RECURRENT LENTIGO MALIGNA: CONSERVATIVE CONTINUOUS TREATMENT WITH IMIQUIMOD OR REPEATED SURGERY? A LONG-TERM FOLLOW-UP DERMOSCOPIC CASE STUDY

A case of recurrent lentigo maligna in a 45-year-old woman is presented. The disease relapsed several times following the surgical excision of the lesion. An alternative treatment with imiquimod 5% cream was then used. After 4 years of follow-upfrom the last surgery, this treatment achieved total clearance of the lesion. The problems of lentigo maligna diagnosis and treatment are discussed.

Synergistic actions of Alpelisib and Melatonin in breast cancer cell lines with PIK3CA gene mutation

AIMS

Breast cancer (BC) presents high mortality rate and about 25-46 % have mutation in the PIK3CA gene. Alpelisib is a PI3K inhibitor that acts on p110α, which is a subunit of the PI3K protein. The melatonin shown important anti-neoplastic effects and may increase the effectiveness of chemotherapy. This study evaluated the synergistic action of Alpelisib and Melatonin in BC lines carrying the H1047R mutation in PIK3CA, relative to the cellular dynamics and the PI3K/AKT/mTOR pathway.

MAIN METHODS

MDA-MB-468 (triple-ernegative), MDA-MB-453 (H1047R PIK3CA, HER2+) and T-47D cells (H1047R PIK3CA, ER+/PR+) were divided into four treatment groups: control; Melatonin (1 mM); Alpelisib (1 μM); and Alpelisib (1 μM) + Melatonin (1 mM). Cell viability and migration were investigated using the MTT assay and Transwell assay, respectively. Protein expression of PI3K, p-AKT, mTOR, HIF-1α, and caspase-3, was verified using immunocytochemistry.

KEY FINDINGS

MTT assay revealed that MDA-MB-453 and T-47D showed reduction in cell viability in all groups, especially in the MDA-MB-453 treated with Melatonin + Alpelisib. MDA-MB-468 presents reduction in cell migration only with Melatonin, while in the lines with mutation, the treatment of Melatonin + Alpelisib caused inhibition of cell migration. PI3K, p-AKT, mTOR and HIF-1α were inhibited after treatment with Melatonin + Alpelisib in MDA-MB-453 and T-47D lines. The expression of caspase-3 increased in all groups in MDA-MB-453 and T-47D cells, being the increase more pronounced in the Melatonin + Alpelisib group.

SIGNIFICANCE

These results indicate that the combined use of Melatonin and Alpelisib may be more effective in inhibiting BC in women carrying the PIK3CA gene mutation than either treatment alone.

Protein Expression of PI3K/AKT/mTOR Pathway Targets Validated by Gene Expression and its Correlation with Prognosis in Canine Mammary Cancer

Mammary cancer is the main type of neoplasia in female dogs and is considered an adequate model for the biological and therapeutic study of cancer in women. The PIK3CA/AKT/mTOR pathway plays a central role in cellular homeostasis and is often dysregulated in cancer. The increased expression of PI3K protein in the literature is associated with a poor prognosis, and alterations in the PIK3CA gene can lead to changes in downstream pathways. Thus, the objective of this study was to validate the protein expression to confirm the gene expression of proteins belonging to the main pathway PI3K and PTEN, and their downstream pathways through ZEB1, ZEB2, HIF1A, VHL, CASP3 and PARP1 relating to prognosis in canine mammary cancer. For protein studies, the samples came from 58 female dogs with mammary neoplasia, immunohistochemistry was performed and its analysis by the histoscore method. For the genetic evaluation, the samples came from 13 patients, the DNA was extracted and the analysis for quantitative expression. Through immunohistochemistry, PI3K positivity was significantly associated with affected regional lymph node, distant metastasis, patients with HER2+, Triple Negative and Luminal B phenotypes, and the lowest survival rates. Through gene expression, we observed higher gene expression of ZEB2 and PARP1 both among patients who were alive and who died, which was not true for the expressions of PIK3CA and HIF1A. In conclusion, the data observed in this work are promising in the study of new molecular prognostic markers such as PI3K, ZEB2 and PARP1 for canine mammary cancer.

Modulation of Epithelial Mesenchymal Transition after AGTR-1 Gene Edition by Crispr/Cas9 and Losartan Treatment in Mammary Tumor Cell Line: A Comparative Study between Human and Canine Species

Breast cancer is the most prevalent tumor type among women and female dogs. Tumor malignancy is characterized by the epithelial-to-mesenchymal transition (EMT) which leads to the metastasis formation. The inhibition of angiotensin II type I receptor (AGTR1) by an antagonist such as losartan can suppress angiogenesis, consequently contributing to the metastasis control. The aim of this study was to analyze the capacity of losartan and AGTR-1 gene edition to modulate the EMT process in triple negative/metastatic mammary tumor cells, compared to existing treatment protocols such as carboplatin. The cell lines CF41.Mg and MDA-MB-468, were cultured and treated with carboplatin, losartan, or submitted to AGTR-1 gene edition by CRISPR/Cas9. EMT markers and PARP-1 protein and gene expression were evaluated by immunofluorescence or immunocytochemistry and qRT-PCR, respectively. Cell migration capacity was also evaluated. For CF41.Mg and MDA-MB-468 cell lines, there was an increase in E-cadherin and a decrease in N-cadherin and PARP-1 protein and gene expression after treatment with carboplatin, losartan, both in combination and after AGTR-1 gene edition. There was a decrease in VEGF and PARP-1 protein and gene expression after AGTR-1 gene edition. Moreover, in both lines, reduction in invasion rate was observed after all treatments. Our data suggest that losartan and the gene edition of AGTR-1 by CRISPR/Cas9 were able to block the DNA repair and control the EMT process, such as carboplatin. The results in the canine species are unprecedented, as there are no data in the literature that demonstrate the action of losartan in this tumor type.

Liquid Biopsy as a Diagnostic and Prognostic Tool for Women and Female Dogs with Breast Cancer

INTRODUCTION

Breast cancer (BC) is the malignant neoplasm with the highest mortality rate in women and female dogs are good models to study BC.

OBJECTIVE

We investigated the efficacy of liquid biopsy to detect gene mutations in the diagnosis and follow-up of women and female dogs with BC.

MATERIALS AND METHODS

In this study, 57 and 37 BC samples were collected from women and female dogs, respectively. After core biopsy and plasma samples were collected, the DNA and ctDNA of the tumor fragments and plasma were processed for next generation sequencing (NGS) assay. After preprocessing of the data, they were submitted to the Genome Analysis ToolKit (GATK).

RESULTS

In women, 1788 variants were identified in tumor fragments and 221 variants in plasma; 66 variants were simultaneously detected in tumors and plasma. Conversely, in female dogs, 1430 variants were found in plasma and 695 variants in tumor fragments; 59 variants were simultaneously identified in tumors and plasma. The most frequently mutated genes in the tumor fragments of women were USH2A, ATM, and IGF2R; in female dogs, they were USH2A, BRCA2, and RRM2. Plasma of women showed the most frequent genetic variations in the MAP3K1, BRCA1, and GRB7 genes, whereas plasma from female dogs had variations in the NF1, ERBB2, and KRT17 genes. Mutations in the AKT1, PIK3CA, and BRIP genes were associated with tumor recurrence, with a highly pathogenic variant in PIK3CA being particularly prominent. We also detected a gain-of-function mutation in the GRB7, MAP3K1, and MLH1 genes.

CONCLUSION

Liquid biopsy is useful to identify specific genetic variations at the beginning of BC manifestation and may be accompanied over the entire follow-up period, thereby supporting the clinicians in refining interventions.

Treatment of Triple Negative Cell Lines with Olaparib to Block DNA Repair

BACKGROUND

The most aggressive breast cancer is the triple negative histological type and the gold standard for its treatment is platinum salts, such as carboplatin. Due to high recurrence, there is a need to test new drugs, such as PARP inhibitors (PARPi) that induce lethality in cells with DNA damage. Olaparib is a PARPi, already used in some tumors, but not tested in canine species. Thus, the aim of this study was demonstrating the efficacy of olaparib in inhibiting DNA repair and controlling disease progression by decreasing the migration capacity of mammary tumor cells.

METHODS

The cell lines, CF41.Mg and MDA-MB-468, were cultured and was performed the MTT to define the best dose of carboplatin. Next, the cells were treated with 10 µM carboplatin, olaparib and with combination of both for 24 hours. PARP-1 protein and gene expression was evaluated by immunofluorescence, western blotting and qRT-PCR, respectively. The analysis of cell migration was performed in transwell chambers.

RESULTS

For CF41.Mg and MDA-MB-468 cell lines, there was decrease in PARP-1 protein and gene expression after treatment with carboplatin, olaparib and both in combination compared to the group without treatment (control) (p<0.05). Moreover, in both lines, reduction in invasion rate was observed after treatment with carboplatin, olaparib and when combined, compared to the control group (p<0.05).

CONCLUSION

Our data suggests that carboplatin and olaparib were able to block DNA repair and control the cancer invasion, especially when used in combination. The results with olaparib in the canine line are unpublished. The olaparib should be a possible agent against human breast cancer and canine mammary tumors.

Liquid Biopsy Can Detect Brca2 Gene Variants In Female Dogs With Mammary Neoplasia

Mammary tumors (MT) is one of the most prevalent malignancies in female dogs and women. Currently, molecular analyzes have shown that each tumor type presents its own genetic signature. In this context, liquid biopsy allows a comprehensive genetic characterization of the tumor, enabling early diagnosis and personalized treatment of patients. In women, deleterious mutations inherited in BRCA2 gene are associated with an increased risk of breast cancer, resistance to therapies, and worse prognosis. In female dogs, there are many divergent data on the involvement of BRCA2 gene with mammary carcinogenesis and what its pathogenic potential is. Therefore, the objective was to identify BRCA2 gene variants in 20 plasma DNA samples, from 10 newly diagnosed dogs with mammary cancer (RD), five control (CTR), and five mastectomized (MAST) patients. Eleven single nucleotide polymorphisms (SNPs) were detected, most of them in the exon 11, and two indels (deletion / insertion) in the BRCA2 gene. However, there was no statistically significant difference in the SNPs/indels detected between the groups. In addition, only one SNP (p.T1425P) and one deletion (p.L2307del) were considered deleterious using in silico computational models. Interestingly, most common variants were present in the plasma of all groups, except for the Ile2614Thr, Ile2614Val, Thr1425Pro, and p.L2307del variants. Thus, we observed that SNPs are common in the BRCA2 gene of female dogs with mammary tumors, with a similar condition identified in women with breast cancer. Liquid biopsy approach in dogs with MT is useful for genetic and therapeutic proposals. This article is protected by copyright. All rights reserved.

Abstract LB113: Regulation of PARP-1 expression in mammary tumor cell lines after treatment with olaparib

Introduction: Breast cancer is the most common tumor type among women and has a high mortality rate, which is associated with late detection of the disease and treatment failure due to the acquisition of resistance to protocol treatments. It is known that a variety of antitumor drugs are capable of inducing chemoresistance by activating DNA repair pathways. Among these, the PARPs are involved in the recognition and repair of simple-strand breaks. As a consequence, new drugs such as PARP inhibitors (olaparib), are being investigated as potential therapeutic targets in cancer, as an alternative to evade the resistance of tumor cells to chemotherapeutic agents, such as those in the class of platinum salts. In this context, the aim of this study was to evaluate the PARP expression after olaparib tratament with in mammary tumor cell lines. Materials and Methods: Mammary tumor cell lines MDA-MB-468 and CF41 was cultured in DMEM high glucose culture medium, at 37°C in 5% CO2. Cell viability was measured by MTT assay after treatment with different concentrations of carboplatin. Once stablished the concentration of 10µM for carboplatin and 10µM of olaparib, the protein and gene expression of PARP-1 were detected by immunofluorescence and real time PCR, respectively. Results: There was a significantly decrease of cell viability after treatment with different concentrations of carboplatin in 24 hours. Both PARP-1 protein and gene expression significantly decreased after treatment with carboplatin and olaparib. In some cases, the treatment action was potentiated when performed in combination. Conclusion: Our results suggest the efficacy of olaparib in controlling the mechanism of DNA repair activated by PARPs in human and canine breast cancer cells.

Citation Format: Marina Gobbe Moschetta-Pinheiro, Jucimara Colombo, Murilo de Souza Tuckumantel, Gabriela Karam Rebolho, Debora Aparecida Zuccari. Regulation of PARP-1 expression in mammary tumor cell lines after treatment with olaparib [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB113.

Melatonin Treatment Combined with TGF-β Silencing Inhibits Epithelial- Mesenchymal Transition in CF41 Canine Mammary Cancer Cell Line

BACKGROUND

Mammary cancer is the most prevalent type of cancer in female dogs. The main cause of mortality is the occurrence of metastasis. The metastatic process is complex and involves the Epithelial- Mesenchymal Transition (EMT), which can be activated by Transforming Growth Factor beta (TGF-β) and involves changes in cellular phenotype, as well as, in the expression of proteins such as E-cadherin, N-cadherin, vimentin and claudin-7. Melatonin is a hormone with oncostatic and anti-metastatic properties and appears to participate in the TGF-β pathway. Thus, the present work aimed to evaluate the expression of EMT markers, E-cadherin, N-cadherin, vimentin and claudin-7, as well as, the cell migration of the canine mammary cancer cell line, CF41, after treatment with melatonin and TGF-β silencing.

METHODS

Canine mammary cancer cell line, CF41, was cultured and characterized in relation to markers ER, PR and HER2. Cell line CF41 with reducing expression level of TGF-βwas performed according to Leonel et al. (2017). Expression of the protein E-caderin, N-cadherin, vimentin and claudin-7 was evaluated by immunocytochemistry and quantified by optical densitometry. The analysis of cell migration was performed in transwell chambers with 8μM pore size membrane.

RESULTS

CF41 cells present a triple negative phenotype, which is an aggressive phenotype. Immunocytochemistry staining showed increased expression of E-caderin and claudin-7 (P˂0.05) and decreased expression of N-cadherin and vimentin (P˂0.05) in CF41 cells after treatment with 1mM melatonin and TGF-β silencing. Moreover, treatment with melatonin and TGF-β silencing was able to reduce migration in cell line CF41 (P˂0.05).

CONCLUSION

Our data suggests that therapies combining TGF- β1 silencing and melatonin may be effective in suppressing the process of EMT, corroborating the hypothesis that melatonin acts on the TGF-β1 pathway and can reduce the metastatic potential of CF41 cells. This is so far the first study that reports melatonin treatment in CF41 cells with TGF-β1 silencing and its effect on EMT. Thus, further studies are needed to confirm this hypothesis.

Micro- CT evaluation of sealers removal by reciprocal instrumentation followed by continuous ultrasonic irrigation in teeth with oval root canals

Background

The ability of the Reciproc system (R40) followed by continuous ultrasonic irrigation (CUI) to remove filling material from oval root canals of mandibular premolars filled with gutta-percha and AH Plus or Bio-C Sealer was evaluated by microtomography (micro-CT).

Material and Methods

The straight and oval root canals of 42 mandibular premolars were prepared with the ProDesign R 35.05 reciprocal file and randomly divided into two groups according to the material used to fill the canals (n=21): Group AH - Master Cone and AH Plus; Group BC - Master Cone and Bio-C Sealer. After filling and provisional sealing, the teeth were stored at 100% relative humidity and a temperature of 37°C for 30 days. The filling material was then removed with an R40 file. The material was considered completely removed when the R40 file reached the working length (WL), and no remaining filling material was visible on the canal walls. CUI was then performed. The teeth were scanned by micro- CT before and after removal of the filling material. The remaining filling material was measured in mm in the last apical 5 mm. The data were analyzed with the nonparametric Friedman test and subsequently with the Dunn test. The Mann-Whitney U test was also performed. Statistical significance was accepted at the 5% level.

Results

After instrumentation with the Reciproc R40, the volume of residual filling material was significantly greater in the BC group than in the AH group (P = 0.035). After CUI, there was no difference in the volume of residual material between the two groups (P = 0.705).

Conclusions

Bio-C sealer was more difficult to remove with the Reciproc file than AH Plus. CUI improved the removal of residual filling material regardless of sealer type. However, no technique was able to completely clear the canals of filling material. Key words:Bioceramic cement, CUI, micro-CT, reciproc, retreatment.

Melatonin Differentially Modulates NF-кB Expression in Breast and Liver Cancer Cells

BACKGROUND

NF-kB (nuclear factor kappa B) is a transcription factor composed of two subunits, p50 and p65, which plays a key role in the inflammatory process. Melatonin has oncostatic, antiangiogenic and antimetastatic properties, and some recent studies have indicated an inhibitory effect of melatonin on NF-kB in some types of cancer. This work aims to investigate the effects of melatonin treatment on the expression of NFkB in breast and liver cancer models.

METHOD

The breast cancer xenographic model was performed using female Balb/c nude athymic mice injected with MDA-MB-231 cells. The animals were treated with 40 mg/Kg of melatonin for 21 days. Volume of the tumors was measured with a digital caliper. Hepatocarcinoma model was developed by using the HepG2 cells in vitro, treated with 1 mM melatonin for 24 h. The expression of NF-kB protein was verified by immunohistochemistry and immunocytochemistry and quantified by optical densitometry, in vivo study and in vitro study, respectively. NF-kB gene expression was performed by quantitative RT-PCR.

RESULTS

The breast cancer xenografts nude mice treated with melatonin showed reduced tumor size (P=0.0022). There was a decrease in NF-kB protein staining (P=0.0027) and gene expression (P=0.0185) in mice treated with melatonin. The opposite results were observed for the hepatocarcinoma model. HepG2 cells treated with melatonin showed an increase in the NF-kB immunostaining when compared to control cells (P=0.0042).

CONCLUSION

Our results indicated that the treatment with melatonin was able to decrease both gene and protein expressions of NF-kB in breast cancer cells and, conversely, increase the transcription factor protein expression in hepatocarcinoma cells. These data highlighted a double role in the expression of NF-kB, depending on the cell type. Further studies are needed to better elucidate the action of melatonin in NF-kB, since this transcription factor acts on different signaling pathways that are fundamental for carcinogenesis.

Medical-surgical activity and the current state of training of urology residents in Spain: Results of a national survey

OBJECTIVES

To determine the actual state of medical-surgical activity and training for urology residents in Spain.

MATERIAL AND METHOD

We designed 2 anonymous surveys, which were uploaded with the Google Docs^© tool so that the respondents could answer the surveys online. The online collection period was September 2015 to January 2016. The collected data were processing using the statistical programme IBM SPSS for Windows, Version 21.0 and the programme R version 3.2.3.

RESULTS

The total number of responders was 163. In reference to the number of physically present on-call residents, the majority conducted between 4 and 6 shifts a month. Eighty-four of those surveyed indicated that they were in the operating room less than 20hours a week, and 43 of these even less than 10hours. Thirty percent of those surveyed had not performed any transurethral resection. The majority had performed at least one prostatic adenomectomy, but had not performed any major oncologic procedure, either laparoscopically or openly. In the questions concerning training and training courses, we found that most of the residents trained in laparoscopy at the hospital or at home. The overall satisfaction for the residence was assessed at 2.6. Based on this score, the overall satisfaction could be considered moderate.

CONCLUSIONS

Efforts should be directed towards standardising the acquisition of surgical and nonsurgical skills, ensuring access to training courses, establishing a minimum of required operations per year and achieving an objective assessment of the specialty.

Predicting the effect of maternal docosahexaenoic acid (DHA) supplementation to reduce early preterm birth in Australia and the United States using results of within country randomized controlled trials

The DHA to Optimize Mother Infant Outcome (DOMInO) and Kansas DHA Outcomes Study (KUDOS) were randomized controlled trials that supplemented mothers with 800 and 600mg DHA/day, respectively, or a placebo during pregnancy. DOMInO was conducted in Australia and KUDOS in the United States. Both trials found an unanticipated and statistically significant reduction in early preterm birth (ePTB; i.e., birth before 34 weeks gestation). However, in each trial, the number of ePTBs were small. We used a novel Bayesian approach to estimate statistically derived low, moderate or high risk for ePTB, and to test for differences between the DHA and placebo groups. In both trials, the model predicted DHA would significantly reduce the expected proportion of deliveries in the high risk group under the trial conditions of the parent studies. Among the next 300,000 births in Australia we estimated that 1112 ePTB (95% credible interval 51-2189) could be avoided by providing DHA. And in the USA we estimated that 106,030 ePTB (95% credible interval 6400 to 175,700) could be avoided with DHA.

Docosahexaenoic acid supplementation (DHA) and the return on investment for pregnancy outcomes

The Kansas University DHA Outcomes Study (KUDOS) found a significant reduction in early preterm births with a supplement of 600mg DHA per day compared to placebo. The objective of this analysis was to determine if hospital costs differed between groups. We applied a post-hoc cost analysis of the delivery hospitalization and all hospitalizations in the following year to 197 mother-infant dyads who delivered at Kansas University Hospital. Hospital cost saving of DHA supplementation amounted to $1678 per infant. Even after adjusting for the estimated cost of providing 600mg/d DHA for 26 weeks ($166.48) and a slightly higher maternal care cost ($26) in the DHA group, the net saving per dyad was $1484. Extrapolating this to the nearly 4 million US deliveries per year suggests universal supplementation with 600mg/d during the last 2 trimesters of pregnancy could save the US health care system up to USD 6 billion.

Effects of melatonin on HIF-1α and VEGF expression and on the invasive properties of hepatocarcinoma cells

Liver cancer is the sixth most commonly occurring cancer globally, and the main histological type is hepatocellular carcinoma. This type of neoplasia has a poor prognosis due to a high rate of recurrence and intrahepatic metastasis, which are closely are closely associated with the angiogenic process. Vascular endothelial growth factor (VEGF), which is under the control of hypoxia inducible factor-1α (HIF-1α), stimulates the proliferation of endothelial cells and increases cell permeability, promoting the growth, spread and metastasis of tumors. Melatonin, the main hormone secreted by the pineal gland, may have a significant role in tumor suppression and has demonstrated antiangiogenic and antimetastatic effects. The aim of the present study was to analyze the cell viability, migration and invasion, as well as the expression of proangiogenic proteins VEGF and HIF-1α, in HepG2 hepatocarcinoma cells, following treatment with melatonin. Cells were cultured and cell viability was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay. The expression of proangiogenic proteins VEGF and HIF-1α, under conditions of normoxia and hypoxia, was verified using immunocytochemistry and quantified by densitometry. The analysis of the processes of cell migration and invasion was performed in a Boyden chamber. The MTT assay revealed a reduction in cell viability (P=0.018) following treatment with 1 mM melatonin for 24 h. The expression of proangiogenic proteins VEGF and HIF-1α was reduced in cells treated with 1 mM melatonin for 24 h in normoxic (P<0.001) and hypoxic (P<0.001) conditions, compared with the control group and with induced hypoxia alone. The rate of cell migration and invasion was additionally reduced in cells treated with 1 mM melatonin for 48 h when compared with the control group (P=0.496). The results of the present study suggest that melatonin may have an antiproliferative, antiangiogenic and antimetastatic role in hepatocarcinoma cells and may present a novel therapeutic option for the treatment of liver cancer.

Molecular markers of angiogenesis and metastasis in lines of oral carcinoma after treatment with melatonin

BACKGROUND

Oral cancer is the most common type of head and neck cancer and its high rate of mortality and morbidity is closely related to the processes of angiogenesis and tumor metastasis. The overexpression of the pro-angiogenic genes, HIF-1α and VEGF, and pro-metastatic gene, ROCK-1, are associated with unfavorable prognosis in oral carcinoma. Melatonin has oncostatic, antiangiogenic and antimetastatic properties in several types of neoplasms, although its relationship with oral cancer has been little explored. This study aims to analyze the expression of the genes HIF-1α, VEGF and ROCK-1 in cell lines of squamous cell carcinoma of the tongue, after treatment with melatonin.

METHODS

SCC9 and SCC25 cells were cultured and cell viability was assessed by MTT assay, after treatment with 100 μM of CoCl2 to induce hypoxia and with melatonin at different concentrations. The analysis of quantitative RT-PCR and the immunocytochemical analysis were performed to verify the action of melatonin under conditions of normoxia and hypoxia, on gene and protein expression of HIF-1α, VEGF and ROCK-1.

RESULTS

The MTT assay showed a decrease in cell viability in both cell lines, after the treatment with melatonin. The analysis of quantitative RT-PCR indicated an inhibition of the expression of the pro-angiogenic genes HIF-1α (P < 0.001) and VEGF (P < 0.001) under hypoxic conditions, and of the pro-metastatic gene ROCK-1 (P < 0.0001) in the cell line SCC9, after treatment with 1 mM of melatonin. In the immunocytochemical analysis, there was a positive correlation with gene expression data, validating the quantitative RT-PCR results for cell line SCC9. Treatment with melatonin did not demonstrate inhibition of the expression of genes HIF-1α, VEGF and ROCK-1 in line SCC25, which has different molecular characteristics and greater degree of malignancy when compared to the line SCC9.

CONCLUSION

Melatonin affects cell viability in the SCC9 and SCC25 lines and inhibits the expression of the genes HIF-1α, VEGF and ROCK-1 in SCC9 line. Additional studies may confirm the potential therapeutic effect of melatonin in some subtypes of oral carcinoma.

Long chain polyunsaturated fatty acid supplementation in infancy increases length- and weight-for-age but not BMI to 6 years when controlling for effects of maternal smoking

Long chain polyunsaturated fatty acids (LCPUFA) are added to infant formula but their effect on long-term growth of children is under studied. We evaluated the effects of feeding LCPUFA-supplemented formula (n = 54) compared to control formula (n = 15) throughout infancy on growth from birth-6 years. Growth was described using separate models developed with the MIXED procedure of SAS(®) that included maternal smoking history and gender. Compared to children fed control formula, children who consumed LCPUFA supplemented formula had higher length-/stature-/and weight-for-age percentiles but not body mass index (BMI) percentile from birth to 6 years. Maternal smoking predicted lower stature (2-6 years), higher weight-for-length (birth-18 months) and BMI percentile (2-6 years) independent of LCPUFA effects. Gender interacted with the effect of LCPUFA on stature, and the relationship between smoking and BMI, with a larger effect for boys. Energy intake did not explain growth differences. A relatively small control sample is a limitation.

Selective pulmonary vasodilation improves ventriculovascular coupling and gas exchange in a patient with unrepaired single-ventricle physiology

We describe a 63-year-old patient with unrepaired tricuspid valve atresia and a hypoplastic right ventricle (single-ventricle physiology) who presented with progressive symptomatic hypoxia. Her anatomy resulted in parallel pulmonary and systemic circulations, pulmonary arterial hypertension, and uncoupling of the ventricle/pulmonary artery. Hemodynamic and coupling data were obtained before and after pulmonary vasoactive treatment, first inhaled nitric oxide and later inhaled treprostinil. The coupling ratio (ratio of ventricular to vascular elastance) shunt fractions and dead space ventilation were calculated before and after treatment. Treatment resulted in improvement of the coupling ratio between the ventricle and the vasculature with optimization of stroke work, equalization of pulmonary and systolic flows, a decrease in dead space ventilation from 75% to 55%, and a significant increase in 6-minute walk distance and improved hypoxia. Inhaled treprostinil significantly increased 6-minute walk distance and improved hypoxia. This is the first report to show that pulmonary vasoactive treatment can be used in a patient with unrepaired single-ventricle anatomy and describes the hemodynamic effects of inhaled therapy on ventriculovascular coupling and gas exchange in the pulmonary circulation in this unique physiology.

Docosahexaenoic acid (DHA) supplementation in pregnancy differentially modulates arachidonic acid and DHA status across FADS genotypes in pregnancy

Some FADS alleles are associated with lower DHA and ARA status assessed by the relative amount of arachidonic acid (ARA) and docosahexaenoic acid (DHA) in plasma and red blood cell (RBC) phospholipids (PL). We determined two FADS single nucleotide polymorphisms (SNPs) in a cohort of pregnant women and examined the relationship of FADS1rs174533 and FADS2rs174575 to DHA and ARA status before and after supplementation with 600mg per day of DHA. The 205 pregnant women studied were randomly assigned to placebo (mixed soy and corn oil) (n=96) or 600mg algal DHA (n=109) in 3 capsules per day for the last two trimesters of pregnancy. Women homozygous for the minor allele of FADS1rs174533 (but not FADS2rs174575) had lower DHA and ARA status at baseline. At delivery, minor allele homozygotes of FADS1rs174533 in the placebo group had lower RBC-DHA compared to major-allele carriers (P=0.031), while in the DHA-supplemented group, all genotypes had higher DHA status compared to baseline (P=0.001) and status did not differ by genotype (P=0.941). Surprisingly, DHA but not the placebo decreased ARA status of minor allele homozygotes of both FADS SNPs but not major allele homozygotes at delivery. Any physiological effects of changing the DHA to ARA ratio by increasing DHA intake appears to be greater in minor allele homozygotes of some FADS SNPs.

Expression, purification and molecular analysis of the human ZNF706 protein

Background

The ZNF706 gene encodes a protein that belongs to the zinc finger family of proteins and was found to be highly expressed in laryngeal cancer, making the structure and function of ZNF706 worthy of investigation. In this study, we expressed and purified recombinant human ZNF706 that was suitable for structural analysis in Escherichia coli BL21(DH3).

Findings

ZNF706 mRNA was extracted from a larynx tissue sample, and cDNA was ligated into a cloning vector using the TOPO method. ZNF706 protein was expressed according to the E. coli expression system procedures and was purified using a nickel-affinity column. The structural qualities of recombinant ZNF706 and quantification alpha, beta sheet, and other structures were obtained by spectroscopy of circular dichroism. ZNF706's structural modeling showed that it is composed of α-helices (28.3%), β-strands (19.4%), and turns (20.9%), in agreement with the spectral data from the dichroism analysis.

Conclusions

We used circular dichroism and molecular modeling to examine the structure of ZNF706. The results suggest that human recombinant ZNF706 keeps its secondary structures and is appropriate for functional and structural studies. The method of expressing ZNF706 protein used in this study can be used to direct various functional and structural studies that will contribute to the understanding of its function as well as its relationship with other biological molecules and its putative role in carcinogenesis.

Effects of docosahexaenoic acid supplementation during pregnancy on fetal heart rate and variability: a randomized clinical trial

DHA (22:6n-3) supplementation during infancy has been associated with lower heart rate (HR) and improved neurobehavioral outcomes. We hypothesized that maternal DHA supplementation would improve fetal cardiac autonomic control and newborn neurobehavior. Pregnant women were randomized to 600 mg/day of DHA or placebo oil capsules at 14.4 (+/-4) weeks gestation. Fetal HR and HRV were calculated from magnetocardiograms (MCGs) at 24, 32 and 36 weeks gestational age (GA). Newborn neurobehavior was assessed using the Neonatal Behavioral Assessment Scale (NBAS). Post-partum maternal and infant red blood cell (RBC) DHA was significantly higher in the supplemented group as were metrics of fetal HRV and newborn neurobehavior in the autonomic and motor clusters. Higher HRV is associated with more responsive and flexible autonomic nervous system (ANS). Coupled with findings of improved autonomic and motor behavior, these data suggest that maternal DHA supplementation during pregnancy may impart an adaptive advantage to the fetus.

Extracorporeal lung perfusion and ventilation to improve donor lung function and increase the number of organs available for transplantation

INTRODUCTION

Ex vivo lung perfusion (EVLP) has been validated as a valuable technique to increase the pool of organs available for lung transplantation.

MATERIAL AND METHODS

After a preclinical experience, we obtained permission from the Ethics Committee of our institution to transplant lungs after EVLP reconditioning. ABO compatibility, size match, and donor arterial oxygen pressure (PaO(2))/fraction of inspired oxygen (FiO(2)) ≤ 300 mm Hg were considered to be inclusion criteria, whereas the presence of chest trauma and lung contusion, evidence of gastric content aspiration, pneumonia, sepsis, or systemic disease were exclusion criteria. We only considered subjects on an extra corporeal membrane oxygenation (ECMO) bridge to transplantation with rapid functional deterioration. Using Steen solution with packed red blood cells oxygenated with 21% O(2), 5% to 7% CO(2) was delivered, targeted with a blood flow of approximately 40% predicted cardiac output. Once normothermic, the lungs were ventilated with a tidal volume of 7 mL/kg a PEEP of 5 cmH(2)O and a respiratory rate of 7 bpm. Lungs were considered to be suitable for transplantation if well oxygenated [P(v-a) O(2) > 350 mm Hg on FiO(2) 100%], in the absence of deterioration of pulmonary vascular resistance and lung mechanics over the perfusion time.

RESULTS

From March to September 2011, six lung transplantations were performed, including two with EVLP. The functional outcomes were similar between groups: at T72 posttransplantation, the median PaO(2)/FiO(2) were 306 mm Hg (range, 282 to 331 mm Hg) and 323 mm Hg (range, 270 to 396 mm Hg) (P = 1, EVLP versus conventional). Intensive care unit ICU and hospital length of stay were similar (P = .533 and P = .663, respectively) with no mortality at 60 days in both groups. EVLP donors were older (49 ± 6 y versus 21 ± 7 y, P < .05), less well oxygenated (184 ± 6 mm Hg versus 570 ± 30, P < .05), displaying higher Oto scores (9.5 ± 0.7 versus 1.7 ± 1.5, P < .05).

CONCLUSIONS

The first 6 months of the EVLP program allowed us to increase the number of organs available for transplantation with short-term outcomes comparable to conventional transplantations.

Gene expression analysis reveals novel altered genes in nasal polyps

Nasal polyposis (NP) is a chronic inflammatory disease of the nasal mucosa characterized by the infiltration of inflammatory cells, mainly eosinophils. Although nasal polyposis occurs in 4% of the population, its physiopathology remains unclear. The aim of this study was to identify and characterize differentially expressed genes that can be used in the prognosis, treatment and elucidation of this physiopathology. To identify novel genes differentially expressed in NP, we applied real-time quantitative PCR to 11 NP samples and to a pool of total RNA from a subset of 13 normal nasal mucosa samples from human autopsies. For selecting genes, the methylated CpG island amplification technique was used. Five differentially methylated clones (ATP2A1, NOVA1, PLCD3, SOLH and TGFβI) were identified. However, these genes presented methylated CpG islands between exons, i.e., not in the promoter regions of the genes. Thus, as shown by real-time PCR, the ATP2A1, SOLH, PLDC3 and TGFβI genes were overexpressed in NP. The genes identified in this study are probably involved in some stage of the process of formation and development of nasal polyposis, as they were highly expressed in the nasal polyp samples.

Alterações Genéticas em Câncer de Cabeça e Pescoço

O carcinoma de células escamosas de cabeça e pescoço (HNSCC) constitui o quinto tipo de câncer mais comum mundialmente, com uma incidência anual global de 780.000 novos casos. Os sítios comuns incluem cavidade oral, orofaringe, hipofaringe, nasofaringe, cavidade nasal, seios paranasais, laringe e glândulas salivares. O consumo de tabaco e/ou álcool são os principais fatores de risco envolvidos no desenvolvimento do HNSCC. Apesar dos recentes avanços no tratamento, o índice de sobrevivência dos pacientes com HNSCC tem permanecido em 40%. A recidiva locorregional e a metástase após terapia convencional parecem ser os principais fatores que contribuem para a sobrevivência reduzida dos pacientes. O desenvolvimento do câncer de cabeça e pescoço é um processo multipasso acompanhado por mudanças genéticas e epigenéticas, incluindo perda de heterozigozidade, inativação gênica por metilação e amplificação gênica. Diferentes estudos têm revelado numerosas alterações moleculares em HNSCC, incluindo ativação de oncogenes, tais como: EGFR, ciclina D1 e COX-2; inativação de genes supressores tumorais, tais como: TP53, p16, p27 e WAF1/C1P1; e expressão de fatores angiogênicos e metastáticos; além dos polimorfismos genéticos de enzimas metabólicas. Esta revisão apresenta informações atuais sobre as principais alterações genéticas envolvidas no desenvolvimento do câncer de cabeça e pescoço, as quais apresentam potencial valor prognóstico, e discute alguns fatores que contribuem para a controvérsia a respeito de sua importância prognóstica.

Gene expression profiling reveals molecular marker candidates of laryngeal squamous cell carcinoma

Laryngeal squamous cell carcinoma is very common in head and neck cancer, with high mortality rates and poor prognosis. In this study, we compared expression profiles of clinical samples from 13 larynx tumors and 10 non-neoplastic larynx tissues using a custom-built cDNA microarray containing 331 probes for 284 genes previously identified by informatics analysis of EST databases as markers of head and neck tumors. Thirty-five genes showed statistically significant differences (SNR > or = | 1.0 |, p< or =0.001) in the expression between tumor and non-tumor larynx tissue samples. Functional annotation indicated that these genes are involved in cellular processes relevant to the cancer phenotype, such as apoptosis, cell cycle, DNA repair, proteolysis, protease inhibition, signal transduction and transcriptional regulation. Six of the identified transcripts map to intronic regions of protein-coding genes and may comprise non-annotated exons or as yet uncharacterized long ncRNAs with a regulatory role in the gene expression program of larynx tissue. The differential expression of 10 of these genes (ADCY6, AES, AL2SCR3, CRR9, CSTB, DUSP1, MAP3K5, PLAT, UBL1 and ZNF706) was independently confirmed by quantitative real-time RT-PCR. Among these, the CSTB gene product has cysteine protease inhibitor activity that has been associated with an antimetastatic function. Interestingly, CSTB showed a low expression in the tumor samples analyzed (p<0.0001). The set of genes identified here contribute to a better understanding of the molecular basis of larynx cancer, and provide candidate markers for improving diagnosis, prognosis and treatment of this carcinoma.

Methylation profile of genes CDKN2A (p14 and p16), DAPK1, CDH1, and ADAM23 in head and neck cancer

Hypermethylation in the promoter region has been associated with a loss of gene function that may give a selective advantage to neoplastic cells. In this study, the methylation pattern of genes CDKN2A (alias p14, p14(ARF), p16, p16(INK4a)), DAPK1, CDH1, and ADAM23 was analyzed in 43 samples of head and neck tumors using methylation-specific polymerase chain reaction. In the oropharynx, there was a statistically significant association between hypermethylation of the DAPK1 gene and the occurrence of lymph node metastases, and in the larynx there was statistically significant evidence of an association between hypermethylation of the ADAM23 gene and advanced stages of the tumors. Thus, a correlation was observed between hypermethylation of the promoter region of genes DAPK1 and ADAM23 and the progression of head and neck cancer.

The prevalence of human papillomavirus in the oropharynx in healthy individuals in a Brazilian population

Oncogenic human papillomavirus (HPV), a causative agent of uterine cervical cancer, has also been detected in head and neck squamous cell cancers, especially in squamous cell carcinomas of the tonsils. However, the true HPV prevalence in normal and neoplasic oropharyngeal mucosa remains uncertain. To determine the prevalence of HPV DNA in normal oropharyngeal mucosa of cancer-free individuals, a study was carried out on 50 Brazilian subjects. PCR was performed to identify HPV DNA in samples from four sites in the oropharynx (tonsils, soft palate, base of the tongue, and back wall of the pharynx). For amplification of the HPV DNA, MY09/11 consensus primers were used, and specific genotypes were identified by dot-blot hybridization or cloning and sequencing. HPV DNA was present in 14.0% of the individuals, and the identified genotypes were 16, 18, 52, and 61. All these types are considered high-risk (HR) HPV. The tonsils and the soft palate were the sites with the highest HPV prevalence. This study shows the prevalence of HR HPV in the oropharynx of normal individuals. However, the prevalence of HPV is still unclear, and if HPV infection in a healthy it is not known individual predisposes to HPV-associated disease such as oropharyngeal cancer. Thus, it is important to assess the prevalence of HPV in cancer-free individuals, in order to compare it with the HPV prevalence in oropharyngeal carcinomas and to attempt to determine the true role of HPV in the development of head and neck squamous cell cancers.

Polymorphisms of DNA repair genes XRCC1 and XRCC3, interaction with environmental exposure and risk of chronic gastritis and gastric cancer

AIM: To evaluate the association between poly-morphisms XRCC1 Arg194Trp and Arg399Gln and XRCC3 Thr241Met and the risk for chronic gastritis and gastric cancer, in a Southeastern Brazilian population.

METHODS: Genotyping by PCR-RFLP was carried out on 202 patients with chronic gastritis (CG) and 160 patients with gastric cancer (GC), matched to 202 (C1) and 150 (C2) controls, respectively.

RESULTS: No differences were observed among the studied groups with regard to the genotype distribution of XRCC1 codons 194 and 399 and of XRCC3 codon 241. However, the combined analyses of the three variant alleles (194Trp, 399Gln and 241Met) showed an increased risk for chronic gastritis when compared to the GC group. Moreover, an interaction between the polymorphic alleles and demographic and environmental factors was observed in the CG and GC groups. XRCC1 194Trp was associated with smoking in the CG group, while the variant alleles XRCC1 399Gln and XRCC3 241Met were related with gender, smoking, drinking and H pylori infection in the CG and GC groups.

CONCLUSION: Our results showed no evidence of a rela-tionship between the polymorphisms XRCC1 Arg194Trp and Arg399Gln and XRCC3 Thr241Met and the risk of chronic gastritis and gastric cancer in the Brazilian population, but the combined effect of these variants may interact to increase the risk for chronic gastritis, considered a premalignant lesion. Our data also indicate a gene-environment interaction in the susceptibility to chronic gastritis and gastric cancer.

GSTT1, GSTM1 and CYP2E1 genetic polymorphisms in gastric cancer and chronic gastritis in a Brazilian population

AIM: To test the hypothesis that, in the Southeastern Brazilian population, the GSTT1, GSTM1 and CYP2E1 polymorphisms and putative risk factors are associated with an increased risk for gastric cancer.

METHODS: We conducted a study on 100 cases of gastric cancer (GC), 100 cases of chronic gastritis (CG), and 150 controls (C). Deletion of the GSTT1 and GSTM1 genes was assessed by multiplex PCR. CYP2E1/PstI genotyping was performed using a PCR-RFLP assay.

RESULTS: No relationship between GSTT1/GSTM1 deletion and the c1/c2 genotype of CYP2E1 was observed among the three groups. However, a significant difference between CG and C was observed, due to a greater number of GSTT1/GSTM1 positive genotypes in the CG group. The GSTT1 null genotype occurred more frequently in Negroid subjects, and the GSTM1 null genotype in Caucasians, while the GSTM1 positive genotype was observed mainly in individuals with chronic gastritis infected with H. pylori.

CONCLUSION: Our findings indicate that there is no obvious relationship between the GSTT1, GSTM1 and CYP2E1 polymorphisms and gastric cancer.

Heart rate-defined phases of attention, look duration, and infant performance in the paired-comparison paradigm

Four-month-old infants (N = 68) were tested in a paired-comparison familiarization-novelty recognition task in which the length of choice trials was systematically manipulated. Peak look duration during pretest and familiarization periods significantly predicted a dichotomous measure of recognition performance, but recognition was unaffected by choice-trial length. Heart rate (HR) was simultaneously assessed during the task, and the amount of time infants spent in various HR-defined phases of attention was assessed. Longer durations of looking during pretest and familiarization were significantly associated with more time spent in both sustained attention (SA) and attention termination (AT). Of these two variables, only individual differences in AT accounted for significant variance in recognition memory performance. A final analysis addressed the possibility that individual differences in AT mediated the relation between look duration and recognition performance. These findings provide support for the hypothesis that individual differences in the disengagement of attention underlie the relation between look duration and cognitive performance in early to midinfancy.

Infants' detection of contingency: a cognitive-neuroscience perspective

Advances in developmental cognitive neuroscience have generated important and interesting data that are relevant to infants' perception of contingencies. The author discusses concepts of "binding" (i.e., the binding of stimulus properties across space, and binding of events across time) within the context of the cognitive-neuroscience approach to learning. Issues relevant to infant contingency perception are also addressed. Previously published data on infant contingency perception and discrimination learning from the author's laboratory are reinterpreted in terms of these binding concepts, as well as the development of the neural substrates that presumably underlie the perception of stimulus attributes and temporal redundancy.

Recent advances in infant cognition: implications for long-chain polyunsaturated fatty acid supplementation studies

The assessment of cognitive function in early life has recently become an issue for consideration in long-chain polyunsaturated fatty acid (LC-PUFA) supplementation studies. This article reviews the various means by which such assessment has been done in past LC-PUFA supplementation studies and provides some background on recent advances in the measurement of infant cognition that may need to be considered when planning or designing future supplementation studies. These include (i) consideration of the specificity of LC-PUFA effects on cognition, (ii) inclusion of multiple tasks or levels of measurement as outcome measures, and (iii) a stronger emphasis on developmental processes in the design of such studies.

The development of visual attention in infancy

Over the past decade, the study of attention in infancy has seen dramatic progress. This review delineates four attentional functions (alertness, spatial orienting, attention to object features, and endogenous attention) that are relevant to infancy and uses these functions as a framework for summarizing the developmental course of attention in infancy. Rudimentary forms of various attentional functions are present at birth, but each of the functions exhibits different and apparently dissociable periods of postnatal change during the first years of life. The role of attention in development should therefore be considered in the context of interaction among different systems at different levels of maturity during the first years of life.

Mass hearing screening in kindergarten students

OBJECTIVE

To determine the types of hearing losses identified by mass hearing screenings in the public school system.

DESIGN

Prospective observational.

PARTICIPANTS

Students enrolled in kindergarten in the public school system.

SETTING

Major metropolitan area.

MAIN OUTCOME MEASURES

(1) hearing screening tests performed by speech pathologists using an audiometer in a quiet room; (2) formal audiologic testing including pure tone audiometry, tympanograms, speech discrimination, and acoustic impedance testing in a sound proof booth.

RESULTS

140 students failed hearing screening on two separate occasions; 91(65%) underwent formal audiologic testing at Milwaukee Public School, 43% demonstrated conductive hearing losses, 14% demonstrated sensorineural losses and 43% demonstrated normal hearing.

CONCLUSION

Mass hearing screening in the school system (1) is useful for detecting transient conductive hearing losses, (2) detects a significant number of sensorineural hearing losses and (3) has a very poor follow-through by the families of those students identified with hearing loss through the screening program.

Individual and developmental differences in disengagement of fixation in early infancy

The current study investigated whether individual and developmental differences in look duration are correlated with the latency for infants to disengage fixation from a visual stimulus. Ninety-four infants (52 3-month-olds, 42 4-month-olds) were tested in a procedure that measured ocular reaction time to shift fixation from a central target to a peripheral target under conditions in which the central-target either remained present ("competition" condition) or was removed from the display ("noncompetition" condition). Look duration was correlated with disengagement latency; longer-looking infants were slower than shorter-looking infants to shift fixation to the peripheral target on competition trials, but not noncompetition trials. Results were similar for 3- and 4-month-olds, although 3-month-olds showed slower latencies on all trials. Furthermore, long-looking infants were not consistently slower, but rather showed greater variability in their response latencies under conditions that required disengagement of fixation. The results support the position that developmental and individual differences in look duration are linked to the development of the neural attentional systems that control the ability to disengage, or inhibit, visual fixation.

Long- and short-looking infants' recognition of symmetrical and asymmetrical forms

Adults process symmetrical visual forms more rapidly than asymmetrical visual forms, presumably because symmetrical forms are amenable to a global visual encoding strategy. Individual differences in look duration during infancy have been hypothesized to covary with different modes of visual intake and encoding, with longer look durations reflecting encoding based on prolonged inspection of local visual properties, and briefer look durations reflecting encoding based on more of a global, or global-to-local processing sequence. This hypothesis predicts that short-looking infants would process symmetrical stimuli faster than asymmetrical stimuli, but that long-looking infants would not. Three experiments are described here in which this prediction is tested. Results were in general accord with the prediction, and provide further support for the hypothesis that individual differences in look duration may reflect different modes of visual encoding or inspection.

Sensitization during visual habituation sequences: procedural effects and individual differences

Although individual differences in visual habituation have long been interpreted in terms of processes derived from comparator theory, research over the last decade has suggested that arousal or arousability as manifest in sensitization may contribute to infants' attentional profiles, and thus, to individual differences in those profiles. We explored this possibility by habituating 4-month-old infants to 4 x 4, 10 x 10, or 20 x 20 checkerboards in a fixed-trial paradigm. The first specific aim was to examine the attentional characteristics of infants with habituation patterns showing sensitization versus those that did not. The second specific aim was to determine whether patterns of attention suggestive of sensitization effects reported in past research might be attributable to the use of illuminated interstimulus intervals (ISIs). Trends were observed for sensitization to occur more frequently with more complex than with less complex checkerboards. Infants who showed looking patterns characteristic of sensitization looked longer and did not habituate as readily as infants who did not show sensitization. Finally, different ISIs did not engender different levels of sensitization, but dark ISIs significantly increased infants' looking times to stimuli during trials.

Establishing pharmaceutical care services in an HIV clinic

OBJECTIVE

To present a brief overview of human immunodeficiency virus (HIV) infection and to describe the implementation of pharmaceutical care services for adult patients with HIV infection.

SETTING

University hospital clinic.

PRACTICE DESCRIPTION

A pharmacist joined a multidisciplinary team serving HIV-infected patients in January 1994.

PRACTICE INNOVATION

Current pharmacy services include taking medication histories, educating patients, counseling patients on compliance, monitoring response to therapy, identifying drug-related problems, documenting all interventions, and making therapeutic decisions and formulary choices. The pharmacist also participates in research.

INTERVENTIONS

The pharmacist sees patients immediately after their physician appointments. Patients with one or more of the following characteristics are targeted to receive pharmaceutical care: multiple drugs, history of noncompliance, initiation of new drug therapy, recently discharged from hospital or emergency department, identification of potential adverse effects, identification of potential drug-drug interactions, and presence of drug toxicities.

CONCLUSION

Pharmacists are uniquely qualified to provide a wide range of pharmaceutical care services to HIV-positive patients. Pharmacy interventions should lead to improved outcomes and decreased costs for a chronic and very expensive disease.

Individual differences in infant visual attention: recognition of degraded visual forms by four-month-olds

In 5 experiments, 4-month-old infants were tested for their ability to recognize degraded visual targets as a function of individual differences in fixation duration. Targets were degraded by removing 10% of the total contour either from vertices (vertex-absent) or from midsegments (vertex-present). Both qualitative and quantitative differences were found in long and short lookers' ability to recognize the degraded forms. Short-looking infants were able to recognize degraded forms in both vertex-absent and vertex-present conditions, but the vertex-absent discrimination was more difficult. Long-looking infants required longer familiarization times before showing evidence of recognition in the vertex-present condition, and were unable to recognize targets in which contour was removed at vertices. The findings are discussed within the framework of the persistence of early visual processing strategies, and reliance of long-looking infants on particular local elements in visual analysis.

Preservation of amplitude modulation coding in the presence of background noise by chinchilla auditory-nerve fibers

Sound envelope temporal fluctuations are important for effective processing of biologically relevant acoustic information including speech, animal vocalizations, sound-source location, and pitch. Amplitude modulation (AM) of sound envelopes can be encoded in quiet with high fidelity by many auditory neurons including those of the auditory nerve (AN) and cochlear nucleus. From both neurophysiological and clinical perspectives, it is critical to understand the effects of background masking noise on the processing of AM. To further this goal, single-unit recordings were made from AN fibers in anesthetized chinchillas. Units were classified according to spontaneous firing rate (SR) and threshold. Best frequency (BF) pure-tone bursts and AM (10-500 Hz) tone bursts were employed as stimuli at several sound levels, both in quiet and in the presence of a continuous wideband noise. It was found that (1) in quiet, low SR AN fibers show the strongest AM coding, followed in order by medium SR and high SR fibers, respectively. (2) AN units of all three classes generally preserve their AM coding even in the presence of loud (0 or +6 dB S/N) background noise and at high sound levels (over 75 dB SPL). (3) This preservation is usually achieved by lowering the average firing rate proportionately to decreases in the synchronous (fundamental frequency) response. (4) For a few AN fibers, the AM coding increases or is reduced in the presence of the background noise. These findings suggest that AN preservation of AM coding in the presence of a continuous masking noise results from shifts in the operating ranges and firing rates of AN fibers resulting from cochlear nonlinearities and adaptive mechanisms.