Intra-Tumoral Nerve-Tracing in a Novel Syngeneic Model of High-Grade Serous Ovarian Carcinoma

Dense tumor innervation is associated with enhanced cancer progression and poor prognosis. We observed innervation in breast, prostate, pancreatic, lung, liver, ovarian, and colon cancers. Defining innervation in high-grade serous ovarian carcinoma (HGSOC) was a focus since sensory innervation was observed whereas the normal tissue contains predominantly sympathetic input. The origin, specific nerve type, and the mechanisms promoting innervation and driving nerve-cancer cell communications in ovarian cancer remain largely unknown. The technique of neuro-tracing enhances the study of tumor innervation by offering a means for identification and mapping of nerve sources that may directly and indirectly affect the tumor microenvironment. Here, we establish a murine model of HGSOC and utilize image-guided microinjections of retrograde neuro-tracer to label tumor-infiltrating peripheral neurons, mapping their source and circuitry. We show that regional sensory neurons innervate HGSOC tumors. Interestingly, the axons within the tumor trace back to local dorsal root ganglia as well as jugular-nodose ganglia. Further manipulations of these tumor projecting neurons may define the neuronal contributions in tumor growth, invasion, metastasis, and responses to therapeutics.

High efficacy and low toxicity of weekly docetaxel given as first-line treatment for metastatic breast cancer

BACKGROUND

Docetaxel is one of the most effective antitumor agents currently available for the treatment of metastatic breast cancer (MBC). This phase II multicenter study prospectively analyzed the efficacy and toxicity of docetaxel given on a weekly schedule as first-line treatment of metastatic breast cancer.

PATIENTS AND METHODS

All patients received docetaxel, 35 mg/m(2) weekly for 6 weeks, followed by 2 weeks of rest. Subsequent cycles (3 weeks of treatment, 2 weeks of rest) were given until a maximum of 5 cycles or disease progression. Premedication consisted of 8 mg dexamethasone intravenously 30 min prior to the infusion of docetaxel.

RESULTS

Fifty-four patients at a median age of 58 years with previously untreated MBC were included in the study. A median of 10 doses (median cumulative dose 339 mg/m(2)) was administered (range: 2-18). The overall response rate was 48.1% (95% CI: 34-61%, intent-to-treat). Median survival was 15.8 months and median time to progression was 5.9 months (intent-to-treat). Hematological toxicity was mild with absence of neutropenia-related complications. Grade 3 neutropenia was observed in 3.7% of patients and grade 3 and 4 anemia was observed in 5.6 and 1.9% of patients, respectively.

CONCLUSION

The weekly administration of docetaxel is highly efficient and safe as first-line treatment for MBC and may serve as an important treatment option specifically in elderly patients and patients with a reduced performance status.

Corticosterone modulates autonomic responses and adaptation of central immediate-early gene expression to repeated restraint stress

We have tested the role of elevated corticosterone in modulating the responses to either a single (acute) or chronic (repeated daily) restraint stress. Male rats were adrenalectomised, and received subcutaneous corticosterone pellets that resulted in either low (ca. 60 ng/ml) or higher (ca. 130-150 ng/ml) levels of plasma corticosterone. They were also implanted with telemetric transmitters relaying heart rate and core temperature. Control rats were unoperated and untreated. In the first experiment, rats were exposed to daily (60 min) restraint stress for 9 days whereas in the second experiments, rats were only exposed to a single restraint stress. Heart rate and core temperature were recorded every 10 min during each stress session. Brains were removed 1 h after the end of the final stress, and stained immunocytochemically for Fos, Fos-b. Plasma corticosterone was measured by radioimmunoassay. Control rats showed marked tachycardia, peaking at about 10 min and declining thereafter (habituation). This pattern did not change significantly across the 9 days of repeated stress. Rats with low dose corticosterone replacement showed a different pattern: maximal heart rate responses were similar, but elevated heart rate persisted during the period of stress. This effect was most marked on the first exposure to restraint. In contrast, high dose replacement rats showed similar heart rate responses to controls. Restraint stress induced a transient hypothermia, which in control rats was reduced during repeated stress (adaptation). High dose corticosterone resulted in accelerated adaptation of this response. As expected, an acute stress increased Fos expression in a range of limbic structures including the lateral septum, lateral preoptic area, bed nucleus of the stria terminalis, and three divisions of the hypothalamic paraventricular nucleus and in the raphe, locus coeruleus and solitary nucleus of the brainstem. After 9 days, there was no longer increased Fos expression in any of these areas. There was no effect of corticosterone treatment on Fos expression after an acute stress, and following repeated stress the low dose group showed increased expression in the lateral preoptic area only. Results with Fos-b were quite different. The effects of an acute stress in control animals was similar to that observed for Fos. Corticosterone had no effects on Fos-b expression after a single stress. Following repeated stress, there were still elevations of Fos-b (compared to controls) in the lateral septum, and in the basolateral and medial amygdala. Rats receiving low dose corticosterone showed increased Fos-b expression following 9 days stress in the lateral septum and in the dorsal and medial parts of the paraventricular nucleus compared to either control, stressed rats or those receiving the higher corticosterone dose and repeated stress. From these results we suggest that persistently elevated corticosterone acts to reduce ('shut-off') stress-induced responses as assessed both by the reaction of the autonomic system and by the expression of immediate-early genes in the brain. However, there are marked differences in the relations between corticosterone and the parameters measured in our experiments. In particular, there are distinctions between Fos and Fos-b both in the way they adapt to repeated restraint stress, and the effect corticosterone has on this adaptive process.

Development and validation of a self-efficacy scale for use in British patients with rheumatoid arthritis (RASE)

OBJECTIVE

Current arthritis self-efficacy scales have attracted some criticism. Therefore, the aim of this study was to develop and validate a measure of self-efficacy for use in British rheumatoid arthritis patients [Rheumatoid Arthritis Self-efficacy (RASE) scale].

METHODS

Phase I: item generation of self-management strategies by rheumatology professionals and patients to create a pilot RASE. Phase II: examination of the internal structure (n=88) using correlation coefficients and principal component analysis (PCA) to create the final RASE. Phase III: reliability in 23 patients. Phase IV: comprehension, construct validity and sensitivity to change in 48 rheumatoid arthritis patients undergoing a self-management programme, using correlation coefficients, PCA and inter-item correlation.

RESULTS

Phase I: of 166 self-management items generated, 100 commonly cited items were selected for the pilot RASE. Phase II: using a correlation matrix and PCA, a 28-item RASE was created. Phase III: good 4-week reliability was seen (r=0.889, P<0.001). Phase IV: the final RASE was shown to be independent of mood, disease status and disability and weakly associated with other self-efficacy scales (r=0.313, P<0.05). The RASE was sensitive to change following an education programme (+5.167, P<0.025), and was associated with behaviour initiation (r=0.35, P<0.01).

CONCLUSIONS

Careful construction means that the RASE examines beliefs in potential ability to perform tasks, rather than actual ability, performance or outcome expectancy. It shows good face validity and reliability, plus reasonable construct validity and sensitivity. Further studies are needed to support the validation of this new scale.

Electrical stimulation therapy in the treatment of cigarette smoking

In this study electrical stimulation therapy (EST) is explored as a possible new treatment for smoking cessation within a randomized controlled trial. The investigation follows reports of several authors that electrical stimulation applied to specific acupuncture points is effective in treating a variety of drug dependencies, including cigarette smoking. Three key features of treatment (electrical stimulation, frequency modulation, and electrode placement), were investigated in a 2 x 2 x 2 factorial design, resulting in eight treatment combinations. Out of 265 smokers recruited into the trial 216 completed the one-week treatment. Outcome was assessed in terms of complete abstinence from smoking and symptomatic relief of withdrawal symptoms. Smokers receiving active electrical stimulation obtained higher abstinence rates than those in the inactive groups although the difference did not achieve statistical significance (all active vs. all placebo groups: lambda 1,1(2) = 0.50, p > 0.10, 95% confidence interval = -8.04 to +17.44%; most effective vs. least effective group: lambda 1,1(2) = 3.11, p = 0.08, CI0.95 = -2.2 to +48.8%). The efficacy of electrical stimulation therapy for smoking is not supported.

Preliminary observations of holmium:YAG laser tissue interaction using human uterus

Preliminary observations of a pulsed Ho:YAG laser on human uterine tissue in-vitro are presented. The tissue effect on the uterine myometrium was demonstrated using fresh uteri which had been subjected to laser energy. The laser crater and surrounding zone of thermal necrosis (ZTN) was quantified. Measurements demonstrated a consistent narrow ZTN (0.8-1.8 mm) irrespective of power or pulse frequency used. The percentage forward transmission of laser energy through 1 mm of myometrium was investigated using a pyroelectric detector and found to be 0.41%. Finally, a visible and measureable photoacoustic component to the Ho:YAG laser was demonstrated using a water bath and needle hydrophone.

A laboratory and clinical study of pneumatic 'grip strength' devices

The use of inflated bags or cuffs to measure grip strength is now a well established technique. The method does have a number of problems. Bags of different diameter and volume were seen to give statistically significantly different pressure readings when squeezed by the same subjects. Different initial pressures (from 20 mmHg to 60 mmHg) also gave significantly different results both in laboratory tests on a materials testing machine and when patients with rheumatoid arthritis squeezed the bag. The technique of squeezing also affected the results. Despite the intrinsic drawbacks of the system, it is likely to remain in general use because of familiarity and convenience. We recommend the minimum details required when pneumodynamometer-derived data are published.

Medical lasers

In this short article it has only been possible to outline the use of lasers in medical applications. As you will have gathered there is still a considerable amount of research and development taking place and new types of lasers are appearing all the time, many of which may prove to be clinically useful.

A comparison of nefopam and flurbiprofen in the treatment of osteoarthrosis

A double-blind cross-over study was undertaken comparing the analgesic nefopam with the NSAID flurbiprofen in the treatment of osteoarthritis of the knees. Thirty patients entered the study and 18 completed the full trial protocol of one month on each drug. There was no significant difference in efficacy between the two treatments, although there were more side effects during the nefopam period. These must be balanced against the known gastrotoxicity of NSAIDs when choosing symptomatic treatment for osteoarthrosis.