Spectrum of rare and common genetic variants in arrhythmogenic cardiomyopathy

Background

Arrhythmogenic cardiomyopathy (ACM) is a rare inherited cardiac disorder, whose genetic cause is elusive in about 50% of cases. ACM pathogenic mutations mainly involve desmosomal genes (PKP2, JUP, DSP, DSG2, DSC2). ACM presents a variable disease course, spanning from mild electrocardiographic alterations and/or contractile dysfunctions, to malignant ventricular arrhythmias and heart failure.

Purpose

In an attempt to broaden etiological diagnosis for ACM patients, this work was aimed at finding potential rare high-impact variants in genes not previously associated with ACM. Secondarily, we meant to assess the impact of genetic polymorphisms on the disease clinical severity.

Methods

We clinically characterized 82 consecutive ACM probands and performed next-generation sequencing, exploring a panel of 174 genes associated with inherited cardiovascular diseases. We evaluated the pathogenicity of rare variants, according to the American College of Medical Genetics / Association for Molecular Pathology guidelines, to select candidates with potential ACM causative role. Further, a genotype-phenotype correlation analysis between common polymorphisms and clinical variables was performed to find genetic factors associated with specific ACM phenotypes. Finally, we carried out event-free survival analyses, linking specific variants to arrhythmias in 8,6±0,7 years follow-up, to estimate their possible impact on arrhythmic risk.

Results

We identified 141 rare genetic variants, of which 23 were classified of high impact, including variants in genes never associated with ACM (e.g. ABCC9, APOB, MIB1). These genes deserve future studies as they could participate in ACM pathogenesis. In addition, we found 69 genotype-phenotype significant associations (p≤0.005) between common variants and clinical parameters. Variants associated to arrhythmic phenotypes were found with genes linked to arrhythmias (e.g. KCNQ1, HCN4) and other cardiomyopathies (e.g. MYBPC3, MYL2). Associations involving substrate impairments were found with genes linked to muscle dysfunctions (e.g. LAMA2, SGCD). Arrhythmia-associated polymorphisms, included in survival analyses, were found to be associated with an increased occurrence of arrhythmic events during patients' follow-up.

Conclusion

The identification of rare high impact variants in novel genes potentially associated with ACM and the observation of genotype-phenotype correlations constitute the starting point to address the current lack of knowledge of the genetic landscape of ACM.

Funding Acknowledgement

Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero Italiano della Salute - Ricerca corrente

Wild rats as urban detectives for latent sources of asbestos contamination

Based on a large body of evidence asbestos minerals have been classified as carcinogens. Despite the Italian ban on asbestos in 1992 and the subsequent remediation activities, latent sources of contamination may still represent a hazard where asbestos were particularly used. Using wild rats as sentinel animals, this study aimed at uncovering sites with the greatest potential for non-occupational exposure to asbestos in the city of Casale Monferrato (Piedmont Region, Italy), where the largest Italian manufacturing plant of asbestos-cement had been active. During the study period (2013-2015) a total of 40 wild rats were captured from 16 sampling capture points. The lungs of wild rats have been investigated by using scanning electron microscopy (SEM) with energy dispersive spectroscopy (EDS). The SEM-EDS detected the presence of asbestos fibers (tremolite/actinolite, amosite, and chrysotile) in rats' lungs from 11 sampling points. The hypothetical rats' home-range and the observed site-specific concentration of asbestos fibers per gram of dry lung tissue were used to identify areas to be targeted by additional search of latent sources of asbestos. In conclusion, our results showed that the use of wild rats as sentinel animals may effectively integrate the strategies currently in use to reduce the exposure to asbestos.

Inappropriate Doses of Chemotherapy in Italian Breast Cancer Patients Enrolled in Clinical Trials

Aims and background

The dose of delivered chemotherapy is important to evaluate the appropriateness of the anticancer treatment. This aspect has been scarcely studied in Italy. About 7 years ago, the Italian Group for Antiemetic Research (IGAR) published a large controlled study on the effectiveness of different antiemetic prophylaxis in patients submitted to moderately emetogenic chemotherapy, where the prescribed chemotherapy was recorded. The aim of our study was to evaluate the incidence of undertreatment and to detect clinical and nonclinical factors able to explain its variability.

Methods

An observational study on the IGAR databank was performed to evaluate the incidence of undertreatment in the prescription in conditions of clinical trial, where the doses belonged to the eligibility criteria, and to analyze the importance of clinical and nonclinical factors using multifactorial logistic models.

Results

317 patients receiving cyclophosphamide, methotrexate, and fluorouracil (CMF) and 224 anthracycline-based chemotherapy were considered. In the CMF-treated patients, 22.4% received full doses, whereas in 53.6% all three drugs of the schedule were down-dosed. In the anthracycline-treated group, 38.6% and 3.4% of patients submitted to chemotherapy containing epirubicin and doxorubicin, respectively, were undertreated. Logistic models showed that undertreatment in CMF-treated patients depended significantly on the geographic area and setting of chemotherapy administration. Although not significant, differences between age class and Karnofsky performance status were also detected. In the epirubicin-treated group, all these factors were significant.

Conclusions

The undertreatment of cancer patients is a relevant problem, because it could give, in daily clinical practice, worse results than those reported in clinical studies. Considering the setting of a clinical trial where our study was carried out, the incidence of undertreatment is surprisingly high. We do not know whether today, about 8 years after the IGAR study was carried out, the inappropriate dose of chemotherapy is still as frequent as we reported, but surely the topic deserves more attention.

Nordic walking increases circulating VEGF more than traditional walking training in postmenopause

OBJECTIVES

Nordic walking (NW) is widely practiced by postmenopausal women. Its effects are peculiar owing to the involvement of more muscle groups than in traditional walking training (WT). Since mechanical load promotes secretion of vascular endothelial growth factor (VEGF) from both skeletal muscle and muscle endothelium, the aim of the study was to compare the effect of NW and WT on VEGF levels.

METHOD

Thirty postmenopausal women were randomly assigned to NW or WT. Both groups trained 40-50 min/day, three times per week, at a mean intensity of 12 on a 15-category scale of the ratings of perceived exertion. Since VEGF is also released from adipocytes, anthropometric parameters were assessed.

RESULTS

NW increased circulating VEGF more than WT (p = 0.041). Furthermore, both study groups exhibited an average decrease in weight (p = 0.023), body mass index (p = 0.024), hip circumference (p = 0.001), and arm fat index, although WT participants had higher values for this index at baseline (p < 0.001) and thus exhibited a greater net decrease compared with the NW participants (p < 0.011).

CONCLUSIONS

These data imply that NW increases the level of circulating VEGF more than does traditional walking when the intensity of training is equivalent.

Which cephalometric analysis for maxillo-mandibular surgery in patients with obstructive sleep apnoea syndrome?

Maxillo-mandibular advancement MMA is considered an efficacious treatment for patients affected by severe obstructive sleep apnoea syndrome (OSAS). Even though OSAS improvement is the main goal of MMA, excessive maxillo-mandibular protrusion should be avoided to guarantee pleasant postoperative facial aesthetics. In order to attain such a result, the amount of MMA should be planned preoperatively by both aesthetic and cephalometric analyses. Steiner and Delaire cephalometric analyses are commonly used in the preoperative planning of orthognatic surgery for dentofacial deformities, however controversies still exist about the basis and postoperative aesthetic results of such cephalometric analyses in OSAS patients candidate for MMA. Forty-eight patients affected by severe OSAS were submitted to MMA. Pre- and post-operative Steiner and Delaire cephalometric tracings were assessed in each subject. For Steiner analysis, the variation in the SNA and SNB angles was measured, while for Delaire tracings the variation in the C3/FM-CPA and C3/FM-Me angles was assessed. Mean MMA was 6.9 + 3.8 mm for the maxilla and 13.6 + 5 mm for the mandible. After surgery, an improvement of the apnoea-hypopnoea index was recorded (40.47 + 7.64 preoperative vs. 12.56 + 5.78 postoperative). In all patients, both cephalometric analyses showed presurgical bimaxillary retrusion. After surgery, the mean value of Steiner's SNA angle increased from 78.18° to 85.58° (p < 0.001), while mean Delaire's C3/FM-CPA angle increased from 81.19° to 89.71° (p < 0.001). The mean value of Steiner's SNB angle increased from 74.33° to 80.73° (p < 0.001), while Delaire's C3/FM-Me angle increased from 80.10° to 87.29° (p < 0.001). Postoperatively, both the maxilla and mandible were in a more protrusive position (p < 0.001) according to Steiner analysis compared with Delaire tracing. Basing MMA on Delaire cephalometric analysis leads to an increased advancement of the maxillo-mandibular complex than Steiner tracing. The consequences of this aspect on facial aesthetics should be considered during surgical planning and preoperative informed consent in OSAS patients candidate for MMA.

Balance impairment in kidney transplant recipients without concurrent peripheral neuropathy

Kidney transplant recipients (KTRs) present with compromised functional capacity, low levels of physical activity, muscle atrophy, and peripheral nerve dysfunction that may result in high postural instability. This study aimed to compare the static balance control of 19 KTRs with 19 healthy adults (HA). All participants completed the Romberg test on a stabilometric platform with eyes open (EO), eyes closed (EC) and during a dual task (DT) condition. Centre of pressure (COP) measures (COP velocity (COPv) and sway area (SA)), as well as position-based outcomes such as anterior-posterior (AP) and medio-lateral (ML) ranges of COP displacements were recorded. Independent ANCOVA revealed an overall lower performance of KTRs compared to HA (p<0.05) with the EC condition exhibiting the worst relative performance for KTRs, suggesting a poorer capacity of relying on proprioceptive information when maintaining the upright posture. The addition of a cognitive task did not further worsen balance performance in KTRs. As impaired postural control is one of the main predictors of falls in elderly subjects, these data might also indicate that this constitutes an equivalent risk factor for falling in middle-aged KTRs.

Natural position of the head: review of two-dimensional and three-dimensional methods of recording

Both the correct position of the patient's head and a standard system for the acquisition of images are essential for objective evaluation of the facial profile and the skull, and for longitudinal superimposition. The natural position of the head was introduced into orthodontics in the late 1950s, and is used as a postural basis for craniocervical and craniofacial morphological analysis. It can also have a role in the planning of the surgical correction of craniomaxillofacial deformities. The relatively recent transition in orthodontics from 2-dimensional to 3-dimensional imaging, and from analogue to digital technology, has renewed attention in finding a versatile method for the establishment of an accurate and reliable head position during the acquisition of serial records. In this review we discuss definition, clinical applications, and procedures to establish the natural head position and their reproducibility. We also consider methods to reproduce and record the position in two and three planes.

Determination of vertical dimension in prosthodontic rehabilitation of a growing patient with severe oligodontia

This report describes the oral rehabilitation of a young boy with severe oligodontia of primary dentition and complete anodontia of permanent dentition, treated by complete maxillary and partial mandibular removable dentures. Since the determination of a proper occlusal vertical dimension in paediatric patients is often difficult, treatment was achieved by means of a multidisciplinary approach involving conventional prosthodontic principles combined with cephalometric analysis and growth prediction. After a follow-up of two years a second lateral cephalogram was taken to evaluate the developmental changes in craniofacial morphology and the superimpositions method was performed, showing an improvement of both sagittal and vertical relationship between basal bones. In this case, the early prosthetic treatment resulted in enhanced aesthetics and masticatory function as well as skeletal growth changes.

Temporomandibular joint dysfunction in Moebius syndrome

AIM

Moebius syndrome is a rare condition characterised by bilateral facial and abducens nerve paralysis. In the present study, it was investigated the effect of the long term facial muscles hypoactivity on temporomandibular joint movements development.

METHODS

Accordingly with Terzis classification (Terzis, 2003), a wide sample of A type and B type Moebius patients was investigated for mandibular range of movements. Moebius patients were compared with a sample of healthy subjects.

RESULTS

Both type A and type B Moebius patients develop a severe articular movement reduction, especially during mouth opening. A highly significant difference was found between Moebius patients and the healthy group. No difference was found between A and B Moebius sub-samples.

CONCLUSION

The authors stress the importance of an early adequate rehabilitation of Moebius patients, in order to avoid the limitation of TMJ movement range.

Characteristics of spontaneous physical activity and executive functions in postmenopause

AIM

Executive functions are susceptible to age-related changes, and menopause has also been shown to be linked with their decline. The aim of the present study was to investigate the variables related to executive functions in postmenopausal women not involved in controlled dietary and physical exercise programs and without hormone-replacement therapy.

METHODS

Fifty-seven women (58.39 ±4.16 yr) were investigated for their medical history, blood lipids, insulin resistance (HOMA-IR), body composition, blood pressure, executive functions (Digit Span and Trail Making tests), maximal aerobic capacity, dietary habits, and spontaneous physical activity.

RESULTS

Cluster analysis performed on the basal data of the Digit Span scores and Trail Making tests identified two subgroups: Group A (N.=24) that showed better executive functions than Group B (N.=33). Although these subgroups differed across several variables of body composition, plasma lipids, dietary habits, spontaneous physical activity, aerobic fitness, and insulin resistance, logistic regression models showed B10m/die as the only predictive variable for subgroup membership.

CONCLUSION

In the absence of a physical exercise program, the knowledge of how spontaneous physical activity is organized (B10m/die) is important for executive functions of post-menopausal women. It is the specific moderate to intense physical activity characteristic of B10m/die, rather than generic physical activity, that seems to determine the maintenance or attainment of cognitive health through body movement.

Lifestyle and high density lipoprotein cholesterol in postmenopause

OBJECTIVES

Menopause is characterized by hormonal and metabolic changes. These are linked to increased risk of cardiovascular disease, for which low blood plasma levels of high density lipoprotein (HDL) cholesterol are an independent risk factor. The present study investigated variables linked with basal plasma HDL cholesterol levels and the effects of aerobic training, on their variations, in 40 postmenopausal women.

METHODS

We assessed body composition, dietary habits and maximal aerobic capacity of participants. Characteristics of daily physical activity and plasma lipoproteins were measured. The women walked on 4 days/week, for 14 weeks, at moderate intensity, and they were grouped according to the resulting tertiles of basal plasma HDL cholesterol levels.

RESULTS

Logistic regression analysis showed that waist-to-hip ratio and number of daily bouts of moderate-intensity physical activity, held for at least 10 consecutive minutes (B10m/day), are predictive variables of basal plasma HDL cholesterol levels. After the training period, the first and second tertiles increased plasma HDL cholesterol levels, while the third tertile decreased plasma HDL cholesterol levels. The tertiles showed different remodelling of spontaneous physical activity: the third tertile reduced B10m/day, while the others did not.

CONCLUSIONS

This study provides knowledge about the relationships of plasma HDL cholesterol levels with characteristics of physical activity. Furthermore, it shows that physical exercise engagement can result in negative compensation of spontaneous physical activity that could counteract or reduce the positive effects of the aerobic training on plasma HDL cholesterol levels.

Orthognathic surgery for the complete rehabilitation of Moebius patients: principles, timing and our experience

Moebius syndrome is a rare disorder found in approximately 1/100,000 neonates and the treatment of facial palsy is now well established worldwide and consists of free-muscle transplants reinnervated with motor nerves. Dentofacial deformities are often detected in Moebius patients, and different degrees of micrognathia are often present, particularly in patients with complete expressions of Moebius syndrome. However only two published reports have described the surgical treatment of such anomalies in these patients; in both cases, the suggested approach consisted of orthognathic surgery followed by soft-tissue management. In this paper we discuss the indications and correct timing of orthognathic surgery and suggest to perform facial animation at an early age and then to wait for the completion of maxillofacial skeletal growth before performing orthognathic surgery. Finally, facial animation should precede orthognathic surgery in adult patients to prevent lower lip deformities and to ensure more predictable and satisfactory results.

[Determinants of short-term memory: is there a difference between young adults and postmenopausal women?]

AIM

The literature indicates that several variables are influencing cognitive health. The aim of the study was to investigate the main determinants of the short-term memory among anthropometric, dietary and performance variables in a sample of healthy women. The role played by the age was also investigated.

METHODS

Forty-five healthy overweight women were recruited through general physicians: 23 were young adults (24.63±4.17 years) and 22 were postmenopausal (53.30±2.95 years). Overweight condition was assessed according to the age-adjusted reference values. Participants were analyzed for Digit Span, blood pressure, body composition, aerobic fitness and dietary habits.

RESULTS

Young adults and postmenopausal women did not differ either in Digit Span or in dietary habits. In postmenopausal women Digit Span was positively correlated with body weight, body mass index, body fat, waist circumference and daily intake of vitamin D. Linear regression model indicated vitamin D as the only significant predictor variable of Digit Span. In young adults Digit Span had no correlations with the others investigated variables.

CONCLUSION

In postmenopause, vitamin D daily intake is important not only for skeletal, but also for cognitive health. Even though young adults and post-menopausal women did not differ for health status, short-term memory in young adulthood seems to be differently linked with the investigated variables than during post-menopause.

Relationships between physical exercise practice, dietary behaviour and body composition in female university students

AIM

The relationship between female body composition, total energy expenditure and physical exercise energy expenditure is not very strong because women can compensate by increasing their energy intake. The aim of this study was to investigate the relationship between total minutes of exercise per week, dietary habits and body composition in female university students using physical activity and the habit to cook as covariates.

METHODS

Fifty-one female university students were investigated for body composition, dietary habits, aerobic fitness, physical activity and physical exercise practice. Participants were grouped in three sub-samples (1, 2 and 3) according to the 33rd and 66th percentiles of weekly minutes (min/wk) of training.

RESULTS

Group 1 had 0.00 min/wk, group 2 had 95±35.59 min/wk and group 3 had 231.66±85.97 min/wk of training. Sub-samples did not differ for IPAQ parameters while differed for aerobic fitness (P=0.001). Group 3 had a higher energy intake (EI) (P=0.008), a higher intake of lipids (P=0.017), saturated (P=0.042) and monounsaturated fat (P=0.024) and a lower intake of carbohydrates (P=0.007). Group 3 maintained the higher EI and the worse composition of lipid intake considering the habit to cook as covariate. Group 3 also had higher muscle mass.

CONCLUSION

In order to positively affect body composition, in the sedentary women it is enough to control the energy balance, whereas in those that trained regularly it is necessary to control both energy balance and composition of daily meals.

Effects of the time of day of walking on dietary behaviour, body composition and aerobic fitness in post-menopausal women

AIM

Post-menopause is linked to an increased risk of death from cardiovascular disease. Physical exercise and healthy dietary habits are normally suggested to enhance health. The aim of this study was to verify whether the time of day of walking had different effects on both spontaneous dietary intake and body composition modification in overweight and sedentary post-menopausal women.

METHODS

Forty-two sedentary post-menopausal women (53.46+/-3.32 yrs) were recruited. Thirty-three completed the study: 29 were suitable for statistical analysis. Of those, 14 walked in the morning (MG) and 15 in the early evening (EG). Body composition, dietary habits and predicted VO2max were investigated. Food intake was analysed for energy, macronutrients and daily distribution.

RESULTS

The Mann-Whitney test showed that according to the time of day of walking there were different fat mass (FM) reductions and dietary behaviour responses. EG reduced FM greater than MG and showed a major increase in morning energy intake (EI). Sub-samples did not differ in total EI, daily macronutrient portioning and daily meals variations. The variation of FM was correlated with that of proteins (r=-0.352), morning EI (r=-0.367) and aerobic performance (r=0.369). Both MG and EG improved their aerobic performance.

CONCLUSION

The positive effects of walking on health could be optimised by its evening execution because it could also be linked to spontaneous dietary habit modification.

Midline mandibular osteotomy in an asymmetric patient

This case report shows the possibility of the application of a mandibular osteotomy to resolve mandibular asymmetry with independent and discordant movements of both bony segments. The authors report the case of a 25-year-old woman referred for mandibular asymmetry, with a transverse excess of the right hemi mandible and vertical defect of the left one. The patient underwent a bilateral sagittal split osteotomy, midline osteotomy, and genioplasty, which corrected the mandibular asymmetry with contraction of the entire right hemi mandible. A slight left vertical increase was also obtained through the surgically created lateral open bite. In the follow-up assessment, the patient's face appeared symmetrical with normalization of the bizygomatic-bigonial relationships, and the facial shape corresponded to ideal anthropometric features. This technique resulted in resolution of mandibular asymmetry. In addition, mandibular osteotomy permits the esthetic management of the shape of the entire mandibular body in relation to the other third of the face.

Facial aesthetics and childhood

AIM

The aim of the study is to evaluate attention and perception of parents about children's facial aesthetics, the paediatrician's role in early diagnosis of these problems and the areas of the face considered as the most important from an aesthetic point of view.

METHODS

The study was carried out collecting 1214 questionnaires at paediatricians waiting room in the North of Italy.

RESULTS

Most parents showed attention toward craniofacial deformities of their children and considered the paediatrician's role as very important in early diagnosis. Profile was considered more important than the front view and face's areas felt as the most important were denture, eyes and nose.

CONCLUSION

Despite public opinion, adults are concerned not only about the general health and growth of their children, but also about their facial aesthetics. They, in fact, not only judge aesthetics of the whole face, but also discriminate different views and specific areas of the face. They require, for early diagnosis of dentofacial problems, skilled attention from the paediatrician.

Are physiological characteristics of Caribbean dance useful for health?

AIM

Although the current literature underlines the main role of physical inactivity in the development of chronic diseases and premature death, 65% of adults do not reach the minimum movement levels required to maintain and improve health. The aim of this study was to investigate whether the metabolic and cardiocirculatory characteristics of a single lesson of Caribbean dance fit with international recommendations to improve health through movement.

METHODS

Energy expenditure, exercise intensity, mean heart rate and blood pressure response to a 90-minute lesson were analysed in 24 beginner and 24 experienced dancers (mean age 33.93+/-9.98 years).

RESULTS

MANCOVA was used to analyse energy expenditure and exercise intensity of our sample, stratified for gender and experience. Body weight was inserted as a covariate. Experienced had a major total energy expenditure (372.75+/- 75.32 vs 297.33+/-87.54 kcal; P<0.001), minutes of exercise intensity >6 metabolic equivalents (METs) (8.04+/-10.65 vs 1.47+/-2.16; P<0.001), mean METs (3.81+/-0.32 vs 3.42+/-0.37; P<0.05) and mean heart rate (60.68+/-1.35 vs 53.24+/-3.91 %HRR; P<0.001) than beginner dancers. There were no statistical differences in blood pressure values.

CONCLUSIONS

Caribbean dance fits with international guidelines to improve health and can aid the promotion and enhancement of health through its physiological characteristics, and may reduce drop-out due to a reduced motivation to move.

Multicenter phase II study of chemo-immunotherapy in the treatment of metastatic breast cancer (MBC)

13501

Background: Several maintenance chemotherapy (CT) strategies have failed to improve the outcome of MBC. With the aim of enhancing the immune function that could eradicate minimal residual disease, we have previously shown that low dose inteterleukin-2 (IL-2) and 13-cis- retinoic acid (RA) restored the immune function of advanced cancer patients that had a clinical benefit (CB) from CT (Clin Cancer Res, 2001). In this study we report on 100 consecutive patients with MBC treated with sequential CT and immunotherapy. Methods: Patients with MBC were eligible if they had no evidence of progression after 6–8 courses of an anthracycline-paclitaxel induction CT. Treatment consisted of IL-2, 1.8 X 106 IU and oral RA, 0.5 mg/Kg for 5 days/week for 2 cycles of 3 weeks, with a 1- week rest, with intermittent schedules, until progression. Hormonal therapy was given to estrogen receptor (ER) + patients. In order to increase ER expression, beta interferon (1 X 106 IU) was added, subcutaneously, twice a week, to 10 patients with low ER content. Primary endpoint was progression-free survival (PFS); secondary endpoints were toxicity, overall survival (OS) and the evaluation of immunological parameters. Results: From 9/1996 to 9/2001, 100 consecutive patients (median age of 59 years), exhibiting a CB from CT were entered into the study. Grade 2 cutaneous toxicity and fever occurred in 19% and 16% of patients, respectively, while grade 2 autoimmune reaction was observed in 10% of patients. After a median follow-up of 49 months, overall median PFS and OS were 37.1 months and 57.5 months, respectively. Patients with ER+ tumors had a similar response rate to that of patients with ER- tumors but had significantly longer PFS (medians of 44.7 and 32.7 months, respectively) and OS (medians of 64.5 and 51.4 months, respectively). With respect to baseline values, a statistically significant decrease of vascular endothelial growth factor (VEGF) and an improvement in lymphocyte, natural killer cell count and CD4+/CD8+ ratio were observed. Conclusions: IL-2 and RA treatment of women with MBC who achieve a CB after 6–8 courses of anthracycline-paclitaxel based CT, is well tolerated, decreases VEGF, improves the immunological parameters, and seems to delay disease recurrence. A randomized trial is warranted.

No significant financial relationships to disclose.

Effect of interleukin-2 (IL-2) and 13-cis retinoic acid (RA) on vascular endothelial growth factor (VEGF) and durable response in patients with advanced solid tumors showing a partial response (PR) or stable disease (SD) to chemotherapy

2521

Background: A large proportion of patients with advanced solid tumors (AST), showing response to chemotherapy, experiences relapse from resistant stem cells that form minimal residual disease (MRD). High serum levels of VEGF have been shown to be associated with MRD and with a short relapse-free survival (RFS). We have shown, that low-dose IL-2 and RA, decreased VEGF and enhanced the immune function of patients with AST responding to chemotherapy (Clin Cancer Res 2001, Anticancer Res 2005). Primary endpoint of this study was to evaluate if IL-2/RA decreased VEGF and restored the immune function in patients with AST that had a PR or SD to chemotherapy. Secondary endpoint was the evaluation of the efficacy of IL2/RA in RFS and overall survival (OS). Methods: 100 consecutive AST patients (66% PR, 34% SD), with a mean VEGF of 520 pg/mm3, were entered into the study from 01/97 to 05/04. Median age was 66 years with 57% males. Diagnosis: Lung 28, head & neck 15, kidney 13, gastric 11, ovary 10, breast 10, miscellanea 13. Therapy consisted of self-administered subcutaneous IL-2, 1.8 X 106 IU and oral RA, 0.5 mg/Kg for 5 days/week for 2 cycles of 3 weeks, with a 1-week rest, for 1 year. Therapy was continued, with intermittent schedules until progression. Immune function and tumor markers were assessed every 2 months, response every 4 months. Results: After a median follow-up time of 42 months (16–106) and 900 courses of therapy, a statistically significant decrease of VEGF (148 pg/mm3, p<0.002) and improvement of lymphocytes, NK and CD4+/CD8+ ratio, with respect to baseline values, was observed. 5-year RFS and OS were 30% and 38%, respectively. 28% of patients were converted to a complete response: Their 5-year RFS and OS were 73% and 94%, respectively. No WHO grade 3 or 4 toxicity was observed, while grade 2 cutaneous toxicity and fever occurred in 20% and 13% of patients, respectively. Conclusions: The administration of IL-2/RA determines, with a low toxicity profile, a statistically significant decrease of VEGF, an improvement of all immunological parameters known to be prognostically relevant and a durable clinical response in 28% of patients.

No significant financial relationships to disclose.

Multicenter phase II study of CPT-11 fractionated over two days with bimonthly leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer

PURPOSE

This multicenter phase II study evaluated the activity and toxicity of the combination of fractionated camptothecin (CPT-11) and 5-fluorouracil/leucovorin (5-FU/LV) (de Gramont regimen) for the treatment of metastatic colorectal cancer (MCC) patients who had received no prior chemotherapy for metastatic disease.

PATIENTS AND METHODS

Fifty-four patients with a median age of 63.5 years (range: 43-75), received, every two weeks, a regimen consisting of 2 daily doses of CPT-11, 90 mg/m2 administered over a period of 90 minutes, followed by LV, 200 mg/m2 administered over 2 hours and 5-FU 400 mg/m2 as a bolus and 600 mg/m2 as a 22-hour continuous infusion. Sixty-five percent of patients had synchronous metastatic disease at diagnosis, while 35% of the patients had received adjuvant chemotherapy after radical surgery.

RESULTS

All 54 patients, receiving a total of 561 cycles of chemotherapy (median 12 per patient, range 1-26), were assessable for toxicity and response to treatment. The most common toxicities (grade 3-4) among treated patients were as follows: diarrhea in 3 patients, (6%), neutropenia in 9 patients (17%) and asthenia in 3 patients (6%), with no treatment-related death. We observed 4 complete (7.4%) and 18 partial responses (33.3%), giving an overall response rate of 40.7% (95% CI: 28% to 55%); 22 patients had stable disease (40.7%) and 10 patients progressed (18.5%). After a median follow-up of 22 months, the median time to progression was 8.7 months (range 2.3-43.9+), while overall median survival was 18.8 months (range 0.7-43.9+).

CONCLUSION

The fractionated bimonthly schedule of CPT-11 plus 5-FU/LV showed a lower gastrointestinal toxicity profile than expected, with substantial activity in patients with MCC.

Multicenter phase II study of fractionated bimonthly oxaliplatin with leucovorin and 5-fluorouracil in patients with metastatic colorectal cancer, pre-treated with chemotherapy

In vitro and in vivo studies have shown that oxaliplatin (L-OHP), 5-fluorouracil (5-FU) and leucovorin (L) have a synergistic activity on metastatic colorectal cancer (MCC). In order to better exploit the synergism of action between the three drugs, L-OHP was administered over 2 days, together with 5-FU-L, in a cohort of patients with MCC that had been pre-treated with chemotherapy. Forty-six patients were entered into the trial. All had been pre-treated with chemotherapy for metastatic disease: 14 with the 'de Gramont' regimen alone, and 32 with the same regimen combined with irinotecan (CPT-11). The outpatient treatment consisted of L-OHP 50 mg/m(2), followed immediately by the 'de Gramont' regimen. All drugs were administered on days 1 and 2, every 14 days. Median patient age was 65 years (range: 46-78), male/female ratio was 29/17. All 46 patients were evaluated for response and toxicity. We observed 1 complete response (2.2%) and 14 partial responses (30.4%), giving an overall response rate of 32.6% (95% CI: 19.5-48.06%); 22 patients had stable disease (47.8%) and 9 patients progressed (19.6%). After a median follow-up of 13 months, median time to progression was 6.4 months (range: 3.1-31.2+), while overall median survival was 12.2 months (range: 3.7-31.2+). Toxicity was manageable: grade 3 or 4 neutropenia was observed in 33% of patients, while only 6% of patients had grade 1-2 neurotoxicity. The fractionated bimonthly schedule of L-OHP plus 5-FU-L, showed activity, with an acceptable toxicity profile, both in patients with MCC pre-treated with the 'de Gramont' regimen alone, or with this regimen associated with CPT-11.

Hemimandibular hyperplasia treated by early high condylectomy: a case report

A case of hemimandibular hyperplasia in a young patient treated 12 years ago is presented. Clinical and radiographic findings were consistent with a diagnosis of right hemimandibular hyperplasia. An early high condylectomy was performed. In our opinion, the esthetic and functional results after this long-term follow-up are fairly satisfactory. We present a brief review of the literature to make a differentiation between condylar hyperplasia and hemimandibular hyperplasia and to stress the importance of early condylectomy to correct this disease.

Role of the renal nerves in the control of renin synthesis during different sodium intakes in the rat

OBJECTIVE

The aim of this study was to evaluate the role of the renal nerves in the regulation of renin synthesis in normotensive rats at different sodium balance.

METHODS

Forty-eight male Sprague-Dawley rats were divided in six experimental groups, combining three diets at different NaCl content (normal 0.4%, low 0.04% or high 4.0%), and the surgical, bilateral renal denervation or the sham procedure. After 7 days of dietary treatment, all rats were sacrificed and plasma renin activity (PRA) was measured. Renin messenger RNA (mRNA) levels in the renal cortex were determined by semiquantitative polymerase chain reaction.

RESULTS

PRA was higher in animals fed the low sodium diet compared with those at standard diet, while it was lower in animals fed the high sodium diet. Renal denervation decreased PRA in normal and low sodium groups, while it did not alter the PRA values in the high sodium group. Renin gene expression significantly increased in rats fed with the low sodium diet compared with the standard diet group, and significantly decreased in rats fed the high sodium diet Renal denervation significantly reduced renin mRNA levels in rats receiving the low sodium diet, but did not produce any significant change in normal or high-sodium groups.

CONCLUSION

The activation of renin gene expression during sodium depletion in rats is dependent on the presence of the renal nerves, while the suppression of renin gene expression during a sodium load seems to be due to the macula densa mechanism alone.

Skeletal relapse of maxillary osteotomies in unilateral cleft lip and palate patients

The outcomes of a consecutive series of 10 adults who had unilateral cleft lip and palate and who had undergone Le Fort I advancement fixed with miniplates were investigated. The amount and timing of horizontal and vertical relapse, the correlation between advancement and relapse, and the effectiveness of various methods of internal fixation were analyzed with respect to the authors' clinical experience and the data from the international literature. Tracings of the preoperative and serial postoperative lateral cephalograms--taken immediately and during the 1 1/2 to 2 postoperative years--were analyzed to calculate horizontal and vertical maxillary change. We found that the use of rigid fixation is associated with a significantly more stable postoperative result, as described by other authors. Our study suggests that this useful technique does not eliminate but reduces and controls the problem of relapse in a series of unilateral cleft lip and palate adult patients undergoing Le Fort I osteotomy.

Measuring plasma fibrinogen to predict stroke and myocardial infarction: an update

Plasma fibrinogen is a major determinant of platelet aggregation and blood viscosity. The decrease in plasma fibrinogen by bezafibrate is associated with a decrease in the risk of reinfarctions. To strengthen the predictive value of plasma fibrinogen with respect to cardiovascular risk, we performed a meta-analysis of studies conducted between 1984 and 1998. Emphasis has been put on the relationship between high levels of plasma fibrinogen and fatal and/or nonfatal cardiovascular events in both the general population and in patients with previous cardiovascular events. Twenty-two studies (13 prospective, 5 cross-sectional, and 4 case-control) addressing the association between fibrinogen plasma concentrations and cardiovascular disease were analyzed. The overall estimate of risk of cardiovascular event in subjects with plasma fibrinogen levels in the higher tertile, was twice as high as that of subjects in the lower one (odds ratio, 1.99; 95% confidence interval, 1.85 to 2.13). High plasma fibrinogen levels were associated with an increased risk of cardiovascular disease in healthy as much as in high-risk individuals. A metaregression showed no confounding effects attributable to selected characteristics of retrieved studies. A subgroup analysis (study design, follow up, mean fibrinogen levels, percentage of smokers, and mean age) allowed us to conclude that fibrinogen is an independent risk factor for cardiovascular disease; that it interacts with major determinants of myocardial and cerebrovascular ischemia; and that, in secondary prevention studies, it enhances by 8% the prediction of future events by established risk factors. Thus, fibrinogen measurements should be encouraged to refine the overall risk profiles of individuals and to better tailor preventive interventions.