Endovascular treatment of wide-neck middle cerebral artery aneurysms with stents: a review of 16 cases

BACKGROUND AND PURPOSE

MCA aneurysms are common and often pose technical challenges to interventionalists. Intracranial stents are widely used in treating wide-neck aneurysms in other locations. To evaluate the feasibility, effectiveness, and safety of stent placement in MCA aneurysms, we performed this retrospective study.

MATERIALS AND METHODS

Between October 2003 and May 2009, 16 patients with 16 wide-neck MCA aneurysms were treated with stents at our institution. We retrospectively collected and analyzed the data for these patients, including demographics, morphologic features of the aneurysms, treatment results, and follow-up.

RESULTS

Seventeen stents, including 12 Neuroform, 4 LEO, and 1 Enterprise, were successfully deployed in this series. Of the 13 aneurysms treated with stent-assisted embolization, complete occlusion was achieved in 9 aneurysms; residual neck remained in 1, and residual aneurysm was present in 3. Contrast stasis in the aneurysm sac was observed in the other 3 aneurysms treated with stent alone. Procedure-related complication occurred in 1 patient, leading to no permanent effect. The mRS score at discharge was 0-2 in 14 patients and 3-6 in 2. The angiographic follow-up results of 9 patients (mean, 5.6 months) showed that all aneurysms remained stable or improved; there was no in-stent stenosis, recurrence, or retreatment. The clinical follow-up (mean, 20.1 months) demonstrated no neurologic deterioration or rebleeding.

CONCLUSIONS

Our preliminary experience demonstrates that stent placement for the treatment of selected wide-neck MCA aneurysms is feasible. However, its safety and efficacy should be further evaluated by larger case series and more adequate follow-up.

A practical method for quantifying atherosclerotic lesions in rabbits

The rabbit has been widely used for the study of human atherosclerosis; however, the method for analysis of the atherosclerotic lesions has not been standardized between laboratories. The present study reports a practical method for quantifying the changes that occur in aortic atherosclerosis of rabbits. Male Japanese white rabbits were fed with either a standard chow or a diet containing 10% fat and 0.3% cholesterol for 16 weeks. Plasma concentrations of glucose, insulin, total cholesterol, triglycerides and high-density lipoprotein were measured. Aortic atherosclerotic lesions were assessed in quantitative fashion using an image analysis system that measured (1) the gross area of the entire aorta affected by atherosclerosis as defined by Sudan IV staining, (2) the microscopical intimal lesion defined by the elastic van Gieson stain and (3) the infiltration of macrophages and smooth muscle cell proliferation as determined immunohistochemically. The rabbits developed severe aortic atherosclerosis without apparent abnormality of glucose metabolism. The quantitative method described here will be useful for the further investigation of atherosclerosis in rabbits.

Expression of Notch1, Jagged1 and beta-catenin and their clinicopathological significance in hepatocellular carcinoma

The Notch/Jagged signaling pathway is important for cellular differentiation and proliferation. Notch1/Jagged1 can either suppress or promote tumors depending on the cell type and context. beta-catenin, one of the mediators of the Wnt signalling pathway, represents a key element in one of the most important pathways of carcinogenesis. The aim of this study was to examine the expression of Notch1/Jagged1 and beta-catenin in hepatocellular carcinoma and to assign clinicopathological correlations. Immunohistochemical detection of Notch1/Jagged1 and beta-catenin was performed in tissue microarrays including 339 Hepatocellular carcinomas, 174 adjacent non-tumor livers and 94 normal livers. The results showed that the rate of expression was 66%, 98% and 97% for Notch1 and 36%, 85% and 92% for Jagged1 respectively in hepatocellular carcinoma, adjacent non-tumor liver and normal liver. Decreased expression of Notch1/Jagged1 was correlated significantly with Edmondson-Steiner grade. However, nuclear beta-catenin was expressed in 37% of hepatocellular carcinoma tissue, which was significantly higher than its non-tumor counterparts. Increased nuclear beta-catenin expression was correlated with HBs-Ag status and Edmondson-Steiner grade. Moreover, The positive expression of Notch1 was parallel with Jagged1 expression (r =0.235, p=0.000) and reduced Notch1 expression was associated with increased beta-catenin expression in hepatocellular carcinoma (r =-0.125, p =0.023). In conclusion, Notch1/Jagged1 were frequently low expressed in hepatocellular carcinoma and correlated with the high expression of beta-catenin suggesting that downregulation of Notch1/Jagged1 signaling may sustain tumor progression.

K/pi Fluctuations at relativistic energies

We report K/pi fluctuations from Au + Au collisions at sqrt[s(NN)]= 19.6, 62.4, 130, and 200 GeV using the STAR detector at the Relativistic Heavy Ion Collider. K/pi fluctuations in central collisions show little dependence on incident energy and are on the same order as those from NA49 at the Super Proton Synchrotron in central Pb + Pb collisions at sqrt[s(NN)]=12.3 and 17.3 GeV. We report results for the collision centrality dependence of K/pi fluctuations and results for charge-separated fluctuations. We observe that the K/pi fluctuations scale with the charged particle multiplicity density.

Roles of trans and cis variation in yeast intraspecies evolution of gene expression

Both cis and trans mutations contribute to gene expression divergence within and between species. We used Saccharomyces cerevisiae as a model organism to estimate the relative contributions of cis and trans variations to the expression divergence between a laboratory (BY) and a wild (RM) strain of yeast. We examined whether genes regulated by a single transcription factor (TF; single input module, SIM genes) or genes regulated by multiple TFs (multiple input module, MIM genes) are more susceptible to trans variation. Because a SIM gene is regulated by a single immediate upstream TF, the chance for a change to occur in its trans-acting factors would, on average, be smaller than that for a MIM gene. We chose 232 genes that exhibited expression divergence between BY and RM to test this hypothesis. We examined the expression patterns of these genes in a BY-RM coculture system and in a BY-RM diploid hybrid. We found that trans variation is far more important than cis variation for expression divergence between the two strains. However, because in 75% of the genes studied, cis variation has significantly contributed to expression divergence, cis change also plays a significant role in intraspecific expression evolution. Interestingly, we found that the proportion of genes with diverged expression between BY and RM is larger for MIM genes than for SIM genes; in fact, the proportion tends to increase with the number of transcription factors that regulate the gene. Moreover, MIM genes are, on average, subject to stronger trans effects than SIM genes, though the difference between the two types of genes is not conspicuous.

Longitudinal assessment of cognitive impairment among lung cancer survivors

9609

Background: Patients undergoing treatment for cancer often report problems with their cognitive function (CF), which is an essential component in maintaining Quality of Life (QoL). We conducted a longitudinal study of lung cancer (LC) patients to systematically evaluate changes in QOL including changes in CF, over time. Methods: Between 2005–2008, we followed 1757 primary LC patients who responded to CF questions at least once within 8 years of diagnosis. Overall QoL measured by LCSS and LASA (scores 0–100 from worst to best) were assessed among 1,604 of 1,757 (91%) who completed the questionnaire at one or both of two time periods: short-term (T1-within 3 years of diagnosis) and long-term follow-up (T2-beyond 5 years of diagnosis). Questions rated overall CF and problems in thinking clearly. Results: The median age at the time of LC diagnosis was 68 years in men (n=834) and 65 years in women (n=770), p<0.0001. At T1, the mean score of patients reporting problems with CF was 63.2 (±22.45) vs 74.4 (±20.38) who reported no problems (p<0.0001). At T2, the mean score was 62.2 (±24.18) for patients who reported CF problems and 78.1 (±18.28) who reported no changes with their CF (p<0.0001). At T1, the mean score of patients reporting problems thinking clearly was 66.1 (±21.65) vs 75.6 (±20.21) reporting no problems with their thinking (p<0.0001). At T2, the mean score was 70.4 (±20.95) for patients reporting problems thinking clearly vs 82.6 (±17.76) who reported no problems (p<0.0001). Conclusions: Self-reported QoL of lung cancer survivors showed substantial deficits with their cognitive function. Prospective and objective assessments are needed to determine if cancer treatments are positively associated with cognitive decline, to identify the patients at risk, and to test appropriate interventions. Funding Source: NIH grants: CA 115857, CA 84354, CA 80127 and CA 77118.

No significant financial relationships to disclose.

Baseline quality of life as a prognostic factor for overall survival in lung cancer patients

e19031

Background: Useful predictors of survival in cancer patients have been found including such as gender, race, age, marital status, state of disease and tumor location. We set to explore the prognostic value of baseline QOL assessments on overall survival in lung cancer patients. Methods: A total of 1,319 lung cancer patients were followed at Mayo Clinic between 1997 and 2007. Overall QOL was assessed by either Lung Cancer Symptom Scale (LCSS) or a single-item Linear Analogue Self Assessment (LASA) with comparable wording. QOL scores were transformed to a 0–100 scale with higher scores representing better status. Patients QOL scores assessed within the first 6 months of follow-up were dichotomized using a priori definition for clinically deficiency score (CDS, ≤50 vs. >50). The Kaplan-Meier method was used to estimate the distribution of survival times by QOL clinical deficient categorization. Cox Proportional Hazards Models were used to evaluate the prognostic importance of QOL on OS alone and in the presence of age, smoking category, gender, treatment, stage of disease, smoking cessation and years of consuming a pack every day. Results: Baseline QOL was significantly associated with OS univariately (HR=0.46 with p<0.0001 based on the CDS categorization). After controlling for all these other factors, the indication of a clinically deficient baseline QOL contributed significantly to the prediction of patient survival (p=0.0002; HR=0.67). Age, treatment, disease stage, smoking cessation and smoking category were also significant predictors of OS multivariately. The median survival for patients that had an overall QOL score less than the CDS (≤50) was 1.6 versus 4.6 years for patients with QOL >50. Conclusions: Baseline overall QOL measured by LCSS or LASA is a significant and independent prognostic factor for OS in lung cancer patients. A meaningful next step in this research is to investigate interventions to improve lung cancer patient QOL and thereby increase their likelihood of survival as well.

No significant financial relationships to disclose.

A first-in-human phase I trial of PBI-05204 (oleandrin), an inhibitor of Akt, FGF-2, NF-Kb, and p70S6K in advanced solid tumor patients

3537

Background: PBI-05204 contains oleandrin, a cardiac glycoside, which inhibits the α-3 subunit Na-K ATPase pump. Over-expression of the α-3 subunit in malignant cells correlates with the tumor proliferation. Oleandrin inhibits FGF- 2 export and activation of NF-Kβ and inhibits phosphorylation of Akt. PBI-05204 also inhibits p70S6K, decreasing mTOR activity. In this ongoing study of PBI-05204, we sought to determine the DLTs, MTD and recommended phase II dose in advanced solid tumors patients (pts) and to characterize its’ pharmacokinetics (PK) and pharmacodynamics (PD). Methods: This was a standard 3+3 phase I design. PBI-05240 was given orally for 21 days of 28 days. Dose was increased by 100% if no related grade 2 adverse event (AE) was observed and increased by 50% if a grade 2 AE occurred. If no other grade 2 AE were observed then subsequent dose escalation was resumed at 100%. In order to determine drug-mediated changes in pAkt, p70S6K, and S6 (mTOR effectors) expression as a surrogate marker of target effect, peripheral blood mononuclear cells (PBMCs) were obtained in addition to PKs. Results: To date 15 pts have received PBI-05204 at 5 dose levels (0.6 mg to 10.2 mg/day), 2 pts are currently active at dose level 5. No DLT has been observed thus far. 10 out of 15 pts (67%) experienced only grade 1 AEs, most common: fatigue and constipation (20%). No significant cardiac toxicities have been observed, only first degree AV block and grade 2 PVC's. Of the 15 evaluable pts, 3 had stable disease for > 4 months, with bladder, colorectal, and fallopian tube cancer pts having an 11, 16, and 10% reduction by RECIST respectively. PKs initially show dose-dependent peak plasma oleandrin concentrations are reached at 2–4 hr following administration with > 50% cleared in 6 hrs. Western blots of PBMCs showed PBI-05204 markedly reduced phosphorylation of Akt, p70S6K, and S6 in a time dependent manner in 4 pts (1 at dose level 2, and 3 and 2 at dose level 5). Reduction of these effectors was observed concomitantly with relatively higher levels of Na, K-ATPase α-3 subunit expression. Conclusions: PBI-05204 is tolerated up to 10.2/mg/day with very little AE's or cardiotoxicity. Initial response evaluation shows activity in diverse tumors with PD analysis suggesting target effect.

[Table: see text]

Quality of life in advanced non-small cell lung cancer patients receiving first-line gefitinib monotherapy

9614

Background: Gefitinib is a potential first-line treatment option for patients with advanced non-small cell lung cancer (NSCLC), especially for patients with activating mutations in the EGFR gene. However, little is known about patient-reported health-related quality of life (HRQOL) in this patient population. The aims of this study were to explore the prognostic values of baseline HRQOL for time-to-treatment failure (TTF), as well as the predictors of repeatedly measured posttreatment HRQOL, in advanced NSCLC patients receiving first-line gefitinib. Methods: A total of 106 chemonaive patients with advanced NSCLC were enrolled in a phase II trial. Gefitinib was given at a dose of 250 mg/d. HRQOL was assessed monthly with the EuroQoL instrument (EQ-5D) and the Lung Cancer Symptom Scale (LCSS) questionnaire. Baseline HRQOL and clinical/molecular predictors of TTF were jointly examined by multiple Cox's proportional hazards model. The associations between the clinical/molecular factors and repeatedly measured posttreatment HRQOL were analyzed by fitting marginal linear regression model using the generalized estimating equations (GEE) method. Results: In this prospective study, HRQOL data were obtained from 94 patients. Baseline EQ-5D index (estimated hazard ratio = 0.286, 95% C.I.: 0.135–0.603, p = 0.001) and the presence of L858R EGFR mutation in adenocarcinoma (estimated hazard ratio = 0.520, 95% C.I.: 0.307–0.880, p = 0.015) were retained as independent prognostic factors in the final multiple Cox's proportional hazards model for TTF. According to preliminary GEE analysis of repeatedly measured posttreatment HRQOL, the patients with wild-type EGFR consistently had worse HRQOL in EQ-5D index (p < 0.0001), EQ-5D VAS score (p = 0.0002), and LCSS global score (p < 0.0001), respectively. Conclusions: In advanced NSCLC patients receiving first-line gefitinib, better baseline EQ-5D index and L858R EGFR mutation in adenocarcinoma predict longer TTF. In addition, patients with wild-type EGFR had worse posttreatment HRQOL.

No significant financial relationships to disclose.

Association between lung cancer survival and pessimistic explanatory style

6518

Background: Several studies have demonstrated the importance of pessimism in cardiovascular disease. However, this construct has not been well explored in oncology. Methods: This study examined the survival time of 534 adult who were diagnosed with lung cancer. These patients had completed the Minnesota Multiphasic Personality Inventory (MMPI) approximately 18.2 years prior to their lung cancer diagnosis. MMPI Optimism-Pessimism (PSM) scores were divided into high (60 or more) and low scores (less than 60), and log-rank tests and Kaplan-Meier curves were used to determine survival differences. Multivariate Cox models were used for assessing prognostic values of pessimism along with other known predictors for survival outcome. Results: At the time of diagnosis, patients were on average 67 years old, 48% were female, 85% had non-small cell lung cancer (NSCLC), 15% had small cell lung cancer (SCLC), 30% were stage I, 4% were stage II, 31% were stage III/Limited, and 35% were stage IV/Extensive. Patients who exhibited a non-pessimistic explanatory style survived approximately six months longer than patients classified as pessimists. Pessimists have significantly worse survival rates even after adjusting for other known prognostic variables. Conclusions: Among lung cancer patients, having a pessimistic explanatory style was related to surviving on average six months less compared to patients with a non-pessimistic explanatory style.

[Table: see text]

No significant financial relationships to disclose.

Effects of immediate compared with delayed gefitinib after front-line chemotherapy in Chinese with advanced non-small cell lung cancer

8069

Background: To compare therapeutic effects of immediate vs. delayed gefitinib used for advanced non-small cell lung cancer (NSCLC) patients who obtained disease control (DC) after front-line chemotherapy in Chinese population. Methods: The study included 121 Chinese with advanced NSCLC treated with standard chemotherapy and obtained DC followed by either immediate gefitinib (66 cases) or delayed gefitinib, i.e. when tumors progressed (55 cases). The disease control rate (DCR), median progression-free survival time (PFS), median overall survival time (OS) of the two groups were analyzed. The impact of EGFR mutation status on the treatments was also evaluated. Results: The median PFS of patients treated in the immediate treatment setting was significantly longer than that of patients without gefitinib treatment (15.23 months versus 8.13 months,P<0.001). However, the overall median PFS was similar in patients treated with either immediate or delayed settings (15.23 months and 16.23 months respectively, P=0.450). There was no significant difference in OS between the two groups. Although patients whose tumors had EGFR mutation showed a longer median PFS compared to those without the mutation in both treatment groups, similar overall PFS was observed between the groups for patients with EGFR mutation (18.75 months and 18.30 months for maintenance and second-line groups, respectively). Conclusions: Immediate gefitinib use may improve PFS for Chinese patients with advanced NSCLC after front-line chemotherapy. However, similar PFS may be achieved by delayed use of gefitinib.

No significant financial relationships to disclose.

Effects of core binding factor alpha1 or bone morphogenic protein-2 overexpression on osteoblast/cementoblast-related gene expressions in NIH3T3 mouse cells and dental follicle cells

OBJECTIVES

Bone morphogenic protein-2 (BMP-2) has long been used to promote bone and periodontal regeneration, while core binding factor alpha1 (CBFA1) plays important roles in both osteogenic differentiation and tooth morphogenesis. The aim of this study was to evaluate the effects of CBFA1 or BMP-2 overexpression on osteoblast/cementoblast-related gene expressions in NIH3T3 cells and dental follicle cells (DFCs).

MATERIALS AND METHODS

CBFA1 or BMP-2 overexpression in NIH3T3 and DFCs was achieved by infection with retroviral vectors containing CBFA1 or BMP-2 cDNA. Cells stably integrated with CBFA1 or BMP-2 cDNA were selected with G418 for 14 days. Western blotting, real-time reverse transcriptase-polymerase chain reaction, and in vitro mineralization assay were performed to evaluate effects of CBFA1 or BMP-2 overexpression in cells undergoing osteoblast/cementoblast differentiation.

RESULTS

Our results demonstrated that osteoblast/cementoblast-related gene expression levels in CBFA1-overexpressing NIH3T3 cells were higher than those in BMP-2-overexpressing cells. More mineral nodules were observed in CBFA1-overexpressing NIH3T3 cells than in BMP-2-overexpressing cells. CBFA1 overexpression in DFCs also increased osteoblast/cementoblast-related gene expression and promoted mineral nodule formation. However, no significant changes in gene expression levels nor mineral nodule formation were found in BMP-2-overexpressing DFCs when compared with empty vector transduced DFCs.

CONCLUSIONS

CBFA1 overexpression up-regulated expression levels of osteoblast/cementoblast-related genes and enhanced in vitro osteogenic differentiation more efficiently than BMP-2 in both NIH3T3 cells and DFCs.

Clinical evaluation of algorithms for context-sensitive physiological monitoring in children

BACKGROUND

Subtle changes in monitored physiological signals might be used to guide clinical actions and give early warning of potential adverse events. Automated early warning systems could enhance the clinician's interpretation of data by instantaneously processing new information and presenting it within the context of previous observations. In this study, we tested algorithms for tracking the behaviour of dynamic physiological systems and automatically detecting key events over time.

METHODS

Algorithms were activated in real-time during anaesthesia to run context-sensitive monitoring of six variables (end-tidal PCO(2), heart rate, exhaled minute ventilation, non-invasive arterial pressure, respiratory rate, and oxygen saturation), alongside standard physiological monitors. The clinical evaluation included real-time feedback on each change point (change in the physiological trend) detected by the algorithms and the completion of a usability questionnaire.

RESULTS

Fifteen anaesthetists completed the evaluation during paediatric surgical cases. A total of 38 cases were evaluated, with a mean duration of 103 (102) min. The mean number of change points per case was 22.8 (23.4). Sixty-one per cent of all rated change points were considered clinically significant, and <7% were due to artifacts.

CONCLUSIONS

The algorithms were able to detect a range of clinically significant physiological changes during paediatric anaesthesia, and were considered useful by participating anaesthetists. These findings indicate that automated detection of context-sensitive changes is possible and could be used by early warning systems during physiological monitoring. Further investigations are required to assess how this information can best be communicated to the anaesthetist.

Apoptosis inducing and differentiation enhancement effect of oridonin on the all-trans-retinoic acid-sensitive and -resistant acute promyelocytic leukemia cells

We investigated the effects of oridonin (Ori), a diterpenoid isolated from Rabdosia rubescens, on apoptosis and differentiation of all-trans-retinoic acid (ATRA)-sensitive (NB4) and ATRA-resistant (NB4-R1) cells. The results showed that reactive oxygen species initiates Ori-induced apoptosis. In addition, we found that neither Ori nor ATRA (10 nM) alone induced marked cell differentiation, while co-treatment of these two compounds can induce differentiation of NB4 and NB4-R1 cells which was accompanied by increased RARalpha, C/EBPepsilon or C/EBPbeta. This is the first report to show that RARalpha could be accumulated by Ori which may be useful as a probe to investigate the mechanism of RARalpha catabolism. These results suggest that Ori is a potential candidate for acute promyelocytic leukemia cancer therapy.

Fabrication of low-loss silicon-on-oxidized-porous-silicon strip waveguide using focused proton-beam irradiation

We have successfully fabricated low-loss silicon-on-oxidized-porous-silicon (SOPS) strip waveguides with high-index contrast using focused proton-beam irradiation and electrochemical etching. Smooth surface quality with rms roughness of 3.1 nm is achieved for a fluence of 1x10(15)/cm(2) after postoxidation treatment. Optical characterization at a wavelength of 1550 nm shows a loss of 1.1+/-0.4 dB/cm and 1.2+/-0.4 dB/cm in TE and TM polarization respectively, which we believe is the lowest reported loss for SOPS waveguides. This opens up new opportunities for all-silicon-based optoelectronics applications.

Intravascular ultrasound predictors of major adverse cardiac events in patients with unstable angina

BACKGROUND

Intravascular ultrasound (IVUS) predictors of native culprit lesion morphology for occurrence of major adverse cardiac events (MACE) have not been reported. Moreover, the published data on IVUS predictors of restenosis include patients with stable and unstable angina, although the development and progression of atherosclerosis related to unstable coronary syndrome is different from that of stable angina.

HYPOTHESIS

This study investigated whether IVUS-derived qualitative and quantitative parameters of native (preangioplastic) plaque morphologic features can predict major adverse cardiac events in patients with unstable angina.

METHODS

Clinical (age, gender, coronary risk factors), qualitative and quantitative angiographic (lesion localization, morphology, pre- and postangioplastic minimal lumen diameter, reference diameter, and percent diameter stenosis), and IVUS variables (soft/fibrocalcific plaque, calcification, presence of thrombus or plaque disruption, different types of arterial remodeling, pre- or postangioplastic minimal lumen, external elastic membrane and plaque cross-sectional area, and plaque burden of the target lesion and reference segments) were analyzed by regression analyses using the Cox model, assuming proportional hazards.

RESULTS

Of 60 consecutively enrolled patients, 21 suffered from MACE, while 39 remained event-free during the followup period. Multivariate regression analyses revealed that the presence of adaptive remodeling [p = 0.0177, risk ratio (RR) = 3.108, with 95% confidence interval (CI) = 1.371-8.289] and the preangioplastic lumen cross-sectional area (p = 0.0130, RR = 0.869, with 95% CI = 0.667-0.913) are independent predictors of MACE during follow-up, as is postangioplastic angiographic minimal lumen diameter (p = 0.0330, RR = 0.715 with 95% CI = 0.678-0.812).

CONCLUSIONS

Adaptive remodeling and preangioplastic lumen cross-sectional area determined by IVUS and postangioplastic minimal lumen diameter calculated by quantitative angiography are significant independent predictors of time-dependent MACE in patients with unstable angina.