Microarray-based comparative genomic hybridisation of breast cancer patients receiving neoadjuvant chemotherapy

We analysed the molecular genetic profiles of breast cancer samples before and after neoadjuvant chemotherapy with combination doxorubicin and cyclophosphamide (AC). DNA was obtained from microdissected frozen breast core biopsies from 44 patients before chemotherapy. Additional samples were obtained before the second course of chemotherapy (D21) and after the completion of the treatment (surgical specimens) in 17 and 21 patients, respectively. Microarray-based comparative genome hybridisation was performed using a platform containing approximately 5800 bacterial artificial chromosome clones (genome-wide resolution: 0.9 Mb). Analysis of the 44 pretreatment biopsies revealed that losses of 4p, 4q, 5q, 12q13.11-12q13.12, 17p11.2 and 17q11.2; and gains of 1p, 2p, 7q, 9p, 11q, 19p and 19q were significantly associated with oestrogen receptor negativity. 16q21-q22.1 losses were associated with lobular and 8q24 gains with ductal types. Losses of 5q33.3-q4 and 18p11.31 and gains of 6p25.1-p25.2 and Xp11.4 were associated with HER2 amplification. No correlations between DNA copy number changes and clinical response to AC were found. Microarray-based comparative genome hybridisation analysis of matched pretreatment and D21 biopsies failed to identify statistically significant differences, whereas a comparison between matched pretreatment and surgical samples revealed a statistically significant acquired copy number gain on 11p15.2-11p15.5. The modest chemotherapy-driven genomic changes, despite profound loss of cell numbers, suggest that there is little therapeutic selection of resistant non-modal cell lineages.

Three-tesla magnetic resonance imaging of the ventrolateral thalamus: a correlative anatomical description

Object

Surgery for tremor targets the ventrolateral nuclei of the thalamus. An initial radiological estimation of this target can be further refined through intraoperative physiological confirmation. Direct visualization of these nuclei has not yet been described. The improved signal-to-noise ratio associated with 3-tesla (3T) magnetic resonance (MR) imaging makes increased spatial resolution possible, which may aid in the identification of subtle morphological features. This study was conducted to describe the anatomy of the nuclei and fiber projections within the ventral thalamus by using 3T MR imaging.

Methods

Using a commercially available 3T MR unit, the authors obtained images of a formalin-fixed, paraffin-embedded brain. Slices with a 2-mm thickness and 0.2-mm gap were obtained parallel to the anterior commissure–posterior commissure (AC–PC) line. The brain was then sectioned through the cerebral hemispheres to obtain tissue slices encompassing the same levels. Adjacent 10-μm paraffin sections from the middle of each level were stained with Luxol fast blue and cresyl violet. The MR image and histological sections at the level of the AC–PC line were then compared in detail. In a separate study, the human thalamus was scanned in vivo using 3T and 1.5T MR imaging for anatomical comparison.

Conclusions

The anatomy of the nuclei and fiber projections within the ventrolateral thalamus in humans can be described using 3T MR imaging. The findings were reproducible in vivo with 3T but not 1.5T MR imaging. Additional studies are needed to confirm the accuracy of this observation for clinical purposes.

Is shared learning the way to bring UK neurology and psychiatry closer: what teachers, trainers and trainees think

BACKGROUND

Rapid advances in brain sciences are challenging the validity of the traditional divide between neurology and psychiatry. The need for closer ties has been widely advocated.

OBJECTIVE

To assess attitudes of neurologists and psychiatrists to closer links in general and to joint education in particular.

METHODS

Postal questionnaire survey of trainees (SpRs) trainers (Members of Special Advisory Committees in Neurology and General and Old Age Psychiatry) and teachers (Undergraduate coordinators). Analysis based on 55 neurology and 50 psychiatry respondents.

RESULTS

5 general attitude questions on links showed most respondents "keen" on links and "unkeen" on current separation of disciplines. 15 topics possibly suitable for joint teaching were offered. 7 were rated between "keen" and very "keen" with maximum support for somatization, dementia, chronic pain and pharmacology. 7 were rated positively, only eating disorders was felt unsuitable. 6 options were offered for joint training opportunities. Trainees were keen on attending joint education, clinical and patient management sessions and outpatient clinics. Psychiatrists were even keener on links than neurologists with psychiatric SpRs significantly more in favour of certain items.

CONCLUSIONS

The survey found widespread support from trainees, trainers and teachers for closer links. Trainees were keen to attend joint clinically focussed sessions. Psychiatrists tended to be keener that neurologists on links. This survey should encourage the establishment of closer educational links at all levels.

Insights into brain microstructure from the T2 distribution

T2 weighting is particularly sensitive, but notoriously unspecific, to a wide range of brain pathologies. However, careful measurement and analysis of the T2 decay curve from brain tissue promise to provide much improved pathological specificity. In vivo T2 measurement requires accurate 180 pulses and appropriate manipulation of stimulated echoes; the most common approach is to acquire multiple echoes from a single slice. The T2 distribution, a plot of component amplitude as a function of T2, can be estimated using an algorithm capable of fitting a multi-exponential T2 decay with no a priori assumptions about the number of exponential components. T2 distributions from normal brain show peaks from myelin water, intra/extracellular water and cerebral spinal fluid; they can be used to provide estimates of total water content (total area under the T2 distribution) and myelin water fraction (MWF, fractional area under the myelin water peak), a measure believed to be related to myelin content. Experiments on bovine brain suggest that magnetization exchange between water pools plays a minor role in the T2 distribution. Different white matter structures have different MWFs. In normal white matter (NWM), MWF is not correlated with the magnetization transfer ratio (MTR) or the diffusion tensor fractional anisotropy (FA); hence it provides unique information about brain microstructure. Normal-appearing white matter (NAWM) in multiple sclerosis (MS) brain possesses a higher water content and lower MWF than controls, consistent with histopathological findings. Multiple sclerosis lesions demonstrate great heterogeneity in MWF, presumably due to varying myelin contents of these focal regions of pathology. Subjects with schizophrenia were found to have significantly reduced MWF in the minor forceps and genu of the corpus callosum when compared to controls, suggesting that reduced frontal lobe myelination plays a role in schizophrenia. In normal controls, frontal lobe myelination was positively correlated with both age and education; this result was not observed in subjects with schizophrenia. A strong correlation between MWF and the optical density from the luxol fast blue histological stain for myelin was observed in formalin-fixed brain, supporting the use of the MWF as an in vivo myelin marker.

Proton T1 relaxation times of cerebral metabolites differ within and between regions of normal human brain

Saturation recovery spectra (STEAM) were acquired at 1.5 T with 7 TRs ranging from 530 to 5000 ms and a constant TE of 30 ms in voxels (7.2 ml) located in occipital grey, parietal white and frontal white matter (10 subjects each location). Spectra were also acquired at 7, 21 and 37 degrees C from separate 100 mm solutions of inositol (Ins), choline-containing compounds (Cho), N-acetyl-aspartate (NAA) and creatine. Simulations of T(1) fits with 2, 3 and 7 TRs demonstrated that at typical SNR there is potential for both inaccurate and biased results. In vivo, different metabolites had significantly different T(1)s within the same brain volume. The same order from shortest to longest T(1) (Ins, Cho, NAA, creatine) was found for all three brain regions. The order (Ins, NAA, creatine, Cho) was found in the metabolite solutions and was consistent with a simple model in which T(1) is inversely proportional to molecular weight. For all individual metabolites, T(1) increased from occipital grey to parietal white to frontal white matter. This study demonstrates that, in spectra acquired with TR near 1 s, T(1) weightings are substantially different for metabolites within a single tissue and also for the same metabolites in different tissues.

Quantitative assessment of an MR technique for reducing metal artifact: application to spin-echo imaging in a phantom

OBJECTIVE

To quantify image artifact reduction using a new technique (MARS--metal artifact reduction sequence) in vitro.

DESIGN

Coronal T1-weighted MR images were obtained through two metal phantoms (titanium/chromium-cobalt and stainless steel femoral prostheses) immersed in water. Comparison of artifact volume was made with images obtained using conventional and modified (MARS) T1-weighted sequences. Signal intensity values outside a range of +/-40% the average signal intensity for water were considered artifact and segmented into low or high signal artifact categories. Considering the arbitrary selection of this threshold value, volumetric calculations of artifact were also evaluated at +/-50%, 60%, 70%, and 80% the mean signal for water.

RESULTS

Conventional T1-weighted images produced 87% more low signal artifact and 212% more high signal artifact compared with the MARS modified T1-weighted images of the stainless steel prosthesis. Conventional T1-weighted images of the titanium prosthesis produced 84% more low signal artifact and 211% more high signal artifact than the MARS modified sequence. The level of artifact reduction was essentially uniform for the various threshold levels tested and was greatest at +/-20% the global signal intensity average for water.

CONCLUSION

The MARS technique reduces the volume of image signal artifact produced by stainless steel and titanium/chromium-cobalt femoral prostheses on T1-weighted spin-echo images in a tissue phantom model.

MRI of spinal hardware: comparison of conventional T1-weighted sequence with a new metal artifact reduction sequence

OBJECTIVE

This study was designed to compare diagnostic quality of MR images of patients with spinal hardware acquired using a conventional T1-weighted spin-echo sequence and a new metal artifact reduction sequence (MARS).

CONCLUSION

The new MARS sequence effectively reduces the degree of tissue-obscuring artifact produced by spinal fixation hardware and subjectively improves image quality compared with the conventional T1-weighted spin-echo sequence.

A model of unloaded human intervertebral disk based on NMR relaxation

NMR relaxation rates were related to the composition of the nucleus pulposus from 11 and anulus fibrosus from six human intervertebral disks. Tissue water was proportional to glycosaminoglycan (GAG) and residue, the noncollagen, non-GAG portion of the dry weight (R2 = 0.74). The solid signal fraction depended on collagen and residue protons (R2 = 0.89). 1/T1 was proportional to collagen and residue (R2 = 0.97). T2 showed 2-4 components labeled A, B, C, and D, with means +/- standard deviations of 3.1 +/- 1.6, 17.5 +/- 9.5, 64 +/- 22, and 347 +/- 162 msec. Signal fractions of A and B depended on the collagen-associated water protons (R2 = 0.94 and 0.85), C on residue-associated water protons (R2 = 0.82), and D on GAG-associated water protons (R2 = 0.74). The data led to a model of disk architecture in which the collagen and residue were largely solid, forming distinct water compartments; the remaining water was present in a proteoglycan gel.

In vitro measurements of water content and T2 relaxation times in lung using a clinical MRI scanner

The purpose of this study was to validate water content measurements and to determine the T2 distribution in lung on a 1.5 T clinical magnetic resonance imaging (MRI) scanner. A single-slice 16 echo pulse sequence with an echo spacing of 10 msec was employed to scan 19 healthy juvenile pig lungs. The in vitro water content of each lung was measured using MRI techniques and compared with gravimetric measurements. The mean difference between the gravimetric and MRI water contents was -4.1 +/- 7.6%, and an excellent linear correlation (R2 = 0.98) was observed between the two independent measurements. The dependence of the geometric mean T2 time upon lung water density exhibited two distinct regions (inflated and deflated) separated by a threshold density of about 0.4 g/mL.

What's water got to do with it? A nuclear magnetic resonance study of molecular motion in pig stratum corneum

The 1H and 2H magnetic resonance signals from pig stratum corneum were measured as a function of hydration. The 1H free induction decay contained two components, one motionally restricted and the other isotropically mobile on the timescale of 10(-5) s. From its T2 decay, the mobile signal was further subdivided into two components; one, which was 11% of the signal and 5.5% of the mass of the dehydrated stratum corneum, was assigned to nonaqueous tissue (likely hydrocarbons) and the other to water. As water content increased from 0 to 0.25 gH2O/gSC, the second moment of the motionally restricted signal decreased from 5.4 x 10(9) to 3.6 x 10(9) s(-2), whereas the water T2 time increased from less than 0.3 ms to 3.3 ms. The 2H quadrupolar echo from stratum corneum hydrated in 2H2O had a signal from motionally restricted deuterons, attributed to deuterons exchanged onto O-H and N-H groups, and a mobile signal from 2H2O. The amount of exchange, 9.5% of the hydrogen sites in the motionally restricted fraction, was close to the number of exchangeable sites on keratin, the most abundant protein in stratum corneum. Our results are consistent with a model in which the bulk of the water interacts closely with the corneocytes in stratum corneum.

Nuclear magnetic resonance relaxation in multiple sclerosis

OBJECTIVES

The theory of relaxation processes and their measurements are described. An overview is presented of the literature on relaxation time measurements in the normal and the developing brain, in experimental diseases in animals, and in patients with multiple sclerosis.

RESULTS AND CONCLUSION

Relaxation time measurements provide insight into development of multiple sclerosis plaques, especially the occurrence of oedema, demyelination, and gliosis. There is also evidence that normal appearing white matter in patients with multiple sclerosis is affected. What is now needed are fast and accurate relaxation time measurement procedures, which cover the whole brain. Relaxation time measurements could then provide an important tool for studying the pathogenesis of demyelinating diseases and thus be useful in follow up studies.

Bi-exponential T2 decay in dairy cream phantoms

MRI phantoms are an important part of any experiment because they provide a reference of known parameters. There are many choices of mono-exponential T2 phantoms, but few choices for bi-exponential T2 phantoms. We have found that dairy cream provides an excellent bi-exponential T2 model with similar relaxation times to those found in white matter. Five cream phantoms of different milk fat percentages (2, 6, 10, 18 and 35 %) were imaged with an optimized Carr-Purcell-Meiboom-Gill sequence. The decay curves for each of the phantoms were fit using Non-Negative Least Squares. We found that the short T2 component fraction relative to the total energy in the distribution correlated linearly (r = 0.9973) with the milk fat percentage. The short T2 time was 38+/-4 ms and the long T2 time was 135+/-4 ms.

Detection of Campylobacter jejuni in food and poultry viscera using immunomagnetic separation and microtitre hybridization

Thermophillic Campylobacter and Camp. jejuni were detected from samples of chicken liver, gall bladder, muscle and contaminated milk and chicken meat after an enrichment step by using immunomagnetic capture of cells with monoclonal antibody against a specific outer membrane protein of thermophilic Campylobacter. The detection of captured cells was achieved using two different hybridization methods. In one of the methods, the captured cells were lysed by guanidine isothiocyanate and the 23S rRNA was reacted with a microtitre plate-immobilized rDNA probe specific for thermophilic Campylobacter. In the other method, the captured cells were subjected to lysis by ultrasonication and the genomic DNA reacted with a microtitre plate-immobilized RNA probe specific for Camp.jejuni. Detection of the RNA-DNA hybrids formed in the wells was carried out using a monoclonal anti-RNA-DNA hybrid antibody.

1H NMR measurements of wet/dry ratio and T1, T2 distributions in lung

Proton-magnetic-resonance measurements have been carried out on juvenile porcine peripheral lung parenchyma. The free-induction-decay signal contained a motionally restricted component which decayed in a few tens of microseconds and a mobile component with a T2 time greater than 1 ms. The average second moment, M2, for the motionally restricted signal was found to be 3.42 +/- (0.25) x 10(9) s-2. The T2 distribution for the mobile signal consistently showed four resolvable components of T2 range: 2-6, 10-40, 80-110, and 190-400 ms. The 2-6 ms component was present in a fully dehydrated preparation and was therefore assigned to a nonaqueous lung constituent. The motionally restricted FID component had a T1 = 0.772 +/- 0.11 s and the mobile component had a T1 = 0.967 +/- 0.02 s. The hydrogen content per unit mass for lung parenchyma and water were estimated in two ways: (1) on the basis of chemical content and (2) on the basis of comparison of restricted and mobile signals to the gravimetric (G) water content for a lung sample studied at a wide range of water contents. Lung wet/dry weight ratios were estimated from the free-induction decays and compared with gravimetric measurement. The ratio of (wet/dry)NMR/(wet/dry)G was 1.00 +/- 0.08 and 1.00 +/- 0.05 for the two methods of estimation.

Postirradiated submandibular gland: a potential model to study salivary gland radioprotection and tumourigenesis

Theoretical reserve cells located in the intercalated and excretory ducts are postulated to be responsible for salivary gland tumourigenesis, with acinar cells playing no role in this process. Animal models, one using low-dose radiation to rat submandibular glands, indicate that this hypothesis is incorrect. Few human models have been devised to demonstrate and verify this theory. Submandibular glands in the field of ionizing radiation, as external-beam radiotherapy for head and neck tumours, were examined using an immunocytochemical technique and an antibody to proliferating cell nuclear antigen (PCNA), a specific marker for cycling cells. In the nonirradiated gland, nuclei positive for PCNA were seen in acinar as well as ductal cells of all types. Six months post irradiation, human submandibular glands show increased proliferative rates in both ductal and acinar cells that are significantly greater than control glands (p = .012). Based on this regenerative capacity, postirradiated human submandibular glands might serve as a model to investigate various treatment modalities for the prevention of radiation damage to acinar cells and the consequent patient morbidity that develops due to xerostomia. As well, these results suggest that even in humans, acinar cells are potential targets for carcinogenic agents and that current histogenic concepts for salivary gland tumourigenesis are incorrect.

Myofilament localization and immunoelectron microscopic detection of muscle-specific actin in neoplastic myoepithelial cells in pleomorphic adenomas and myoepitheliomas

Elucidating the cellular characteristics of the nonluminal or myoepithelial cells of pleomorphic adenomas is one approach to establishing the diagnostic criteria for myoepitheliomas. Ultrastructural features of nonluminal tumor cells in 22 pleomorphic adenomas and of tumor cells in 9 myoepitheliomas were assessed from micrographs of routinely fixed and epoxy resin-embedded samples. Recognizable myofilaments were only moderately prominent in 1 myoepithelioma. In the rest of the cases, irrespective of whether nonluminal cells of pleomorphic adenomas or tumor cells of myoepitheliomas were spindle, angular, round, or plasmacytoid in form, myofilaments were noted only in one third of the cases and were present even in these in a small proportion of the tumor cells. Intermediate filament accumulations and basal lamina were more frequent findings associated with nonluminal tumor cells. Six pleomorphic adenomas and 2 myoepitheliomas had been fixed in half-strength glutaraldehyde and embedded in LR White resin for immunoelectron microscopic detection of muscle-specific actin. In 3 (2 pleomorphic adenomas and myoepitheliomas) of these 8 cases, readily visualized bands of filaments in many tumor cells were strongly labeled by the colloidal gold probe detecting muscle-specific actin even when myofilaments were minimal and infrequent in 2 cases and undetectable in the third by routine transmission electron microscopy. Lack of myofilament detection by immunocytochemistry or routine electron microscopy does not exclude a diagnosis of pleomorphic adenoma or myoepithelioma when growth patterns and cytology indicate such diagnoses. Immunoelectron microscopy, in fact, shows that muscle-specific actin can be detected even when myofilaments or muscle actin are apparently absent or minimal by routine electron microscopy or immunohistochemistry, respectively. Because examples of pleomorphic adenoma and myoepithelioma each with similar histologic and cytologic features of the myoepitheliomatous cells can have variable degrees or complete absence of expression of myofilaments or muscle-specific actin, the time-honored term myoepithelial for the nonluminal cells of pleomorphic adenomas and the term myoepithelioma are legitimate even in the absence of those markers that are specific for normal myoepithelial cells.

In vivo visualization of myelin water in brain by magnetic resonance

We exploit the intrinsic difference in magnetic resonance spin-spin relaxation time, T2, between water associated with myelin sheaths and water in other central nervous system tissue in order to measure myelin water content within any region of an image or to generate indirectly a myelin map of the brain. In normal volunteers, myelin water maps give the expected myelin distribution. In multiple sclerosis patients, lesions exhibit different myelin water contents providing insight into the demyelination process unavailable from conventional magnetic resonance images. In vivo myelin measurement has important applications in the clinical management of multiple sclerosis and other white matter diseases.

Collagen gel cultures of normal salivary gland: conditions for continued proliferation and maintenance of major cell phenotypes in vitro

The presence of three functionally and phenotypically distinct epithelial cell populations--acinar, duct, and myoepithelial cells--in major salivary glands creates problems when developing physiologically appropriate culture systems for the study of these tissues in vitro. Previous attempts to establish cultures of rat submandibular gland resulted in continued proliferation and maintenance of glandular architecture, but loss of distinct features of differentiation of the three epithelial cell types. The present study describes an ultrathin free-floating collagen gel culture technique (mantle gels). Using this method, immunohistochemical and ultrastructural studies indicate that rat submandibular gland continues to cycle, and secretory activity and phenotypic markers for acinar, duct, and myoepithelial cells are all demonstrable after 4 weeks in culture, suggesting that this constitutes the ideal system for in vitro investigation of the pathobiology of the salivary gland.