Probabilistic assessment of Autonomic Nervous System fluctuations during tilt table tests

A number of reports have advocated the use of Heart Rate Variability (HRV) as a non invasive method of monitoring the Autonomic Nervous System (ANS). In the anesthesia and critical care monitoring settings, the development of an instrument able to provide real-time information about the ANS state at different stages of any procedure would provide improved safety for patients undergoing diagnostic or therapeutic interventions. However, real-time analysis of HRV can be particularly challenging since larger effective lengths of observation provide better spectral resolution. Our study explores a probabilistic approach that analyzes changes in HRV parameters obtained from an autoregressive (AR) model technique using Burg's methods to evaluate very short observation windows while preserving appropriate frequency resolution. These HRV parameters are continuosly compared to a baseline state, and a probability trend is updated during provocative maneuvers. Preliminary results show that trends from classical parameters such as RMSSD and LFn are consistent and reliable instruments capable of providing significant information about ANS fluctuations in a timely fashion.

Hepatocyte inflammation model for cytotoxicity research: fructose or glycolaldehyde as a source of endogenous toxins

Insulin resistance and hepatotoxicity induced in high fructose fed rats may involve fructose derived endogenous toxins formed by inflammation. Thus fructose was seventy-fold more toxic if hepatocytes were exposed to non-toxic levels of hydrogen peroxide (H(2)O(2)) released by inflammatory cells. This was prevented by iron (Fe) chelators, hydroxyl radical scavengers, and increased by Fe, copper (Cu) or catalase inhibition. Fructose or glyceraldehyde/dihydroxyacetone metabolites were oxidized by Fenton radicals to glyoxal. Glyoxal (15 microM) cytotoxicity was increased about 200-fold by H(2)O(2). Glycolaldehyde was enzymically formed from glyceraldehyde, the fructokinase/aldolase B product of fructose. Glycolaldehyde cytotoxicity was increased 20-fold by H(2)O(2). The oxidative stress cytotoxicity induced was attributed to the Fenton oxidation of glycolaldehyde forming glycolaldehyde radicals and glyoxal, since cytotoxicity was prevented by aminoguanidine (glyoxal trap) or Fenton inhibitors. Glyoxal was also the Fenton product responsible for glycolaldehyde protein carbonylation as carbonylation was prevented by aminoguanidine or Fenton inhibitors.

Application of multiple correspondence analysis to asses the relation between time after transplantation and sympathetic activity in cardiac transplant recipient

The aim of the present study was to evidence that the heart reinnervation can occur and it is related with the time after transplantation (evolution with time). Data were evaluated using Multiple Correspondence Analyses (MCA), which is the ideal method to study the relation, probably nonlinear, between the Time After Transplantation (TAT) and the probable restoration of normal heart rate responses of sinus node regulated by the autonomic nervous system. Twenty four nonrejecting transplant recipients (60 +/- 48 months after transplantation) and nine healthy subjects were studied by heart rate variability parameters. Results showed that sympathetic activity is restored some time after transplantation. Until 48 months, the recent HTR are in direct correlation to low values SD and LF and for the oldest transplant recipient, these parameters are similar to that observed in normal subjects.

Association between cancer risk perception and screening behavior among diverse women

BACKGROUND

We measured the perception of breast, cervical, and colon cancer risks and screening in diverse women to examine the association between risk perception and screening behavior.

METHODS

Cross-sectional telephone and in-person interviews of women aged 50 to 80 years were conducted in English, Spanish, or Chinese. The women were recruited from primary care practices in San Francisco, California (academic general internal medicine, family medicine, women's health practices, a community-based clinic in Chinatown, and the Community Health Network Clinics, which is affiliated with the San Francisco Department of Public Health), with at least 1 visit within the previous 2 years. Perceived personal risk for each cancer was measured on a word scale (no risk to very high risk) and compared with self-reported screening behavior by ethnicity.

RESULTS

A total of 1160 women participated: 338 (29%) were White, 167 (14%) were African American, 239 (21%) were Latina, and 416 (36%)were Asian. The average participant was 61 years old and a high school graduate; 18% had a personal history of cancer, and 42% had a family history of cancer. The perceived lifetime risk of cancer varied by ethnicity. Compared with White women, Latinas had a higher perceived risk for cervical cancer (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.8-4.6) and colon cancer (OR, 3.0; 95% CI, 1.8-5.0) after multivariate adjustment, and Asians had a lower perceived risk for cervical cancer (OR, 0.6; 95% CI, 0.4-0.9) and colon cancer (OR, 0.6; 95% CI, 0.3-0.9). Higher colon cancer risk perception was associated with having undergone colonoscopy within 10 years (OR, 2.8; 95% CI, 1.4-5.4).

CONCLUSIONS

Risk perception was significantly associated with colon cancer screening behavior (P=.001). Evaluation of patients' perceived risk of cancer may be useful to clinicians who are recommending screening tests.

A structural basis for reading fluency: white matter defects in a genetic brain malformation

BACKGROUND

Multiple lines of evidence have suggested that developmental dyslexia may be associated with abnormalities of neuronal migration or axonal connectivity. In patients with periventricular nodular heterotopia--a rare genetic brain malformation characterized by misplaced nodules of gray matter along the lateral ventricles--a specific and unexpected reading disability is present, despite normal intelligence. We sought to investigate the cognitive and structural brain bases of this phenomenon.

METHODS

Ten adult subjects with heterotopia, 10 with dyslexia, and 10 normal controls were evaluated, using a battery of neuropsychometric measures. White matter integrity and fiber tract organization were examined in six heterotopia subjects, using diffusion tensor imaging methods.

RESULTS

Subjects with heterotopia and those with developmental dyslexia shared a common behavioral profile, with specific deficits in reading fluency. Individuals with dyslexia seemed to have a more prominent phonological impairment than heterotopia subjects. Periventricular nodular heterotopia was associated with specific, focal disruptions in white matter microstructure and organization in the vicinity of gray matter nodules. The degree of white matter integrity correlated with reading fluency in this population.

CONCLUSIONS

We demonstrate that a genetic disorder of gray matter heterotopia shares behavioral characteristics with developmental dyslexia, and that focal white matter defects in this disorder may serve as the structural brain basis of this phenomenon. Our findings represent a potential model for the use of developmental brain malformations in the investigation of abnormal cognitive function.

Herniation of caecum through the foramen of Winslow

The radiological features on plain abdominal imaging and CT in a case of caecal herniation through the foramen of Winslow is presented. This rare condition is associated with a high morbidity and mortality, which emphasizes the importance of accurate preoperative diagnosis.

A pilot crossover study to evaluate the use of Regenecare topical wound gel in patients with cutaneous toxicity caused by epidermal growth factor receptor (HER1/EGFR) inhibitors

19643

Background: Acneform rash, including pain and pruritus, presents as a dose-limiting toxicity for HER1/EGFR (epidermal growth factor receptor) inhibitors which can lead to secondary skin infection. Antibiotics and corticosteroids are treatment options with minimal or moderate success. Better rash management is desirable for optimal use of these agents. Regenecare™ Gel contains 2% lidocaine for local pain management, marine collagen to promote tissue formation, aloe vera to promote circulation and emollient effect, and sodium alginate to absorb exudates. This study evaluates the effectiveness of Regenecare™ Gel in relieving the clinical symptoms of HER1/EGFR inhibitors-induced skin rash. The secondary objective assesses patient tolerability and satisfaction. Methods: A single center, prospective pilot cross- over study of 10–15 cancer patients treated with HER1/EGFR inhibitor. At the occurrence of grade 2 skin rash, subjects who signed an informed consent started applying study gel on the right side of the face and then crossed-over to both sides of the face after 1 week. Subjects were examined weekly for facial evaluations and photographs. The study continued for a total of six weeks. Results: Eight patients were enrolled with 6 evaluable (3 cetuximab, 2 panitumumab, 1 erlotinib). A summary of the itch and pain score responses are outlined below. Comparative analysis for Treatment vs. No Treatment show significant improvement with respect to self-reported level of itch (p=0.019) and pain (p=0.033). All patients tolerated the study gel without any adverse effect and 5 patients were very satisfied with the effectiveness of the gel. Conclusions: Regenecare™ Gel appears effective in relieving EGFR inhibitors rash-associated pruritus and pain based on these preliminary analyses. Study is ongoing for further assessment.

No significant financial relationships to disclose.

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First-in-human study of the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of PF-00299804, a small molecule irreversible panHER inhibitor in patients with advanced cancer

3599

Background: There are scientific rationale for inhibitors which provide combined and irreversible blockade of HER family members. PF-00299804 is an orally available, potent, irreversible small molecule inhibitor of the HER tyrosine kinases. Methods: The safety, tolerability, PK, PD, and efficacy of PF-00299804 administered orally once daily in 3-week cycles were assessed in patients with advanced solid tumors using an accelerated dose-escalation design. Safety assessments included adverse event (AE), laboratory, ECG, and LVEF assessments. PK parameters were determined after a single lead-in dose and on Day 14 by non-compartmental techniques. PD measures included assessment of HER-related signaling pathways via IHC analyses of serial skin and, in some patients, tumor biopsies. Serial 18F-FDG- PET/CT has been performed on a subset of patients with scans being classified according to modified EORTC criteria by a central reader. Results: 32 pts have been treated across 8 sequential dose levels ranging from 0.5 to 60 mg. The most common AEs were diarrhea, fatigue, nausea, and rash. 3/6 patients at 60 mg experienced a DLT [hand-foot syndrome (1), dehydration related to diarrhea(1), mucositis(1)]. Cmax and AUC of PF-00299804 increased with dose in an approximately proportional manner. Accumulation ranged from 3.3 to 6.8, suggesting a terminal t1/2>24 h. At the 30 mg dose level, mean Day 14 drug concentration was above the predicted efficacious concentration for tumor growth inhibition based on A431 xenograft model. Of 7 sets of PET data evaluated thus far, partial responses (PR) have been observed in 2 patients. A PR as assessed using RECIST criteria has been reported in 1 of 2 patients with advanced refractory NSCLC treated to date. Conclusions: Daily administration of PF-00299804 across many dose levels appears safe and tolerable. Diarrhea, fatigue, nausea, and rash are the most frequent AEs. Evaluation of 45 mg/d as the potential MTD is ongoing. Systemic exposures at doses = 30 mg exceed the threshold for efficacy as predicted from preclinical studies. Clinical and biological activity of PF-00299804 was observed including a PR in 1 of 2 patients with advanced refractory NSCLC.

No significant financial relationships to disclose.