Clinical impact of mutations in driver oncogenes and TP53/RB1 in advanced prostate cancer

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Background: Prostate cancer (PCa) is characterized by considerable genetic heterogeneity, and complex genomic features may influence prognosis and treatment response. We created a database of aggressive PCa that integrates comprehensive genomic sequencing with detailed clinical outcomes to better understand the optimal use of genomic sequencing. Methods: From 4/2005-7/2021, PCa cancer patients older than 18 years of age underwent tissue collection for tumoral RNA-sequencing and tumor/normal whole exome sequencing at our institution (HUM00046018, HUM00048105, HUM00067928, SU2C). Genomic and transcriptomic sequencing data was processed using Turnkey Precision Oncology. Genetic alterations, including ETS fusions, SPOP, FOXA1 class 1, and CDK12 mutations, as well as TP53 and RB1 mutations were analyzed. Clinical data was collected from 05/2021-01/2022, and clinical associations (metastasis free survival (MFS), time to castrate resistant prostate cancer (CRPC), and overall survival (OS)) were determined. Results: Data was available for 325 men. Median follow up from diagnosis was 106 months (IQR, 90-121), median age at diagnosis was 61 (IQR, 54-67), and most (91%) presented with PCa adenocarcinoma (n=292/325). At diagnosis, 51% (n=165) had localized, 5% (n=18) had clinical node positive, and 40% (n=128) had de-novo M1 disease. At time of tissue sampling, 87% (n=283) had metastatic disease, and 59% (n=192) were castrate resistant. Established PCa driver mutations included 140 ETS fusions (49%), 26 SPOP mutations (9%), 22 FOXA1 class 1 mutations (8%), and 15 (5%) CDK12 mutations. For men with localized disease at diagnosis (n=197/325), ETS fusion was associated with improved MFS (HR: 0.55; 95% CI: 0.37-0.81), time to CRPC (HR: 0.53; 0.35-0.80), and OS (HR: 0.56; 0.35-0.89). SPOP mutations were also associated with improved prognosis in this population (n=197/325): MFS (HR: 0.45; 0.24-0.84), time to CRPC (HR: 0.36; 0.18-0.73), and OS (HR: 0.46; 0.21-0.99). TP53 mutations were identified in 38% (n=122) of all patients and were associated with worse OS from the time of biopsy after adjusting for PCa castration state and disease spread at biopsy (HR: 2.2; 1.7-2.9, p<0.001). RB1 mutations were identified in 12% (n=40; 24/40 also TP53 mutants). OS from the time of biopsy was worse in the presence of dual TP53/RB1 mutants when compared to TP53 or RB1 mutants alone, independent of the disease state at time of biopsy (HR, 4.3; 95%CI: 2.7-7.0). Conclusions: In a cohort of aggressive PCa, oncogenic driver mutations were associated with significant differences in prognosis. ETS fusions and SPOP mutations correlated with improved outcomes for men with localized disease at presentation. TP53 loss was associated with worse prognosis, as was the combination with RB1 loss, across the disease spectrum. Future efforts will focus on correlating sensitivity to PCa treatments with genetic alterations throughout the disease course.

A Phase I Trial of Neoadjuvant Stereotactic Body Radiotherapy Prior to Radical Prostatectomy for Locally Advanced Prostate Cancer

PURPOSE

Men with locally advanced prostate cancer who undergo radical prostatectomy (RP) often develop recurrence and require postoperative radiotherapy. We aimed to determine the safety of neoadjuvant stereotactic body radiotherapy (SBRT) before RP in this population.

METHODS AND PATIENTS

A single-institution phase 1 trial (NCT02946008) of men with high-risk or node-positive prostate cancer were enrolled between March and October 2017. The primary endpoint was to determine the maximum tolerated dose of SBRT based on a composite 30-day post-RP toxicity goal of ≤28% of patients experiencing a dose-limiting toxicity (DLT). Secondary outcomes included toxicity, efficacy, and multiple quality of life (QoL) inventories. SBRT (30-35 Gy/5 fractions) was delivered to the prostate and seminal vesicles, and 25 Gy/5 fractions to the pelvic lymph nodes. RP was performed for a median of 6 weeks post-SBRT. Hormone therapy was not allowed.

RESULTS

Median follow-up was 40 months (range, 33-44). Twenty-five percent of the patients (n = 4) experienced a DLT within 30 days post-RP; however, the trial was stopped early (n = 16 of planned 38 patients) owing to the proportion and severity of the late adverse events. Post-RP grade 3 genitourinary and gastrointestinal toxicities occurred in 75% (n = 12) and 25% (n = 4) of patients, respectively. Two patients required cystectomy and urinary diversion ≥2 years post-RP. At 24 months post-RP, 75% (n = 12) of men used ≥1 pad/d and 0% had erections suitable for intercourse. Surgical margins were negative in all patients and 31% (n = 5) had complete or partial (pre-RP) MRI-response to SBRT. Three-year biochemical recurrence and distant metastasis were 45% (95% CI, 5%-68%) and 28% (95% CI, 0%-49%), respectively.

CONCLUSIONS

Neoadjuvant SBRT followed by RP resulted in unacceptably high toxicity and severe QoL declines.

Single-Fraction Celiac Plexus Radiosurgery: A Preliminary Proof-of-Concept Phase 2 Clinical Trial

BACKGROUND

Refractory epigastric/midback pain is associated with locally advanced abdominal malignancies, especially pancreatic cancer. The pain is caused by tumor infiltration of the celiac plexus, a nerve network attached to the abdominal aorta. Contemporary palliative approaches are often inadequate. We hypothesized that ablative radiation targeted to the celiac plexus would alleviate this pain.

METHODS AND MATERIALS

We performed a single-arm prospective clinical trial (ClinicalTrials.gov identifier: NCT02356406). Eligible and evaluable patients had celiac pain of at least 5 out of 10 on the Numerical Rating Scale, completed treatment per protocol, and had at least 1 posttreatment visit. The entire retroperitoneal celiac plexus was irradiated with a single 25-Gy fraction. The primary endpoint was change in the Numerical Rating Scale 3 weeks posttreatment. Toxic effects and pain interference (as measured with the Brief Pain Inventory) were secondary endpoints.

RESULTS

For our study, 31 patients signed consent, and, of these, 18 patients were treated and evaluable. Median age was 68 years (range, 51-79); 89% of the patients had pancreatic cancer; the median Eastern Cooperative Oncology Group performance status was 1; and the median interval from initial diagnosis to treatment was 9 months (range, 1-36), and, in this interval, patients received a median of 1 systemic treatment line (range, 0-3). Acute toxicity was limited to grade 1 to 2. Three weeks after treatment, 16 patients (84%) reported decreased celiac pain, with median pain level falling from 6 out of 10 (interquartile range [IQR], 5.0-7.5) at baseline to 3 out of 10 (IQR, 1.0-4.3); six weeks after treatment, the Numerical Rating Scale number fell further to 2.8 out of 10 (IQR, 0-3.3; both P < .005 vs baseline), including 4 patients who reported complete eradication of their celiac pain. Total daily morphine milligram equivalents decreased from 59 pretreatment to 50 at 3 weeks, and from 50 to 45 at 6 weeks. Significant improvement was seen in pain-interference scores.

CONCLUSIONS

Celiac plexus radiosurgery appears to alleviate cancer-related pain. An international multicenter phase 2 trial is currently accruing.

Coeliac plexus radiosurgery for pain management in patients with advanced cancer : study protocol for a phase II clinical trial

INTRODUCTION

Pancreatic cancer is characterised by severe mid-back and epigastric pain caused by tumour invasion of the coeliac nerve plexus. This pain is often poorly managed with standard treatments. This clinical trial investigates a novel approach in which high-dose radiation (radiosurgery) is targeted to the retroperitoneal coeliac plexus nerve bundle. Preliminary results from a single institution pilot trial are promising: pain relief is substantial and side effects minimal. The goals of this study are to validate these findings in an international multisetting, and investigate the impact on quality of life and functional status among patients with terminal cancer.

METHODS AND ANALYSIS

A single-arm prospective phase II clinical trial. Eligible patients are required to have severe coeliac pain of at least five on the 11-point BPI average pain scale and Eastern Cooperative Oncology Group performance status of two or better. Non-pancreatic cancers invading the coeliac plexus are also eligible. The intervention involves irradiating the coeliac plexus using a single fraction of 25 Gy. The primary endpoint is the complete or partial pain response at 3 weeks. Secondary endpoints include pain at 6 weeks, analgesic use, hope, qualitative of life, caregiver burden and functional outcomes, all measured using validated instruments. The protocol is expected to open at a number of cancer centres across the globe, and a quality assurance programme is included. The protocol requires that 90 evaluable patients" be accrued, based upon the assumption that a third of patients are non-evaluable (e.g. due to death prior to 3-weeks post-treatment assessment, or spontaneous improvement of pain pre-treatment), it is estimated that a total of 120 patients will need to be accrued. Supported by Gateway for Cancer Research and the Israel Cancer Association.

ETHICS AND DISSEMINATION

Ethic approval for this study has been obtained at eight academic medical centres located across the Middle East, North America and Europe. Results will be disseminated through conference presentations and peer-reviewed publications.

TRIAL REGISTRATION NUMBER

NCT03323489.

Is Ultra Hypofractionated Radiation Therapy a Safe and Effective Treatment for Invasive Bladder Cancer in the Elderly?: A Retrospective Single Institution Review

PURPOSE

The aim was to determine the efficacy, safety, and tolerability of weekly ultra hypofractionated radiation therapy for older unfit patients with invasive bladder cancer.

METHODS

We retrospectively analyzed a cohort of patients with muscle invasive bladder cancer deemed unfit for chemoradiation therapy and thus treated with 6 weekly doses of 6 Gy using intensity modulated radiotherapy. Charlson comorbidity was calculated retrospectively. Cystoscopy and computed tomography were used to evaluate local control and toxicity using the common terminology criteria. Survival outcomes were estimated using the Kaplan-Meier method.

RESULTS

Twenty-two patients with a median age of 84 (range: 70 to 96) years were included. The median comorbidity index was 6±1.5 SD. Nineteen (90%) patients received the full 36 Gy dose. Median follow-up was 10±7 months (range: 6 to 27 mo). Local control in the bladder was achieved in 16 of 19 evaluable patients (84%). One-year overall survival was 62.5%, 1 patient had a retroperitoneal nodal recurrence and 3 patients developed distant metastasis. Grade 3 genitourinary and gastrointestinal toxicity was observed in 4 (18%) and 1 (4.5%) patients, respectively.

CONCLUSION

Weekly ultra hypofractionated intensity modulated radiotherapy with image guidance and bladder training is an effective, safe, and well-tolerated regimen for older patients with invasive bladder cancer unfit for radical treatment.

Abstract CT147: Celiac plexus radiosurgery a new palliative modality for upper gastrointestinal malignancies - final quality of life results from a proof-of-concept clinical trial

Background: Many patients with upper-abdominal malignancies suffer from severe low back / epigastric pain caused by infiltration of the celiac plexus. The celiac plexus is a network of nociceptive nerves, located along the aorta. Contemporary approaches (opioids, celiac plexus chemical neurolysis, systemic chemotherapy) are often inadequate. The celiac plexus has not previously been targeted using radiation. We hypothesized that ablative radiation targeted to the celiac plexus would alleviate pain and improve quality of life (QOL).

Methods: We conducted a single arm prospective clinical trial. Eligible patients had celiac-pain &gt; 4/10 on Numerical Rating Scale (NRS) and completed treatment per protocol with at least one post-treatment visit. The celiac plexus was irradiated from D12 to L2. Radiation was given as either five fractions of 9 Gy or a single-fraction 25 Gy. The primary endpoint was NRS pain 3 weeks post-treatment. Secondary endpoints were toxicity, pain at 6w, analgesic use, and pain interference with daily activities as evaluated by ‘Brief pain assessment short-form’. Analgesic use was not restricted. Here we report results from those who received single fraction treatment.

Results: 19 patients were evaluable. The median age of the study population was 67 yr with a median ECOG of 2, 89% had pancreatic cancer. Patients were a median 8 months from diagnosis, and had received a median of one systemic treatment. Toxicity was limited to grade 1-2. Average pain decreased from 5.9/10 at baseline, to 3.1/10 at 3w, and to 1.8/10 (both p &lt; 0.0001) at 6w post-treatment. Number of rescue analgesic doses decreased from 3.6 (baseline) to 1.9 at 3w and 1.7 at 6w (both p&lt;0.001). Improvement was seen in all domains of pain-interference (table).

Conclusions: Single fraction celiac plexus radiosurgery alleviates pain, and improves quality of life among patients with advanced upper-GI cancer. An international phase II trial is accruing.

Pain interference measuresdomainweek 0 (baseline)week 3p (w0 vs v3)week 6p (w0 vs v6)General Activity7.93.4&lt;0.00012.0&lt;0.0001Mood6.93.6&lt;0.0051.80.0001Walking ability4.21.80.051.00.01Normal Work7.43.4&lt;0.0051.30.0001Relations with other people62.40.0031.70.003Sleep6.93.2&lt;0.0051.80.0001Enjoyment of life8.32.4&lt;0.00011.8&lt;0.0001

Citation Format: Yaacov R. Lawrence, Liat Hammer, Ofir Morag, Maoz Ben-Ailan, Dror Alezra, Ofer Margalit, Naama Halpern, Ben Boursi, Einat Shacham Shmueli, Galia Jacobson, Uri Amit, Tamar Katzman, Kinneret Shefer, Ilana Weiss, Inessa Yanovsky, Adam P. Dicker, Talia Golan, Zvi Symon, David Hausner. Celiac plexus radiosurgery a new palliative modality for upper gastrointestinal malignancies - final quality of life results from a proof-of-concept clinical trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT147.

Single-shot celiac plexus radiosurgery in pancreatic cancer: Palliative and functional outcomes—Final results of a prospective clinical trial

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Background: Pancreatic cancer is characterized by severe epigastric/lower back pain caused by infiltration of the celiac plexus. The celiac plexus is a network of nociceptive nerves, located along the abdominal aorta. Contemporary approaches (opioids, celiac plexus chemical neurolysis, systemic chemotherapy) are often inadequate. We hypothesized that ablative radiation targeted to the celiac plexus would alleviate pain. Here we report results for pancreatic cancer patients treated with a single fraction of radiation. Methods: We conducted a single-institution single-arm prospective clinical trial. Eligible cancer patients had celiac-pain > 4/10 on Numerical Rating Scale (NRS) and completed treatment per protocol with at least one post-treatment visit. The celiac plexus was irradiated from D12 to L2. Radiation was given as a single-fraction 25 Gy. The primary endpoint was NRS pain 3 weeks post-treatment. Secondary endpoints were toxicity, pain at 6w, analgesic use, and pain interference with daily activities as evaluated by the ‘The Brief Pain Inventory’. Analgesia was not restricted. Total daily dose of opioids was measured in morphine milligram equivalents (MME). Results: Seventeen patients were evaluable, 65% female, median age 68 yr (range 51-79), three had undergone pancreatic resection, nine had liver metastases, median ECOG = 1. Sixteen patients reported 3-week outcomes, and 10 reported 6-week outcomes. At time of treatment subjects were a median of 8.2 months from diagnosis, and had received a median of one systemic treatment (range 0-3). Toxicity was limited to grade 1. Median baseline pain was 6/10 (IQR 5-7), was reduced to 2.3/10 (IQR 0.9-3.6) (p < 0.0005) at 3 w, and to 2.5/10 (IQR 0-3.1) at 6 w post-treatment, for both p < 0.001. Median opioid consumption numerically decreased (baseline 52.9 MME, 3 w 43.9 MME, 6 w 37.5 MME, NS). ‘BPI pain interference’ improved significantly: median baseline score 7.1 dropped to 1.1 at 3 weeks and 0 at 6 weeks (p < 0.01 for both time points). Conclusions: Celiac plexus radiosurgery alleviates pain, and improves quality of life among patients with pancreatic cancer. A follow-up international trial is accruing. Clinical trial information: NCT02356406.

Modulation of scar tissue formation in injured nervous tissue cultivated on surface-engineered coralline scaffolds

Following traumatic brain injury, there is no restoration of the lost nervous tissue, mainly due to the formation of a scar. One promising strategy to overcome this hurdle is grafting scaffolds that can disturb the scar blockade, enabling cell invasion into the wound. The aragonite skeleton of corals is useful scaffolds for testing this strategy, being supportive for neural cells in culture. The purpose of this work was to check if a contact between a coralline scaffold and an injured nervous tissue affects scar formation and if this effect can be regulated by engineering the scaffold's surface topology. To address that, hippocampal slices were cultivated on a coral skeleton having two distinct surface shapes: (1) intact skeleton pieces (ISP): porous, microrough surface; (2) grained skeleton (GS): nonporous, macrorough surface. On ISP, slices deformed by engulfing the scaffold's outer surface without penetrating the pores, yet, they preserved their coherence. By contrast, on GS slices were flat, but broken into interconnected small segments of tissue. In addition, whereas on ISP astrocytes were significantly more active and diffusely distributed, on GS reactive astrocytes tightened into a single <90 μm wide scar-like stripe at the slice's periphery. Hence, by grafting coralline scaffolds of predesigned surface roughness and porosity into brain wounds, control over scar tissue formation can be gained, providing an opportunity for cell migration and damage repair. © 2017 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 106B: 2295-2306, 2018.

Crystallographic structure and energetics of the Rh(1 0 0)-(3 × 1)-2O phase

In this study we investigate the crystallographic structure of the Rh(1 0 0)-([Formula: see text])-2O phase by quantitative low energy electron diffraction (LEED) and scanning tunnelling microscopy as well as the energetics of the system applying density functional theory calculations (DFT). The ([Formula: see text]) structure forms upon exposing the clean Rh(1 0 0) surface to 1200 L of oxygen at 520 K. A full-dynamical LEED intensity analysis (Pendry R-factor [Formula: see text]) reveals an oxygen-induced shifted row-reconstruction of the rhodium top layer where every third Rh-row is displaced by half a surface lattice parameter along the [0 1 1]-direction. There are two oxygen atoms within the unit cell which assume threefold coordinated sites on both sides of the shifted Rh-row with one bond to the shifted and two bonds to the unshifted rows. DFT calculations yield a total energy gain of 0.27 eV per oxygen atom compared to adsorption on the unreconstructed surface. This by far overcompensates the energetic penalty of 0.10 eV per oxygen atom for shifting the Rh-row and thus drives the substrate reconstruction. A coadsorption of oxygen at remaining regular sites of the substrate is not observed in experiment and is found to be energetically unfavorable.

Thermal evolution of cobalt deposits on Co3O4(111): atomically dispersed cobalt, two-dimensional CoO islands, and metallic Co nanoparticles

Cobalt deposition onto Co₃O₄(111) leads to formation of atomically dispersed cobalt species, which form ordered two-dimensional oxide islands upon annealing.

Subsurface cation vacancy stabilization of the magnetite (001) surface

Iron oxides play an increasingly prominent role in heterogeneous catalysis, hydrogen production, spintronics, and drug delivery. The surface or material interface can be performance-limiting in these applications, so it is vital to determine accurate atomic-scale structures for iron oxides and understand why they form. Using a combination of quantitative low-energy electron diffraction, scanning tunneling microscopy, and density functional theory calculations, we show that an ordered array of subsurface iron vacancies and interstitials underlies the well-known (√2 × √2)R45° reconstruction of Fe3O4(001). This hitherto unobserved stabilization mechanism occurs because the iron oxides prefer to redistribute cations in the lattice in response to oxidizing or reducing environments. Many other metal oxides also achieve stoichiometry variation in this way, so such surface structures are likely commonplace.

Epitaxial cobalt oxide films on Ir(100)-the importance of crystallographic analyses

Epitaxial cobalt oxide films on Ir(100) exhibit a rich scenario of different structural phases which are reviewed in this paper. The great majority of phases could be, as a rare case, crystallographically described by the joint application of atomically resolved STM and quantitative LEED, whereby structural surprises were more the rule than the exception. So, the oxide grows in the polar (111) orientation for both the Co3O4 and CoO stoichiometry on the bare Ir substrate in spite of the latter's square symmetry. Moreover, the film orientation can be tuned to non-polar (100) growth when one or several pseudomorphic Co layers are introduced as an interface between oxide and Ir substrate. By using the nanostructured Ir(100)-(5 × 1)-H phase as a template a nanostructured Co film can be formed whose oxidation leads to a nanostructured oxide. The nominally polar films circumvent the polarity problem by appropriate surface terminations. That of CoO(111) is, again as a surprise, realized by a switch from rocksalt-type to wurtzite-type stacking near the surface, by which the latter becomes metallic. The stepwise oxidation of a pseudomorphic Co layer on the bare Ir substrate leads to the sequential formation of rocksalt-type tetrahedral Co-O building blocks (with intermediate BN-type blocks) whereby the Co species more and more assume positions determined by the inner-oxidic binding.

Mistletoe as complementary treatment in patients with advanced non-small cell lung cancer treated with carboplatin-based combinations: A randomized phase II study

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Background: The mistletoe preparation, iscador, is commonly used in complementary medicine for improving the quality of life (QoL) of cancer patients, but its efficacy needs to be further proved. This randomized phase II study was aimed at assessing the value of iscador as a modifier of chemotherapy-induced toxicity in chemotherapy-naïve non-small-cell lung cancer (NSCLC) patients treated with carboplatin containing regimens. Methods: Patients with stage IIIA or IIIB/IV NSCLC, ECOG performance status 0-2, and no history of brain metastasis were randomized to receive either chemotherapy alone (arm-1) or chemotherapy plus iscador Q 10mg SC injections 3 times weekly until tumor progression (arm-2). Chemotherapy consisted of 21-day cycles of IV carboplatin area under curve 5.0, day 1, combined with IV gemcitabine 1000mg/m2, days 1, 8, or with IV pemetrexed 500mg/m2, day 1. Results: Seventy-two patients were enrolled, 39 to arm-1 and 33 to arm-2. The arms were well balanced except that more patients with PS-0 were in arm-1 (p=0.041). Most patients (65%) were in stage IV and 62% had squamous histology. Median overall survival was 11 months in both arms. Median TTP was 4.8 months (arm-1) and 6 months (arm-2) (p=0.07). Carboplatin dose reductions and delays in gemcitabine on day 8 were more frequent in arm-1 (44% vs. 13% in arm-2, p<0.005; 31% vs. 13% in arm-2, p< 0.013). The difference in grade 3-4 hematological toxicity was not significant. More non-hematological toxicity was observed in arm-1 (41% compared to 16% in arm-2, p=0.043). The number of hospitalizations was higher in arm-1, 54%, compared to 24% in arm-2 (p=0.016). No significant difference was seen in QoL using the EORTC QLQ-C30 questionnaire; However, significant improvement in arm-2 was seen in coughing (p=0.013) and peripheral neuropathy (p=0.019). Conclusions: Chemotherapy dose reductions, severe non-hematological side effects, and hospitalizations were less frequent in patients treated with iscador. Further investigation of iscador as a modifier of chemotherapy-related toxicity is warranted.

Substoichiometric cobalt oxide monolayer on Ir(100)-(1 × 1)

A substoichiometric monolayer of cobalt oxide has been prepared by deposition and oxidation of slightly less than one monolayer of cobalt on the unreconstructed surface of Ir(100). The ultrathin film was investigated by scanning tunnelling microscopy (STM) and quantitative low-energy electron diffraction (LEED). The cobalt species of the film reside in or near hollow positions of the substrate with, however, unoccupied sites (vacancies) in a 3 × 3 arrangement. In the so-formed 3 × 3 supercell the oxide's oxygen species are both threefold and fourfold coordinated to cobalt, forming pyramids with a triangular and square cobalt basis, respectively. These pyramids are the building blocks of the oxide. Due to the reduced coordination as compared to the sixfold one in the bulk of rock-salt-type CoO, the Co-O bond lengths are smaller than in the latter. For the threefold coordination they compare very well with the bond length in oxygen terminated CoO(111) films investigated recently. The substoichiometric 3 × 3 oxide monolayer phase transforms to a stoichiometric c(10 × 2)-periodic oxide monolayer under oxygen exposure, in which, however, cobalt and oxygen species are in (111) orientation and so form a CoO(111) layer.

Phases and phase transitions of hexagonal cobalt oxide films on Ir(100)-(1 × 1)

Cobalt oxides on the unreconstructed Ir(100) surface were prepared by reactive deposition of Co established by simultaneous oxygen flux at about 50 °C and subsequent annealing. The films were investigated by low-energy electron diffraction (LEED), scanning tunnelling microscopy (STM) and thermal desorption spectroscopy (TDS). We show that in spite of the quadratic unit mesh of the substrate, oxide films of (111) orientation develop. As long as oxygen-rich conditions are maintained they are of spinel-type Co(3)O(4)(111). They are non-pseudomorphic and transform to rocksalt-type CoO(111) when oxygen loss is induced by annealing at elevated temperatures. Thin films of CoO(111) are commensurate, and so, in order to realize that, they exhibit a slightly distorted unit cell when below a thickness equivalent to about seven cobalt monolayers. With increasing film thickness the uniaxial strain accompanied by the commensurability is gradually relieved by the insertion of dislocations so that eventually the film assumes ideal hexagonality. All CoO(111)-type surfaces are reconstructed at low sample temperatures equivalent to a [Formula: see text] superstructure. They reversibly transform into a (1 × 1) phase at about 50 °C.

Point defects in the NiAl(100) surface

The stability of various point defects in NiAl(100) has been investigated by first-principles calculations. For Al-rich surfaces, Ni vacancies within the first Al layer are energetically most favourable. For Ni-rich surfaces, so-called double defects, consisting of both Ni-antisite atom in the first Al layer and a Ni vacancy within the second Ni layer, form the configuration of lowest energy, superior to singular Ni antisites. An additional and significant energy gain is found in both cases by mutual lateral interaction of the defects, when they are arranged in the diagonal direction. Respective [Formula: see text] ordered configurations were found as the most stable structures. A 50:50 mixture of both defect types turns out to be even lower in energy than the ideal Al-terminated NiAl(100) surface, proving the latter to be metastable only. This is in line with the often reported inability in experiments to prepare ideal NiAl(100) surfaces.

Coexistence of rocksalt and wurtzite structure in nanosized CoO films

Cobalt oxide (CoO) films epitaxially grown on Ir(100) in (111) orientation were investigated by means of quantitative low-energy electron diffraction and scanning tunneling microscopy. We find with high crystallographic precision that in the bulk of the films the rocksalt structure prevails while near the surface there is a switch towards the wurtzite structure. As a consequence, nanosized CoO cannot be considered as a single structural phase. The film surfaces prove to be metallic, apparently connected with polarity compensation.

Surface structure of polar Co(3)O(4)(111) films grown epitaxially on Ir(100)-(1 × 1)

Cobalt oxide films were prepared by oxidation of different amounts of cobalt deposited on Ir(100)-(1 × 1), where oxygen rich conditions were applied during deposition. The resulting oxide films with thicknesses of up to about 40 Å were investigated as regards their crystallographic structure and morphology, applying quantitative low energy electron diffraction (LEED) and scanning tunnelling microscopy (STM). It can be unequivocally shown that the spinel-type Co(3)O(4) phase develops, for which an excellent fit between measured and calculated LEED intensity spectra is achieved (Pendry R-factor R = 0.124). In spite of the quadratic unit cell of the substrate the oxide films are in the polar (111) orientation. Also, the native lattice parameter of the material is assumed, i.e. there is no pseudomorphic relation to the substrate. However, by means of orientational epitaxy, one of the unit-mesh vectors of the oxide and one of those of the substrate layer are aligned, leading to two mutually orthogonal domains in the oxide. The oxide is terminated by a sublayer of cobalt ions which in the bulk were tetrahedrally coordinated Co(2+) ions. There are drastic relaxations of layer spacings at and near the surface. As a consequence, the bond length between the surface terminating cobalt ions and oxygen ions below is considerably reduced, indicative of a substantial change of the ionicity of the cobalt and/or oxygen ions. This is interpreted as accounting for polarity compensation of the film, as surface reconstruction, oxygen vacancies and species adsorbed can be ruled out.

[Cardiogenic shock due to acute myocarditis complicating leptospirosis]

A 48 year old man was admitted to the intensive care unit with septicaemic shock associated with febrile jaundice and anuric renal failure. Within hours, he developed cardiogenic shock with multi-organ failure due to an acute myocarditis refractory to catecholamines and requiring intra-aortic balloon pumping. The diagnosis was an ictero-haemorrhagic leptospirosis, the outcome of which was finally favourable. Myocarditis is an underestimated complication of leptospirosis because it is often symptomless. The main signs are arrhythmias, conduction defects and ST-T wave abnormalities which have little clinical expression. The disease may progress and is sometimes fatal. Leptospirosis myocarditis should therefore be carefully considered because of its potential severity and its reversibility with appropriate antibiotic therapy and also the necessity of initial management in a specific infrastructure.

Reversible H-induced switching of the magnetic easy axis in Ni/Cu(001) thin films

A reversible switching of the easy axis of magnetization for Ni on Cu(001) from in plane to out of plane is found by changing the partial pressure of hydrogen in the gas phase around the sample, allowing even for oscillations of the magnetization direction. A quantitative low-energy electron diffraction study of the diffracted intensity versus electron energy [I(E)] shows that the hydrogen-induced spin reorientation transition is accompanied by changes of the tetragonal distortion of the topmost Ni layer upon hydrogen adsorption. Surprisingly, the orientation switch to perpendicular to the surface comes with a relaxation, i.e., reduction of the film's tetragonal distortion rather than its amplification.

First-principles-based surface phase diagram of fully relaxed binary alloy surfaces

The combination of density-functional theory (DFT) calculations of geometrically fully relaxed binary alloy surfaces with concepts from statistical physics is applied to construct a DFT-based phase diagram for a binary alloy surface. As a first example, we studied the appearance of Co antisite atoms at CoAl(100) surfaces. The structural parameters as multilayer relaxations, surface buckling, lateral order, and segregation profile of the predicted stable surface phases are in excellent agreement with experimental structure determinations applying low-energy electron diffraction.

Hydrogen-induced self-organized nanostructuring of the Ir(100) surface

We show that the Ir(100) surface forms a new nanostructure in a self-organized way when its reconstructed equilibrium surface is exposed to hydrogen. Scanning tunneling microscopy and quantitative low-energy electron diffraction retrieve that a long-range ordered superlattice of defect-free Ir chains with average lateral spacing of 1.36 nm and micrometer lengths develops. This can be used as a template for the formation of other nanostructures as is demonstrated.

[Cardiovascular consequences of obstructive sleep apnea syndrome]

PURPOSE

This article is an update of past and current data on the relationship between obstructive sleep apnea syndrome and cardiovascular diseases.

CURRENT KNOWLEDGE AND KEY POINTS

Obstructive sleep apnea syndrome is a common, but under-recognised, condition and should not be considered simplistically as the association of snoring and obesity. It may be suspected by the clinical history but a definite diagnosis requires the practice of polysomnography. Numerous studies have found a significant relationship between the presence of obstructive sleep apnea syndrome and the occurrence of cardiovascular events. Nonetheless, a definite causal relationship has only been established for the occurrence of hypertension. There are multiple immediate and delayed cardiovascular responses to the apneic events and thus there are many possible physiopathological mechanisms to explain the association of obstructive sleep apnea and cardiac and vascular events, the primary one being sympathetic hyperactivity. The prognosis of obstructive sleep apnea syndrome is closely related to the incidence of cardiovascular events. FUTURE PROSPECTS AND PROJECS: The existence of an independent relationship between obstructive sleep apnea syndrome and atherosclerosis is not yet demonstrated. The beneficial effects of continuous positive airway pressure, the treatment of choice for this condition, on the incidence of cardiovascular diseases remains to be confirmed although recent studies suggest that correct treatment of obstructive sleep apnea syndrome by continuous positive airway pressure may reduce the cardiovascular risk and in particular that of hypertension.

Segregation in strongly ordering compounds: a key role of constitutional defects

For the example of the B2 CoAl(100) surface, we demonstrate that even slight deviations from an ordered alloy's ideal stoichiometry in a subsurface region or in the bulk can drastically affect its surface composition. By experimental surface analysis and first-principles calculations, we show that Co antisite atoms segregate to the very surface, driven by the same strong interactions which enforce order in the bulk. Our findings are consistent with the lack of antisite segregation we found earlier for the much weaker ordering FeAl(100), and resolve contradictory reports for NiAl(100).

Predicting children's reported eating disturbances at 8 years of age

OBJECTIVES

To examine differential parental influences on eating attitudes and behaviors of 8-year-old children with a specific focus on gender effects and to assess the specificity of this relationship.

METHOD

One hundred eight infants were monitored from birth and interviewed at age 8 for eating disturbances and negative affect with an adaptation of the McKnight Risk Factor Survey. Parental measures included the Three Factor Eating Questionnaire subscales Disinhibition and Restraint as well as body mass index, assessed at study entry.

RESULTS

No gender differences were found for frequencies of children's self-reported eating disturbances. Higher maternal restraint scores predicted worries about being too fat in girls but not in boys. Higher maternal disinhibition scores also differentially predicted weight control behaviors in their daughters. Negative affect in the child was (weakly) predicted by higher maternal body mass index. No association between paternal predictors of disturbed eating and the child's eating disturbances and negative emotionality was found.

CONCLUSIONS

The impact of maternal eating disorders and disturbances is much stronger than that of fathers and is specifically directed at their daughters. The clinical importance of these disturbances in terms of precursors of adolescent eating disorders has to be determined by monitoring the sample through puberty.

Metastatic phaeochromocytoma: risks of diagnostic needle puncture and treatment by arterial embolisation

A 62-year-old man had an acute episode of hypertension 72 h after fine needle aspiration biopsy of an intra- hepatic nodule. The patient had been operated 3 years previously for a right adrenal phaeochromocytoma with no evidence of metastases at that time. Thus, a relapse of the tumour was postulated and confirmed by raised levels of urinary metanephrines. The extent of the metastases precluded surgical intervention and thus localised embolisation was proposed and permitted a clinical stabilisation over 8 months. This case indicates the necessity of long-term post-operative follow-up of phaeochromocytoma as well as the dangers of fine needle aspiration biopsy of metastases from this kind of tumour. Treatment of malignant phaeochromocytoma is difficult and embolisation was a useful therapeutic alternative in this case where the metastases were well defined.

A prospective study of the influence of eating-disordered mothers on their children

OBJECTIVE

This study examined the effects of eating disordered mothers on their children.

METHOD

Women with a past or present eating disorder (ED; N = 41) and non-eating disordered women (NED); N = 153) and their offspring were followed prospectively.

RESULTS

Female infants of ED mothers sucked significantly faster and were weaned 9 months later than offspring of NED mothers. ED mothers fed their children on a less regular schedule, used food for nonnutritive purposes, and demonstrated significantly higher concern about their daughters' weight than NED mothers from 2 years of age onward. At 5 years, the offspring of ED mothers were reported to demonstrate greater negative affect than the offspring of NED mothers.

DISCUSSION

The female offspring of ED mothers demonstrate a high avidity for feeding early in life which, combined with increased maternal concern over their daughters weight and the use of food for nonnutritive purposes, may pose a serious risk for the later development of an eating disorder.

Serine 232 and methionine 272 define the ligand binding pocket in retinoic acid receptor subtypes

The transcriptional response mediated by retinoic acid involves a complex series of events beginning with ligand recognition by a nuclear receptor. To dissect the amino acid contacts important for receptor-specific ligand recognition, a series of retinoic acid receptor (RAR) mutants were constructed. Transcriptional studies revealed that serine 232 (Ser232) in RARalpha and methionine 272 (Met272) in RARgamma are critical residues for the recognition of their respective receptor-selective analogs. The identification of these key amino acids in the ligand binding pocket is confirmed by the reported crystal structure of RARgamma. Interestingly, the serine at position 232 in RARalpha gives an explanation for the observed differences in the affinity of the naturally occurring ligand, all-trans-retinoic acid (t-RA), in this receptor compared with that for the other receptors, since hydrogen bonding would not be permitted between the hydroxyl of serine and the hydrophobic linker of t-RA. Using this model, a molecular mechanism for the transcriptional antagonism of a synthetic analog is suggested that involves an alteration in the structure of the receptor protein in the region around the AF2 domain in helix 12.

Weight concerns influence the development of eating disorders: a 4-year prospective study

The authors examined factors prospectively associated with age of onset of partial syndrome eating disorders over a 4-year interval in a community sample (N = 877) of high school-age adolescent girls. Four percent developed a partial syndrome eating disorder over the interval. A measure of weight concerns was significantly associated with onset in a multivariate Cox proportional hazard analysis (p < .001). Girls scoring in the highest quartile on the measure of weight concerns had the highest incidence (10%) of partial syndrome onset, whereas none of the girls in the lowest quartile developed eating disorder symptoms. This finding is consistent with both theoretical and clinical perspectives and may represent a useful step toward the establishment of a rational basis for the choice of a prevention intervention target.

Weight concerns influence the development of eating disorders: a 4-year prospective study

The authors examined factors prospectively associated with age of onset of partial syndrome eating disorders over a 4-year interval in a community sample (N = 877) of high school-age adolescent girls. Four percent developed a partial syndrome eating disorder over the interval. A measure of weight concerns was significantly associated with onset in a multivariate Cox proportional hazard analysis (p < .001). Girls scoring in the highest quartile on the measure of weight concerns had the highest incidence (10%) of partial syndrome onset, whereas none of the girls in the lowest quartile developed eating disorder symptoms. This finding is consistent with both theoretical and clinical perspectives and may represent a useful step toward the establishment of a rational basis for the choice of a prevention intervention target.

Retinoic acid receptor beta,gamma-selective ligands: synthesis and biological activity of 6-substituted 2-naphthoic acid retinoids

In search for retinoic acid receptor (RAR) selective ligands, a series of 6-substituted 2-naphthoic acid retinoids were synthesized and evaluated in vitro in a transactivation assay and a competition binding assay for all RARs. These derivatives, in general, showed RAR beta,gamma selectivity. Among these naphthoic acids, oxime derivative 12 was identified as a potent RAR gamma-selective retinoid, while olefinic derivative 11 was found to be comparable to retinoic acid and slightly RAR beta,gamma selective. For the bioassays, a general correlation was observed between the binding affinity of the ligand to the receptors and the potency of the compounds in the transactivation assay. The structure-activity relationship of these naphthoic acids will be discussed.