Pathological and molecular predictors of the response of rectal cancer to neoadjuvant radiochemotherapy

AIMS

The prediction of sensitivity and resistance to neoadjuvant therapy has great potential value for many tumour sites. A neoadjuvant regimen is increasingly the gold standard in rectal cancer management and the aim of this review was to highlight predictive markers currently assessed and evaluate their clinical utility.

METHODS

A systematic search of Medline was conducted using the following keywords 'colorectal', 'neoadjuvant', 'molecular', 'predict' and 'radiotherapy'. Original manuscripts from all relevant listings were sourced. These were hand searched for further articles of relevance.

RESULTS

Conventional indices including tumour stage and grade were unable to predict histological response. Immunohistochemical assessment of P53 gene, Bcl 2, Bax and microsatellite instability are of no predictive value. Studies utilising molecular response predictors from archival pre-treatment tumour tissues have identified several promising predictive markers including p21, spontaneous apoptosis and direct sequencing of the p53 gene. Global gene expression from fresh pre-treatment tissue using cDNA microarray has only recently been assessed but identified expression differences between 54 genes and was able to predict response with 78% sensitivity and 86% specificity.

CONCLUSIONS

Currently there are no clinically useful predictors of response based on standard pathological assessment and immunocytochemistry. Direct gene sequencing of p53, studies of apoptosis and global gene sequencing may hold promise.

The "golden section" and bias in perceptions of social consensus

Meta-analytic examination of I28 false consensus effect issues supports the hypothesis that the "Golden Section" (61.8% group size) approximates the level of actual consensus that separates overestimation of consensus (group size < 61.8%) from underestimation (group size > 61.8%). Overestimation of the actual percentage of others who endorse one's own view increases as actual consensus decreases from 61.8%, and underestimation increases as it exceeds 61.8%. The form of the response (viz, a yes or no answer to a question) moderates this conclusion. The Golden Section holds for majorities and minorities defined by agreement with an issue. For majority and minority groups defined by disagreement, the inflection point is higher. Contrary to Mullen and Hu (1988), for agreeing majorities, the slope for consensus underestimation as a function of increased majority size does not differ from that of minority overestimation.

Psychiatric comorbidity in gender identity disorder

OBJECTIVE

Despite being recognized as an important prognostic factor for the outcome in gender identity disorder (GID), psychiatric comorbidity has rarely been assessed by means of standardized diagnostic instruments. The aim of this study was to assess current and lifetime psychiatric comorbidity in patients with GID.

METHODS

A cross-sectional sample of 31 patients who were treated for GID was assessed by the structured clinical interview for Axis I and II (SCID-I/II) and the Hospital Anxiety and Depression Scale (HADS).

RESULTS

Twenty-nine percent of the patients had no current or lifetime Axis I disorder; 39% fulfilled the criteria for current and 71% for current and/or lifetime Axis I diagnosis. Forty-two percent of the patients were diagnosed with one or more personality disorders.

CONCLUSIONS

Lifetime psychiatric comorbidity in GID patients is high, and this should be taken into account in the assessment and treatment planning of GID patients.

Molecular identification and expression analysis of tumor necrosis factor in channel catfish (Ictalurus punctatus)

A tumor necrosis factor (TNF) alpha-like gene, encoding a propeptide of 230 amino acids and a mature (soluble) peptide of 162 amino acids, was identified in channel catfish (Ictalurus punctatus). While the catfish protein shared features in common with both mammalian TNFalpha and TNFbeta homologs, overall sequence identity/similarity was slightly higher vs. TNFalpha genes when mature TNF sequences were compared. Phylogenetic analysis placed catfish and other fish TNF sequences within their own cluster apart from mammalian TNFalpha and beta genes, and supported the suggestion that TNFalpha and beta genes separated after the divergence of mammals and teleosts. In contrast to trout and carp, but similar to flounder, catfish TNF was present as a single copy gene. Expression studies demonstrated that catfish TNFalpha mRNA was present in all tested tissues (i.e. liver, spleen, head kidney, mesonephros, gill, thymus, and PBLs) from an unstimulated fish. Moreover, catfish TNF was constitutively expressed in actively proliferating, but otherwise unstimulated, macrophage (42TA) and T cell (G14D; TS32.17) lines, but not in B cell (1G8 or 3B11) or fibroblast lines. TNF expression was upregulated in PBLs, and in G14D and 42TA cells, but not in 3B11 cells, by PMA/calcium ionophore treatment. These results demonstrate that a catfish homolog of TNFalpha has been identified, and indicate that catfish TNFalpha is expressed in catfish in a manner similar to that seen in mammals.

Effects of situational aggression cues: a quantitative review

Meta-analytic procedures were used to assess the degree to which aggression-related cues present in the environment facilitate aggressive responding among negatively aroused subjects. The first study, which examined the so-called weapons effect, the effect of name-mediated cues, and other cue effects, showed clear evidence that aggression cues augment aggressive responses in negatively aroused subjects. This was true for the overall analysis and for name-mediated cues, but confirmation of the weapons effect was restricted to cases wherein subject sophistication and evaluation apprehension were low. A second study used partial correlation analysis to assess independently the effects of seven potential mediators of aggression cue effects. Of these, target-based facilitation and harm capacity of the aggressive response were found to mediate the magnitude of cue-facilitated aggression. A third study showed that these mediators augmented cue effects among neutral as well as negatively aroused subjects. These outcomes are interpreted as emphasizing the role of cognitive factors in the expression of both impulsive and nonimpulsive aggression.

Myocardial performance during maximal exercise in adolescents with anorexia nervosa

AIM

To examine cardiac responses and indicators of myocardial function during maximal exercise in adolescent girls with anorexia nervosa.

METHODS

Eight girls (mean age 16.3+/-2.7 years) who satisfied criteria for the diagnosis of anorexia nervosa underwent maximal cycle testing. Cardiac stroke volume and peak aortic velocity and mean acceleration of flow (markers of myocardial contractility) were assessed using Doppler echocardiography and compared to healthy control subjects. Gas exchange variables were measured using open circuit spirometry techniques.

RESULTS

Resting and maximal heart rates were less in the patients, and maximal oxygen uptake was significantly lower than controls. Maximal stroke index was greater in the patients than controls, with a normal pattern of response to progressive exercise. Peak aortic velocity and mean acceleration of flow were similar in the two groups when adjusted for heart rate.

CONCLUSION

Findings of low heart rate and aerobic fitness previously described in patients with anorexia nervosa were confirmed. However, there was no evidence of abnormal myocardial performance during maximal exercise testing.

Short-term natural history of isolated gastrocnemius and soleal vein thrombosis

OBJECTIVE

Lower extremity deep vein thrombosis is often isolated to the sinusoidal veins draining the gastrocnemius and soleus muscles. The purpose of this study was to establish the incidence rate of propagation of isolated gastrocnemius and soleal vein thrombosis (IGSVT) into the deep veins of the calf and thigh.

METHODS

All patients who were referred for color flow duplex ultrasonography (CFDU) for suspected deep vein thrombosis were prospectively evaluated for IGSVT. Patients with IGSVT received no systemic anticoagulation therapy and underwent serial CFDU at 5, 9, 14, 30, and 90 days after recruitment. The incidence and extent of IGSVT propagation were noted. Factors predictive of IGSVT extension were sought, including age, gender, side, symptoms, ambulatory status, and the presence of comorbid illness, including cardiac disease, cancer, hypercoagulable states, recent surgery or trauma, and previous venous disease.

RESULTS

One hundred thirty-five limbs with IGSVT were studied for 3 months, and 16.3% of cases with IGSVT extended the thrombus to the level of the adjacent tibial, or peroneal, veins or higher. Only 3% of the cases with IGSVT propagated as cephalad as the popliteal vein, and 90.9% of IGSVT propagation occurred within 2 weeks of CFDU diagnosis. No IGSVT propagated to the level of the popliteal vein beyond 2 weeks from the time of CFDU diagnosis. No IGSVT extended into the deep veins of the thigh. By the end of the 3-month study period, 45.9% of thrombi had completely resolved. Only the presence of cancer was prognostic for IGSVT progression.

CONCLUSION

During the 3-month study period, the short-term incidence rate of untreated IGSVT propagation to the level of the popliteal vein, even in the presence of cancer, was only 3%. Follow-up imaging to detect IGSVT propagation beyond 2 weeks from the time of diagnosis may not be necessary.

A randomized, double-blind trial of the efficacy and safety of 10 or 20 mg rabeprazole compared with 20 mg omeprazole in the maintenance of gastro-oesophageal reflux disease over 5 years

BACKGROUND

Gastro-oesophageal reflux disease has a chronic course, and often requires long-term treatment. Proton pump inhibitors are the treatment of choice for both acute and maintenance treatment, but little is known from randomized controlled trials of their effects beyond 1 year.

AIM

To compare the efficacy and safety of two doses of rabeprazole with 20 mg omeprazole in the maintenance treatment of erosive gastro-oesophageal reflux disease over 5 years.

METHODS

Two hundred and forty-three patients who had previously responded to acute treatment for erosive gastro-oesophageal reflux disease were prospectively randomized to receive 5 years of treatment with rabeprazole (10 or 20 mg daily) or omeprazole (20 mg daily). The primary outcome measure was endoscopically confirmed relapse of erosive gastro-oesophageal reflux disease.

RESULTS

One hundred and twenty-three patients (51%) completed all 5 years of the study, with similar completion rates in the three groups. Relapses occurred in nine of 78 (11.5%), eight of 82 (9.8%) and 11 of 83 (13.3%) patients in the rabeprazole 20 mg, rabeprazole 10 mg and omeprazole 20 mg groups, respectively. Gastric biopsy showed no evidence of any harmful effects. All treatments were well tolerated.

CONCLUSIONS

Rabeprazole 10 mg, rabeprazole 20 mg and omeprazole 20 mg all had similar efficacy in the maintenance treatment of gastro-oesophageal reflux disease. All three were safe and well tolerated during 5 years of treatment.

The neurological bases of apraxia of speech

Which site(s) of brain damage are associated with apraxia of speech (AOS)? There appears to be little agreement. The article first considers some reasons why not. Even allowing for factors that may have influenced findings, a definitive answer to the question of the neurological bases of AOS is not currently possible. The article goes on to look briefly at developments in the field of motor control, and limb and buccofacial apraxia in particular, that may hold clues to an answer or at least to asking the right questions. In particular, if AOS is to be understood as a motor disorder, then models compatible with motor control and its neurophysiological underpinnings must be sought. Current models of motor control and apraxia stress the sensorimotor, distributed, interactive nature of control across multiple brain areas.

Using ultrasound to investigate intrapersonal variability in durational aspects of tongue movement during swallowing

The purpose of this study was to determine the extent of intrapersonal variability in durational aspects of tongue movement during swallowing. Using ultrasound, the entire duration of tongue movement and the duration of the oral transport stage during swallowing was measured in a group of patients with neurogenic swallowing disorder and a group of matched healthy control subjects. The results indicate considerable intrapersonal variability in both groups. The patient group performed significantly more variably in terms of the duration of the transport stage. However, when looking at individual results, this finding can not be generalized, in that some patients showed rather decreased variability. Other differences between patient the group and control subjects were not statistically significant. Ultrasound was found to be a highly suitable technique for the purpose of this study.

Isolation of the provisionally named Desulfovibrio fairfieldensis from human periodontal pockets

Sulfate-reducing bacteria have recently been associated with periodontitis and proposed to play a role in the pathogenesis of this chronic inflammatory process. Eight isolates of sulfate-reducing bacteria belonging to the genus Desulfovibrio were obtained from the periodontal pockets of five out of seven patients presenting with active periodontitis. A multiplex PCR was devised for their identification at the species level. All isolates were identified as Desulfovibrio fairfieldensis, a recently proposed new species. This finding reinforces the suggestion that Desulfovibrio fairfieldensis is a human bacterium that may present a pathogenic potential.

Effects of rabeprazole, 20 mg, or esomeprazole, 20 mg, on 24-h intragastric pH and serum gastrin in healthy subjects

AIM

To compare the antisecretory effects of rabeprazole and esomeprazole in an open, randomized, two-way crossover, clinical pharmacology study.

METHODS

Twenty-four healthy subjects (14 men, 10 women; mean age 26.8 years) received rabeprazole 20 mg or esomeprazole 20 mg daily on days 1-5, with a 14-day 'wash-out'. Intragastric pH was recorded continuously, and serum gastrin measured, on days 0, 1 and 5.

RESULTS

On day 0, mean intragastric pH AUC was significantly higher before the esomeprazole than before the rabeprazole treatment in four of the five time intervals analysed. On days 1 and 5, mean intragastric pH AUC was higher after rabeprazole than esomeprazole during 5-11, 14-24 and 0-24 h after dosing. Mean pH AUC in the first 5 h after dosing on day 5 was higher after esomeprazole than rabeprazole (P=0.012). On day 1, mean per cent times pH > 3 and > 4 were significantly greater after rabeprazole than esomeprazole during 0-14, 14-24 and 0-24 h. On day 5, mean serum gastrin AUC0-4 was higher (P = 0.017) after rabeprazole than esomeprazole (335 vs. 316 pg/mL.h).

CONCLUSION

In this clinical pharmacology study, rabeprazole 20 mg daily was more effective than esomeprazole 20 mg daily in increasing intragastric pH and maintaining pH > 3 and > 4. On day 5, mean pH AUC was higher after esomeprazole than rabeprazole.

Access of target groups to 1915(c) Medicaid home and community based waiver services

OBJECTIVES

The study examined the access of specific target groups to the 1915(c) home and community based waiver program in terms of the number of participants, services, and expenditures for 1992 and 1997.

METHODS

The study collected HCFA 372 waiver program statistics from each of the states and compared statistics for the two time periods. A regression examined the increase in program expenditures.

RESULTS

An unequal distribution of HCBS expenditures across target groups was found where individuals with developmental disability were 39 percent of participants but used 77 percent of the total $7.9 billion waiver expenditures in 1997. The aged and disabled were 58 percent of waiver participants but received 21 percent of expenditures. The program growth was primarily due to increases in participants and reimbursement rates.

CONCLUSIONS

Individuals with MR/DD used more costly services such as habilitation and residential care than other target groups. Studies are needed to examine what accounts for the unequal access and whether program expenditures are sufficient to meet the long-term care needs of various target groups.

Genome sequence of the plant pathogen and biotechnology agent Agrobacterium tumefaciens C58

Agrobacterium tumefaciens is a plant pathogen capable of transferring a defined segment of DNA to a host plant, generating a gall tumor. Replacing the transferred tumor-inducing genes with exogenous DNA allows the introduction of any desired gene into the plant. Thus, A. tumefaciens has been critical for the development of modern plant genetics and agricultural biotechnology. Here we describe the genome of A. tumefaciens strain C58, which has an unusual structure consisting of one circular and one linear chromosome. We discuss genome architecture and evolution and additional genes potentially involved in virulence and metabolic parasitism of host plants.

Rapid and specific detection of the Mycobacterium tuberculosis complex using fluorogenic probes andreal-time PCR

A rapid and sensitive strategy for the specific identification of Mycobacterium tuberculosis (TB) was designed and evaluated using crude mycobacterial lysates. The speed of real-time polymerase chain reaction (PCR) was combined with the sensitivity of fluorogenic probes to confirm the presence of mycobacteria as well as specifically identify the presence of members of the mycobacteria tuberculosis complex (MTC) in a single-tube assay. Oligonucleotides were designed to amplify the internal transcribed spacer (ITS) from several mycobacterial species. Specific fluorogenic probes were included in the PCR reaction for the identification of TB as well as Mycobacterium bovia and Mycobacterium africanum in bacterial lysates. The combination of TB-specific fluorogenic probes with real-time PCR formed an approach determined to be fast (less than 40 min), sensitive (less than 800 copies of DNA) and reliable for the specific detection of the MTC. Our data demonstrate the use of real-time PCR and fluorogenic probes in a rapid and sensitive assay to distinguish members of the MTC from other mycobacterial species.

A meta-analytic, quantitative assessment of osseointegration establishment and evolution of submerged and non-submerged endosseous titanium oral implants

Two implant placement methods are used in oral implantology: submerged (S, two-stage surgical procedure) and non-submerged (NS, one-stage surgery). However, a quantitative assessment of their influence on implant osseointegration, summarising the whole present experience, is not directly possible, owing to the lack of normalisation of the published results. To overcome this difficulty, selection criteria have been applied to the latter in a process of a meta-analysis of specialised literature, in order to authorise a pooled treatment with an adequate statistical method. Survival life tables are established (up to 15 and 10 years respectively for S and NS implants placed in normal situations) for extended samples (13049 S and 5515 NS implants). Early (before loading) failure rates and 95% confidence level ranges of cumulative implant survival rates are shown. For both categories, the quality of the placement stage remains critical to ensure optimal osseointegration behaviour. Both categories match current survival requirements, but with a quite different behaviour over time. NS implants, while osseointegrating better initially, are subject to causes of osseointegration loss, which persist over a longer period of time. Implant design characteristics (including the type of surface) seem to be more relevant than the placement procedure for the implant's behaviour. This is in agreement with recent histological and preliminary clinical results, and should be confirmed by further studies.

Extraordinary variation in a diversified family of immune-type receptor genes

Immune inhibitory receptor genes that encode a variable (V) region, a unique V-like C2 (V/C2) domain, a transmembrane region, and a cytoplasmic tail containing immunoreceptor tyrosine-based inhibition motifs (ITIMs) have been described previously in two lineages of bony fish. In the present study, eleven related genes encoding distinct structural forms have been identified in Ictalurus punctatus (channel catfish), a well characterized immunological model system that represents a third independent bony fish lineage. Each of the different genes encodes an N-terminal V region but differs in the number of extracellular Ig domains, number and location of joining (J) region-like motifs, presence of transmembrane regions, presence of charged residues in transmembrane regions, presence of cytoplasmic tails, and/or distribution of ITIM(s) within the cytoplasmic tails. Variation in the numbers of genomic copies of the different gene types, their patterns of expression, and relative levels of expression in mixed leukocyte cultures (MLC) is reported. V region-containing immune-type genes constitute a far more complex family than recognized originally and include individual members that might function in inhibitory or, potentially activatory manners.

Perceptual asymmetry in consensus estimates of majority and minority members

Three experiments revealed a consistent pattern of consensus estimates. Numerical status and group growth or decline were manipulated between subjects. Growth was manipulated orthogonally to a 3rd variable: focus. Focus was manipulated by describing growth information with respect either to the in-group or the out-group (e.g., in-group growth and out-group decline). A Numerical Status X Focus interaction emerged in Study 1. Numerical minority members' consensus estimates for an opinion issue increased when growth information was out-group focused, whereas majority members' estimates did not differ as a function of the focus variable. Study 2 replicated these effects across other opinion dimensions. Study 3 confirmed the importance of the growth and focus variables in the absence of numerical status manipulations.

Time-resolved imaging of spatiotemporal patterns in a one-dimensional dielectric-barrier discharge system

A makeshift streak camera produces time-resolved images of filament patterns in a one-dimensional dielectric-barrier discharge system. The images reveal a variety of spatial and temporal structures, including temporally distinct discharge stages that occur at specific phases of the 12.5 kHz driving oscillation and spatially periodic filament arrays that are generated during the discharge stages. The data answer recent questions regarding time-averaged images of a similar system. Most notably, all but the simplest time-averaged images are due to the integration of multiple filament patterns generated in different discharge stages. Disordered states of the system are also examined. Some of these are spatially disordered but display temporal structure; others appear to lack both spatial and temporal order. Possibilities are suggested for investigations of surface-charge spreading and pattern stability in similar systems.

CD9 and HLA-DR expression by crevicular epithelial cells and polymorphonuclear neutrophils in periodontal disease

BACKGROUND, AIMS

The composition of gingival crevicular fluid (GCF) is likely to reflect inflammatory modifications that take place in the gingiva during periodontal diseases.

METHOD

In this study, GCF was collected at 3 different sites from 23 periodontal patients. The sites were assessed to be healthy, presenting gingivitis or periodontitis. 10 healthy individuals without any form of periodontal disease formed the control group and were sampled at one site each. The cell content of GCF was collected using Durapore Millipore strips, and 2 types of cells were studied: epithelial cells (EC) and polymorphonuclear neutrophils (PMN). The expression of CD9 and HLA-DR within or on the surface of these cells was studied in immunofluorescence on cytospin smears.

RESULTS

Both CD9 and HLA-DR expression on EC differed significantly from control subjects, and the latter decreased according to the severity of the pathology. None of the PMN found in controls expressed CD9 or HLA-DR. However, in periodontal patients, the expression of HLA-DR within PMNs was detectable and increased according to the severity of lesions. CD9 expression on PMNs also increased with inflammation.

CONCLUSION

This study shows that clinically healthy sites of periodontal patients already present signs of immunological activation characterised by a down modulation of HLA-DR expression on EC and an upregulation of these 2 molecules in PMN.

Benefits of a joint nursing and laboratory point-of-care program: nursing and laboratory working together

Critical care nurses contend daily with high pace, crisis-care, and dealing with patients, physicians, coworkers, and patients' family members. A point-of-care testing (POCT) program can assist with the quick decision making required of today's critical care nursing staff. By meshing the backgrounds of nursing and the central laboratory into one workable philosophy, POCT can ensure optimal patient care.