[Characterization and management of incidentally detected solitary pulmonary nodules]

How to deal with solitary pulmonary nodules (SPN) which are incidentally detected by computed tomography (CT) is an increasingly important task in the era of modern multislice CT. This paper reviews the morphological and functional characteristics and their value for discrimination between benign and malignant SPNs. In particular, the importance of nodule size, growth rate, margin morphology, density, calcifications or fatty components within the nodules, the significance of cavitations or aerobronchograms, enhancement patterns at dynamic contrast-enhanced CT and findings on positron emission tomography (PET) are discussed. The Bayesian analysis to calculate the probability of malignancy is presented. Finally, flow charts demonstrate the national and international recommendations for nodule management.

Non-Sentinel Lymph Node Status of Patients with T1/T2 Breast Cancer and Micrometastasis in the Sentinel Lymph Node

Background: Micrometastatic disease in the sentinel lymph node is still an indication for complete axillary lymph node dissection. To further reduce morbidity in breast cancer patients the omission of complete axillary lymph node dissection in patients with micrometastasis in the sentinel lymph node would be desirable.Methods: We retrieved our data-base and looked for the non-sentinel lymph node status in patients with micrometastasis in the sentinel lymph node.Patients with primary T1/T2 breast cancer and sentinel lymph node biopsy were examined for their sentinel lymph node status. Patients with a micrometastasis in the sentinel lymph node, who received a complete axillary lymph node dissection were eligible for evaluation. Patients with a micrometastisis in the sentinel lymph node, who did not receive complete axillary lymph node dissection and patients after primary systemic therapy were excluded.Results: 103 patients were eligible for evaluation. All patients had micrometastases (0,2 to 2,0mm) in the sentinel lymph nodes. In total 15/103 patients (14.6%) had a further metastasis in one or two non-sentinel lymph nodes. 8/103 patients (7.8%) had one macrometastasis in a non-sentinel lymph node with sizes from 2.1mm to 5.0mm. 3/103 patients (2.9%) had a micrometastasis in two non-sentinel lymph nodes and 4/103 patients (3.9%) had one micrometastasis in one non-sentinel lymph node.Mean age of the patients was 57 years, 34 (33%) being premenopausal and 69 (67%) being postmenopausal. 22 patients (21.4%) received immediate axillary dissection after sentinel lymph node biopsy, but 81 patients (78.6%) had a secondary axillary lymph node dissection after the final pathological report. In 19 patients (18.4%) the micrometastasis in the sentinel lymph node could be detected by frozen sections, in 77 patients (74.8%) by serial sections at 250µm in the paraffin embedded sentinel lymph node and in 22 patients (21.4%) by immunohistochemistry only.Discussion: As long as we are lacking reliable methods for predicting the non-sentinel lymph node status for patients with micrometastases in the sentinel lymph node, and as long as the impact of micrometastases in the axilla are subject of debate, axillary lymph node dissection should be performed after sentinel lymph node biopsy with micrometastases in the sentinel lymph node.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1034.

BLADE in sagittal T2-weighted MR imaging of the cervical spine

BACKGROUND AND PURPOSE

Image quality and diagnostic reliability of T2-weighted MR images of the cervical spine are often impaired by several kinds of artifacts, even in cooperative patients. The aim of this study was to evaluate if BLADE sequences might solve these problems in a routine patient collective.

MATERIALS AND METHODS

TSE and BLADE sequences were compared in 60 patients for T2-weighted sagittal imaging of the cervical spine. Image sharpness, motion artifacts, truncation artifacts, metal artifacts, CSF flow phenomena, contrast of anatomic structures (vertebral body/disk, spinal cord/CSF), and diagnostic reliability of spinal cord depiction were evaluated by 2 independent readers. Another 2 readers selected the sequence they would prefer for diagnostic purposes. Statistical evaluations were performed by using the Wilcoxon and the chi(2) test; differences with P < .05 were regarded as statistically significant.

RESULTS

BLADE was significantly superior to TSE regarding image sharpness, image contrast, diagnostic reliability of spinal cord depiction, motion artifacts, CSF flow phenomena, and truncation artifacts; for metal artifacts no significant improvements were found. In 50 of 60 patients, BLADE was preferred for diagnostic purposes, and TSE was favored in 3 patients. The number of examinations that were nondiagnostic due to impaired spinal cord depiction was reduced from 12 in TSE to 3 in BLADE, and nondiagnostic examinations due to overall motion artifacts were reduced from 2 to 1.

CONCLUSIONS

Using the BLADE sequence for sagittal T2-weighted imaging of the cervical spine proved to be advantageous to reduce various kinds of artifacts.

Spiral-type terahertz antennas and the manifestation of the Mushiake principle

We report on the experimental and theoretical study of the resonant eigenmodes of spiral-type terahertz antennas. The analysis is carried out for a varying number of spiral windings. For larger numbers the structure possesses a self-complementary property which allows the application of the Mushiake principle predicting that the impedance of such structures is half the impedance of free space. This permits to observe an equal and frequency independent reflection and transmission coefficient. This property makes the spiral-type terahertz antenna not only a fascinating example of a medium supporting strong resonances in the long wavelength limit but also a medium which can be easily and reasonably homogenized at higher frequencies. This is in stark contrast to most of the existing metamaterials.

Double-element metamaterial with negative index at near-infrared wavelengths

We present the realization of a metamaterial that combines double cut wires and continuous wires in its unit cell. This double-element geometry together with the applied layer-by-layer fabrication technique permits an independent tuning of the geometry of the unit-cell components. The characterization of the samples is based on the measurement of transmission and reflection spectra combined with rigorous numerical simulations. The results show that the metamaterial exhibits an effective refractive index of n=-0.5+1.9i at the wavelength lambda=2.1 microm.

Comparison between vacuum sublimed matrices and conventional dried droplet preparation in MALDI-TOF mass spectrometry

The properties of several cinnamic acid compounds used as matrices for matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) were investigated as standard dried droplet (DD) and vacuum sublimed preparations. The differences between both preparation methods were analyzed with regard to matrix grain size, internal ion energy, initial velocity, analyte intensity, and analyte incorporation depth. Some of the used cinnamic acid derivatives exhibit clearly reduced grain sizes as sublimed preparations compared with standard DD approaches. In these cases higher effective temperatures could be measured accompanied by increased analyte intensities, which can be explained by stronger volatilization processes caused by a hindered heat dissipation resulting in a raised analyte transfer into the gas phase. For all sublimed compounds, a strong increase of the initial ion velocity compared with DD preparations could be measured. Higher initial ion velocities correlate with a decrease in internal ion energy which might be attributed to the very uniform crystal morphology exhibited by sublimed compounds. For sublimed matrices without reduced grain size, at least slightly higher analyte intensities could be detected at raised laser fluences. Analyte accumulation in the uppermost matrix layers or the detected higher ion stability can be explanations for these results.

Polarization-independent negative-index metamaterial in the near infrared

We present and evaluate theoretically and experimentally a design for a negative-index metamaterial that is termed the "Swiss cross" structure. Compared with the established fishnet structure, the proposed design eliminates the drawback of polarization-dependent effective optical parameters. The new design is fabricated by means of e-beam technology and experimentally analyzed using spectroscopic techniques. The thorough comparison with numerical simulations reveals an effective refractive index of n=-1.9 at an operational wavelength of 1400 nm that is independent of the incident polarization. The resonances of the system are comprehensively discussed.

On-chip solid-phase extraction pre-concentration/focusing substrates coupled to atmospheric pressure matrix-assisted laser desorption/ionization ion trap mass spectrometry for high sensitivity biomolecule analysis

Atmospheric pressure matrix-assisted laser desorption/ionization (AP-MALDI) has proven a convenient and rapid method for ion production in the mass spectrometric (MS) analysis of biomolecules. AP-MALDI and electrospray ionization (ESI) sources are easily interchangeable in most mass spectrometers. However, AP-MALDI suffers from less-than-optimal sensitivity due to ion losses during transport from the atmosphere into the vacuum of the mass spectrometer. Here, we study the signal-to-noise ratio (S/N) gains observed when an on-chip dynamic pre-concentration/focusing approach is coupled to AP-MALDI for the MS analysis of neuropeptides and protein digests. It was found that, in comparison with conventional AP-MALDI targets, focusing targets showed (1) a sensitivity enhancement of approximately two orders of magnitude with S/N gains of 200-900 for hydrophobic substrates, and 150-400 for weak cation-exchange (WCX) substrates; (2) improved detection limits as low as 5 fmol/microL for standard peptides; (3) significantly reduced matrix background; and (4) higher inter-day reproducibility. The improved sensitivity allowed successful tandem mass spectrometric (MS/MS) sequencing of dilute solutions of a derivatized tryptic digest of a protein standard, and enabled the first reported AP-MALDI MS detection of neuropeptides from Aedes aegypti mosquito heads.

Ipsilateral breast tumor recurrence rates in breast cancer patients treated with preoperative chemotherapy, breast conserving surgery and intraoperative radiotherapy with electrons

Abstract #5156

Introduction: Ipsilateral breast tumor recurrence (IBTR) rates are reported to be increased in patients treated with breast conserving surgery after preoperative chemotherapy. Aim of this study was to evaluate the IBTR rate in patients who were treated with preoperative chemotherapy followed by breast conserving surgery and intraoperative radiotherapy with electrons (IOERT).&#x2028; Patients and Methods: 84 patients with clinical stage II or III breast cancer were included in the study. Patients received 3 to 6 cycles of anthracyclin/taxane containing preoperative chemotherapy. All patients had breast conserving surgery with sentinel node biopsy and axillary lymph node dissection and received intraoperative radiotherapy with 9 Gy to the 90% reference isodose as an anticipated boost radiation. Whole breast radiotherapy (WBRT) was performed after surgery for all patients.&#x2028; Results: Pathologic complete response was achieved in 18/84 (21%) patients. Mean resection volume was 250 ml. After a median follow-up of 30.5 months (range 6 – 77 months) no IBTR could be observed. One patient developed a locoregional recurrence in the axilla and nine patients developed distant disease, five of those died of disease. Three patients developed contralateral breast cancer. 71 patients are alive without evidence of disease.&#x2028; Conclusion: Breast conserving surgery with IOERT in boost modality after preoperative chemotherapy is a reliable tool for the prevention of IBTR. The period between IOERT and WBRT is short as no adjuvant chemotherapy is necessary. Cosmetic outcome is excellent.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5156.

Improved identification of membrane proteins by MALDI-TOF MS/MS using vacuum sublimated matrix spots on an ultraphobic chip surface

Integral membrane proteins are notoriously difficult to identify and analyze by mass spectrometry because of their low abundance and limited number of trypsin cleavage sites. Our strategy to address this problem is based on a novel technology for MALDI-MS peptide sample preparation that increases the success rate of membrane protein identification by increasing the sensitivity of the MALDI-TOF system. For this, we used sample plates with predeposited matrix spots of CHCA crystals prepared by vacuum sublimation onto an extremely low wettable (ultraphobic) surface. In experiments using standard peptides, an up to 10-fold gain of sensitivity was found for on-chip preparations compared with classical dried-droplet preparations on a steel target. In order to assess the performance of the chips with membrane proteins, three model proteins (bacteriorhodopsin, subunit IV(a) of ATP synthase, and the cp47 subunit from photosystem II) were analyzed. To mimic realistic analysis conditions, purified proteins were separated by SDS-PAGE and digested with trypsin. The digest MALDI samples were prepared either by dried-droplet technique on steel plates using CHCA as matrix, or applied directly onto the matrix spots of the chip surface. Significantly higher signal-to-noise ratios were observed for all of the spectra resulting from on-chip preparations of different peptides.In a second series of experiments, the membrane proteome of Rhodococcus jostii RHA1 was investigated by AIEC/SDS-PAGE in combination with MALDI-TOF MS/MS. As in the first experiments, Coomassie-stained SDS-PAGE bands were digested and the two different preparation methods were compared. For preparations on the Mass.Spec.Turbo Chip, 43 of 60 proteins were identified, whereas only 30 proteins were reliably identified after classical sample preparation. Comparison of the obtained Mascot scores, which reflect the confidence level of the protein identifications, revealed that for 70% of the identified proteins, higher scores were obtained by on-chip sample preparation. Typically, this gain was a consequence of higher sequence coverage due to increased sensitivity.

Multiparameter scoring system for the prognosis of differentiated thyroid cancer

The AIM of the study was to develop a scoring system consisting of multiple parameters that are significant for prognosis of thyroid cancer. The score was designed to permit a risk stratification with all available information at any time of presentation.

PATIENTS, METHODS

A score using 25 parameters was used for 171 patients with differentiated thyroid cancer, who were included in follow up over a mean of 9 (+/- 5) years. The significance of each parameter as well as of a summation outcome score was determined. The result of this scoring system was compared to other scores reported in the literature applied to the same patients' group. Thirty-two out of the 171 patients presented with recurrence during follow up.

RESULTS

The summation score was highly significant for prognosis of differentiated thyroid cancer. Out of 25 parameters, 18 showed a significant association with outcome also as individual parameters. In comparison to the scores commonly used, this new system showed the highest significance (p < 0.0001, chi square 90, df 1) to estimate recurrence free survival. At a cutoff of -5.95 the sensitivity and specificity for the distinction between high and low risk patients were 87.5 and 77.0%, respectively.

CONCLUSION

With our multiparameter scoring system a reliable prognosis with respect to recurrence free survival is possible in patients suffering from differentiated thyroid cancer. A summation score of all parameters gives the best results. Scoring is also possible, if several important parameters are missing.

Hypergonadotropic hypogonadism in a patient with inv ins (2;4)

We report on a 30-year-old man with azoospermia, primary hypogonadism and minor dysmorphic features who carried a balanced insertional chromosome translocation inv ins (2p24;4q28.3q31.22)de novo. Molecular cytogenetic analyses of the chromosome breakpoints revealed the localization of the breakpoint in 4q28.3 between BACs RP11-143E9 and RP11-285A15, an interval that harbours the PCDH10 gene. In 4q31.22, a breakpoint-spanning clone (RP11-6L6) was identified which contains the genes LSM6 and SLC10A7. On chromosome 2, BACs RP11-531P14 and RP11-360O18 flank the breakpoint in 2p24, a region void of known genes. In conclusion, the chromosome aberration of this patient suggests a gene locus for primary hypogonadism in 2p24, 4q28.3 or 4q31.2, and three possible candidate genes (LSM6, SLC10A7 and PCDH10) were identified by breakpoint analyses.

Design, construction, and in vitro analysis of A33scFv::CDy, a recombinant fusion protein for antibody-directed enzyme prodrug therapy in colon cancer

Antibody-directed enzyme-prodrug therapy (ADEPT) aims at improving the specificity of conventional chemotherapy by employing artificial antibody-enzyme constructs to convert a non-toxic prodrug into a cytotoxic agent specifically localized to the tumor site. The gpA33 antigen is a promising target for ADEPT in colon cancer, as it is expressed by >95% of human colon cancers, but is absent in all non-gastrointestinal tissues. We designed a recombinant fusion construct of a phage display-generated anti-gpA33 single chain fragment, A33scFv, with cytosine deaminase from yeast (CDy), which converts 5-fluorocytosine (5-FC) into 5-fluorouracil (5-FU). The resulting construct, A33scFv::CDy, was overexpressed in Pichia pastoris and secreted into culture supernatant. The fusion protein was purified by affinity chromatography on protein L. Silver-staining after SDS-polyacrylamide gel electrophoresis confirmed molecular mass and purity. Antibody binding and specificity were quantified by flow cytometry. The complete ADEPT system was applied in vitro on gpA33-positive LIM1215 cells, assessing cell survival by a fluorescein diacetate assay. Cytotoxicity of the prodrug 5-FC after A33scFv::CDy binding was equimolar to that of 5-FU, and this effect depended specifically on both antibody and enzyme function. These results demonstrate bifunctional activity of the heterogeneous Pichia-produced A33scFv::CDy fusion protein and proof of principle for the ADEPT system proposed herein.

Peptidomic analysis of human peripheral monocytes persistently infected by Chlamydia trachomatis

Peptidomic analysis using Differential Peptide Display (DPD) of human peripheral blood mononuclear cells (PBMC) mock-infected or persistently infected by Chlamydia trachomatis (CT) revealed 10 peptides, expressed upon CT infection. Analysis of these 10 candidates by tandem mass spectrometry enabled the determination of seven candidates as fragments from the precursors (I) ferritin heavy chain subunit, (II) HLA class II histocompatibility antigen, (III) vimentin, (IV) indoleamine 2,3-dioxygenase, (V and VI) pre-B cell enhancing factor (PBEF), and (VII) Interleukin-8 (CXCL8). The identified candidates proved the presence of anti-bacterial and immunologically active monocytic proteins after CT infection.

Impact of low copy repeats on the generation of balanced and unbalanced chromosomal aberrations in mental retardation

Low copy repeats (LCRs) are stretches of duplicated DNA that are more than 1 kb in size and share a sequence similarity that exceeds 90%. Non-allelic homologous recombination (NAHR) between highly similar LCRs has been implicated in numerous genomic disorders. This study aimed at defining the impact of LCRs on the generation of balanced and unbalanced chromosomal rearrangements in mentally retarded patients. A cohort of 22 patients, preselected for the presence of submicroscopic imbalances, was analysed using submegabase resolution tiling path array CGH and the results were compared with a set of 41 patients with balanced translocations and breakpoints that were mapped to the BAC level by FISH. Our data indicate an accumulation of LCRs at breakpoints of both balanced and unbalanced rearrangements. LCRs with high sequence similarity in both breakpoint regions, suggesting NAHR as the most likely cause of rearrangement, were observed in 6/22 patients with chromosomal imbalances, but not in any of the balanced translocation cases studied. In case of chromosomal imbalances, the likelihood of NAHR seems to be inversely related to the size of the aberration. Our data also suggest the presence of additional mechanisms coinciding with or dependent on the presence of LCRs that may induce an increased instability at these chromosomal sites.

Uterotubal transport disorder in adenomyosis and endometriosis—a cause for infertility

OBJECTIVE

Uterine hyperperistalsis and dysperistalsis are common phenomena in endometriosis and may be responsible for reduced fertility in cases of minimal or mild extent of disease. Since a high prevalence of adenomyosis uteri has been well documented in association with endometriosis, we designed a study to examine whether hyperperistalsis and dysperistalsis are caused by the endometriosis itself or by the adenomyotic component of the disease.

DESIGN

A prospective observational study.

SETTING

University hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 300 in vitro fertilisation/intracytoplasmatic sperm injection cycles and 350 intrauterine insemination cycles/year.

POPULATION

Forty-one subjects with infertility and with laparoscopically proven endometriosis and patent fallopian tubes. Thirty-five subjects (85%) additionally showed signs of adenomyosis.

METHODS

All subjects underwent T2-weighed magnetic resonance imaging (MRI) and hysterosalpingoscintigraphy (HSSG) during the subsequent menstrual cycle. MRI revealed the extent of the adenomyotic component of the disease and the integrity of uterotubal transport capacity was evaluated by HSSG.

MAIN OUTCOME MEASURES

Influence of adenomyosis on uterotubal transport capacity in endometriosis.

RESULTS

In 35 of the 41 subjects (85%) with endometriosis, signs of adenomyosis were detected using T2-weighed MRI. Two of six (33%) subjects with no adenomyosis (group I) showed dysperistalsis and hyperperistalsis, compared with 14 of 24 (58%) women with focal adenomyosis (group II) and 10 of 11 (91%) women with diffuse adenomyosis (seven showed a failure in transport capacity and two contralateral transport).

CONCLUSIONS

Our data suggest that endometriosis is associated with impeded hyperperistaltic and dysperistaltic uterotubal transport capacity. However, adenomyosis is of even more importance, especially when diffuse adenomyosis is detected. Both forms of adenomyosis are commonly found in subjects with mild to moderate endometriosis. We suggest that the extent of the adenomyotic component in subjects with endometriosis explains much of the reduced fertility in subjects with intact tubo-ovarian anatomy.

Spontaneous Remission of Metastases of Cancer of the Uterine Cervix

BACKGROUND

Spontaneous remission (SR) is the complete or incomplete disappearance of a disease or cancer despite no or inadequate treatment. SR is a rare event, and only 5 cases of SR of carcinoma of the uterine cervix have been reported so far.

CASE REPORT

We report the case of a young woman suffering from carcinoma of the uterine cervix metastasized to the lung, pleura, bone, skin and brain. The primary tumor was removed. After diagnosis of the histologically proven metastases, further palliative treatment was inadequate, except for radiotherapy to the brain. In all other metastases, spontaneous remission occurred. 8 years after the initial diagnosis of metastasis, there is no evidence of active disease.

CONCLUSION

SR is a rare but evident phenomenon. Individual features of malignant tumors should be taken into account much more when determining the best treatment for the patient.

Prerequisites for peptidomic analysis of blood samples: I. Evaluation of blood specimen qualities and determination of technical performance characteristics

Proteomics studies aiming at a detailed analysis of proteins, and peptidomics, aiming at the analysis of the low molecular weight proteome (peptidome) offer a promising approach to discover novel biomarkers valuable for different crucial steps in detection, prevention and treatment of disease. Much emphasis has been given to the analysis of blood, since this source would by far offer the largest number of meaningful biomarker applications. Blood is a complex liquid tissue that comprises cells and extra-cellular fluid. The choice of suitable specimen collection is crucial to minimize artificial occurring processes during specimen collection and preparation (e.g. cell lysis, proteolysis). After specimen collection, sample preparation for peptidomics is carried out by physical methods (filtration, gel-chromatography, precipitation) which allow for separation based on molecular size, with and without immunodepletion of major abundant proteins. Differential Peptide Display (DPD) is an offline-coupled combination of Reversed-Phase-HPLC and MALDI mass spectrometry in combination with in-house developed data display and analysis tools. Identifications of peptides are carried out by additional mass spectrometric methods (e.g. online LC-ESI-MS/MS). In the work presented here, insights into semi-quantitative mass spectrometric profiling of plasma peptides by DPD are given. This includes proper specimen selection (plasma vs. serum), sample preparation, especially peptide extraction, the determination of sensitivity (i.e. by establishing detection limits of exogenously spiked peptides), the reproducibility for individual as well as for all peptides (Coefficient of Variation calculations) and quantification (correlation between signal intensity and concentration). Finally, the implications for clinical peptidomics are discussed.

High-throughput biomarker discovery and identification by mass spectrometry

Native peptides and proteins are of increasing interest in biomedical research because they hold promise to represent a large number of useful diagnostic and therapeutic biomarkers. Discovery attempts from patient samples have to deal with the complexity of biology from a disease perspective as well as with a high individual variability. High throughput screening of samples is therefore the strategy of choice to detect relevant peptidic biomarkers, and requires a high order of automation particularly in the detection process. In this contribution, a novel technical approach employing a fully automated MALDI-TOF/TOF mass spectrometer is described. This approach combines high throughput biomarker discovery with the identification of corresponding endogenous peptides in one instrument and from the same set of samples. The degree of automation allows the analysis of thousands of chromatographic fractions corresponding to up to one hundred patient samples per day. The applied relative quantification via Differential Peptide Display((R)) is performed in a label-free way and shows a dynamic range of up to four orders of magnitude in the accessible peptide concentrations. The typical limit of detection is in the mid- to low-picomolar range for body fluids such as blood plasma, urine and cerebrospinal fluid. Sequence assignment via MALDI-TOF/TOF mass spectrometry is carried out either in an overview approach, characterizing rapidly the peptide composition e.g. of a novel sample, or in a directed approach, analyzing a list of biomarker candidates deduced from statistically significant abundance differences from the biomarker discovery process.

Peptidomic analysis of breast cancer reveals a putative surrogate marker for estrogen receptor-negative carcinomas

Estrogen-receptor status provides a major biomarker in breast cancer classification and has an important impact on prognosis and treatment options. The aim of this study was to investigate peptide profiles of invasive breast cancer with positive (n=39) and negative receptor status (n=41). Peptide profiles were generated by 'Differential Peptide Display', which is an offline-coupled combination of reversed-phase-HPLC and MALDI mass spectrometry. Mass spectrometric data were correlated with the immunohistochemically determined receptor state. Identification of peptides of interest was carried out by additional mass spectrometric methods (eg MALDI-TOF-TOF-MS-MS). Approximately 3000-7000 signals were detected per sample and thymosin alpha-1, an asparaginyl endopeptidase generated cleavage product of the ubiquitous acidic protein prothymosin-alpha, was found to differentiate the tumor samples according to their receptor status with the highest specificity. The concentration of Thymosin alpha-1 was found to be upregulated (n=37) in estrogen-negative cancer samples and downregulated (n=32) in estrogen-positive breast cancer samples. The expression of the precursor protein (Prothymosin-alpha) has been discussed previously as a prognostic factor in breast cancer. It is involved in the ER signal transduction pathway as an anti-coactivator-inhibitor. From our findings we conclude that Thymosin alpha-1 could serve as a surrogate marker in breast cancers and may indicate ER functionality.

Therapy of hepatocellular carcinoma with iodine-131-lipiodol. Results in a large German cohort

AIM

To evaluate the efficacy and tolerance of iodine-131-lipiodol ((131)I-lipiodol) for hepatocellular carcinoma (HCC) in German long term patients and comparison with medically treated controls.

PATIENTS, METHODS

38 courses of intra-arterial (131)I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC (6 with portal vein thrombosis). Liver and tumour volume and lipiodol deposition were measured by computed tomography and (131)I activity by scintigraphy. Therapeutic efficacy was determined by tumour volume change and matched-pairs analysis in comparison to medically (i.e. tamoxifen or medical support) treated patients.

RESULTS

Tumour volume decreased in 20/32 index nodules (63%) after the first course. Repeated therapy frequently resulted in further tumour reduction. Overall response to treatment was partial in 11 nodules, minor response in 4 nodules, and disease was stable in 12 and progressive in 5. Significant response was associated with pretherapeutic nodule volume up to 150 ml (diameter of 6.6 cm). Survival rate after 3, 6, 9, 12, 24 and 36 months was 78, 61, 50, 39, 17, and 6%. Matched-pairs analysis of survival revealed (131)I-lipiodol to be superior to medical treatment. The most important side effect was a pancreatitis-like syndrome whereas overall tolerance was good.

CONCLUSION

The long term results confirm that HCC therapy with (131)I-lipiodol is effective and probably superior to medical treatment. Tumour nodules of up to 6 cm diameter are well suited for this therapy even in the presence of portal vein thrombosis.

FDG uptake after intraarterial chemotherapy in head and neck cancer

AIM

The intraarterial chemotherapy (i.a.CHT) using high dose cisplatin combined with systemic neutralization in patients with head and neck cancer (HNSCC) is used to reduce the tumor volume preoperatively. Aim of the study is the evaluation of the influence of i.a.CHT on the metabolism of fluor-18-deoxyglucose (FDG) in the primary and lymph nodes (LN). The value of FDG positron emission tomography (PET) preoperative and as follow-up method after i.a.CHT is examined.

PATIENTS, METHODS

Altogether 16 patients with HNSCC underwent two preoperative FDG PET examinations: the baseline examination one week before and the follow-up three weeks after i.a.CHT. The SUVmax values of the primary and the LN and LN metastases were evaluated and compared with each other and the histopathology.

RESULTS

The SUVmax value of the primary decreased after i.a.CHT significantly from a median (25 (th) percentile/75 (th) percentile) of 6.4 (4.1/7.8) to 3.6 (2.4/6.7) (p = 0.01). In 11 out of 16 patients cervical LN metastases were detected. The cervical LN metastases showed a decrease of the SUVmax value from 3.6 (2.3/4.8) in the pretreatment examination to 2.3 (1.7/3.6) after i.a.CHT (p = 0.008). Only in one patient with LN metastases the SUVmax of the nodes increased. The histopathologically measured size of the LN metastases ranged from 2 to 30 mm. Non malignant LN did not reveal a significant SUVmax decrease after i.a.CHT (p = 0.13).

CONCLUSIONS

As expected, primaries of HNSCC showed a significant reduction of SUV after i.a.CHT. Compared to the primary the SUVmax decrease in LN metastases was less, but also significant. Since cytotoxic levels of cisplatin do not occur systemic, postinflammatory reactions of the LN or a lymphatic drainage of the chemotherapeutic drug into the LN could be an explanation. PET for staging of HNSCC must thus be performed prior to i.a.CHT.

Towards Characterization of the Human Urinary Peptidome

Biomarker discovery in human urine has become an evolving and potentially valuable topic in relation to renal function and diseases of the urinary tract. In order to deliver on the promises and to facilitate the development of validated biomarkers or biomarker panels, protein and peptide profiling techniques need high sample throughput, speed of analysis, and reproducibility of results. Here, we outline the performance characteristics of the liquid chromatography/MALDI-TOF-MS based differential peptide display (DPD(1)) approach for separating, detecting, abundance profiling and identification of native peptides derived from human urine. The typical complexity of peptides in human urine (resolution of the technique with respect to detectable number of peptides), the reproducibility (coefficient of variation for abundance profiles of all peptides detected in biological samples) and dynamic range of the technique as well as the lower limit of detection were characterized. A substantial number of peptides present in normal human urine were identified and compared to findings in four published proteome studies. In an explorative approach, pathological urines from patients suffering from post-renal-filtration diseases were qualitatively compared to normal urine. In conclusion, the peptidomics technology as shown here has a great potential for high throughput and high resolution urine peptide profiling analyses. It is a promising tool to study not only renal physiology and pathophysiology and to determine new biomarkers of renal diseases; it also has the potential to study remotely localized or systemic aberrations within human biology.

Peptidomic analysis of human blood specimens: comparison between plasma specimens and serum by differential peptide display

The human Plasma Proteome Project pilot phase aims to analyze serum and plasma specimens to elucidate specimen characteristics by various proteomic techniques to ensure sufficient sample quality for the HUPO main phase. We used our proprietary peptidomics technologies to analyze the samples distributed by HUPO. Peptidomics summarizes technologies for visualization, quantitation, and identification of the low-molecular-weight proteome (<15 kDa), the "peptidome." We analyzed all four HUPO specimens (EDTA plasma, citrate plasma, heparin plasma, and serum) from African- and Asian-American donors and compared them to in-house collected Caucasian specimens. One main finding focuses on the most suitable method of plasma specimen collection. Gentle platelet removal from plasma samples is beneficial for improved specificity. Platelet contamination or activation of platelets by low temperature prior to their removal leads to distinct and multiple peptide signals in plasma samples. Two different specimen collection protocols for platelet-poor plasma are recommended. Further emphasis is placed on the differences between plasma and serum on a peptidomic level. A large number of peptides, many of them in rather high abundance, are only present in serum and not detectable in plasma. This ex vivo generation of multiple peptides hampers discovery efforts and is caused by a variety of factors: the release of platelet-derived peptides, other peptides derived from cellular components or the clot, enzymatic activities of coagulation cascades, and other proteases. We conclude that specimen collection is a crucial step for successful peptide biomarker discovery in human blood samples. For analysis of the low-molecular-weight proteome, we recommend the use of platelet-depleted EDTA or citrate plasma.

Diminished pregnancy rates in endometriosis due to impaired uterotubal transport assessed by hysterosalpingoscintigraphy

OBJECTIVE

To investigate uterotubal transport by means of hysterosalpingoscintigraphy (HSSG) in women with and without endometriosis.

DESIGN

A prospective observational study.

SETTING

University Hospital, Department of Obstetrics and Gynaecology, Division of Reproductive Medicine and Gynaecologic Endocrinology with 350 in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycles and 400 intrauterine insemination (IUI) cycles/year.

POPULATION

Cases included 56 infertile women with laparoscopic proven endometriosis and patent fallopian tubes. Twenty-two women with partners suffering from male factor infertility served as controls.

METHODS

A diagnostic cycle incorporating HSSG was performed. Subsequently, patients underwent either four cycles of timed intercourse (TI) or IUI in order to achieve pregnancy. If pregnancy did not occur, IVF or ICSI was performed.

MAIN OUTCOME MEASURES

Evaluation of uterotubal transport capacity in women with endometriosis and healthy controls.

RESULTS

Patients suffering from endometriosis (group I) showed a significant reduction in physiologic uterotubal transport function: While 20 patients (36%) had ipsi- or bilateral uterotubal transport, there was pathological uterotubal transport contralateral to the dominant follicle or a complete failure of transport capacity (negative HSSG) in 36 patients (64%). In the controls (group II), transport function was significantly different: 15 of 22 patients (68%) revealed ipsi- and bilateral tubal demonstration, while 5 patients (22%) showed contralateral transport and 2 patients (10%) showed negative HSSG (P= 0.01). Twenty-three pregnancies were observed (pregnancy rate: 29%). Eleven out of 14 (79%) women with ipsi- or bilateral tubal transport function fell pregnant by means of TI or IUI. In seven of nine patients (78%) with a failure in tubal transport, pregnancy was achieved by IVF/ICSI, despite acceptable semen parameters (P= 0.01).

CONCLUSIONS

Endometriosis is significantly associated with a reduction in physiologic uterotubal transport capacity compared with controls. This resulted in diminished pregnancy rates even in women with normozoospermic partners. Therefore, IVF/ICSI may be required even when fallopian tubes are patent or semen quality is normal.

The prognostic value of FDG PET in head and neck cancer. Correlation with histopathology

AIM

The aim of the present FDG PET study was to evaluate the prognostic value of the standardized uptake value (SUVmax) of head and neck cancer (HNSCC) with respect to the chemotherapy response and tumor recurrence.

METHODS

The FDG PET findings of 40 patients with HNSCC were compared with the final histopathology results after removal of the primary tumor and surgical neck dissection. The clinical T staging was based on clinical examinations and computed tomography was used for assessment of bone involvement. The pretreatment baseline SUVmax of the primary tumor were correlated with the intra-arterial chemotherapy response prior to the tumor resection and the frequency of tumor relapse.

RESULTS

The median SUVmax of tumors which did not relapse was 3.4, compared to a SUVmax of 4.7 for tumors with local tumor relapse (p=0.36, n.s.). Regarding chemotherapy response, the tumor SUVmax was significantly lower in cases with complete remission (CR) (median 2.6, n=11) compared to those with stable disease (5.8, n=10), (p=0.002). Whereas no tumor with CR after chemotherapy relapsed except stage IV tumors, tumor relapse was observed in both a stage II and a stage IV tumor without chemotherapy response.

CONCLUSIONS

In patients with HNSCC the tumor SUVmax seems to be a useful prognostic indicator for assessing the clinical chemotherapy response, but did not correlate significantly with the recurrence risk. Thus, in tumors with higher SUVmax alternative chemotherapy regimes have to be discussed.

Breakpoints around the HOXD cluster result in various limb malformations

BACKGROUND

Characterisation of disease associated balanced chromosome rearrangements is a promising starting point in the search for candidate genes and regulatory elements.

METHODS

We have identified and investigated three patients with limb abnormalities and breakpoints involving chromosome 2q31. Patient 1 with severe brachydactyly and syndactyly, mental retardation, hypoplasia of the cerebellum, scoliosis, and ectopic anus, carries a balanced t(2;10)(q31.1;q26.3) translocation. Patient 2, with translocation t(2;10)(q31.1;q23.33), has aplasia of the ulna, shortening of the radius, finger anomalies, and scoliosis. Patient 3 carries a pericentric inversion of chromosome 2, inv(2)(p15q31). Her phenotype is characterised by bilateral aplasia of the fibula and the radius, bilateral hypoplasia of the ulna, unossified carpal bones, and hypoplasia and dislocation of both tibiae.

RESULTS

By fluorescence in situ hybridisation, we have mapped the breakpoints to intervals of approximately 170 kb or less. None of the three 2q31 breakpoints, which all mapped close to the HOXD cluster, disrupted any known genes.

CONCLUSIONS

Hoxd gene expression in the mouse is regulated by cis-acting DNA elements acting over distances of several hundred kilobases. Moreover, Hoxd genes play an established role in bone development. It is therefore very likely that the three rearrangements disturb normal HOXD gene regulation by position effects.

[Is measuring by portable heart rate monitors (sport watches) dependable in patients with an implanted pacemaker?]

BACKGROUND AND OBJECTIVE

Regular physical exercise is advantageous for physical fitness and endurance. The intensity of exercising can be controlled by portable heart rate monitors. The aim of the study was to investigate if wearable monitors work properly in pacemaker patients.

PATIENTS AND METHODS

In 30 patients with an implanted single or dual chamber pacemaker made by five different manufacturers their heart rate was determined simultaneously by surface ECG and Holter ECG, and was compared with the heart rates derived from portable heart rate monitors (Polar A1) at rest, during 6 minutes in-house walk, and while exercising at 25, 50, and 75 watts in a bicycle exercise test. The tests were done with pacing set at uni- as well as bipolar stimulation mode.

RESULTS

At rest in two of 30 patients (6,6 %) paced in unipolar mode the portable heart rate monitors counted double. Under exercise conditions the portable monitors counted double in six of 26 patients (23 %) while being stimulated in unipolar mode. In bipolar stimulation mode, the portable heart rate monitors were working properly in all patients under all conditions.

CONCLUSIONS

Patients with an implanted bipolar pacing system can control their physical exercising safely and accurately by means of portable heart rate monitors. Pacemaker patients who are planning regular physical exercising should be provided with an implanted bipolar pacemaker system.

Sentinel-Lymphonodektomie als Staging-Methode bei Kopf-Hals-Karzinomen

BACKGROUND

The excision of sentinel lymph nodes has a growing relevance in the diagnosis of oral and oropharyngeal cancer in cases of N0 necks. The validity of sentinel node biopsy (SNB) was examined as a single surgical staging tool.

PATIENTS AND METHODS

Within the framework of a multi-modal treatment scheme, SNB without elective neck dissection was carried out on 70 previously untreated patients in the same session as the surgery for the primary cancer. Control of accuracy was via observation of the manifestation of neck node metastases in 45 patients who were postoperatively irradiated.

RESULTS

A total of 94% of sentinel nodes could be excised; 9 patients (13%) had positive nodes and were treated with a therapeutic neck dissection (ND). There were 2 neck node metastases as second primaries, all other patients remained regionally inconspicuous (median observation time 26 months).

CONCLUSION

As a staging tool for N0 necks and T1-3 tumors, SNB could lead to a considerable reduction in the number of elective NDs. It could be well integrated into a multi-modal treatment scheme.

Dopaminergic function in a family with the PARK6 form of autosomal recessive Parkinson’s syndrome

A G309D mutation in the PINK1 gene in a consanguineous Spanish kindred with seven siblings, three of whom are clinically affected, has recently been shown to be a cause of the PARK6 form of autosomal-recessive Parkinson's syndrome. In this family, we studied pre- and postsynaptic dopaminergic function using 123I-FP-CIT- and 123I-iodobenzamide-SPECT to determine binding to the presynaptic dopamine transporter (DAT) and postsynaptic D2 receptors respectively. All three PARK6 patients showed reduced striatal DAT binding with posterior preponderance similar to sporadic idiopathic PD, but only one patient showed significant striatal asymmetry. In two of the siblings, DAT binding was markedly increased. IBZM-SPECT was normal in both patients and sibs. Our findings indicate that 123I-FP-CIT-SPECT shows similar DAT binding in PARK6 patients compared to idiopathic Parkinson's disease. The increased DAT binding in heterozygous PARK6 carriers may be a new very early preclinical finding, but its significance is still unclear.