Overall survival benefit with masitinib mesylate in imatinib-naive, locally advanced, or metastatic gastrointestinal stromal tumor (GIST): 4-years follow-up of the French Sarcoma Group phase II trial

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Background: Masitinib is a novel tyrosine kinase inhibitor which, in vitro, has greater activity and selectivity than imatinib (IM) against both wild-type KIT receptor and its mutated form in the juxtamembrane region (IC 50=100 nM versus 200 nM for IM, 3 nM versus 27nM and 40 nM versus 120nM, respectively, for exons 9,11, and 13). This multicenter phase II study evaluated efficacy and safety of masitinib as a first-line treatment of advanced GIST.

Methods: IM-naïve patients with inoperable, locally advanced or metastatic GIST received oral masitinib (7.5 mg/kg/day) until progression, refusal or toxicity. Efficacy variables included response rate, best response (RECIST), progression-free survival (PFS) and overall survival (OS). Initial results were previously reported in EJC 2010. We present here the same series with updated PFS and OS (median follow up of 48 months).

Results: 30 patients with a median age of 58 years (60% of males) were included from June 2005 to April 2007 in five French institutions. At the cut-off date (31 august 2010), 9 patients are still under treatment with a median treatment duration of 41 months (min=33, max=52). Two additional progressions have been reported for a total of 14 events (13 progressions and 1 death). Updated median PFS is 41 months (95% CI: [17.5; NR]) with PFS rates of 60% [39; 77], 56% [35; 73] and 45% [24; 64] respectively at 2, 3 and 4 years. With 8 patients dead, median OS is not yet reached with OS rates of 90% [72; 97], 87% [68; 95] and 74% [52; 87], respectively, at 2, 3, and 4 years. The main frequent relevant grade 3 toxicities were: rash (10%), neutropenia (7%) and abdominal pain (7%) with one patient presented a grade 4 skin exfoliation. No other relevant long-term toxicities were reported and no more patients discontinued treatment due to suspected toxicity.

Conclusions: The long term results observed with masitinib confirm a very interesting activity with prolonged PFS and OS. These results support the head to head comparison with imatinib in the currently ongoing phase III randomized clinical trial in first line locally advanced or metastatic GIST patients.

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A comparative study of endothelial cell markers expressed in chronically inflamed human tissues: MECA-79, Duffy antigen receptor for chemokines, von Willebrand factor, CD31, CD34, CD105 and CD146

Endothelial cells play a central role in chronic inflammation: for example, they express adhesion molecules and present chemokines leading to enhanced leukocyte recruitment into tissues. Numerous markers of endothelial cells have been reported but there has been a lack of comparative data on their specificity. The present study compared the specificity of seven endothelial cell markers in the rheumatoid synovium and the colon of patients with Crohn's disease. These markers were: the sulphated epitope MECA-79, the Duffy antigen receptor for chemokines (DARC), von Willebrand factor, CD31 (PECAM-1), CD34, CD105 (endoglin) and CD146. MECA-79, DARC and von Willebrand factor showed a specific endothelial cell distribution. MECA-79, which recognizes sulphated ligands for leukocyte adhesion receptor L-selectin (CD62L), was selective for a subset of venules in highly inflamed tissue and was present in rheumatoid but not control osteoarthritic synovia. DARC was also specific for venules but had a more widespread distribution than MECA-79, and was present in rheumatoid and control synovia. The other markers all labelled endothelial cells in venules, arterioles and capillaries. However, they also localized to other cell types. For example, CD34 stained fibroblasts, CD146 was expressed by the pericytes and smooth muscle cells of vessel walls and CD31 and CD105 labelled a broad range of cell types.

Endothelial cell phenotypes in the rheumatoid synovium: activated, angiogenic, apoptotic and leaky

Endothelial cells are active participants in chronic inflammatory diseases. These cells undergo phenotypic changes that can be characterised as activated, angiogenic, apoptotic and leaky. In the present review, these phenotypes are described in the context of human rheumatoid arthritis as the disease example. Endothelial cells become activated in rheumatoid arthritis pathophysiology, expressing adhesion molecules and presenting chemokines, leading to leukocyte migration from the blood into the tissue. Endothelial cell permeability increases, leading to oedema formation and swelling of the joints. These cells proliferate as part of the angiogenic response and there is also a net increase in the turnover of endothelial cells since the number of apoptotic endothelial cells increases. The endothelium expresses various cytokines, cytokine receptors and proteases that are involved in angiogenesis, proliferation and tissue degradation. Associated with these mechanisms is a change in the spectrum of genes expressed, some of which are relatively endothelial specific and others are widely expressed by other cells in the synovium. Better knowledge of molecular and functional changes occurring in endothelial cells during chronic inflammation may lead to the development of endothelium-targeted therapies for rheumatoid arthritis and other chronic inflammatory diseases.

[Association between work exposure to neurotoxic substances with workers' relationships with their social network]

BACKGROUND

This study explored the impact on family life and social relations that may result from symptoms associated with exposure to neurotoxic substances in the workplace. We assessed the associations between exposure to neurotoxic substances in the workplace, workers'mental health, and workers'relationships with their social network.

METHODS

A sample of 53 workers and their spouse completed a series of questionnaires, an interview on work history, and a structured interview assessing their personal relationships. Exposure to neurotoxic substances in the workplace were assessed by an interview, using a semiquantitative classification system. Mental health was measured with the Profile of Mood States (POMS), and marital satisfaction with the Marital Adjustment Test (MAT). The social network's characteristics were assessed with the Northern California Community Study Interview Schedule (NCCS). The associations between exposure and social networks were assessed with regression analyses.

RESULTS

There were no associations between exposure and marital satisfaction. However, we found a negative association between workers'exposure and degrees of overlap between husbands' and wives' social networks (Pearson's correlation r=-0.27; p<0.05) and a positive association between exposure and workers' dependency on their support network (r=0.46; p<0.01).

CONCLUSION

The results are discussed in terms of variables potentially linking exposure to social relationships as well as in terms of couples' vulnerability to marital distress among exposed workers.

Interaction structure of husbands' and wives' disclosure of marital conflict to their respective best friend

Husbands' and wives' conversations with their respective best friend (N = 88) were coded to assess spouses' and friends' mutual influence in regulating support and interference with regard to spouses' marriage and to assess the impact of spouses' sex and marital satisfaction on the conversation processes. Dissatisfied husbands and wives expressed fewer positive and more negative views of marriage than satisfied husbands and wives and the friends in the 2 groups. There were no group and no sex differences in interference sequences. There were group and sex differences in support sequences. Friends of satisfied wives and those of dissatisfied husbands were more likely than satisfied wives and dissatisfied husbands to get support for their positive views of marriage. The findings are discussed with reference to the specific effects of outsiders' support and interference on satisfied and dissatisfied spouses.

Beyond the workplace: an exploratory study of the impact of neurotoxic workplace exposure on marital relations

BACKGROUND

The impact on family life and social relations that may result from symptoms associated with exposure to neurotoxic substances has never been addressed. This exploratory study assessed the associations between exposure to neurotoxic agents in the workplace, mental health, and marital difficulties.

METHODS

Fifty-five (55) male workers and their spouses completed standardized measures of mental health and marital difficulties. Workers' exposure to neurotoxic substances was evaluated by questionnaire and interview, using a semiquantitative classification system.

RESULTS

A positive relation was observed between exposure level and measures of workers' psychological symptoms and marital stress; no relation was observed between workers' exposure level and wives' psychological symptoms. More severe exposure to neurotoxic substances was associated with wives' reports of more severe marital conflicts, and this association was mediated by husbands' psychological symptoms. As compared to low exposure husbands, high exposure husbands reported higher degrees of stress surrounding marital discussions, more consistent incidence of minor physical assaults by wives, and stronger associations between their levels of stress, the verbal aggressions of wives, and the number of marital conflicts.

CONCLUSIONS

The results of this study confirm that neurotoxic exposure is a risk factor for mental health and suggest how this may influence marital relations. Because of the importance of these findings for the well-being of workers and their families, these associations should be further studied.

Chip-based genotyping by mass spectrometry

Silicon chips with immobilized target DNAs were used for accurate genotyping by mass spectrometry. Genomic DNAs were amplified with PCR, and the amplified products were covalently attached to chip wells via N-succinimidyl (4-iodoacetyl)aminobenzoate (SIAB) chemistry. Primer annealing, extension, and termination were performed on a 1-microl scale directly in the chip wells in parallel. Diagnostic products thus generated were detected in situ by using matrix-assisted laser desorption ionization mass spectrometry. This miniaturized method has the potential for accurate, high-throughput, low-cost identification of genetic variations.

Location score and haplotype analyses of the locus for autosomal recessive spastic ataxia of Charlevoix-Saguenay, in chromosome region 13q11

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a clinically homogeneous form of early-onset familial spastic ataxia with prominent myelinated retinal nerve fibers. More than 300 patients have been identified, and most of their families originated in the Charlevoix-Saguenay region of northeastern Quebec, where the carrier prevalence has been estimated to be 1/22. Consistent with the hypothesis of a founder effect, we observed excess shared homozygosity at 13q11, among patients in a genomewide scan of 12 families. Analysis of 19 pedigrees demonstrated very tight linkage between the ARSACS locus and an intragenic polymorphism of the gamma-sarcoglycan (SGCG) gene, but genomic DNA sequence analysis of all eight exons of SGCG revealed no disease-causing mutation. On the basis of haplotypes composed of seven marker loci that spanned 11.1 cM, the most likely position of the ARSACS locus was 0.42 cM distal to the SGCG polymorphism. Two groups of ARSACS-associated haplotypes were identified: a large group that carries a common SGCG allele and a small group that carries a rare SGCG allele. The haplotype groups do not appear to be closely related. Therefore, although chromosomes within each haplotype group may harbor a single ARSACS mutation identical by descent, the two mutations could have independent origins.

Temporal linkages between wives' pursuit and husbands' withdrawal during marital conflict

This study examined the association between wives' pursuit and husbands' withdrawal during marital conflict discussions, and the affects associated with these behaviors. Ten distressed and 10 nondistressed couples completed a videotaped interaction in which the wives requested changes in husbands' behaviors. Results showed sequential dependencies between wives' pursuit and husbands' withdrawal, but distressed couples, as compared to nondistressed couples, did not engage in stronger pursuit/withdrawal patterns. Distressed husbands showed the highest proportions of anxious affects. The findings are discussed with reference to the affective context of the pursuit/withdrawal pattern.

Phenotypic variability in Friedreich ataxia: role of the associated GAA triplet repeat expansion

We studied genotype-phenotype correlations in a group of 100 patients with typical Friedreich ataxia (FRDA), and in three groups of patients with atypical clinical presentations, including 44 Acadian FRDA, 8 late-onset FRDA (LOFA), and 6 FRDA with retained reflexes (FARR). All patients, except 3 with typical FRDA, carried two copies of the FRDA-associated GAA triplet repeat expansion. Overall, the phenotypic spectrum of FRDA appeared to be wider than defined by the currently used diagnostic criteria. Our study indicated the existence of several sources of variability in FRDA. Patients with larger GAA expansions tended to have earlier onset and were more likely to show additional manifestations of the disease. Mitotic instability of the expanded GAA repeats may partially account for the limited degree of correlation between expansion sizes as determined in lymphocytes and clinical parameters. Some clinical variants associated with specific FRDA haplotypes, such as Acadian FRDA and FARR, turned out to be unrelated to expansion sizes. No polymorphism in the frataxin coding sequence could be associated with these clinical variants.

Friedreich ataxia in Acadian families from eastern Canada: clinical diversity with conserved haplotypes

The gene for Friedreich ataxia (FRDA), an autosomal-recessive neurodegenerative disease, remains elusive. The current candidate region of about 150 kb lies between loci FR2 and F8101 near the D9S15/D9S5 linkage group at 9q13-21.1. Linkage homogeneity between classical FRDA and a milder, slowly progressive Acadian variant (FRDA-Acad) has been demonstrated. An extended D9S15-D9S5 haplotype (C6) predominates in FRDA-Acad chromosomes from Louisiana. We studied 10 Acadian families from New Brunswick, Canada. In eight families, affected individuals conformed to the clinical description of FRDA-Acad; in one, 2 sibs presented with spastic ataxia (SPA-Acad). In the last family, 2 sibs had FRDA-Acad, and one had SPA-Acad. We found that SPA-Acad is linked to the FRDA gene region. The C6 haplotype and a second major haplotype (B7) were identified. The same ataxia-linked haplotypes segregated with both FRDA-Acad and SPA-Acad in two unrelated families. The parental origins of these haplotypes were different. Our observation of different phenotypes associated with the same combination of haplotypes may point to the influence of the parent of origin on gene expression, indicate the effect of modifier genes, or reflect the presence of different mutations on the same haplotypes. Our findings underline the need to investigate families with autosomal-recessive ataxias for linkage to the FRDA region, despite lack of key diagnostic manifestations such as cardiomyopathy or absent deep-tendon reflexes.

[Masculine inexpressiveness: myths and facts]

This article examines the common admission that men express their emotions less than do women. Research data shows little difference between the behaviours of boys and girls before adolescence. During adulthood, however, evidence points to men being less expressive than women except in situations involving aggressive behaviour. Men's diminished expressiveness is apparent in a context of intimate interaction. But in situations where they compete for social status, men seem more likely to express emotions. The authors suggest that more studies take into account the social contexts of emotional expressiveness generated by division of labor based on sex.

[From a community clinic to a CLSC : the desintegrated word.]

SUMMARY In this article, the authors relate their experience as clinical psychologists in a CLSC. The study questions certain ideological foundations of CLSCs which, as a consequence, entirely discard psycho-clinical services. According to the authors, the major elements of the "CLSC approach" - namely multidisci-plinarity, global intervention and programming - lead to the denial of a person's psychic dimension. As well, the authors argue that this approach is the source of questionable decisions in the area of mental health; for example, individual requests to talk freely seem to be ignored in the public health care system. The authors raise the underlying issues surrounding the coexistence of willingness to offer services to "people" on one hand and exclusion of these people as free-talking subjects (sujets parlants) on the other, while at the same time requests of clients to do so are totally neglected.

Influence of propranolol and acebutolol on isoprenaline-induced changes in heart rate and peripheral blood flow in man

The authors studied the variations in the effects of isoprenaline hydrochloride on heart rate (beta 1) and on peripheral blood flow of the upper extremity (beta 2), determined by plethysmography, in a group of 5 men with a mean age of 31 +/- 3 years. The trial was conducted on a single-blind cross-over basis, each subject being infused over 30 min with propranolol (30 microgram/kg), acebutolol (150 microgram/kg) or a placebo (isotonic glucose solution) with at least an 8-day interval between each administration. At the end of the infusion they received isoprenaline (0.01 to 0.075 microgram/kg, in logarithmic progression) every 15 min, for 1 hour. The doses of isoprenaline were injected randomly using a latin square design. The peripheral flow, assessed by the curve of the initial part of the plethysmogram for the first 10 sec, increased with the dose of isoprenaline in the placebo series (Tg alpha = 219.9 log d + 583.4; p less than .01), did not increase in the propranolol series and increased with the dose in the acebutolol series (Tg alpha = 221.5 log d + 567.7; p less than .01); the variations in flow with isoprenaline after placebo and after acebutolol, did not differ significantly. The hear rate increased with the dose of isoprenaline in the placebo series (+55%) although tachycardia was inhibited by propranolol and acebutolol. Under the experimental conditions of this trial, propranolol inhibited beta 1 and beta 2 receptors at the same time, whereas acebutolol inhibited only beta 1 receptors.

[Effects of beta blockaders on ventilatory function in chronic bronchitis]

This study was carried out to determine whether beta blockers could be prescribed for patients with coronary insufficiency and chronic bronchitis. The effects of intravenous infusions (30 mn) of propranolol (30 micrograms/kg), practolol 90 micrograms/kg), atenolol (90 micrograms/kg) and acebutolol (150 micrograms/kg) on vital capacity and expiratory flow rates were investigated in chronic bronchitics. Propranolol (n = 51) moderately reduced the vital capacity and FEV1, by an average 9% and a maximum of 20%. The three other infused agents given to groups of 10 patients did not change the ventilatory function. When the same patients were investigated by cross over with propranol bronchoconstriction was observed. This effect was seen in all stages of chronic bronchitis but was much less severe than in a group of 50 asthmatic patients (-23%). The respiratory tolerance of the cardioselective beta blockers seems to be better but there is considerable individual variation and the diagnosis between asthma and chronic bronchitis may itself be very difficult.

[Evaluation of an analgesic activity in man: thermodolorimetery]

The authors propose an experimental technique which makes possible the evaluation in man of the activity of analgesic or anti-inflammatory medications. The principle of thermodolorimetre threshold of painful thermic sensitivity (S.S.T.D. in the french text) which is stable over a period of time in a given individual receiving a placebo but which varies in a significant fashion in groups treated with a medication belonging to one of the two classifications studied.