MiR-130b modulates the invasive, migratory, and metastatic behavior of leiomyosarcoma

Leiomyosarcoma (LMS) is an aggressive, often poorly differentiated cancer of the smooth muscle (SM) lineage for which the molecular drivers of transformation and progression are poorly understood. In microRNA (miRNA) profiling studies, miR-130b was previously found to be upregulated in LMS vs. normal SM, and down-regulated during the differentiation of mesenchymal stem cells (MSCs) into SM, suggesting a role in LMS tumor progression. In the present study, the effects of miR-130b on human LMS tumorigenesis were investigated. Stable miR-130b overexpression enhanced invasion of LMS cells in vitro, and led to the formation of undifferentiated, pleomorphic tumors in vivo, with increased growth and metastatic potential compared to control LMS cells. TSC1 was identified as a direct miR-130b target in luciferase-3'UTR assays, and shRNA-mediated knockdown of TSC1 replicated miR-130b effects. Loss-of-function and gain-of-function studies showed that miR-130b levels regulate cell morphology and motility. Following miR-130b suppression, LMS cells adopted a rounded morphology, amoeboid mode of cell movement and enhanced invasive capacity that was Rho/ROCK dependent. Conversely, miR-130b-overexpressing LMS cells exhibited Rho-independent invasion, accompanied by down-regulation of Rho-pathway effectors. In mesenchymal stem cells, both miR-130b overexpression and TSC1 silencing independently impaired SM differentiation in vitro. Together, the data reveal miR-130b as a pro-oncogenic miRNA in LMS and support a miR-130b-TSC1 regulatory network that enhances tumor progression via inhibition of SM differentiation.

Functional mutants of Azospirillum brasilense elicit beneficial physiological and metabolic responses in Zea mays contributing to increased host iron assimilation

Iron (Fe), an essential element for plant growth, is abundant in soil but with low bioavailability. Thus, plants developed specialized mechanisms to sequester the element. Beneficial microbes have recently become a favored method to promote plant growth through increased uptake of essential micronutrients, like Fe, yet little is known of their mechanisms of action. Functional mutants of the epiphytic bacterium Azospirillum brasilense, a prolific grass-root colonizer, were used to examine mechanisms for promoting iron uptake in Zea mays. Mutants included HM053, FP10, and ipdC, which have varying capacities for biological nitrogen fixation and production of the plant hormone auxin. Using radioactive iron-59 tracing and inductively coupled plasma mass spectrometry, we documented significant differences in host uptake of Fe2+/3+ correlating with mutant biological function. Radioactive carbon-11, administered to plants as 11CO2, provided insights into shifts in host usage of 'new' carbon resources in the presence of these beneficial microbes. Of the mutants examined, HM053 exhibited the greatest influence on host Fe uptake with increased plant allocation of 11C-resources to roots where they were transformed and exuded as 11C-acidic substrates to aid in Fe-chelation, and increased C-11 partitioning into citric acid, nicotianamine and histidine to aid in the in situ translocation of Fe once assimilated.

Glycine Substitution at Helix-to-Coil Transitions Facilitates the Structural Determination of a Stabilized Subtype C HIV Envelope Glycoprotein

Advances in HIV-1 envelope glycoprotein (Env) design generate native-like trimers and high-resolution clade A, B, and G structures and elicit neutralizing antibodies. However, a high-resolution clade C structure is critical, as this subtype accounts for the majority of HIV infections worldwide, but well-ordered clade C Env trimers are more challenging to produce due to their instability. Based on targeted glycine substitutions in the Env fusion machinery, we defined a general approach that disfavors helical transitions leading to post-fusion conformations, thereby favoring the pre-fusion state. We generated a stabilized, soluble clade C Env (16055 NFL) and determined its crystal structure at 3.9 Å. Its overall conformation is similar to SOSIP.664 and native Env trimers but includes a covalent linker between gp120 and gp41, an engineered 201-433 disulfide bond, and density corresponding to 22 N-glycans. Env-structure-guided design strategies resulted in multiple homogeneous cross-clade immunogens with the potential to advance HIV vaccine development.

Food Allergy Emergencies in Children - To what extent are Early Years Services Prepared? A cross-sectional survey

Food allergies are common in preschool children. This study's aims are to establish prevalence, to clarify management practices, levels of preparedness and the perceived role of General Practitioners amongst Early Years Services providers. This study is an anonymous, quantitative, cross sectional study. An online questionnaire was distributed to 282 Early Years Service providers. Data were analysed using SPSS. Response rate was 35% (n=98). Prevalence of food allergy was 3% (n=119). Allergic reactions to food had occurred on site in 16% (n=15). Written emergency action plans were available in 47% of facilities (n=46). Medications were not kept on site in 63% (n=62) of facilities. General practitioners were felt to have an important role in the management of food allergies by 76% of respondents (n=61). This study identifies significant areas for improvement in the management of food allergic child in Early Years Services.

Duration of acetowhitening as a novel objective tool for diagnosing high risk neoplasia in Barrett's esophagus: a prospective cohort trial

BACKGROUND AND STUDY AIMS

Acetic acid reacts with Barrett's mucosa to produce acetowhitening which disappears with time. The clinical significance of this is unknown. We aimed to quantify the acetowhitening time, developing an objective tool for diagnosis of neoplasia in Barrett's esophagus.

PATIENTS AND METHODS

Prospective cohort study in a tertiary referral center, enrolling patients undergoing surveillance of Barrett's metaplasia or referred with suspected neoplasia. Acetic acid 2.5 % was applied to the mucosa via a spray catheter. Acetowhitening was observed and time to disappearance recorded. Targeted biopsies of any neoplasia and quadrantic 2-cm biopsies of residual Barrett's area were then taken. Histological findings were investigated in relation to duration of acetowhitening.

RESULTS

132 patients were examined. A receiver operating characteristic (ROC) curve was produced for identifying high risk neoplasia according to acetowhitening duration. The area under the curve (AUC) was 0.93 (0.89 - 0.97). Using a threshold of 142 seconds yielded a sensitivity for neoplasia of 98 % (95 % confidence interval [95 %CI] 89 % - 100 %) and specificity of 84 % (74 % - 91 %). The ROC curve for mucosal neoplasia (high grade dysplasia or intramucosal carcinoma) versus deep invasive cancer showed an AUC of 0.786 (0.61 - 0.96); a cutoff of 20 seconds yielded a sensitivity and specificity for invasive cancer of 67 % (35 % - 90 %) and 85 % (69 % - 95 %), respectively.

CONCLUSION

The time to disappearance of acetowhitening can serve as a simple but very sensitive tool for the diagnosis of high risk neoplasia in Barrett's esophagus. It can be used to distinguish mucosal neoplasia from deep invasive cancer.

High-definition vs. standard-definition colonoscopy in the characterization of small colonic polyps: results from a randomized trial

BACKGROUND AND STUDY AIMS

The resolution of endoscopes has increased in recent years. Modern Fujinon colonoscopes have a charge-coupled device (CCD) pixel density of 650,000 pixels compared with the 410,000 pixel CCD in standard-definition scopes. Acquiring high-definition scopes represents a significant capital investment and their clinical value remains uncertain. The aim of the current study was to investigate the impact of high-definition endoscopes on the in vivo histology prediction of colonic polyps.

PATIENTS AND METHODS

Colonoscopy procedures were performed using Fujinon colonoscopes and EPX-4400 processor. Procedures were randomized to be performed using either a standard-definition EC-530 colonoscope or high-definition EC-530 and EC-590 colonoscopes. Polyps of <10 mm were assessed using both white light imaging (WLI) and flexible spectral imaging color enhancement (FICE), and the predicted diagnosis was recorded. Polyps were removed and sent for histological analysis by a pathologist who was blinded to the endoscopic diagnosis. The predicted diagnosis was compared with the histology to calculate the accuracy, sensitivity, and specificity of in vivo assessment using either standard or high-definition scopes.

RESULTS

A total of 293 polyps of <10 mm were examined–150 polyps using the standard-definition colonoscope and 143 polyps using high-definition colonoscopes. There was no difference in sensitivity, specificity or accuracy between the two scopes when WLI was used (standard vs. high: accuracy 70% [95% CI 62–77] vs. 73% [95% CI 65–80]; P=0.61). When FICE was used, high-definition colonoscopes showed a sensitivity of 93% compared with 83% for standard-definition colonoscopes (P=0.048); specificity was 81% and 82%, respectively.

CONCLUSIONS

There was no difference between high- and standard-definition colonoscopes when white light was used, but FICE significantly improved the in vivo diagnosis of small polyps when high-definition scopes were used compared with standard definition.

Time trends in the prevalence of peanut allergy: three cohorts of children from the same geographical location in the UK

BACKGROUND

This article investigated the prevalence of peanut allergy in three cohorts of children born in the same geographical location, Isle of Wight, UK and seeks to determine whether the prevalence of peanut allergy has changed between 1994 and 2004.

METHODS

Three cohorts of children (age 3-4 years) born on the Isle of Wight, were assessed for peanut allergy and the outcomes compared: Cohort A: Born in 1989; reviewed at 4 years of age (n = 2181). Cohort B: Born between 1994 and 1996; reviewed between 3 and 4 years of age (n = 1273). Cohort C: Born between 2001 and 2002; reviewed at 3 years of age (n = 891).

RESULTS

Peanut sensitization increased significantly from 1.3% in Cohort A to 3.3% (P = 0.003) in Cohort B before falling back to 2.0% in Cohort C (P = 0.145). Similarly, clinical peanut allergy increased significantly from 0.5% in Cohort A to 1.4% (P = 0.023) in Cohort B, with a subsequent fall to 1.2% in Cohort C (P = 0.850).

CONCLUSIONS

Our data from three cohorts of 3- to 4-year-old children born in the same geographical area shows that peanut allergy prevalence has changed over time. Peanut sensitization and reported allergy in children born in 1994-1996 increased from 1989 but seems to have stabilized or slightly decreased since the late 1990s, although not significant.

Chemotherapy Induced Febrile Neutropenia of Docetaxel with Cyclophosphamide (TC) for Adjuvant Therapy of Breast Cancer in the Community – Reality Check

Following the publication of the paper utilising docetaxel and cyclophosphamide as adjuvant therapy for breast cancer Jones et al JCO 24:5381-5387/2006, we elected to use this program for low to intermediate risk breast cancer patients at the Carlo Fidani Cancer Centre in Mississauga Ontario. From January 2008 until June 2009 we have treated 86 patients. After treating our first 16 patients 6 had developed febrile neutropenia requiring admission to hospital. These patients were subsequently treated with either dose reduction or filgastrim/pegfilgastrim was added. For all 70 subsequently treated patients with this program, either dose reduction or primary prophylaxis with filgatrim or pegfilgastrim was used,prophylactic antibiotics were not used. In this cohort 2 patients required admission to hospital with infection and only 1 was neutropenic (2/70=3%). Details of all patients will be presented. The likelihood of this difference occurring from chance was small p&lt; .0005. (Fischer exact test) Within the paper the quoted febrile neutropenia rate was 5% for the TC group. In the first publication JCO 24:5381-5387, 2006 it is stated that neither prophylactic antibiotics nor growth factors were routinely used whereas in the second paper JCO 27:1177-1183,2009 it is stated that prophylactic quinoline antibiotics were recommended but not required. It is important in a landmark study like this one that details regarding anciliary treatments be detailed so that it may be used safely in the community. Our rate of febrile neutropenia without filgastrim/pegfilgastrim was 6/16=37.5%. The causes of the differences between our rate of fne and that seen in the paper will be discusseed. In addition the differences we saw in the fne rate when either filgastrim/pegfilgatrim were added were markedly improved. In conclusion the TC program given a fne rate &gt; 30 % would mandate the usage of filgastrim or pegfilgastrim for primary prophylaxis. The addition of figastrim/pegfilgastrim markedly reduced our fne rate.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2092.

Coagulation factors in the airways in moderate and severe asthma and the effect of inhaled steroids

BACKGROUND

There is evidence of activation of the extrinsic coagulation cascade in the asthmatic airway, and both plasma and locally derived factors may be involved. The hypothesis that the normal haemostatic balance of healthy airways sampled by sputum induction favours fibrin formation in asthmatic airways, and that inhaled corticosteroids (ICS) and plasma exudation influence this balance, was tested.

METHODS

ELISA and activity assays were used to measure alpha(2)-macroglobulin (an index of plasma leakage) and coagulation factors in hypertonic saline-induced sputum of 30 stable subjects (10 controls, 10 with moderate asthma and 10 with severe asthma). Additionally, the moderate cohort were weaned off their ICS, followed by further sputum induction 5 days after cessation of steroids.

RESULTS

ICS wean induced a significant rise in plasminogen (median (interquartile range (IQR)): 13.92 (6.12-16.17) vs 4.82 (2.14-13.32) ng/ml; 95% CI 0.003 to 8.596, p = 0.0499) and tissue plasminogen activator (tPA; 5.57 (3.57-14.35) vs 3.88 (1.74-4.05) ng/ml; 95% CI 0.828 to 9.972, p = 0.0261) levels in sputum, such that tPA in untreated moderate asthma was significantly (p = 0.0029) higher than normal (2.14 (0.0-2.53) ng/ml). Subjects with severe asthma had significantly more alpha(2)-macroglobulin (p = 0.0003), tissue factor (p = 0.023), plasminogen activator inhibitor (p = 0.0091), thrombin-activatable fibrinolysis inhibitor (p = 0.0031) and fibrin degradation products (p = 0.0293) in their sputum than control subjects.

CONCLUSION

Untreated moderate asthma is associated with increased fibrinolysis that is corrected by ICS. Severe asthma and high dose corticosteroid therapy is associated with a profibrinogenic, antifibrinolytic environment in the airways. This study suggests that inhibition of fibrin deposition in severe asthma may be a therapeutic approach.

Models for the prediction of successful induction of labor based on pre-induction sonographic measurement of cervical length

OBJECTIVE

To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.

METHODS

In 822 singleton pregnancies, induction of labor was carried out at 35 to 42(+6) weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24 hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24 hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.

RESULTS

Successful vaginal delivery within 24 hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportional hazard model indicated that significant prediction of the induction-to-delivery interval was provided by the pre-induction cervical length (HR=0.89, 95% CI 0.88-0.90, p<0.0001), parity (HR=2.39, 95% CI 1.98-2.88, p<0.0001), gestational age (HR=1.13, 95% CI 1.07-1.2, p=or<0.0001) and birth weight percentile (HR=0.995, 95% CI 0.99-0.995, p=0.001), but not by maternal age or BMI. Logistic regression analysis indicated that significant prediction of the likelihood of vaginal delivery within 24 hours was provided by pre-induction cervical length (OR=0.86, 95% CI 0.84-0.88, p<0.0001), parity (OR=3.59, 95% CI 2.47-5.22, p<0.0001) and gestational age (OR=1.19, 95% CI 1.07-1.32, p=or<0.0001) but not by BMI or maternal age. The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length (OR=1.09, 95% CI 1.06-1.11, p<0.0001), parity (OR=0.25, 95% CI 0.17-0.38, p<0.0001), BMI (OR=1.85, 95% CI 1.24-2.74, p=0.0024), gestational age (OR=0.88, 95% CI 0.78-0.98, p=0.0215) and maternal age (OR=1.04, 95% CI 1.01-1.07, p=0.0192). The risk of cesarean section for failure to progress was also significantly associated with pre-induction cervical length (OR=1.11, 95% CI 1.07-1.14, p<0.0001), parity (OR=0.26, 95% CI 0.15-0.43, p<0.0001), gestational age (OR=0.83, 95% CI 0.73-0.96, p=0.0097) and BMI (OR=2.07, 95% CI 1.27-3.37, p=0.0036).

CONCLUSION

In women undergoing induction of labor, pre-induction cervical length, parity, gestational age at induction, maternal age and BMI have a significant effect on the interval between induction and delivery within 24 hours, likelihood of vaginal delivery within 24 hours and the risk of cesarean section.

In vivo activity of R1530 (R) alone and in combination with bevacizumab (B) and peginterferon alfa-2a (P) in a renal cell carcinoma (RCC) xenograft model

e14629

Background: R1530 is a multikinase inhibitor currently in clinical phase I testing. Its inhibitory profile includes several kinases that play critical roles in cancer cell growth and division as well as tumor angiogenesis. These properties translate into a potent cytotoxicity in a wide range of cancer cell lines in vitro and tumor growth inhibition in human tumor xenografts. Preclinical studies were conducted to evaluate the effects of R alone and in combination with B and P in the Caki-1 RCC xenograft model. Methods: We initially evaluated the antitumor activity of optimal dose (OD) and 1/2 OD R alone and with OD B. This was followed up with testing of OD & 1/2 OD P ± OD B, along with triplets of 1/2 OD P + OD B + 1/2 OD R and OD P + OD B + 1/2 OD R. A final study compared 1/2 OD R to OD R triplets to attempt to increase tumor growth inhibition (TGI) and increase life span (ILS). Results: No doublets or triplets tested showed antagonism or enhanced toxicity. Antitumor activity and survival results are listed below (Table). Conclusions: 1/2 OD R + OD B or OD R + OD B doublets gave better TGI and ILS than monotherapy. Comparing these two doublets, TGI is better in the high dose combination but ILS is equivalent. All TGI and ILS are better in doublet P + B combinations over respective single agent arms except for TGI (but not ILS) for 1/2 OD P vs its correlative doublet with B. The OD P + B doublet gave better TGI and ILS than 1/2 OD P + B doublet. TGI and ILS do not differ between triplets containing OD R + 1/2 OD or OD P or for triplets containing the OD P + 1/2 OD or OD R. Therefore, either agent can be alternatively dose reduced without a loss of tumor response or detriment to survival in this preclinical model of RCC. [Table: see text]

[Table: see text]

In vivo activity of R1530 (R) alone and in combination with docetaxel (D) and bevacizumab (B) in a prostate carcinoma (PCa) xenograft model

e16124

Background: R is a multikinase inhibitor currently in phase I clinical testing. Its inhibitory profile includes several kinases that play critical roles in cancer cell growth and division leading to disruption at M-phase and antiangiogenic effects. Studies were conducted to evaluate the efficacy and tolerability of R alone and in combination with D and B in the 22rv1 androgen independent PCa model. Methods: Initially TGI of optimal dose (OD) R, D and B were evaluated. Then the TGI and increased life span (ILS) of the minimum efficacious dose (MED) and 2/3 OD R ± 2/3 OD D was tested. A final study compared doublets of 2/3 OD R + 2/3 OD D, 2/3 OD D + OD B, 2/3 OD R + OD B, and triplet of 2/3 OD D + 2/3 OD R+ 2/3 OD B. Results: All treatment groups were tolerated and there was no antagonism. TGI and ILS results are listed below ( Table ). Conclusions: The OD of R B and D showed monotherapy TGI in this model. MED R + 2/3 OD D gave ILS statistically better (sb) than singlets but TGI was sb than MED R but not the D singlet. 2/3 OD R + 2/3 OD D produced sb TGI and ILS than each singlet. TGI and ILS with 2/3 OD R is sb than 2/3 OD D. TGI and ILS of 2/3 OD R + 2/3 OD D was sb than the 2/3 OD D + OD B but not the 2/3 OD R + B doublet. TGI and ILS was sb for 2/3 OD R + OD B versus 2/3 OD D + OD B. The TGI of the triplet was equivalent to the 2/3 OD R + 2/3 OD D doublet, but ILS was sb in the triplet. Also, the TGI and ILS was sb for triplet versus 2/3 OD D + OD B. TGI and ILS of the triplet was equal to 2/3 OD R + OD B. In general, the results demonstrate that the shared mechanism of mitotic disruption by R and D do not render antagonism, but in fact, allow for potentiated TGI and ILS. Also of note is the equally superior TGI and ILS provided by R + B and R + B + D. In general, the preclinical results generated support clinical testing of these agents in PCa. * p value for all. [Table: see text]

[Table: see text]

Characterization of 155 EST-derived microsatellites from Atlantic cod (Gadus morhua) and validation for linkage mapping

Microsatellite markers for Atlantic cod (Gadus morhua) were identified from a collection of 30 630 expressed sequence tags. Primers were designed for 395 microsatellites and 155 were successfully amplified. Allele number varied from 1 to 26 (average 6.34). Average observed and expected heterozygosities were 0.50 and 0.54, respectively. A subset of 105 microsatellites tested for Mendelian segregation showed no significant distortion of segregation when correcting for multiple tests. Null alleles were detected at four loci. Significant blastx matches were found for 23 loci. These microsatellites will be used to create a linkage map to enhance genetic selection in commercial cod breeding.

Prevalence and cumulative incidence of food hypersensitivity in the first 3 years of life

BACKGROUND

Prevalence and incidence of food hypersensitivity (FHS) and its trends in early childhood are unclear.

METHODS

A birth cohort born on the Isle of Wight (UK) between 2001 and 2002 was followed-up prospectively. Children were clinically examined and skin prick tested at set times and invited for food challenges when indicated.

RESULTS

Nine hundred and sixty-nine children were recruited and 92.9%, 88.5% and 91.9% of them respectively were assessed at 1, 2 and 3 years of age. Prevalence of sensitization to foods was 2.2%, 3.8% and 4.5% respectively at these ages. Cumulatively, 5.3% [95% confidence interval (CI): 3.9-7.1] children were sensitized to a food. Using open food challenge and a good clinical history, the cumulative incidence of FHS was 6.0% (58/969, 95% CI: 4.6-7.7). Based on double-blinded, placebo-controlled, food challenge (DBPCFC) and a good clinical history, the cumulative incidence was 5.0% (48/969, 95% CI: 3.7-6.5). There is no evidence to suggest that the incidence of FHS has increased, comparing these results with previous studies. Overall, 33.7% of parents reported a food-related problem and of these, 16.1% were diagnosed with FHS by open challenge and history and 12.9% by DBPCFC and history. Main foods implicated were milk, egg and peanut.

CONCLUSIONS

By the age of 3 years, 5-6% of children suffer from FHS based on food challenges and a good clinical history. There were large discrepancies between reported and diagnosed FHS. Comparing our data with a study performed in the USA more than 20 years ago, there were no significant differences in the cumulative incidence of FHS.

Comparison of open and double-blind placebo-controlled food challenges in diagnosis of food hypersensitivity amongst children

BACKGROUND

Correct diagnosis of food hypersensitivity (FHS) is important to ensure appropriate patient care and to accurately establish the population prevalence and incidence. Food challenges play a very important role in the diagnosis of FHS, but it is unclear when open food challenges (OFCs) opposed to double-blind placebo-controlled food challenges (DBPCFCs) should be used. This study investigated the use of OFCs and DBPCFCs when diagnosing FHS.

METHODS

Children with a reported history of FHS or with sensitization to a food without known previous consumption were invited to undergo food challenges. Children of consenting parents underwent an OFC and those with a positive OFC were approached to undergo a DBPCFC. Food challenges were either performed as 1-day or 1-week challenges depending on sensitization status and clinical history.

RESULTS

Forty-one children underwent both OFCs and DBPCFCs. The positive predictive values for 1-day and 1-week OFCs were 73% (8/11; 95% CI: 39-94%) and 57% (20/35; 95% CI: 39-74%) respectively. There was no evidence to indicate that the younger children were more likely to have a positive OFC confirmed by a DBPCFC compared to older children (Fisher's exact P = 0.53). In the 1-day challenges parents indicated a preference for OFC rather than DBPCFC. By contrast, in the 1-week challenge parents indicated a preference for DBPCFC (P = 0.0192).

CONCLUSION

Open food challenge may be suitable for diagnosing immediate objective symptoms, whereas DBPCFC may be needed for the diagnosis of delayed and mainly subjective symptoms, irrespective of the child's age.

Metal ion levels after metal-on-metal Ring total hip replacement: a 30-year follow-up study

Metal-on-metal bearings for total hip replacement (THR) are becoming increasingly popular. Improved wear characteristics mean that these articulations are being inserted into younger patients in the form of THR and resurfacing procedures. This has led to concerns regarding potential carcinogenicity because of the increased exposure to metal ions that the procedure brings. We have studied the serum cobalt and chromium concentrations in patients who had primary, well-fixed Ring metal-on-metal THRs for more than 30 years. The levels of cobalt and chromium were elevated by five and three times, respectively compared with those in our reference groups. Metal-on-metal articulations appear to be the source of metal ions throughout the life of the prosthesis. In three patients who had undergone revision of a previous metal-on-metal THR to a metal-on-polyethylene replacement the levels of metal ions were within the normal range. The elevations of cobalt and chromium ions seen in our study were comparable with those in patients with modern metal-on-metal THRs.

Preclinical activity of combinations of capecitabine (C), docetaxel (D), and trastuzumab (T) in a breast cancer xenograft model

13508

Background: C is highly active, well tolerated, and extends survival when added to D in pretreated metastatic BC. We report preclinical data on CD doublets ± T, a humanized monoclonal antibody against HER2-neu, in the KPL-4 human BC xenograft model (ER-, HER2+). Methods: Initially, the antitumor activity of optimal dose (OD) and ½ OD C and D monotherapy was evaluated alongside ½ OD C + ½ OD D or ½ OD C + OD D. Data showed ½ OD C + OD D was toxic; thus, OD C + OD D was not considered further. The OD C + ½ OD D doublet and the optimal doublet from the initial study (½ OD C + ½ OD D) were tested ± T in this HER2+ model. Results: In the initial study, tumor response (TR) and increased life span (ILS) were significantly better for ½ OD C + ½ OD D than for ½ OD C, OD C, ½ OD D, or OD D. In the follow-up study, TR and ILS were not significantly different in the ½ OD C + ½ OD D and OD C + ½ OD D doublets but were better with the addition of T to each doublet. In comparing triplicates, TR was not statistically different, and survival was equivalent at this point because of complete responses (CRs) in both groups. At day 127, there were 2/10 CRs in the ½ OD C + ½ OD D + T group (ILS=267%) vs 6/10 CRs in the OD C + ½ OD D + T group (ILS>370%, ongoing). Conclusions: Adding T to the non-toxic CD doublets increases TR and ILS. Thus far, results argue for the most dense dose of C in triplicate combinations for sustaining CRs. However, since CRs are present in both triplicate groups of limited sample size (n=10), an overall survival difference is not yet significant. The data support clinical testing of CD doublets with or without T, which is ongoing in the neoadjuvant setting in HER2- and HER2+ BC patients, respectively.

[Table: see text]

No significant financial relationships to disclose.

Preclinical testing of a novel regimen of capecitabine (C) in combination with bevacizumab (B) and trastuzumab (T) in a breast cancer xenograft model

1049

Background: Mathematical methods applied to xenograft breast cancer models have determined that the maximum impact of C therapy occurs after ∼7 days (7d) of treatment (Norton AACR 2005). The model predicts that doses of C beyond 7d will contribute to toxicity without additional antitumor benefit. The tolerability and anti-tumor activity of C 7d on/7d off (7/7) in female nude mice bearing KPL-4 breast cancer xenografts has been established (SABCS 2006). We now report preclinical models of C7/7 with targeted therapies. Methods: We evaluated the tumor growth inhibition (TGI%) and increase in life span (ILS%) of C7/7 and B with or without T in female nude mice bearing KPL-4, HER2+ breast cancer xenografts. C at maximum tolerated dose (MTD) and ½MTD were tested in combination with conventional doses of the antibodies. Results: C7/7 at MTD is well tolerated in combination with conventional dose B + T. No toxicity was observed at any dose level. The addition of B ± T to C7/7 monotherapy significantly improves TGI%. Survival is significantly prolonged for the combination of C7/7 MTD with B ± T. Comparative results for C7/7 at MTD and ½ MTD are shown in the Table . Additional comparative data will be shown at the meeting. Assessment of ILS% is ongoing for the triplet C7/7 + B + T but has exceeded 463% and >152 days. Conclusions: The improvement in response and survival shown here supports the study of combination C7/7 with B and T. Combinations with B and anti-HER2 therapy will be tested in the clinical, Phase II program at MSKCC.

[Table: see text]

[Table: see text]

Mechanisms of local immunosuppression in cutaneous melanoma

Cutaneous melanoma is highly immunogenic, yet primary melanomas and metastases develop successfully in otherwise immunocompetent patients. To investigate the local immunosuppressive microenvironment, we examined the presence of suppressor T lymphocytes and tolerising dendritic cells (DCs), the expression of immunosuppressive cytokines (IL-10, TGFβ1 and TGFβ2) and the enzyme indoleamine 2,3-dioxygenase (IDO) using qRT–PCR and immunohistochemistry in primary skin melanomas, negative and positive sentinel lymph nodes (SLN), and lymph nodes with advanced metastases. Our results indicate that tolerogenic DCs and suppressor T lymphocytes are present in melanoma at all stages of disease progression. They express transforming growth factor β receptor 1 (TGFβR1), and are therefore susceptible to TGFβ1 and TGFβ2 specifically expressed by primary melanoma. We found that expression of IDO and interleukin 10 (IL-10) increased with melanoma progression, with the highest concentration in positive SLN. We suggest that negative SLN contain immunosuppressive cells and cytokines, due to preconditioning by tolerogenic DCs migrating from the primary melanoma site to the SLN. In primary melanoma, TGFβ2 is likely to render peripheral DCs tolerogenic, while in lymph nodes IDO and TGFβ1 may have a major effect. This mechanism of tumour-associated immunosuppression may inhibit the immune response to the tumour and may explain the discrepancy between the induction of systemic immunity by anti-melanoma vaccines and their poor performance in the clinic.

Government advice on peanut avoidance during pregnancy--is it followed correctly and what is the impact on sensitization?

BACKGROUND

In 1998, the UK government issued precautionary advice that pregnant or breast-feeding women with a family history of atopy, may wish to avoid eating peanuts during pregnancy and lactation. This study aimed to assess the compliance with this recommendation and investigate its impact upon peanut sensitization.

METHODS

A total of 858 children born immediately after the advice were followed for 2 years and assessed for peanut sensitization. A standardized questionnaire was used to ascertain history of atopy and maternal exposure to peanuts during pregnancy. Following parental consent children were skin prick tested to assess sensitization to peanuts.

RESULTS

Sixty-five per cent of mothers had avoided peanuts during pregnancy. Forty-two per cent of the mothers had heard about the government advice, and half modified their diet as a consequence. Neither maternal nor family history of atopy had any significant effect on peanut consumption. Parity did play a role, and mothers having their first child were twice as likely to change their diet (P<0.001). Mothers of 77% of the children sensitized to peanuts had avoided peanuts during pregnancy. In this cohort study maternal consumption of peanut during pregnancy was not associated with peanut sensitization in the infant.

CONCLUSIONS

The majority of mothers in this cohort avoided peanut consumption during pregnancy. It is likely that either the government advice is misunderstood by mothers, or that those who communicate the advice have not fully explained who it is targeted at.

Randomized, double-blind comparison of patient-controlled epidural infusion vs nurse-administered epidural infusion for postoperative analgesia in patients undergoing colonic resection

BACKGROUND

There is little published evidence of the analgesic efficacy of patient-controlled epidural analgesia (PCEA) for postoperative pain relief. The aim of this study was to compare the analgesic efficacy of epidural infusion of bupivacaine 0.125% and fentanyl 4 microg ml(-1) administered by either PCEA with a background infusion or nurse-administered continuous epidural infusion (CEI) after major intra-abdominal surgery.

METHODS

In a double-blind, randomized clinical trial, 205 adult patients undergoing colonic resection by laparotomy received either PCEA or CEI. Pain scores were recorded via a four-point verbal rating scale at 1, 2, 3, 4, 8, 12, 24, 48, and 72 h after surgery. The administration of epidural top-ups and systemic analgesia over the same period was also recorded, and patient satisfaction questionnaires completed.

RESULTS

The median area under the curve of pain against time was significantly lower in the PCEA group (2 vs 24, P<0.001) as were median summary pain scores on movement (0.67 vs 1.33, P<0.001). Significantly fewer patients in the PCEA group received one or more epidural top-ups (13 vs 36%, P = 0.0002) or any systemic analgesics (41 vs 63%, P = 0.0021). Patients in the PCEA group were significantly more likely to be very satisfied than in the CEI group (76 vs 43%, P<0.0001).

CONCLUSIONS

PCEA provides greater analgesic efficacy than CEI for postoperative analgesia after major intra-abdominal surgery, and a decreased requirement for physician or nurse intervention.

Eicosapentaenoic acid (EPA, an omega-3 fatty acid from fish oils) for the treatment of cancer cachexia

BACKGROUND

Cancer cachexia is a distressing weight loss syndrome commonly seen in advanced cancer patients. It is associated with reduced quality of life and shorter survival time. Eicosapentaenoic acid (EPA) is a long chain polyunsaturated fatty acid found naturally in some fish which has been used to decrease weight loss, promote weight gain and increase survival times in patients affected with cancer cachexia.

OBJECTIVES

To evaluate the effectiveness and safety of EPA in relieving symptoms associated with the cachexia syndrome in patients with advanced cancer.

SEARCH STRATEGY

Studies were sought through an extensive search of a range of electronic databases. Hand searching was conducted on selected journals and reference lists as well as contact made with investigators, manufacturers and experts. The most recent electronic search was conducted in February 2005.

SELECTION CRITERIA

Studies were included in the review if they assessed oral EPA compared with placebo or control in randomised controlled trials of patients with advanced cancer and either a clinical diagnosis of cachexia or self-reported weight loss of 5% or more.

DATA COLLECTION AND ANALYSIS

Both methodological quality evaluation of potential trials and data extraction were conducted by two independent review authors.

MAIN RESULTS

Five trials (involving 587 patients) met the inclusion criteria. Three trials compared EPA at different doses with placebo with two outcomes, nutritional status and adverse events comparable across two of the three included trials. In addition, two trials compared different doses of EPA with an active matched control. It was possible to compare the outcomes of weight, quality of life and adverse events across these two trials. There were insufficient data to define the optimal dose of EPA.

AUTHORS' CONCLUSIONS

There were insufficient data to establish whether oral EPA was better than placebo. Comparisons of EPA combined with a protein energy supplementation versus a protein energy supplementation (without EPA) in the presence of an appetite stimulant (Megestrol Acetate) provided no evidence that EPA improves symptoms associated with the cachexia syndrome often seen in patients with advanced cancer.

Reliability and validity of a maternal food frequency questionnaire designed to estimate consumption of common food allergens

BACKGROUND

Maternal food intake during pregnancy may influence the development of food hypersensitivity (FHS) in the child. A food frequency questionnaire estimating the frequency with which some of the mains food allergens are consumed was designed and validated.

MATERIALS AND METHODS

Pregnant women were recruited at the ante-natal clinic of St. Mary's Hospital, Isle of Wight, UK. A food frequency questionnaire was developed and validated by comparing responses to information recorded in 7 days food diaries. The reliability of the food frequency questionnaire was evaluated by asking women to complete the questionnaire on two separate occasions at 30 and 36 weeks gestation.

RESULTS

Fifty-seven women completed the validity study and 91 women completed the reliability study. For both validity and reliability, questions with dichotomous response categories showed the highest level of agreement. Frequency of intake of foods commonly "hidden" in foods produced the lowest validity and reliability scores. In the validity study responses to the food frequency questionnaire identically matched information recorded in the food diaries 80% of the time, on average. In the reliability study, responses were identical on both questionnaires 85% of the time on average.

CONCLUSION

In this study a food frequency questionnaire estimating the frequency with which some of the main food allergens are consumed during pregnancy was designed and validated. This food frequency questionnaire could be used in future studies to assess the role of maternal food intake in the development of FHS in the infant.

Inhaled heparin in cystic fibrosis

Cystic fibrosis (CF) is characterised by inspissated airway secretions and chronic endobronchial infection associated with exuberant neutrophilic inflammation. Unfractionated heparin may be mucolytic and has demonstrated a number of anti-inflammatory properties; however, further safety data are needed in these subjects who are at risk of airway bleeding. The current study aimed to assess the medium-term safety and tolerability of moderately high-dose inhaled heparin in CF adults and to explore possible in vivo mucolytic and anti-inflammatory outcomes. A randomised, double-blind, placebo-controlled crossover study of twice daily inhalation of 50,000 IU of heparin for 2 weeks was undertaken in CF adults, with a 1-week washout period. Eighteen subjects were randomised and 14 (mean+/-sd age 23+/-7.8 yrs and percentage-predicted forced expiratory volume in one second 52.1+/-15.56%) completed the study protocol. Heparin neither affected blood coagulation parameters nor resulted in any increase in adverse events. Heparin inhalation had no significant effect upon forced expiratory volume in one second, symptoms of sputum clearance or sputum inflammatory markers. The current pilot study demonstrated no evidence of improved sputum clearance with 50,000 IU of inhaled heparin given twice daily to adult cystic fibrosis subjects. However, inhaled heparin was safe and the future evaluation of larger doses over a longer period may be warranted.

The effects of smoking on labour after uncomplicated pregnancy: a comparison between the progress and outcome of labour in 400 smokers and 400 matched non-smokers

A comparison was made between the progress of labour and its outcome after an uncomplicated pregnancy, in 400 smokers and 400 non-smokers. Strict selection criteria were applied to eliminate, as far as possible, the variables which might have influenced labour in both groups and to ensure that the two groups of women were matched. The duration of labour was longer in smokers, who also had a higher incidence of caesarean sections. Smokers had a higher incidence of retained placenta and postpartum haemorrhage. The neonates of smokers had a higher incidence of problems in the immediate post-delivery period.

Educational psychology in medical learning: a randomised controlled trial of two aide memoires for the recall of causes of electromechanical dissociation

OBJECTIVES

Although mnemonics are commonly used in medical education there are few data on their effectiveness. A RCT was undertaken to test the hypothesis that a new aide memoire, "EMD-aide", would be superior to the conventional "4Hs+4Ts" mnemonic in facilitating recall of causes of electromechanical dissociation (EMD) among house officers.

METHOD

"EMD-aide", organises causes of EMD by frequency of occurrence and ease of reversibility: four groups organised by shape, colour, position, numbering, clockwise sequence, and use of arrows. Eight hospitals were randomised in a controlled trial and 149 house officers were then recruited by telephone. Baseline ability to recall causes of EMD was recorded at one minute and overall. House officers were then sent a copy of either "4Hs+4Ts" or "EMD-aide" according to randomisation group. Recall ability was retested at one month.

RESULTS

68 of 80 and 51 of 69 house officers completed the study in the "4Hs+4Ts" and "EMD-aide" groups respectively (NS) with similar baseline recall. After intervention median number of recalled causes was greater in the "EMD-aide" group, eight compared with seven at one minute (p = 0.034) and eight compared with seven overall, p = 0.067. Recall of all eight causes was more common in "EMD-aide" group, 54% compared with 35%, p = 0.054, and these house officers spent longer examining their aide memoire, p<0.001.

CONCLUSIONS

"EMD-aide" may be superior to "4Hs+4Ts" in facilitating the recall of the causes of electromechanical dissociation. Educational psychology of medical learning and the use of aide memoires in general are worthy of further study.

The value of ultrasound in the prediction of successful induction of labor

OBJECTIVES

To examine the value of pre-induction sonographic assessment of cervical length, posterior cervical angle and occipital position in the prediction of the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h, the likelihood of Cesarean section and to compare sonographic assessment with the Bishop score.

METHODS

In 604 singleton pregnancies, induction of labor was carried out at 35-42 weeks of gestation. Immediately before induction, transvaginal sonography was performed for measurement of cervical length and posterior cervical angle and a transabdominal scan was carried out to determine the position of the fetal occiput. The value of occipital position, posterior cervical angle, cervical length, parity, gestational age, maternal age, and body mass index (BMI) on the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h and the likelihood of Cesarean section were investigated by Cox proportional hazard model or logistic regression analysis.

RESULTS

Vaginal delivery occurred in 484 (80.1%) women and this was within 24 h of induction in 388 (64.2%). Cesarean section was performed in 120 (19.9%). Occiput-anterior (OA) and transverse (OT) positions were analyzed as one group as the odds ratios (OR) and the HR were similar and different from occiput-posterior (OP), which was analyzed as another group. Prediction of the induction-to-delivery interval was provided by the occipital position, pre-induction cervical length, parity and posterior cervical angle. Prediction of the likelihood of vaginal delivery within 24 h was provided by the occipital position, cervical length, posterior cervical angle and BMI. Prediction of the likelihood of Cesarean section was provided by the occipital position, cervical length, parity, maternal age and BMI. In the prediction of vaginal delivery within 24 h, for a specificity of 75%, the sensitivity for ultrasound findings was 89% and for the Bishop score it was 65%. The respective sensitivities for Cesarean section were 78% and 53%.

CONCLUSION

In women undergoing induction of labor, significant independent prediction of the induction-to-delivery interval within 24 h, the likelihood of vaginal delivery within 24 h and the likelihood of Cesarean section are provided by pre-induction cervical length, occipital position, posterior cervical angle and maternal characteristics. Sonographic parameters were superior to the Bishop score in the prediction of the outcome of induction.