Likelihood of late relapse assessed by the Breast Cancer Index (BCI) in LN-invasive lobular compared to invasive ductal carcinoma

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Background: Women with HR+ breast cancer remain at risk for late distant recurrences (DR) despite optimal adjuvant therapy. Invasive lobular carcinoma (ILC) is the 2nd most common subtype of invasive breast cancer. When compared to invasive ductal carcinoma (IDC), ILC has distinguishing clinical and pathologic characteristics that may result in different response to therapy and long term prognosis. BCI is a validated gene expression-based assay for pts with early stage HR+ breast cancer that provides risk of late (5-10 y) DR and predicts likelihood of benefit of extended endocrine therapy (EET). Here, we compared BCI assay results in pts with HR+, LN- ILC vs IDC. Methods: The BCI Clinical Database for Correlative Studies is an IRB-approved de-identified database that contains >50 clinicopathologic and molecular variables from cases submitted for BCI in clinical practice (N=14,463). Molecular variables include BCI Prognostic score, HoxB13/IL17BR ratio (H/I), and molecular grade index (MGI). Clinicopathologic variables were abstracted from pathology reports (available for a subset of cases). LN- pts with available pathologic data were analyzed. Chi-squared tests were used to compare BCI results between IDC and ILC subgroups. Results: Analyses included 2554 LN- pts with available histologic subtype data (80.7% IDC; 13.7% ILC; 2.6% mixed; 2.9% other). Median age was 59.3y (range 27-89y; 74% ≥ 50y). BCI Prognostic had a broad distribution of individual risk assessment in both IDC and ILC. However, BCI Prognostic had a lower median BCI scores (P<0.0001) in ILC, and classified a smaller proportion of pts with ILC as high risk for late DR compared to IDC (36.5% vs 53.1%; P<0.0001). IDC had a higher median molecular proliferative status (MGI) compared to ILC (P<0.0001). BCI Predictive (H/I) identified a slightly decreased proportion of pts with ILC benefiting from extended endocrine therapy compared to IDC (38.2% vs 41.1%). There was no difference in quantitative ER or PR (by PCR) between groups. Conclusions: BCI identified a smaller proportion of pts with ILC at high risk of late DR compared to IDC. Further studies evaluating outcomes are warranted to further validate BCI in pts with ILC.

Abstract P3-10-02: Increasing participation in research - breast cancer (Inspire-BrC)

Background: Increasing Black patients' participation in cancer clinical trials is important because of the population's lower survival rate. Accrual for Blacks is the lowest of all groups at 0.5-1.5%. Our study aims to increase trial participation rates among Black breast cancer patients by testing the effectiveness of a culturally tailored video intervention on the decision to participate in a clinical trial.

Methods: We hypothesized that the intervention would increase clinical trial enrollment by 6 percentage points compared to our 2012 enrollment baseline of 6% (22/384). Self- identified Black patients with invasive breast cancer at 5 MedStar Hospitals watched a 15' video about clinical trials, targeting six cultural and attitudinal barriers to participation. The Attitudes and Intention to Enroll in therapeutic clinical Trials (AIET) pre-/post-/follow-up tests with 31 items was used to determine the impact of the video on three domains: actual trial enrollment; likely participation in trials; and attitudes toward trials. The pre-test was conducted at baseline; post-test immediately after video; and follow-up 7-21 days after the intervention. Participants were followed for 6 months to assess trial enrollment status. Descriptive statistics were used to describe study subjects with respect to basic characteristics; means and standard deviations for continuous variables; and frequencies and percentages for categorical variables. Repeated measures analysis of variance was used to examine whether the changes in attitudinal barriers were statistically significant over time. The primary outcome measure was the proportion of Black breast cancer patients who signed consent and/or enrolled in a therapeutic clinical trial.

Results: From Mar/2014 to Sept/2015, 279 patients were approached to join INSPIRE-BrC prior to discussion about therapeutic clinical trials; 52 declined participation. 208 signed consent and 200 completed it. Average age was 59 yrs (SD=12), 75% were stage I-III; 29% were married; 85% had 1 or more children; 29% attended some college or technical school; 53% had private insurance, 31% Medicare, 16% Medicaid; and 53% had a household income &lt;$40,000/yr. A total of 41 INSPIRE-BrC participants (20.5%) signed consent and 29 (14.5%) enrolled onto a therapeutic study (one-sided p=0.027 vs H0: P=0.06). Pre-video, 52% of patients expressed that it was likely they would participate in a hypothetical therapeutic clinical trial; immediately post-video, 67% (p=&lt;0.001) and 7-21 days after the intervention, 64% (p=0.003). Among 31 AIET items, 25 (81%) showed statistically significant and positive change after the intervention. Specifically, trust in the doctor increased and, suspicion in trials decreased (p&lt;0.001). Further, patient views on fairness for treatment of poor people and Blacks became significantly more positive (p&lt;0.001).

Conclusion: Study findings show that the video is a promising tool for rapid dissemination of a theory-driven, evidence-based model to enhance clinical trial accrual among Black cancer patients. The video also has the potential to positively change attitudes about clinical trial participation.

The study was supported by the Breast Cancer Research Foundation.

Citation Format: Swain S, Robinson BN, Newman AF, Tefera E, Herbolsheimer P, Nunes R, Gallagher C, Randolph-Jackson P, Omogbehin A, Dilawari A, Pohlmann P, Mohebtash M, Ottaviano Y, Mohapatra A, Lynce F, Mete M. Increasing participation in research - breast cancer (Inspire-BrC) [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 P3-10-02.

Effects of chronic exposure to benzalkonium chloride in Oncorhynchus mykiss: cholinergic neurotoxicity, oxidative stress, peroxidative damage and genotoxicity

Benzalkonium chloride (BAC) is one of the most used conservatives in pharmaceutical preparations. However, its use is limited to a small set of external use formulations, due to its high toxicity. Benzalkonium chloride effects are related to the potential exertion of deleterious effects, mediated via oxidative stress and through interaction with membrane enzymes, leading to cellular damage. To address the ecotoxicity of this specific compound rainbow trouts were chronically exposed to BAC at environmental relevant concentrations (ranging from 0.100 to 1.050mg/L), and the biological response of cholinergic neurotoxicity, modulation of the antioxidant defense, phase II metabolism, lipid peroxidation and genotoxicity was studied. The obtained results showed a dual pattern of antioxidant response, with significant alterations in catalase activity (starting at 0.180mg/L), and lipid peroxidation, for intermediate (0.180 and 0.324mg/L) concentrations. No significant alterations occurred for glutathione-S-transferases activity. An unexpected increased of the acetylcholinesterase activity was also recorded for the individuals exposed to higher concentrations of BAC (starting at 0.180mg/L). Furthermore, exposure to BAC resulted in the establishment of genotoxic alterations, observable (for the specific case of the comet assay results) for all tested BAC concentrations. However, and considering that the oxidative response was not devisable, other mechanisms may be involved in the genotoxic effects reported here.

REDES DE COLABORAÇÃO EM ENGENHARIA DE BIOSSISTEMAS NO BRASIL

A Engenharia de Biossistemas é uma especialidade entre as engenharias que ainda está se moldando, no Brasil e no exterior. No caso brasileiro, existe um pequeno número de instituições de ensino e/ou pesquisa que reúnem professores/pesquisadores que têm se ocupado com a docência e pesquisa em Engenharia de Biossistemas. Com o objetivo de se determinar como essa moldagem está se processando, aplicou-se à algumas das comunidades de ensino existentes, as técnicas de Análise de Redes Sociais. Para isso, os CVs Lattes (Plataforma Lattes, CNPq) dos membros dessas comunidades, foram utilizados para determinar as parcerias em coautoria na produção de artigos científicos em cada comunidade analisada. Como resultado determinou-se, entre os pesquisadores líderes em cada comunidade, uma significativa dispersão das áreas de pesquisa e também um baixo índice de colaboração interna nas coautorias em cada comunidade estudada.

Molecular Cytotoxic Mechanisms of 1-(3,4,5-Trihydroxyphenyl)-dodecylbenzoate in Human Leukemia Cell Lines

Recent studies have shown that gallic acid and its alkylesters induce apoptosis in different cell lines. Since new compounds with biological activity and less cytotoxicity to normal cells are necessary for cancer therapy, the aim of this study was to evaluate the cytotoxic effect of 1-(3,4,5-trihydroxyphenyl)-dodecylbenzoate on human acute myeloid leukemia K562 cells and on human acute lymphoblastic leukemia Jurkat cells. The cell viability was determined by MTT method. The apoptosis induction was assessed by bromide and acridine orange staining and by Annexin V-FITC Apoptosis Detection kit. The cell cycle analysis was carried out by flow cytometry using propidium iodide. Cytometric analysis was also performed to evaluate the expression of the following proteins: AIF, p53, Bcl-2 and Bax. The mitochondrial potential was also assessed by flow cytometry using MitoView633 kit. The results showed that the compound significantly reduced the cell viability of K562 and Jurkat cells in a concentration and time dependent manner (IC50 of 30 μM). The compound induced cell cycle arrest in G0/G1phase and significantly increased the proportion of cells in the sub-G0/G1phase. Apoptosis was confirmed by the sight of morphological characteristics of apoptosis and by phosphatidylserine externalization (73.47±5.71% of cells expressing annexin). The results also showed that the compound promotes a modification in Bax:Bcl-2 ratio and increases p53 expression. Thus, it is possible to conclude that 1-(3,4,5-trihydroxyphenyl)-dodecylbenzoate induces apoptosis by inhibiting the antiapoptotic protein Bcl-2 and by increasing the release of AIF, Bax and p53. In addition, it blocks the cell cycle at G0/G1, stopping cell proliferation. So far, the results suggest that this compound may have a potential therapeutic effect against leukemia cells.

Abstract P1-03-01: Cardiac function in BRCA1/2 mutation carriers with a history of breast cancer (BC) treated with anthracyclines (anthra)

Introduction: Animal data suggest that cardiac-specific loss of BRCA1/2 genes leads to increased cardiac dysfunction in the setting of stressors such as ischemia or anthra chemotherapy (CT). Women with BRCA1/2 mutations who develop BC may receive anthra-based CT. It is not known whether BRCA1/2 mutation carriers treated for early stage BC with anthra-based CT are at higher risk for anthra-induced cardiac toxicity than similarly treated women with sporadic BC. This study investigates left ventricular ejection fraction (LVEF) and myocardial global longitudinal strain (GLS), a novel echocardiographic measure of cardiac contractility, in women with and without BRCA1/2 mutations who were treated with anthra-based CT.

Methods: We identified 41 women with a history of BRCA1/2 mutation-associated BC and 52 women with a history of sporadic BC, all of whom received anthra-based adjuvant or neoadjuvant CT. We excluded women who received HER2 therapy or who had stage IV disease. BC CT was completed at least 6 months prior to study enrollment. All participants completed a cardiac questionnaire and underwent a comprehensive 2D and 3D echocardiographic exam with assessment of myocardial GLS using speckle-tracking software (QLAB10, Philips, Andover, MA). Abnormal LVEF was defined as less than 55% (50-54.9% borderline reduced and 40-49% mildly reduced) and abnormal GLS was defined as absolute value of less than 18.9%. Patients with history of hypertension (HTN) were excluded from this analysis to avoid confounding effects of HTN on GLS.

Results: We present data on 57 normotensive participants, 34 BRCA1/2 mutation-carriers and 23 non-mutation carriers. Mean age was 49.5 +/- 8.7 years in the BRCA mutation-carrier group and 51.1 +/- 8.7 years in the non-mutation carrier group (p=0.496). Women with BRCA1/2 mutations were more likely to be Caucasian (p=0.026) and have undergone oophorectomy (p&lt;0.001). The average time from anthra treatment to study enrollment was 5 +/- 4.4 years. Groups were well balanced with regards to age, diabetes, hyperlipidemia, history of coronary disease, smoking and cumulative dose of anthra. Four BRCA1/2 mutation-carriers (12%) and 4 non-mutation carriers (17%) had reduced GLS (p= 0.450). Mean LVEF was similar between the groups: LVEF was borderline reduced in one BRCA1/2 mutation-carrier (3%) and borderline or mildly reduced in 4 non-mutation carriers (18%)(p= 0.091).

Conclusions: In this population, reduced LVEF and myocardial GLS were present in a small percentage of women treated with anthra-based CT for early stage BC. However, reduction in LVEF and myocardial GLS did not differ between the BRCA1/2 mutation carriers and the women with a history of sporadic BC. Larger studies are needed to definitively rule out a difference in cardiac toxicity by BRCA mutation status in BC survivors treated with anthra. This project is supported by Fisher Center for Familial Cancer Research Award at Lombardi Comprehensive Cancer Center. AB is supported by Georgetown-Howard Universities Center for Clinical & Translational Science (GHUCCTS) post-doctoral KL2 Award (5KL2TR000102-04).

Citation Format: Filipa Lynce, Ana Barac, Karen L Smith, Mihriye Mete, Lynette Wray, Madeline Nardacci, Pia Herbolsheimer, Raquel Nunes, Sandra M Swain, Robert Warren, Claudine Isaacs. Cardiac function in BRCA1/2 mutation carriers with a history of breast cancer (BC) treated with anthracyclines (anthra) [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-03-01.

Abstract OT1-1-12: SAFE-HEaRt: A pilot study assessing the cardiac SAFEty of HER2 targeted therapy in patients with HER2 positive breast cancer and reduced left ventricular function

Background: Substantial benefit of trastuzumab is associated with cardiac side effects, mostly asymptomatic. According to current FDA approved package insert, patients should not receive trastuzumab or newer HER2 targeted therapies if there is evidence of cardiomyopathy.

Trial design: SAFE-HEaRt is a pilot study evaluating the cardiac safety of trastuzumab, pertuzumab and ado-trastuzumab emtansine in 30 patients with HER2 positive breast cancer (BC) and mild LV dysfunction (LVEF≥40% and &lt;50%) while on optimized cardiac therapy with B-Blockers and ACE inhibitors. Left ventricular ejection fraction (LVEF) and myocardial strain will be assessed at baseline, week 6,12,18 and then every 12 weeks. Troponin I (cTnI) and high-sensitivity cardiac troponin T (hs-cTnT) will be collected at the same time points.

Main Eligibility criteria: Patients diagnosed with stage I-IV HER2 positive BC; LVEF≥40% and &lt;50% prior to or while receiving non-lapatinib HER2 targeted therapy.

Specific aims: The primary endpoint is the proportion of patients who complete planned oncologic therapy without the development of a cardiac event (presence of symptoms attributable to heart failure (HF) confirmed by a cardiologist, cardiac arrhythmia requiring pharmacological or electrical treatment, myocardial infarction, sudden cardiac death or death due to myocardial infarct, arrhythmia or HF) or asymptomatic worsening of cardiac function (i.e. asymptomatic decline in LVEF &gt;10% points from baseline and/or LVEF&lt;35% corroborated by a confirmatory echocardiogram in 2-4 weeks).

Additional endpoints include: Median time to development of an event; absolute changes in LVEF during HER2 targeted therapy; HER2 therapy holds attributed to cardiotoxicity; correlation of myocardial strain and serum biomarkers with cardiac events and asymptomatic worsening of cardiac function.

Statistical methods: A two-stage design is used to test if the completion rate of planned oncologic therapy will be at least 30% versus less than 10% with 80% power at a significance level of 5%. At the first stage, 15 patients will be entered. If one or more patients complete therapy in the absence of a cardiac event, then additional 15 patients will be enrolled in the second stage. Early stopping rules are incorporated for safety based on cardiac death and symptomatic HF. Safety monitoring plan consists of an internal cardiac review panel and a Data Safety Monitoring Board (DSMB) that includes an external cardiologist expert.

Present accrual and target accrual: The Institutional Review Board has approved the study. Enrollment of the first patient is expected in July 2013 with a total of 30 patients planned to be recruited. The initial recruitment sites are MedStar Washington Hospital Center and MedStar Georgetown University Hospital. This trial is partially supported by Genentech and funded by a Conquer Cancer Foundation of ASCO Young Investigator Award, supported by The Breast Cancer Research Foundation. Any opinions, findings, and conclusions expressed in this material are those of the author(s) and do not necessarily reflect those of the American Society of Clinical Oncology, the Conquer Cancer Foundation, or The Breast Cancer Research Foundation.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-1-12.

Genomic profiling of breast cancer in African-American women

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Background: Molecular profiling of breast cancer (BC) identifies intrinsic subtypes with distinct gene expression and clinical characteristics. In the US, BC is less frequent in African-American females (AAF); however mortality is higher, particularly among younger women. Unfavorable subtypes of BC seem to be more frequent in premenopausal AAF. Methods: Tumor gene expression in AAF presenting with early stage or locally advanced BC was performed using the Symphony platform on fresh and paraffin-embedded tissue (Agendia inc), a microarray-based method which classifies tumors according to prognosis (MammaPrint, MP), molecular subtype (BluePrint, BP) and estrogen receptor (ER), progesterone receptor (PR) and Human Epidermal Growth Factor Receptor 2 (HER2) mRNA levels (TargetPrint, TP). Genomic information is correlated with clinical and pathologic characteristics and Oncotype DX recurrence score (RS) when available. We plan to enroll 100 patients. Results: Results available in 46 patients. Median age 62 years (range 24-100), 20 stage I, 15 stage II, 11 stage III disease. There was no significant association between MP risk and stage, but MP risk was significantly associated with grade 3 disease (p=.006). 9 cancers were triple negative by IHC; using BP, 8 of these were Basal-type and 1 HER2-type. Basal-type was the most common subtype in patients ≤ 40 years old (p < .001). In the 6 cases ER positive by IHC but negative by TP, 3 were Basal-type and 3 were HER2-type.14 patients had Oncotype RS results available: 2 were High Risk by Oncotype and MP; 3 had intermediate RS, 2 of which were High Risk by MP; 9 had a low RS, 4 of which were High Risk by MP. Conclusions: African-American women with stage I to III BC often present with High-Risk disease irrespective of stage. BP classified all young patients (≤40) as Basal-type. Molecular subtyping confirmed the biologic heterogeneity in triple negative and hormone positive tumors. Oncotype RS and MP offered different prognostic information. Follow up will be needed to determine correlation with outcome. Funding: MP, BP and TP test provided by Agendia. Biostatistical support by GHUTTCS-CTSA. [Table: see text]

Reporting of ethical committee approval and patient consent in the Portuguese Journal of Pulmonology and in the other Portuguese medical journals with impact factor

INTRODUCTION

Reporting of ethical committee (EC) approval and patient consent in publications involving human subjects may be lower than recommended. In this paper this ethical issue was analysed in the Portuguese Journal of Pulmonology and in the other two Portuguese medical journals with impact factor indexed in the ISI Web of Knowledge.

METHODS

Reporting of EC approval and patient consent was searched in all publications involving human subjects published in the Acta Médica Portuguesa, Acta Reumatológica Portuguesa and Portuguese Journal of Pulmonology, from the 1(st) July 2010 until the 30(th) June 2011. The search also looked for the involvement of vulnerable and potentially identifiable subjects.

RESULTS

Most of the analysed publications, which included a considerable proportion of vulnerable (23%) and of potentially identifiable case reports (14%), were case reports (49%). Overall EC approval ranged from 0% to 28%, in case reports and prospective studies, respectively, whereas overall patient consent ranged from 0% to 26%. There were not statistically significant differences in results among the selected journals.

CONCLUSIONS

Reporting of EC approval and patient consent in the three leading Portuguese medical journals has been lower than in their leading world counterparts. This should be taken into account and further audited in future, not only for the protection of the research subjects but also to maintain public trust in the process.

T cell receptor excision circles (TREC) and recent thymic migrant cells in specific immunotherapy and respiratory allergy to Dermatophagoides pteronyssinus

INTRODUCTION

T cell receptor excision circles (TREC) on CD31+ T cells are related to recent thymic emigrant cells (RTEs). The involvement of the functional thymic tissue occurs early in the IgE-mediated allergic reaction, and in response to specific immunotherapy (SIT).

AIM

Evaluation of specific immunotherapy effects on TREC number in peripheral T cells in patients allergic to Dermatophagoides pteronyssinus (Dpt).

METHOD

85 respiratory allergic patients (both genders), 41 of them (Group II) under maintenance treatment to Dpt SIT (21 sublingual-SLIT, and 20 subcutaneous-SCIT), were selected. The allergic patients (Group I) without specific treatment were submitted to an allergen challenge test (22 nasal and 22 conjunctival). Peripheral cell analysis was performed immediately before treatment and 60 or 240 minutes after allergenic extract administration. TREC quantification was performed in CD4+CD31+ and CD8+CD31+. The results were expressed per 100.000 cells related to RTEs. Samples from 10 healthy individuals (Control - Group III) were obtained with the same method.

RESULTS

The value of TRECs on RTEs was constant in control groups. For Group I patients (nasal or conjunctival test), TREC quantification in CD31+ T cells showed relevant individual changes, even in the patients tested earlier (60 minutes), and statistical significant at 240 minutes. Both SCIT and SLIT had also demonstrated enormous individual changes, particularly on TRECs/CD4+CD31+ cells assay. Basal values in Group III were significantly higher than those observed in active patients groups.

CONCLUSION

Thymic functional activity is earlier involved in the allergic reaction and SIT IgE-mediated allergy is able to induce RTEs in the periphery, particularly TRECs/CD4+CD31+ cells. Both SLIT and SCIT showed reduced RETs in the periphery, probably due to maturation of regulatory T cells. Our results suggest a crucial role of the functional thymic tissue on the central mechanism of this therapy.

Epidemiological study of myiases in the Hospital do Andaraí, Rio de Janeiro, including reference to an exotic etiological agent

Myiases are infestations with dipteran larvae in both necrosed and living tissues, the food source of these insects. These illnesses occur in warm humid climates, and are most frequent in developing countries. We assessed the epidemiological aspects and the influence of climate on the occurrence of myiases and the bioagents in patients admitted to the federal Hospital do Andaraí in Rio de Janeiro from February 2007 to 2008. The influence of abiotic factors (temperature, humidity, and rainfall) on the incidence of myiases was investigated by using the Pearson's correlation test. Of the 40 patients studied, the prevalence of myiases was higher in adults, particularly in the 40 to 65 year-old (37.5%) African descent males (57.5%). Most of the injuries were caused by trauma (62.5%). Some patients made use of licit (50%) and illicit drugs (17.2%). The occurrence of myiases was not affected by the abiotic factors investigated. The cases reported here were treated in only one hospital, indicating that the disease is relatively common. The most frequent bioagent was Cochliomyia hominivorax (Coquerel), but Cochliomyia macellaria (Fabricius), Chrysomya albiceps (Wiedemann) and Dermatobia hominis (Wiedemann) (Diptera: Calliphoridae) were also detected causing myiases. Chrysomya albiceps is an exotic etiologic agent of myiases.

Ethical issues related to professional exposure of pregnant women in the medical field: monitoring and limiting effective dose

The International Commission on Radiological Protection recommendations for occupational exposed pregnant women do not imply necessarily the complete avoidance of work with radiation or radioactive materials. Instead, a careful review of the exposure conditions, once the pregnancy is declared, as part of the exercise of the ICRP optimisation principle (based in a teleological ethics point of view) is suggested. The dose limitation (following a deontological ethics point of view) of the fetus/embryo is, however, not clearly well established as happens in the case of workers or members of the public. Also, the justification of practices (to continue to work or not with radiation or radioactive materials) is not clearly addressed in most national or international recommendations. An analysis of this justification (bearing in mind both teleological and deontological ethics) is examined in this work having in mind the best interest of the child-to-be as well as other existing social and economical factors.

Spray-Deposited Metal Oxide Films with Various Properties for Micro- and Optoelectronic Applications: Growth and Characterization

This work reports the structure and electro-optical characteristics of different metal oxide films obtained by spray pyrolysis on heated glass substrates, aiming their application in optoelectronic devices. The results show that this technique leads to thin films with properties ranging from dielectric to degenerate semiconductors, offering the following advantages: simplicity, low cost, high productivity and the possibility of covering large areas, highly important for large area device applications.

Can we improve gait skills in chronic hemiplegics? A randomised control trial with gait trainer

AIM

Partial body weight support (PBWS) is an accepted treatment for hemiplegic patients. The aim of this study is to compare the efficiency of gait trainer with conventional treatment on the gait management after stroke.

METHODS

Forty chronic post-stroke hemiplegics were part of a prospective research. Inclusion criteria were: first ever stroke in a chronic stage with stabilised motor deficits; age >18 and <80 years; cognitive and communication skills to understand the treatment; absence of cardiac, psychological and orthopedic contraindications. Patients were randomised into two groups: the control group (CG) that used the Bobath method in 40 minutes sessions, 5 times a week, for 5 weeks, and the experimental group (EG) that used the gait trainer, for the same period of time and frequency. Assessment tools: Motricity Index (MI); Toulouse Motor Scale (TMS); modified Ashworth Spasticity Scale (mASS); Berg Balance Scale (BBS); Rivermead Mobility Index (RMI); Fugl-Meyer Stroke Scale (F-MSS); Functional Ambulation Category (FAC); Barthel Index (BI); 10 meters, time up and go (TUG), 6 minutes, and step tests. EG and CG did the assessments before treatment (T(0)), right after treatment (T(1)), and on follow-up, 3 months later (T(2)).

RESULTS

CG and EG were homogenous in all the variables at T(0). CG and EG showed improvement in almost all the assessment scales after treatment, although only some with relevant differences. EG showed statistically relevant improvement on T(1) and on T(2) in several of the assessment tools, whereas CG only showed statistically significant improvement after T(1) and only in some of the assessment tools.

CONCLUSIONS

Both groups of chronic hemiplegic patients improved after either PBWS with gait trainer or Bobath treatment. Only subjects undergoing PBWS with gait trainer maintained functional gain after 3 months.

A clinical-scale selective allodepletion approach for the treatment of HLA-mismatched and matched donor-recipient pairs using expanded T lymphocytes as antigen-presenting cells and a TH9402-based photodepletion technique

Selective allodepletion is a strategy to eliminate host-reactive donor T cells from hematopoietic stem cell allografts to prevent graft-versus-host disease while conserving useful donor immune functions. To overcome fluctuations in activation-based surface marker expression and achieve a more consistent and effective allodepletion, we investigated a photodepletion process targeting activation-based changes in p-glycoprotein that result in an altered efflux of the photosensitizer TH9402. Expanded lymphocytes, generated using anti-CD3 and IL-2, were cocultured with responder cells from HLA-matched or -mismatched donors. Optimal results were achieved when cocultured cells were incubated with 7.5 muM TH9402, followed by dye extrusion and exposure to 5 Joule/cm(2) light energy at 5 x 10(6) cells/mL. In mismatched stimulator-responder pairs, the median reduction of alloreactivity was 474-fold (range, 43-fold to 864-fold) compared with the unmanipulated responder. Third-party responses were maintained with a median 1.4-fold (range, 0.9-fold to 3.3-fold) reduction. In matched pairs, alloreactive helper T-lymphocyte precursors were reduced to lower than 1:100 000, while third-party responses remained higher than 1:10 000. This establishes a clinical-scale process capable of highly efficient, reproducible, selective removal of alloreactive lymphocytes from lymphocyte transplant products performed under current Good Manufacturing Practice. This procedure is currently being investigated in a clinical trial of allotransplantation.

Reconstitution of FOXP3+ regulatory T cells (Tregs) after CD25-depleted allotransplantation in elderly patients and association with acute graft-versus-host disease

Selective depletion (SD) of host-reactive donor T cells from allogeneic stem-cell transplants (SCTs) using an anti-CD25 immunotoxin (IT) is a strategy to prevent acute graft-versus-host disease (aGvHD). There is concern that concurrent removal of regulatory T cells (T(regs)) with incomplete removal of alloactivated CD25(+) T cells could increase the risk of aGvHD. We therefore measured T(regs) in the blood of 16 patients receiving a T-cell-depleted allograft together with anti-CD25-IT-treated SD lymphocytes, in 13 of their HLA-identical donors, and in 10 SD products. T(regs) were characterized by intracellular staining for forkhead box protein 3 (FOXP3) and by quantitative reverse-transcription-polymerase chain reaction (qRT-PCR) for FOXP3 gene in CD4(+) cells. Patients received a median of 1.0 x 10(8)/kg SD T cells and a stem cell product containing a median of 0.25 x 10(4)/kg residual T cells. T(regs) reconstituted promptly after SCT and underwent further expansion. Of the CD4(+) T cells in SD products, 1.5% to 4.8% were CD25(-) T(regs). Acute GvHD (>or= grade II) was restricted to 5 patients whose donors had significantly (P = .019) fewer T(regs) compared with those without clinically significant aGvHD. These results suggest that rapid T(reg) reconstitution can occur following SD allografts, either from CD25(-) T(regs) escaping depletion, or from residual CD25(-) and CD25(+) T(regs) contained in the stem-cell product that expand after transplantation and may confer additional protection against GvHD.

Endoscopic sphincterotomy for prevention of the recurrence of acute biliary pancreatitis in patients with gallbladder in situ: long-term follow-up of 88 patients

BACKGROUND

Endoscopic sphincterotomy without cholecystectomy is a therapeutic option in selected patients after acute biliary pancreatitis. We conducted a prospective evaluation of the long-term effects of sphincterotomy in terms of the need for of subsequent cholecystectomy and the recurrence of gallstone pancreatitis.

METHODS

We studied 88 patients with acute biliary pancreatitis and an intact gallbladder who, underwent endoscopic sphincterotomy either because they were high-risk candidates for surgery or because they had refused of cholecystectomy. The median follow-up was 51 months (range, 5-86).

RESULTS

Only two patients (2.2%) experienced recurrent pancreatitis. Subsequent cholecystectomy was performed in 10 patients because of acute cholecystitis in eight cases and biliary colic in two cases. Sixty-six patients (75%) remained asymptomatic.

CONCLUSIONS

Endoscopic sphincterotomy is a safe and acceptable alternative to cholecystectomy for the prevention of recurring attacks of gallstone pancreatitis. As a result of this procedure, 75% of patients remained free of symptoms in the long term.

Ethical and legal issues in xenotransplantation

In most western countries, there is a 'human organ shortage' with waiting lists for the performance of transplantation. In a recent report of the UNOS Ethics Committee it is stated that there are approximately 31,000 potential recipients on waiting lists, but only one fourth of potential donors give their specific consent. Xenotransplantation--defined as the transplantation of animal cells, tissues or organs into human beings--is associated with particular ethical dilemmas, namely the problems of efficiency and safety of this medical procedure. The objective of this study is to analyse the ethical dilemmas in xenotransplantation with the background of a personal view of moral life. Also, xenotransplantation will be evaluated as far as the legal regulation of transplantation is concerned. In particular, we will consider patients rights in accordance with existing laws on organ and tissue transplantation, animal research and clinical trials.

Phaeohyphomycotic cyst caused by Colletotrichum crassipes

A case of phaeohyphomycosis is reported in a male renal transplant recipient with a nodular lesion in the right leg who was treated with immunosuppressing drugs. The lesion consisted of a purulent cyst with thick walls. The cyst was excised surgically, and the patient did not receive any antifungal therapy. One year later he remains well. Histological study of the lesion showed a granulomatous reaction of epithelioid and multinucleate giant cells, with a central area of necrosis and pus. Fontana-Masson staining demonstrated the presence of pigmented hyphal elements. The fungus Colletotrichum crassipes was grown in different cultures from the cyst. The in vitro inhibitory activities of eight antifungal drugs against the isolate were tested. Clotrimazole and UR-9825 were the most active drugs. This case represents the first known reported infection caused by this rare species.

Ethical dimension of paediatric cochlear implantation

In congenitally or prelingually deaf children cochlear implantation is open to serious ethical challenge. The ethical dimension of this technology is closely related to both a social standard of quality of life and to the uncertainty of the overall results of cochlear implantation. Uncertainty with regards the acquisition of oral communicative skills. However, in the western world, available data suggest that deafness is associated with the lowest educational level and the lowest family income. Notwithstanding the existence of a Deaf-World, deafness should be considered as a handicap. Therefore, society should provide the means for the fulfilment of a deaf child's specific needs. For the time being there is no definitive answer with regard the best way to rehabilitate a particular deaf child. Therefore, communitarian values may be acceptable. If the deaf child parents' decide not to implant, their decision should be respected. Guardians are entitled to determine which standard of best interest to use in a specific circumstance. They are the proper judges of what (re)habilitation process is best for their deaf child. However, most deaf children are born to two hearing parents. Probably, they will not be acculturated in the Deaf-World. It follows that cochlear implantation is a welcomed (re)habilitation technology. If auditory (re)habilitation will in the future provide the necessary communicative skills, in particular oral language acquisition, customs, values and attitudes of the hearing world should be regarded as necessary to accomplish a deaf child's right to an open future. If cochlear implantation technology will provide all deaf children with the capacity to develop acceptable oral communicative skills--whatever the hearing status of the family and the cultural environment--then auditory (re)habilitation will be an ethical imperative.

PD-L2 is a second ligand for PD-1 and inhibits T cell activation

Programmed death I (PD-I)-deficient mice develop a variety of autoimmune-like diseases, which suggests that this immunoinhibitory receptor plays an important role in tolerance. We identify here PD-1 ligand 2 (PD-L2) as a second ligand for PD-1 and compare the function and expression of PD-L1 and PD-L2. Engagement of PD-1 by PD-L2 dramatically inhibits T cell receptor (TCR)-mediated proliferation and cytokine production by CD4+ T cells. At low antigen concentrations, PD-L2-PD-1 interactions inhibit strong B7-CD28 signals. In contrast, at high antigen concentrations, PD-L2-PD-1 interactions reduce cytokine production but do not inhibit T cell proliferation. PD-L-PD-1 interactions lead to cell cycle arrest in G0/G1 but do not increase cell death. In addition, ligation of PD-1 + TCR leads to rapid phosphorylation of SHP-2, as compared to TCR ligation alone. PD-L expression was up-regulated on antigen-presenting cells by interferon gamma treatment and was also present on some normal tissues and tumor cell lines. Taken together, these studies show overlapping functions of PD-L1 and PD-L2 and indicate a key role for the PD-L-PD-1 pathway in regulatingT cell responses.

Multicenter evaluation of resistance patterns of Klebsiella pneumoniae, Escherichia coli, Salmonella spp and Shigella spp isolated from clinical specimens in Brazil: RESISTNET Surveillance Program

Surveillance programs are essential to detect the increase of antimicrobial resistance, and several different programs are being conducted in many countries. The RESISTNET is a surveillance program for bacterial resistance against several antimicrobial agents initiated in 1998 among Latin American countries. In Brazil, several centers were invited to join this surveillance and a total of 11 centers (6 from São Paulo and 5 from other states) participated in the study. All results were analyzed using the WHONET program. A total of 894 Escherichia coli, 386 Klebsiella pneumoniae, 70 Shigella spp and 57 Salmonella spp strains were analyzed in this study from April, 1998, to April, 1999. Susceptibility testing was performed by the disk diffusion method using NCCLS 1998 guidelines for several different drugs. For all strains, imipenem was the most effective drug (100% of the strains were susceptible). Klebsiella pneumoniae presented a high resistance rate to ampicillin (96.4%). The rate of probable ESBL producers among K. pneumoniae strains was 36.3%, most of them being isolated from catheters (58.8%). Among all Escherichia coli strains analyzed, the highest resistance rate was found for trimethoprim/sulfamethoxazole (46.9%) and the majority of the resistant strains were isolated from urine samples (47.8%). Among Salmonella spp, the resistance rates were low for all antibiotics tested. For Shigella spp strains there was a high resistance to trimethoprim/sulfamethoxazole (80.0%). No resistance to ceftriaxone was observed in these strains. Surveillance of antimicrobial resistance is critical for the successful management of infectious diseases. The results of this survey show significant resistance rates among these bacteria which are responsible for several types of human infections.

Metabolism of 3-(13)C-malate in primary cultures of mouse astrocytes

Malate, specifically labeled with carbon 13 on C(3), was synthesized by chemical means and used to study malate metabolism by primary cultures of mouse cortical astrocytes. 3-(13)C-Malate in combination with glucose as well as 3-(13)C-malate alone were used as substrates; the effect of 3-nitropropionic acid, an inhibitor of succinate dehydrogenase and fumarase was also examined. The consumption of malate was only 0.26 micromol/mg of protein, approx. 25-fold lower than the consumption of glucose. Besides lactate, glutamine and fumarate were the two major metabolites released to the medium. Very low and similar levels of isotopic enrichment were detected on C(2) and C(3) of lactate; glutamine was labeled on C(2) and C(3) to a similar extent as well and labeling on C(4) was only detected when glucose was not added. These labeling studies suggest that cytosolic malic enzyme is not active in primary astrocytes and support the occurrence of pyruvate recycling in astrocytes.

Efficacy of the nocturnal bite plate in the control of bruxism for 3 to 5 year old children

Bruxism occurs in nearly 60% of children between 3 and 5 years, with important repercussions to the different components of the stomatognathic system. Nevertheless, there is little information in the literature about this topic. The aim of this study was to compare two groups of children with bruxism. One group was not submitted to treatment, serving as a control. To the other group, nocturnal bite plate was made. Cast models were made for both groups, to evaluate the progression of wear facets, during 8 months. The results are as follows: The 4 children of the control group displayed increased wear facets during the study period. On the other hand, of the 5 children that used nocturnal bite plate, showed no increase of wear facets, even after the removal of the device. From this study, we can conclude that the use of nocturnal bite plate is efficient against bruxism in 3- to 5-year-old children.

Cardiac papillary fibroelastoma of a mitral valve chordae revealed by stroke

We report the case of a young male patient referred to our hospital after having a stroke due to a papillary fibroelastoma arising from a mitral valve chorda. The tumor was identified by two-dimensional echocardiography and was treated by surgery with preservation of valve integrity. Cardiac papillary fibroelastoma as an uncommon source of cerebral emboli is discussed.

[Systemic vasculitis as the initial presentation of a left atrial myxoma]

Left atrial myxoma remains a diagnostic challenge. The authors briefly review previously reported cases and their individualistic clinical and laboratory features. This report documents an unusual clinical presentation, initially directing attention to the central nervous system as well as bilateral tenderness and weakness of the extremities. The illness was considered to be a vasculitis until thirty-one months later when the diagnosis of left atrial myxoma was made. The tumor was successfully removed.