Daily ciprofloxacin treatment for patients with advanced liver disease awaiting liver transplantation reduces hospitalizations

BACKGROUND

Progressive deterioration in liver function is a common cause of hepatic decompensation and indication for liver transplantation in patients with advanced liver disease. Previous studies in animal models of acute and chronic liver disease revealed that daily ciprofloxacin improves biochemical parameters of hepatic function.

AIMS

The primary objective of this study was to determine whether hepatic function improves in patients with advanced liver disease after 1 month of daily ciprofloxacin therapy. A secondary objective was to determine whether ciprofloxacin treatment for 1 or 3 months results in fewer hospitalizations for decompensated liver disease.

METHODS

Forty-four patients with advanced liver disease awaiting liver transplantation received oral ciprofloxacin (250 or 500 mg twice daily) or placebo for 1 (n=22/group) or 3 (n=10 ciprofloxacin, 14 placebo) months.

RESULTS

Compared to placebo recipients, ciprofloxacin-treated patients had mild improvements in serum albumin levels (+1.5 versus -3.4%, p=0.026) while bilirubin and international normalized ratios (INR) of prothrombin times remained unchanged. Overall, fewer hospitalizations occurred in ciprofloxacin-treated patients (1/22, 5% versus 7/22, 32%, respectively, p=0.02) during the study period. Treatment was well tolerated and no resistant infections occurred in either cohort.

CONCLUSIONS

The results of this study suggest that daily ciprofloxacin may result in fewer hospitalizations for patients with advanced liver diseases awaiting liver transplantation but not by enhancing hepatic function.

Evaluation of chronic disease self-management programme (CDSMP) for older adults in Hong Kong

OBJECTIVES

To evaluate the locally-adapted CDSMP for older adults with chronic diseases in Hong Kong in the primary care setting.

DESIGN

A longitudinal, quasi-experimental study.

SETTING

Community-based and primary care setting.

PARTICIPANTS

Seven hundred and seventy-two participants aged 55 or above with at least one chronic disease and were living in the community.

INTERVENTION

The 6-weeks programme consisted of 6 group sessions, with each session lasting for 2.5 hours. Trained professional and elder lay leaders facilitated participants to gain essential self-management knowledge and skills for the effective management of chronic diseases.

MEASUREMENTS

At baseline and 6 months, four categories of outcome measures were documented, covering self-management behaviours, self-efficacy, health status, and health care utilization.

RESULTS

302 and 298 participants in the intervention and control groups completed 6 months follow-up respectively. Participants in the intervention group reported significant improvements in all self-management behaviours and self-efficacy measures, and 5 health status measures (social role limitation, depressive symptoms, health distress, symptoms of pain and discomfort, and self-rated health) when compared with those in the control group.

CONCLUSIONS

The locally-adapted CDSMP may improve self-management behaviours, self-efficacy and health status among older adults with chronic diseases in Hong Kong. CDSMP may be integrated into primary care services for older adults.

Perceptions of insulin therapy amongst Asian patients with diabetes in Singapore

AIMS

The objective of this study was to determine the prevalence of insulin refusal amongst Singaporean patients with Type 2 diabetes mellitus, to compare perceptions regarding insulin therapy use between patients who were willing to use insulin and those who were not and to identify demographic factors that might predict insulin refusal.

METHODS

A cross-sectional interviewer-administered survey incorporating demographic variables and 17 perceptions regarding insulin use (14 negative and three positive) was conducted among a sample of 265 patients attending a public primary healthcare centre.

RESULTS

Seven of every 10 patients expressed unwillingness to use insulin therapy (70.6%). The greatest differences in perceptions between patients willing to use insulin therapy and those who were not included fear of not being able to inject insulin correctly (47.4 vs. 70.6%), fear of pain (44.9 vs. 65.8%), belief that insulin therapy would make it difficult to fulfil responsibilities at work and home (46.2 vs. 66.8%) and belief that insulin therapy improved diabetes control (82.1 vs. 58.3%). A tertiary level of education was associated with willingness to use insulin (odds ratio 3.3, confidence interval 1.8-6.1), and significant differences in perceptions were present in patients with different educational levels.

CONCLUSIONS

Insulin refusal is an important problem amongst our patients with Type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin therapy use should focus on injection-related concerns, perceived lifestyle adaptations and correction of misconceptions. Different interventions may also be required for patients of different educational groups.

RYR1-related central core myopathy in a Chinese adolescent boy

Central core myopathy is a rare, inherited neuromuscular disorder with a wide spectrum of phenotypic presentations. It is also considered an allelic disease of malignant hyperthermia. We report a case of central core myopathy in a Chinese adolescent boy presenting with atypical clinical features and a moderately elevated serum creatine kinase level. The diagnosis was made from the histopathological findings of central cores on muscle biopsy, and confirmed by the molecular genetic testing for the RYR1 gene mutation. This is the first case of central core myopathy confirmed by molecular study in our locality.

Calf stretching in non-weight bearing versus weight bearing

Limited ankle dorsiflexion passive range of motion (DF PROM) has been associated with lower extremity overuse injuries. Therefore, clinicians often prescribe stretching exercises to increase ankle DF PROM. However, there is limited evidence to indicate if any particular gastrocnemius stretching exercise results in greater improvement in DF PROM. The aim of this study was to determine if gastrocnemius stretching in non-weight bearing (NWB) or weight bearing (WB) results in a greater increase of ankle DF PROM. 28 healthy volunteers, aged 18-55 years, who exhibited less than 10 degrees of ankle DF PROM completed the study. Participants were randomized into 2 stretching groups: NWB and WB. Both groups completed a 3-week home gastrocnemius stretching program, consisting of 5 repetitions held for 30 s each, 2 times daily. Participants' ankle DF PROM was measured with a blinded standard goniometer in NWB and WB positions before and after participation in a 3-week home gastrocnemius stretching program. Two 3-way mixed model ANOVAs demonstrated no significant difference in ankle DF PROM between the NWB and WB groups for either the NWB measurement condition (p=0.49) or WB measurement condition (p=0.86). Gastrocnemius stretching exercises performed in NWB or WB were equally effective in increasing ankle DF PROM.

Surveillance of autopsy cases for D222G substitutions in haemagglutinin of the pandemic (H1N1) 2009 virus in Alberta, Canada

Pandemic (H1N1) 2009 virus-positive specimens were collected from autopsy patients and matched to pandemic (H1N1) 2009 virus-positive nasopharyngeal specimens from community control patients and pandemic (H1N1) 2009 virus-positive specimens from intensive-care unit (ICU) patients. Specimens were analysed for polymorphisms at amino acid 222 of the haemagglutinin (HA) glycoprotein. Whereas some specimens from autopsy patients were positive for D222N, none was positive for D222G. All control patient specimens were wild-type D222. D222G polymorphisms were also identified in a subset of ICU patients with admixtures of D222G and D222 and of D222N, D222G and D222 present. The relevance of D222N and D222G to influenza pathogenesis and transmissibility currently remains unclear.

Monosulfidic black ooze accumulations in sediments of the Geographe Bay area, Western Australia

Mobilisation of sedimentary monosulfidic black ooze (MBO) may result in rapid deoxygenation and acidification of surface waters, and release of potentially toxic metals. This study examines the extent and nature of MBO accumulation in the Geographe Bay area, Western Australia. MBO accumulations were found to be widespread in benthic sediments of the Geographe Bay area with acid-volatile sulfide (AVS) contents as high as 320 μmol g(-1). The MBO materials often had unusually high dissolved sulfide (S(-II)) concentrations in their pore-waters (up to 610 mg L(-1)) and elevated elemental sulfur (S(0)) contents (up to 51 μmol g(-1)). Dissolved S(-II) is able to accumulate due to limited iron availability and S(0) is largely its partial oxidation product. The availability of organic carbon and Fe limited MBO accumulation at many sites. A comparison of AVS and simultaneously extracted metal (SEM) concentrations has shown that metals are likely to be bound in sulfide complexes.

Uptake of critical knowledge in nursing practice: lessons learned from a knowledge translation study

This article is based on a knowledge translation (KT) study of the transition of patients from hospital to home. It focuses on the lessons learned about the challenges of translating research-derived critical knowledge in practice settings. The authors situate the article in current discourses about KT; discuss their understanding of the nature of critical knowledge; and present themes from their body of research, which comprises the knowledge that was translated. The findings have the potential to guide future KT research that focuses on the uptake of critical knowledge in nursing practice.

Signal-Transduction Based Network Biomarkers for Tumor-Initiating Cells in a p53-Null Mouse Model of Breast Cancer

Introduction: Tumor initiating cells (TICs), or cancer stem cells, have the capacity to self-renew, and are likely to be responsible for resistance to conventional therapies, disease recurrence, and metastasis. Known TIC biomarkers may allow us to understand which genes are critical to self-renewal of TICs. However, little is known about how these biomarkers manipulate other molecules to enable TICs to self-renew. Here, we develop a systems biology approach to identify the signal-transduction network biomarkers for understanding the mechanisms in the renewal of TICs.Methods: Comparing with conventional biomarker discovery, the network biomarkers are identified by not only differential genes but also protein-protein interaction (PPI) network and available signaling pathways. Depending on the interacting patterns in PPI network and their associated cellular processes in signaling pathways, we can reveal the key signal transductions or subnetworks responsible for self-renewal of TICs. We chose two types of enriched interacting patterns, i.e. triangle and spoon, to indicate the signal transductions around the single biomarkers. A published RNA microarray (GSE8863) was performed on mammary epithelial cells from p53-null tumors sorted by two stem cell markers CD29 and CD24. The differential genes were identified by the Fold-Changes (FCs) comparing the subpopulations of Lin —CD29HCD24H with other subpopulations. Gene Set Enrichment Analysis (GSEA) revealed that the identified differential genes are significantly enriched in 20 regulatory pathways including 'Cell cycle', 'Adherens junction', 'Cell adhesion molecules (CAMs)', 'Tight junction' (P<10-3). A model called Multiple Objective Optimization (MOO) was employed to search the network biomarkers whose component proteins satisfy that (1) be most differentially expressed in Lin —CD29HCD24H cells and (2) pass through a large number of enriched signaling pathways.Results: Four genes (Lsm5, Calm3, Bmi1 and Ezh2) are extremely up-regulated in the Lin —CD29HCD24H subpopulations (FC>4), in which Bmi1 is important in regulating the self-renewal capacity of hematopoietic, as well as human mammary gland stem cells. To understand how these genes manipulate other genes and the enriched signaling pathways, we first analyzed the interacting patterns around these genes. Calm3 and Bmi1 are surrounded by 355 and 22 interacting patterns respectively. The component coding-genes in the interacting patterns are more likely to be differentially expressed (91/127, P <10-61). Then, the protein-paths were identified from the interacting patterns of Calm3 and Bmi1 by MOO. IPA (Ingenuity Pathway Analysis) indicated that these protein paths have many particular cellular functions related to self-renewal, such as 'Cell Growth and Proliferation', 'Hematological System Development and Function', 'Cell-To-Cell Signaling and Interaction', and 'Cell Death' (P <10-3).Conclusion: The network biomarkers revealed that the surrounding interaction patterns and related signaling pathways of single biomarkers are essential to understand the signal-transduction mechanisms of TICs in self-renewal. They may be useful as prognostic or predictive indicators as well as suggest possible targets for novel therapies.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2138.

Study of the Effect of Micro-Environment Stresses on Breast Tumor Initiating Cells by In Vitro Cell Tracking

Increasing clinical as well as experimental evidence supports the existence of a small population of tumor initiating cells (TIC) that possesses enhanced self-renewal capacity, and the ability to form tumors upon transplantation. These TIC, which highly resemble normal stem cells, are believed to be responsible for tumor initiation and propagation. Evidence also suggests that TIC reside in unique micro-environment which may account for their resistance to traditional chemo- and radiotherapy. Understanding the effect of micro-environment on TIC will have dramatic implications for breast cancer prevention, treatment, and drug development.It is known that tumor micro-environment is characterized by various degrees of chemical imbalance, including oxygen depletion (hypoxia), lactic acidosis, glucose deprivation and high oxidative stresses caused by elevated reactive oxygen species (ROS) [1]. These physiological stresses have significant clinical impact and are often related to poor patient prognosis [2]. Interestingly, recent studies revealed that there are molecular connections between physiological stress regulated transcription factors and pathways known to control stem cell function [3], suggesting that the micro-environment stresses may either promote TIC cell transformation or proliferation [4]. However, despite these molecular level findings, direct evidence on the effect of physiological stresses on the proliferation and differentiation of TIC is still missing.We use in vitro live cell tracking to study the influence of micro-environment on TIC. Primary cultured cells are prepared from breast cancer surgery specimen. They are cultured in suspension in serum free medium as mammospheres which have been demonstrated to be highly enriched with TIC [5]. Various physiological stresses are mimicked by growing cells in tissue culture incubators with 2% O2 (hypoxia), acidic medium (pH 6.7) with 25mM lactic acid, glucose deprivation condition by using glucose free DMEM medium, high ROS condition with 100uM H2O2. Cells are also infected with lentivirus to express H2B-GFP to label the cell nuclei so that they can be tracked by fluorescence imaging. Experiments are carried out in a full environmental controlled (CO2, O2, temperature, humidity) chamber and monitored by confocal imaging over prolonged time up to 96 hours. Since mammosphere cells grow in 3D instead of monolayer, they were scanned by confocal to reconstruct the 3D structure. We also developed computer programs for 3D segmentation to separate each cell, so that each cell within the mammosphere can be labeled and monitored individually. Such system allows us to draw a lineage tree for all the cells in the final mammosphere and detect the active dividing cells (which represent the differentiated cells) and the cells which reenter the quiescent status (which represent the progenitor cells), and hence allow us to study the effect of various micro-environment stresses on them.1. Vaupel, P., Semin Radiat Oncol, 2004. 14(3): p. 198-206.2. Schwickert, G., et al., Cancer Res, 1995. 55(21): p. 4757-9.3. Keith, B. and M.C. Simon, Cell, 2007. 129(3): p. 465-72.4. Li, Z., et al., Cancer Cell, 2009. 15(6): p. 501-13.5. Ponti, D., et al., Cancer Res, 2005. 65(13): p. 5506-11.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1163.

Effects of Rapamycin on Breast Cancer Cell Migration through the Cross-Talk of MAPK Pathway

Phase I/II clinical studies with rapamycin analogs in breast and other cancers have demonstrated favorable responses. However, little is known on the effects of the mTOR inhibitor on breast cancer cell metastasis, which is a major cause of morbidity and death. We developed a highly sensitive 3-dimensional (3D) proliferation/invasion assay using quantitative bioluminescence (BL) imaging and applied this assay to evaluate the effects of rapamycin on the triple negative breast cancer cell line MDA-MB231. Without cytotoxicity of rapamycin on this cell line, rapamycin at 10nM inhibited the cell migration/invasion, but not at 1nM and 100nM, which was confirmed by the time-lapse single cell tracking analysis. The quantification of cytoskeleton changes showed most potent effects of 10nM rapamycin on the MDA-MB231 cells, with the formation and rearrangement of specialized cell membrane structures and actin fiber implicated in cell motility. Then, the Panorama Cell Signaling Antibody Microarray, enabling the global comparative analysis of cell signal proteins simultaneously, was exploited to analyze the effects of rapamycin on the cellular signaling network of the MDA-MB231 breast cancer cell line. 100nM rapamycin activated the MAPK pathway obviously, through the attenuated negative feedback of activated S6K1 to PI3K-Raf, which increased the expressions of activated Jun N-terminus kinase (JNK), Erk1/2, MEK-1, Raf-pS621, and MAPK-activated protein kinase 2 (MAPKAPK2) in the cells exposed to 100nM rapamycin. MEK inhibitor U0126 or PD98059 could restore the anti-migration effects of 100nM rapamycin on the MDA-MB231 cells. Furthermore, the combination of MEK inhibitors and rapamycin performed synergism on inhibiting the cell proliferation and migration/invasion. Accordingly, rapamycin at a certain dose suppresses MDA-MB231 cell migration/invasion, and the co-targeting of mTOR and MAPK pathways enhances the inhibition on cell proliferation and migration/invasion, underscoring the potential therapeutic utility of rapamycin, and rapamycin combining with MAPK inhibitors in triple negative breast cancer progression, and the results highlight the cross-talk homeostasis of mTOR and MAPK pathways in cancer treatment.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5080.