Emission and distribution of PCDD/Fs, chlorobenzenes, chlorophenols, and PAHs from stack gas of a fluidized bed and a stoker waste incinerator in China

The concentrations, homologue, and congener profiles, as well as the gas/particle distribution of polychlorinated dibenzo-p-dioxins and furans (PCDD/Fs), chlorobenzenes (CBzs), chlorophenols (CPhs), and polyaromatic hydrocarbons (PAHs) from stack gas of two different municipal solid waste incinerators in China, were characterized. The incinerators were a stoker furnace incinerator equipped with the advanced air pollution control device (APCD) and a common circulating fluidized bed (CFB) furnace. The concentration of PCDD/Fs in the stack gas of the stoker incinerator ranged 0.011-0.109 ng international toxic equivalent factor (I-TEQ)/Nm³ and was below the current limit for PCDD/F emissions from the municipal solid waste incinerators (MSWIs) in China (0.1 ng I-TEQ/Nm³) in most of the cases. Moreover, the concentration of PCDD/Fs in the stack gas of the stoker incinerator was significantly lower than that of the CFB incinerator (0.734 to 24.6 ng I-TEQ/Nm³). In both incinerators, the majority of the total PCDD/F emissions (above 90%) ended up in the gas phase. 2,3,4,7,8-PeCDF, which occupied 24.3-43.6 and 32.5-75.6% of I-TEQ contribution in MSWIs A and B, respectively, was the most abundant congener. However, different types of incinerators and APCDs induced different congener and homologue distributions. The total concentration of CBzs from the stoker incinerator (0.05-3.2 μg/Nm³) was also much lower than that formed from the CFB incinerator (10.9-75.2 μg/Nm³). The phase distribution of CBzs followed the same pattern as with the PCDD/Fs. Moreover, the emission level of CBz was 100-1000 times higher than that of the PCDD/Fs, which determines the applicability of CBzs as indicators of PCDD/F emissions. High correlations between the emission concentrations of PCDD/Fs, TeCBz, and PCBz in specific ranges were revealed. Furthermore, high concentrations of CPhs (0.6-141.0 μg/Nm³) and PAHs (148.6-4986.5 μg/Nm³) were detected in the stack gases of MSWI B. In some cases, the concentrations were as high as the concentrations in the fumes exiting the boiler of one foreign stoker without flue gas purification indicating the abundance of CPh and PAH emissions in the stack gas of waste incinerators.

Emission characteristics and relationships among PCDD/Fs, chlorobenzenes, chlorophenols and PAHs in the stack gas from two municipal solid waste incinerators in China

An investigation was conducted into polychlorinated dibenzo-p-dioxin and furan formation mechanisms and the relationships with chlorobenzenes, chlorophenols and PAHs in the stack gas from two fluidized bed municipal solid waste incinerators.

Suppression of dioxins after the post-combustion zone of MSWIs

Thiourea was selected as representative of combined S- and N-inhibitors and injected after the post-combustion zone of two full-scale municipal solid waste incinerators (MSWIs) using a dedicated feeder. Firstly, the operating conditions were scrutinised by monitoring the concentrations of SO2, NH3 and HCl in the clean flue gas. The suppression experiment showed that in MSWI A thiourea could reduce the total I-TEQ value in flue gas by 73.4% from 1.41ng I-TEQ/Nm(3) to 0.37I-TEQ/Nm(3), those in fly ash by 87.1% from 14.3ng I-TEQ/g to 1.84I-TEQ/g and the total dioxins emission factor by 87.0wt.%, with a (S+N)/Cl molar ratio of 9.4. The suppression efficiencies of PCDD/Fs in flue gas and fly ash in MSWI B could be up to 69.2% and 83.0% when the (S+N)/Cl molar ratio attained 7.51. Furthermore, the congener distributions of dioxins were also analysed in the flue gas and fly ash, before and after addition of thiourea, to find cues to some suppression mechanism. In addition, the filtered fly ash was explored by the Scanning Electron Microscope (SEM) and Energy Dispersive Spectrometer (EDS) analysis of fly ash. These results suggest that poisoning the metal catalyst and blocking the chlorination are most probably responsible for suppression.

Suppression of dioxins in waste incinerator emissions by recirculating SO2

Sulphur is an effective inhibitor of the formation of Polychlorinated dibenzo-p-dioxins and polychlorinated dibenzo-furans (PCDD/Fs), as was proven in laboratory and pilot plant studies. In this study, a pilot-scale system with capacity 300 N m(3) h(-1) was situated at the bypass of an actual hazardous waste incinerator (HWI) and tested to reduce the emission of PCDD/Fs. Activated carbon was used as a medium to adsorb SO2 from flue gas and release it again at the higher temperature of filtered ash detoxification to achieve SO2 circulation in the system. Most PCDD/Fs in the filtered ash are decomposed by thermal treatment. Experimental results indicate that the system is capable of stable operation with SO2 accumulation at a high level of concentration and a high reduction efficiency of PCDD/Fs. A reduction of more than 80% was already achieved without addition of other sulphur compounds. When pyrite (FeS2) was added the reduction of PCDD/Fs could reach 94%, with a residual PCDD/Fs concentration in the flue gas as low as 0.13 ng TEQ N m(-3). This SO2 recirculating and suppression technology potentially provides significant progress for dioxin emission control in waste incineration and could be useful for controlling emissions of PCDD/Fs and other chlorinated organic chemicals in China.

Simultaneous suppression of PCDD/F and NO(x) during municipal solid waste incineration

Thiourea was tested as a dioxins inhibitor in a full-scale municipal solid waste incinerator with high capacity (34 t h(-1)). The suppressant, featuring a high S- and N-content, was converted into liquor and then injected (35 kg h(-1)) into the furnace (850 °C) through the inlets already used for Selective Non-Catalytic Reduction (SNCR) of flue gas NOx. The first results show that thiourea reduces the dioxins in flue gas by 55.8 wt.%, those in fly ash by 90.3 wt.% and the total dioxins emission factor by 91.0 wt.%. The concentration of PCDD/Fs was 0.08 ng TEQ Nm(-3), below the national standard of 0.1 ng TEQ Nm(-3). The weight average chlorination degree of dioxins decreases slightly after adding the inhibitor, indicating that it suppresses both the formation and the chlorination of dioxins. Analysis of fly ash by scanning electron microscope (SEM) suggests that the particle size becomes larger after adding the inhibitor. Further analysis using an energy dispersive spectrometer (EDS) reveals that the sulphur content in fly ash rises, but the chlorine content declines when adding thiourea. These results suggest that poisoning the metal catalyst and blocking the chlorination are probably responsible for suppression. NOx reduction attains 42.6 wt.%. These tests are paving the way for further industrial application and assist in controlling the future emissions of dioxins and NOx from MSWI.

Predictors of early treatment discontinuation in a cohort of patients treated with boceprevir-based therapy for hepatitis C infection

In this real-world cohort, 49% of patients stopped boceprevir-based hepatitis C therapy early, with only 20% stopping due to treatment futility. Having more comorbidities was significantly associated with early discontinuation. Tolerability of boceprevir-based regimens may be substantially worse than reported in clinical trials, particularly for patients with comorbidities.

Abstract P4-02-08: Quantitative Characterization of 3D Vasculature Spatial Patterns Within Tumor Microenvironment of Breast Cancer Stem Cells

The sustainment characters of cancer stem cells (CSCs) such as self-renew and differentiation to other tumor cells greatly depend on the tumor microenvironment, which is composed of many components, e.g. vasculature, extracellular matrix, epithelial cells, stromal cells, as well as nutrients and oxygen. As vasculature is an important factor for the CSC and tumor development, the understanding of their spatial patterns is essential for calibrating the CSC-microenvironment interactions in mathematical modeling. In this study, we acquired the vasculature in side tumors and normal breast tissues by using two-photon fluorescence microscopy, which enables 3D in vivo imaging. We developed an advanced vasculature segmentation approach for an objective and accurate quantification of the vasculature in 3D image volumes. The approach integrates supervoxel analysis and the orientation guided hidden Markov random field (ori-HMRF) modeling together to compensate for low quality images, e.g., low signal-to-noise ratio (SNR) and uneven background. By constructing a new feature space that combines the CIELAB color space and the coordinates space, the supervoxel analysis divides an image volume into subregions with local similar intensity and restricted regular shape, boundaries of which can delineate the vasculature boundaries accurately even in low intensity contrast regions. We further designed a set of features for the separation of blood vessel regions from the background. To make use of the context information, i.e. the continuity of vasculature, the ori-HMRF model is used to incorporate the consistency of vasculatures' orientation in order to reduce the false positives and negatives. Experimental results on image volumes from both breast cancer and normal breast tissues show that the proposed method can effectively reconstruct the vasculature structure with the CSC embedded tumor microenvironment.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-02-08.

Abstract P3-06-14: Identification of Prognosis-Relevant Subgroups in Patients with Chemoresistant Triple Negative Breast Cancer

Purpose: Triple-negative breast cancer (TNBC) is a highly heterogeneous disease. TNBC patients with pathologic complete response (pCR) have excellent survival, but those with residual disease after neoadjuvant chemotherapy have significantly worse outcome. However, some patients having extensive residual cancer burden after neoadjuvant chemotherapy do not relapse, and we hypothesize that there may be subgroups with diverse prognosis among these chemoresistant TNBC patients.

Methods: Forty-nine cases with residual cancer from 111 TNBC patients treated with neoadjuvant chemotherapy (in M.D. Anderson Cancer Center, 2000–2006) constituted the discovery cohort. Twenty-five chemoresistant samples from 47 neoadjuvant chemotherapy-treated TNBC (in Baylor College of Medicine and Methodist Hospital, 2002–2006) were chosen for validation. Extended validation was performed in 269 operable TNBC predicted to be chemoresistant (using a JAMA-published genomic predictor) from public databases.

Results: By comparing the gene expression data from cases in relapse with those from un-relapsed cases, we established a 7-gene prognostic signature (including AR, ESR2, GATA3, GBX2, KRT16, MMP28, and WNT11) using dChip and gene enrichment analyses. In the discovery cohort, the signature showed positive predictive value (PPV; i.e., cumulative relapse rate of patients predicted to relapse in 3 years) of 95.4% and negative predictive values (NPV; i.e., relapse-free survival of patients predicted not to relapse in 3 years) of 100%. In the validation cohort, the classifier predicted correctly with PPV of 75.0% and NPV of 76.9% at 3 years. Compared with patients predicted not to relapse, those predicted to relapse had a hazard ratio of 3.37 (95% CI, 1.15–9.85) for disease recurrence or death in 3 years. In an extended validation cohort of 269 patients, our signature discriminated chemoresistant TNBC in overall cohort (PPV, 52.4%; NPV, 77.7%; log rank P < 0.0001), or each subset (e.g., log rank p = 0.001 for Rotterdam set; p = 0.013 for Frankfurt set), with adjusted overall hazard ratio of 2.07 (95% CI, 1.26–3.39). This signature was the only marker that could effectively predict the relapse in patients with chemoresistant TNBC. Of note, the subgroup predicted not to relapse was characterized by high expression of luminal-like genes (AR, GATA3), while the subgroup predicted to have high possibility of relapse was characterized by high expression of cancer stem cell and epithelial-to-mesenchymal transition associated genes (WNT11, MMP28). The former corresponded to the luminal AR subtype and the latter to the mesenchymal stem-like subtype, according to Pietenpol's TNBC subtype classification.

Conclusion: We developed a clinically useful prognostic signature for chemoresistant TNBC. For these chemoresistant TNBC patients, new therapeutic strategies targeting AR-activation or cancer stem cells need to be developed.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-06-14.

GP88 Serum Level Is Increased in Breast Cancer Patients with Disease Progression

GP88 (progranulin) is an 88-kDa glycoprotein autocrine growth factor that plays a critical role in breast tumorigenesis. GP88 is expressed in human BC tumors in a positive correlation with their tumorigenicity. In estrogen receptor positive (ER+) cells, GP88 expression is low and is stimulated by estradiol whereas in ER negative (ER-) cells, it is constitutively overexpressed. In ER+ cells, increased GP88 expression was found to be associated with resistance to anti-estrogen therapy. In Her-2 overexpressing breast tumors, increased GP88 expression was associated with Herceptin resistance. Inhibition of GP88 expression in human breast adenocarcinoma cells resulted in a drastic reduction of tumor incidence and tumor growth in nude mice. Immunohistochemical studies carried out with 206 paraffin-embedded human breast biopsies have shown that GP88 is expressed in invasive ductal carcinomas in correlation with expression of markers of poor prognosis whereas normal tissues and benign breast lesions were negative. Importantly, high GP88 expression in tissue biopsies was accompanied by decreased disease-free and overall survival. Since GP88 contains a signal peptide for secretion, we have shown that GP88 can be found in serum. An IRB approve blood sampling study of 189 patients (Race: Caucasian- 91, African American-92, Asian-6; median age- 51 with a range from 26 to 81) established at the University of Maryland demonstrated that GP88 was measurable in serum and that GP88 serum level was statistically elevated in breast cancer patients when compared to healthy individuals. Median level of GP88 was 40.7 ng/ml (range 6.4-80) in early stage (stage 1 –3) BC pts (p- value = 0.007) and 45.3 ng/ml (range 9.8 to 158.4) in stage 4 metastatic BC patients (p-value= 0.0007). Statistically significant increase in circulating GP88 level was found in early stages as well as in metastatic disease when compared to healthy individuals.Since we have shown that GP88 tissue expression was associated with increased disease recurrence, the present study was focused on examining whether GP88 serum level was also increased in disease progression and could be used to monitor disease recurrence. Our data show that patients with disease recurrence or progression presented a 5 to 10 fold increase in their GP88 serum levels.This study identifies GP88 as a measurable biomarker for recurrence or disease progression not only at the tissue but also at the serum level.This study is supported by grants from MIPS, the Avon Foundation and from the National Cancer Institute.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6040.

A Culturally-Specific Dietary Plan To Manage Weight Gain among African American Breast Cancer Survivors: A Feasibility Study

Background. African American (AA) women are less likely to survive for five years after a breast cancer diagnosis than Caucasian women. The higher prevalence of obesity in AA women may contribute to this disparity. Weight gain following breast cancer treatment is one of the few modifiable risk factors for breast cancer recurrence and mortality. AA breast cancer survivors face unique cultural and economic barriers to adopting diets which reduce the likelihood of weight gain.Objective. To determine the feasibility of adopting and maintaining a culturally-specific low-fat eating plan in a population of low to middle income AA breast cancer survivors.Participants. AA women recruited through urban medical centers who were between 30 to 75 years old, had a confirmed diagnosis of stage 0, I, II, III, or IIIA primary breast cancer, and had incomes < $50,000 per year.Methods. A culturally-specific dietary intervention was developed, based on the Women's Intervention Nutrition Study (WINS), to reduce consumption of dietary fat to 25% of total calories, while increasing fruits and vegetables.Eligible participants were enrolled in a one-year feasibility study. Participants received the Culturally-Specific WINS Low-Fat Eating Plan (WLEP) and 8 individual nutritional counseling sessions with a trained diet technician, to help reduce and maintain their fat intake to 25% of total calories. The intervention also included bi-monthly educational group meetings and follow-up telephone contacts with diet technicians.Study Measures. Dietary patterns were assessed with 3-day food records at baseline and follow-up. Compliance with the Culturally-Specific WLEP was defined as 1) dietary fat intake ≤ 25% of total calories; and 2) at least 6 to 7 servings of fruits and vegetables per day. Psychosocial factors and dietary biomarkers were also measured at baseline and follow-up to examine their association with study outcomes. Psychosocial factors included perceived susceptibility to recurrence, quality of life, and social support. Dietary biomarkers included weight, height, waist-hip circumference, blood pressure, lipids, serum fatty acid concentrations, insulin and insulin-like growth factors, glucose, and levels of sex hormone-binding globulins.Results. A total of 9 AA breast cancer survivors are enrolled and receiving the intervention. Baseline and six-month follow-up results for the psychosocial factors and dietary biomarkers associated with dietary compliance and weight maintenance will be reported in October 2009.Conclusions. A population of low to middle income AA breast cancer survivors with limited education and resources demonstrated compliance with the Culturally-Specific WLEP, thereby reducing their risk of cancer recurrence through diet. Procedures and data from this feasibility study will be used in a multi-center clinical trial of the Culturally-Specific WLEP.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1053.

Association of serum levels of the growth factor GP88 with disease progression in breast cancer patients

e22021

Background: The autocrine growth factor GP88 is an important player in breast cancer. GP88 is expressed in human BC tumors in correlation with their tumorigenicity. Increased GP88 expression was associated with anti-estrogen therapy resistance in ER+ cells and Herceptin resistance in Her-2 overexpressing breast tumors. Inhibition of GP88 expression inhibited tumor incidence and growth in nude mice. Immunohistochemical studies have shown that GP88 is expressed in invasive ductal carcinomas (IDC) and that high GP88 expression correlated with increased recurrence and mortality. Since GP88 is found in serum, we hypothesized that GP88 was elevated in the sera of breast cancer patients compared to healthy individuals and that GP88 serum level increases with disease progression. Methods: An IRB approved prospective study was established at the University of Maryland Breast Clinic to determine the serum level of GP88 in breast cancer patients (BC pts). Approximately 5 ml of blood was drawn every three months. GP88 serum concentration was determined in triplicate by human GP88 enzyme immunoassay. 190 BC pts were accrued. Sera from healthy volunteers (HV) were obtained to establish GP88 baseline. BC patient characteristics: Caucasian- 91, African American-92, Asian-6; median age, 51 (range 29- 86), stage I - 48, II - 52, III - 26, IV - 63. Results: Median serum GP88 level was 28.7 ng/ml (range 16.6–38.2) in HV, 40.7 ng/ml (range 6.4–100) in early stage (stage 1 -3) BC pts (p- value = 0.007) and 45.3 ng/ml (range 9.8 to 158.4) in stage 4 BC patients (p- value= 0.0007). Statistically significant increase in serum GP88 level was found in early stages as well as in metastatic disease when compared to HV. In addition, patients that were initially diagnosed with early stage disease but recurred showed a 5 to 10 fold increase in their GP88 serum levels. Conclusions: GP88 serum level is significantly higher in the sera of BC than HV subjects. Moreover, GP88 serum level increased in association with disease recurrence and progression. This study identifies GP88 as a measurable biomarker for disease progression not only at the tissue but also at the serum level. These results are also interesting since GP88 is also a therapeutic target of malignant progression of breast carcinoma.

No significant financial relationships to disclose.

Elevated serum levels of the growth factor GP88 are found in breast cancer patients when compared to healthy individuals

Abstract #2006

Background: GP88 is an autocrine growth factor that plays a critical role in breast tumorigenesis. GP88 is expressed in human BC tumors in a positive correlation with their tumorigenicity. Increased GP88 expression is associated with resistance to anti-estrogen therapy in ER + cells and with herceptin resistance in Her-2 overexpressing breast tumors. Inhibition of GP88 expression in human breast adenocarcinoma inhibited tumor incidence and growth in nude mice. Immunohistochemical studies have shown that GP88 was expressed in invasive ductal carcinomas in correlation with the expression of poor prognosis markers whereas normal tissues and benign lesions were negative. High GP88 expression in tumor biopsies was accompanied by decreased disease-free survival. Since GP88 can be secreted, we have hypothesized that GP88 could be secreted in the circulation and found in serum. We examined whether GP88 could be found in the circulation and whether GP88 could be elevated in the sera of breast cancer patients when compared to healthy individuals.
 Methods: An IRB approved blood sampling study was conducted at the University of Maryland Breast Clinic to determine the serum level of GP88 in healthy volunteers (HV) and breast cancer patients (BC pts). Serum GP88 concentration was determined in triplicate by quantitative enzyme immunoassay. 189 BC pts were accrued. In addition, sera from 18 HV were obtained to establish a GP88 baseline in healthy volunteers. BC patient characteristics: Race: Caucasian- 91, African American-92, Asian-6; median age, 51 (range 29-86), stage I – 48, II - 52, III – 26, IV - 63.
 Results: Circulating GP88 was measurable in the serum. Median level of GP88 was 28.7 ng/ml (range 16.6-38.2) in HV; 40.7 ng/ml (range 6.4-100) in early stage (stage 1 –3) BC pts (p- value = 0.007) and 45.3 ng/ml (range 9.8 to 158.4) in stage 4 metastatic BC patients (p-value= 0.0007). Statistically significant increase in circulating GP88 level was found in early stages as well as in metastatic disease. Correlation studies with BC prognostic factors such as stage, tumor size, lymph node involvement, tumor grade and presence of ER and HER-2 will be presented.
 Conclusion: GP88 can be detected in the sera of HV and BC pts. Comparison between the two groups of subjects indicates that GP88 level is significantly higher in the sera of BC pts. These studies are important as they identify as a measurable circulating biomarker GP88 that is also a therapeutic target of malignant transformation or malignant progression of breast carcinoma (BC). Future studies will examine whether there is any correlation between the serum level of GP88 and therapeutic response to systemic therapy in breast cancer patients.
 This study was supported by grant from MIPS, the Avon Foundation and 1R43 CA 124179-01A1 from the National Institutes of Health.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2006.

Serum protein signatures detect early radiographic osteoarthritis

OBJECTIVE

To test the hypothesis that early knee and hand osteoarthritis (OA) development is characterized by detectable changes in serum proteins relevant to inflammation, cell growth, activation, and metabolism several years before OA becomes radiographically evident.

METHODS

Using microarray platforms that simultaneously test 169 proteins relevant to inflammation, cell growth, activation and metabolism, we conducted a case-control study nested within the Baltimore Longitudinal Study of Aging (BLSA). Subjects included 22 incident cases of OA and 66 age-, sex- and body mass index (BMI)-matched controls. Serum samples tested were obtained at the time of radiographic classification as either case or control, and up to 10 years earlier at a time when all participants were free of radiographic OA. Proteins with mean signal intensities fourfold higher than background were compared between cases and controls using multivariate techniques.

RESULTS

Sixteen proteins were different between OA cases compared to controls. Four of these proteins [matrix metalloproteinase (MMP)-7, interleukin (IL)-15, plasminogen activator inhibitor (PAI)-1 and soluble vascular adhesion protein (sVAP)-1] were already different in samples obtained 10 years before radiographic classification and remained different at the time of diagnosis. Six additional proteins were only associated with subsequent OA development and not with established OA.

CONCLUSIONS

Changes in serum proteins implicated in matrix degradation, cell activation, inflammation and bone collagen degradation products accompany early OA development and can precede radiographic detection by several years.

Clinical significance of pleural lavage cytology in non-small cell lung cancer: A meta-analysis

18031

Background: The clinical significance of pleural lavage cytology (PLC) in non-small-cell lung cancer (NSCLC) remains controversial. This study was performed to estimate the associations of positive PLC with the main clinicopathological characteristics, and its prognostic value. Methods: PLC studies were identified on Medline, supplemented by manual search of bibliographies and proceedings. Authors were contacted for updated information. The quality of the studies was evaluated, and the data were extracted. Pooled odds ratios (ORs) and pooled hazard ratios (HRs) with confidence intervals [95% CIs] were calculated to evaluate the association of positive PLC with clinico-pathological characteristics and survival respectively. Results: Nineteen articles assessing PLC in NSCLC were selected for this study after exclusion of repeated publications or reports with little clinical detail. Positive PLC was diagnosed in 10.2% (516) of a total of 5073 patients. Positive PLC was strongly associated with lymphatic permeation (OR 4.96 [3.29, 7.54]), pleural invasion (OR 4.38 [2.16, 8.89], and vascular involvement (OR 2.94 [1.99, 4.35]). It was also found to be associated with advanced T stage, N stage, and TNM stage. Positive PLC was more frequent in adenocarcinoma than in squamous cell carcinoma (OR 2.32, [1.51, 3.52]). It was relatively more common in moderately- and poorly-differentiated tumors than in well-differentiated tumors (OR 1.89 [0.86, 4.16]). No association was found between positive PLC and fine needle aspiration cytology (OR 1.04 [0.58, 1.81]). Positive PLC was associated with high overall recurrence (OR 2.51 [1.79, 3.53]), as well as high local recurrence (OR 3.85 [1.57, 9.44]) and distant recurrence (2.58 [1.76, 3.76]). In analysis of survival, the overall HR for mortality was 2.43 [1.87, 3.16], suggesting significantly poorer survival for patients with positive PLC. Conclusions: Positive PLC in NSCLC is strongly associated with several existing poor prognosticators including pleural invasion, lymphatic spread, and vascular involvement. It may indicate locally advanced disease with high risk of recurrence and poor survival. We recommend that the PLC test be included in future clinical trials of adjuvant therapy for patients with NSCLC.

No significant financial relationships to disclose.

Transcriptional profiling suggests that Barrett's metaplasia is an early intermediate stage in esophageal adenocarcinogenesis

To investigate the relationship between Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), we determined gene expression profiles of discrete pathological stages of esophageal neoplasia using a sequence-verified human cDNA microarray. Fifty one RNAs, comprising 24 normal esophagi (NE), 18 BEs, and nine EACs were hybridized to cDNA microarrays. Five statistical analyses were used for the data analysis. Genes showing significantly different expression levels among the three sample groups were identified. Genes were grouped into functional categories based on the Gene Ontology Consortium. Surprisingly, the expression pattern of BE was significantly more similar to EAC than to NE, notwithstanding the known histopathologic differences between BE and EAC. The pattern of NE was clearly distinct from that of EAC. Thirty-six genes were the most differentially modulated, according to these microarray data, in BE-associated neoplastic progression. Twelve genes were significantly differentially expressed in cancer-associated BE's plus EAC (as a single combined tissue group) vs noncancer-associated BE's. These genes represent potential biomarkers to diagnose EAC at its early stages. Our results demonstrate that molecular events at the transcriptional level in BE are remarkably similar to BE's-associated adenocarcinoma of the esophagus. This finding alarmingly implies that BE is biologically closer to cancer than to normal esophagus, and that the cancer risk of BE is perhaps higher than we had imagined. These findings suggest that changes modulated at the molecular biologic level supervene earlier than histologic changes, and that BE is an early intermediate stage in the process of EAC.

Interferon-beta-1a induces increases in vascular cell adhesion molecule: implications for its mode of action in multiple sclerosis

We investigated soluble vascular cell adhesion molecule-1 (sVCAM) levels and MRI lesions over 24 weeks in 15 Relapsing Remitting MS (RRMS) patients randomized prospectively to receive once-weekly (qw) IFN-beta-1a 30 mug intramuscularly (IM) (Group I, 8 patients) or three-times-weekly (tiw) IFN-beta-1a 44 mug subcutaneously (SC) (Group II, 7 patients). Both groups demonstrated a significant increase in sVCAM during treatment when compared to pre-treatment levels. Patients on IFN-beta-1a 44 mug SC tiw had a significant (p<0.0001) mean increase in sVCAM of 321.9 ng/ml which was significantly greater (p<0.0001) than with IFN-beta-1a 30 mug IM qw (68.6 ng/ml). There was a negative correlation between combined unique (CU) MRI lesions and sVCAM levels within the IFN-beta-1a 44 mug SC tiw group (slope=-0.00106, p=0.009). We postulate that the mode of action of IFN-beta therapy in MS may involve the induction of an increase in sVCAM. sVCAM could bind VLA-4 on T-cells and intercept their adhesion to the blood brain barrier (BBB). This mechanism is consistent with the observed clinical effect of IFN-beta in reducing MRI contrast enhancing lesions.

Epidemiology of capsular and surface polysaccharide in Staphylococcus aureus infections complicated by bacteraemia

Staphylococcus aureus is a leading cause of serious hospital- and community-acquired infections. The discovery of serologically distinct capsular polysaccharides on the surface of clinical isolates has allowed the development of vaccines and passive protective immunity. We have studied patient characteristics, infection characteristics and the surface and capsular polysaccharide serotype distribution in patients with S. aureus infections complicated by bacteraemia admitted to VA hospitals in Maryland between 1995 and 2000. Nine hundred and ninety-three blood cultures from 331 patients were positive for S. aureus. Thirty-eight percent of patients had diabetes, 11% had end-stage renal failure, and 23% were injection drug users. Forty-two percent of infections were caused by methicillin-resistant strains (MRSA), and 60% were acquired during hospitalization. Serotyping of the first available isolate per patient (N=234 isolates) using polyclonal antibodies showed three major phenotypes--42%, type 8 (T8) capsule; 50%, type 5 (T5) capsule; and 8%, 336 polysaccharide. MRSA isolates were significantly more likely to be T5 than methicillin-susceptible isolates (66% vs. 39%, P<0.001). The proportion of T5 MRSA increased significantly (years 1-2: 41%; years 3-4: 65%; years 5-6: 90%, P<0.001). This large sample of patients with serious S. aureus infection confirms that capsular polysaccharides T5 and T8 cause most human infections, and together with serotype 336, account for nearly all those with bacteraemia.

Phosphatidylinositide 3-kinase/AKT in radiation responses

Ionizing or ultraviolet radiation-induced cellular survival signaling pathways induce development of cancer and insensitivity of tumor cells to radiation therapy. Accumulating evidence suggests that the phosphatidylinositide 3-kinase (PI3K)/AKT signal pathway is a major contributor to radioresistance. In many cell types PI3K/AKT signaling is a key cytoprotective response downstream of the EGFR family receptors and mediated carcinogenesis. Cytokines, such as HGF, IGF-I, and IL-6 also protects cells against apoptosis induced by radiation through PI3K/AKT pathway. The mechanics by which PI3K/AKT signaling functions in radiation responses may include its regulation of mitochondrial proteins, transcription factors, translation machinery, and cell-cycle progression. In addition, cross-talk between the PI3K/AKT pathway and mitogen-activated protein kinases, protein kinase A, and protein kinase C signal pathway may also play an important role.

Signalling mechanisms of anoikis

Apoptosis following loss of cell anchorage ('anoikis') is of relevance for development, tissue homeostasis and disease. Integrins regulate cell viability through their interaction with the extracellular matrix and they can sense mechanical forces arising from the matrix and convert these stimuli to chemical signals capable of modulating intracellular signal transduction. Recently it has been shown that protein kinase signalling pathways and apoptosis-related molecular control anoikis both positively and negatively. Focal adhesion kinase, when activated by integrins, can suppress anoikis. Phosphatidylinositol 3-kinase/Akt and mitogen-activated protein kinase may mediate the anoikis-suppressing effects of cells. Conversely, the stress-activated protein kinase/Jun amino-terminal kinase pathway promotes anoikis. In addition, certain bcl-2 and bcl-2-related proteins may also participate in the regulating of anoikis. In this review, molecular mechanisms of signal pathway inducing and perpetuating detachment-induced apoptosis will be discussed with special emphasis on the role of integrins, focal adhesion kinase, phosphatidylinositol 3-kinase/Akt, mitogen-activated protein kinase and bcl-2 family members.