Current and future diagnostic and treatment strategies for patients with invasive lobular breast cancer

BACKGROUND

Invasive lobular breast cancer (ILC) is the second most common type of breast cancer after invasive breast cancer of no special type (NST), representing up to 15% of all breast cancers.

DESIGN

Latest data on ILC are presented, focusing on diagnosis, molecular make-up according to the European Society for Medical Oncology Scale for Clinical Actionability of molecular Targets (ESCAT) guidelines, treatment in the early and metastatic setting and ILC-focused clinical trials.

RESULTS

At the imaging level, magnetic resonance imaging-based and novel positron emission tomography/computed tomography-based techniques can overcome the limitations of currently used imaging techniques for diagnosing ILC. At the pathology level, E-cadherin immunohistochemistry could help improving inter-pathologist agreement. The majority of patients with ILC do not seem to benefit as much from (neo-)adjuvant chemotherapy as patients with NST, although chemotherapy might be required in a subset of high-risk patients. No differences in treatment efficacy are seen for anti-human epidermal growth factor receptor 2 (HER2) therapies in the adjuvant setting and cyclin-dependent kinases 4 and 6 inhibitors in the metastatic setting. The clinical utility of the commercially available prognostic gene expression-based tests is unclear for patients with ILC. Several ESCAT alterations differ in frequency between ILC and NST. Germline BRCA1 and PALB2 alterations are less frequent in patients with ILC, while germline CDH1 (gene coding for E-cadherin) alterations are more frequent in patients with ILC. Somatic HER2 mutations are more frequent in ILC, especially in metastases (15% ILC versus 5% NST). A high tumour mutational burden, relevant for immune checkpoint inhibition, is more frequent in ILC metastases (16%) than in NST metastases (5%). Tumours with somatic inactivating CDH1 mutations may be vulnerable for treatment with ROS1 inhibitors, a concept currently investigated in early and metastatic ILC.

CONCLUSION

ILC is a unique malignancy based on its pathological and biological features leading to differences in diagnosis as well as in treatment response, resistance and targets as compared to NST.

[Surveillance data on notifiable infectious diseases among students aged 6-22 years in China, 2011-2016]

Objective: To analyze the epidemiological characteristics of notifiable infectious diseases among Chinese students from 2011 to 2016 and to provide reference for the effective prevention and control programs on infectious disease among students. Methods: Both morbidity and mortality of notifiable infectious diseases among Chinese students aged 6-22 years from 2011 to 2016 were analyzed, with main characteristics of the disease described. Results: During 2011 to 2016, morbidities of Categories A, B and C infectious diseases among the Chinese students aged 6-22 years showed a decreasing trend, from 248.24/100 000 in 2012 to 158.57/100 000 in 2016. Mortality rates of Category A, B and C infectious diseases had also decreased from 0.12/100 000 in 2011 to 0.07/100 000 in 2016. The average morbidity of the top four diseases from Category A and B infectious diseases appeared as: tuberculosis (16.24/100 000), scarlet fever (9.39/100 000), hepatitis B (7.69/100 000) and bacillary and amebic dysentery (7.15/100 000). The average rates of mortality on the top four diseases appeared as: rabies (0.044 8/100 000), HIV/AIDS (0.027 7/100 000), tuberculosis (0.008 0/100 000) and Japanese encephalitis (0.005 9/100 000). The average rates of morbidity on the top four diseases appeared as: mumps (75.81/100 000), hand-foot-mouth disease (28.55/100 000), other infectious diarrhea (22.41/100 000) and influenza (15.67/100 000) in the Category C. Reported death cases were from hand-foot-mouth disease (11 cases), influenza (9 cases), mumps (1 case) and rubella (1 case). The prevalence rates varied among different student populations, with higher HIV/AIDS, hepatitis B and tuberculosis rates among college and senior high school students, while higher mumps, influenza and hand-foot-mouth disease rates among primary school and junior high school students. Conclusions: Both morbidity and mortality of notifiable infectious diseases among Chinese students aged 6-22 years had decreased significantly in 2011-2016. However, the major infectious diseases had become new challenges among students. HIV/AIDS had become a key infectious disease among college students and the relatively high prevalence of tuberculosis was seen in college and high school students.

[Investigation of human brucellosis diagnosis and report quality in medical institutions in key areas of Shanxi province]

Objective: To evaluate the accuracy of human brucellosis diagnosis and reporting in medical institutions in Shanxi province, and understand the performance of clinical doctors to diagnose human brucellosis according to diagnostic criteria. Methods: Field investigation was conducted in 6 medical institutions in the key areas of human brucellosis in Shanxi province. The diagnosis data of the reported brucellosis cases in 2015 were collected and reviewed retrospectively for the evaluation of the diagnosis accuracy with systematic sampling method. The database was established with Excel 2010 and the descriptive analysis and statistical test were conducted with software R 3.3.2. Results: The diagnosis consistent rate of the 377 brucellosis cases reviewed was 70.8% (267/377), the diagnosis consistent rates in medical institutions at city-level and country-level were 77.0% (127/165) and 66.0% (140/212) respectively, the differences had significance (χ(2)=5.4, P=0.02). Among the reviewed cases, the diagnosis consistent rate of laboratory diagnosis and clinical diagnosis were 87.1% (256/294) and 13.3% (11/83) respectively, and the differences had significance (χ(2)=170.7, P<0.001). Among the 21 investigated clinical doctors, the numbers of the doctors who correctly diagnosed the suspected cases, probable cases and lab-confirmed cases were only 3, 0 and 8 respectively. All of the clinical doctors knew that it is necessary to report the brucellosis cases within 24 hours after diagnosis. Conclusion: The accuracy of human brucellosis diagnosis in key areas of human brucellosis in Shanxi was low, and the performance of the clinical doctors to diagnose human brucellosis according to diagnostic and case classification criteria was unsatisfied.

Peripherally inserted central catheters for calcium requirements after successful parathyroidectomy: a comparison with centrally inserted catheters

BACKGROUND Intravenous calcium supplements are often required following parathyroidectomy to avoid postoperative hypocalcaemia. The aim of this study was to compare application effect of a femoral central venous catheter (CVC) and peripherally inserted central catheter (PICC) on intravenous calcium supplements after parathyroidectomy. METHODS We retrospectively reviewed the hospital records of 73 patients with secondary hyperparathyroidism who underwent a successful parathyroidectomy at the Huashan Hospital attached to Fudan University between 1 April 2011 and 1 February 2016. RESULTS Of the 73 study participants, 39 (53.4%) had a PICC and 34 (46.6%) had a CVC, respectively. Patients in the CVC group needed 6-7 days of intravenous calcium supplements, while patients in PICC group needed only 2-3 days to achieve normal serum calcium concentration (2.2-2.6 mmol/L). Furthermore, the duration of calcium supplementation was 71.62 ± 4.48 hours in PICC group and 100.4 ± 5.43 hours in CVC group (P < 0.05). Of the patients in PICC group, the incidence of catheter occlusion, operation failure and hypocalcaemia was 0%, which was significantly lower than those in CVC group (2.56%, 7.69% and 7.69%, respectively). CONCLUSIONS PICC is a safe and efficient alternative in contrast to CVC for providing venous access for calcium supplementation in surgical patients after parathyroidectomy.

Association of BCSC-1 with human esophageal squamous cell carcinoma

Breast cancer suppressor candidate-1 (BCSC-1) is a newly identified candidate tumor suppressor gene. BCSC-1 shows decreased levels in a variety of cancer types. In this study, we investigated the association between BCSC-1 and human esophageal squamous cell carcinoma (ESCC). BCSC-1 expression was detected in ESCC and normal tissues adjacent to tumor tissues by Western blot analysis and real-time PCR  as well as immunohistochemistry of paraffin sections. The relationships between BCSC-1 expression and various clinicopathological characteristics were analyzed. Western blot analysis and real-time PCR showed that levels of BCSC-1 protein and mRNA expression in ESCC significantly decreased compared with those in adjacent normal tissues.  Immunohistochemistry exhibited marked reduction of BCSC-1 in 38 of 105 ESCC specimens. Moreover, downregulation of BCSC-1 was associated with the grade of tumor cellular differentiation (P<0.05). These findings indicate that BCSC-1 downregulation in ESCC is associated with carcinogenesis and may play important roles during the process of ESCC cancer development.

The effect of calcium channel blockers on prevention of preeclampsia in pregnant women with chronic hypertension

BACKGROUND

Pregnant women with chronic hypertension are at increased risk for complications. This study aims to investigate whether calcium channel blockers plus low dosage aspirin therapy can reduce the incidence of complications during pregnancy with chronic hypertension and improve the prognosis of neonates.

MATERIALS AND METHODS

From March 2011 to June 2013, 33 patients were selected to join this trial according to the chronic hypertension criteria set by the Preface Bulletin of American College of Obstetricians and Gynecologists, (ACOG). Patients were administrated calcium channel blockers plus low-dosage aspirin and vitamin C. The statistic data of baseline and prognosis from the patients were retrospectively reviewed and compared.

RESULTS

Blood pressure of patients was controlled by these medicines with average systolic pressure from 146.3 to 148.7 mmHg and average diastolic pressure from 93.8 to 97.9 mmHg; 39.4% patients complicated mild preeclampsia; however, none of them developed severe preeclampsia or eclampsia, or complicate placental abruption. 30.3% patients delivered at preterm labour; 84.8% patients underwent cesarean section. The neonatal average weight was 3,008 ± 629.6 g, in which seven neonatal weights were less than 2,500 g. All of the neonatal Apgar scores were 9 to 10 at one to five minutes. Small for gestational age (SGA) occurred in five (15%).

CONCLUSIONS

Calcium channel blockers can improve the outcome of pregnancy women with chronic hypertension to avoid the occurrence of severe pregnancy complication or neonatal morbidity.

Stability of daphnoretin in vitro

The stability of daphnoretin in sodium phosphate buffers at different pH and temperature, and in different biological samples at 37 degrees C was investigated using HPLC with UV detector set at 345 nm. Daphnoretin degraded rapidly in alkaline environment and was stable in acidic environment. Daphnoretin was stable in simulated gastrointestinal liquid, stomach contents, gastric mucosa and colon contents; it was unstable in plasma, liver homogenates, small intestine contents, small intestinal mucosa and blind gut contents. The stability of daphnoretin in plasma and other biomaterials could have a significant impact on its absorption.

Hollow fiber liquid-phase microextraction for the determination of nimesulide in human plasma and its application to a pharmacokinetic study

A hollow fiber liquid-phase microextraction (HF-LPME) method in combination with HPLC-UV for the determination of nimesulide in human plasma was developed and validated. A small volume of dihexyl ether contained within a polypropylene hollow fiber was used for the extraction of nimesulide from acidified plasma solutions. Factors affecting the extraction efficiency were optimized and discussed. With HPLC-UV as the end analysis technique, the procedure was validated for nimesulide in the concentration range of 50-5000 ng/mL. The intra- and inter-assay precisions were less than 9.1%, and accuracy was within 3.2%. The lower limit of quantification (LLOQ) was 50 ng/mL. Enrichment factor from 144-fold to 156-fold was achieved at three quality control (QC) concentrations. The mean extraction recovery was greater than 41.2%. This method was successfully applied for the evaluation of pharmacokinetics of nimesulide after single oral doses of 100 mg nimesulide to six healthy Chinese volunteers.

Nitric oxide regulates body temperature, neuronal activation and interleukin-1 beta gene expression in the hypothalamic paraventricular nucleus in response to immune stress

An immune challenge initiates a complex cascade of events in the body including important responses from the central nervous system. As nitric oxide (NO) has been implicated in the central regulation of neuroendocrine and autonomic responses, this study was performed to determine if NO regulates physiological responses, neuronal activation, and/or interleukin-1 beta (IL-1 beta) gene expression in the paraventricular nucleus of the rat hypothalamus (PVN) in response to intravenous endotoxin, lipopolysaccharide (LPS, 100 microg/kg). Intracerebroventricular injections of NO synthase (NOS) inhibitors (7-nitroindazole sodium salt for neuronal NOS, N(G)-nitro-L-arginine for neuronal NOS and endothelial NOS, and aminoguanidine for inducible NOS) in LPS-treated rats showed that inhibition of NOS eliminated the drop in body temperature and led to increased neuronal activation in the PVN as assessed by immunohistochemistry for Fos-like immunoreactivity. Activation of NO-producing PVN neurons was also increased in these rats suggesting that NO influences neuronal NOS activity in PVN neurons. Finally, increased IL-1 beta gene expression in the PVN of LPS-treated rats receiving N(G)-nitro-L-arginine showed that NO regulates brain IL-1 beta gene expression. The results obtained with the NOS inhibitors support the hypothesis that NO produced from eNOS in the brain participates in temperature regulation, and inhibits PVN neuronal activity and IL-1 beta gene expression during immune stress.

NMR structures of a nonapeptide from DNA binding domain of human polymerase-alpha determined by iterative complete-relaxation-matrix approach

Nuclear magnetic resonance structures of a nonapeptide, ERFKCPCPT, selected from the DNA binding domain of human polymerase-alpha, were determined by complete relaxation matrix analysis of transverse NOE data. The structures exhibit a type III turn with residues KCPC, and the remaining residues exhibit non-ordered structures. The turn was confirmed by alpha, N (i,i+3) connectivity, a low temperature coefficient of NH chemical shift (-3.1 x 10(-3)) of the fourth residue, 3J(NHalpha) coupling constants, and characteristic CD peaks at 228 and 200 nm. Furthermore, phi and psi dihedral angles for the i + 1, and i + 2 residues of the turn are found to be -80 and -41 and -60 and -40 degrees. The first proline residue is trans- while the second exists in both cis- and trans- configurations, with trans- being more than 80% populated. The trans-configuration was established from C5alpha-P6alpha correlation and phi and psi angles of the proline. The five-membered proline ring is in DOWN puckered (C-beta-exo/C-gamma-endo) conformation. The structure of the peptide reveals that the two cysteine thiols are approximately 5 A(o) apart and appropriately positioned to covalently bind cis-diamminedichloroplatinum(II), a widely used anti-cancer drug.

Relation of hemoglobin measured at different times in pregnancy to preterm birth and low birth weight in Shanghai, China

This paper addresses two questions: 1) What is the relation of hemoglobin in the second gestational month to preterm birth and low birth weight? 2) How does the relation differ when hemoglobin in the fifth or eighth month or the lowest pregnancy hemoglobin are examined in place of first trimester values? These relations were examined prospectively in 829 women from Shanghai, China in 1991-1992. The population was nearly homogeneous by race, parity, antenatal care, and smoking. Rates of birth outcomes were compared between hemoglobin categories based on 10 g/liter groupings, with 110-119 g/liter as the reference group. Rates of low birth weight and preterm birth (but not small-for-gestational age) were related to early pregnancy hemoglobin concentration in a U-shaped manner. The relative risks (95% confidence intervals) for preterm birth in women by g/liter of hemoglobin were 2.52 (0.95-6.64) for > or = 130 g/liter, 1.11 (0.41-2.99) for 120-129 g/liter, 1.64 (0.77-3.47) for 100-109 g/liter, 2.63 (1.17-5.90) for 90-99 g/liter, and 3.73 (1.36-10.23) for 60-89 g/liter. Use of hemoglobin values in the fifth or eighth month attenuated the association with preterm birth. When lowest pregnancy hemoglobin values were used, the association of anemia with both outcomes was obscured, and risk of preterm birth at high hemoglobin values increased dramatically.