Nuclear localization of heparanase 2 (Hpa2) attenuates breast carcinoma growth and metastasis

Unlike the intense research effort devoted to exploring the significance of heparanase in cancer, very little attention was given to Hpa2, a close homolog of heparanase. Here, we explored the role of Hpa2 in breast cancer. Unexpectedly, we found that patients endowed with high levels of Hpa2 exhibited a higher incidence of tumor metastasis and survived less than patients with low levels of Hpa2. Immunohistochemical examination revealed that in normal breast tissue, Hpa2 localizes primarily in the cell nucleus. In striking contrast, in breast carcinoma, Hpa2 expression is not only decreased but also loses its nuclear localization and appears diffuse in the cell cytoplasm. Importantly, breast cancer patients in which nuclear localization of Hpa2 is retained exhibited reduced lymph-node metastasis, suggesting that nuclear localization of Hpa2 plays a protective role in breast cancer progression. To examine this possibility, we engineered a gene construct that directs Hpa2 to the cell nucleus (Hpa2-Nuc). Notably, overexpression of Hpa2 in breast carcinoma cells resulted in bigger tumors, whereas targeting Hpa2 to the cell nucleus attenuated tumor growth and tumor metastasis. RNAseq analysis was performed to reveal differentially expressed genes (DEG) in Hpa2-Nuc tumors vs. control. The analysis revealed, among others, decreased expression of genes associated with the hallmark of Kras, beta-catenin, and TNF-alpha (via NFkB) signaling. Our results imply that nuclear localization of Hpa2 prominently regulates gene transcription, resulting in attenuation of breast tumorigenesis. Thus, nuclear Hpa2 may be used as a predictive parameter in personalized medicine for breast cancer patients.

[Population Dynamics of Cancer: a Model of Second Order Phase Transition]

The paper deals with an approach to the description of the age and temporal dynamics of cancer, based on the model describing the dynamics of the age of cancer as a second order phase transition. This approach is widely used for studying physical systems. This model of cancer development as second order phase transitions is in a good agreement with medical statistics. The cancer incidence dynamics is described only with two free parameters, easily verified according to statistics and well interpreted. The applicability of the second order phase transition model for description of a non-physical system defines the universal nature of the processes occurring during phase transitions.

Abstract P3-06-03: Oral bisphosphonates and survival of breast and colon malignancies

Bisphosphonates are traditionally used for treatment of osteoporosis and more recently for treatment and prevention of bone metastases in various malignancies. The use of 2nd-generation oral bisphosphonates has been reported to reduce the risk of developing breast and colon cancer but their influence on cancer survival has not been studied.

Methods Two large cohorts of consecutively diagnosed cases with breast or colorectal cancer were studied for the association between use of 2nd-generation oral bisphosphonates and cancer survival. Using computerized prescription records, sustained use of alendronate/risedronate was assessed in postmenopausal women with newly diagnosed breast (n = 2,843) or colorectal cancer (n = 1,706). Overall survival and cancer-specific survival were evaluated using time dependent analysis.

Results Postmenopausal women with breast cancer previously unexposed to bisphosphonates who used 2nd-generation bisphosphonates after diagnosis for at least one year had a significantly better survival than non-users, adjusted for age, tumor stage and grade (Overall survival: HR = 0.53, 0.33-0.86, breast cancer-specific survival: HR = 0.26, 0.10-0.71, p = 0.009). A similar advantageous hazard ratio was found in users with ER positive, ER negative and HER2neu positive tumors. A similar significantly better survival was noted for colorectal cancer after adjustment for age, tumor stage and grade (Overall survival: HR = 0.53, 0.33-0.85, colorectal cancer-specific survival: HR = 0.44, 0.21-0.88, p = 0.02). Women who used bisphosphonates before diagnosis did not exhibit a significant survival benefit. Pharmacogenetic studies of F(D)PPS (Farnesyl Pyrophosphate Synthase), a gene coding a key step in the mevalonate pathway revealed direct correlation between a minor homozygous status and survival in bisphosphonate users.

Conclusions The use of 2nd-generation bisphosphonates initiated after diagnosis was associated with a significant improvement in overall and in cancer-specific survival of postmenopausal women with breast or colon cancers.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-03.

Expression of vascular permeability factor (VPF/VEGF) is altered in many glomerular diseases

Vascular permeability factor (VPF), also known as vascular endothelial growth factor (VEGF), is a potent enhancer of microvascular permeability and a selective endothelial cell growth factor. In normal human kidney, VPF/VEGF mRNA and protein are strongly expressed by visceral glomerular epithelial cells, and VPF/VEGF may be an important regulator of glomerular endothelial cell function. This study examined 47 renal biopsies from patients with a variety of glomerular diseases for expression of VPF/VEGF mRNA and protein by in situ hybridization and immunohisto-chemistry. In many glomerular diseases, VPF/VEGF-expressing cells were decreased in number or absent in areas of focal or global glomerular sclerosis. Decreased numbers of VPF/VEGF-expressing cells in glomeruli were also noted in amyloidosis, diabetes, crescentic glomerulonephritis, and diffuse endocapillary proliferative glomerulonephritis associated with systemic lupus erythematosus. Normally, release of VPF/ VEGF must be under strict control because it is some 50,000 times more potent than histamine as an inducer of microvascular permeability. Damage to visceral epithelial cells in a variety of glomerular diseases has the potential for releasing relatively large amounts of VPF/VEGF locally, leading to increased glomerular permeability. In addition, because VPF/ VEGF is also an endothelial growth factor, the loss of normal, controlled secretion of VPF/VEGF after damage to visceral epithelial cells could lead to important alterations in glomerular endothelial cell function.

Caregiving and dementia: predicting negative and positive outcomes for caregivers

A sample of 118 caregivers, maintaining relatives with dementia at home, were interviewed and completed questionnaires at initial and follow-up assessment six months later. All dependents received a cognitive assessment. The results of LISREL analysis of the data supported a model of caregiving in which negative outcomes of burden and impaired health reduced positive outcomes of enjoyment of aspects of caregiving. Caregivers with larger social support networks were more satisfied with their support, reducing feelings of impaired health, although as caregiving became more difficult, satisfaction with support decreased. The retrospective perception of the premorbid relationship as more difficult lead to the appraisal of the patient's symptoms as presently being more extensive and increased burden. Women caregivers reported both greater feelings of burden and more aspects of caregiving as enjoyable.

Abnormal brain biomechanics in the hydrocephalic child. From: Concepts in Pediatric Neurosurgery, 1982,vol 2

Sixteen children with active hydrocephalus were studied using the Pressure Volume Index (PVI) technique to characterize neural axis compliance and the resistance to CSF absorption (Ro). Intracranial pressure for the series was 16.2 +/- 6.2/13.3 +/- 6.1 mm Hg. Measured PVI was twice that predicted for each child, indicating abnormally compliant systems. Ro was 7.8 +/- 1.7 mm Hg/ml/min, a three-fold increase above normal. There was no correlation between PVI and ventricular size. These studies indicate that the biomechanical properties of the brain and its coverings are altered by the hydrocephalic process in a way that encourages further accumulation of volume.

UK survey of psychiatric services for the elderly: direction for developing services

As an important step in health care planning for the elderly, a systematic descriptive study of ten psychogeriatric services was undertaken in the United Kingdom. A definite trend emerged of a reduction in the number of hospital beds as community services developed. Health authorities tended to establish a clinical base in general hospitals rather than in mental hospitals. The recent effect of the rapid growth of the private nursing home sector is also described. Some rough guidelines are provided for the basic resources needed to establish a comprehensive service including one assessment bed and one day place per 1,000 elderly persons; the number of long-stay beds depends on the number of places available in the private sector. While the Canadian health care system differs in some fundamental ways from that in the UK, the principles and guidelines derived from the UK experience may be applied to meet the psychiatric needs of the elderly in Canada.

Issues in determining financial competence in the elderly

With the ever-increasing numbers and relative proportion of elderly in the population, physicians are now frequently facing the difficult task of determining the financial competence of vulnerable individuals. The determination of financial competence in the elderly is still a very poorly defined issue. In this paper an attempt is made to clarify the existing law and the physician's legal obligations. The Mental Health Act, Powers of Attorney Act and Mental Incompetency Act, as they relate to a patient's financial competence, are reviewed. The difficulties in the clinical application of these laws are illustrated by two reports of patients referred to the geriatric psychiatry service of Sunnybrook Medical Centre, University of Toronto. Some general principles and practical guidelines are proposed to help physicians deal more effectively with this issue.

Roses in December: imaginary companions in the elderly

This paper focuses on one mental mechanism used in alleviating distress viz. illusion. Three patients are discussed with particular reference to their use of this mechanism. Some relevant literature is reviewed.

Quantitative evaluation of cerebrospinal fluid shunt flow

We describe a rigorous method for measuring the flow of cerebrospinal fluid (CSF) in shunt circuits implanted for the relief of obstructive hydrocephalus. Clearance of radioactivity for several calibrated flow rates was determined with a Harvard infusion pump by injecting the Rickham reservoir of a Rickham -Holter valve system with 100 microCi of Tc-99m as pertechnetate. The elliptical and the cylindrical Holter valves used as adjunct valves with the Rickham reservoir yielded two different regression lines when the clearances were plotted against flow rates. The experimental regression lines were used to determine the in vivo flow rates from clearances calculated after injecting the Rickham reservoirs of the patients. The unique clearance characteristics of the individual shunt systems available requires that calibration curves be derived for an entire system identical to one implanted in the patient being evaluated, rather than just the injected chamber. Excellent correlation between flow rates and the clinical findings supports the reliability of this method of quantification of CSF shunt flow, and the results are fully accepted by our neurosurgeons.

An improved gravimetric measure of cerebral edema

Significant errors are introduced into the measurement of brain tissue water by the specific gravity technique when the edema fluid contains protein. Protein adds to the tissue solids, increasing the density of the tissue, and masks the proportional increase of brain water. Existing equations relating measured specific gravity and tissue water are not applicable, and a new formula was developed that compensates for the protein component of edema and reduces the experimental error. The new method was applied to the measurement of tissue water in cat brain made edematous by direct infusion of fluids of known composition and volume to test the theory. This technique for improving the gravimetric assessment of brain edema is presented.

Characterization of clinical CSF dynamics and neural axis compliance using the pressure-volume index: I. The normal pressure-volume index

The pressure-volume index (PVI) technique was used to measure neural axis compliance, cerebrospinal fluid (CSF) formation (If), and CSF absorption (Ro) in 23 children and 7 adults, all free from intracranial masses, who were undergoing diagnostic or therapeutic procedures. Using bolus manipulation of CSF, If was 0.36 +/- 0.08 ml/min and Ro was 2.8 +/- 0.8 mm Hg/ml/min in both adults and children. PVI, as a measure of neural axis compliance or volume buffering capacity, was 25.9 +/- 3.7 ml for the adults. Measured PVI in the children varied from 8.2 to 30.1 ml but correlated well (r = 0.93) with predicted PVI based on estimates of intracranial and spinal volumes obtained from external measurements. This study provides normal reference data in humans for assessing CSF hydrodynamics and neural axis compliance using the PVI technique in pathological settings.

Breaststroker's knee: pathology, etiology, and treatment

Twenty-three breaststroke swimmers (ranging in age from 6 to 30 years old) with painful knees were examined. Underwater movies of these swimmers were taken. Eighteen swimmers had tenderness under the medial facet of the patella and over the medial femoral intercondylar ridge. Five of these 18 swimmers also had tenderness along the tibial collateral ligament. Five swimmers had tenderness just along the tibial collateral ligament. The onset of knee pain usually occurred within 3 years of the swimmers' beginning the breaststroke. Initially, the knees were only symptomatic when the swimmers performed the whipkick. As the swimmer continued the breaststroke, in spite of discomfort, the knees became symptomatic during other athletic and nonathletic activity. Breaststroke who had been using the whipkick for more than 8 years had clinical evidence of patellofemoral osteoarthritis. The site of pain in the knee was related to the way in which the whipkick was performed. Breaststroke without knee pain used a whipkick with characteristics that were consistently different than those of the symptomatic swimmers. Treatment of breaststroke's knee should be directed toward correcting the swimmer's whipkick. This approach is most likely to be successful if applied as soon as the swimmer becomes symptomatic.

Intracranial meningiomas of infancy, childhood and adolescence. Review of the literature and addition of 9 case reports

The authors add 9 cases of pediatric meningiomas to 112 previously published cases and review clinical findings. Characteristic clinical and radiologic features are discussed in an attempt to identify settings where the diagnosis of intracranial meningioma should be considered in a child. Preoperative evaluation and outcome are also reviewed.

Bipolar affective disorder in old age

In a retrospective study of 67 elderly bipolar patients the first manic attack occurred at about age 60, often after a long period from the time of the first affective episode, after which further depressive episodes occurred. This calls into question Perris' criteria for unipolar diagnosis. Among the men, a preponderance of cerebral-organic disorders was found. The evidence for sub-classification of bipolar disorders into secondary or symptomatic manias is discussed. The recurrent nature of the illness in old age stresses the need for further evaluation of lithium prophylaxis.

Pulmonary shunt as a prognostic indicator in head injury

Severe head injury may cause momentary respiratory arrest. Resultant hypoxia would increase cerebral edema and adversely affect the quality of survival. This study examines the effect of hypoxemia on outcome. Pulmonary shunt was calculated as a convenient measurement of respiratory insufficiency in 86 severely head-injured patients who underwent surgery. All samples were taken shortly after induction into anesthesia when controlled ventilation with high inspired-oxygen concentration had been established. In 39 patients who improved, mean pulmonary shunt was 8.9%. Twelve patients who survived with deficit showed a mean shunt of 13.6%, and in 35 patients who died, the mean initial shunt was 15.6%. No significant correlation was found between abnormal chest x-ray findings or the occurrence of hypertension and shunt percentage. The American Society of Anesthesiologists at-risk classification correlated grossly with the outcome. Early pulmonary shunt is a prognostic indicator in severe head injury and should be used in conjunction with the Glasgow Coma Scale in assessing outcome. Despite an apparently adequate respiratory pattern, all patients with severe head injury must be assumed to be hypoxic until proven otherwise. While hypoxemia may prove to be refractory in overwhelming injury, patients who score low on the Glasgow Coma Scale but who have relatively normal oxygen exchange may still survive with little deficit.

Precocious puberty of cerebral origin

Eighty-two cases of precocious puberty of cerebral origin were reviewed. All shared as a common factor the distortion, compression, or destruction of diencephalic structures. Attempts were made to parallel basic research findings with those derived from human pathology, hoping to gain further insight into the physiopathology of precocious puberty of cerebral origin.

Suicide and parasuicide in old age: a review

The disproportionately high suicide rate among the elderly is examined in this review. As opposed to younger age groups, a close association exists between suicide and parasuicide in old age. Factors associated with these events include a high incidence of depression, serious physical illness, as well as social factors that serve to isolate the individual and deprive him of positive support and therapeutic intervention. A high risk profile and integrative model are proposed.

A simple gravimetric technique for measurement of cerebral edema

A simple method was developed for the laboratory preparation of gradient columns of specific gravity used in measurement of brain-tissue water. By this automated technique, virtually linear and repeatable density gradients were obtained from which values of tissue specific gravity could be determined. The specific gravity of both solid and fresh cortex and white matter from adult cats was measured and converted to units of percent water per gram tissue using conversion factors derived for this purpose and applicable to studies of brain edema.

A nonlinear analysis of the cerebrospinal fluid system and intracranial pressure dynamics

A mathematical model of the cerebrospinal fluid (CSF) system was developed to help clarify the kinetics of the intracranial pressure (ICP). A general equation predicting the time course of pressure was derived in terms of four parameters: the intracranial compliance, dural sinus pressure, resistance to absorption, and CSF formation. These parameters were measured in the adult cat, and the equation was tested by comparing experimental and calculated values of the time course of pressure in response to volume changes. The theoretical and experimental results were in close agreement, and the role of each parameter in governing the dynamic equilibrium of the ICP was determined. From this analysis, dynamic tests were developed for rapid measurement of CSF formation, absorption resistance, and the bulk intracranial compliance. These techniques are applicable to clinical settings, providing data that are useful in characterizing the physiological mechanisms responsible for raised ICP and assessing changes induced by therapy.

Fall in admission rate of old people to psychiatric units

The numbers of the elderly, and particularly the very old, have been increasing and continue to increase rapidly; but admission rates of old people to psychiatric hospitals in England and Wales suddenly started to fall in 1970. They were still generally falling in 1974 (the most recent year for which figures are available). There is no evidence that the incidence of dementia has suddenly fallen, or that expansion of extramural or other non-psychiatric services is everywhere coping with the severely demented. It is probably becoming more difficult for demented people to be admitted to psychiatric hospitals that are often still overcrowded, in view of the greater scrutiny of institutional care that has become established since the Ely Report of 1969. If this is so the cost to the demented and those who care for them of the undoubted improvements in conditions in psychiatric hospitals needs to be counted.

Choroidal epithelial cyst. Case report

A supratentorial cyst in the leptomeninges of an 8-month-old infant was studied with the electron microscope. The lining of the cyst consisted of a single layer of peg-shaped epithelial cells rich in organelles and glycogen. Their free border had numerous microvilli but no cilia, and their basal portions rested on a basement membrane. Tight junctions and interdigitations were frequent between contiguous cells. The blood vessels were fenestrated. Since these features characterize developing choroidal epithelial cells, we felt the diagnosis of choroidal epithelial cyst was justified. Cysts lined by choroidal epithelium may continue to secrete cerebrospinal fluid after surgical extirpation when this is incomplete. Accumulation of the fluid in the partially excised cyst bed may therefore account for recurrence of symptoms.

Tissue pressure gradients in spinal cord injury

Using cotton wick catheters, local tissue pressure was measured in the dorsal white matter of the impacted feline spinal cord. Twenty gram and 30 gram weights dropped 20 cm did not produce statistically significant elevations in tissue pressure adjacent to and remote from the site of injury. Forty gram weights dropped 20 cm produced pressure gradients of less than 10 mmHg between areas near and remote from the injury and between parenchyma and cerebrospinal fluid. In a group studied 18-24 hours after similar injuries, no gradients were found, although edema formation as indicated by Evan's blue migration had progressed. These findings indicate that gradients of pressure within parenchyma are associated with edema spread following high impaction forces and that edema spread can continue after dissipation of these gradients.

Cyclic AMP and adenyl cyclase in brain tumors

Some of the regulatory mechanisms of cyclic adenosine monophosphate (AMP) production in human brain tumors were investigated by assessing both cyclic AMP levels and adenyl cyclase activity. A large disparity was found between the levels of cyclic AMP of normal brain and brain-tumor tissue. Cyclic AMP levels were much lower in brain tumors (25.8 pmoles (picomoles)/mg protein) than in normal brain (98.8 pmoles/mg protein). These studies also show that the abnormally low levels of cyclic AMP in tumors parallel those of adenyl cyclase. The mean adenyl cyclase activity of brain tissue was found to be 111.0 pmoles of cyclic AMP/min/mg protein, while that of the tumor was only 23.0 pmoles/min/mg protein. Levels of cyclic AMP and adenyl cyclase activity were inversely related to the degree of malignancy. Attempts to stimulate adenyl cyclase in homogenates of human brain and brain tumors resulted in a similar response in both tissues. Norepinephrone was the most effective stimulant and produced a two- to threefold increase in cyclic AMP production, while histamine had no effect. It is concluded that one of the factors governing tumor growth may be a defect in the adenyl cyclase system.

Facial nevi associated with anomalous venous return and hydrocephalus

The authors describe two children with anomalous intracranial venous return associated with bilateral facial nevi, macrocrania, and cephalic venous hypertension. Both children had functional absence of the jugular bulbs, forcing the intracranial venous effluent to exit through persistent emissary pathways. Both children had sustained intracranial hypertension, with one child developing symptomatic communicating hydrocephalus that responded satisfactorily to shunting. The relationship between these patients and those with Sturge-Weber syndrome is discussed. The embryologic abnormality producing the anomalous venous return is characterized. The link between venous hypertension and the development of hydrocephalus is discussed. The increased cranial compliance seen in this age group may predispose certain pediatric patients to develop hydrocephalus when stressed by venous hypertension.

Primary intracranial Burkitt's lymphoma in an infant

A case of intracranial Burkitt's lymphoma is reported in a child whose symptoms began at 3 months of age with a definite histologic diagnosis established at 18 months. Serologic studies demonstrated high antibody titers to Epstein-Barr virus (EBV) in the patient and in four out of five members of the immediate family. The patient also demonstrated immunity to antigens derived from African Burkitt's lymphoma cell lines. The autopsy findings strongly support the case for the primary intracranial origin of the neoplasm and a perinatal infection with EBV is probable in this case.

Spinal cord seeding from cerebellar astrocytomas

Three juvenile patients with cerebellar astrocytomas which have seeded the spinal subarachnoid space are presented. Histologic verification of the similarity between the posterior fossa tumor and its spinal implant was obtained in two of the three patients. The cerebellar tumors in all cases have been benign (grade I),and the behavior, other than their seeding has also been indolent. Review of pertinent literature discloses no similar experience with cerebellar astrocytomas. Aggressive therapy is advocated for the rare patient with subarachnoid seeding from this benign lesion.

Compartmental analysis of compliance and outflow resistance of the cerebrospinal fluid system

The distribution of compliance and outflow resistance between cerebral and spinal compartments was measured in anesthetized, ventilated cats by analysis of the cerebrospinal fluid (CSF) pressure response to changes in CSF volume. Cerebral and spinal compartments were isolated by inflating a balloon positioned epidurally at the level of C-6. The change of CSF volume per unit change in pressure (compliance) and change of CSF volume per unit of time (absorption) were evaluated by inserting pressure data from the experimental responses into a series of equations developed from a mathematical model. It was found that 68% of total compliance is contributed by the cerebral compartment while the remaining 32% is contained within the spinal axis. The cerebral compartment accounted for 84% of total CSF absorption. The mechanism for spinal absorption appears to be similar in that no differences were obvious on the basis of pressure dynamics.

Pial microcirculation in subarachnoid hemorrhage

Microsurgical and microscopic methods were employed in guinea pigs to expose, observe, and measure response characteristics of cerebral cortical pial microvessels and microcirculation to traumatic and nontraumatic experimental subarachnoid hemorrhage. Bleeding produced by vascular micropuncture was associated with a 44.3% arteriolar constriction. Topical application of homologous blood alone produced a 33.2% vasoconstriction. Observed microcirculatory flow characteristics subsequent to such microvascular changes were consistent with those known to be associated with cerebral cortical infarction. These changes could be prevented or reversed by topical application of the alpha adrenergic blocker, phenoxybenzamine. Topical pretreatment with the beta adrenergic blocker, propranolol, prevented blood-induced spasm, but did not reverse such spasm once it had been established. A chemo-mechanical mechanism is suggested as underlying the vasoconstriction association with rupture of pial microvessels. It is thought that consideration of such microvascular characteristics, in conjunction with those known to be associated with larger intracranial vessels, adds to current knowledge of the pathophysiology of subarachnoid hemorrhage and may be extrapolated to bear future clinical import.