[Towards a positive physiological definition of the deep brain nuclei in humans]

INTRODUCTION

Using microelectrodes for recording purposes in deep brain stimulation (DBS) has proven to be very useful. Their efficiency can be improved by characterising the properties of extracellular action potentials (EAPs).

PATIENTS AND METHODS

We analysed the records of nine patients who underwent surgery for epilepsy or aggressiveness under general anaesthesia. The properties of the EAPs of the centromedian, ventral intermediate, ventrocaudal and posteromedial hypothalamic nuclei of the thalamus have been determined.

RESULTS

We have analysed 706 thalamic and 142 hypothalamic cells. The proportion of cell types was found to be specific to each cell nucleus. The most frequent cell type was P1P2N1 (59.5%), followed by N1P1N2 (23.1%). The first phase of the EAP is highly variable. The properties of the EAP phases of the same morphology differ greatly from one nucleus to another.

CONCLUSIONS

We have shown that several deep brain nuclei have properties that are specific to the morphology of the EAPs. This will allow for improved localisation of these nuclei during DBS.

Nanoplastics are bioaccumulated in fish liver and muscle and cause DNA damage after a chronic exposure

The extent of the widespread, planetary contamination by plastic waste is difficult to fully capture. Nanoplastics (NPs) are currently in the center of research concerning plastic litter, both for the analytical challenges they pose and for their potential to provoke hazardous effects in organisms. However, there are still many unanswered questions in this multidisciplinary field, with a crucial missing piece being the quantification of NPs in fish tissues after in vivo exposures. Another relevant question that is still greatly unexplored is how a chronic exposure to NPs will affect fish health. This study aims to provide answers to both of these relevant knowledge gaps. To this end, goldfish (Carassius auratus) were exposed to 44 nm polystyrene (PS)-NPs via water for 30 days. Following the exposure, gastrointestinal tract, liver and muscle were sampled for PS-NPs analysis by means of size exclusion chromatography coupled to high resolution mass spectrometry. PS-NPs were detected in all liver and muscle samples of exposed fish, with higher concentrations in liver than in muscle, whereas no PS-NPs were detected in the gastrointestinal tract. Nevertheless, exposure to PS-NPs did not induce changes in hematology parameters nor in cortisol and glucose levels in plasma. On the other hand, even a relatively low concentration of PS-NPs was able to cause DNA damage, measured by an increase in erythrocyte nuclear abnormalities, suggesting that PS-NPs can reach the cell nucleus and cause genotoxicity. These results show for the first time that PS-NPs find their way to fish muscle after chronic exposure, where they bioaccumulate, but do not alter fish survival nor hematological or physiological stress indicators. The accumulation of PS-NPs in fish muscle can represent a threat to human health as a possible route of exposure to small-sized plastics. The present results in a model fish species open windows for future studies in edible fish species.

A clinically compatible drug-screening platform based on organotypic cultures identifies vulnerabilities to prevent and treat brain metastasis

We report a medium-throughput drug-screening platform (METPlatform) based on organotypic cultures that allows to evaluate inhibitors against metastases growing in situ. By applying this approach to the unmet clinical need of brain metastasis, we identified several vulnerabilities. Among them, a blood-brain barrier permeable HSP90 inhibitor showed high potency against mouse and human brain metastases at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, in situ proteomic analysis applied to metastases treated with the chaperone inhibitor uncovered a novel molecular program in brain metastasis, which includes biomarkers of poor prognosis and actionable mechanisms of resistance. Our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is compatible with human samples. Thus, this clinically relevant strategy is aimed to personalize the management of metastatic disease in the brain and elsewhere.

Deep brain stimulation in Parkinson's disease: analysis of brain fractional anisotropy differences in operated patients

INTRODUCTION

Deep brain stimulation (DBS) of the subthalamic nucleus is currently an evidence-based therapeutic option for motor symptoms in patients with Parkinson's disease (PD), although other non-motor symptoms can be affected by stimulation.

AIM

Our objective is to evaluate the global changes in the connectivity of the large-scale structural network in PD patients that have obtained a benefit from subthalamic DBS.

SUBJECTS AND METHODS

Retrospective study of 31 subjects: 7 PD patients with subthalamic DBS (group A), 12 age and gender-matched non-operated PD (B) and 12 healthy controls (C). All subjects had undergone a 1.5 T brain MRI with DTI. DICOM images were processed with the FSL5.0 software and TBSS tool.

RESULTS

The study group comprised 23 men and 8 women. No statistically significant differences in age, gender, scores on the HandY scale and mean follow-up between group A and B were found, and in age and gender between groups A and C. Statistical analysis revealed differences in the fractional anisotropy of the different groups in certain areas: bilateral corticospinal tract, anterior thalamic radiations, bilateral fronto-occipital fascicle, both superior longitudinal fascicles, and left inferior longitudinal fascicle.

CONCLUSIONS

In our series, PD patients treated with bilateral subthalamic DBS showed a significantly higher fractional anisotropy in widespread areas of the cerebral white matter; suggesting that neuromodulation produces connectivity changes in different neural networks.

Main pitfalls of skin surgical suturing - review for junior surgeons and medical students

Every surgeon starts the training with suturing, which can be very confusing as most of the senior surgeons have their own style, approach, tricks and different rules to follow. It is hard for residents and medical students to know what is an evidence-based rule that should be followed and what is a personal trick of their teacher that can be modified. We provide a review of current data on surgical suturing with all the reasons for specific techniques. Parameters of the correct skin suture, practical guide and all the complications are mentioned in the text.

Macrocyclization as a Source of Desired Polypharmacology. Discovery of Triple PI3K/mTOR/PIM Inhibitors

The PI3K/AKT/mTOR and PIM kinase pathways contribute to the development of several hallmarks of cancer. Cotargeting of these pathways has exhibited promising synergistic therapeutic effects in liquid and solid tumor types. To identify molecules with combined activities, we cross-screened our collection of PI3K/(±mTOR) macrocycles (MCXs) and identified the MCX thieno[3,2-d]pyrimidine derivative 2 as a moderate dual PI3K/PIM-1 inhibitor. We report the medicinal chemistry exploration and biological characterization of a series of thieno[3,2-d]pyrimidine MCXs, which led to the discovery of IBL-302 (31), a potent, selective, and orally bioavailable triple PI3K/mTOR/PIM inhibitor. IBL-302, currently in late preclinical development (AUM302), has recently demonstrated efficacy in neuroblastoma and breast cancer xenografts. Additionally, during the course of our experiments, we observed that macrocyclization was essential to obtain the desired multitarget profile. As a matter of example, the open precursors 35-37 were inactive against PIM whereas MCX 28 displayed low nanomolar activity.

OS06.7A METPlatform identifies brain metastasis vulnerabilities and predicts patient response to therapy

BACKGROUND

The diagnosis of brain metastasis involves high morbidity and mortality and remains an unmet clinical need in spite of being the most common tumor in the brain. Exclusion of these cancer patients from clinical trials is a major cause of their limited therapeutic options.

MATERIAL AND METHODS

We report a novel drug-screening platform (METPlatform) based on organotypic cultures which allows identifying effective anti-metastasis agents in the presence of the organ microenvironment. We have applied this approach to clinically relevant stages of brain metastasis using both experimental models and human tumor tissue (by performing patient-derived organotypic cultures - PDOCs -). We have also used METPlatform to perform unbiased proteomics of brain metastases in situ to identify potential novel mediators of this disease and explore resistance mechanisms to targeted therapy. Finally, we have exploited METPlatform as “avatars” to predict response to therapy in patients with primary brain tumors.

RESULTS

We identified heat shock protein 90 (HSP90) as a promising therapeutic target for brain metastasis. DEBIO-0932, a blood-brain barrier permeable HSP90 inhibitor, shows high potency against mouse and human brain metastases from different primary origin and oncogenomic profile at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, in situ proteomic analysis of brain metastases treated with the chaperone inhibitor revealed non-canonical clients of HSP90 as potential novel mediators of brain metastasis and actionable mechanisms of resistance driven by autophagy. Combined therapy using HSP90 and autophagy inhibitors showed synergistic effects compared to sublethal concentrations of each monotherapy, demonstrating the potential of METPlatform to design and test rationale combination therapies to target metastasis more effectively. Finally, we show that brain tumor PDOCs predict the response of the corresponding patient to standard of care, thus proving the potential of METPlatform for improving personalized care in cancer.

CONCLUSION

Our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is fully compatible with human samples and questions the rationale of excluding patients with brain metastasis from clinical trials. We envision that METPlatform will be established as a clinically relevant strategy to personalize the management of metastatic disease in the brain and elsewhere.

BSCI-02. METPlatform identifies brain metastasis vulnerabilities and predicts patient response to therapy

The diagnosis of brain metastasis involves high morbidity and mortality and remains an unmet clinical need in spite of being the most common tumor in the brain. Exclusion of these cancer patients from clinical trials is a major cause of their limited therapeutic options. We report a novel drug-screening platform (METPlatform) based on organotypic cultures which allows identifying effective anti-metastasis agents in the presence of the organ microenvironment. By applying this approach to brain metastasis, we identified heat shock protein 90 (HSP90) as a promising therapeutic target for CNS dissemination. DEBIO-0932, a blood-brain barrier permeable HSP90 inhibitor, shows high potency against mouse and human brain metastases from different primary origin and oncogenomic profile at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, in situ proteomic analysis of brain metastases treated with the chaperone inhibitor revealed non-canonical clients of HSP90 as potential novel mediators of brain metastasis and actionable mechanisms of resistance driven by autophagy. Combined therapy using HSP90 and autophagy inhibitors showed synergistic effects compared to sublethal concentrations of each monotherapy, demonstrating the potential of METPlatform to design and test rationale combination therapies to target metastasis more effectively. Finally, we have exploited METPlatform as “avatars” to show that brain tumor PDOCs predict response of the corresponding patient to standard of care, thus proving the potential of METPlatform for improving personalized care in cancer. In conclusion, our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is fully compatible with human samples and questions the rationale of excluding patients with brain metastasis from clinical trials. We envision that METPlatform will be established as a clinically relevant strategy to personalize the management of metastatic disease in the brain and elsewhere.

OP0214 IMPACT OF A MULTI-MORBIDITY SCREENING AND PREVENTION PROGRAM IN CHRONIC INFLAMMATORY RHEUMATIC DISEASES ON THE ONE-YEAR HOSPITALIZATION RATE BASED ON AN ANALYSIS OF THE FRENCH NATIONAL HEALTH DATABASE

Background:

A screening program for multimorbidities started in 2014 at the Montpellier University Hospital for primary prevention in patients with chronic inflammatory rheumatic diseases (IRD).

Objectives:

The objective of this work was to assess the impact of this program on morbidity by comparing the hospitalization rate of those patients in the year following the screening to the one of patients with IRD who did not benefit from this program.

Methods:

Patients with IRD who benefit from the screening program in 2015, 2016 and 2017 were identified in the French national health database PMSI and matched to 3 controls living in the same area on age, sex, type of IRD, use of intravenous (IV) biologic (b) DMARDs and index date. The exclusion criteria were subjects in secondary prevention identified as history of myocardial infarction in the previous 5 years or use of antiplatelet therapy. The primary outcome was the rate of all-cause hospitalization in the following year. The secondary endpoints were hospitalizations for another reason than IRD (“non-IRD”) including those for cardiovascular [CV] events and major fractures. Hospitalization rates were compared between the two groups in the year after screening (or index date) and also between the year preceding screening and the year after for each group. Univariate and multivariate odds ratios (CI95%) were calculated, taking into account the medical history (hypertension, diabetes, heart failure, CV disease, COPD, major fractures in the 5 years preceding the index date) and hospitalizations in the previous year.

Results:

486 patients were identified and matched with 1458 controls. 67.08% had rheumatoid arthritis and 21.81% spondyloarthritis; 7% of them had IV bDMARDs. Unscreened patients had more hypertension (19% vs 10.1%), diabetes (9% vs 4.9%), heart failure (2.3% vs 0.4%) and “non-IRD” hospitalizations (78.5% vs 72.2%) in the 5 years preceding the index date. In the year following the index date, the percentages of “all causes” and “non-IRD” hospitalizations were significantly higher in non-screened than in screened patients (n = 1944, 64.8% versus 51%, Chi2 test, p <0.001; and 47.1% versus 37.9%, p <0.001 respectively). 17 (1.17%) cardiovascular events occurred in non-screened versus 2 (0.41%) in screened patients (n = 1944, Chi2 test, p = 0.14). There was no difference in the occurrence of CV events or major fractures between the 2 groups. In multivariate analysis, screening was associated with a 49% (0.51 [0.41-0.64]) reduction in “all causes” hospitalization and a 27% (0, 73 [0.58-0.91]) decrease in “non-IRD” hospitalization, with no difference for CV or fracture cardiological events. The risk factors associated with “non-IRD” hospitalization were: history of “non-IRD” hospitalization in the previous year (2.26 [1.63-3.13]), IV bDMARDs (1.69 [1, 14-2.53]) and age> 70 years (1.44 [1.02-2.03] vs <50 years). Hospitalization in the previous year for “all causes” or “non-IRD” was associated with rehospitalization in the following year in the non-screened group (p <0.001), but not in the screened group (p = 0.750 and p = 0.066 respectively).

Conclusion:

Our screening and prevention program was associated with a reduction in hospitalizations in the following year and a decrease in the risk of re-hospitalization compared to unscreened patients with IRD. This suggests a positive impact of performing systematic screening for multi-morbidities in IRD patients.

Acknowledgements:

We thank Pfizer for their financial support

Disclosure of Interests:

guillaume decarriere: None declared, Jenica PASTOR: None declared, David DEMOULIN: None declared, Gael Mouterde Speakers bureau: Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Pfizer, Cédric Lukas Speakers bureau: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Consultant of: Abbvie, Amgen, Janssen, Lilly, MSD, Novartis, Pfizer, Roche-Chugai, UCB, Grant/research support from: Pfizer, Novartis and Roche-Chugai, Bernard Combe Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Grégoire Mercier: None declared, Jacques Morel Speakers bureau: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Consultant of: AbbVie; Bristol-Myers Squibb; Gilead; Janssen; Lilly; Merck; Novartis; Pfizer; Roche-Chugai; and Sanofi, Grant/research support from: Novartis, Pfizer, and Roche-Chugai, Claire Daien Speakers bureau: Pfizer, Roche-Chugai, Fresenius, BMS, MSD, Lilly, Novartis, Galapagos, Consultant of: Abivax, Abbbvie, BMS, Roche-Chugai, Grant/research support from: Pfizer, roche-chugai, fresenius, MSD

[Response to perampanel in a patient with chronic post-hypoxic myoclonus]

INTRODUCTION

Chronic post-hypoxic myoclonus is a condition in which the predominant clinical picture is myoclonus following hypoxic brain damage, usually due to cardiorespiratory arrest. It is a condition that is usually treated with antiepileptic drugs, in most cases with a modest clinical response.

CASE REPORT

We report the case of a patient who started with jerking movements, compatible with myoclonus in the four limbs and the face the day after recovering from a cardiorespiratory arrest. An electroencephalogram was performed during which the myoclonias were recorded with no electrical correlates. During admission, and in successive visits after discharge, different antiepileptic treatments were tried for the myoclonias, which were refractory and affected the patient's quality of life. Two years after onset, treatment with perampanel up to a dose of 4 mg was initiated and the patient reported a significant clinical improvement, as evidenced in the visits.

CONCLUSIONS

Perampanel may be an effective alternative for the treatment of myoclonias in patients with chronic post-hypoxic myoclonus.

Omipalisib inspired macrocycles as dual PI3K/mTOR inhibitors

Activation of the phosphatidylinositol 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) signaling pathway occurs frequently in a wide range of human cancers and is a main driver of cell growth, proliferation, survival, and chemoresistance of cancer cells. Compounds targeting this pathway are under active development as anticancer therapeutics and some of them have reached advanced clinical trials or been approved by the FDA. Dual PI3K/mTOR inhibitors combine multiple therapeutic efficacies in a single molecule by inhibiting the pathway both upstream and downstream of AKT. Herein, we report our efforts on the exploration of novel small molecule macrocycles (MCXs) as dual PI3K/mTOR inhibitors. Macrocyclization is an attractive approach used in drug discovery, as the semi-rigid character of these structures could provide improved potency, selectivity and favorable pharmacokinetic properties. Importantly, this strategy allows access to new chemical space thus obtaining a better intellectual property position. A series of MCXs based on GSK-2126458, a known clinical PI3K/mTOR inhibitor is described. These molecules showed potent biochemical and cellular dual PI3K/mTOR inhibition, demonstrated strong antitumoral effects in human cancer cell lines, and displayed good drug-like properties. Among them, MCX 83 presented remarkable selectivity against a panel of 468 kinases, high in vitro metabolic stability, and favorable pharmacokinetic parameters without significant CYP450 and h-ERG binding inhibition. This profile qualified this compound as a suitable candidate for future in vivo PK-PD and efficacy studies in mouse cancer models.

42. IDENTIFICATION OF BRAIN METASTASIS VULNERABILITIES USING METPLATFORM

The diagnosis of brain metastasis involves high morbidity and mortality and remains an unmet clinical need in spite of being the most common tumor in the brain. Exclusion of these cancer patients from clinical trials is a major cause of their limited therapeutic options. In this study, we report a novel drug-screening platform (METPlatform) based on organotypic cultures which allows identifying effective anti-metastasis agents in the presence of the organ microenvironment. We have applied this approach to clinically relevant stages of brain metastasis using both experimental models and human tumor tissue (by performing patient-derived organotypic cultures). We identified heat shock protein 90 (HSP90) as a promising therapeutic target for brain metastasis. Debio-0932, a blood-brain barrier permeable HSP90 inhibitor, shows high potency against mouse and human brain metastases from melanoma, lung and breast adenocarcinoma with distinct oncogenomic profiles at clinically relevant stages of the disease, including a novel model of local relapse after neurosurgery. Furthermore, we have also used METPlatform to perform unbiased proteomics of brain metastases in situ. By applying this analysis to brain metastases treated with the chaperone inhibitor, we uncovered non-canonical clients of HSP90 as potential novel mediators of brain metastasis and actionable mechanisms of resistance driven by autophagy. Combined therapy using HSP90 and autophagy inhibitors showed synergistic effects compared to sublethal concentrations of each monotherapy, demonstrating the potential of METPlatform to design and test rationale combination therapies to target metastasis more effectively. In conclusion, our work validates METPlatform as a potent resource for metastasis research integrating drug-screening and unbiased omic approaches that is fully compatible with human samples and questions the rationale of excluding patients with brain metastasis from clinical trials. We envision that METPlatform will be established as a clinically relevant strategy to personalize the management of metastatic disease in the brain and elsewhere.

Induction of Lysosome Membrane Permeabilization as a Therapeutic Strategy to Target Pancreatic Cancer Stem Cells

Despite significant efforts to improve pancreatic ductal adenocarcinoma (PDAC) clinical outcomes, overall survival remains dismal. The poor response to current therapies is partly due to the existence of pancreatic cancer stem cells (PaCSCs), which are efficient drivers of PDAC tumorigenesis, metastasis and relapse. To find new therapeutic agents that could efficiently kill PaCSCs, we screened a chemical library of 680 compounds for candidate small molecules with anti-CSC activity, and identified two compounds of a specific chemical series with potent activity in vitro and in vivo against patient-derived xenograft (PDX) cultures. The anti-CSC mechanism of action of this specific chemical series was found to rely on induction of lysosomal membrane permeabilization (LMP), which is likely associated with the increased lysosomal mass observed in PaCSCs. Using the well characterized LMP-inducer siramesine as a tool molecule, we show elimination of the PaCSC population in mice implanted with tumors from two PDX models. Collectively, our approach identified lysosomal disruption as a promising anti-CSC therapeutic strategy for PDAC.

History of thyroid surgery

The authors present an outline of the development of thyroid surgery from the ancient times to the beginning of the 20th century, when the defini-tive surgical technique have been developed and the physiologic and pathopfysiologic consequences of thyroid resections have been described. The key representatives, as well as the contribution of the most influential czech surgeons are mentioned.

Screening protocol for the identification of modulators by immunofluorescent cell-based assay

High-throughput assays are a common strategy for the identification of compounds able to modulate a certain cellular activity. Here, we show an automatized analysis platform for the quantification of nuclear foci as inhibitory effect of compounds on a target protein labeled by fluorescent antibodies. Our experience led us to a fast analysis platform that combines cell-based assays, high-content screening, and confocal microscopy, with an automatic and user-friendly statistical analysis of plate-based assays including positive and negative controls, able to identify inhibitory effect of compounds tested together with the Z-prime and Window of individual plate-based assays to assess the reliability of the results. The platform integrates a web-based tool implemented in Pipeline Pilot and R, and allows computing the inhibition values of different parameters obtained from the high-content screening and confocal microscopy analysis. This facilitates the exploration of the results using the different parameters, providing information at different levels as the number of foci observed, the sum of intensity of foci, area of foci, etc, the detection and filtering of outliers over the assay plate, and finally providing a set of statistics of the parameters studied together with a set of plots that we believe significantly helps to the interpretation of the assay results.

Multiple cancer pathways regulate telomere protection

Telomeres are considered as universal anti-cancer targets, as telomere maintenance is essential to sustain indefinite cancer growth. Mutations in telomerase, the enzyme that maintains telomeres, are among the most frequently found in cancer. In addition, mutations in components of the telomere protective complex, or shelterin, are also found in familial and sporadic cancers. Most efforts to target telomeres have focused in telomerase inhibition; however, recent studies suggest that direct targeting of the shelterin complex could represent a more effective strategy. In particular, we recently showed that genetic deletion of the TRF1 essential shelterin protein impairs tumor growth in aggressive lung cancer and glioblastoma (GBM) mouse models by direct induction of telomere damage independently of telomere length. Here, we screen for TRF1 inhibitory drugs using a collection of FDA-approved drugs and drugs in clinical trials, which cover the majority of pathways included in the Reactome database. Among other targets, we find that inhibition of several kinases of the Ras pathway, including ERK and MEK, recapitulates the effects of Trf1 genetic deletion, including induction of telomeric DNA damage, telomere fragility, and inhibition of cancer stemness. We further show that both bRAF and ERK2 kinases phosphorylate TRF1 in vitro and that these modifications are essential for TRF1 location to telomeres in vivo. Finally, we use these new TRF1 regulatory pathways as the basis to discover novel drug combinations based on TRF1 inhibition, with the goal of effectively blocking potential resistance to individual drugs in patient-derived glioblastoma xenograft models.

[Is it possible to extract intracranial pressure information based on the EEG activity?]

INTRODUCTION

The capability of the electroencephalography (EEG) of recording the bioelectrical activity of the brain has made of it a fundamental tool for the evaluation of the patient's neurological condition. In recent years, moreover, it has also begun to be used in obtaining information for other kind of variables, as the ones related with the cerebral hemodynamics.

AIM

To study the potential relationship between the EEG activity and the intracranial pressure (ICP) in patients suffering from traumatic brain injury and subarachnoid hemorrhage, during their stay at the intensive care unit.

PATIENTS AND METHODS

Twenty-one adult patients (10 women) were included in the present observational prospective cohort study. They suffered from either traumatic brain injury or subarachnoid hemorrhage, requiring continuous EEG and ICP monitoring. In every patient, Granger causality between spectral functions of the EEG and the ICP was evaluated. Temporal windows of 10 minute were used to evaluate whether a causal relationship between those variables exist or not. In all of the cases, several days of continuous recording and assessment were performed.

RESULTS

In most patients and during most of the time, Granger causality turns out to be significant in the direction from the EEG to the ICP, meaning that the EEG dynamics actually leads the ICP dynamics.

CONCLUSIONS

The present work provides useful information and shed light in discovering a hidden relationship between the ICP and EEG dynamics. The potential use of this relationship could lead to develop a medical device to measure ICP in a non-invasive fashion.

Outcomes and prognostic factors in intermediate-risk prostate cancer: multi-institutional analysis of the Spanish RECAP database

PURPOSE

To retrospectively assess outcomes and to identify prognostic factors in patients diagnosed with intermediate-risk (IR) prostate cancer (PCa) treated with primary external beam radiotherapy (EBRT).

MATERIALS AND METHODS

Data were obtained from the multi-institutional Spanish RECAP database, a population-based prostate cancer registry in Spain. All IR patients (NCCN criteria) who underwent primary EBRT were included. The following variables were assessed: age; prostate-specific antigen (PSA); Gleason score; clinical T stage; percentage of positive biopsy cores (PPBC); androgen deprivation therapy (ADT); and radiotherapy dose. The patients were stratified into one of three risk subcategories: (1) favourable IR (FIR; GS 6, ≤ T2b or GS 3 + 4, ≤ T1c), (2) marginal IR (MIR; GS 3 + 4, T2a-b), and (3) unfavourable IR (UIR; GS 4 + 3 or T2c). Biochemical relapse-free survival (BRFS), disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) were assessed.

RESULTS

A total of 1754 patients from the RECAP database were included and stratified by risk group: FIR, n = 781 (44.5%); MIR, n = 252 (14.4%); and UIR, n = 721 (41.1%). Mean age was 71 years (range 47-86). Mean PSA was 10.4 ng/ml (range 6-20). The median radiotherapy dose was 74 Gy, with mean doses of 72.5 Gy (FIR), 73.4 Gy (MIR), and 72.8 Gy (UIR). Most patients (88%) received ADT for a median of 7.1 months. By risk group (FIR, MIR, UIR), ADT rates were, respectively, 88.9, 86.5, and 86.9%. Only patients with ≥ 24 months of follow-up post-EBRT were included in the survival analysis (n = 1294). At a median follow-up of 52 months (range 24-173), respective 5- and 10-year outcomes were: OS 93.6% and 79%; BRFS 88.9% and 71.4%; DFS 96.1% and 89%; CSS 98.9% and 94.6%. Complication rates (≥ grade 3) were: acute genitourinary (GU) 2%; late GU 1%; acute gastrointestinal (GI) 2%; late GI 1%. There was no significant association between risk group and BRFS or OS. However, patients with favourable-risk disease had significantly better 5- and 10-year DFS than patients with UIR: 98.7% vs. 92.4% and 92% vs. 85.8% (p = 0.0005). CSS was significantly higher (p = 0.0057) in the FIR group at 5 (99.7% vs. 97.3%) and 10 years (96.1% vs. 93.4%). On the multivariate analyses, the following were significant predictors of survival: ADT (BRFS and DFS); dose ≥ 74 Gy (BRFS); age (OS).

CONCLUSIONS

This is the first nationwide study in Spain to report long-term outcomes of patients with intermediate-risk PCa treated with EBRT. Survival outcomes were good, with a low incidence of both acute and late toxicity. Patients with unfavourable risk characteristics had significantly lower 5- and 10-year disease-free survival rates. ADT and radiotherapy dose ≥ 74 Gy were both significant predictors of treatment outcomes.

[Bilateral two-stage implantation for deep brain stimulation in the treatment of bilateral idiopathic Parkinson's disease: clinical outcomes]

AIMS

Simultaneous bilateral implantation of electrodes in the subthalamic nucleus for idiopathic Parkinson's disease (IPD) is associated with long surgery time, language disorders and post-operative confusion. Moreover, there is evidence of ipsilateral improvement after stimulation of the subthalamic nucleus. In order to optimise perioperative management a prospective study is conducted with deep brain stimulation (DBS) in the subthalamic nucleus in two consecutive unilateral procedures.

PATIENTS AND METHODS

We conducted a prospective study of 41 patients with bilateral IPD, with DBS implantation in two unilateral surgical phases. Its clinical outcomes are analysed according to the Unified Parkinson's Disease Rating Scale (UPDRS), the Hoehn and Yahr, and the Schwab and England scales, together with their complications.

RESULTS

The mean age was 61 ± 7 years old, 23 males. Five patients (12%) did not undergo surgery of the contralateral subthalamic nucleus due to good control. The mean on the motor UPDRS and the Hoehn and Yahr in preoperative pharmacological off was 44 ± 14 and 3, respectively, and 19 ± 8 and 1.8 at six months' follow-up. The mean improvement on the Schwab and England scale in the pre-operative period and at six months was 39%. Two patients suffered post-operative confusion, and one of them had transient dysarthria.

CONCLUSIONS

Bilateral DBS in two unilateral stages was an effective option with few complications in our series of patients with IPD. 10% of the patients did not require contralateral electrodes. It would be necessary to conduct a randomised study in patients who underwent bilateral surgery in one and two stages in order to confirm these results.

Inhibition of TRF1 Telomere Protein Impairs Tumor Initiation and Progression in Glioblastoma Mouse Models and Patient-Derived Xenografts

Glioblastoma multiforme (GBM) is a deadly and common brain tumor. Poor prognosis is linked to high proliferation and cell heterogeneity, including glioma stem cells (GSCs). Telomere genes are frequently mutated. The telomere binding protein TRF1 is essential for telomere protection, and for adult and pluripotent stem cells. Here, we find TRF1 upregulation in mouse and human GBM. Brain-specific Trf1 genetic deletion in GBM mouse models inhibited GBM initiation and progression, increasing survival. Trf1 deletion increased telomeric DNA damage and reduced proliferation and stemness. TRF1 chemical inhibitors mimicked these effects in human GBM cells and also blocked tumor sphere formation and tumor growth in xenografts from patient-derived primary GSCs. Thus, targeting telomeres throughout TRF1 inhibition is an effective therapeutic strategy for GBM.

[New thalamic potential associated with somatosensory evoked potentials]

INTRODUCTION

The response of the thalamus during the study with somatosensory evoked potentials (SSEP) is not sufficiently understood.

CASE REPORT

A 17-year-old man undergoing surgery for deep brain stimulation in the centromedian nucleus for drug-resistant epilepsy under complete sedation. During the intervention, the responses to SSEPs of the thalamic nuclei were recorded by means of four microelectrodes. These responses can be decomposed into three types: local field potentials (LFP), low amplitude fast oscillations (LFO), and high amplitude slow oscillations (HSO). LFO are widespread in much of the registered regions. However, HSOs are located at a single point in the registry and are closely associated with LFPs.

CONCLUSIONS

Although the presence of LFO has been considered as an indicator of the presence of the sensory thalamus, its wide extension by different thalamic nuclei suggests that it is an unspecific response to SSEPs. However, the restricted spatial location of HSO and their association with LFP suggest that these newly described potentials are the markers for the presence of the sensory thalamus. Their identification may prove very useful in thalamic deep brain stimulation either in awake patients or especially in those requiring sedation.

Adjuvant versus salvage radiotherapy in prostate cancer: multi-institutional retrospective analysis of the Spanish RECAP database

PURPOSE

To compare adjuvant radiotherapy (ART) to salvage radiotherapy (SRT) after radical prostatectomy (RP) in a cohort of prostate cancer (PCa) patients. The primary aim was to comparatively assess 2- and 5-year biochemical relapse-free survival (BRFS). A secondary aim was to identify predictors of survival.

PATIENTS AND METHODS

Data were acquired from the RECAP database, a population-based prostate cancer registry in Spain. Inclusion criteria included RP (with or without lymphadenectomy) followed by ART or SRT. A total of 702 patients were analyzed. Pre-RT PSA values (>0.5 vs. ≤0.5 ng/ml), pathological stage (T1-2 vs. T3-4), post-surgical Gleason score (≤7 vs. 8-10), margin status (positive vs. negative), hormonal treatment (yes vs. no), and RT dose (≤66 Gy vs. >66 Gy) were evaluated to assess their impact on BRFS.

RESULTS

The mean patient age in the ART and SRT groups, respectively, was 64 years (range 42-82) and 64.8 years (range 42-82). Median follow-up after RT in the whole sample was 34 months (range 3-141). A total of 702 patients were included: 223 (31.8%) received ART and 479 (68.2%) SRT. BRFS rates (95% CI) in the ART and SRT groups at months 24 and 60 were, respectively: 98.1% (95.9-100.0%) vs. 91.2% (88.2-94.2%) and 84.5% (76.4-92.6%) vs. 74.0% (67.4-80.7%) (p = 0.004). No significant differences in OS were observed (p = 0.053). The following variables were significant predictors of biochemical recurrence in the SRT group: (1) positive surgical margin status (p = 0.049); (2) no hormonotherapy (p = 0.03); (3) total prostate dose ≤66 Gy (p = 0.004); and pre-RT PSA ≥0.5 ng/ml (p = 0.013).

CONCLUSIONS

This is the first nationwide study in Spain to evaluate a large cohort of PCa patients treated with RP followed by postoperative RT. ART yielded better 2- and 5-year BRFS rates, although OS was equivalent. These findings are consistent with most other published studies and support ART in patients with adverse prognostic characteristics after radical prostatectomy. Prospective trials are needed to compare immediate ART to early SRT to better determine their relative benefits.

[When does post-ictal period start in temporal lobe epilepsy? A quantitative EEG perspective]

INTRODUCTION

In partial seizures, from a clinical point of view or even from electroencephalography characterization of post-ictal period can be difficult. The spectral and complex network analysis could lead to a more accurate definition of its limits, as well as to a great understanding of the seizures.

PATIENTS AND METHODS

Digital EEG recordings from scalp and foramen oval electrodes were used, 32 seizures, from 15 patients with drug-resistant mesial temporal lobe epilepsy (Engel I). We analyzed numerically: the spectral entropy, the different frequency bands and several variables used to characterize the cortical network, density of links, modularity, cluster coefficient and average path length. Variations of for post-ictal versus pre-ictal periods were quantified.

RESULTS

The cortical network density of links increased during the post-ictal period of complex seizures matching with an spectral entropy decrease, mainly due to an increase in Delta band activity. This variables reached extreme values around one minute after seizure end, defined by classical electroencephalography.

CONCLUSIONS

Our results can be explained by the appearance of an 'ending' mechanism that starts in the ictal period, classically defined, and reach their maximum effect during the post-ictal period. These results could be useful to define the post-ictal period start, as the moment with maximum synchrony, which has a highest density of links and a lowest spectral entropy.

Clinical leishmaniasis in dogs living in the UK

OBJECTIVES

To investigate the prevalence of leishmaniasis in dogs in the UK and to describe clinical presentation, clinicopathological abnormalities, therapeutic protocols and outcome in this non-endemic country.

MATERIALS AND METHODS

Medical records of dogs diagnosed with leishmaniasis at seven referral centres in the UK were retrospectively reviewed.

RESULTS

The prevalence was between 0·007 and 0·04% with a higher number of cases in southern England. All dogs had a history of travel to or from an endemic country. Lethargy, dermatological disease, decreased appetite and lameness were the most common reasons for presentation. Allopurinol was used alone for treatment in the majority of cases.

CLINICAL SIGNIFICANCE

Although rare, leishmaniasis should be considered in dogs in the UK if they have compatible clinical signs and history of travel to or from endemic areas.

Therapeutic inhibition of TRF1 impairs the growth of p53-deficient K-RasG12V-induced lung cancer by induction of telomeric DNA damage

Telomeres are considered anti-cancer targets, as telomere maintenance above a minimum length is necessary for cancer growth. Telomerase abrogation in cancer-prone mouse models, however, only decreased tumor growth after several mouse generations when telomeres reach a critically short length, and this effect was lost upon p53 mutation. Here, we address whether induction of telomere uncapping by inhibition of the TRF1 shelterin protein can effectively block cancer growth independently of telomere length. We show that genetic Trf1 ablation impairs the growth of p53-null K-Ras^G12V-induced lung carcinomas and increases mouse survival independently of telomere length. This is accompanied by induction of telomeric DNA damage, apoptosis, decreased proliferation, and G2 arrest. Long-term whole-body Trf1 deletion in adult mice did not impact on mouse survival and viability, although some mice showed a moderately decreased cellularity in bone marrow and blood. Importantly, inhibition of TRF1 binding to telomeres by small molecules blocks the growth of already established lung carcinomas without affecting mouse survival or tissue function. Thus, induction of acute telomere uncapping emerges as a potential new therapeutic target for lung cancer.

ETP-46321, a dual p110α/δ class IA phosphoinositide 3-kinase inhibitor modulates T lymphocyte activation and collagen-induced arthritis

Class IA phosphoinositide 3-kinases (PI3Ks) are essential to function of normal and tumor cells, and to modulate immune responses. T lymphocytes express high levels of p110α and p110δ class IA PI3K. Whereas the functioning of PI3K p110δ in immune and autoimmune reactions is well established, the role of p110α is less well understood. Here, a novel dual p110α/δ inhibitor (ETP-46321) and highly specific p110α (A66) or p110δ (IC87114) inhibitors have been compared concerning T cell activation in vitro, as well as the effect on responses to protein antigen and collagen-induced arthritis in vivo. In vitro activation of naive CD4(+) T lymphocytes by anti-CD3 and anti-CD28 was inhibited more effectively by the p110δ inhibitor than by the p110α inhibitor as measured by cytokine secretion (IL-2, IL-10, and IFN-γ), T-bet expression and NFAT activation. In activated CD4(+) T cells re-stimulated through CD3 and ICOS, IC87114 inhibited Akt and Erk activation, and the secretion of IL-2, IL-4, IL-17A, and IFN-γ better than A66. The p110α/δ inhibitor ETP-46321, or p110α plus p110δ inhibitors also inhibited IL-21 secretion by differentiated CD4(+) T follicular (Tfh) or IL-17-producing (Th17) helper cells. In vivo, therapeutic administration of ETP-46321 significantly inhibited responses to protein antigen as well as collagen-induced arthritis, as measured by antigen-specific antibody responses, secretion of IL-10, IL-17A or IFN-γ, or clinical symptoms. Hence, p110α as well as p110δ Class IA PI3Ks are important to immune regulation; inhibition of both subunits may be an effective therapeutic approach in inflammatory autoimmune diseases like rheumatoid arthritis.

Inhibition of malignant thyroid carcinoma cell proliferation by Ras and galectin-3 inhibitors

Anaplastic Thyroid carcinoma is an extremely aggressive solid tumor that resists most treatments and is almost always fatal. Galectin-3 (Gal-3) is an important marker for thyroid carcinomas and a scaffold of the K-Ras protein. S-trans, transfarnesylthiosalicylic acid (FTS; Salirasib) is a Ras inhibitor that inhibits the active forms of Ras proteins. Modified citrus pectin (MCP) is a water-soluble citrus-fruit-derived polysaccharide fiber that specifically inhibits Gal-3. The aim of this study was to develop a novel drug combination designed to treat aggressive anaplastic thyroid carcinoma. Combined treatment with FTS and MCP inhibited anaplastic thyroid cells proliferation in vitro by inducing cell cycle arrest and increasing apoptosis rate. Immunoblot analysis revealed a significant decrease in Pan-Ras, K-Ras, Ras-GTP, p-ERK, p53, and Gal-3 expression levels and significant increase in p21 expression levels. In nude mice, treatment with FTS and MCP inhibited tumor growth. Levels of Gal-3, K-Ras-GTP, and p-ERK were significantly decreased. To conclude, our results suggest K-Ras and Gal-3 as potential targets in anaplastic thyroid tumors and herald a novel treatment for highly aggressive anaplastic thyroid carcinoma.

Classification of structural lesions in magnetic resonance imaging. Surgical implications in drug-resistant epilepsy patients

INTRODUCTION

The presence of a structural lesion in the preoperative magnetic resonance imaging (MRI) of drug-resistant epilepsy patients has been usually associated with a favourable surgical outcome. We present our experience in our Epilepsy Surgery Unit.

PATIENTS AND METHODS

Clinical records from 265 patients, operated on from 1990-2010 in our institution, were reviewed. Patients were classified, according to MRI findings, into three groups: surgical lesion (SL), tumors or vascular malformations requiring surgery 'per se'; orientative lesion (OL), dysplasia, atrophy or mesial temporal sclerosis; and (NL) group, with normal MRI. Seizure outcomes were analysed in relation to this classification.

RESULTS

Period 1990-2000, 151 patients: 87% of SL, 65% of OL and 57% of NL patients were in Engel class I or II at the two-year follow-up. Among temporal lobe epilepsy cases (TLE), 87% of SL, 67% of OL and 56% of NL patients achieved seizure control. Differences were statistically significative. Period 2001-2010, 114 patients: 100% of SL, 90% of OL, and 81% of NL patients were in Engel's class I or II. Both TLE and extratemporal (ETLE) SL patients obtained a 100% seizure control. Among the OL patients, 95% with TLE and 43% of ETLE achieved seizure control. In the NL group, the percentages were 88% in TLE, and 50% in ETLE.

CONCLUSIONS

In our series, SL was a predictor of a favorable outcome. In TLE patients, good results were achieved despite normal MRI. Patients with ETLE and NL did not have a worse outcome than those with OL. A classification in SL, OL and NL seems more helpful for predicting the surgical outcome than the traditional classification lesion versus non-lesion MRI. Radiological findings must be carefully evaluated in the context of a complete epilepsy surgery evaluation.

[Segmental testicular infarction. Unusual complication of intravenous immunoglobulin therapy for multifocal motor neuropathy]

We describe the previously unknown case of segmental testicular infarction as an iatrogenic complication of intravenous immunoglobulin administration in a patient with multifocal motor neuropathy.

Alternative Activation Mechanisms of Protein Kinase B Trigger Distinct Downstream Signaling Responses

Protein kinase B (PKB/Akt) is an important mediator of signals that control various cellular processes including cell survival, growth, proliferation, and metabolism. PKB promotes these processes by phosphorylating many cellular targets, which trigger distinct downstream signaling events. However, how PKB is able to selectively target its substrates to induce specific cellular functions remains elusive. Here we perform a systematic study to dissect mechanisms that regulate intrinsic kinase activity versus mechanisms that specifically regulate activity toward specific substrates. We demonstrate that activation loop phosphorylation and the C-terminal hydrophobic motif are essential for high PKB activity in general. On the other hand, we identify membrane targeting, which for decades has been regarded as an essential step in PKB activation, as a mechanism mainly affecting substrate selectivity. Further, we show that PKB activity in cells can be triggered independently of PI3K by initial hydrophobic motif phosphorylation, presumably through a mechanism analogous to other AGC kinases. Importantly, different modes of PKB activation result in phosphorylation of distinct downstream targets. Our data indicate that specific mechanisms have evolved for signaling nodes, like PKB, to select between various downstream events. Targeting such mechanisms selectively could facilitate the development of therapeutics that might limit toxic side effects.

[Using a stent graft in the treatment of hepatic artery bleeding after pancreatoduodenectomy]

Delayed bleeding is a potential complication of pancreatoduodenectomy. Its treatment is either endovascular or surgical (stentgraft, embolization). Our case report presents a patient with bleeding from the hepatic artery pseudoaneurysm within a period of 3 months after pancreatoduodenectomy for common bile duct carcinoma, resolved using a stent graft.

A novel phosphatidylinositol 3-kinase (PI3K) inhibitor directs a potent FOXO-dependent, p53-independent cell cycle arrest phenotype characterized by the differential induction of a subset of FOXO-regulated genes

Introduction

The activation of the phosphoinositide 3-kinase (PI3K)/AKT signalling pathway is one the most frequent genetic events in breast cancer, consequently the development of PI3K inhibitors has attracted much attention. Here we evaluate the effect of PI3K inhibition on global gene expression in breast cancer cells.

Methods

We used a range of methodologies that include in silico compound analysis, in vitro kinase assays, cell invasion assays, proliferation assays, genome-wide transcription studies (Agilent Technologies full genome arrays), gene set enrichment analysis, quantitative real-time PCR, immunoblotting in addition to chromatin immunoprecipitation.

Results

We defined the physico-chemical and the biological properties of ETP-45658, a novel potent PI3K inhibitor. We demonstrated that ETP-45658 potently inhibited cell proliferation within a broad range of human cancer cells, most potently suppressing the growth of breast cancer cells via inhibiting cell cycle. We show that this response is Forkhead box O (FOXO) protein dependent and p53 independent. Our genome-wide microarray analysis revealed that the cell cycle was the most affected biological process after exposure to ETP-45658 (or our control PI3K inhibitor PI-103), that despite the multiple transcription factors that are regulated by the PI3K/AKT signalling cascade, only the binding sites for FOXO transcription factors were significantly enriched and only a subset of all FOXO-dependent genes were induced. This disparity in gene transcription was not due to differential FOXO promoter recruitment.

Conclusions

The constitutive activation of PI3Ks and thus the exclusion of FOXO transcription factors from the nucleus is a key feature of breast cancer. Our results presented here highlight that PI3K inhibition activates specific FOXO-dependent genes that mediate cell cycle arrest in breast cancer cells.

Electronic supplementary material

The online version of this article (doi:10.1186/s13058-014-0482-y) contains supplementary material, which is available to authorized users.

Non-genotoxic activation of p53 through the RPL11-dependent ribosomal stress pathway

Nucleolar disruption has recently emerged as a relevant means to activate p53 through inhibition of HDM2 by ribosome-free RPL11. Most drugs that induce nucleolar disruption also possess important genotoxic activity, which can have lasting mutagenic effects. Therefore, it is of interest to identify compounds that selectively produce nucleolar disruption in the absence of DNA damage. Here, we have performed a high-throughput screening to search for nucleolar disruptors. We have identified an acridine derivative (PubChem CID-765471) previously known for its capacity to activate p53 independently of DNA damage, although the molecular mechanism underlying p53 activation had remained uncharacterized. We report that CID-765471 produces nucleolar disruption by inhibiting ribosomal DNA transcription in a process that includes the selective degradation of the RPA194 subunit of RNA polymerase I. Following nucleolar disruption, CID-765471 activates p53 through the RPL11/HDM2 pathway in the absence of detectable DNA damage. In a secondary screening of compounds approved for medical use, we identify two additional acridine derivatives, aminacrine and ethacridine, that operate in a similar manner as CID-765471. These findings provide the basis for non-genotoxic chemotherapeutic approaches that selectively target the nucleolus.

Phytoremediation of soils co-contaminated by organic compounds and heavy metals: bioassays with Lupinus luteus L. and associated endophytic bacteria

In the central part of the Iberian Peninsula there are old sealed landfills containing soils co-contaminated by several heavy metals (Cu, Zn, Pb, Cd, Ni, As, Cr, Fe, Al, Mn) and organic pollutants of different families (hydrocarbons, polycyclic aromatic hydrocarbons, polychlorinated biphenyls, pesticides and other organochlorinated compounds, phenols and volatile compounds), which this work will address. We have focused on phytoremedial plants that are able to deal with this type of complex pollution, not only species that tolerate the joint effect of heavy metals in the soil, but also those that can take advantage of associated bacteria to efficiently break down organic compounds. This study was carried out with Lupinus luteus and its endophytes in two greenhouse experiments: A) growing in a substrate artificially contaminated with benzo(a)pyrene (BaP), and B) using real co-contaminated landfill soils. Endophytes of roots and shoots were isolated in both bioassays. Plant growth-promotion tests and organic pollutant tolerance and degradation tests were conducted on all strains isolated in bioassay A), and on those proving to be pure cultures from bioassay B). The selected landfill is described as are isolation and test procedures. Results indicate that plants did not show toxicity symptoms when exposed to BaP but did when grown in landfill soil. Some endophytes demonstrated plant growth-promotion capacity and tolerance to BaP and other organic compounds (diesel and PCB commercial mixtures). A few strains may even have the capacity to metabolize those organic pollutants. The overall decline in plant growth-promotion capacity in those strains isolated from the landfill soil experiment, compared with those from the bioassay with BaP, may indicate that lupin endophytes are not adapted to metal concentration in roots and shoots and fail to grow. As a result, most isolated root endophytes must have colonized root tissues from the soil. While preliminary degradation tests showed promising results (some strains exhibiting the potential to use organic pollutants as their sole source of carbon), these are not conclusive and further in-depth degradation assays need to be performed.

Antileishmanial activity of essential oil from Chenopodium ambrosioides and its main components against experimental cutaneous leishmaniasis in BALB/c mice

Chenopodium ambrosioides have been used during centuries by native people to treat parasitic diseases.

AIMS OF THE STUDY

To compare the in vivo anti-leishmanial activity of the essential oil (EO) from C. ambrosioides and its major components (ascaridole, carvacrol and caryophyllene oxide).

MATERIALS AND METHODS

Anti-leishmanial effect was evaluated in BALB/c mice infected with Leishmania amazonensis and treated with the EO, main compounds and artificial mix of pure components by intralesional route at 30 mg/kg every 4 days during 14 days. Diseases progression and parasite burden in infected tissues were determined.

RESULTS

EO prevented lesion development compared (p<0.05) with untreated animals and treated with vehicle. In addition, the efficacy of EO was also statistically superior (p<0.05) compared with the glucantime-treated animals. No potential effects were observed with pure components treatment. Mix of pure compounds cause death of animals after 3 days of treatment.

CONCLUSIONS

Our results demonstrate the superiority of EO against experimental cutaneous leishmaniasis caused by L. amazonensis.

[Primary small bowel volvulus in a young adult]

The authors present a rare case of a young male patient with primary small bowel volvulus. They show the main points to be considered in clinical diagnosis of this kind of acute abdomen and the importance of CT scan in such cases.