A resonant sextuplet of sub-Neptunes transiting the bright star HD 110067

Planets with radii between that of the Earth and Neptune (hereafter referred to as 'sub-Neptunes') are found in close-in orbits around more than half of all Sun-like stars1,2. However, their composition, formation and evolution remain poorly understood3. The study of multiplanetary systems offers an opportunity to investigate the outcomes of planet formation and evolution while controlling for initial conditions and environment. Those in resonance (with their orbital periods related by a ratio of small integers) are particularly valuable because they imply a system architecture practically unchanged since its birth. Here we present the observations of six transiting planets around the bright nearby star HD 110067. We find that the planets follow a chain of resonant orbits. A dynamical study of the innermost planet triplet allowed the prediction and later confirmation of the orbits of the rest of the planets in the system. The six planets are found to be sub-Neptunes with radii ranging from 1.94R⊕ to 2.85R⊕. Three of the planets have measured masses, yielding low bulk densities that suggest the presence of large hydrogen-dominated atmospheres.

SEOM clinical guideline for management of adult medulloblastoma (2020)

Recent advances in molecular profiling, have reclassified medulloblastoma, an undifferentiated tumor of the posterior fossa, in at least four diseases, each one with differences in prognosis, epidemiology and sensibility to different treatments. The recommended management of a lesion with radiological characteristics suggestive of MB includes maximum safe resection followed by a post-surgical MR < 48 h, LCR cytology and MR of the neuroaxis. Prognostic factors, such as presence of a residual tumor volume > 1.5 cm2, presence of micro- or macroscopic dissemination, and age > 3 years as well as pathological (presence of anaplastic or large cell features) and molecular findings (group, 4, 3 or p53 SHH mutated subgroup) determine the risk of relapse and should guide adjuvant management. Although there is evidence that both high-risk patients and to a lesser degree, standard-risk patients benefit from adjuvant craneoespinal radiation followed by consolidation chemotherapy, tolerability is a concern in adult patients, leading invariably to dose reductions. Treatment after relapse is to be considered palliative and inclusion on clinical trials, focusing on the molecular alterations that define each subgroup, should be encouraged. Selected patients can benefit from surgical rescue or targeted radiation or high-dose chemotherapy followed by autologous self-transplant. Even in patients that are cured by chemorradiation presence of significant sequelae is common and patients must undergo lifelong follow-up.

A nearby transiting rocky exoplanet that is suitable for atmospheric investigation

Spectroscopy of transiting exoplanets can be used to investigate their atmospheric properties and habitability. Combining radial velocity (RV) and transit data provides additional information on exoplanet physical properties. We detect a transiting rocky planet with an orbital period of 1.467 days around the nearby red dwarf star Gliese 486. The planet Gliese 486 b is 2.81 Earth masses and 1.31 Earth radii, with uncertainties of 5%, as determined from RV data and photometric light curves. The host star is at a distance of ~8.1 parsecs, has a J-band magnitude of ~7.2, and is observable from both hemispheres of Earth. On the basis of these properties and the planet's short orbital period and high equilibrium temperature, we show that this terrestrial planet is suitable for emission and transit spectroscopy.

Recent catalytic routes for the preparation and the upgrading of biomass derived furfural and 5-hydroxymethylfurfural

Furans represent one of the most important classes of intermediates in the conversion of non-edible lignocellulosic biomass into bio-based chemicals and fuels. At present, bio-furan derivatives are generally obtained from cellulose and hemicellulose fractions of biomass via the acid-catalyzed dehydration of their relative C6-C5 sugars and then converted into a wide range of products. Furfural (FUR) and 5-hydroxymethylfurfural (HMF) are surely the most used furan-based feedstocks since their chemical structure allows the preparation of various high-value-added chemicals. Among several well-established catalytic approaches, hydrogenation and oxygenation processes have been efficiently adopted for upgrading furans; however, harsh reaction conditions are generally required. In this review, we aim to discuss the conversion of biomass derived FUR and HMF through unconventional (transfer hydrogenation, photocatalytic and electrocatalytic) catalytic processes promoted by heterogeneous catalytic systems. The reaction conditions adopted, the chemical nature and the physico-chemical properties of the most employed heterogeneous systems in enhancing the catalytic activity and in driving the selectivity to desired products are presented and compared. At the same time, the latest results in the production of FUR and HMF through novel environmental friendly processes starting from lignocellulose as well as from wastes and by-products obtained in the processing of biomass are also overviewed.

[Results and complications of adjacent segment disease treated by minimally invasive lateral intersomatic arthrodesis]

INTRODUCTION

A comparative clinical study has been conducted on patients involved using lateral intersomatic arthrodesis for the treatment of adjacent segment disease using titanium and PEEK intersomatic devices.

MATERIAL AND METHODS

Clinical (EVA and oswestry disability index ODI) and radiological (alignment and fusion), complications (major and minor) and quality of life (EQ5D) of 32 patients intervened from September 2015 to September 2018 have been analyzed and compared, with an average follow-up of 25 months (46-18). The average age in surgery was 66 years (39-89) and 68% of patients were women.

RESULTS

The most common segment involved was L3-L4 (62%) right retroperitoneal approach 86%. Lumbar EVA improved from 6.2 ± 2.12 to 4.1 ± 1.71 (p = 0.028). The LEG EVA descended from 5.3 ± 2.26 to 1.9 ± 1.58 (p = 0.02). The ODI scales improved from 50.2 ± 18.9 to 33.3 ± 10.2 (p = 0.025) and the EQ5D went from 0.52 to 0.73 (p = 0.039) with no statistically significant differences between the groups (ODI p = 0.18, EQ5D p = 0.293). Radiologically increased intervertebral height, lumbar and segmental lordosis, decreased Cobb's angle and the overall melting rate was 84.3% (88% Ti/82% PEEK), with no differences between the groups.

CONCLUSION

Lateral lumbar interbody fusion is an effective method for treating adjacent segment disease with clinical-radiological results and literature-like complications. No differences have been found between Ti and PEEK implants.

A multiplanet system of super-Earths orbiting the brightest red dwarf star GJ 887

The closet exoplanets to the Sun provide opportunities for detailed characterization of planets outside the Solar System. We report the discovery, using radial velocity measurements, of a compact multiplanet system of super-Earth exoplanets orbiting the nearby red dwarf star GJ 887. The two planets have orbital periods of 9.3 and 21.8 days. Assuming an Earth-like albedo, the equilibrium temperature of the 21.8-day planet is ~350 kelvin. The planets are interior to, but close to the inner edge of, the liquid-water habitable zone. We also detect an unconfirmed signal with a period of ~50 days, which could correspond to a third super-Earth in a more temperate orbit. Our observations show that GJ 887 has photometric variability below 500 parts per million, which is unusually quiet for a red dwarf.

A giant exoplanet orbiting a very-low-mass star challenges planet formation models

Surveys have shown that super-Earth and Neptune-mass exoplanets are more frequent than gas giants around low-mass stars, as predicted by the core accretion theory of planet formation. We report the discovery of a giant planet around the very-low-mass star GJ 3512, as determined by optical and near-infrared radial-velocity observations. The planet has a minimum mass of 0.46 Jupiter masses, very high for such a small host star, and an eccentric 204-day orbit. Dynamical models show that the high eccentricity is most likely due to planet-planet interactions. We use simulations to demonstrate that the GJ 3512 planetary system challenges generally accepted formation theories, and that it puts constraints on the planet accretion and migration rates. Disk instabilities may be more efficient in forming planets than previously thought.

P14.58 Extending adjuvant temozolomide longer than six cycles doesn’t add any benefit to glioblastoma patients according to the randomized GEINO-014 TRIAL

BACKGROUND

Standard treatment of glioblastoma (GBM) is focal radiation with concomitant and adjuvant temozolomide (TMZ) for 6 cycles. The GEINO-14-01 trial (NCT02209948) investigated the role of extending adjuvant TMZ to 12 cycles in a randomized multicenter study.

MATERIAL AND METHODS

Between Aug/2014 and Nov/2018, 166 patients (p) were screened and 159 randomized to extend (80p) or not (79p) TMZ treatment to 12 cycles after proving stable disease in the MRI performed before inclusion. The trial was stratified by MGMT status and presence or absence of residual disease (defined as a residual enhancement larger than 1cm on the MRI). The primary endpoint was differences in 6monthsPFS, secondary endpoints were differences in PFS, OS, toxicity, between arms and per stratification factors.

RESULTS

Median age was 60.4 (range 29–83), 97p (61%) were methylated and 83 p (52.2%) were reported with residual disease. Median (m) PFS was 7.9 months (95%CI: 6.1–9.8) and mOS: 20.9 (95%CI: 17.6–24.1). A methylated status was a factor of better PFS (HR=0.29, 95% CI 0.46–0.95; p=0.029) and better OS (HR= 0.43: 95% CI 0.28–0.66; p=0.000) as well as the absence of residual disease (PFS: HR = 0.84: 95% CI =0.71–1.01; p=0.068; OS: HR=0.77, 95%CI 0.63–0.96; p=0.019). We didn’t find any difference in PFS (HR=1.02, 95%CI 0.85–1.21; p=0.82), or OS (HR=0.90; 0.73–1.11; p=0.34) on extending treatment with temozolomide longer than 6 cycles.

CONCLUSION

There is no benefit of continuing TMZ treatment for more than 6 cycles in the adjuvant treatment of glioblastoma. Final data will be presented at the congress. Supported by a Grant of the ISCIII: PI13/01751

Delay in starting radiotherapy due to neoadjuvant therapy does not worsen survival in unresected glioblastoma patients

PURPOSE

We retrospectively examined the potential effect on overall survival (OS) of delaying radiotherapy to administer neoadjuvant therapy in unresected glioblastoma patients.

PATIENTS AND METHODS

We compared OS in 119 patients receiving neoadjuvant therapy followed by standard treatment (NA group) and 96 patients receiving standard treatment without neoadjuvant therapy (NoNA group). The MaxStat package of R identified the optimal cut-off point for waiting time to radiotherapy.

RESULTS

OS was similar in the NA and NoNA groups. Median waiting time to radiotherapy after surgery was 13 weeks for the NA group and 4.2 weeks for the NoNA group. The longest OS was attained by patients who started radiotherapy after 12 weeks and the shortest by patients who started radiotherapy within 4 weeks (12.3 vs 6.6 months) (P = 0.05). OS was 6.6 months for patients who started radiotherapy before the optimal cutoff of 6.43 weeks and 19.1 months for those who started after this time (P = 0.005). Patients who completed radiotherapy had longer OS than those who did not, in all 215 patients and in the NA and NoNA groups (P = 0.000). In several multivariate analyses, completing radiotherapy was a universally favorable prognostic factor, while neoadjuvant therapy was never identified as a negative prognostic factor.

CONCLUSION

In our series of unresected patients receiving neoadjuvant treatment, in spite of the delay in starting radiotherapy, OS was not inferior to that of a similar group of patients with no delay in starting radiotherapy.

Abstract P3-01-07: Comparison of the prognostic value of lymph node ratio versus residual lymph node status in triple negative breast cancer

Background: Triple negative breast cancer (TNBC) patients with residual disease are characterized for a bad outcome. In these patients nodal involvement after neoadjuvant chemotherapy (NAC) is one of the most important prognostic determinants. In this study we compare two prognostic variables based on nodal status, the lymph node ratio (LNR=#positive nodes/#resected nodes) and residual lymph node status (ypN) in TNBC who received NAC.

Methods: We evaluated a retrospective cohort of TNBC patients with residual disease in the lymph nodes (at least 4 resected nodes) and treated with NAC between 2000-2014 at the Instituto Nacional de Enfermedades Neoplasicas (Lima-Peru). Patients were grouped in three LNR groups (≤0.20, 0.20-0.69 and ≥0.70). Survival differences were calculated by the log rank test. Prognostic factors for progression free survival (PFS) and overall survival (OS) were assessed by the Cox regression analysis.

Results: Overall, 189 were evaluated. Mean age was 48y (range: 26-73) where 53.5% were premenopausal and 16.5% had breast/ovary cancer familial background. A total of 175 pts (92.6%) had clinical T3-T4 tumors and 85.2% had nodal involvement at diagnosis. Indeed, the majority of patients had III CS (94.2%). Regarding to the LNR, 48.2% (n=91), 29.6% (n=56) and 22.2% (n=42) (22.2) had LNR ≤0.20, 0.21-0.69 and ≥0.70, respectively. Distribution of clinical differences was similar between groups, except for the clinical N stage (N2-N3: 15.4%, 46.4%, 52,3%, respectively; p&lt;0.001). The median follow-up was 7 years. Progression risk was higher in patients with LNR ≤0.20 than 0.20-0.69 and ≥0.70 (HR=1.77, 95%CI:1.21-2.59, p=0.003 and HR=2.22, 95%CI:1.47-3.35, respectively, p&lt;0.001). It was similar for the risk of death (HR=1.78, 95%CI: 1.17-2.70, p=0.007 and HR=2.95, 95%CI:1.91-4.56, respectively, p&lt;0.001). LNR groups were associated to progression events (P=0.02) in contrast to ypN groups (P=0.07). In the multivariate analysis, pre-menopausal status, a higher LNR and ypT with non-complete response were prognostic factors of worse DFS. Only a higher LNR has a negative impact on OS (table 1).

Conclusion: LNR was an independent prognostic factor for TNBC in patients with residual disease with better capability than ypN to predict progression events. LNR should be considered in the risk stratification after NAC among these patients.

Table 1. Multivariate Cox Regression AnalysisCharacteristicsDFS  OS   HR95%CIp valueHR95%CIp valuePremenopausal status1.931.37-2.73&lt;0.001nsnsnsLNR 0.20 vs 0.21-0.692.011.36-2.970.0011.781.17-2.700.007LNR 0.20 vs 0.701.751.57-3.74&lt;0.0012.921.88-4.55&lt;0.001ypT complete vs partial1.751.13-2.710.012nsnsnsypT complete vs non-response2.041.20-3.480.009nsnsnsns=not significant

Citation Format: De la Cruz-Ku G, Morante Z, Pinto J, Enriquez D, Eyzaguirre E, Saavedra A, Luján M, Luque R, Ramírez M, Araujo J, Fuentes H, Flores C, Moller M, Yakoub D, Neciosup S, Gomez H. Comparison of the prognostic value of lymph node ratio versus residual lymph node status in triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-07.

Abstract P1-15-02: Benefit of adjuvant chemotherapy in disease-free survival for T1N0 triple negative breast cancer

Background: Although chemotherapy is not recommended in low-risk early breast cancer, triple-negative breast cancers (TNBC) have twice risk of recurrence despite an aggressive treatment. In this study we evaluated the role of chemotherapy in the outcome of T1N0 TNBC patients in terms of disease-free survival (DFS) and overall survival (OS).

Methods: We evaluated a retrospective cohort T1N0 TNBC patients diagnosed between 2000 to 2014 at the Instituto Nacional de Enfermedades Neoplasicas (Lima-Peru). Survival rates differences were assessed by Log-rank test and prognostic factors were identified using the Cox proportional hazards model.

Results: We identified 123 T1N0 TNBC patients. The median age was 51 years (range: 28-85), where 38.5% were premenopausal. Thirty-six (29.3%) were pT1a/b and 87 were pT1c (70.7%). ACT was administered more frequently in pT1c patients (74.7% vs 55.6%; P=0.036). Locoregional relapse and distant metastases rates were 8.3% vs 19.5% and 5.6% vs 16.1% for tumors pT1a/b and pT1c, respectively. The median of follow-up was 8.8 years. Independent prognostic factors were pT stage and treatment with ACT. In relation to pT stage, DFS rates were 97% vs 78% (at 5-years) and 97% vs 70% (at 8-years) for pT1a/b vs pT1c patients, respectively (HR=4.8; 95%CI:1.46-17.0; P=0.015). In the other hand, patients treated with ACT had a better outcome with DFS rates to 5-years of 86% vs 74% and 8-years of 81% vs 65% (HR: 0.41, 95%CI: 0.17-0.97, p=0.043). Our study had not statistical power to evaluate benefit of ACT in pT1a/b patients. In cases with pT1c tumors, treatment with ACT was the only factor associated with a better DFS (HR=0.29, 95%CI: 0.11-0.77, p=0.012). Because the low mortality in our cohort, OS was not evaluable.

Conclusions: Treatment with adjuvant chemotherapy reduces the recurrence risk in 71% among pT1cN0 TNBC.

Citation Format: Morante Z, De la Cruz-Ku G, Pinto J, Araujo J, Fuentes H, Enriquez D, Luque R, Eyzaguirre E, Saavedra A, Luján M, Neciosup S, Gomez H. Benefit of adjuvant chemotherapy in disease-free survival for T1N0 triple negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-15-02.

Abstract P6-08-26: Outcomes and prognostic factors in 2000 patients with TNBC: Long-term results covering 10 years

Background: Triple-negative breast cancer (TNBC) is characterized by being a heterogeneous disease with different risk factors and poor survival rates. TNBC have a higher prevalence in the Peruvian population (21.3%) than in Caucasian groups. Our study aims to determine the outcome and identify prognostic factors in Peruvian women with TNBC.

Methods: We retrospectively analyzed TNBC patients treated at the “Instituto Nacional de Enfermedades Neoplasicas” between 2000 and 2014. Survival rates and differences were calculated by the Kaplan-Meier method and Log-rank test, respectively. With the Cox regression, in univariate and multivariate analysis, we identified prognostic factors in for our TNBC population.

Results: In total, 2007 patients were diagnosed.The mean age was 50 years (range: 19-95 years); 44.8% were premenopausal and 26.2% had obesity at diagnosis. A family history of breast and/or ovarian cancer was present in 266 (28.9%) patients. Regarding the clinical-pathological features, 1860 (93.5%) had ductal invasive carcinoma and 1024 (51.6%) patients were in Stage (S) III. Local relapse and distant metastasis affected to 34.5% and 51.4% of our patients, respectively. Lung (14.5%) and bone (9.7%) were the most frequent sites of metastasis. The median follow-up was 9 years. The 5 and 10 yrs DFS/OS rates are shown in table 1. In the multivariate analysis, adjuvant chemotherapy (ACT) (HR: 0.60, 95%CI: 0.44-0.82, p=0.001) and radiotherapy (RT) (HR:0.72, 95%CI:0.55-0.93, p=0.014) were associated with a reduced risk of recurrence, while nodal involvement were associated to a high recurrence risk. Factors associated to a reduction in the risk of death were ACT (HR:0.73, 95%CI:0.61-0.88, p=0.001), RT (HR: 0.70, 95%CI: 0.60-0.92, p&lt;0.001), and Neoadjuvant CT (HR: 0.61, 95%CI: 0.51-0.73, p&lt;0.001); in contrast, a NLR≥3 (HR:1.60,95%CI: 1.36-1.87, p&lt;0.001), N stage were associated with a higher risk of death.

Conclusions: Sociodemographic features of Peruvian patients with TNBC resemble other populations; however, our population is diagnosed at more advanced clinical stages, hence DFS and OS were lower than international reports while prognostic factors were similar to previous studies.

Table 1. 5- and 10-years DFS/OS ratesClinical StageIIIIIIIVTotalp (value)DFS (%)     &lt;0.0015-years837540-63 10-years696429-52 OS (%)     &lt;0.0015-years938239655 10-years837532550 

Citation Format: De la Cruz-Ku G, Morante Z, Pinto J, Enriquez D, Araujos J, Luque R, Eyzaguirre E, Saavedra A, Fuentes H, Neciosup S, Gomez H. Outcomes and prognostic factors in 2000 patients with TNBC: Long-term results covering 10 years [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-26.

SEOM clinical guidelines for diagnosis and treatment of glioblastoma (2017)

Glioblastoma (GB) is the most common brain malignancy and accounts for over 50% of all high-grade gliomas. Radiotherapy (RT) with concomitant and adjuvant temozolomide (TMZ) chemotherapy is the current standard of care for patients with newly diagnosed GB up to age 70. Recently, a new standard of care has been adopted for elderly patients (≥ 65 years) based on short course of RT and TMZ. Several clinically relevant molecular markers that assist in diagnosis and prognosis have recently been identified. The treatment for recurrent GB is not well defined, and decision-making is usually based on prior strategies as well as several clinical and radiological factors. The presence of neurologic deficits and seizures can significantly impact quality of life.

[Congenital knee dislocation: case report]

Congenital knee dislocation is an infrequent condition with unknown etiology. In some cases it occurs as an isolated condition, while in others it coexists with associated conditions or syndromes. The treatment of congenital knee dislocation is driven by the severity and flexibility of the deformity. The literature includes from serial casting or the Pavlik harness to quadriceps tendon plasty or femoral osteotomies. We report herein the case of a congenital dislocation treated with serial casting with a good outcome.

Familial isolated pituitary adenoma caused by a Aip gene mutation not described before in a family context

The cause of familial isolated pituitary adenomas (FIPA) remains unknown in a high percentage of cases, but the AIP gene plays an important role in the etiology. The aim of the study is to describe a family with FIPA syndrome and the results of genomic studies. A 16-year-old man had a giant prolactinoma resistant tomedical treatment with delayed growth and pubertal development. His mother had been previously diagnosed with a nonfunctioning pituitary macroadenoma. Transsphenoidal endoscopic resection was performed and a genetic study revealed a heterozygous mutation in exon 6: 974G>A (p.Arg325Gln). Because the AIP gene is a tumor suppressor gene, we searched for loss of heterozygosity within the AIP gene by amplifying exon 6 from tumor tissue of the patient. In the electropherogram, only the A allele was amplified (hemizygous state), indicating loss of the normal allele. We report a Spanish family with FIPA in whom a mutation in the AIP gene previously unreported in a familiar context was identified.

Diversity of culturable halophilic archaea isolated from Rambla Salada, Murcia (Spain)

We have studied the diversity of culturable halophilic Archaea at Rambla Salada, Murcia (south-eastern Spain). We made 8 samplings at different places in this habitat during the years 2006 and 2007 and isolated a total of 49 strains, which were identified by means of phenotypic tests and the hypervariable V1-V3 region of the 16S rRNA gene sequences (around 500 bp). The ribosomal data showed that the isolates belonged to 12 genera within the Halobacteriaceae family, with Haloferax and Natrinema being the most abundant. Five strains showed less than 97% sequence identity with validly described species and may well represent new taxa. All the strains grew best with around 25% w/v salts, required high concentrations of NaCl and magnesium and produced red to pink colonies. They were facultative anaerobes with both respiratory and fermentative metabolisms. The diversity of the archaeal community was analysed with the MOTHUR package. We identified 14 OTUs at the 3% genetic distance level and found quite high diversity. Rarefaction curves of richness estimators and diversity indices demonstrated that our collection of isolates represented the archaeal community at Rambla Salada that can be isolated under the conditions used in this work. This is the first report to be published on the culturable archaea at Rambla Salada, an area of considerable ecological interest.

Bacillary angiomatosis with atypical clinical presentation in an immunocompetent patient

Bacillary angiomatosis is a recently described infectious disease that usually affects immunosupressed hosts with a previous history of contact with cats. We report a rare case of bacillary angiomatosis in an immunocompetent 59-year-old woman with no history of previous exposure to cats, and atypical clinical features (fever and subcutaneous nodules with ulceration on the left ankle). Histopathology of the lesion showed extensive ulceration and reactive tumor-like vascular proliferation of the blood vessels with swollen endothelial cells and an inflammatory infiltrate including neutrophils and lymphocytes in the dermis and subcutis. Staining with the Warthin-Starry method demonstrated the presence of clustered bacilli located in the extracellular matrix adjacent to the proliferating endothelial cells. Diagnosis was confirmed with the detection of Bartonella spp. DNA in the affected skin and in bone marrow using polymerase chain reaction.

Association between cerebral metabolic and structural abnormalities and cognitive performance in schizophrenia

The possible association in schizophrenia between frontal abnormalities, such as hypofrontality and frontal grey matter (GM) deficits, and neuropsychological deficits is not yet well defined. Our objective was to study such an association and to clarify the cognitive relevance of metabolic and anatomical variability across schizophrenia patients. To do so, we studied dorsolateral prefrontal (DLPF) metabolism during an attention test using fluoro-deoxy-glucose positron emission tomography and DLPF structure with magnetic resonance imaging (MRI) in 22 schizophrenia patients [9 neuroleptic-naïve (NN) first episodes]. These patients also underwent a comprehensive battery of neuropsychological tests aimed at evaluating global intelligence and the proposed domains of cognitive alteration in schizophrenia, i.e., attention, visual and verbal learning and memory, working memory, problem solving and processing speed. The metabolic activity in the right DLPF region was significantly and directly related to processing speed, and a measure of structural deficit in the same area was directly related to working memory scores. In the NN group studied alone, these associations were replicated. We may conclude that hypofrontality during cognitive activation, and the degree of DLPF structural deficit may be associated to a particular profile of cognitive deficit, including lower processing speed and working memory capacity.

Microarray study of gene expression profiles in peripheral blood samples from lung cancer patients before and after erlotinib treatment

e19072

Background: The gene expression profile in peripheral blood samples from lung cancer patients is a potential predictor to treatment response. Methods: The study has been developed using 10 healthy volunteers as the control group and 10 lung cancer patients (stage IV). Written informed consent was obtained being the protocol approved by the local Clinical Research and Ethics Committee. Peripheral blood samples were obtained from lung cancer patients before (T0) and after treatment (T15d). RNA from peripheral blood samples was extracted and purified selecting 28S/18S ratios>1.5 to obtain cDNA and cRNA for hybridization of the 20,000 genes included in Human 20K CodeLink. An array from each participant was obtained in duplicate. For each array, 2 μg of cRNA was compared to 2 μg of healthy cRNA.. Significant genes were found using Significance Analysis of Microarrays which uses repeated permutations of the data. Results: The selected genes were expressed >3-fold with a false discovery rate =0.05. Before treatment (T0) when patients were compared to healthy volunteers there was an increase in the expression of: histone 1 H4c, transforming growth factor beta 2, endothelial cell growth factor 1 (platelet-derived), glucose-6-phosphatase catalytic 2, Relaxin 3 receptor 1, Insulin-like growth factor binding protein 2, RAS-like family 11 member B, and ELK4. After treatment (T15d), when each lung cancer patient's results were compared to their own before treatment results (T0), there was an increase in the expression of: Bcl2, myosin light polypeptide 4; interferon alpha-inducible protein 27; interferon gamma receptor 1; RASSF5, ARHGEF6, IGFBP5, tumor protein p53 inducible nuclear protein 1, peroxisome proliferative activated receptor gamma. Conclusions: The data presented identifies biologically relevant over-expressed genes in lung cancer. A validation of these results and the analysis of the genes that identify patients who will respond positively to erlotinib treatment is being carried out.

No significant financial relationships to disclose.

Biochemical changes in the cingulum in patients with schizophrenia and chronic bipolar disorder

Biochemical changes have been reported in vivo in the brain in schizophrenia patients using 1H-magnetic resonance spectroscopy (MRS). The aim of this study was to assess the specificity of biochemical changes occurring in schizophrenia patients, in a direct comparison with bipolar disorder patients. Fourteen patients with chronic paranoid schizophrenia, 17 euthymic type I bipolar patients with no previous history of psychotic symptoms and 15 healthy controls were included, most of them were female. They underwent a study with MRS: proton spectra were acquired using a Signa 1.5 T CVI scanner, with a localised single voxel PRESS sequence. N-acetyl aspartate (NAA), Creatine (Cr), and Choline (Cho) metabolite resonance intensities were all quantified in the cingulum, a region of interest in schizophrenia and bipolar disorder. Schizophrenia patients showed a significantly higher Cho/Cre as well as lower NAA/Cho ratios as compared with controls and bipolar patients. No significant differences were found among the three groups as regards NAA/Cre levels. These data are consistent with an increase in the concentration of choline in the cingulum in chronic schizophrenia, at least in this predominantly female group. Such an increase seems to be more intense than in psychosis-free bipolar disorder patients.

Cotard's syndrome in adolescents and young adults is associated with an increased risk of bipolar disorder

OBJECTIVES

To assess the effect of age at onset on the phenomenology of Cotard's syndrome (CS) as a recent study reported a high rate of occurrence of bipolar disorder (BD) in adolescents and young adults with CS followed up for > or =2 years.

METHODS

We reviewed all cases of CS reported since it was first described. A statistical analysis was carried out to determine the effect of age at onset on CS phenomenology.

RESULTS

We found 138 cases including 21 cases aged 25 years or younger. In these younger CS patients, BD was more frequent, and the risk of associated BD was increased nine times (p < 0.0001). Within the BD sub-group (n = 27), admixture analysis identified two sub-groups with mean ages at onset of 18.7 years [standard deviation (SD) = 3.2] and 50.5 years (SD = 11.7).

CONCLUSIONS

Young people with CS should be monitored carefully for the onset of BD, and families should be educated about this risk. Treatment with mood stabilizers can be helpful for those who develop BD. Within BD associated with CS, early versus late onset should be distinguished.

No association between dorsolateral prefrontal gray matter deficit and N-acetyl aspartate ratios in schizophrenia

The cellular substrates of cortical volume deficit in schizophrenia are unclear. We may hypothesize that, if that deficit was related to a decrease in the amount in neuronal tissue, it should correlate with N-acetyl aspartate levels. We studied a group of 34 schizophrenia patients (of them, 17 first episodes) with both structural and spectroscopic magnetic resonance (MR). Using the data of 50 controls, we were able to calculate for each case residuals of gray matter and cortical cerebrospinal fluid (CSF) in the dorsolateral prefrontal (DLPF) region, representing the deviation from the expected values in normals, given individual intracranial volume and age. Although our patients showed a significant deficit in gray matter and excess in cortical CSF in the DLPF region, that deficit was unrelated to N-acetyl aspartate levels. This was also true for the chronic and first episode groups analyzed separately. These results do not support a neuronal tissue deficit as contributing to the cortical volume deficit in schizophrenia, at least in the DLPF region.

Selection of induction chemotherapy (CT) in esophageal and gastroesophageal junction cancer by positron emission tomography (PET)

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Background: Preoperative CT improves survival in esophageal cancer. 50% of patients (pts) do not respond to cisplatin+5-FU (C+F). The reduction of fluorodeoxyglucose uptake after 14 days (d) of CT predicts clinical response (rsp). Our objective was to measure the rsp (rsp) rate after CT adjusted according to PET rsp. Methods: Eligible pts were ≥ stage II esophageal cancer and able to tolerate CT. By adjusting CT according to PET rsp, we expected an increase of rsp rate by 25%. Taking into account a confidence level of 90%, an error β of 20% and a minimal error of 15% (even with such a high error rate the data will exceed the standard results), we calculated a sample size of 23 pts. All underwent esophagoscopy, computed tomography and PET scan prior to C (100mg/m2 d1) +5-FU (1,000mg/m2 d1–5). If PET rsp after first cycle (uptake decreased ≥ 35%), we continued up to third C+F cycle, then if endoscopy rsp: C+F + concurrent radiation only if stage II or III. If no endoscopy rsp, surgery only if stage II or III. On the other hand, if the pts had no rsp in PET after first C+F cycle they continued with 2 cycles of docetaxel (35mg/m2 d 1 & 8) and irinotecan (50mg/m2 d 1 & 8) (D+I) every 21 d and then if endoscopy rsp: radiation + docetaxel only if stage II or III. If no endoscopy rsp, surgery. Results: Since 2/04, 23 pts have been enrolled. Location: 2 cervical, 4 upper thoracic, 7 mid-thoracic, 10 GE junction. PET stage: 7 IIA, 6 IIB, 2 III, 2 IVA, 6 IVB. Up-staging with PET in 6 pts, down-staging in 4 pts. Histology: 10 Adenocarcinoma, 13 squamous carcinoma. Improved swallowing function: from a total of 12 PET responders, 9 had a clinical rsp after C+F, 3 did not. From 11 PET non-responders, 7 had a clinical rsp after D+I, 4 did not. Global clinical rsp = 16/23 (70%). Endoscopy rsp (frequent inaccuracy by overstaging): from a total of 12 PET responders, 6 had a clinical rsp after C+F, 6 did not. From 11 PET non-responders, 7 had a clinical rsp after D+I, 4 did not. Global clinical rsp = 13/23 (57%). Conclusion: Our results suggest that it is possible to significantly increase the percentage of pts who respond to induction CT adjusted according to PET in esophagogastric cancer before concurrent chemoradiotherapy or esophagectomy, or both.

No significant financial relationships to disclose.

Depersonalization in psychiatric patients: a transcultural study

There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences.

Dorsolateral prefrontal and superior temporal volume deficits in first-episode psychoses that evolve into schizophrenia

Regions with a likely involvement in schizophrenia may differ between patients with first-episodes of psychosis respectively with and without evolution into schizophrenia following the initial episode. We have used magnetic resonance imaging (MRI) to assess the volumes of dorsolateral prefrontal (DLPF) and superior temporal gyrus (STG) in a group of 37 first-episode psychotic patients. After an initial MRI study performed by the time of the first episode, the subjects were followed for two years. After this period 22 cases were diagnosed with schizophrenia, while the other 15 did not show clinical evidence for this illness. A Talairach-based tool was used for segmentation and volumetry of the MRI scans. A group of 44 healthy controls was used for comparison and, using lineal regression, to control for the normal effects of age and intracranial volume on the regional parameters of the patients. By the time of their first episode, patients with schizophrenia had significantly less grey matter in the right DLPF and STG regions as compared to both controls and FE without schizophrenia. Nevertheless, these parameters could not predict final diagnosis in a discriminant analysis model. Our findings indicate that subtle structural defects are already found by the time of the first psychotic break in schizophrenia, although clinical implications for these differences seem unclear.