The assessment of tumor-infiltrating lymphocytes in invasive apocrine carcinoma of the breast in relation to the HER2 status

In the current study, we assessed the prevalence and molecular features of HER2-low phenotype in the apocrine carcinomas of the breast (ApoCa) and its relationship with tumor-infiltrating lymphocytes (TILs). A cohort of 64 well-characterized therapy-naïve ApoCa was used. The TIL distribution was assessed using the hematoxylin and eosin whole slide/scanned images following the international TILs working group recommendations. Next-generation sequencing (NGS) was performed in a subset of HER2-low ApoCa. All patients were women, with a mean age of 62 years. Forty-three carcinomas were pure apocrine carcinoma (PAC; ER-/AR+), and the remaining 21 were classified as apocrine-like carcinomas (ALCs; ER+/-, AR+/-). HER2/neu was positive (score 3+ by IHC and/or amplified by FISH) in 20/43 (47%) PAC and 4/21 (19%) ALC. The prevalence of HER2-low expression (scores 1+ or 2+ without HER2 amplification) in ApoCa was 39% without significant differences between PAC and ALC (P = 0.14); however, the HER2-low phenotype was more prevalent in triple-negative PAC than in ALC (P < 0.001). Levels of TILs were low (≤10%) in 74% of ApoCa (median 5%, range 0%-50%). TIL levels were significantly higher in ALC than in PAC (P = 0.02). HER2 status had no impact on TIL distribution (P = 0.45). The genomic profile of HER2-low ApoCa was similar to other subtypes of ApoCa. ApoCa has predominantly low TIL, particularly PAC. The prevalence of the HER2-low phenotype in ApoCa is high, which should have therapeutic and clinical implications given the recently approved therapies with antibody-drug conjugates (ADCs) for HER2-low breast cancers.

Dietary Supplementation Before, During and After Pregnancy: Results of the Cluster-Randomized GeliS Study

Introduction The nutritional status of women before, during, and after pregnancy plays an important role in the health of mother and child. In addition to a balanced mixed diet, the increased need for folic acid and iodine should be met and ensured with supplements. The aim of this study was to assess dietary supplementation in the context of pregnancy and to investigate the effect of targeted counselling on supplementation behavior during and after pregnancy.

Methods In the context of the “Gesund leben in der Schwangerschaft” (GeliS; “Healthy living in pregnancy”) trial, women in the intervention group (IG) received four structured lifestyle counselling sessions during pregnancy as well as postpartum, during which they were informed about appropriate dietary supplementation. The women in the control group (CG) received routine prenatal care. The intake of dietary supplements was recorded at different points using a questionnaire.

Results In total, 2099 women were included in the analysis. Prior to conception, 31.3% of the women in the IG and 31.4% of the women in the CG took folic acid supplements. Prenatally, about half of the women took folic acid (IG: 54.1%; CG: 52.0%) and iodine (IG: 50.2%; CG: 48.2%). Statistically significant differences between the groups with regard to supplementation behavior could not be observed, neither prior to inclusion in the study nor during the intervention. During pregnancy, 23.0% of all women took docosahexaenoic acid (DHA) supplements and 21.8% iron supplements. 49.4% of the women additionally took vitamin D supplements. A higher educational level (p < 0.001), advanced age (p < 0.001), primiparity (p < 0.001), and a vegetarian diet (p = 0.037) were all associated with a higher level of dietary supplementation.

Conclusion The GeliS lifestyle counselling did not significantly improve the supplementation behavior of women during and after pregnancy. Women should be informed about adequate dietary supplementation early on within the scope of gynecological prenatal care.

Programmed cell death 1 (PD-1) and its ligand (PD-L1) in common cancers and their correlation with molecular cancer type

Cancer cells expressing PD-1 ligands (PD-L1/PD-L2) inhibit immune-modulatory T-cell activation facilitating disease progression. Preliminary clinical trials exploring interruption of PD-1/PD-L1 signaling showed benefit in several cancer types. We analyzed the distribution of PD-1-positive tumor-infiltrating lymphocytes (TIL) and cancer cells' expression of PD-L1 in a molecularly profiled cohort of 437 malignancies (380 carcinomas, 33 sarcomas, and 24 melanomas). We showed that the presence of PD-1(+) TILs significantly varied among cancer types (from 0% in extraskeletal myxoid chondrosarcomas to 93% in ovarian cancer), and was generally associated with the increased number of mutations in tumor cells (P = 0.029). Cancer cell expression of PD-L1 varied from absent (in Merkel cell carcinomas) to 100% (in chondro- and liposarcomas), but showed the inverse association with the number of detected mutations (P = 0.004). Both PD-1 and PD-L1 expression were significantly higher in triple-negative breast cancers (TNBC) than in non-TNBC (P < 0.001 and 0.017, respectively). Similarly, MSI-H colon cancers had higher PD-1 and PD-L1 expression than the microsatellite stable tumors (P = 0.002 and 0.02, respectively). TP53-mutated breast cancers had significantly higher PD-1 positivity than those harboring other driver mutations (e.g., PIK3CA; P = 0.002). In non-small cell lung cancer, PD-1/PD-L1 coexpression was identified in 8 cases (19%), which lacked any other targetable alterations (e.g., EGFR, ALK, or ROS1). Our study demonstrated the utility of exploring the expression of two potentially targetable immune checkpoint proteins (PD-1/PD-L1) in a substantial proportion of solid tumors, including some aggressive subtypes that lack other targeted treatment modalities.

Differences in biomarker expression in HNSCC according to p53 status

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Background: Patients with p53 wildtype head and neck squamous cell carcinoma (HNSCC) tend to be HPV-positive, which associates with better prognosis. The purpose of this study was to explore biomarker expression profiles for insight into molecular differences in HNSCC patients based on p53 status. Methods: TP53 gene sequencing using the AmpliChip p53 microarray (Roche Molecular Systems, Inc.) was attempted on 61 HNSCC patients previously tested with Caris Target Now tumor profiling service. DNA was extracted from a FFPE sample, amplified and processed on the AmpliChip p53 microarray to detect single base pair substitution and deletion mutations in exons 2 - 11 and their flanking splice sites in the TP53 gene (GenBank X54156). EGFR FISH , HER2 IHC and 22 other predictive biomarkers, e.g. TS, TOPO2A, MGMT, etc., were assayed and retrospectively analyzed. All tests were performed in a CLIA-certified lab and interpreted by board-certified pathologists or cytogeneticists. Statistical analysis was performed using SPSS (PASW statistics17) for parametric and non-parametric tests of independence. Results: 52 cases provided sufficient quality DNA for p53 analysis and results revealed a mutation rate of 25% in HNSCC patients. Interestingly, only EGFR FISH and HER2 IHC (p=.002 and p=.004, respectively) were differentially expressed in wildtype vs. mutated p53. Matched-pair analysis in the p53 mutated subgroup (n=13) showed no significant trend regarding EGFR status (p=.763) but a slight trend towards HER-2 negativity (p=.020). In the p53 wildtype subgroup (n=39), a strong association with EGFR FISH non-amplification (n=28, 71.8%, p<.001) as well as HER-2 negativity (n=38, 97.4%, p<.001) was shown. Conclusions: To our knowledge, this is the first analysis of differential biomarker expression profiles in HNSCC based on p53 status. We hypothesize that the absence of EGFR amplification in the p53 wildtype cancers may be a contributing factor to the improved prognosis observed in HPV-positive HNSCC. Additionally, the strong association between p53 wildtype HNSCC patients and EGFR non-amplification suggests EGFR-targeted therapies like cetuximab would likely fail in p53 wildtype patients.

Ubiquitin at Fox Chase

My interest in protein breakdown as a research problem began in 1955. In 1963, when we relocated from Yale to the Institute for Cancer Research of Fox Chase, Philadelphia, nothing new was being reported. Here, I review how we get the ubiquitin proteasome system all together.

Ergebnisse aus dem Gesundheitsprogramm Hypertonie der Deutschen Krankenversicherung (DKV)

BACKGROUND AND OBJECTIVE

In 2003 the German Health Insurance (DKV: Deutsche Krankenversicherung) initiated a "Health Program Hypertension" for its insured persons with the aim of motivating patients to adopt the accepted general measures for blood pressure reduction and to self-monitor their blood pressure.

PATIENTS AND METHODS

Participation in the program was voluntary and without charge. The interventional measures included regular contact by phone with trained medical personnel, personal consultations targeting general measures and self measurement of blood pressure. Each patient was given training material and a blood pressure monitor, and a risk profile was made for each patient. Regular reports were given to the patients and their physicians.

RESULTS

The data of the first 1373 hypertensives who have been in the continuing program were analysed. The patients" average age was 61+/-9.9 years, 81% males. 94% of the participants reported taking antihypertensive medication. Initially 615 patients (44.8%) had an increased blood pressure on self-measurement ((3)135/85 mmHg). The blood pressure of these patients was significantly reduced, after an average of 16.3 months, from 145/91+/-12.7 mmHg to 135/84 +/-12.8 mmHg (p<0.001). A statistically significant weight reduction was achieved in 308 patients (22.4%) with a body mass index (BMI) of (3) 30 kg/m2, from 33.4 to 32.9 kg/m2 (p<0.001). Lipid metabolism, important life-style parameters (food and physical activity) and a knowledge of important laboratory tests (glucose and creatinine) also changed positively. Antihypertensive medication remained nearly unchanged during the period of observation.

CONCLUSIONS

The patients participating in the Health Program Hypertension were already reasonably well controlled. The program achieved further lasting improvement of blood pressure. In addition the participants were motivated to adopt a more health-conscious life style. Training and care of the patients by a medical services centre would seem sensible and successful. But it remains a challenge, especially to reach poorly controlled hypertensives and to motivate them to an active participation in the program.

Simulating fababean development, growth, and yield in Australia

The capability to simulate fababean (Vicia faba L.) production across the range of environments in which it is grown in Australia provides a tool for assessing agronomic and management options for the crop. This paper describes the building and testing of a model of fababean (cv. Fiord) development and growth, designed for use in the cropping systems simulator, APSIM. Parameters describing leaf area expansion, radiation interception, biomass accumulation and partitioning, root growth, water use, and nitrogen accumulation were sourced from the literature or developed from experiments conducted by the authors. In addition, parameters defining phenological development in response to temperature and photoperiod were derived from a comprehensive dataset of times to flowering and maturity.Routines for pre-flowering phenology predicted time to flowering ranging from 43 to 94 days with a root mean squared deviation (RMSD) of 4.3 days. Post-flowering development could not be satisfactorily predicted using thermal time alone; analysis of the collated data suggested that the lengths of some post-flowering phases were related to photoperiod. With incorporation of a photoperiod effect on post-flowering development, time from sowing to maturity was simulated with an R2 of 92% and an RMSD of 6.7 days.The model was tested over a diverse range of latitudinal and climatic conditions within Australia, using data from experiments in which sowing date, crop density, and water supply varied. Observed grain yield (n = 42) varied from 500 to 5600 kg/ha. In general, observed biomass and yield patterns within a growing season were reproduced well. Simulated grain yield explained 87% of the variance in observed yields (RMSD = 466 kg/ha). Apart from demonstrating the capability of the model over a wide range of growing conditions, the tests highlighted a number of areas for future improvement, including accounting for lodging, variation in harvest index under wet conditions, and accurate simulation of the response of leaf area expansion to mild levels of water deficit.

Chronic granulomatous disease--a report in two Malay families

Chronic granulomatous disease (CGD) is a very rare disease whose defect lies in an abnormal intracellular killing resulting in recurrent abscesses, lymphadenitis and granuloma formation. We describe 2 Malay male infants with CGD whom we believe to be the first report of this disorder in Malays. Both children presented with recurrent abscesses, pneumoniae and hepatosplenomegaly; lymphadenopathy was also present in one of the patients. The organisms isolated were catalase positive bacteria. Both neutrophil chemiluminescence (against fungal and bacterial antigens, phorbol myristate acetate) and intracellular killing assays were severely depressed. Recognition of CGD is important as great strides have been made in the treatment of this disease which include gamma interferon therapy besides the conventional prophylactic antibacterial therapy.

[Bilateral segmental neurofibromatosis]

Segmental neurofibromatosis is a rare type of neurofibromatosis. We report a case of bilateral manifestation, review the literature on this extremely uncommon variant, and discuss the possible causative mechanisms and the genetic risk of segmental neurofibromatosis.

[Erythrokeratodermia anularis migrans--a new genetic dermatosis?]

An unusual type of erythrokeratodermia in an 11-year-old boy is presented. It can be distinguished from the well-known classic types of erythrokeratodermia by clinical criteria, such as the persisting, very slowly migrating, annular lesions, and also by immunohistochemical and ultrastructural findings. In view of the distinct clinical features of this new genodermatosis, the term erythrokeratodermia annularis migrans is proposed.

Perforating invasive mole masquerading as an ovarian tumour--case report

An invasive mole causing uterine perforation is a rare occurrence. We describe below a case with an unusual presentation which was mistaken for an ovarian tumour. The difficulty in diagnosis and the need for a high index of suspicion is highlighted.

Chronic mucocutaneous candidiasis with deficient CD2 (E receptor) but normal CD3 mononuclear cells

A case of chronic mucocutaneous candidiasis in a Malaysian child who subsequently developed disseminated tuberculosis and toxoplasmosis is described. The phenotype of her peripheral blood mononuclear cells showed discordance for her T cell markers. The presence of a subpopulation of CD2-/CD3+ mononuclear cells leading to an immunodeficiency state is consistent with failure of activation of CD2-mediated alternative pathway resulting in immunodeficiency. Such abnormal CD2-/CD3+ subpopulations have been described in lepromatous leprosy and foetal abortuses.

Pharmacokinetics of bisoprolol during repeated oral administration to healthy volunteers and patients with kidney or liver disease

The pharmacokinetics of bisoprolol were investigated following oral administration of 10mg once daily for 7 days in 8 healthy subjects, in 14 patients with different degrees of renal impairment and in 18 patients with liver disease. In healthy subjects peak and trough steady-state concentrations of 52 micrograms/L and 11 micrograms/L, respectively, an elimination half-life of 10.0 hours and total body clearance of 14.2 L/h were observed. 5.21 mg/24 hours of unchanged bisoprolol were recovered following urinary excretion during the dosage interval. In 11 patients with renal impairment (mean CLCR = 28 +/- 5 ml/min/1.72m2) half-life was prolonged to 18.5 hours, and peak and trough concentrations were 74 and 32 micrograms/L, respectively. Correspondingly, urinary excretion decreased to 3.35 mg/24 hours and total body clearance to 7.8 L/h. In uraemic patients (CLCR less than 5 ml/min/1.73m2) the total clearance of bisoprolol was 5.0 L/h and the elimination half-life was 24.2 hours. In patients with liver cirrhosis half-life increased to 13.5 hours, steady-state peak and trough concentrations increased to 62 and 22 micrograms/L, respectively, and total body clearance decreased to 10.8 L/h. The present study indicates that in patients with impairment of kidney or liver function accumulation of bisoprolol above a factor of 2 did not occur. However, in the terminal stages of insufficiency of kidney or liver function bisoprolol dosage should not exceed 10mg.

Interaction of bisoprolol with cimetidine and rifampicin

In 6 healthy volunteers the pharmacokinetics of bisoprolol under steady-state conditions was investigated over three consecutive phases: over 7 days of 10 mg of bisoprolol once daily per os, 7 days of 10 mg of bisoprolol once daily plus 400 mg of cimetidine t.i.d. and 14 days of 10 mg of bisoprolol and 600 mg of rifampicin once daily with adequate intervals free of medication. After therapy with bisoprolol alone peak plasma levels (Cssmax) of the beta-blocker were 55.5 +/- 6.4 ng/ml (means +/- SEM), area under the plasma level-time curve (AUC tau) was 597 +/- 70 ng/ml.h, total body clearance (CL) 15.8 +/- 1.8 l/h and elimination half-lives (t1/2 beta) 10.1 +/- 1.2 h. Cimetidine did not cause any significant changes in the pharmacokinetics of bisoprolol. Co-administration of rifampicin resulted in a decrease in Cssmax (43.0 +/- 6.9 ng/ml), AUC tau (397 +/- 54 ng/ml X h) and t1/2 beta (6.2 +/- 0.4 h). Accordingly, total body clearance increased to 23.8 +/- 2.5 l/h (p less than 0.05). In conclusion bisoprolol showed a statistically significant but probably clinically not important interaction with the enzyme-inducing drug rifampicin, but not with the enzyme inhibitor cimetidine.

Organ specificity of epithelial cells grown in tissue culture from explants obtained from various levels of the rat gut

Monolayer cultures of epithelial cells grown from explants of fetal rat small intestine can differentiate into columnar as well as goblet cells in tissue culture (Kondo et al., Exp cell res 153 (1984) 12) [9]. In this study we have cultured tissue from various levels of the fetal rat gastrointestinal tract in order to characterize those cell types that can be cultured from these tissues and to determine the growth potential of these cells using this culture system. Explants of esophagus and forestomach tissue yielded monolayer outgrowths of squamous epithelial cells which grew as closely apposed polygonal cells capable of developing cornified envelopes. Explants of the glandular portion of the stomach yielded outgrowths of densely packed cells which were more pleiomorphic and which did not desquamate or form cornified envelopes. Explants of small intestine and colon yielded outgrowths of epithelial cells, some of which differentiated into goblet cells, while others developed a 'columnar' cell morphology. The following differences between squamous- and non-squamous cultures were observed. Squamous epithelium showed self-sustained growth, while growth of non-squamous epithelial cells became self-limiting. Cytochalasin B (CB) (5 micrograms/ml for 1 h) induced contraction of the whole cell sheet of non-squamous cells, but of only individual squamous cells. Squamous cell outgrowth was observed from tissues derived from fetuses of all ages (13-day fetuses through to 3-week-old rats); whereas non-squamous epithelial outgrowth was poor when rats older than the 21st gestational day were studied. These results indicate that cultures established in this manner developed the general characteristics of the cells of the organ from which they were derived, even when undifferentiated fetal tissue was used. The growth conditions needed for columnar epithelium are more stringent than those needed for squamous tissues. This technique opens the way for further characterization of growth requirements of gastrointestinal columnar epithelium.

Growth and differentiation of fetal rat small intestinal epithelium in tissue culture. Relationship to fetal age

Explants of small intestinal tissue have been cultured from fetal and young rats (from 13-day fetuses to 3-week-old rats). Growth of morphologically typical epithelial cells was obtained from explants of tissue from 14-20 day fetuses. Optimal growth was obtained using tissue from 17-day fetuses with outgrowth from the explant being observed 1-day after explant. Eighty per cent of explants developed epithelial growth by 11 days in culture. Initially, the epithelial outgrowth showed no morphological evidence of differentiation but after 5-10 days in culture differentiation into goblet or elongated cells with alkaline phosphatase activity occurred. Cells with brush borders and goblet cells were identified using electron microscopy. No differentiation occurred if the explant was removed even though growth continued. It was very difficult to culture tissue from fetuses older than 20 days' gestation, and when small intestine of 18-20-day fetuses was divided into two parts (proximal and distal) and cultured separately, growth of epithelial cells from explants of the proximal segment was less successful than that of the distal segment, indicating that the growth ability of these epithelial cells in vitro was closely related to tissue maturation in vivo. In contrast to the apparent relationship between fetal age and successful growth of intestinal epithelial cells, squamous epithelial cells of the esophagus could be grown from explants of 14-day fetus through newborn and 3-week-old rats.

Dialysis for psoriasis

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Pathomorphologic changes of the cardiovascular system in twins

The author reports on primary diseases and on secondary reactions of adaptation in fetal hearts of twins. Cases of fibroelastosis endocardica, cases of hypertrophy of the heart, and the circulatory reactions following feto-fetal transfusion in twins, are discussed.

Using histochemical methods, several enzymes of the myocardium in deceased twins have been investigated.

Puzzling cases of secondary syphilis

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Lectureshipmanship

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Analysis

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The Adventures and Times of Eosilred, Prince of Elfour: A Bloodtime Story: Part II

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