Systematic review: Progression of beryllium sensitization to chronic beryllium disease

BACKGROUND

The relevance of beryllium sensitization testing for occupational health practice and prevention is unclear.

AIMS

To analyse the natural course of beryllium sensitization and clarify the prognosis following cessation of exposure among sensitized workers.

METHODS

An electronic literature search was conducted in PubMed, Embase, Toxline and Cochrane databases supplemented by a manual search. Data abstraction and study quality assessment with adapted guideline checklists were performed independently by three reviewers. Seven studies met the eligibility criteria and were included in the systematic review; however, six of the seven studies were of low methodological quality.

RESULTS

A substantial (although not specifically quantifiable) proportion of beryllium-sensitized employees will develop chronic beryllium disease (CBD). To date, it is unknown if cessation of exposure in sensitized workers reduces the progression rate to CBD.

CONCLUSIONS

To determine the utility of regular assessments for beryllium sensitization among exposed workers, there is a need for prospective studies. This should include detailed and continuous exposure monitoring, regular tests for beryllium sensitization and a thorough diagnostic evaluation of sensitized workers to confirm or exclude CBD.

uPA and PAI-1 in breast cancer: review of their clinical utility and current validation in the prospective NNBC-3 trial

The plasminogen activator system is a complex system with multiple interactions and members participating in fibrinolysis, cell migration, angiogenesis, wound healing, embryogenesis, tumor cell dissemination, and metastasis in a variety of solid tumors. Increased levels of uPA and/or PAI-1 in primary tumor tissues of breast cancer patients correlate with tumor aggressiveness and poor clinical outcome. Patients with high tumor tissue antigen content of uPA and/or PAI-1 have a worse probability of disease-free and overall survival than patients with low levels of both of the biomarkers, serving as prognostic markers. The clinical utility of uPA and PAI-1 has been proven on the highest level of evidence (LOE-I). Next to being clinically useful prognostic factors allowing estimates of the course of disease in early breast cancer, uPA and PAI-1 may also serve as predictive factors predicting response to systemic therapy. Node-negative primary breast cancer patients with high uPA/PAI-1 levels benefit significantly from adjuvant chemotherapy. The aim of the ongoing NNBC-3 trial is to determine the benefits of a sequential anthracycline-docetaxel regimen in high-risk node-negative breast cancer patients compared to the current standard of anthracycline-based chemotherapy. At present, uPA and PAI-1 provide the unique opportunity to allow validated and clinically relevant risk assessment of breast cancer patients, over and above that provided by established risk factors. Therefore, in the evidence-based, annually updated AGO guidelines for breast cancer management, the German Working Group for Gynecological Oncology (AGO) has recommended both biomarkers as risk-group-classification markers for routine clinical decision making in node-negative breast cancer, next to established clinical and histomorphological factors.

Comparison of outcome prediction in node-negative breast cancer based on biomarkers uPA/PAI-1 or Adjuvant Online using the 10-year follow-up of the randomized multicenter Chemo N0 trial

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Background: Chemo N0 was the first multicenter randomized clinical trial in breast cancer using biomarkers uPA/PAI-1 for risk stratification and chemotherapy selection. Chemo N0 validated uPA/PAI-1 as clinically relevant parameters for risk assessment in N0 breast cancer. About 50% of N0 patients have low uPA/PAI-1 in their primary tumor with excellent 5-year OS (>95%), even without adjuvant therapy. Patients with high uPA/PAI-1 benefit from adjuvant chemotherapy. We evaluated whether biomarkers can predict outcome more accurately than a computer-program. Methods: In Chemo N0, patients (n=689, 1993–98) were stratified according to uPA/PAI-1: High-risk patients were randomized (6x CMF vs. observation), low-risk patients observed. Retrospectively, we divided recruited patients into two groups (chemotherapy vs. no adjuvant therapy) and stratified using uPA/PAI-1 (low vs. high). Individual 10-year OS was calculated by www.adjuvantonline.org (Version 7.0); these estimated values were compared to the observed 10-year OS in Chemo N0. Results: 81/151 patients with already available complete follow-up data 10 years after trial start have 10-year OS results. Median 10-year OS estimated by Adjuvant Online was 77.1% (median 78.6%) taking into account administered adjuvant therapy. 10-year Chemo N0 follow-up revealed an observed 10-year OS of 66.7% (27/81 deceased). 64/81 did not receive chemotherapy: In high-risk untreated patients (n=22), 10-year OS was 54.6% vs. estimated 75.0%. In CMF-treated patients (all high-risk, n=17), observed OS was 58.8% vs. estimated 74.6%. Conclusions: For the first time, risk assessment by novel biomarkers is compared to that by Adjuvant Online in data from a randomized clinical trial. In patients with high uPA/PAI-1, the individual 10-year OS calculated by Adjuvant Online seems to be underestimated compared to observed patient outcome. Further follow-up data will show whether uPA/PAI-1 can predict the individual course of disease more precisely than a computer-program based on large clinical data sets. Final Chemo N0 10-year follow-up is currently being completed.

No significant financial relationships to disclose.

Expression of endothelin-A-receptor predicts unfavourable response to neoadjuvant chemotherapy in locally advanced breast cancer

Endothelin-1 (ET-1) and its receptors (ET_AR and ET_BR), referred to as the endothelin (ET) axis, are overexpressed in breast carcinomas and appear to influence tumour growth and progression. The objective of this study was to determine the effect of expression of the ET axis in breast carcinomas on response to cytotoxic chemotherapy. The study included 44 patients with locally advanced breast cancer participating in a prospective phase III study evaluating high-dose neoadjuvant chemotherapy of epirubicin and cyclophosphamide. Expression of ET-1, ET_AR and ET_BR was determined by semiquantitative immunohistochemical analysis of breast cancer tissue from prechemotherapy tru-cut biopsies. Immunohistochemical staining was positive for ET-1 in 61.5%, for ET_AR in 35% and for ET_BR in 35.9% of breast carcinomas. Pathological response to chemotherapy was significantly decreased in ET_AR-positive patients (P=0.002). In total, 50% of ET_AR-positive patients as compared to 7.7% of ET_AR-negative patients attained pathologically ‘no change’. Logistic regression confirmed ET_AR as an independent predictive marker for pathological response (P=0.009). These data indicate that increased expression of ET_AR in breast carcinomas is associated with resistance to chemotherapy. Determination of ET_AR status may serve as a predictive marker for identifying patients less likely to be responsive to conventional chemotherapy.

[The death of moulages - wax figures in dermatology]

Wax has been used for illustration purposes back to antiquity. Since the renaissance period human anatomy and different diseases have often been depicted in wax. During the last century the art of moulage preparation evolved to three-dimensional, realistic representations of diseased parts of the human body. Its heyday and wide spread distribution paralleled the growing independence of dermatology. Apart from few exceptions, most mouleurs did not permit access to their technique either to successors or the public. Just like other European hospitals, the Department of Dermatology at Kiel University houses a comprehensive collection of moulages dating back to a century. The 455 objects left today were collected by Professor Viktor Felix Karl Klingmüller (1870-1942) who was head of the department from 1906 to 1937. The mouleur Alfons Kröner from Breslau who died 1937 supplied most (354) of the wax models. Highly esteemed at his time, Kröner was quite secretive about his art of moulagig. 35 of his moulages bear the abbreviation "DRP" standing for Deutsches Reichspatent (German patent); Kröner was granted a patent in 1902. In his patent application both wax mixtures and technical procedure of moulaging are described in great detail. Kröner, similarly to Jules Baretta (Paris), coloured his moulages at the back of the wax layers. Applying for a patent demonstrates his effort to meet increasing commercial pressure among suppliers of teaching aids at that time. Knowledge of individual technical procedures is essential for medical history as well as proper restauration of moulages as they continually deteriorate with time. Because of their three-dimensional and realistic disease representations, moulages still compare well to modern media used today. Consequently, the "dying of moulages" concerning the wax objects themselves as well as public or medical interest has to be stopped to preserve moulages for future generations.