Lung cancer staging update: the revised TNM classification

Staging systems aim to describe malignant tumours in a standardized fashion to assist in therapy planning and estimation of prognosis, allow comparison of different therapeutic strategies, facilitate communication between individuals and institutions, improve our knowledge of malignant disease and ultimately improve the outcome for patients. With the continuous increase in data and, ideally, our understanding of a disease and its potential therapy, every staging system requires continuous adjustment. The TNM staging system by the International Union against Cancer (UICC) is applied worldwide and revised regularly, with intervals aiming at a compromise between up-to-date information on the one hand and providing continuity by avoiding too short-lived revisions on the other hand. The 6th edition was published in 2002 and the 7th edition was published in 2009. The 7th edition became current from January 2010 on.

Tyrosine residues in the cytoplasmic domains affect sorting and fusion activity of the Nipah virus glycoproteins in polarized epithelial cells

The highly pathogenic Nipah virus (NiV) is aerially transmitted and causes a systemic infection after entering the respiratory tract. Airway epithelia are thus important targets in primary infection. Furthermore, virus replication in the mucosal surfaces of the respiratory or urinary tract in later phases of infection is essential for virus shedding and transmission. So far, the mechanisms of NiV replication in epithelial cells are poorly elucidated. In the present study, we provide evidence that bipolar targeting of the two NiV surface glycoproteins G and F is of biological importance for fusion in polarized epithelia. We demonstrate that infection of polarized cells induces focus formation, with both glycoproteins located at lateral membranes of infected cells adjacent to uninfected cells. Supporting the idea of a direct spread of infection via lateral cell-to-cell fusion, we could identify basolateral targeting signals in the cytoplasmic domains of both NiV glycoproteins. Tyrosine 525 in the F protein is part of an endocytosis signal and is also responsible for basolateral sorting. Surprisingly, we identified a dityrosine motif at position 28/29 in the G protein, which mediates polarized targeting. A dileucine motif predicted to function as sorting signal is not involved. Mutation of the targeting signal in one of the NiV glycoproteins prevented the fusion of polarized cells, suggesting that basolateral or bipolar F and G expression facilitates the spread of NiV within epithelial cell monolayers, thereby contributing to efficient virus spread in mucosal surfaces in early and late phases of infection.

Pulmonary nodules: do we need a separate algorithm for non-solid lesions?

This article describes the aetiology, epidemiology and clinical significance of incidental non-solid pulmonary nodules. Non-solid nodules are more likely malignant. If malignant, they are mostly due to atypical adenomatous hyperplasia and bronchioloalveolar carcinoma. As these may be negative on positron emission tomography and slow growing, the diagnostic algorithms that are used for solid nodules have to be modified for non-solid nodules.

[Multiple bilateral pulmonary nodes following breast cancer]

HISTORY AND ADMISSION FINDINGS

Multiple new pulmonary nodules were demonstrated at chest radiography in a 69-year-old woman who had been treated for breast cancer ten years previously.

INVESTIGATIONS

Laboratory tests suggested mild inflammation. Pulmonary function tests demonstrated small airways disease. But because of an atypical morphology at computed tomography (CT), metastases were considered unlikely. CT-guided percutaneous biopsy revealed cryptogenic organizing pneumonia (COP).

TREATMENT AND COURSE

Oral medication with decreasing doses of steroids resulted in clinical and radiological improvement.

CONCLUSIONS

Even in a patient with known malignancy the differential diagnosis of multiple bilateral pulmonary nodules includes a variety of conditions and is meticulous, if necessary invasive diagnostic procedures are required.

Cardiovascular and cerebrovascular comorbidities of hypokalemic and normokalemic primary aldosteronism: results of the German Conn's Registry

CONTEXT

Primary aldosteronism (PA) is associated with vascular end-organ damage.

OBJECTIVE

Our objective was to evaluate differences regarding comorbidities between the hypokalemic and normokalemic form of PA.

DESIGN AND SETTING

This was a retrospective cross-sectional study collected from six German centers (German Conn's registry) between 1990 and 2007.

PATIENTS

Of 640 registered patients with PA, 553 patients were analyzed.

MAIN OUTCOME MEASURES

Comorbidities depending on hypokalemia or normokalemia were examined.

RESULTS

Of the 553 patients (61 +/- 13 yr, range 13-96), 56.1% had hypokalemic PA. The systolic (164 +/- 29 vs. 155 +/- 27 mm Hg; P < 0.01) and diastolic (96 +/- 18 vs. 93 +/- 15 mm Hg; P < 0.05) blood pressures were significantly higher in hypokalemic patients than in those with the normokalemic variant. The prevalence of cardiovascular events (angina pectoris, myocardial infarction, chronic cardiac insufficiency, coronary angioplasty) was 16.3%. Atrial fibrillation occurred in 7.1% and other atrial or ventricular arrhythmia in 5.2% of the patients. Angina pectoris and chronic cardiac insufficiency were significantly more prevalent in hypokalemic PA (9.0 vs. 2.1%, P < 0.001; 5.5 vs. 2.1%, P < 0.01). Overall, cerebrovascular comorbidities were not different between hypokalemic and normokalemic patients, however, stroke tended to be more prevalent in normokalemic patients.

CONCLUSIONS

Our data indicate a high prevalence of comorbidities in patients with PA. The hypokalemic variant is defined by a higher morbidity than the normokalemic variant regarding some cardiovascular but not cerebrovascular events. Thus, PA should be sought not only in hypokalemic but also in normokalemic hypertensives because high-excess morbidity occurs in both subgroups.

Ephrin-B2 expression critically influences Nipah virus infection independent of its cytoplasmic tail

Background

Cell entry and cell-to-cell spread of the highly pathogenic Nipah virus (NiV) requires binding of the NiV G protein to cellular ephrin receptors and subsequent NiV F-mediated fusion. Since expression levels of the main NiV entry receptor ephrin-B2 (EB2) are highly regulated in vivo to fulfill the physiological functions in axon guidance and angiogenesis, the goal of this study was to determine if changes in the EB2 expression influence NiV infection.

Results

Surprisingly, transfection of increasing EB2 plasmid concentrations reduced cell-to-cell fusion both in cells expressing the NiV glycoproteins and in cells infected with NiV. This effect was attributed to the downregulation of the NiV glycoproteins from the cell surface. In addition to the influence on cell-to-cell fusion, increased EB2 expression significantly reduced the total amount of NiV-infected cells, thus interfered with virus entry. To determine if the negative effect of elevated EB2 expression on virus entry is a result of an increased EB2 signaling, receptor function of a tail-truncated and therefore signaling-defective ΔcEB2 was tested. Interestingly, ΔcEB2 fully functioned as NiV entry and fusion receptor, and overexpression also interfered with virus replication.

Conclusion

Our findings clearly show that EB2 signaling does not account for the striking negative impact of elevated receptor expression on NiV infection, but rather that the ratio between the NiV envelope glycoproteins and surface receptors critically influence cell-to-cell fusion and virus entry.

Selective receptor expression restricts Nipah virus infection of endothelial cells

Nipah virus (NiV) is a highly pathogenic paramyxovirus that causes severe diseases in animals and humans. Endothelial cell (EC) infection is an established hallmark of NiV infection in vivo. Despite systemic virus spread via the vascular system, EC in brain and lung are preferentially infected whereas EC in other organs are less affected. As in vivo, we found differences in the infection of EC in cell culture. Only brain-derived primary or immortalized EC were found to be permissive to NiV infection. Using a replication-independent fusion assay, we could show that the lack of infection in non-brain EC was due to a lack of receptor expression. The NiV entry receptors ephrinB2 (EB2) or ephrinB3 were only expressed in brain endothelia. The finding that EB2 expression in previously non-permissive aortic EC rendered the cells permissive to infection then demonstrated that EB2 is not only necessary but also sufficient to allow the establishment of a productive NiV infection. This strongly suggests that limitations in receptor expression restrict virus entry in certain EC subsets in vivo, and are thus responsible for the differences in EC tropism observed in human and animal NiV infections.

Intravenous lipid and heparin infusion-induced elevation in free fatty acids and triglycerides modifies circulating androgen levels in women: a randomized, controlled trial

BACKGROUND

The polycystic ovarian syndrome (PCOS) is characterized by hyperandrogenism and associated with obesity and impaired glucose metabolism. Despite the high prevalence of PCOS and the considerable clinical impact, the precise interplay between metabolism and hyperandrogenemia is not entirely clear.

OBJECTIVE

The objective of the study was to analyze the effects of iv lipid and heparin infusion on circulating androgen levels in healthy women.

DESIGN

This was a randomized, controlled, crossover trial.

SETTING

The study was conducted at an endocrinology center.

PATIENTS

Patients included 12 healthy young women during the early follicular phase of two subsequent cycles.

INTERVENTION

After an overnight fast, a 20% lipid/heparin or a saline/heparin infusion was administered in random order for 330 min.

MAIN OUTCOME MEASURES

A detailed characterization of androgen metabolism was performed.

RESULTS

Elevations in free fatty acids and triglycerides, induced by lipid/heparin infusion, elevates the levels of androstenedione, dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), testosterone, 5alpha-dihydrotestosterone, estrone, and 17beta-estradiol. Urinary excretion of DHEA, DHEAS, 5-androstene-3beta,17beta-diol, and the sum of urinary excreted DHEA and its 16-hydroxylated downstream metabolites, 16alpha-hydroxy-DHEA and 5-androstene-3beta,16alpha,17beta-triol, were reduced.

CONCLUSION

The mechanism of iv lipid and heparin infusion-induced elevation of circulating androgens described here might contribute to the development of hyperandrogenism in women with PCOS and suggests that lowering of hyperlipidemia might be a potential therapeutic target in patients with PCOS to treat hyperandrogenemia.

Role of endocytosis and cathepsin-mediated activation in Nipah virus entry

The recent discovery that the Nipah virus (NiV) fusion protein (F) is activated by endosomal cathepsin L raised the question if NiV utilize pH- and protease-dependent mechanisms of entry. We show here that the NiV receptor ephrin B2, virus-like particles and infectious NiV are internalized from the cell surface. However, endocytosis, acidic pH and cathepsin-mediated cleavage are not necessary for the initiation of infection of new host cells. Our data clearly demonstrate that proteolytic activation of the NiV F protein is required before incorporation into budding virions but not after virus entry.

Effect of immunosuppressive and other drugs on the cortisol-cortisone shuttle in human kidney and liver

BACKGROUND

Impaired 11beta-hydroxysteroid dehydrogenase type 2 (11beta-HSD2) has been suggested in patients with hypertension or renal disease, where it may contribute to sodium retention and hypertension. 11beta-HSD1, which is expressed predominantly in liver and adipose tissue, influences glucose homeostasis and fat distribution by altering intracellular cortisol (F) concentrations. We tested immunosuppressive drugs that cause hypertension, and substances that interfere with steroidogenesis or influence glucose homeostasis for their ability to influence the inhibition of 11beta-HSD isozymes.

METHODS

For inhibition experiments, we used microsomes prepared from unaffected parts of human liver segments and resected human kidney cortex because of hepatocarcinoma or renal cell cancer. The inhibitory potency of several compounds was evaluated in concentrations from 10(-9)-10(-5) mol/l.

RESULTS

Only sirolimus, but not cyclosporine A, tacrolimus, mycophenolate mofetil, or azathioprine showed a slight inhibition of 11beta-HSD2 activity. None of the drugs that inhibit steroidogenesis (suramine, mitotane, etomidate, and aminogluthethimide) or steroid metabolism (rifampicine) influenced 11beta-HSDs, nor did ginsenoides Re, Rc, and Rb1. Among sulfonylureas, only gliclazide decreased significantly 11beta-HSD1 activity.

CONCLUSIONS

Increased blood pressure due to immunosuppressive drugs is probably not caused by direct inhibition of 11beta-HSD2. An additional glucose lowering effect of sulfonylurea gliclazide may be due to its ability to inhibit 11beta-HSD1.