Nasal type extranodal NK/T cell lymphoma diagnosed in a patient with rheumatoid arthritis under methotrexate

Rheumatoid arthritis (RA) patients have increased risk of lymphoma which seems associated mainly with high inflammatory state and disease activity, but also with immunosuppressive agents or Epstein-Barr virus (EBV) infection. Many case reports describe lymphoproliferative lesions arising during methotrexate therapy, often EBV positive with possible regression after methotrexate withdrawal. The authors report the case of an 85-year-old patient with erosive and seronegative RA, in remission under methotrexate who developed a midfacial destructive lesion with epistaxis and local inflammatory signs. The magnetic resonance imaging showed a large nasal septum defect. Anti-neutrophil cytoplasmic antibodies titres and angiotensin converting enzyme were normal. Biopsies of the lesion identified a NK/ T nasal type lymphoma. EBV latent membrane protein research on the lesion was negative. Polymerase chain reaction analysis of the bone marrow aspirate showed EBV DNA positivity. Withdrawal of methotrexate was performed without tumour regression. The authors described the single case of a patient with RA in stable remission under methotrexate who presented a rare type of lymphoma, a nasal type NK/T. EBV active replication was found in the bone marrow.

RANKL enhances the effect of an antagonist of inhibitor of apoptosis proteins (cIAPs) in RANK-positive breast cancer cells

Objective

Between 65% and 75% of patients with metastatic breast cancer will have decreased 5-year survival and increased morbidity due to cancer relapse in bone. At this stage of disease treatment is palliative, but tumor-targeted compounds could add to the benefits of anti-resorptive agents, improving clinical outcome. Inhibitor-of-apoptosis proteins (IAPs) are overexpressed in many tumors and second mitochondria-derived activator of caspases (Smac) mimetics have been designed to antagonize IAPs. In this work we explored the use of AT-406, a Smac mimetic, to target the tumor compartment of bone metastases.

Methods

Effect of AT-406 on cancer cells apoptosis, expression of IAPs and osteogenic potential was addressed in vitro using the RANK-positive MDA-MB-231 breast cancer cell line. Effect of AT-406 on osteoclastogenesis was determined by inducing the differentiation of the RAW 264.7 mouse monocytic cell line. Osteoclastogenesis was measured by TRAP staining and TRACP 5b quantification.

Results

AT-406 increased apoptosis in MDA-MB-231 breast cancer cells in vitro, and activation of RANK-pathway improved this effect. RANKL stimuli induced a strong increase in c-IAP2. AT-406 increased osteoclast differentiation and activity, by up-regulating the osteogenic transcription factor Nfatc1, but also increased the apoptosis of mature osteoclasts in the absence of RANKL.

Conclusions

Our results indicate that despite the anti-tumoral effect of AT-406, its use in the context of bone metastatic disease needs to be carefully monitored for the induction of increased bone resorption. We also hypothesize that the combination of AT-406 with anti-RANKL directed therapies could have a beneficial effect, especially in RANK-positive tumors.

In-vivo degradation of poly(carbonate-urethane) based spine implants

Fourteen explanted Dynesys® spinal devices were analyzed for biostability and compared with a reference, never implanted, control. Both poly(carbonate-urethane) (PCU) spacers and polyethylene-terephthalate (PET) cords were analyzed. The effect of implantation was evaluated through the observation of physical alterations of the device surfaces, evaluation of the chemical degradation and fluids absorption on the devices and examination of the morphological and mechanical features. PCU spacers exhibited a variety of surface damage mechanisms, the most significant being abrasion and localized, microscopic surface cracks. Evidence of oxidation and chain scission were detected on PCU spacers ATR-FTIR. ATR-FTIR, DSC and hardness measurements also showed a slight heterogeneity in the composition of PCU. The extraction carried out on the PCU spacers revealed the presence of extractable polycarbonate segments. One spacer and all PET cords visually exhibited the presence of adherent biological material (proteins), confirmed by the ATR-FTIR results. GC/MS analyses of the extracts from PET cords revealed the presence of biological fluids residues, mainly cholesterol derivatives and fatty acids, probably trapped into the fiber network. No further chemical alterations were observed on the PET cords. Although the observed physical and chemical damage can be considered superficial, greater attention must be paid to the chemical degradation mechanisms of PCU and to the effect of byproducts on the body.

[Gastric atresia, diaphragmatic hernia, and gastroesophageal reflux: a rare malformation requiring a multiple approach]

The first cases of atresia or web in the pyloric and prepyloric regions were described in the literature since 1937. To date, only one case of atresia at the junction between the fundus and the body of the stomach has been reported. We want to describe a complex case with incomplete atresia between fundus and gastric body, with left lateral diaphragmatic hernia, treated in several stages by endoscopic, open surgery and minimally invasive surgery

Solution-cast high-aspect-ratio polymer structures from direct-write templates

This letter presents a novel strategy for template synthesis of polymer structures with laser machined substrates. User-designed patterns of submicrometer holes with aspect ratios >10:1 and depths >10 μm were produced by focusing 160 fs, 5.2 μJ laser pulses on the surface of fused silica with a high numerical aperture microscope objective. Some holes were enlarged by chemical etching. Polymer solutions were cast into the templates to create high-aspect-ratio polymer structures using replication. Engineered polymer structures prepared by this unique method are useful for a number of applications such as high surface area electrodes and biological substrates.

Abstract P3-06-33: Effect of trastuzumab-based therapy on serum activin A levels in metastatic breast cancer

Background: Only half of HER2-positive metastatic breast cancer patients will respond to first-line trastuzumab-containing therapy, but of these, most will progress within a year. Trastuzumab resistance remains a continuing clinical problem, and better biomarkers and therapies are needed. Activin A is a TGF-beta superfamily member that regulates cell proliferation, apoptosis, differentiation, and immune response. We have previously reported that higher pretreatment serum activin A level predicted reduced progression-free survival (PFS) and overall survival (OS) to first-line trastuzumab, independent of age, line of therapy, CA 15–3, and hormone receptor status (ASCO Ab ID 607, 2012).

Methods: Serum activin A was measured using ELISA (R&D Systems, Minneapolis, MN) in 60 metastatic breast cancer patients before and 1 month after starting first-line trastuzumab-containing therapy. PFS and OS were analyzed using the Kaplan-Meier method and Cox modeling with both continuous and dichotomous (median) serum activin A analyses.

Results: Pretreatment serum activin A levels had a median of 629 pg/mL and an inter-quartile range of 406 to 1791 pg/mL. There was no significant change in activin A levels between pretreatment and one month after starting trastuzumab therapy. Median activin A level at one month was 655 pg/mL, with an inter-quartile range of 405 to 1517 pg/mL. 83% of patients who had low pretreatment activin A levels (below median) had low activin levels at one month, and 83% who had high activin levels (above median) at baseline had high activin A levels at one month. Patients who had high activin A levels at baseline and one month had the worst outcome for both PFS (HR 3.9; median 134 days vs.776 days; p < 0.0001) and OS (HR 6.7; p < 0.0001) when compared to patients with low activin A levels which remained low at one month.

Conclusions: Higher pretreatment and 1 month post-treatment serum activin A predicted for reduced PFS and overall survival in metastatic breast cancer patients treated with first-line trastuzumab-containing therapy. Trastuzumab-based therapy did not have a significant effect on activin A levels at one month. Patients with persistently high activin A levels had significantly worsened outcomes compared to those with low activin A levels. Serum activin A deserves further study to select patients most likely to respond to activin A-targeted therapy.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-33.

Ventilatory threshold is related to walking tolerance in patients with intermittent claudication

BACKGROUND

This study assessed the relationship between lower limb hemodynamics and metabolic parameters with walking tolerance in patients with intermittent claudication (IC).

PATIENTS AND METHODS

Resting ankle-brachial index (ABI), baseline blood flow (BF), BF response to reactive hyperemia (BFRH), oxygen uptake (VO2), initial claudication distance (ICD) and total walking distance (TWD) were measured in 28 IC patients. Pearson and Spearman correlations were calculated.

RESULTS

ABI, baseline BF and BF response to RH did not correlate with ICD or TWD. VO2 at first ventilatory threshold and VO2peak were significantly and positively correlated with ICD (r = 0.41 and 0.54, respectively) and TWD (r = 0.65 and 0.71, respectively).

CONCLUSIONS

VO2peak and VO2 at first ventilatory threshold, but not ABI, baseline BF and BFHR were associated with walking tolerance in IC patients. These results suggest that VO2 at first ventilatory threshold may be useful to evaluate walking tolerance and improvements in IC patients.

Assessing caries, dental plaque and salivary flow in asthmatic adolescents using inhaled corticosteroids

BACKGROUND

A number of studies have reported that inhaled corticosteroids may cause a greater incidence of caries, reduced salivary flow, changes in saliva composition and an increased frequency of dental plaque, probably through alterations in the oral microbiota. The objective was to compare the frequency of caries, dental plaque and non-stimulated salivary flow rate among asthmatic adolescents using inhaled corticosteroids and non-asthmatic adolescents, as well as the salivary biochemical parameters (pH and leucocytes) in both groups.

METHODS

This research has a descriptive cross-sectional design to compare dental health of 40 asthmatics on inhaled corticosteroids and 40 non-asthmatic adolescents (median age 13 years).

RESULTS

The findings were a higher number of tooth surfaces affected by dental caries (median 4 versus 1.5), and more dental plaques (median 70.5 versus 60.7) among asthmatic adolescents. They also had a significantly higher frequency of salivary leucocytes. The non-stimulated salivary flow was similar in both groups.

CONCLUSIONS

The results suggest an association between the use of inhaled corticosteroids and an increased risk of dental caries and bacterial plaque, which calls for special attention of these patients by doctors and dental health professionals.

Composição e extração de nutrientes por trachypogon plumosus sob adubação e idades de rebrota

No manejo de pastagens, a adequada disponibilidade de nutrientes do solo e a utilização de períodos de descanso compatíveis com as características morfofisiológicas da gramínea são fatores importantes para a obtenção de forragem de alta qualidade e, consequentemente, índices satisfatórios de produtividade animal. Avaliaram-se os efeitos da correção da fertilidade do solo (testemunha, calagem, adubação e calagem + adubação) e da idade de rebrota (28, 42, 56, 70 e 84 dias) sobre a composição química e extração de nutrientes por Trachypogon plumosus nos cerrados de Roraima. Os teores de nitrogênio, fósforo, cálcio, magnésio e potássio foram inversamente proporcionais às idades de rebrota, ocorrendo o oposto quanto aos teores dos constituintes da parede celular. Os maiores teores de N e K foram obtidos com a adubação e a calagem + adubação, enquanto que a testemunha apresentou maiores teores de P, Ca e Mg. O efeito da idade de rebrota sobe a extração de nutrientes foi quadrático e os máximos valores registrados aos 67,8 (26,71 kg ha-1 de N), 63,4 (2,82 kg ha-1 de P), 62,9 (5,17 kg ha-1 de Ca), 68,4 (3,32 kg ha-1 de Mg) e 66,0 dias (12,71 kg ha-1 de K). A máxima extração de macronutrientes foi, em ordem decrescente, a seguinte: N > K > Ca > Mg > P. A adubação e a calagem + adubação proporcionaram maior extração de nutrientes e forragem de melhor qualidade com menor teor de fibras.

Artrodese interfalângica: eficácia e retorno laboral com fios Kirschner e parafuso Acutrak®

A artrodese interfalângica (IF) é um procedimento osteoarticular frequente e os fios de Kirschner são os mais usados. Outras técnicas descritas são parafusos compressivos ou, recentemente, parafuso sem cabeça, completamente roscado, Acutrak® (Acumed LLC, Hillsboro, OR). Os autores propuseram comparar duas técnicas de artrodese IF: com fios Kirschner e parafusos Acutrak®. Trata-se de um estudo retrospectivo de 2009 a 2012 englobando 67 artrodeses. Destes foram excluídos doentes com infecção, osteopenia ou perda óssea como artrite reumatóide. Obteve-se um total de 53 artrodeses: 22 com fios Kirschner (grupo I) e 31 com parafusos Acutrak® (grupo II). Foi determinada a taxa e tempo de fusão, complicações e tempo de retorno laboral. Os resultados foram analisados pelo SPSS® 20 Statistics (p<0.05). No grupo I, verificou-se 77.3% de fusão com 9% de complicações menores. No grupo II ocorreu consolidação em 100%, na ausência de complicações. O tempo médio de fusão foi 9.6 (r: 6-14) semanas no grupo I e 5.1 (r: 4-8) semanas no grupo II. O retorno laboral foi às 11.5 semanas e 5.4 semanas, respectivamente. O parafuso Acutrak® permite uma artrodese mais eficaz que os fios Kirschner e retorno laboral precoce.

Posterior reversible encephalopathy syndrome: the importance of its recognition in patients with systemic lupus erythematosus

The posterior reversible encephalopathy syndrome (PRES) is a clinical-radiological entity characterized by the association of clinical neurological signs (headache, confusion, vision changes, vomiting and seizures) and the typical changes in magnetic resonance imaging of the brain. Its pathogenesis is still poorly defined but seems to imply a vascular and endothelial dysfunction. It occurs more frequently in patients with hypertensive encephalopathy, eclampsia, renal failure and has also been associated with the use of immunosuppressive drugs. The authors present a case of PRES in a young woman with systemic lupus erythematosus with active and severe manifestations of the disease.

P5-01-03: Correlation between Aromatase Expression in Metastatic and Primary Breast Cancer

Background: Estrogens are the major mitogenic factor in hormone dependent breast cancer. In postmenopausal women, estrogen production results mainly from extra-glandular conversion of androstenedione to estrone. This conversion is catalyzed by the enzyme aromatase (Aro). It is known that an higher expression and activity of the enzyme Aro is present in primary breast carcinoma compared with normal breast tissue. These data may indicate that tumors have the ability to produce their own estrogen. However, it is not known whether this process can occur at the level of metastasis. This study aims to determine the expression of aromatase in metastatic breast cancer and to analyze its correlation with expression at primary tumor and response to aromatase inhibitors (AI).

Material and Methods: We selected 41 patients with metastatic breast cancer, followed in the Department of Medical Oncology since 1995, undergoing surgery or biopsy of a metastatic lesion in the course of the disease (24 liver metastases; 10 bone metastases; 6 lung metastases; 1 lymph node metastases). For all these patients a detailed clinical chart review regarding clinical information (including treatment and tumor status) was obtained. Samples (formalin fixed and paraffin embedded) were analyzed for aromatase expression by immunohistochemistry (IHC), using the anti-aromatase monoclonal antibody # 677 (Novartis). Slides were scored considering the proportion of immunoreactive cells and intensity of the staining, and evaluating separately the epithelial and stromal component. The Fisher and log-rank test were used to determine the correlation between Aro expression in metastatic tissue and response to AI. Results: Aromatase was expressed in 51% (21/41) of the samples (13 liver metastases; 8 bone metastases). The average combined score was 130 (10 — 320). The average score was higher in the epithelial component versus the stromal component (123 vs. 17.5). There was a strong expression of Aro in bone metastases (average combined score: 176) compared with other sites.

There was no correlation between Aro expression and estrogen receptors expression. In 15 patients, it was also possible to evaluate the expression of Aro in the primary tumor. Aro was expressed in four cases (36%), with an average combined score of 52.5. The Aro expression between the primary tumor and metastasis was concordant in nine cases.

Thirty-four patients received AI to treat metastatic disease. The median time to progression (TTP) with AI in the entire population was 17.8 months. In the group of patients with Aro expression in metastasis, the median TTP in AI was 19.5 months, significantly higher than that obtained in the group without detectable Aro expression: 6.5 months (p = 0.045). The overall survival in the group with Aro expression was125 months and the 77 months in patients without Aro expression (p = 0.54).

Conclusions: Aromatase is expressed by metastatic tumor cells from breast cancer, with a positive and statistically significant correlation between its expression in the metastasis and the clinical benefit to IA. Its expression was higher in bone metastases compared with other sites of metastasis although this difference was not, in our study, statistically significant.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-01-03.

A benchmark study on 883 nasopharyngeal cancer patients treated in two Italian centres from 1977 to 2000. Part I: Evolving technical choices and survival

PURPOSE

The authors sought to define treatment results according to the different accrual periods and clinical-therapeutic features in a large series of nasopharyngeal cancer (NPC) patients treated in two Italian centres over more than two decades.

MATERIALS AND METHODS

A total of 883 patients consecutively treated with radiotherapy between 1977 and 2000 at the Florence (FLO) and Brescia (IRA) Radiation Oncology centres were studied. Five-year overall (OS) and disease-specific (DSS) actuarial survival rates in the different pathological, clinical and therapeutic subgroups were calculated, along with the actuarial local-regional control (LRC) probability.

RESULTS

At univariate analysis, survival and local control rates were significantly better in the more recent accrual periods and in the more favourable disease presentations; treatment-related parameters mainly affect LRC. At multivariate analysis, patient- and disease-related factors had a more evident prognostic effect than did therapeutic factors, although dose to the nasopharynx and treatment technique had a marginally significant impact on DSS and OS.

CONCLUSIONS

Results of this benchmark study may be useful for understanding the development of new radio-therapy techniques for NPC, such as three-dimensional conformal radiotherapy (3D-CRT) and particularly intensity-modulated radiotherapy (IMRT).

A benchmark study on 883 nasopharyngeal cancer patients treated in two Italian centres from 1977 to 2000. Part II: Evolving technical choices and toxicity patterns

PURPOSE

The authors sought to define toxicity patterns according to the different accrual periods and clinical-therapeutic features in a large series of nasopharyngeal cancer (NPC) patients treated in two Italian centres over more than two decades.

MATERIALS AND METHODS

A total of 883 patients consecutively treated with radiotherapy from 1977 to 2000 at the Florence (FLO) and Brescia (IRA) radiation oncology centres were studied. The crude incidence of late treatment toxicity in the different subgroups of patients was calculated and compared.

RESULTS

Higher total and fractional doses and the "older" treatment techniques were related with an increased incidence of the main late effects of treatment. More recently treated patients experienced less treatment-related complications.

CONCLUSIONS

Results of this benchmark study may have implications for understanding and developing new radiotherapy techniques, such as three-dimensional conformal radiotherapy (3D-CRT) and, in particular, intensity-modulated radiotherapy (IMRT) for NPC patients.