: PTX 80 mg/m(2) intravenous infusion for 1 h, d1, d8 (given routine premedications before PTX), DDP 20 mg/m(2) intravenous infusion, d1, d8, every 21 days.

RESULTS

Total 50 patients were enrolled, and 48 patients were evaluable for response. The ORR (overall response rate) was 39.6%; median survival time (MST) was 14.8 months; One year survival rate was 58.3%. Most common adverse events were leucopenia (60%), anemia (62%), nausea and vomiting (30%), alopecia (100%). There were no chemotherapy-related deaths.

CONCLUSIONS

The patients of advanced NSCLC more than 70 years old can tolerate weekly paclitaxel and cisplatin and can get benefit from this regiment.

[Brain radiotherapy combined with sequential chemotherapy in non-small-cell lung cancer patients with brain metastases.]

BACKGROUND

Brain irradiation is the traditional treatment for NSCLC patients with brain metastases, whereas combined with chemotherapy is the nowadays treatment direction. Since sequential/maintenance chemotherapy has shown promising results in advanced NSCLC, we carried out the study to explore the role of sequential chemotherapy combined with brain radiotherapy in patients with brain metastases.

METHODS

Treatment naive NSCLC patients with brain metastases sequentially received the 3 chemotherapy regimens TP-NP-GP. The TP regimen consisted of Paclitaxol 175 mg/m(2) d1, Cisplatin 20 mg/m(2) d1-5. The NP regimen consisted of Nevalbine 25 mg/m(2) d1 and 8, Cisplatin 20 mg/m(2) d1-5. The GP regimen consisted of Gemcitabine 1 g/m(2) d1 and 8, Cisplatin 20 mg/m(2) d1-5. All regimens were repeated every 3 weeks. Each regimen was executed for at least 2 cycles and no more than 4 cycles.

RESULTS

The response rates of TP, NP and GP sequentially used were 41.2%, 35.6% and 27.8% respectively for the out brain lesions and 60.8% for the brain lesions combining with brain irradiation. Median survival time was 14.7 months and the 1, 2 and 3 year overall survivals were 67.8%, 20.6% and 1.3% respectively.

CONCLUSIONS

The 3rd generation regimen-based sequential chemotherapy combined with WBRT was effective for NSCLC patients with brain metastasis with an encouraging survival and acceptable tolerability.

Immunorepertoire analysis by multiplex PCR amplification and high throughput sequencing (42.6)

An immunorepertoire is the sum of functionally diverse B and T cells in one's circulation at any given moment. Three key factors shape the personal immunorepertoire: HLA type, antigen exposure history, and immunoregulation. Two major challenges have made studying the immunorepertoire difficult: the enormous diversity of V(D)Js, and the scarcity of each VDJ in a sample. To overcome these challenges, a powerful multiplex PCR method has been developed to amplify, inclusively and unbiased, all expressed VDJs in a sample. The amplicon mixture was sequenced directly with Roche 454 platform. In one run, for example, more than 73,000 and 119,000 unique V(D)Js were obtained from B and T cells, respectively. High resolution HLA typing was also carried out with the same sequencing run. This novel technology can be used to uncover possible disease mechanisms associated with abnormal immunorepertoires, to evaluate vaccine efficiency, to identify new biomarkers, and to develop new therapeutics. An online dababase and unique analytical tools have been developed for data sharing, deposition, and mining.

The effects of head flexion on airway seal, quality of ventilation and orogastric tube placement using the ProSeal laryngeal mask airway

This prospective self-controlled study was designed to evaluate the influences of head flexion on airway seal, quality of ventilation, and orogastric tube placement through the ProSeal laryngeal mask airway (ProSeal LMA) in 80 anaesthetised, paralysed adult patients. After the ProSeal LMA was inserted and the cuff pressure was set at 5.9 kPa, ventilation quality, airway seal pressure, fibreoptic positions of the cuff and the drainage tube, orogastric tube placement and efficacy of intermittent positive pressure ventilation (IPPV) were assessed in two randomly selected positions: neutral and flexed position. When compared to the neutral head position, the head flexed significantly improved the airway seal pressure and the quality of ventilation of the ProSeal LMA (p < 0.05). Fibreoptic scores of the cuff position did not correlate with either the ability to obtain excellent or adequate ventilation through the ProSeal LMA or the ability to generate an airway seal pressure of >or= 2 kPa. Orogastric tube placement via the drainage tube was successful on the first attempt in all patients in the neutral position compared with seven failures following three attempts in the flexed position (p < 0.05). There were no significant differences between the two head positions in the volume of air required to obtain an intracuff pressure of 5.9 kPa, fibreoptic score of the drainage tube position, and expiratory tidal volume and peak inspiratory pressure during IPPV (p > 0.05). In conclusion, head flexion improves airway seal and ventilation quality of the ProSeal LMA. However, placement of an orogastric tube via the drainage tube is impaired in the flexed position compared to the neutral position. Fibreoptic scoring of the ProSeal cuff position is not an accurate test to assess the airway seal and ventilation function.

Different small-dose sufentanil blunting cardiovascular responses to laryngoscopy and intubation in children: a randomized, double-blind comparison

BACKGROUND

Sufentanil is a potent opioid analgesic frequently used in clinical anaesthesia. This prospective, randomized, double-blind study was designed to assess the efficacy of different small-dose sufentanil attenuating the cardiovascular intubation response in healthy children, aiming at determining the optimal dose of sufentanil for this purpose.

METHODS

A total of 165 children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), sufentanil 0.1 microg kg(-1) (Group 2), sufentanil 0.2 microg kg(-1) (Group 3), and sufentanil 0.3 microg kg(-1) (Group 4). Anaesthesia was induced with propofol 2.5 mg kg(-1) and vecuronium 0.1 mg kg(-1). Non-invasive blood pressure (BP) and heart rate (HR) were recorded before induction of anaesthesia (baseline value), at immediately before intubation (post-induction values), at intubation, and at 1 min intervals for 5 min after intubation. The per cent changes of systolic blood pressure (SBP) and HR during the observation were calculated.

RESULTS

Except for Group 4, tracheal intubation caused significant increases in BP and HR in Groups 1, 2, and 3 compared with baseline values. BP and HR at intubation and their maximum values during the observation were significantly different among the four groups. The maximum per cent increases of SBP and HR during the observation were 20 and 28% of baseline values, respectively, in Group 2, 13 and 13% in Group 3, and 0 and 4% in Group 4 compared with 24 and 37% in Group 1. Except for the Group 3 vs Group 4 comparison, the incidences of SBP and HR per cent increases >30% of baseline values were also significantly different among the four groups.

CONCLUSIONS

In combination with propofol for induction of anaesthesia in children, the bolus administration of sufentanil can produce a dose-related attenuation of the cardiovascular intubation response and sufentanil 0.3 microg kg(-1) can completely abolish the cardiovascular intubation response.

MicroRNA let-7a down-regulates MYC and reverts MYC-induced growth in Burkitt lymphoma cells

Regulation of the MYC oncogene remains unclear. Using 10058-F4, a compound that inhibits MYC-MAX transcription factor, MYC protein and gene expression were down-regulated in Namalwa cells, a Burkitt lymphoma. Compound 10058-F4 decreased MYC mRNA (45%), MYC protein (50%), and cell growth (32%). MYC-MAX transcription factor was disrupted 24 h after treatment, resulting in transcriptional inhibition of target genes. Because microRNAs (miRNA) disrupt mRNA translation, let-7a, let-7b, and mir-98 were selected using bioinformatics for targeting MYC. Inhibition of MYC-MAX transcription factor with 10058-F4 increased levels of members of the let-7 family. In inhibited cells at 24 h, let-7a, let-7b, and mir-98 were induced 4.9-, 1.3-, and 2.4-fold, respectively, whereas mir-17-5p decreased 0.23-fold. These results were duplicated using microRNA multianalyte suspension array technology. Regulation of MYC mRNA by let-7a was confirmed by transfections with pre-let-7a. Overexpression of let-7a (190%) decreased Myc mRNA (70%) and protein (75%). Down-regulation of Myc protein and mRNA using siRNA MYC also elevated let-7a miRNA and decreased Myc gene expression. Inverse coordinate regulation of let-7a and mir-17-5p versus Myc mRNA by 10058-F4, pre-let-7a, or siRNA MYC suggested that both miRNAs are Myc-regulated. This supports previous results in lung and colon cancer where decreased levels of the let-7 family resulted in increased tumorigenicity. Here, pre-let-7a transfections led to down-regulation of expression of MYC and its target genes and antiproliferation in lymphoma cells. These findings with let-7a add to the complexity of MYC regulation and suggest that dysregulation of these miRNAs participates in the genesis and maintenance of the lymphoma phenotype in Burkitt lymphoma cells and other MYC-dysregulated cancers.

Different small-dose remifentanil blunting the cardiovascular response to laryngoscopy and intubation in children: a randomized double-blind comparison

BACKGROUND

The available data provide inconsistent results on the efficacy of small-dose remifentanil attenuating the cardiovascular response to intubation in children. Therefore, this randomized double-blind study was designed to assess the ability of different small doses of remifentanil on the cardiovascular intubation response in children, with the aim of determining the optimal dose of remifentanil for this purpose.

METHODS

One hundred and twenty-four children aged 3-9 yr were randomized to one of four groups to receive the following in a double-blind manner: normal saline (Group 1), remifentanil 0.75 microg kg(-1) (Group 2), remifentanil 1 microg kg(-1) (Group 3) and remifentanil 1.25 microg kg(-1) (Group 4). Non-invasive blood pressure and heart rate were recorded before anaesthesia induction (baseline value), immediately before intubation (postinduction values), at intubation and at 1 min intervals for 5 min after intubation.

RESULTS

Tracheal intubation caused significant increases in systolic blood pressure and heart rate in Groups 1-3 compared with the baseline values. The maximum percent increases of systolic blood pressure and heart rate were 10% and 26% of the baseline values, respectively, in Group 2; 5% and 14% in Group 3; and 1% and 8% in Group 4 compared with 27% and 37% in Group 1. Except for the Group 3 vs. Group 4 comparison, there were significant differences among the four groups in the maximum percent increases of systolic blood pressure and heart rate.

CONCLUSIONS

When used as part of anaesthesia induction with propofol and vecuronium in children, bolus administration of remifentanil resulted in a dose-related attenuation of the cardiovascular intubation response.

The clinical assessment of Glidescope in orotracheal intubation under general anesthesia

AIM

The aims of this study were to further evaluate the efficacy and safety of the GlideScope as a device to aid orotracheal intubation, and to further determine whether the GlideScope can provide a better laryngeal view in patients predicted to have a difficult laryngoscopy compared to the Macintosh laryngoscope.

METHODS

Ninety-one adult patients, ASA physical status I-II, scheduled for elective plastic and intraoral surgery under general anesthesia requiring orotracheal intubation were included in this study. The laryngeal view was estimated by the classification of Cormack-Lehane and the orotracheal intubation was then performed using a GlideScope. The times required for full visualization of the glottis and for the successful tracheal intubation were recorded, respectively. Noninvasive blood pressure and heart rate were also recorded before (baseline values) and immediately after induction (postinduction values), at intubation and every minute for 5 min after intubation. In patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views obtained by a GlideScope and a Macintosh laryngoscope were also compared.

RESULTS

All patients were successfully intubated using a GlideScope, of which 97% (88/91) required only one attempt. In the patients with successful intubation at one attempt, the times required for full visualization of the glottis and for successful tracheal intubation were 21+/-9 s and 38+/-11 s, respectively. The orotracheal intubation caused significant increases in blood pressure and heart rate compared to the postinduction values, and the maximal values of blood pressure and heart rate during the observation were significantly higher than the baseline values. In 27 patients preoperatively predicted to have a difficult laryngoscopy, the laryngeal views in using the GlideScope were significantly better than those in using the Macintosh laryngoscope. The incidence of minor upper airway trauma was 3.4% in all patients.

CONCLUSION

The orotracheal intubation using a GlideScope had advantages of easy and simple operation, excellent laryngeal view, and the ability to provide an improved laryngeal view in the patients with a difficult laryngoscopy. The general anesthesia of clinical standard depth was able to suppress the pressor response, but not temporary tachycardiac response to the orotracheal intubation using a GlideScope.

StaphPlex system for rapid and simultaneous identification of antibiotic resistance determinants and Panton-Valentine leukocidin detection of staphylococci from positive blood cultures

Phenotypic methods take several days for identification and antimicrobial susceptibility testing of staphylococcal isolates after gram-positive cocci in clusters (GPCC) are observed in positive blood cultures. We developed and validated a StaphPlex system that amplifies and detects 18 gene targets simultaneously in 1 reaction for species-level identification of staphylococci, detection of genes encoding Panton-Valentine leukocidin (PVL), and antimicrobial resistance determinants of staphylococci. The StaphPlex system was compared to phenotypic methods for organism identification and antimicrobial resistance detection for positive blood culture specimens in which GPCC were observed. Among a total of 360 GPCC specimens, 273 (75.8%), 37 (10.3%), 37 (10.3%), 1 (0.3%), 3 (0.8%), and 9 (2.5%) were identified by StaphPlex as coagulase-negative Staphylococcus (CoNS), methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible S. aureus (MSSA), or mixed infections of CoNS and MRSA, CoNS and MSSA, or nonstaphylococci, respectively, with an overall accuracy of 91.7%. The 277 CoNS-containing specimens were further identified to the species level as containing 203 (73.3%) Staphylococcus epidermidis isolates, 10 (3.6%) Staphylococcus haemolyticus isolates, 27 (9.7%) Staphylococcus hominis isolates, 1 (0.4%) Staphylococcus lugdunensis isolate, and 36 (13.0%) other CoNS isolates, with an overall accuracy of 80.1% compared to an API STAPH test and CDC reference identification. Numerous very major errors were noticed when detection of aacA, ermA, ermC, tetM, and tetK was used to predict in vitro antimicrobial resistance, but relatively few major errors were observed when the absence of these genes was used to predict susceptibility. The StaphPlex system demonstrated 100% sensitivity and specificity, ranging from 95.5% to 100.0% when used for staphylococcal cassette chromosome mec typing and PVL detection. StaphPlex provides simultaneous staphylococcal identification and detection of PVL and antimicrobial resistance determinants within 5 h, significantly shortening the time needed for phenotypic identification and antimicrobial susceptibility testing.

The circulatory responses to tracheal intubation in children: a comparison of the oral and nasal routes

The circulatory responses to laryngoscopic tracheal intubation in 62 healthy children undergoing surgery requiring tracheal intubation were studied. They were randomly assigned to receive either the oral or nasal route for intubation. Baseline non-invasive blood pressure and heart rate were recorded following induction of anaesthesia, at intubation and then every minute for 5 min. The percentage changes of systolic blood pressure and heart rate during the measurement period were calculated. The results demonstrated that intubation time was significantly longer in the nasal group. Both oral and nasal intubation caused significant increases in blood pressure and heart rate compared to baseline and postinduction values. However, there were no significant differences found between the two groups in relation to blood pressure and heart rate. The two groups were similar with respect to the percentage changes of systolic blood pressure and heart rate during the observation period. It is concluded that oral and nasal intubation using a direct laryngoscopy can result in a similar circulatory response in anaesthetised children.

[The clinical features of B cell lymphoblastic lymphoma and outcomes after BFM-90 regimen therapy]

OBJECTIVE

To analyse the clinical features of patients with B cell lymphoblastic lymphoma(BCLL) and the outcomes after modified BFM-90 protocol therapy.

METHODS

The clinical features of 14 patients with BCLL were analysed, and compared with that of T cell lymphoblastic lymphoma in the same period. The efficacy and toxicity of modified BFM-90 protocol were analysed.

RESULTS

The 14 patients were aged 3 to 18 and diagnosed as BCLL by morphology and immunohistology. One case was in stage I , 2 stage III and 11 stage IV. Most common involved sites were lymph nodes (70% ), skin (50% ) and bone marrow (64% ). One patient received CHOP + HD-MTX, and 13 received modified BFM-90 protocol chemotherapy. Twelve patients (92.3%) achieved complete remission( CR) , 1 patient(7. 7% ) partial remission( PR). The median follow-up duration was 19. 5 months (2 to 44 months). At present 13 patients are alive except one PR patient who gave up treatment and died of disease. The major toxicity of the protocol was myelosuppression, but could be tolerated.

CONCLUSIONS

The most common involvement sites of BCLL were lymph nodes, skin and bone marrow. The effectiveness is improved as treated with modified BFM-90 protocol.

Once-a-month treatment with a combination of mifepristone and the prostaglandin analogue misoprostol

In this two centre study, the efficacy of 200 mg mifepristone orally followed 48 h later by 0.4 mg misoprostol orally for menstrual regulation was investigated. The dose of mifepristone was taken the day before the expected day of menstruation. Each volunteer was planned to participate for up to 6 months. A plasma beta human chorionic gonadotrophin (HCG) was measured on the day of mifepristone intake. The study was disrupted prematurely due to low efficacy. In 125 treatment cycles the overall pregnancy rate was 17.6% (22 pregnancies) and the rate of continuing pregnancies (failure) was 4.0%. Eight women discontinued the study due to bleeding irregularities which were seen in 15 cycles (12%). These effects on bleeding pattern made the timing of treatment day difficult. Late luteal phase treatment with a combination of mifepristone and misoprostol is not adequately effective for menstrual regulation.

Effects of different doses of norethisterone on ovarian function, serum sex hormone binding globulin and high density lipoprotein-cholesterol

The ovarian effects of different doses of norethisterone (NET) were compared in 45 normally menstruating women in order to find the lowest effective dose of the Chinese NET "visiting pill". Subjects were randomly divided into 3 groups. Each subject in each group was taking 0.5, 1.5 or 3.0 mg per day from days 5 to day 18 of the cycle. Blood samples were taken on days 5, 8, 11, 14, 17, 20, 23, 26 and 29 of the cycle. Serum oestradiol (E2), progesterone (P), sex hormone binding globulin (SHBG), high density-lipoprotein cholesterol (HDL-C), and NET concentrations were measured. Ovulation, delayed ovulation, ovulation inhibition and follicular activity were classified by the analysis of the peripheral serum levels of sex hormones. Ovulation occurred in 7 women in the 0.5 mg group, in 2 women in the 1.5 mg group and in none of the 3.0 mg group. Mean serum SHBG levels were reduced progressively by 6.6% (Group 0.5), 15.5% (Group 1.5) and 23.4% (Group 3.0). There were no significant changes in HDL-C levels in any group. There was a significant correlation of mean serum NET concentrations with dose. The lack of complete inhibition of ovulation in most women in the 1.5 mg and 0.5 mg groups might suggest that the dose of NET required when used as a visiting pill could not be reduced below 3.0 mg.