Phase II study of sorafenib in combination with cisplatin and 5-fluorouracil to treat recurrent or metastatic nasopharyngeal carcinoma

BACKGROUND

We aimed to investigate the efficacy and tolerability of sorafenib combined with cisplatin and 5-fluorouracil (5-FU) in patients with recurrent or metastatic nasopharyngeal carcinoma (NPC).

PATIENTS AND METHODS

It was a Simon two-stage designed trial. Chemotherapy-naive patients with recurrent or metastatic disease were enrolled. The regimen was sorafenib 400 mg orally b.i.d., cisplatin 80 mg/m(2) i.v. day 1, and 5-FU 1000 mg/m(2)/day CIV for 4 days, repeated every 21 days. After a maximum of six cycles of chemotherapy, patients received maintenance of sorafenib.

RESULTS

In total, 54 patients were enrolled. The objective response rate reached 77.8%, including 1 complete response and 41 partial responses. The median progression-free survival was 7.2 months (95% CI 6.8-8.4 months), and the median overall survival was 11.8 months (95% CI 10.6-18.7 months). Major toxic effects included hand-foot skin reaction, myelosuppression, and gastrointestinal (GI) reaction. The incidence of hemorrhage was 22.2%, and one patient with liver metastases died of GI bleeding. Contrast-enhanced ultrasonography was carried out in a subset of patients with liver metastases.

CONCLUSION

Combination of sorafenib, cisplatin (80 mg/m(2)) and 5-FU (3000 mg/m(2)) was tolerable and feasible in recurrent or metastatic NPC. Further randomized trials to compare sorafenib plus cisplatin and 5-FU with standard dose of cisplatin plus 5-FU in NPC are warranted.

Indexing and the object concept: developing `what' and `where' systems

The study of object cognition over the past 25 years has proceeded in two largely non-interacting camps. One camp has studied object-based visual attention in adults, while the other has studied the object concept in infants. We briefly review both sets of literature and distill from the adult research a theoretical model that we apply to findings from the infant studies. The key notion in our model of object representation is the `sticky' index, a mechanism of selective attention that points at a physical object in a location. An object index does not represent any of the properties of the entity at which it points. However, once an index is pointing to an object, the properties of that object can be examined and featural information can be associated with, or `bound' to, its index. The distinction between indexing and feature binding underwrites the distinction between object individuation and object identification, a distinction that turns out to be crucial in both the adult attention and the infant object-concept literature. By developing the indexing model, we draw together two disparate sets of literature and suggest new ways to study object-based attention in infancy.

Sarcoidosis: vaginal wall and vulvar involvement

Sarcoidosis is a non-caseous granulomatous disease which could involve numerous organs including lungs, eyes, skin, nervous system, heart, liver. However, the genitourinary tract involvement was rarely reported in sarcoidosis. We report the case of a 45-year-old married woman who presented with 2 months history of a vulval mass as large as a soybean, and did not reveal any remarkable pulmonary signs. Biopsy results showed non-caseous granulomatous inflammation consistent with sarcoidosis in the vulvar lesion. To our knowledge, this is the first reported case of this entity in the world. Based on the related literature, we highlight the possibility of gynecologic involvement in sarcoidosis.

Age Interactions in Breast Cancer: An Analysis of a 10-Year Multicentre Study in China

OBJECTIVES: The effects of age at diagnosis on the clinical characteristics of breast cancer and trends over time were investigated in Chinese women. METHODS: Data from 4211 women with pathologically confirmed primary breast cancer collected between 1999 and 2008 for a multicentre retrospective study were analysed according to age at diagnosis. RESULTS: Age at diagnosis ranged from 21 to 86 years, with a mean of 48.7 years, and was shown to be significantly related to tumour size, lymph node status, hormone receptor status and human growth factor receptor-2 status, but not to pathological type or tumour, node, metastasis stage. The age-corrected proportion of patients aged 50 – 64 years at diagnosis increased significantly between 1999 and 2008. There was a significant difference in the age-corrected distribution of age at diagnosis in China compared with Western countries. CONCLUSIONS: Age at diagnosis is related to the clinical and pathological characteristics of breast cancer. The age at diagnosis in China increased over the decade from 1999 to 2008, but is still lower than in Western countries.

Physical activity, family history of diabetes and risk of developing hyperglycaemia and diabetes among adults in Mainland China

AIMS

To investigate the joint influence of physical activity and family history of diabetes on the subsequent risk of developing hyperglycaemia and Type 2 diabetes among Chinese adults.

METHODS

A prospective community-based cohort study was conducted among adults aged 35 years and older during 2004-2007 in Nanjing, China. Four communities (three urban and one rural) were randomly selected from 11 urban districts and two rural counties. Hyperglycaemia and Type 2 diabetes were defined using World Health Organization criteria based on fasting blood glucose concentration and physicians' diagnosis, respectively. Physical activity, parental diabetes history, and other important covariates were assessed at baseline and in the third-year follow-up survey.

RESULTS

At study conclusion data were collected from 3031 participants (follow-up rate 81.3%). The 3-year cumulative incidence of hyperglycaemia and Type 2 diabetes was 6.2% and 2.4%, respectively. After adjustment for potential confounding variables, compared with those with positive family history and insufficient physical activity, the adjusted relative risk ratio (95% CI) of developing hyperglycaemia was 0.19 (0.02, 1.51) for participants with sufficient physical activity and a positive family history; 0.55 (0.31, 0.97) for participants with insufficient physical activity and a negative family history; and 0.36 (0.19, 0.70) for participants with sufficient physical activity but a negative family history. Participants who had a negative family history and insufficient physical activity were also less likely to develop Type 2 diabetes (RRR = 0.28; 0.14, 0.54), and participants with a negative family history and sufficient physical activity were the least likely to develop Type 2 diabetes (0.23; 0.10, 0.56).

CONCLUSIONS

Sufficient physical activity and negative family history of diabetes may jointly reduce the risk of developing hyperglycaemia and Type 2 diabetes in Chinese adults.

Pharmacokinetics of 5-fluorouracil and cyclophosphamide in depression rats

OBJECTIVES

Efficacy and toxicity of the drug are mainly determined by physicochemical properties and pharmacological effects of its own. In addition, they are also affected by other factors, such as gender, age, genetic character, pathophysiological status, mood states and so on. The paper aims to study whether mood disorder alters drug metabolism process through the pharmacokinetic research on some clinically important anticancer drugs in depression model rats.

MATERIALS AND METHODS

The depression model rats were built by exposing to chronic unpredicted mild stresses (CUMS) for 8 weeks. 36 female Sprague-Dawley (SD) rats were randomized into model group and control group. In each group, 18 rats were randomized into 2 subgroups: 5-fluorouracil (5-FU) subgroup and cyclophosphamide (CP) subgroup which were given a certain doses of 5-FU and CP. The blood samples were collected at different time points and plasma drug concentration were respectively assayed by high performance liquid chromatography (HPLC) for 5-FU and high performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) for CP. Pharmacokinetic parameters were processed with DAS software.

RESULTS

There were significant differences in the pharmacokinetic parameters of 5-FU and CP between in depression model rats group and in the normal control group (p < 0.05), except t1/2alpha (p > 0.05) for CP pharmacokinetics in depression model rats group and in the normal control rats group, with the value of those was 0.07 and 0.09 h.

CONCLUSIONS

Depression mood disorder might alter drug metabolism process.

Unique genomic structure and distinct mitotic behavior of ring chromosome 21 in two unrelated cases

A ring chromosome replacing a normal chromosome could involve variable structural rearrangements and mitotic instability. However, most previously reported cases lacked further genomic characterization. High-resolution oligonucleotide array comparative genomic hybridization with single-nucleotide polymorphism typing (aCGH+SNP) was used to study 2 unrelated cases with a ring chromosome 21. Case 1 had severe myopia, hypotonia, joint hypermobility, speech delay, and dysmorphic features. aCGH detected a 1.275-Mb duplication of 21q22.12-q22.13 and a 6.731-Mb distal deletion at 21q22.2. Case 2 showed severe growth and developmental retardations, intractable seizures, and dysmorphic features. aCGH revealed a contiguous pattern of a 3.612- Mb deletion of 21q22.12-q22.2, a 4.568-Mb duplication of 21q22.2-q22.3, and a 2.243-Mb distal deletion at 21q22.3. Mitotic instability was noted in 13, 30, and 76% of in vitro cultured metaphase cells, interphase cells, and leukocyte DNA, respectively. The different phenotypes of these 2 cases are likely associated with the unique genomic structure and distinct mitotic behavior of their ring chromosome 21. These 2 cases represent a subtype of ring chromosome 21 probably involving somatic dicentric ring breakage and reunion. A cytogenomic approach is proposed for characterizing the genomic structure and mitotic instability of ring chromosome abnormalities.

First Report of Amphobotrys ricini Causing Gray Mold Disease on Acalypha australis in Central China

In 2008, we isolated a strain of an Amphobotrys sp., CotAr-12, from a cotton plant showing Verticillium wilt symptoms in Hubei Province, China. In October 2010 and 2011, surveys for Amphobotrys sp. on cotton were conducted in 14 counties in Hubei. No signs of an Amphobotrys sp. was observed on cotton. However, a gray mold disease was found on the weed, Acalypha australis in 40 of 51 cotton fields with an average disease incidence of 18.6%. The disease started on the inflorescences at the top of stems or branches and then spread downward to the main stems, branches, and leaves. Abundant sporulation on the necrotic tissues and formation of sclerotia underneath the epidermis or in the stem pith were evident. A total of 128 isolates, including CopAr-5, were obtained from A. australis (1 to 10 isolates per field). All isolates from A. australis and CotAr-12 appeared similar in colony morphology; ragged colony margins, erect conidiophores with long stipes and dichotomous branches at the top, globose and subhyaline conidia with an average diameter of 5.3 to 8.5 μm, and black, oval sclerotia of 0.6 to 26.2 × 0.5 to 19.0 mm. These characteristics matched the description for Amphobotrys ricini (Buchw.) Hennebert (teleomorph Botryotinia ricini [Godfrey] Whetzel) (2). Strains CopAr-5 and CotAr-12 were selected for molecular identification. DNA was extracted from mycelia and used for cloning of three nuclear genes (e.g., G3PDH, HSP60, and RPB2) using the procedures described by Staats et al. (4). The resulting DNA sequences were used for phylogenetic analysis with the corresponding sequences for Botrytis spp. (4). Results showed that strains CopAr-5 (GenBank Accession Nos. JN681883, JN681881, and JN6981879), CotAr-12 (GenBank Accession Nos. JN681882, JN681880, and JN6981878), and Botrytis (teleomorph Botrytinia) ricini (GenBank Accession Nos. GQ860998, GQ860996, and GQ860997) formed a separate clade that was distinct from Botrytis spp., supporting the distinction of Amphobotrys from Botrytis and suggesting that the two strains were Amphobotrys ricini. Pathogenicity was determined by placing mycelia of strains CopAr-5 and CotAr-12 on 10 detached leaves of A. australis, castor bean, and cotton. Control leaves of these plants were inoculated with potato dextrose agar alone. After incubation at 20°C under moist conditions (>90% relative humidity) for 60 h, the control leaves remained healthy, while the leaves of A. australis and castor bean inoculated with both strains formed extensively expanded lesions of 20 and 27 mm in diameter on average, respectively. Both strains also caused disease on cotton leaves with discontinuous and localized lesions of 18 mm in average diameter. A fungus was reisolated from the leaf lesions on these plant species and were identical to Amphobotrys ricini in colony morphology and conidial characteristics. We conclude that Amphobotrys ricini is a major pathogen on A. australis in central China. It is an important pathogen of castor bean (1) and has been reported to infect several euphorbiaceous plants, including A. hispida (3). To our knowledge, this is the first report of Amphobotrys ricini on A. australis. References: (1) G. H. Godfrey. J. Agric. Res. 23:679, 1923, (2) G. L. Hennebert. Persoonia 7:183, 1973. (3) B. V. Lima et al. Australas. Plant Dis. Notes 3:5, 2008. (4) M. Staats et al. Mol. Biol. Evol. 22:333, 2005.

A power-law rheology-based finite element model for single cell deformation

Physical forces can elicit complex time- and space-dependent deformations in living cells. These deformations at the subcellular level are difficult to measure but can be estimated using computational approaches such as finite element (FE) simulation. Existing FE models predominantly treat cells as spring-dashpot viscoelastic materials, while broad experimental data are now lending support to the power-law rheology (PLR) model. Here, we developed a large deformation FE model that incorporated PLR and experimentally verified this model by performing micropipette aspiration on fibroblasts under various mechanical loadings. With a single set of rheological properties, this model recapitulated the diverse micropipette aspiration data obtained using three protocols and with a range of micropipette sizes. More intriguingly, our analysis revealed that decreased pipette size leads to increased pressure gradient, potentially explaining our previous counterintuitive finding that decreased pipette size leads to increased incidence of cell blebbing and injury. Taken together, our work leads to more accurate rheological interpretation of micropipette aspiration experiments than previous models and suggests pressure gradient as a potential determinant of cell injury.

Clearance of amyloid-β protein deposits in transgenic mice following focal cerebral ischemia

BACKGROUND/AIMS

There is increased amyloid-β protein precursor (AβPP) expression and amyloid-β protein (Aβ) production in the brain shortly following cerebral ischemic stroke in rodent models. It has been postulated that this may seed amyloid deposition in the brain. On the other hand, it remains unclear how cerebral ischemia affects preexisting Aβ deposits in the brain. Here we determine the consequences of focal ischemic stroke on existing Aβ pathology in Tg-SwDI transgenic mice.

METHODS

At 12 months of age, Tg-SwDI mice were subjected to photo-induced focal cerebral ischemia in one hemisphere. One, 7, or 21 days after lesioning, the amount of deposited Aβ in the ischemic and control hemispheres was measured using ELISA. Image analysis was used to visualize deposited Aβ and the presence of microglia/macrophages.

RESULTS

After 7 days, and further after 21 days, there was a dramatic reduction in the amount of deposited Aβ and increased presence of microglia/macrophages in the ischemic hemisphere of the mice.

CONCLUSIONS

Focal cerebral ischemia leads to clearance of deposited Aβ in Tg-SwDI mice starting at 7 days with almost complete removal in the ischemic area by 21 days. The delayed clearance of Aβ following focal cerebral ischemia may involve the infiltration of activated neuroinflammatory cells.

Correlation of brain natriuretic peptide and microalbuminuria in patients with heart failure

OBJECTIVE

To evaluate the changes of plasma levels of N-terminal pro-brain natriuretic pepide (NT-proBNP) and microalbuminuria (MAU) in patients with heart failure and the correlation between them.

METHODS

Ninety-one patients with heart failure were divided into different groups according to different stages of heart failure. Plasma levels of NT-proBNP were measured by microsome enzyme immunoassay (MEIA). Plasma levels of MAU were determined by immune scattering turbidimetry (ICTM). Simultaneously, left ventricular ejection fraction (LVEF) and left ventricular end diastolic diameter (LVEDD) were measured by Doppler echocardiography for all patients. The correlation of NT-proBNP and MAU was evaluated at different stages of heart failure.

RESULTS

The plasma levels of NT-proBNP and MAU increased with the severity of heart failure. There was a high correlation between NT-proBNP and MAU (r = 0.885, p < 0.001).

CONCLUSION

Both NT-proBNP and MAU levels were closely associated with the severity of heart failure.