Comparison of three methods to detect mutations in the PI3K oncogene in FFPE cancer samples

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Background: PI3Kinase is an important target for new oncology therapies, since it is central to several cell signalling pathways associated with proliferation and survival. Many pharmaceutical companies have PI3K inhibitors in their drug development pipelines all of which are in early phase trials. Activating mutations in exons 9 and 20 of the PI3KCA oncogene have been observed in a number of important cancer types including: gastrointestinal, breast, liver, lung and genito-urinary cancers. The presence of such mutations may prove useful as companion diagnostic biomarkers for prediction of response to therapy. Methods: Source BioScience (Nottingham, UK) tested three different methods for the detection of PI3K mutations in archival tumour samples, in their CPA and GLP accredited laboratories. Eighty formalin-fixed paraffin-embedded (‘FFPE') samples from histologically confirmed breast cancer samples were tested by the new DxS P13K Mutation Test Kit using real-time PCR, by pyrosequencing (Qiagen), and by conventional bidirectional capillary sequencing. Tumour content was evaluated by pathology review. Results: The results of the comparison showed that the DxS test using rtPCR technology was easy to perform, convenient and robust. The DxS test had a high degree of sensitivity provided there was more than 20% tumour content in the test sample as determined by histology and pathology review. Conclusions: In conclusion, the DxS test is a valuable tool for detecting PI3K mutations in FFPE samples from breast cancer patients.

No significant financial relationships to disclose.

The effect of mushroom and pokeweed extract on salmonella, egg production, and weight loss in molting hens

An experiment was conducted to evaluate the effects of mushroom and pokeweed extract alone or in combination with alfalfa meal on Salmonella spp. population, egg production, and weight loss in laying hens during a 10-d molting period. The trial used 54 active laying hens approximately 77 wk of age that were naturally infected with Salmonella spp. The layers were subjected to 1 of 9 treatment groups, replicated 3 times with 2 hens per replicate cage. The treatment conditions were as follows: 1) full-fed + H(2)0 (FFW), 2) full-fed + mushroom (FFM), 3) full-fed + pokeweed (FFP), 4) nonfed + H(2)0 (NFW), 5) nonfed + mushroom (NFM), 6) nonfed + pokeweed (NFP), 7) full-fed alfalfa meal + H(2)0 (FFAW), 8) full-fed alfalfa meal + mushroom (FFAM), and 9) full-fed alfalfa meal + poke-weed (FFAP). The results showed that the base-10 logarithm values of Salmonella from the ceca significantly increased (P <or= 0.05) in treatment NFW (3.48), NFM (3.22), and FFAW (3.33), whereas the greatest reduction was observed in treatment FFAM (2.72). The number of Salmonella bacteria recovered from the crop was significantly greater in the NFW treatment (3.43) and lowest in treatment FFAM (2.62). Treatment FFAM (30.0%) had the lowest BW loss and differed significantly from treatment NFW (42.3%), NFM (39.7%), and NFP (41.5%) but not from FFAW (38.0%) and FFAP (34.0%). Ovary weights for treatments NFW, NFP, FFAM, and FFAP did not differ significantly from each other but did so for NFM and FFAW (38.0%), which had the lowest weight. Return to egg production at 2 mo lagged behind in treatments FFAM, NFP, and FFM more than in any other treatments. At 3 mo, treatments FFAAM and NFW differed from the other treatments. Findings indicate that a greater decrease in the natural Salmonella population in the ceca and crop can be obtained with the combination of full-fed alfalfa plus mushroom extract in molting hens and induce a comparable molt with feed withdrawal.

Idiopathic chondrolysis condition in two young, wild-caught Cynomolgus monkeys (Macaca fascicularis) reared in captivity

Idiopathic chondrolysis is a human clinical entity typically reported in adolescent individuals. In this brief communication, we report 2 cases of presumptive idiopathic chondrolysis of the femoral head in Cynomolgus macaques and discuss the clinical symptomatology and pathology of the disease. In detail, we describe the histomorphologic changes of idiopathic chondrolysis and compare these findings with those typically observed in the primary differential diagnoses of Legg-Calve-Perthes disease and nonspecific osteoarthritis. Consideration of this entity among differential diagnoses in young Cynomolgus macaques with unilateral osteoarthritis could be important both for laboratory animal veterinarians and pathologists.

Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): pooled trial results, systematic review, and meta-analysis

BACKGROUND

Early endometrial cancer with low-risk pathological features can be successfully treated by surgery alone. External beam radiotherapy added to surgery has been investigated in several small trials, which have mainly included women at intermediate risk of recurrence. In these trials, postoperative radiotherapy has been shown to reduce the risk of isolated local recurrence but there is no evidence that it improves recurrence-free or overall survival. We report the findings from the ASTEC and EN.5 trials, which investigated adjuvant external beam radiotherapy in women with early-stage disease and pathological features suggestive of intermediate or high risk of recurrence and death from endometrial cancer.

METHODS

Between July, 1996, and March, 2005, 905 (789 ASTEC, 116 EN.5) women with intermediate-risk or high-risk early-stage disease from 112 centres in seven countries (UK, Canada, Poland, Norway, New Zealand, Australia, USA) were randomly assigned after surgery to observation (453) or to external beam radiotherapy (452). A target dose of 40-46 Gy in 20-25 daily fractions to the pelvis, treating five times a week, was specified. Primary outcome measure was overall survival, and all analyses were by intention to treat. These trials were registered ISRCTN 16571884 (ASTEC) and NCT 00002807 (EN.5).

FINDINGS

After a median follow-up of 58 months, 135 women (68 observation, 67 external beam radiotherapy) had died. There was no evidence that overall survival with external beam radiotherapy was better than observation, hazard ratio 1.05 (95% CI 0.75-1.48; p=0.77). 5-year overall survival was 84% in both groups. Combining data from ASTEC and EN.5 in a meta-analysis of trials confirmed that there was no benefit in terms of overall survival (hazard ratio 1.04; 95% CI 0.84-1.29) and can reliably exclude an absolute benefit of external beam radiotherapy at 5 years of more than 3%. With brachytherapy used in 53% of women in ASTEC/EN.5, the local recurrence rate in the observation group at 5 years was 6.1%.

INTERPRETATION

Adjuvant external beam radiotherapy cannot be recommended as part of routine treatment for women with intermediate-risk or high-risk early-stage endometrial cancer with the aim of improving survival. The absolute benefit of external beam radiotherapy in preventing isolated local recurrence is small and is not without toxicity.

Vascular cell responsiveness to Toll-like receptor ligands in carotid atheroma

BACKGROUND

Atherosclerosis is potentiated by stimulation of Toll-like receptors (TLRs), which serve to detect pathogen associated molecular patterns (PAMPs). However little is known of which PAMPs may be present in atheroma, or capable of stimulating inflammatory signalling in vascular cells.

MATERIALS AND METHODS

DNA extracted from human carotid atheroma samples was amplified and sequenced using broad-range 16S gene specific primers to establish historical exposure to bacterial PAMPs. Responsiveness of primary human arterial and venous endothelial and smooth muscle cells to PAMPs specific for each of the TLRs was assessed by measurement of interleukin-8 secretion and E-selectin expression.

RESULTS

Extracts of atheromatous tissue stimulated little or no signalling in TLR-transfected HEK-293 cells. However, sequencing of bacterial DNA amplified from carotid atheroma revealed the presence of DNA from 17 different bacterial genera, suggesting historical exposure to bacterial lipopeptide, lipopolysaccharide and flagellin. All cells examined were responsive to the ligands of TLR3 and TLR4, poly inosine:cytosine and lipopolysaccharide. Arterial cells were responsive to a wider range of PAMPs than venous cells, being additionally responsive to bacterial flagellin and unmethylated cytosine-phosphate-guanosine DNA motifs, the ligands of TLR5 and TLR9, respectively. Cells were generally unresponsive towards the ligands of human TLR7 and TLR8, loxoribine and single stranded RNA. Only coronary artery endothelial cells expressed TLR2 mRNA and responded to the TLR2 ligand Pam(3)CSK(4).

CONCLUSIONS

Vascular cells are responsive to a relatively diverse range of TLR ligands and may be exposed, at least transiently, to ligands of TLR2, TLR4, TLR5 and TLR9 during the development of carotid atheroma.

The impact of legislation in Ireland on handheld mobile phone use by drivers

Under the Road Traffic Act, 2006 handheld mobile phone use whilst driving is an offence liable to a fine and penalty points. The aim of this study was to determine whether there has been a change in driver behaviour following the introduction of this legislation. This study found that 2.3% of drivers were still using a handheld mobile phone.

The efficacy and harm of prostaglandin analogues for IOP reduction in glaucoma patients compared to dorzolamide and brimonidine: a systematic review

AIM

To systematically review the literature on the efficacy and harm of prostaglandin analogues (PGAs) compared to brimonidine and dorzolamide in treating elevated intraocular pressure (IOP).

METHODS

Keywords were searched in major literature databases to identify relevant randomised clinical trials (RCTs) of PGAs for ophthalmic use. The study quality of RCTs was assessed using the Jadad scale. Outcomes assessed included reduction in IOP in individual patients, adverse events (AEs) and withdrawals due to AEs.

RESULTS

Eight unique RCTs evaluating a total of 1,722 individuals were included in this systematic review. Analysis did not show a significant reduction in the mean IOP from patients receiving latanoprost compared with those receiving brimonidine (WMD = -1.04; p = 0.30). On the other hand, the latanoprost group showed a significant reduction in mean IOP compared to the dorzolamide group (WMD = -2.64; p<0.00001). The number of ocular AEs (excluding hyperaemia) was significantly higher in the brimonidine group compared with the latanoprost group (RR = 0.66; p = 0.0005).

CONCLUSION

Latanoprost was found to be significantly superior to dorzolamide but not brimonidine. However, ocular adverse events were significantly fewer in latanoprost users than in brimonide users. Neither travoprost nor bimatoprost was compared to dorzolamide or brimonidine in the present literature.

Examining a community model of epilepsy care for people with learning disabilities

PURPOSE

To assess the use of specialised medical epilepsy services by people with learning disabilities (LD) and epilepsy in a community healthcare setting, to compare medical epilepsy care in this group to current management guidelines, and to contrast important outcomes with those achieved in different healthcare settings.

METHODS

Postal survey with a carer completed questionnaire addressed to all adults with epilepsy registered on an LD register in Sheffield, UK (n=442).

RESULTS

An analysis based on 225 returned questionnaires revealed that 22.7% of individuals with LD and epilepsy had been free of seizures for over 1 year. 95.1% were taking antiepileptic drugs (AEDs), 46.2% had had an EEG, and 41.3% a brain scan. 53.3% of diagnoses had been made by epilepsy experts, 38.7% of individuals with LD and epilepsy were under specialist review. Although patients with more severe epilepsy were more likely to be under specialist care, 60.6% of patients with ongoing seizures, 57.9% with major seizures and 68.7% of individuals taken to hospital with prolonged had no access to specialist advice.

CONCLUSION

The proportion of people with LD who achieved seizure-control in the described population was lower than in all previously reported studies of LD patient groups. The poor outcome in terms of seizure-control, the lack of access to the epilepsy specialist service, and the apparent under-utilisation of investigations indicate that there are grounds for serious concern about this community model of medical epilepsy care for people with LD.

Expressed sequence tags from the midgut of Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae)

The midgut is a key tissue in insect science. Physiological roles include digestion and peritrophic membrane function, as well as being an important target for insecticides. We used an expressed sequence tag (EST) approach to identify candidate genes and gene families involved in these processes in the light brown apple moth, Epiphyas postvittana (Walker) (Lepidoptera: Tortricidae). Two cDNA libraries were constructed from dissected midgut of third to fifth instar larvae. Clustering analysis of 6416 expressed sequence tags produced 1178 tentative unique genes comprising 725 tentative contigs and 453 singletons. The sequences show similar codon usage to sequences from other lepidopterans, a Kozak consensus sequence similar to Drosophila and single nucleotide polymorphisms (SNPs) were detected at a frequency of 1.35/kb. The identity of the most common Interpro families correlates well with major known functions of the midgut. Phylogenetic analysis was conducted on representative sequences from selected multigene families. Gene families include a broad range of digestive proteases, lipases and carbohydrases that appear to have degradative capacity against the major food components found in leaves, the diet of these larvae; and carboxylesterases, glutathione-S-transferases and cytochrome P450 monooxygenases, potentially involved in xenobiotic degradation. Two of the larger multigene families, serine proteases and lipases, expressed a high proportion of genes that are likely to be catalytically inactive.

Rhinoconjunctivitis in 5-year-old children: a population-based birth cohort study

BACKGROUND

There is a paucity of data on the prevalence, risk factors and natural history of rhinitis in early childhood.

OBJECTIVE

Within the context of a whole-population birth cohort we investigated the prevalence of and risk factors for current rhinoconjunctivitis (CRC) at age 5 years.

METHODS

Children were followed prospectively to age 5 years [questionnaires (n = 815), skin testing (n = 717), specific immunoglobulin E (n = 478), lung function (n = 711), dry air challenge (n = 556)]. Endotoxin and allergen exposures were measured in dust samples.

RESULTS

The prevalence of rhinitis ever, current rhinitis and rhinoconjunctivitis was 28.2%, 26.1%, and 12.1%, respectively. Asthma, wheeze and eczema coexisted with CRC (P < or = 0.01). In a multivariate model, maternal asthma (OR 2.38, 95% CI: 1.30-4.38, P = 0.005), paternal hay fever (1.96, 1.11-3.46, P = 0.02) and sensitization to grass (3.46, 1.86-6.42, P < 0.001) and cat (2.42, 1.14-5.18, P = 0.02) remained significant and independent associates of CRC. Whilst almost half of children with CRC were nonatopic, there was little difference in risk factors between atopic and nonatopic CRC. Amongst children with current wheeze, the presence of concurrent CRC had no effect on either severity or frequency of wheezy episodes. There was no difference in specific airway resistance, forced expiratory volume in 1 second (FEV(1)) or airway reactivity between children with and without CRC after adjustment for the presence of wheeze.

CONCLUSION

Family history of allergic disease and sensitization to inhalant allergens are risk factors for rhinoconjunctivitis in preschool children. In this age group, there is no association between the presence of rhinoconjunctivitis and severity of wheeze, increased airway reactivity and reduced lung function.

An integrative review of Canadian childhood obesity prevention programmes

To examine successful Canadian nursing and health promotion intervention programmes for childhood obesity prevention during gestation and infancy, an integrative review was performed of the literature from 1980 to September 2005. The following databases were used: PubMed; Cochrane Database of Systematic Reviews; Cochrane Controlled Trials Register; Database of Abstracts of Reviews of Effects; ACP Journal Club; MEDLINE; EMBASE; CINAHL; Web of Science; Scopus; Sociological Abstracts; Sport Discus; PsycInfo; ERIC and HealthStar. MeSH headings included: infancy (0-24 months), gestation, gestational diabetes, nutrition, prenatal care, pregnancy, health education, pregnancy outcome, dietary services with limits of Canadian, term birth. Of 2028 articles found, six Canadian childhood obesity prevention programmes implemented during gestation and/or infancy were found; three addressed gestational diabetes with five targeting low-income Canadian urban and/or Aboriginal populations. No intervention programmes specifically aimed to prevent childhood obesity during gestation or infancy. This paucity suggests that such a programme would be innovative and much needed in an effort to stem the alarming increase in obesity in children and adults. Any attempts either to develop new approaches or to replicate interventions used with obese adults or even older children need careful evaluation and pilot testing prior to sustained use within the perinatal period.

Evaluation of HER-2 expression in breast cancer using image analysis incorporating automatic feature recognition

20007

The currently favoured method for evaluation of HER-2 in routine clinical practice and research studies is immunohistochemistry (IHC). As standardised scoring of protein expression, using a scale of 0 - 3+, generates a significant number of false positives, fluorescent in situ hybridisation (FISH) is used to confirm the presence of gene amplification. Both techniques are laborious, and in the case of by-eye scoring of IHC, semi-quantitative at best. We have developed a high-throughput platform for the quantitative analysis of immunostained slides, based on fast, high-resolution scanning followed by analysis of digitised images (IA) using proprietary software, and in this study compared results obtained using this platform with those obtained using conventional methods. Archival sections of primary breast cancers collected at Nottingham City Hospital in 2004 and 2005 were stained for HER-2 (Herceptest, Dako), and evaluated by eye. Equal numbers of slides from scoring categories 0–3+ were then selected for further image analysis. The digitised images were subjected to automatic delineation to define areas of tumour parenchyma, and these areas further analysed using colour segmentation. Between 100 and 2000 fields were quantified on each section. Staining was expressed as a product of field fraction of coloured pixels and optical density. The results of IA demonstrate a continuum of staining values over the four conventional by-eye categories, with a non-linear correlation to by-eye scores. Inter-sample variation was greatest in the 3+ category, although the mean was much higher than that of the 2+ samples. The 2+ samples showed some variation, with several values not rising above baseline. To further investigate the relationship between FISH scores and IA results in the 2+ category, we analysed an additional set of slides in this group, and found a correlation between FISH and automated IA scores. We conclude that automated image analysis is sensitive to small differences in protein expression, has a wide dynamic range, and provides data superior to conventional by-eye scoring. In undecided cases HER-2 protein expression correlates with FISH data; therefore ultimately IA of HER-2 protein expression alone may provide a basis for clinical decisions.

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Arnold Chiari type 1 malformation presenting with sleep disordered breathing in well children

Healthy children, aged 3, 9, and 13 years referred with sleep disordered breathing had marked central apnoea and bradypnoea on polysomnography, necessitating the use of non-invasive bilevel ventilation in two cases. Each had normal neurological examinations and an Arnold Chiari type 1 malformation was confirmed on magnetic resonance imaging. All underwent urgent posterior fossa decompression which normalised their sleep breathing.

Non-genetic and non-gestational parenthood: consequences for parent-child relationships and the psychological well-being of mothers, fathers and children at age 3

BACKGROUND

Findings are presented of the third phase of a longitudinal study of children conceived by assisted reproduction procedures involving surrogacy and/or donor conception.

METHODS

At the time of the child's third birthday, 34 surrogacy families, 41 donor insemination families and 41 oocyte donation families were compared with 67 natural conception families on standardized interview and questionnaire measures of the psychological well-being of the parents, mother-child relationships and the psychological well-being of the child.

RESULTS

The differences found between family types reflected higher levels of warmth and interaction between mothers and their 3-year-old children in assisted reproduction families than in families with a naturally conceived child. A higher proportion of surrogacy parents than donor conception parents had told their children about the nature of their birth.

CONCLUSIONS

It appears that the absence of a genetic and/or gestational link between parents and their child does not have a negative impact on parent-child relationships or the psychological well-being of mothers, fathers or children at age 3.

Potent blockers of the monocarboxylate transporter MCT1: novel immunomodulatory compounds

A novel series of potent blockers of the monocarboxylate transporter, MCT1, is disclosed. From very potent but lipophilic lead compounds, systematic changes to all parts of the molecule, targeting reduction in log D, afforded compounds with significantly improved overall properties. These compounds show potent immunomodulatory activity.

Allergy and infection: understanding their relationship

Sensitization to indoor allergens has long been recognized as a risk factor for asthma and its associated phenotypes. Immunoglobulin E antibody quantification may be used to confirm that a particular sensitization has a role in the development of respiratory symptoms. However, in order to use quantitative information effectively, it is essential to understand the factors that contribute to the deterioration of symptoms and cause exacerbations. One such risk factor is high allergen exposure. Worsening asthma control is also associated with virus infections, in particular rhinovirus infection. Each of these factors in isolation is unlikely to have a major effect on symptoms. However, the combination of respiratory virus infection, allergen sensitization and concurrent high exposure to allergens markedly increases the risk for hospitalization. Further investigation of this synergism could help to understand the mechanisms of asthma exacerbations and lead to the development of strategies for prevention.

Solo mothers and their donor insemination infants: follow-up at age 2 years

BACKGROUND

Findings are presented of the second phase of a longitudinal study of solo-mother families created through donor insemination (DI).

METHODS

At the time of the child's second birthday, 21 solo DI mother families were compared with 46 married DI families on standardized interview and questionnaire measures of the psychological well being of the mothers, mother-child relationships and the psychological development of the child.

RESULTS

The solo DI mothers showed greater pleasure in their child and lower levels of anger accompanied by a perception of their child as less 'clingy'. Fewer emotional and behavioural difficulties were shown by children of solo than married DI mothers.

CONCLUSIONS

The findings from this first cohort of solo DI families to be studied lend further weight to the view that these women represent a distinct subgroup of single parents, who, out of a strong desire for a child, have made the active choice to go it alone. Moreover, this route to parenthood does not necessarily seem to have an adverse effect on mothers' parenting ability or the psychological adjustment of the child.