[Outcome of selective mating in the Entlebucher Mountain Dog for reduction of ureteral ectopia]

INTRODUCTION

The Entlebucher Mountain Dog is predisposed to ureteral ectopia and associated diseases of the urinary tract as well as the kidneys, which can have severe to lethal consequences. Due to the clustered occurrence of clinical signs in 11 % of Entlebucher Mountain dogs in the absence of a genetic test for ureteral ectopia, screening was introduced in 2008 to allow phenotype-based breeding selection. The ureteral orifices of the dogs are visualized by ultrasound and existing urinary retention or urinary incontinence is documented. The diagnostic findings were evaluated centrally with assignment to one of five phenotypes depending on the localization of the ureteral orifices and the renal and ureteral shape. Breeding approval and mating restrictions are the responsibility of the respective breeding associations and predominantly Entlebucher Mountain Dogs with extravesical ectopic ureters and/or clinical signs were excluded from breeding. The effect of phenotype-based selective mating on the incidence of ureteral ectopia and its clinical signs, as well as possible factors influencing the expression of the phenotype, were determined in the birth cohorts after the introduction of screening. Analysis of the data set of 1456 phenotyped Entlebucher Mountain Dogs showed, that at 11 % versus 5 %, males were more frequently assigned to the extravesical phenotype than females. The effect of phenotype-based breeding selection was examined in a subpopulation consisting of phenotyped parents and their offspring (n = 876). The prevalence of the extravesical phenotype decreased from 24 % in the 2005 to 2007 birth cohorts to 1,4 % in the 2015 to 2017 birth cohorts. Since 2015 almost no Entlebucher Mountain Dogs with incontinence, hydroureter or hydronephrosis have been recorded. It was feared that the additional selection measures to control ureteral ectopia in the small Entlebucher Mountain Dog population would intensify the inbreeding increase. However, this has so far remained absent. Therefore, as long as no genetic test is available, it is recommended to continue phenotype-based breeding selection with exclusion of dogs with extravesical ureteral ectopia and/or hydroureter/hydronephrosis/urinary incontinence, while keeping an eye on the development of the inbreeding coefficient.

Slice cultures from head and neck squamous cell carcinoma: a novel test system for drug susceptibility and mechanisms of resistance

Background:

Human head and neck squamous cell carcinoma (HNSCC) fundamentally vary in their susceptibility to different cytotoxic drugs and treatment modalities. There is at present no clinically accepted test system to predict the most effective therapy for an individual patient.

Methods:

Therefore, we established tumour-derived slice cultures which can be kept in vitro for at least 6 days. Upon treatment with cisplatin, docetaxel and cetuximab, slices were fixed and paraffin sections were cut for histopathological analysis.

Results:

Apoptotic fragmentation, activation of caspase 3, and cell loss were observed in treated tumour slices. Counts of nuclei per field in untreated compared with treated slices deriving from the same tumour allowed estimation of the anti-neoplastic activity of individual drugs on an individual tumour.

Conclusion:

HNSCC-derived slice cultures survive well in vitro and may serve not only to improve personalised therapies but also to detect mechanisms of tumour resistance by harvesting surviving tumour cells after treatment.

Saturation of gyrokinetic turbulence through damped eigenmodes

In the context of toroidal gyrokinetic simulations, it is shown that a hierarchy of damped modes is excited in the nonlinear turbulent state. These modes exist at the same spatial scales as the unstable eigenmodes that drive the turbulence. The larger amplitude subdominant modes are weakly damped and exhibit smooth, large-scale structure in velocity space and in the direction parallel to the magnetic field. Modes with increasingly fine-scale structure are excited to decreasing amplitudes. In aggregate, damped modes define a potent energy sink. This leads to an overlap of the spatial scales of energy injection and peak dissipation, a feature that is in contrast with more traditional turbulent systems.

Free energy cascade in gyrokinetic turbulence

In gyrokinetic theory, the quadratic nonlinearity is known to play an important role in the dynamics by redistributing (in a conservative fashion) the free energy between the various active scales. In the present study, the free energy transfer is analyzed for the case of ion temperature gradient driven turbulence. It is shown that it shares many properties with the energy transfer in fluid turbulence. In particular, one finds a (strongly) local, forward (from large to small scales) cascade of free energy in the plane perpendicular to the background magnetic field. These findings shed light on some fundamental properties of plasma turbulence, and encourage the development of large-eddy-simulation techniques for gyrokinetics.

Abstract P4-10-06: 10-Years Results of Intraoperative Electron Radiotherapy (IOERT) in Boost Modality in Breast Cancer Patients Treated with Breast Conserving Surgery

Introduction:

The aim of this nonrandomized study was to compare the ipsilateral breast tumor recurrence rates in patients with invasive breast cancer, who had been treated with breast conserving surgery and whole breast irradiation and conventional boost or intraoperative electron radiotherapy boost (IOERT).

Patients and Methods:

378 patients were included in the study, 188 patients in group 1 (conventional boost) and 190 patients in group 2 (IOERT boost). Patients were comparable with regard to age, menopausal status, tumor size, histological type, grading and axillary lymph node status. Included were patients with invasive breast cancer pT1 and pT2, N0, N1, N2, M0, and breast conserving surgery with clear margins >3mm. Excluded were patients with DCIS only, patients with invasive breast cancers larger than pT2, patients after primary systemic therapy and patients with multicentric disease. All patients (group 1 and group 2) received postoperative whole breast irradiation of 51-56.1 Gy. Group 1 received postoperative electron boost irradiation of 12 Gy after whole breast irradiation and group 2 received one intraoperative electron boost of 9 Gy in a single fraction during surgery before whole breast irradiation. Results:

The 10-years actuarial rates of ipsilateral breast tumor recurrence (IBTR), true local recurrence (TLR), distant recurrence (DR) and disease free survival (DFS) were 7.1% (95%CI, 3.2-11.0%), 4.8% (95%CI, 1.5-8.0%), 14,2% (95%CI, 9.1-19.4%) and 82.4% respectively in group1 and 2.7% (95%CI, 0.0-5.9%, P=0.062), 0.7% (95%CI, 0.0-2.0%, P=0.016), 13.6% (95%CI, 5.0-22.2%, P=0.90) and 84.0% (P= 0.76) respectively in group 2.

Conclusion:

Patients treated with IOERT boost and whole breast irradiation achieve excellent local control rates at 10 years and exhibit statistically significant decreased true local recurrence rates compared to patients treated with whole breast irradiation and conventional electron boost.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-10-06.

Nonlinear saturation of trapped electron modes via perpendicular particle diffusion

In magnetized fusion plasmas, trapped electron mode (TEM) turbulence constitutes, together with ion temperature gradient (ITG) turbulence, the dominant source of anomalous transport on ion scales. While ITG modes are known to saturate via nonlinear zonal flow generation, this mechanism is shown to be of little importance for TEM turbulence in the parameter regime explored here. Instead, a careful analysis of the statistical properties of the ExB nonlinearity in the context of gyrokinetic turbulence simulations reveals that perpendicular particle diffusion is the dominant saturation mechanism. These findings allow for the construction of a rather realistic quasilinear model of TEM induced transport.

Nonlinear gyrokinetic simulations of ion-temperature-gradient turbulence for the optimized Wendelstein 7-X stellarator

Ion-temperature-gradient turbulence constitutes a possibly dominant transport mechanism for optimized stellarators, in view of the effective suppression of neoclassical losses characterizing these devices. Nonlinear gyrokinetic simulation results for the Wendelstein 7-X stellarator [G. Grieger, in (IAEA, Vienna, 1991) Vol. 3, p. 525]-assuming an adiabatic electron response-are presented. Several fundamental features are discussed, including the role of zonal flows for turbulence saturation, the resulting flux-gradient relationship, and the coexistence of ion-temperature-gradient modes with trapped ion modes in the saturated state.

Low temperature of GroEL/ES overproduction permits growth of Escherichia coli cells lacking trigger factor DnaK

Escherichia coli trigger factor (TF) and DnaK cooperate in the folding of newly synthesized proteins. The combined deletion of the TF-encoding tig gene and the dnaK gene causes protein aggregation and synthetic lethality at 30 degrees C. Here we show that the synthetic lethality of deltatigdeltadnaK52 cells is abrogated either by growth below 30 degrees C or by overproduction of GroEL/GroES. At 23 degrees C deltatigdeltadnaK52 cells were viable and showed only minor protein aggregation. Overproduction of GroEL/GroES, but not of other chaperones, restored growth of deltatigdeltadnaK52 cells at 30 degrees C and suppressed protein aggregation including proteins >/= 60 kDa, which normally require TF and DnaK for folding. GroEL/GroES thus influences the folding of proteins previously identified as DnaK/TF substrates.

Functional dissection of Escherichia coli trigger factor: unraveling the function of individual domains

In Escherichia coli, the ribosome-associated chaperone Trigger Factor (TF) promotes the folding of newly synthesized cytosolic proteins. TF is composed of three domains: an N-terminal domain (N), which mediates ribosome binding; a central domain (P), which has peptidyl-prolyl cis/trans isomerase activity and is involved in substrate binding in vitro; and a C-terminal domain (C) with unknown function. We investigated the contributions of individual domains (N, P, and C) or domain combinations (NP, PC, and NC) to the chaperone activity of TF in vivo and in vitro. All fragments comprising the N domain (N, NP, NC) complemented the synthetic lethality of Deltatig DeltadnaK in cells lacking TF and DnaK, prevented protein aggregation in these cells, and cross-linked to nascent polypeptides in vitro. However, DeltatigDeltadnaK cells expressing the N domain alone grew more slowly and showed less viability than DeltatigDeltadnaK cells synthesizing either NP, NC, or full-length TF, indicating beneficial contributions of the P and C domains to TF's chaperone activity. In an in vitro system with purified components, none of the TF fragments assisted the refolding of denatured d-glyceraldehyde-3-phosphate dehydrogenase in a manner comparable to that of wild-type TF, suggesting that the observed chaperone activity of TF fragments in vivo is dependent on their localization at the ribosome. These results indicate that the N domain, in addition to its function to promote binding to the ribosome, has a chaperone activity per se and is sufficient to substitute for TF in vivo.

Low temperature or GroEL/ES overproduction permits growth of Escherichia coli cells lacking trigger factor and DnaK

Escherichia coli trigger factor (TF) and DnaK cooperate in the folding of newly synthesized proteins. The combined deletion of the TF-encoding tig gene and the dnaK gene causes protein aggregation and synthetic lethality at 30 degrees C. Here we show that the synthetic lethality of DeltatigDeltadnaK52 cells is abrogated either by growth below 30 degrees C or by overproduction of GroEL/GroES. At 23 degrees C DeltatigDeltadnaK52 cells were viable and showed only minor protein aggregation. Overproduction of GroEL/GroES, but not of other chaperones, restored growth of DeltatigDeltadnaK52 cells at 30 degrees C and suppressed protein aggregation including proteins >/=60 kDa, which normally require TF and DnaK for folding. GroEL/GroES thus influences the folding of proteins previously identified as DnaK/TF substrates.

Intraoperative radiotherapy given as a boost after breast-conserving surgery in breast cancer patients

Conventional radiotherapy after breast-conserving therapy is confined to 50-55 Gy external beam radiation therapy (EBRT) to the whole breast and 10-16 Gy external boost radiation to the tumour bed or brachytherapy to the tumour bed. Local recurrence rate after breast-conserving surgery varies between 5 and 18%. External boost radiation can partially miss the tumour bed and therefore can result in local failure. Intra-operative radiotherapy (IORT) as a high precision boost can prevent a 'geographical miss'. From October 1998 to December 2000, 156 patients with stage I and stage II breast cancer were operated upon in a dedicated IORT facility. After local excision of the tumour, the tumour bed was temporarily approximated by sutures to bring the tissue in the radiation planning target volume. A single dose of 9 Gy was applied to the 90% reference isodose with energies ranging from 4 to 15 MeV, using round applicator tubes 4-8 cm in diameter. After wound healing, the patients received additional 51-56 Gy EBRT to the whole breast. No acute complications associated with IORT were observed. In 5 patients, a secondary mastectomy had to be performed because of tumour multicentricity in the final pathological report or excessive intraductal component. 2 patients developed rib necroses. In 7 patients, wound healing problems occurred. After a mean follow-up of 18 months, no local recurrences were observed. Cosmesis of the breast was very good and comparable to patients without IORT. Preliminary data suggest that IORT given as a boost after breast-conserving surgery could be a reliable alternative to conventional postoperative fractionated boost radiation by accurate dose delivery and avoiding geographical misses, by enabling smaller treatment volumes and complete skin-sparing and by reducing postoperative radiation time by 7-14 days.

[Long-term tumor control and fertility after para-aortic limited radiotherapy of stage I seminoma]

PURPOSE

To review patterns of relapse in a long-term analysis of patients with Stage I seminoma treated by orchidectomy and radiotherapy to the paraaortic lymph nodes only and to follow follicle stimulating hormone (FSH) levels dependent on testicular scatter dose.

PATIENTS AND METHODS

From 1980 to 1995, 58 patients with Stage I seminoma received elective radiotherapy to the paraaortic lymph nodes only (Th12 to L4), with a mean total dose of 28.07 Gy (+/- 2.2 SD), using fractional doses between 1.5 and 2 Gy (mean 1.62 Gy +/- 0.083 SD). Since 1989, testicular scatter doses were measured routinely by in-vivo thermoluminescent dosimetry (TLD) in 45 patients. In 26 patients with normal pre-treatment values of FSH, FSH-levels were repeatedly controlled after radiotherapy in order to evaluate any radiation-induced sequelae.

RESULTS

During a mean observation period of 69.4 months (range 30 to 210), 2 out of 57 patients (3.5%) developed regional recurrences in the ipsilateral pelvic lymph nodes 14 months and 5 years after radiotherapy, respectively. One patient was lost to follow-up. The relapse-free survival rate at 5 years was 96.5% after radiotherapy alone. After salvage chemotherapy, both relapse-free survival and overall survival rates come to 100%. The mean testicular scatter dose in 45 patients was 0.22 Gy (+/- 0.087 SD). Seven out of 26 patients (26.9%) developed a transient increase of FSH-levels, reaching peak values at 4.2 months and returning to normal ranges within 18 months after radiotherapy. Below 0.2 Gy, no effect on FSH was observed. Testicular scatter doses showed no clear correlation to FSH risings (Figure 1).

CONCLUSION

After exclusive paraaortic radiation of Stage I seminoma, even at follow-up periods in excess of 5 years the incidence of pelvic lymph node relapses remains below 4%. However, there seems to be a small potential for the development of late recurrences. With limited radiotherapy, permanent radiation-induced effects on the remaining testicle are very unlikely.

Radiotherapy for lung cancer: target splitting by asymmetric collimation enables reduction of radiation doses to normal tissues and dose escalation

PURPOSE

This study was performed to develop a method of reducing the radiation doses to normal thoracic tissues, increasing the target dose, especially in the primary radiotherapy of non-small cell lung cancer (NSCLC), and to evaluate acute/subacute toxicity of dose escalation.

METHODS AND MATERIALS

From December 1195 to March 1998, the technique of target splitting has been applied to 58 patients. In this period, 30 patients were treated with doses > 80 Gy (ICRU-specification, mean 85.1 Gy, range 80. 1-90.2 Gy). The target volume is split into a cranial part (e.g., upper mediastinum) and a caudal part (e.g., primary tumor and middle mediastinum). Both volumes are planned and treated independently, using conformal irradiation techniques for both parts with half-collimated fields to prevent over- or underdosage in the junction plane. After fine-adjustment of the jaws, a verification film, exposed in a polymethylmethacrylate (PMMA) phantom, demonstrates the homogeneity of dose in the entire target volume. For comparison with conventional techniques, planning to identical doses is performed for 5 patients. Dose-volume histograms (DHVs) for normal lung tissue are presented for both methods.

RESULTS

The irradiated volume of normal tissue of the ipsilateral lung can be lowered at dose levels > or = 65, > or =45 Gy, and > or = 20 Gy to values of 37% (range 25-54%), 49% (range 46-54%), and 86% (range 55-117%), respectively. Other organs at risk, such as heart or esophagus, can also be spared significantly. Only 1 patient showed a transient grade 3 toxicity (pneumonitis), and there where no grade 4 acute/subacute side-effects. Two patients with Stage III A central tumors in close proximity to the large vessels died due to a pulmonary hemorrhage 2 and 4 months after therapy, respectively. No patient developed esophagitis. Antimycotic prophylaxis for esophagitis and posttherapeutic steroid prophylaxis for pneumonitis for several weeks were routinely used.

CONCLUSION

The technique of target splitting by asymmetric collimation helps to increase conformation, and thus enhances the sparing of normal tissues. It can be used whenever there is a marked difference in the shape of the planning target volume (PTV) in a cranio-caudal direction. This technique can principally be handled with 2D-planning systems, because it is coplanar. We consider target splitting as an important tool for dose escalation in the primary radiotherapy of NSCLC, that should also be used for other lung cancer patients necessitating moderate doses only.

Quality assurance in breast cancer brachytherapy: geographic miss in the interstitial boost treatment of the tumor bed

PURPOSE

To assess the role of geographic misses in the interstitial boost treatment of breast cancer patients and to evaluate methods of optimizing breast implants in design, performance, and dosimetry.

METHODS AND MATERIALS

During lumpectomy, the tumor excision sites of 89 patients were marked by five hemoclips. Postoperative radiographs demonstrated the clips' positions with respect to the extension of the surgical cavity, which was demarcated by air and hematoseroma. Twenty-seven selected patients received interstitial boosts to the tumor bed. The implant was first designed according to the clinical assumptions of the tumor bed's topography and then compared with the radiological findings. Prior to brachytherapy, the planning of the implant's dimension and the needle guidance was performed under simulator control. Dose distributions were first calculated following the Paris System and then electively optimized for the target volume by changing source positions and dwell times.

RESULTS

Compared to clinical estimations, the radiological determination of the tumor bed's location revealed an overall potential of topographic errors of 51.8% (14 out of 27 patients), rising up to 78.5% in patients with large adipose breasts (11 out of 13 patients). This observation was due to a high mobility of the tissue, leading to varying tumor site projections at the time of mammography, surgery, and brachytherapy. In all patients, the presimulation of the implant resulted in an adequate coverage of the target volume. In 17 of the 27 treated patients, dose distributions were modified to achieve a higher dose delivery in zones where a higher residual tumor load was expected (boost-in-boost).

CONCLUSION

Breast implants have a high potential of geographic misses that can be avoided by intraoperative clip demarcation. The delineation of the tumor bed allows for dose reports actually referring to the target volume and not to the implant system to be obtained. In addition, modern afterloading techniques offer possibilities of individual dose planning with regard to high risk subvolumes within the implanted tissue.