Diagnostic conundrum of a perineal tumour: a rectal gastrointestinal stromal tumour mimic

Gastrointestinal stromal tumour (GIST) is a common mesenchymal tumour arising in the gastrointestinal tract, but not frequently encountered in the rectum. Herein, we describe a case of a rectal GIST which mimicked histomorphological features of a schwannoma; thus, making intraoperative frozen section evaluation challenging. Although subsequent immunohistochemistry and molecular findings readily confirmed the diagnosis of a GIST, we wish to draw attention to three clues that will help the pathologist steer clear of this potential diagnostic pitfall. One, GISTs are relatively more common than schwannomas in the rectum. Two, schwannomas usually have very little mitoses. Three, rectal GISTs commonly exhibit nuclear palisades. We also discuss the diagnostic, prognostic and therapeutic functions of immunohistochemical and molecular investigations. As the surgical intent for rectal GISTs is for en-bloc excision with wide margins, we surmise that the intraoperative consult should include GIST as a possible differential diagnosis for rectal mesenchymal tumours. In view of the potential for neoadjuvant treatment with imatinib before surgical excision to preserve sphincter function, a multidisciplinary approach is recommended for establishing most effective treatment strategy in these rare complex cases.

Molecular and structural changes related to hepatitis E virus antigen and its expression in testis inducing apoptosis in Mongolian gerbil model

Hepatitis E virus (HEV) infection has been associated with a wide range of extrahepatic manifestations, so this study was designed to examine the effect and role of HEV on structural and molecular changes in the testicular tissues of Mongolian gerbils experimentally infected with swine HEV. HEV RNA was first detected in testis at 14 days post-inoculation and reached a peak between 28 and 42 days later with viral load between 3.12 and 6.23 logs/g by PCR assays. Changes including vacuolation, sloughing of germ cells, formation of multinuclear giant cells, degeneration, necrosis of tubules and damaged blood-testis barrier were observed through transmission electron microscopy. HEV ORF2 antigen was detected in the sperm cell cytoplasm along with decrease in relative protein of zonula occludens-1 through immunohistochemistry. HEV ORF3 antigen and ZO-1 protein were detectable by Western blotting. Lower (P<.05) serum testosterone and higher (P<.05) blood urea nitrogen level was observed in inoculated Mongolian gerbils. Likewise, increased (P<.05) germ cell apoptosis rate was detected with significant increased expression of Fas-L and Fas in HEV-inoculated groups at each time points. Up-regulation (P<.05 or P<.01) in mRNA level of Fas-L, Fas, Bax, Bcl-2 and caspase-3 was observed in HEV RNA-positive testes. Our study demonstrated that after experimental inoculation, HEV can be detected in testis tissues and viral proteins produce structural and molecular changes that in turn disrupt the blood-testis barrier and induce germ cell apoptosis.

Metformin improves the glucose and lipid metabolism via influencing the level of serum total bile acids in rats with streptozotocin-induced type 2 diabetes mellitus

OBJECTIVE

To study the effects of metformin on streptozotocin-induced type 2 diabetes mellitus (T2DM) in rats.

MATERIALS AND METHODS

Wistar male rats were divided into two groups: standard diet (SD, n = 20) group and high-fat diet (HFD, n = 80) group. Twenty rats in HFD group were randomly treated with metformin (EI group). After 6 weeks, among rats in HFD group, 20 rats were intraperitoneally injected with citrate buffered saline (IR group), 20 rats treated with metformin per day for 4 weeks (LI group), and 20 rats were given nothing (DM group). Rats in SD group were injected with citrate buffered saline as normal control (NC) group. Moreover, streptozotocin (STZ) was used for inducing diabetes. The metabolic parameters, such as body weight, fasting blood glucose (FBG), fasting insulin concentration (FINS), total cholesterol (TC), total triglycerides (TG), low-density lipoprotein cholesterol (LDLC) and total bile acid (TBA) were measured.

RESULTS

Compared with SD group, the levels of body weight, FBG, TC, LDLC, TBA and FINS and AUC (glucose) were significantly higher in HFD group. After administration of metformin, the levels of FBG, TG, TC, LDLC and TBA in DM and LI group were higher than NC group. Besides, the FBG, TG, TC, TBA and LDLC levels in EI group were higher than DM group.

CONCLUSIONS

Metformin may help to improve the glucose and lipid metabolism by influencing the level of serum total bile acids. A combination of HFD and metformin could be effective in the treatment of rats with T2DM.

Abstract P5-14-02: Triple negative breast cancer - Adjuvant chemotherapy use and survival outcomes in Stage IA disease

Background: The potential benefit of adjuvant chemotherapy in patients with Stage IA triple negative breast cancer (TNBC) has not been defined. In general, patients with T1a and T1b lesions have not been included in adjuvant chemotherapy trials and the inclusion of T1c tumors has been limited. In this study using National Cancer Data Base (NCDB) we investigated the actual use of adjuvant chemotherapy in Stage IA TNBC patients relative to tumor size (T1a, T1b, T1c) and report their survival outcomes.

Patients and Methods: Using NCDB we evaluated a cohort of 13,065 women with TNBC diagnosed between 2010-2012 who had American Joint Committee on Cancer Stage IA (node-negative with pathological T1a, T1b or T1c) tumors. Overall survival (OS) was the primary outcome variable. Based on the tumor size, patients were stratified on receipt of adjuvant chemotherapy or not. Patients were also stratified according to receipt of adjuvant radiation, radiation with boost, or none. Other adjusted variables included: age, race, Charlson comorbidity index, payer status, income, education, distance traveled, treating facility, and treatment delays. Multivariate Cox regression was employed to analyze the effect of adjuvant chemotherapy on overall survival.

Results: The mean patient age for the entire cohort was 59.2 years (range 22-90 years), 55.8 years for the chemotherapy group, and 67.8 years for the non-chemotherapy group. There were 1275 T1a, 3197 T1b, and 7729 T1c patients. Tumor size was a very strong predictor of survival. Compared to T1a tumors, HR for death was 1.43 (95% CI: 0.86 –2.37) for T1b tumors and 3.00 (95% CI: 1.86 – 4.83) for T1c tumors. Out of all T1a, T1b, and T1c tumors in this cohort, 48.1 %, 72.6%, and 89.3% of patients received adjuvant chemotherapy respectively. A hazard ratio (HR) of death was 0.42 (95% CI: 0.31 – 0.57) for all patients who received chemotherapy compared to non-chemotherapy group. 4-year OS by tumor size and chemotherapy usage is listed in the table indicating an absolute increase of OS with adjuvant chemotherapy employment. HR for death was 0.90 (CI: 0.62 – 1.31) with use of radiation only and 0.67 (95% CI: 0.53 – 0.85) with use of radiation with boost when compared to no radiation therapy.

4-year OS (in percentage) with and without adjuvant chemotherapy use for node-negative T1a, T1b, and T1c TNBCTumor sizeNo ChemotherapyChemotherapyP ValueT1a93.78 %98.36 %0.146T1b91.91 %97.10 %&lt;0.0001T1c80.62 %94.41 %&lt;0.0001

Conclusion: NCDB indicated that the majority of patients with Stage IA TNBC received adjuvant chemotherapy, including 48% of patients with T1a lesions. Our data analysis demonstrated a statistically significant 4-year OS benefit in patients with T1b and T1c tumors who received adjuvant chemotherapy compared to those who did not. The survival benefit of adjuvant chemotherapy in patients with T1a tumors, however, did not reach statistical significance. Prospective randomized trials could define the potential benefits of adjuvant chemotherapy in patients with Stage IA TNBC, particularly for those with T1a and T1b tumors.

Citation Format: Patel AN, Shi R, Peddi P, Burton GV. Triple negative breast cancer - Adjuvant chemotherapy use and survival outcomes in Stage IA disease [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-14-02.

Evidence of Hepatitis E virus breaking through the blood-brain barrier and replicating in the central nervous system

Neurologic dysfunctions such as Guillain-Barre' syndrome, encephalitis, meningitis and transverse myelitis occur frequently in patients with hepatitis E virus (HEV) infection, and this study was conducted to better characterize the role of HEV in the pathogenesis of neurologic disorders. Genotype 4 strain of swine HEV was used to inoculate Mongolian gerbils. Reverse transcription-nested polymerase chain reaction (RT-nPCR), ELISA, histopathology, ultrastructural pathology and enzyme immunohistochemistry method were conducted to investigate the replication and localization of HEV in the central nervous system (CNS) and the consequent pathological changes. Both positive- and negative-strand HEV RNA was detectable in brain and spinal cord from 7 to 28 dpi (days postinoculation) via RT-nPCR. Various pathological changes such as perineural invasion, neuron necrosis, microglia nodule, lymphocyte infiltration, perivascular cuff and myelin degeneration were observed in HEV-positive brains and spinal cords. Immunohistochemical (IHC) staining targeting on HEV ORF2 protein revealed positive signals concentrated mainly in the cytoplasm of neuron, ependymal epithelium and choroid plexus area. Positive area density of ZO-1 (zonula occludens-1) in brain of HEV-positive gerbils decreased, while the GFAP (glial fibrillary acidic protein) expression was upregulated compared with control groups. These results provide strong evidence that HEV is able to damage the blood-brain barrier (BBB), replicate in brain and spinal cord, and hammer the causative role of HEV in the pathogenesis of neurologic disorders.

Hypoxia regulates sumoylation pathways in intervertebral disc cells: implications for hypoxic adaptations

OBJECTIVE

To explore the hypoxic regulation of sumoylation pathways and cell viability in nucleus pulposus (NP) and annulus fibrosus (AF) cells.

DESIGN

Expression of small ubiquitin-like modifier (SUMO) molecules, SUMO E1 activating enzymes SAE1 and SAE2, SUMO E2 conjugating enzyme UBC9, and de-sumoylation enzyme sentrin/SUMO-specific proteases (SENP)1 was immunolocalized in rat intervertebral disc (IVD) cells. NP and AF cells were cultured in hypoxia and cell viability was evaluated by quantifying cell proliferation, cellular senescence, apoptosis, and cell cycle distribution. Hypoxic regulation of sumoylation pathways was studied by analyzing the transcription and expression of SUMO molecules and sumoylation enzymes. Loss of function study using SENP1 siRNA was performed to investigate the regulatory role of sumoylation on the function of hypoxia inducible factor 1α (HIF-1α) and the hypoxic tolerance of IVD cells.

RESULTS

Sumoylation pathways were expressed in IVD cells and localized predominantly in nuclei. Both NP and AF cells maintained viability under hypoxia and upregulated the expression of SENP1. In NP cells hypoxia transiently increased the expression of SUMO-1, SUMO-2/3, SAE2, and UBC9, whereas SUMO-1 was elevated while SUMO-2/3, SAE1, SAE2, and UBC9 were reduced by low oxygen tensions in AF cells. Although downregulation of SENP1 decreased the transcriptional activity of HIF-1α, the viability of disc cells showed no significant loss under hypoxia.

CONCLUSIONS

NP and AF cells equally tolerate oxygen deficiency, but differently regulate the sumoylation pathways under hypoxia. The distinct sumoylation dynamics may help extend our understanding of the cell-specific regulation of the molecular basis that promotes cell survival in the hypoxic IVD.

Aging and age related stresses: a senescence mechanism of intervertebral disc degeneration

Intervertebral disc (IVD) degeneration is a complicated process that involves both age-related change and tissue damage caused by multiple stresses. In a degenerative IVD, cellular senescence accumulates and is associated with reduced proliferation, compromised self-repair, increased inflammatory response, and enhanced catabolic metabolism. In this review, we decipher the senescence mechanism of IVD degeneration (IVDD) by interpreting how aging coordinates with age-related, microenvironment-derived stresses in promoting disc cell senescence and accelerating IVDD. After chronic and prolonged replication, cell senescence may occur as a natural part of the disc aging process, but can potentially be accelerated by growth factor deficiency, oxidative accumulation, and inflammatory irritation. While acute disc injury, excessive mechanical overloading, diabetes, and chronic tobacco smoking contribute to the amplification of senescence-inducing stresses, the avascular nature of IVD impairs the immune-clearance of the senescent disc cells, which accumulate in cell clusters, demonstrate inflammatory and catabolic phenotypes, deteriorate disc microenvironment, and accelerate IVDD. Anti-senescence strategies, including telomerase transduction, supply of growth factors, and blocking cell cycle inhibitors, have been shown to be feasible in rescuing disc cells from early senescence, but their efficiency for disc regeneration requires more in vivo validations. Guidelines dedicated to avoiding or alleviating senescence-inducing stresses might decelerate cellular senescence and benefit patients with IVD degenerative diseases.

A novel laparoscopic surgical technique for severe adenomyoma

Qbjctives: The aim of this study was to investigate the feasibility and safety of the treatment of laparoscopic adenomyomectomy for severe adenomyoma.

STUDY DESIGN

The study included 216 patients with severe adenomyoma, who underwent a laparoscopic adenomyomectomy between January 2008 and September 2012 in the Department of Gynecology, Second People's Hospital of Changzhou, affiliated with Nanjing Medical University.

RESULTS

The mean age of the patients was 37 (± 3.3) years and the BMI was,26 (± 2.7). The volume of bleeding during surgery was 150.2 ± 22.7 ml, the mean operative time was 60 ±48.6 minutes, the mean time for anal ex- haust was one ±1.8 days, and the mean time of hospital stay was five ±1.2 days. During the surgeries, no bladder or bowel injuries occurred, and all the surgeries were completed successfully, with no conversions to open laparotomies. Of the 176 patients, 170 (96.6%) showed significant improvement in their dysmenorrheal symptoms after the surgeries, whereas six patients had a poor clinical outcome. Of the 157 patients,151 (96.2%) had an obvious effect on their menstrual cycle. Concluitons: Laparoscopic adenomyomectomy is feasible and safe for severe adenomyoma.

Mouse undifferentiated spermatogonial stem cells cultured as aggregates under simulated microgravity

Dynamic simulated microgravity (SMG) culture systems provide environments that stimulate stem cell proliferation and differentiation. However, the effect of SMG on spermatogonial stem cells (SSCs) remains unclear. Here, we used a rotating cell culture system (RCCS) to determine its effect on mouse SSC proliferation and differentiation. SSCs were enriched from mouse pub testis and cocultured with Sertoli cell feeders pre-treated with mitomycin C on fibrin scaffolds in a rotary bioreactor for 14 days. Our results show that mouse SSCs cultured in a rotary bioreactor exhibited enhanced proliferation surpassing those cultured in static conditions, although SSC cultures in SMG underwent a growth lag at initial 3 days. After 14 days, mouse SSCs and feeders grew into cell aggregates with average diameters of 242.63 ± 16.53 μm compared with those in conventional static culture (49.51 ± 15.64 μm). Related detection revealed that proliferating SSCs in SMG remained undifferentiated, maintained clone-forming capacity and were capable of differentiation into round spermatids with flagella. The growth characteristics of mouse SSCs in RCCS suggest that the resulting aggregates are similar to native in vivo cells. Rotary bioreactors that create SMG environments may be an alternative to conventional systems for the clinical application of SSCs.

GLP-1-Exendin-4/IgG4 (Fc) fusion protein as a novel drug for diabetes treatment

In this paper, we aimed to look for a potent long acting GLP-1 receptor agonist for diabetes treatment. In this work, we constructed the eukaryotic expression vector of GLP-1-Exendin-4/IgG4 (Fc)-pOptiVEC™-TOPO(®) and then transfected it into Chinese hamster ovary DG44 (CHO/DG44) cells using liposome method. Then the beta-cell line INS-1 cells were treated with purified GLP-1-Exendin-4/IgG4 (Fc) fusion protein (0.01, 0.1, 1.0 mM respectively) and randomly assigned to 2 groups, each group were then grown in KRB buffer in the presence of 2.8 mM or 16.8 mM glucose for 2 h separately. In addition, single dose of fusion protein was intraperitoneally injected into male CD1 mice for pharmacokinetic study. Besides, multiple low doses of streptozotozin (STZ) induced diabetes mice were used to evaluate the effect of fusion protein for anti-diabetes in male CD1 mice. GLP-1-Exendin-4/IgG4 (Fc) had stimulatory effect on insulin secretion glucose-dependently from INS-1 cells in a dose-dependent manner. Pharmacokinetic studies showed that the GLP-1 level increased significantly after injecting fusion protein and maintained a higher level for 200 h. Besides, multiple-low-dose STZ-induced diabetes mice which received intraperitoneal injections of fusion protein did not show sign of diabetes. Our results indicated that GLP-1-Exendin-4/IgG4 (Fc) fusion protein retained native GLP-1 activities and had effect on long-term glucose regulation. All the results suggest that this fusion protein may serve as a potent long acting GLP-1 receptor agonist.

Molecular mechanisms of acrolein-mediated myelin destruction in CNS trauma and disease

Myelin is a critical component of the nervous system facilitating efficient propagation of electrical signals and thus communication between the central and peripheral nervous systems and the organ systems that they innervate throughout the body. In instances of neurotrauma and neurodegenerative disease, injury to myelin is a prominent pathological feature responsible for conduction deficits, and leaves axons vulnerable to damage from noxious compounds. Although the pathological mechanisms underlying myelin loss have yet to be fully characterized, oxidative stress (OS) appears to play a prominent role. Specifically, acrolein, a neurotoxic aldehyde that is both a product and an instigator of OS, has been observed in studies to elicit demyelination through calcium-independent and -dependent mechanisms and also by affecting glutamate uptake and promoting excitotoxicity. Furthermore, pharmacological scavenging of acrolein has demonstrated a neuroprotective effect in animal disease models, by conserving myelin's structural integrity and alleviating functional deficits. This evidence indicates that acrolein may be a key culprit of myelin damage while acrolein scavenging could potentially be a promising therapeutic approach for patients suffering from nervous system trauma and disease.

Nutritional status of an elderly population in Southwest China: a cross-sectional study based on comprehensive geriatric assessment

OBJECTIVE

Few data is available on the nutritional status of old Chinese. The present study aimed to describe the nutritional status and clinical correlates for malnutrition risk in the older people.

DESIGN

Cross-sectional study.

SETTING

Hospital- and community-based older people were recruited in the region of Chongqing, China.

PARTICIPANTS

558 individuals aged 60 years old or over between April 2011 and October 2012.

MEASUREMENTS

Comprehensive geriatric assessment was performed and nutritional status was assessed by the Mini Nutritional Assessment Short Form (MNA-SF). Nutrition-associated factors were analyzed, including health status (chronic diseases, depression, cognition, function impaired), social factors (education status, marital status, the type of work before 60 years old) and life style factors (smoking, drinking, diet).

RESULTS

The mean age was 73.1±8.0 years and 43.9% were men. Prevalence of malnutrition and risk for malnutrition were 3.2% and 19.3 %, respectively. Several factors increased poor nutrition independently including self-rated health, comorbidity, chronic obstructive pulmonary disease, gastrointestinal disease and cognitive impairment. Fish decreased the risk of poor nutrition.

CONCLUSIONS

The prevalence was relatively low in older people of Chongqing, Southwest China. Poor nutrition was found to be increased due to the common health problems. Thus the patients with these problems should pay more attention on nutritional status. The older people should often have fish because of their nutritional benefit.

Characteristics of spermatogonial stem cells derived from neonatal porcine testis

The aim of this study was to isolate and characterise porcine spermatogonial stem cells (PSSCs). The putative porcine germline stem cells from testis were isolated successfully by an improving way of enrichment with lymphocyte separation medium (LSM). Results from RT-PCR analyses showed that PSSCs were positive for OCT4, SOX2, NANOG, PGP9.5, c-MYC, KEL4 and PRDM-14 which are multipotent stem cell markers. At the protein level, the results of immunofluorescence analyses showed that PSSCs were positive for OCT4, PGP9.5, SOX2 and CD29. We successfully differentiated these PSSCs into adipocytes and muscle cells and then defined their characteristics, including morphology, surface stem cell markers, and mechanical properties. But the experiment of teratoma formation was negative. The results indicated the PSSCs could be multipotent. Atomic force microscopy was used to characterise the morphological and mechanical properties of undifferentiated PSSCs, as well as the differentiated adipocytes and muscle cells, which could be potentially useful for distinguishing PSSCs from differentiated cells.

Optimization of culture medium for anaerobic production of rhamnolipid by recombinant Pseudomonas stutzeri Rhl for microbial enhanced oil recovery

Response surface methodology was employed to enhance the anaerobic production of rhamnolipid by recombinant Pseudomonas stutzeri Rhl. Glycerol is a promising carbon source used to anaerobically produce rhamnolipid. In a Plackett-Burman design, glycerol, KH2 PO4 and yeast extract were significant factors. The proposed optimized medium contained the following: 46·55 g l(-1) glycerol; 3 g l(-1) NaNO3 ; 5·25 g l(-1) K2 HPO4 ·3H2 O; 5·71 g l(-1) KH2 PO4 ; 0·40 g l(-1) MgSO4 ·7H2 O; 0·13 g l(-1) CaCl2 ; 1·0 g l(-1) KCl; 1·0 g l(-1) NaCl; and 2·69 g l(-1) yeast extract. Using this optimized medium, we obtained an anaerobic yield of rhamnolipid of 3·12 ± 0·11 g l(-1) with a 0·85-fold increase. Core flooding test results also revealed that Ps. stutzeri Rhl grown in an optimized medium enhanced the oil recovery efficiency by 15·7%, which was 6·6% higher than in the initial medium. Results suggested that the optimized medium is a promising nutrient source that could effectively mobilize oil by enhancing the in situ production of rhamnolipid.

SIGNIFICANCE AND IMPACT OF THE STUDY

The ex situ application of rhamnolipid for microbial enhanced oil recovery (MEOR) is costly and complex in terms of rhamnolipid production, purification and transportation. Compared with ex situ applications, the in situ production of rhamnolipid in anaerobic oil reservoir is more advantageous for MEOR. This study is the first to report the anaerobic production optimization of rhamnolipid. Results showed that the optimized medium enhanced not only the anaerobic production of rhamnolipid but also crude oil recovery.

The MEK1/2 inhibitor U0126 reverses imatinib resistance through down-regulating activation of Lyn/ERK signaling pathway in imatinib-resistant K562R leukemia cells

Chronic myelogenous leukemia (CML) is triggered by the constitutively activated BCR-ABL oncoprotein and multiple downstream signaling pathways, including the Raf/MEK/ERK, Akt/mTOR, SRC, and STAT5 pathways. The BCR-ABL tyrosine kinase inhibitor imatinib is the standard treatment for CML. However, the development of imatinib resistance has become a new challenge for CML treatment. Here, we investigated the expression levels of the signaling pathways to explore the cause of imatinib resistance and seek new reversing drugs. Our results showed that abnormal activation of the BCR-ABL-independent Lyn/ERK signaling pathway was involved in imatinib-resistance of K562R cells. Furthermore, p-Lyn and p-ERK were up-regulated after treatment with imatinib alone. However, U0126, a MEK1/2 inhibitor, could counteract the up-regulation induced by imatinib, and the combination of imatinib and U0126 could overcome the resistance to imatinib in K562R cells. In conclusion, our studies suggest that the combination of imatinib and an inhibitor of the ERK signaling pathway may be effective in imatinib-resistant CML patients.

More satisfied, but why? A pooled patient-level analysis of treatment satisfaction following the initiation of insulin glargine vs. comparators in insulin-naïve patients with type 2 diabetes mellitus

AIM

To assess patient-reported outcomes associated with initiating insulin glargine among insulin-naïve patients with type 2 diabetes mellitus (T2DM).

METHODS

This was a pooled analysis of patient-level data from Phase 3, randomized controlled trials evaluating once-daily insulin glargine vs. comparator treatment for ≥24 weeks in previously insulin-naïve adult patients with T2DM and poor glycaemic control. Eligible studies utilized strict, predefined insulin titration algorithms with weekly dose-adjustment to achieve fasting plasma glucose (FPG) levels of ≤5.6 mmol/l. Treatment satisfaction was measured using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) change (c) and status (s) versions.

RESULTS

A total of 1577 patients from four studies were included; 830 patients treated with insulin glargine and 747 with comparators. At week 24, DTSQc scores improved in both groups with a significantly higher increase in treatment satisfaction for insulin glargine vs. comparators (13.5 vs. 12.1; p < 0.0001). Multivariate regression analysis revealed that significant predictors of DTSQc improvement at week 24 were insulin glargine treatment (p < 0.0001), higher baseline DTSQs (p < 0.0001), and lower baseline body weight (p = 0.0103). Greater improvement in DTSQc at week 24 was significantly associated with decrease from baseline in glycosylated haemoglobin (p < 0.001) and FPG (p = 0.0001); a numerically more positive change in weight from baseline approached significance (p = 0.07).

CONCLUSION

Initiation of insulin glargine in insulin-naïve patients with T2DM is associated with greater improvements in treatment satisfaction than alternative interventions, with perceived improvements in glycaemic control and baseline weight likely to be important factors.

Effects of chemotherapy on global gene expression in non-small cell lung cancer

INTRODUCTION

Gene expression profiles of peripheral blood monocytes from patients with non-small cell lung cancer (NSCLC) before and after chemotherapy were used to investigate the effect of chemotherapy on gene expression.

MATERIALS AND METHODS

Microarray dataset GSE39345 was downloaded from Gene Expression Omnibus, including 32 NSCLC samples before chemotherapy, 17 NSCLC samples after chemotherapy and 20 healthy samples. Raw data pretreatment and differentially expressed genes (DEGs) analysis between health and NSCLC samples before chemotherapy, health and NSCLC samples after chemotherapy were performed with packages of R. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis was done for the common DEGs with WebGestalt to investigate their underlying function.

RESULTS

A total of 904 DEGs were identified in health vs. NSCLC samples before chemotherapy and 2148 in health vs. NSCLC samples after chemotherapy. Further, they were divided into three sets: 584 common DEGs, 320 unique DEGs (health vs NSCLC samples before chemotherapy), and 1564 unique DEGs (health vs NSCLC samples after chemotherapy). Function enrichment analysis showed that these common DEGs were associated with cell cycle and cell differentiation.

CONCLUSIONS

Chemotherapy could not completely reverse the lung cancer development because several cell growth-related genes are still present even after chemotherapy.

Extracellular superoxide dismutase, a potential extracellular biomarker candidate for prolactinoma

AIM

To investigate whether the extracellular superoxide dismutase (EC-SOD) and manganese superoxide dismutase (Mn-SOD) level changes during prolactinoma (PRL) development.

METHODS

Surgical tissues from 37 female patients with PRL were tested for Mn-SOD and serum samples from such PRL patients were tested for EC-SOD level changes with Western Blot. The MnSOD level from blood cells was also investigated to show whether the Mn-SOD variation could locate tumorigenesis tissues.

RESULTS

According to the patients' age analysis, age 20-40 years is high risk for getting PRL. There is a positive relationship between the PRL severity and EC-SOD. The Mn-SOD level from surgical tissues, but not blood cells, also shows a corresponding positive relationship to PRL severity, which indicates that elevated Mn-SOD might only happen in PRL tumorigenesis tissues.

CONCLUSIONS

Extracellular superoxide dismutase is an extracellular protein and the serum EC-SOD could be a good candidate for the diagnoses of prolactinoma.

Study of HIV/AIDS-related knowledge among junior high-school students in Shanghai, China

The aim of this study was to assess the HIV/AIDS-related knowledge among junior high-school students in Shanghai, China, and the factors influencing this knowledge. A cross-sectional study was conducted in 20 middle schools of two districts by a cluster-stratified selection procedure in Shanghai, China. The 2432 sampled students, aged from 11.1 to 16.7 years, completed a self-administered questionnaire of HIV/AIDS prevention. The results showed that the overall correct rate of HIV/AIDS-related knowledge was 62%. Using multivariable logistic regression analysis, we found that the main factors influencing HIV/AIDS-related knowledge among junior high school students were the type of school (odds ratio [OR] = 1.641), age (OR = 1.727), whether the student was a single child in the family (OR = 1.389), whether the student had previous HIV/AIDS-related education experience (OR = 2.003) and whether the student had ever discussed HIV/AIDS with their parents (OR = 1.282). The results indicate that HIV/AIDS-related knowledge among Shanghai junior high school students is not high enough, and more attention needs to be paid to enhance HIV/AIDS-related knowledge, especially among younger students from common type schools without HIV/AIDS-related education experience. We encourage Chinese parents to get involved in their children's HIV/AIDS prevention education.

Phosphorylation of Mps1 by BRAFV600E prevents Mps1 degradation and contributes to chromosome instability in melanoma

Activating BRAF mutations that deregulate the mitogen-activated protein kinase (MAPK) pathway commonly occur in cancer. BRAF(V600E) induces centrosome amplification and spindle abnormalities that result in aneuploidy. We find modification of Mps1 is critical for contributing to centrosome amplification and chromosome instability induced by BRAF(V600E). Phosphorylation of Mps1 at residue S281 induced by BRAF(V600E) stabilizes Mps1 protein by preventing its ubiquitination by APC/C and subsequent degradation, allowing the non-degraded protein to accumulate at centrosomes. Cells in which endogenous Mps1 was replaced with a phospho-mimetic Mps1 mutant are viable but amplify centrosomes and missegregate chromosomes frequently. Importantly, analysis of tumor micro arrays revealed that phospho-MAPK and S281-phosphorylated Mps1 were highly correlated in human melanoma tissues, implying that MAPK contributes to defects in the degradation of Mps1 in situ. We propose that continuously activated BRAF(V600E) signaling may be a possible mechanism for the deregulation of Mps1 stability and kinase activity in human tumors, and that persistent phosphorylation of Mps1 through BRAF(V600E) signaling is a key event in disrupting the control of centrosome duplication and chromosome stability that may contribute to tumorigenesis. Our findings raise the possibility that targeting the oncogenic BRAF and S281-phosphorylated Mps1, especially when used in combination could potentially provide great therapeutic opportunities for cancer treatment.

Abstract PD09-08: Obesity in Long-Term Disease Free Survivors of Invasive Breast Cancer

Background: As the number of breast cancer survivors increases due to improvements in screening and treatment for breast cancer, there is a particular interest in identifying lifestyle factors associated with long-term survival. Obesity may be one of the modifiable risk factors that can play a role in the outcome of breast cancer patients however studies shown controversial results. Besides, little is known about the role of obesity in long-term survivors. The objective of this study is to examine the role of obesity in breast cancer patients who remained disease free at least 5 years after diagnosis.

Methods: We reviewed the medical records of all women with invasive breast cancer diagnosed at LSUHSC between 1980 and 2005. The patients with stage IV breast cancer at diagnosis were excluded from the analysis. For this study we selected patients whom were disease free at least five years after the breast cancer diagnosis. We classified our patients by body mass index (BMI) at the time of breast cancer diagnosis into: normal weight (BMI &lt;25 kg/m2), overweight (BMI 25-29 kg/m2), and obese (BMI &gt;30 kg/m2). Data on demographics clinical characteristics, tumor characteristic, breast cancer therapy, and relapse were analyzed within BMI classes. Results: A total of 967 patients were diagnosed with invasive breast cancer between 1980 and 2005. Out of those 49% were African American, 29% were overweight, and 49% were obese. From this population 597 (62%) patients were disease free more than 5y: 217 (49%) obese, 113 (26%) overweight, 112 (25%) normal weight. Obese breast cancer survivors in comparison to overweight and normal weight survivors were more likely to: be African American (61%, P&lt;0.01), received Medicaid coverage (14.2%, p=0.05) and to have lower rates of mastectomy (p=0.017). There was not difference in tumor characteristics (ER status, Nodal status, Tumor size) and adjuvant treatment (chemotherapy, radiotherapy and hormonal therapy) between obese and non-obese patients. One hundred and ten patients (19%) developed a recurrence 5 years after diagnosis (48 obese and 33 overweight): 65 local (48 obese and 33 overweight) and 45 systemic (21 obese and 10 overweight).

Discussion: Our study has some limitations typical of retrospective studies and the generalization of the results may be limited. Our analysis suggests that in long-term disease free survivors obesity and race might be associated. To further clarify the role of obesity in long-term breast cancer survivors prospective studies with long term follow up are warranted.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-08.

Abstract P6-09-07: Obesity; Not Associated with Risk of Second Malignancy in Early Stage Breast Cancer

Introduction: Early diagnosis and effective local and systemic therapy has reduced the risk of relapse and death from breast cancer; thus, patients are living longer but experience an increased risk for the development of a second malignancy (SM). Risk factors for SM may be genetic, related to environmental or behavioral factors or to breast cancer treatments such as radiotherapy, chemotherapy or hormone therapy. Controversy exists over the role of obesity and breast cancer outcomes, and there is little information on long term survivors. LSUHSC Shreveport provides care for a predominantly indigent population with high rates of obesity. This allows us to study the role of obesity and risk of SM after breast cancer diagnosis. In this study, we sought to determine the incidence and risk factors for SM in women after treatment for early stage breast cancer. Methods: We performed a retrospective analysis of all patients treated for invasive breast cancer from 1980 through 2006 at LSUHSC Shreveport. Patients with stage IV at diagnosis were excluded. Second malignancy was defined as a new diagnosis of primary malignancy at least three months after initial breast cancer diagnosis. We reviewed the demographics, smoking status, BMI at diagnosis of breast cancer, tumor characteristics, breast cancer treatments (surgery, radiotherapy, chemotherapy and hormonal therapy) and site and date of second malignancies. Descriptive statisticswere performed to characterize the group of patients who developed a SM and Cox proportional hazard regression model was used to estimate the relative risk of development of SM.

Results: Of the 1214 patients analyzed, 118 (9.72%) patients developed a SM: 54% (n=64) breast cancer, 12.7% (n=15) gynecologic cancer, 8.5% (n=10) GI malignancy, 6.8% (n= 8) lung cancer, 6.8% (n=8) hematologic malignancy and 11% (n=13) various miscellaneous cancers. The median time for the development of SM was 7.6 years. The risk for development of SM increased with longer follow up: the risk at 5 years after breast cancer diagnosis was 2.3%, at 10 years was 10% and at 20 years was 30%. Patients with SM in comparison with patients without it were more likely to be obese (57%, p=0.05) and to have received radiotherapy (60%, p=0.01). No differences were observed with age at diagnosis, race, smoking status, use of chemotherapy, ER status, or use of hormone therapy. In a multivariate analysis using the Cox regression model, after adjusting for race, age, smoking status, use of chemotherapy and ER status, radiotherapy was a significant predictor of SM (HR=2.8, p=0.01). Obesity was not associated with an increased risk of SM (HR=0.91, p=0.82). Conclusions: Our study has some limitations typical of retrospective studies and the generalization of the results may be limited. We found that obesity at diagnosis of breast cancer did not adversely affect the rate of SM while radiotherapy represents a significant risk factor. Further studies are needed to define the role of lifestyle and cancer treatments on develop of SM in patients with early stage breast cancer.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-09-07.

Anti-acrolein treatment improves behavioral outcome and alleviates myelin damage in experimental autoimmune encephalomyelitis mouse

Oxidative stress is considered a major contributor in the pathology of multiple sclerosis (MS). Acrolein, a highly reactive aldehyde byproduct of lipid peroxidation, is thought to perpetuate oxidative stress. In this study, we aimed to determine the role of acrolein in an animal model of MS, experimental autoimmune encephalomyelitis (EAE) mice. We have demonstrated a significant elevation of acrolein protein adduct levels in EAE mouse spinal cord. Hydralazine, a known acrolein scavenger, significantly improved behavioral outcomes and lessened myelin damage in spinal cord. We postulate that acrolein is an important pathological factor and likely a novel therapeutic target in MS.

Cooperative adhesion and friction of compliant nanohairs

The adhesion and friction behavior of soft materials, including compliant brushes and hairs, depends on the temporal and spatial evolution of the interfaces in contact. For compliant nanofibrous materials, the actual contact area individual fibers make with surfaces depends on the preload applied upon contact. Using in situ microscopy observations of preloaded nanotube hairs, we show how nanotubes make cooperative contact with a surface by buckling and conforming to the surface topography. The overall adhesion of compliant nanohairs increases with increasing preload as nanotubes deform and continuously add new side-wall contacts with the surface. Electrical resistance measurements indicate significant hysteresis in the relative contact area. Contact area increases with preload (or stress) and decreases suddenly during unloading, consistent with strong adhesion observed for these complaint nanohairs.

Evaluation of a school-based HIV/AIDS peer-led prevention programme: the first intervention trial for children of migrant workers in China

The effectiveness of a peer-led education intervention in HIV/AIDS prevention was assessed in the Chinese children of migrant workers. A prospective study was conducted in 12 junior high schools for migrant children. Among the intervention group, a peer-education-based HIV/AIDS prevention was implemented for three months. The results during the baseline survey indicated that the level of knowledge on HIV/AIDS was lower in children of migrant workers. After three months of peer-led intervention, compared with the control group, students in the intervention group positively increased their HIV/AIDS-related knowledge, modified their attitude and improved their protection self-efficacy. Compared with attitude, intervention was more effective in the improvement of knowledge and protection self-efficacy, especially knowledge. The findings suggest that peer-led education was an effective method in improving knowledge, attitude and protection self-efficacy in Chinese children of migrant workers. Heightened concerns targeting the group students were particularly necessary, given their lower level of related knowledge and vulnerability to HIV infection.

HIV/AIDS education effects on behaviour among senior high school students in a medium-sized city in China

Few studies have examined the long-term effects of peer-led HIV prevention in Chinese adolescents. A two-year follow-up study was conducted among senior high school students in a medium-sized city of Fujian Province, from 1 March 2006 to 30 April 2008. In all, 3068 students from 14 schools were invited in March 2006, and 893 students in five schools were followed up. Data were collected at baseline, right after intervention (one month later) and two years later by a self-administered questionnaire. In the intervention group, the average knowledge score including reproductive health and HIV/AIDS/sexually transmitted diseases rose from 4.30 to 7.06 one month later (P < 0.01) and to 7.08 two years later (P < 0.01). There was no significant difference between the average knowledge score after one month and two years (P > 0.05). Sustained increases were found in the attitude scores towards people living with HIV/AIDS (PLWH) and intention of condom use after intervention. The study indicates that peer-led HIV prevention education succeeds in improving and sustaining HIV/AIDS-related knowledge and some behaviour intentions. Future research should focus on strategies to sustain long-term behaviour change.

Pretreatment with calcitonin gene-related peptide attenuates hepatic ischemia/reperfusion injury in rats

OBJECTIVE

Oxygen free radicals and apoptosis play important roles in liver ischemia/reperfusion (I/R) injury. We sought to investigate the protective effect of calcitonin gene-related peptide (CGRP) to attenuate liver I/R injury due to oxygen free radicals and apoptosis.

MATERIALS AND METHODS

Harvested rat livers were perfused via the portal vein with 60 mL of 4 degrees C histidine-tryptophan-ketoglutarate (HTK) solution alone in the control group, or with the same solution containing CGRP (3 microg/10 g body weight) in the experimental group. After 24 hours of cold storage, hepatic enzyme leakage, portal venous pressure, oxygen consumption, total adenine nucleotides (TAN), bile production, lipoperoxide (LPO) release, apoptosis, and histochemical changes were evaluated upon 45 minutes of isolated reperfusion.

RESULTS

Compared with control livers, CGRP-treated organs showed significantly decreased alanine aminotransferase (ALT) and glutamate-lactate dehydrogenase (GLDH) leakage and portal venous pressure (2.0 +/- 0.3 vs 4.0 +/- 0.4 mmHg; P < .01), with significantly increased bile production (8.56 +/- 0.76 vs 3.34 +/- 0.68 microL/g/45 min; P < .01), oxygen consumption (5.14 +/- 0.4 vs 2.57 +/- 0.2 microL/g/min; P < .01), and total adenine nucleotides (TAN) (11.1 +/- 0.71 vs 7.02 +/- 0.53 micromol/g; P < .01) upon reperfusion as signs of recovered viability. We observed infrequent positive terminal deoxynucleotidyl transferase-mediated dUTP biotin nick end labeling (TUNEL) staining, especially in sinusoidal lining cells (SLC). The percentage of TUNEL-positive cells in the CGRP group was significantly decreased compared with the control group: (4.1 +/- 0.67 vs 8.0 +/- 1.27; P < .05). Perfusate levels of low molecular weight (LMW) histone-associated DNA fragments (0.36 +/- 0.04 vs 0.53 +/- 0.06 AU; P < .05) were also decreased, coupled with strong 5'-nucleotidase (5'-NT) and LDH activity staining concentrated on the endothelial cells. LPO release in the perfusate was largely decreased: (0.12 +/- 0.02 vs 0.36 +/- 0.04 nmoL/g, P < .01).

CONCLUSION

CGRP ameliorated liver I/R injury due to reactive oxygen species and apoptosis.

HIV/AIDS-related knowledge, sources and perceived need among senior high school students: a cross-sectional study in China

This study aimed to assess HIV/AIDS-related knowledge, sources and perceived need among senior high school students in China. A total of 2668 senior high school students aged 15.17–23.42 years participated in the survey. A self-administered questionnaire was used to collect information on HIV/sexually transmitted infection-related knowledge, sources and perceived information need. The results showed that levels of HIV/AIDS knowledge were distributed as follows: low for 6.8%, moderate for 29.6% and high for 63.7%. The most important information sources were, in rank order, TV/photographic recording (72.1%), school heath education curriculum (51.8%) and reading materials (45.7%). About half of the students, 46.3%, confirmed a need for more information and 87.8% of the sampled senior high school students communicated with others if he/she had problems related to HIV/AIDS. Strengthening and improving information sources, particularly its accuracy and comprehensiveness, would help in ensuring that adolescents obtained the HIV/AIDS health information they needed.

Survey on the function, structure and operation of hospital ethics committees in Shanghai

OBJECTIVE

The objectives of this study are to understand the current functions, structure and operation of hospital ethics committees (HECs) in Shanghai and to facilitate their improvement.

METHODS

(1) A questionnaire survey, (2) interviews with secretaries and (3) on-site document reviews of HECs in Shanghai were used in the study, which surveyed 33 hospitals.

RESULTS

In Shanghai, 57.56% of the surveyed hospitals established HECs from 1998 to 2005. Most HECs used bioethical review of research involving human subjects as well as bioethical review or consultation regarding medical care services and administrative decision- making. Of the surveyed HECs, 14.3% did not provide any formal bioethical training to the HECs' members and many HECs had no standard operating procedures. Some HECs had no clear definition of what was "conflict of interest" that should be considered by the HECs, while 44.4% of the HECs did not perform continuing review.

DISCUSSION

After the issues of related national regulations, more and more hospitals established HECs in Shanghai, but the functions of HECs need to be further developed and formal training on bioethics should be provided to HEC members. To assure the independence and good performance of HECs, the conflict of interest procedure, the standard operating procedures and bioethical review should be improved.

CONCLUSION

HECs in Shanghai had developed in the preceding 10 years and they played great roles in protecting the rights and welfare of human subjects and patients; some areas need improvement.

Evaluation of thymoquinone (TQ) as an antiproliferative, proapoptotic, and immunomodulatory agent in a non-small cell lung cancer cell (NSCLC) line

e14644

Background: NSCLC is the most common cause of cancer death worldwide. We performed in vitro testing of Thymoquinone (TQ), a derivative of black caraway seed against NSCLC cell line NCI-H460 Methods: Cells were grown in RPMI and were plated at a density of 5,000 cells per well in a 96 well plate and cell growth determined in the presence of 80 and 100μM of TQ dissolved in DMSO with appropriate solvent only as control. Cell proliferation was determined at 24, 48 and 72 hrs intervals using 3-(4,5-dimethyltiazol 2-yl)-2,5-diphenyltetraolium bromide (MTT) assay. Factorial analyses of variance (ANOVA) were used to determine the effect of TQ and control with the time. Student-Newman-Keuls test was used to determine statistical significance with P value <0.05 considered significant. Apoptosis was detected using Annexin V-FITC Aptosis Detection Kit analyzing the effects of TQ at 24 hrs after treatment by flow cytometry. The immunomodulatory effects of TQ were tested using RayBio Human Cytokine Antibody Array C series 200. NCI-H460 cells (50,000 cells per well in duplicate 6 well plates) were grown in serum free RPMI media. 24 hrs after treatment with TQ or DMSO media was collected and analyzed for expression of various cytokines. Results: The MTT assay showed that TQ at 80 and 100 μM significantly inhibited cell growth as compared to control and at 24 hrs for example, 100 μM TQ inhibited cell growth by 78%. Apoptosis occurred rapidly after treatment with TQ with 73.5% of cells being positive for expression of Annexin-V as detected by flow cytometry after 24 hrs of exposure to TQ as compared to 2.6% of controls. The cytokine array revealed that TQ significantly decreased expression of ENA-78(Epithelial neutrophil activating peptide), and GRO (Growth related oncogene).ENA-78 is correlated with vascularity and tumor growth in NSCLC tumor, whereas GRO is associated with neoangiogenesis. Conclusions: TQ is shown to be a powerful anti-proliferative, pro-apoptotic and anti- angiogenic agent in a NSCLC cell line.

No significant financial relationships to disclose.