Distinguishing metal bioconcentration from particulate matter in moss tissue: testing methods of removing particles attached to the moss surface

Accurate differentiation of the proportion of bioconcentrated metals (i.e. incorporated into cells) and the proportion that is not bioconcentrated (i.e. adsorbed at the surface) would lead to a better understanding of the uptake processes and would represent an advance in the use of mosses as biomonitors. Traditionally the methods used to remove contaminants that are not bioconcentrated were to wash the plant material with water or to apply the sequential elution technique, but nowadays both options are considered inaccurate for these purposes. The remaining possibilities are to clean the moss samples with a nitrogen jet or by power ultrasound. Samples of terrestrial moss Pseudoscleropodium purum (Hewd.) Fleisch. were collected from five sampling stations. Different nitrogen jet cleaning procedures and ultrasound cleaning procedures were applied to the mosses. To determine whether any of the treatments altered the membrane integrity of the moss samples, the concentrations of K were determined. The shoots were observed under a scanning electron microscope, and the size and number of particles were determined. Nitrogen jet cleaning was determined to be unacceptable because it damaged the phyllids and/or altered the membrane permeability and did not eliminate the particles from the moss surface. Moreover, ultrasound cleaning treatment should also discarded because of the loss of extracellular metals that are transferred to the water in which the moss is cleaned.

Improved biomonitoring of airborne contaminants by combined use of holm oak leaves and epiphytic moss

Concentrations of 12 elements (Ca, Cd, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, Pb and Zn) and 16 EPA-listed PAHs were detected in Quercus ilex leaves and the epiphytic moss Leptodon smithii collected at urban, periurban and extraurban holm oak stands, in two Italian Regions (Campania and Tuscany). Levels of environmental contaminants were generally higher in leaves and moss from urban areas than periurban and extraurban ones and samples from Campania had the highest PAH content. The epiphytic moss accumulated higher concentrations of trace elements than leaves and the latter showed a higher accumulation capability for PAHs, especially for those with low molecular weight. The different bioaccumulation in leaves and moss were explained in terms of their distinctive morphological and ecophysiological characteristics. The combined approach seems a promising tool for the monitoring of a wide range of pollutants in Mediterranean urban and extraurban environments.

Daptomycin in the treatment of invasive Gram-positive bacterial infections in children: personal experience

AIM

The emergence and dissemination of antimicrobial resistance among Gram-positive pathogens has become troublesome for pediatric patients. Daptomycin is a first-in-its-class cyclic lipopeptide, which can be useful for treatment of these infections in children, but clinical experience is lacking.

METHODS

Retrospective review of medical records of seven hospitalized children who received daptomycin for treatment of invasive Gram-positive bacterial infections at Children's Cardiosurgery of AORNAS Civico-Di Cristina-Benfratelli, Palermo (Italy), from December 2009 to September 2010. Six patients had a congenital cardiomyopathy; only one patient had not any underlying comorbid condition. Bacterial isolates were tested for susceptibility to daptomycin by gradient diffusion method (E-test, Biomerieux).

RESULTS

Seven children received daptomycin. All these children had invasive disease and only one of them was not receiving care in our Intensive Care Unit. Organisms isolated were 2 S. aureus methicillin-resistant; 4 S. Epidermidis methicillin-resistant and 1 E. faecium. Six infections were bloodstream infections and one was a complicated skin and soft tissue infection. All these infections had failed standard empirical antimicrobial therapy and had persistently positive blood cultures and/or fever prior to initiation of daptomycin. Outcomes after the initiation of daptomycin included clearance of blood cultures and defervescence within 72 hours. No drug related adverse events were documented.

CONCLUSION

All our patients improved but two patients died of complications of their pre-existing pathology. Further studies are necessary to assess the pharmacological characteristics, safety and effectiveness of daptomycin in children, but it seems to be promising antimicrobial agent in pediatric patients.

Accumulation of airborne trace elements in mosses, lichens and synthetic materials exposed at urban monitoring stations: towards a harmonisation of the moss-bag technique

Mosses, lichens and cellulose filters were exposed for 17 weeks at four urban monitoring stations in Naples (S Italy) to assess the accumulation of airborne Al, As, Ba, Ca, Cd, Co, Cr, Cu, Fe, Hg, K, Mg, Mn, Mo, Ni, Pb, Ti, V, and Zn. In each site, the element accumulation was significantly higher in the moss Hypnum cupressiforme than in the lichen Pseudevernia furfuracea. Acid washed mosses accumulated the highest amount of trace elements, but the differences in element concentrations among the moss samples exposed after water washing and different devitalisation treatments (acid washing, oven drying and water boiling) and between the lichen samples exposed with and without the nylon bag were not statistically significant. The cellulose filters showed the lowest accumulation capability. The reciprocal ordination of sites and exposed materials showed an increasing contamination gradient (especially for Pb, Cu and Zn) from the background site to the trafficked city streets; this pattern was undetectable from PM(10) data recorded by the automatic monitoring devices operating in the four exposure sites. The element profile in exposed materials did not change substantially throughout the urban area and particles of polluted urban soils seem the main source of airborne metals in Naples. Through a comprehensive evaluation of the results from this and previous studies, a protocol is suggested for the moss-bag monitoring of trace element deposition in urban environments.

Sequential analysis of multistage hepatocarcinogenesis reveals that miR-100 and PLK1 dysregulation is an early event maintained along tumor progression

MicroRNAs (miRNAs) have an important role in a wide range of physiological and pathological processes, and their dysregulation has been reported to affect the development and progression of cancers, including hepatocellular carcinoma (HCC). However, in the plethora of dysregulated miRNAs, it is largely unknown which of them have a causative role in the hepatocarcinogenic process. In the present study, we first aimed to determine changes in the expression profile of miRNAs in human HCCs and to compare them with liver tumors generated in a rat model of chemically induced HCC. We found that members of the miR-100 family (miR-100, miR-99a) were downregulated in human HCCs; a similar downregulation was also observed in rat HCCs. Their reduction was paralleled by an increased expression of polo like kinase 1 (PLK1), a target of these miRNAs. The introduction of miR-100 in HCC cells impaired their growth ability and their capability to form colonies in soft agar. Next, we aimed at investigating, in the same animal model, if dysregulation of miR-100 and PLK1 is an early or late event along the multistep process of hepatocarcinogenesis. The obtained results showed that miR-100 downregulation (i) is already evident in very early preneoplastic lesions generated 9 weeks after carcinogenic treatment; (ii) is also observed in adenomas and early HCCs; and (iii) is not simply a marker of proliferating hepatocytes. To our knowledge, this is the first work unveiling the role of a miRNA family along HCC progression.

Moss bag biomonitoring: a methodological review

Although the moss bag technique has been used for active biomonitoring for the past 40years, there is still no standardized protocol that enables application of the technique as a tool to monitor air quality. The aim of this review paper is to evaluate the degree of standardization of each of the variables that must be considered in applying the technique (i.e. the variables associated with preparation of the moss and moss bags, exposure of the bags, and post-exposure treatment). For this purpose, 112 scientific papers that report the methods used in applying the moss bag technique were consulted. Finally, on the basis of the conclusions reached, we propose a protocol that will enable each of these variables to be investigated separately, with the final aim of developing a standardized methodology.

Adherence to recommendations for fall prevention significantly affects the risk of falling after hip fracture: post-hoc analyses of a quasi-randomized controlled trial

BACKGROUND

Few studies focused on fall prevention in hip-fracture survivors.

AIM

To investigate the role of adherence to targeted recommendations on both home environment and behaviors in affecting the hazard of falling after a fall-related hip fracture.

DESIGN

Post-hoc analysis of a quasi-randomized controlled trial.

SETTING

Post-acute rehabilitation hospital.

POPULATION

Ninety-five of 119 women living in the community with a fall-related fracture of the hip.

METHODS

We assessed home hazard of falling and suggested targeted modifications of home environment and behaviors in activities of daily living to prevent falls during inpatient rehabilitation. Falls were recorded at a six-month follow-up during a pre-planned home visit.

RESULTS

Nineteen of the 95 women sustained at least one fall during the six-month follow-up. Women with > 2 uncorrected risk factors had a significantly higher risk of falling than those with 0-2 risk factors; the odds ratio adjusted for four confounders was 4.58 (95%CI 1.472-4.250; P=0.009). Adherence to recommendations for fall prevention was negatively associated with fall risk. The adjusted odds ratio for a ten percent increase in adherence rate was 0.749 (95%CI 0.594-0.945; P=0.015).

CONCLUSION

Uncorrected environmental and behavioral risk factors and poor adherence to targeted recommendations for fall prevention significantly predicted the risk of falling in community-dwelling women who sustained a fall-related hip fracture.

CLINICAL REHABILITATION IMPACT

Fall-risk assessment should be performed during inpatient rehabilitation following a fall-related hip fracture. Improving adherence to targeted recommendations emerges as a major goal to prevent falls in hip-fracture survivors.

[Renal abscess in childhood: a case report]

We describe the case of a previously healthy six-year-old boy with a right renal abscess due to a methicillin-resistant Staphylococcus aureus, which necessitated a radical nephrectomy. Although renal ultrasonography is often the initial tool to identify fluid collection, in our case the diagnosis was obtained only after performing an abdominal CT with intravenous contrast. It is therefore necessary to combine these different imaging techniques in all children with fever and abdominal/lumbar pain without any apparent cause in order to obtain an early diagnosis and minimise organ damage.

Latissimus Dorsi Free Flap Harvesting May Affect the Shoulder Joint in Long Run

Background:

The latissimus dorsi (LD) muscle or myocutaneous flap is one of the most commonly used flaps and is believed to result in minimal donor-side morbidity. The impact on shoulder function from LD removal is important due to the common nature of this procedure. Previous studies have been performed after relatively short follow-up time and mostly after breast reconstruction. The purpose of this study was to objectively evaluate shoulder function years after latissimus dorsi muscle free flap operation.

Methods:

Between 1998 and 2004, eight patients who underwent LD-free flap for lower limb (7) or head and neck (1) soft tissue reconstruction were enrolled in this study. Scar, shoulder pain, function, mobility, stability and strength were evaluated and measured by using the Patient Scar Assessment Questionnaire (PSAQ), the Scar Evaluation Scale (SES) score, the American Shoulder and Elbow Surgeons (ASES) form, goniometer and isokinetic tests. Measurements of the operated sides were compared to the non-operated sides.

Results:

Mean age was 54 ± 21 years and mean follow-up was 92.5 ± 36 months after surgery. Mean PSAQ was 73 (65%), mean SES score was 2 ± 1. When comparing the operated sides to the unoperated sides, ASES score was significantly lower in the operated side (76 versus 93, p = 0.008); The range of motion in active and passive endorotation, active extrarotation and active forward elevation were significantly reduced after surgery. Operated side revealed a significant joint instability (3.6 versus 1.2, p = 0.007) using the ASES form. Isokinetic tests revealed that only intra-rotation strength was significantly reduced (35.74 Newton-metre versus 42.7 Newton-metre, p = 0.03) in the operated side.

Conclusion:

LD harvesting can affect the function of the shoulder joint in the long run. Reduced mobility, instability and weakness could be obtained with objective measurements. However, the results should be interpreted with caution because of the small sample size, internal controls and retrospective nature of this study.

Cytological stress and element uptake in moss and lichen exposed in bags in urban area

In this study cytological ultrastructure, total content of C, N and S, and cellular location of major and trace elements (K, Ca, Mg, Cu, Pb and Zn) were investigated in the moss Hypnum cupressiforme and in the lichen Pseudevernia furfuracea exposed in bags for a spring-summer 12-weeks period in the urban area of Naples city. In the moss, severe ultrastructural damages, such as membrane interruptions and dehydration, developed after exposure supporting the occurrence of a dead biomonitor. In the lichen, the post-exposure stress marks, such as the development of lysosome-like vesicles and concentric bodies, or the production of melanin, were overall compatible with life. With exposure, N, S, major and trace element contents all increased in both biomonitors, while C remained substantially unchanged. Copper and Pb were mainly retained in extracellular and particulate forms. Intracellular concentration of Zn consistently increased in both biomonitors, irrespective of their vitality. In transplants, cellular location of elements can better reflect the form in which they occur in the environment.

Implementation of airborne trace element monitoring with devitalised transplants of Hypnum cupressiforme Hedw.: assessment of temporal trends and element contribution by vehicular traffic in Naples city

A biomonitoring of airborne trace elements was performed in 2006 in Naples urban area through the exposure of devitalised Hypnum cupressiforme for 10 weeks at 4m height. In one street, the moss was exposed at different heights to assess vertical gradients of element concentrations. Results were compared with those of a 1999 biosurvey. Correlations among Al, Fe and Ti suggested a soil particles contribution to element uptake. Cu, Mo and Fe were related with traffic flows. Long-range transport contributed to Cd, Cu and Mo accumulation in moss at higher heights. As in 1999, the airborne element load was higher in coastal sites, more affected by marine aerosols and traffic. In all sites, contents of Cd, Fe, Pb, Ni and V in moss were remarkably lower than in 1999, indicating a positive effect of actions set up in recent years to reduce the traffic and to improve the city air quality.

Ultrasonography and MR Imaging in Progressive Supranuclear Palsy

Progressive supranuclear palsy (PSP) also known as Steele, Richardson and Olszewski disorder (1-4) is a neurodegenerative brain disease that has no known cause, treatment or cure. PSP has no known geographical, occupational or racial preference and affects brain cells that control walking, balance, mobility, vision, speech and swallowing. Symptoms begin on average in the early 60s, but may start as early as in the 40s: a good history and physical examination support the clinical diagnosis and latency of each feature makes us suspect a probable PSP, an atypical Parkinsonism. The diagnosis of a large number of cases of PSP is missed or delayed: 75% of the patients are never clinically diagnosed by neurologist and in most cases the median interval between onset and diagnosis is three years. Notwithstanding such differences in clinical presentation, there remains an overlap in symptoms making the differential diagnosis between such neurodegenerative disorders challenging. A few imaging techniques developed to evaluate brain anatomy and function are used extensively to improve the diagnostic accuracy of different forms of Parkinsonism. Non-invasive and safe methods can now document brain structures. Transcranial sonography (TCS) is a very low cost tool to assess the basal ganglia and mesencephalic echogenicity (5,6). Conventional magnetic resonance imaging (MRI) is a valuable tool to exclude secondary Parkinsonism. Our purpose is to define characteristic objectively measured imaging markers that point out normal biological processes, and pathogenic processes in PSP. Such markers should be sufficiently sensitive and specific to show the underlying biological disease and the pharmacological responses to therapy.

Abstract P1-16-02: Retrospective Review of Male Breast Cancer Patients: Analysis of Tamoxifen-Related Side Effects

Background: Male breast cancer (MBC) is an uncommon malignancy with approximately 2000 American men diagnosed per year. It has been observed that the side effect profiles and tolerability with anti-hormonal treatments such as tamoxifen differ between women and men. There is a paucity of data specifically evaluating the side effect profiles of antihormonal treatments in MBC patients (pts).

Objective: To specifically study the side effects of tamoxifen in a cohort of MBC pts and to determine toxicities in this population. Methods: We retrospectively reviewed all MBC pts evaluated at our institution from 1999-2009. Out of a total of 126 MBC pts, 64 met the following inclusion criteria: stage I-III, treated with tamoxifen, and at least one follow-up visit after starting tamoxifen. A descriptive analysis of side effects was performed on these 64 pts.

Patient Characteristics and Results: Median follow-up time at our institution was 4.2 years (range 0.3-10.9). Median follow-up from the start of tamoxifen therapy was 4.0 years (range 0.3-19.4). The median age at diagnosis was 61 years (range 30-79). Breakdown by stage included: 29.7% Stage I, 54.7% stage II, and 15.6% stage III. Median initial tumor size was 2.0 cm (range 0.5-6.5). 100% were hormone-receptor positive and 7 tumors (11%) were HER2/neu-positive. Two pts had history of prior therapeutic radiation, and 11 pts (17%) had a prior or concomitant cancer diagnosis, including 6 pts with history of prostate cancer and 2 pts with history of renal cell carcinoma. Sixteen (25%) developed metastatic disease or recurrence. Thirty (47%) pts experienced at least one or more side effect while taking tamoxifen. There were a total of 101 documented side effects (more than one side effect in some pts). The most common toxicity was weight gain (14 out of 64 pts, 22%) and sexual dysfunction/loss of libido (14pts, 22%), followed by hot flashes (8pts, 13%), neurocognitive deficits (6 pts, 1%), thromboembolic events (4 pts, 1%) ocular events (3pts), mood alterations (2pts), depression (2 pts), GI disturbance(2 pts), insomnia (1) and leg cramps (1). Importantly, 13 out of the 64 (20.3%) pts discontinued tamoxifen due to toxicity: 1 for ocular, 2 for neurocognitive deficits, 4 for thromboembolic events, 2 for bone pain, 3 for loss of libido, and 1 for leg cramps.

Conclusions: To our knowledge, this is the largest retrospective study specifically examining tamoxifen-related side effects among MBC pts. Among MBC pts, there is a high rate of discontinuation of tamoxifen. Further prospective work regarding better understanding of male hormonal biology as well as novel anti-hormonal drug development may be warranted in this unique population.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-16-02.

Comparision of linear versus circular stapling techniques in laparoscopic gastric bypass surgery - a pilot study

BACKGROUND

there is major variability in how the gastrojejunostomy (GJ) is created when laparoscopic gastric bypass (LRYGB) is performed. This is a prospective, non-randomised pilot comparison of two different techniques during our learning curve period performed by two different surgeons with similar surgical experience.

METHODS

from March 2006 until May 2008, 71 consecutive patients, 28 men and 43 woman, mean age 44 (range 24 to 62 years) who were operated for morbid obesity by laparoscopic by-pass surgery have been included. Mean preoperative Body Mass Index (BMI) (range) was 47 (34-63). The patients were divided into two groups on the basis of the stapler used. Group 1 comprised 30 patients who underwent surgery using a 25 mm circular stapler to create the GJ. Group 2 comprised 41 patients who underwent surgery using a 45 mm, blue cartridge linear stapler. Operative time, intra-operative complications, hospital stay, major and minor complications were detected.

RESULTS

intra-operative complications occurred in 4 patients (13.3%) in Group 1, in 5 patients (12.2%) in Group 2. Re-operations occurred 3 times (10.0%) in Group 1, and 4 times (9.8%) in Group 2 due to anastomotic complications, bleeding and/or bowel obstruction. Major complications occurred in four patients in Group 1 (13.3%) and in seven patients in Group 2 (17.1%). There was a significant difference in the overall morbidity rate (major and minor complications), which was 56.7% in Group 1 and 34.1% in Group 2 (p = 0.05). Mean operative time in Group 1 was 135 minutes, and in Group 2 122 minutes. Mean hospital stay was significantly shorter in Group 2 (3.9 days) than in Group 1 (5.7 days, p = 0.04).

CONCLUSIONS

learning to handle the technique when performing the gastrojejunostomy during laparoscopic gastric bypass surgery may be faster and easier by using the linear stapler. This may be important knowledge for centres considering starting LRYGB practice, although the surgeon factor needs to be taken in account. The results should be interpreted with caution because the confounding effect of one surge-on performing one type of operation while the other surgeon (is performing) the second type of operation could not be taken into account in this prospective non-randomized analysis.

Induction of antibacterial activity by alpha-d-oligogalacturonides in Nephrolepis sp. (pteridophyta)

This paper presents data on the induction by alpha-d-oligogalacturonides (OG) of antibiotic activity in vitro by the fern Nephrolepis sp. The extracts from the fern grown aseptically, partly in a medium containing a mixture of OG and partly in a medium lacking OG, as control, were tested against several bacterial strains. The results show that the OG mixture promotes the production of antibiotic compounds. Comparing the present results with those on the antimicrobial properties of the same fern grown in a greenhouse, we discuss the hypothesis that the production of antibiotic substances can be elicited by different factors, such as products of synthesis or degradation of the biotic component of the soil or by OG (in axenic culture) that can mimic the effect of natural elicitors.

Thomboembolic Events in Patients with Breast Cancer: A Population Based Study

BACKGROUND: Thromboembolic events (TEEs) are common in patients with cancer. Metastatic disease, treatment and comorbidities have been associated with increased risk. In this population-based study we sought to evaluate the risk factors and the prevalence of different TEEs in patients with breast cancer.METHODS: Retrospective cohort study using the SEER-Medicare linked database. Patients with breast cancer (stage I-IV) diagnosed from 1992-2002, who were 66 and older, and had full coverage of Medicare A and B were identified. ICD-9, HCPCS codes were used to identify different TEEs that occurred within one year of the breast cancer diagnosis. We identified pulmonary embolism (PE), deep venous thrombosis (DVT)/thrombophlebitis, other TEEs, as well as the use of chemotherapy, radiotherapy, surgery and comorbidities. Analyses were conducted using descriptive statistics and logistic regression.RESULTS: 71,864 patients were included. Age groups were distributed as follows: 66-70 (24.1%), 71-75 (26.4%), 76-80 (23.2%), >80 (26.3%). At diagnosis 52.4% of patients had stage I, 35.2% stage II, 6.6% stage III and 5.8% stage IV. 66.8% of the patients had ER-positive breast cancer. Within one year of diagnosis, 2652 (3.7%) of patients developed a TEE, including 800 patients with at least two events. 3565 total number of events were observed. A total of 596 (0.85%) PEs, 1252 (1.74%) DVT/thrombophlebitis, and 1717 (3.39%) other TEEs were identified. In the univariate analysis race, marital status, education and poverty level, geographical location, stage, tumor grade, estrogen receptor status, comorbidities, as well as surgical modality, radiation therapy and chemotherapy use, were associated with the development of any TEE.After adjusting for potential confounders, the development of any TEE was associated with ER-positive tumors (OR 1.20, 95% CI 1.07-1.34), stage II vs. I (OR 1.22, 95% CI 1.11-1.35), stage III vs. I (OR 1.63, 95% CI 1.40-1.90), stage IV vs. I (OR 2.16, 95% CI 1.82-2.57), chemotherapy (OR 2.02, 95% CI 1.82-2.23), radiotherapy (OR 1.39, 95% CI 1.27-1.52), comorbidity score (OR 1.19, 95% CI 1.08-1.32 and OR 1.74, 95% CI 1.54-1.96 for score 1 and 2 respectively), and type of surgery (OR 1.25, 95% CI 1,13-1.38 for mastectomy vs. breast conservation surgery and OR 1.23, 95% CI 1.02-1.49 for no surgery vs. breast conservation surgery). Borderline association was seen with age (using 66-70 as a reference value, the ORs for the 71-75, 76-80 and >80 year old categories were: 1.14, 95%CI 1.02-1.28; 1.17, 95% CI 1.04-1.32; and 1.15, 95% CI 1.01-1.29 respectively). Relatively similar estimates were seen for the analysis of PE, DVT/thrombophlebitis and other TEEs.CONCLUSION: 3.7% of patients in this cohort developed a TEE within one year from breast cancer diagnosis. Age, stage, type of treatment, comorbidities and receptor status were associated with the development of TEEs. To the best of our knowledge this is the largest cohort of patients older than 66years old, in which the patterns and risk factors associated with TEEs are analyzed. Whether these observations apply to patients younger than age 65, remains to be established.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2053.

Bags with oven-dried moss for the active monitoring of airborne trace elements in urban areas

To define a harmonized methodology for the use of moss and lichen bags as active monitoring devices of airborne trace elements in urban areas, we evaluated the element accumulation in bags exposed in Naples in different spring weather conditions for 6- and 12-weeks. Three different pre-exposure treatments were applied to moss and lichen materials: water-washing, acid-washing and oven-drying. During the different exposure periods in the Naples urban environment the moss accumulated always higher amounts of elements (except Hg) than lichens and the element accumulation increased during wetter weather and higher PM(10) conditions. The oven pre-treatment did not substantially modify the morphology and element composition of moss and the exposure in bags of this material for 6-weeks was sufficient to detect the pattern of airborne trace elements.

Zygomycosis in Italy: a survey of FIMUA-ECMM (Federazione Italiana di Micopatologia Umana ed Animale and European Confederation of Medical Mycology)

The aims of the study were to analyze the clinical and epidemiological characteristics and treatments for patients who developed zygomycosis enrolled in Italy during the European Confederation of Medical Mycology of medical mycology survey. This prospective multicenter study was performed between 2004 and 2007 at 49 italian Departments. 60 cases of zygomycosis were enrolled: the median age was 59.5 years (range 1-87), with a prevalence of males (70%). The majority of cases were immunocompromised patients (42 cases, 70%), mainly hematological malignancies (37). Among non-immunocompromised (18 cases, 30%), the main category was represented by patients with penetrating trauma (7/18, 39%). The most common sites of infection were sinus (35%) with/without CNS involvement, lung alone (25%), skin (20%), but in 11 cases (18%) dissemination was observed. According to EORTC criteria, the diagnosis of zygomycosis was proven in 46 patients (77%) and in most of them it was made in vivo (40/46 patients, 87%); in the remaining 14 cases (23%) the diagnosis was probable. 51 patients received antifungal therapy and in 30 of them surgical debridement was also performed. The most commonly used antifungal drug was liposomal amphotericin B (L-AmB), administered in 44 patients: 36 of these patients (82%) responded to therapy. Altogether an attributable mortality rate of 32% (19/60) was registered, which was reduced to 18% in patients treated with L-AmB (8/44). Zygomycosis is a rare and aggressive filamentous fungal infection, still associated with a high mortality rate. This study indicates an inversion of this trend, with a better prognosis and significantly lower mortality than that reported in the literature. It is possible that new extensive, aggressive diagnostic and therapeutic procedures, such as the use of L-AmB and surgery, have improved the prognosis of these patients.

Off-label drug use in women with breast cancer

1016

Background: Despite reports of widespread use of off-label agents in cancer treatment, little is known about the off-label use of agents in the treatment of breast cancer patients. Methods: We used data from the Surveillance, Epidemiology, and End Results (SEER) - Medicare linked database to identify 2082 persons older than 65 years who were diagnosed with distant stage breast cancer between 1991 and 2002 and who were treated with chemotherapy between diagnosis and death. Off versus on-label classification was based upon FDA-approved indication in the treatment of breast cancer. We calculated the percentage of patients receiving off-label chemotherapy and used multivariate logistic regression models to estimate predictors of off-label chemotherapy use. We also evaluated the appropriateness of off-label chemotherapy drugs using DRUGDEX classifications. Results: Overall, 34.9% of patients were treated with off-label chemotherapy drugs. Of the thirty-six agents that were used to treat these patients, only 8 (22%) were FDA-approved for use in the treatment of breast cancer. Off-label use was least common in patients age 80 years and older (OR 1.93, 95% 1.35–2.76 for 80+ vs. 66–70 years) and varied by diagnosis year and geographic region. The most commonly used off-label agents were vinorelbine and gemcitabine, with 16.0% and 8.4% of patients receiving these agents, respectively. While 71% of the drugs used off-label lacked supporting evidence for their use in the treatment of breast cancer, these drugs were used in a small number of patients. Only 6.7% of patients were treated with drugs considered inappropriate for use in the treatment of breast cancer. Conclusions: Off-label chemotherapy use is widespread among patients with metastatic breast cancer. However, the majority of patients who received off-label chemotherapy received drugs with scientific data supporting such use.

No significant financial relationships to disclose.

Phase I trial of escalating doses of weekly everolimus (RAD001) in combination with docetaxel for the treatment of metastatic breast cancer (MBC)

1066

Background: Inhibition of mTOR with everolimus (E) may improve efficacy in combination with docetaxel (D), but both drugs are metabolized by CYP3A4, thus a pharmacokinetic (PK) interaction may also exist. Methods: 15 patients (pts) with MBC were treated with docetaxel and everolimus using the continuous reassessment method (CRM) to determine maximum tolerated dose (MTD). Docetaxel doses were 40–75 mg/m2 IV on day 1 of a 21 day cycle. Everolimus doses were 20–50 mg PO on days 1 and 8 of a 21 day cycle (except cycle 2, where only day 8 was given to allow single agent PK analyses of both drugs). Response was measured every 2 cycles using RECIST. Results: Median age= 58 years and 77% of pts had >2 prior chemotherapies for MBC. Initially 2 of 2 pts treated (D= 75 mg/m2, E= 30 mg) developed DLT (neutropenic fever/infection), prompting a mandatory PK evaluation for all pts enrolled in subsequent cohorts. A second cohort of 3 patients (D=60 mg/m2, E=20mg) had no DLT, but no pts received day 8 of E due to grade 3–4 neutropenia. PK analyses demonstrated a 42% lowered (-42%) D clearance at the 60 mg/m2 in the presence of E (n=1). Subsequent cohorts were accrued at D=40 mg/m2 with escalating doses of E (Table). For the entire group, an 18% decrease (-18%) in D clearance was observed when D was administered concomitantly with E. High interpatient variability of D clearance was observed (range +16% to -135%). No pts had CR/PR, but 6 had SD>4 cycles and 2 had SD=8 cycles. Conclusions: Weekly everolimus appears to cause widely variable and unpredictable changes in docetaxel clearance making this combination unfeasible.

[Table: see text]

No significant financial relationships to disclose.

Recent divergence, intercontinental dispersal and shared polymorphism are shaping the genetic structure of amphi-Atlantic peatmoss populations

Several lines of evidence suggest that recent long-distance dispersal may have been important in the evolution of intercontinental distribution ranges of bryophytes. However, the absolute rate of intercontinental migration and its relative role in the development of certain distribution ranges is still poorly understood. To this end, the genetic structure of intercontinental populations of six peatmoss species showing an amphi-Atlantic distribution was investigated using microsatellite markers. Methods relying on the coalescent were applied (IM and MIGRATE) to understand the evolution of this distribution pattern in peatmosses. Intercontinental populations of the six peatmoss species were weakly albeit significantly differentiated (average F(ST) = 0.104). This suggests that the North Atlantic Ocean is acting as a barrier to gene flow even in bryophytes adapted to long-range dispersal. The im analysis suggested a relatively recent split of intercontinental populations dating back to the last two glacial periods (9000-289,000 years ago). In contrast to previous hypotheses, analyses indicated that both ongoing migration and ancestral polymorphism are important in explaining the intercontinental genetic similarity of peatmoss populations, but their relative contribution varies with species. Migration rates were significantly asymmetric towards America suggesting differential extinction of genotypes on the two continents or invasion of the American continent by European lineages. These results indicate that low genetic divergence of amphi-Atlantic populations is a general pattern across numerous flowering plants and bryophytes. However, in bryophytes, ongoing intercontinental gene flow and retained shared ancestral polymorphism must both be considered to explain the genetic similarity of intercontinental populations.

Survival differences among women with newly diagnosed stage IV and recurrent breast cancer

Abstract #2077

Background 
 The objective of this retrospective study was to determine whether differences in survival exist between women with newly diagnosed stage IV disease and those with recurrent breast cancer.
 Methods
 Women with newly diagnosed stage IV disease or recurrent breast cancer with distant metastases diagnosed between 1992 and 2007 were identified from the Breast Cancer Management System Database at UTMDACC. Among women with recurrent breast cancer, distant disease-free interval (DDFI) was defined as the time from diagnosis of primary breast cancer to the date of the first distant metastases. For all patients, overall survival (OS) was measured from the date of first distant metastases to the date of death from any cause or last follow-up. The Kaplan-Meier product limit method was used to estimate OS, and OS was compared across groups using log-rank statistic. Cox-proportional hazards models were fit to determine the association between stage IV breast cancer (recurrent versus newly diagnosed) and OS after controlling for other patient and tumor characteristics.
 Results
 The analysis included 3524 patients of whom 643 (18.2%) had newly diagnosed disease and 2881 (81.8%) had recurrent disease. Median follow-up was 19 months. Median OS among patients with newly diagnosed stage IV disease and recurrent disease was 39.2 and 27.2 months, respectively (p<0.0001). Patients with recurrent disease with DDFI < 5 years had worse OS compared to those with newly diagnosed disease (p<0.0001). Patients with DDFS >5years had better OS compared to those with newly diagnosed stage IV disease (p<0.005). In the multivariable model patients with recurrent disease had an increased risk of death compared to patients with newly diagnosed stage IV disease (HR=1.75, 95% CI 1.47-2.08, p<0.0001). When the multivariable model was stratified by DDFI, patients with recurrent disease with DDFI <5 years had 1.74 times the risk of death compare to those with newly diagnosed stage IV disease (95% CI 1.44-2.10, p<0.0001). The risk of death was not statistically different among patients with recurrent disease with DDFI >5 years compared to those with newly diagnosed stage IV disease (HR=1.11, 95% CI 0.88-1.41, p=0.38).
 ConclusionThis large cohort study provides further insight into the natural history of recurrent and newly diagnosed stage IV breast cancer. Compared to women with newly diagnosed stage IV disease, those with recurrent disease whose DDFI was >5 years and <5 years had similar and worse OS respectively.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2077.

[Thrombocytopenia associated with brucellosis: a case report]

Brucellosis, a common disease in some areas of the world, beside its typical signs and symptoms, as fever, arthropathy, hepatomegaly and splenomegaly, sometimes can complicate into thrombocytopenia, even in severe forms. The pathogenesis of thrombocytopenia in course of brucellosis is variable, and a main role is played by immunological reactions. Authors describe a case report of an eight years child who presented a severe thrombocytopenia in course of acute brucellosis. The patient responded efficaciously to the antibiotic therapy combined with immunoglobulin intravenous therapy.

Lives in a chiaroscuro. Should we suspend the puberty of children with gender identity disorder?

Transgender children who are not treated for their condition are at high risk of violence and suicide. As a matter of survival, many are willing to take whatever help is available, even if this is offered by illegal sources, and this often traps them into the juvenile criminal system and exposes them to various threats. Endocrinology offers a revolutionary instrument to help children/adolescents with gender identity disorder: suspension of puberty. Suspension of puberty raises many ethical issues, and experts dissent as to when treatment should be commenced and how children should be followed up. This paper argues that suspension of puberty is not only not unethical: if it is likely to improve the child's quality of life and even save his or her life, then it is indeed unethical to defer treatment.

Natural and pre-treatments induced variability in the chemical composition and morphology of lichens and mosses selected for active monitoring of airborne elements

To enhance the reliability of the moss and lichen transplant technique for active biomonitoring of trace metals in urban environments, we evaluated the natural variability in the chemical composition of the (epilithic and epiphytic) moss Hypnum cupressiforme and the epiphytic lichen Pseudevernia furfuracea from two reference areas in NE Italy. Green shoots of epilithic mosses and lobes of epiphytic lichens from larch branches showed rather homogenous composition and were selected for the exposure in nylon bags. As different physico-chemical pre-treatments are usually applied to selected cryptogamic material before its exposure, we also evaluated the effects of oven-drying at 120 degrees C for 24h, washing in 1N HNO3 solution, and in 0.5% NH4 oxalate solution at 85 degrees C for 15 h on the chemical composition and morphology of water-washed moss shoots and lichen lobes. Pre-treatments remarkably changed the chemical composition of selected materials but not their surface morphology.

Silencing the MET oncogene leads to regression of experimental tumors and metastases

In spite of the established knowledge of the genetic alterations responsible for cancer onset, the genes promoting and maintaining the invasive/metastatic phenotype are still elusive. The MET proto-oncogene, encoding the tyrosine kinase receptor for hepatocyte growth factor (HGF), senses unfavorable micro-environmental conditions and drives cell invasion and metastasis. MET overexpression, often induced by tumor hypoxia, leads to constitutive activation of the receptor and correlates with poor prognosis. To establish the role of MET in different phases of tumor progression, we developed an inducible lentiviral delivery system of RNA interference. Silencing the endogenous MET gene, overexpressed in tumor cells, resulted in (i) impairment of the execution of the full invasive growth program in vitro, (ii) lack of tumor growth and (iii) decreased generation of experimental metastases in vivo. Notably, silencing MET in already established metastases led to their almost complete regression. This indicates that persistent expression of the MET oncogene is mandatory until the advanced phases of cancer progression.

Trends in survival of stage IV breast cancer (BC) among Caucasian and African American (AA) BC patients (pts)

1000

Background: The aim of this review was to look at the trends in survival over time in patients(pts) with de novo stage IV BC and to identify factors that impact survival. Methods: We searched the SEER registry to identify pts with de novo stage IV breast cancer diagnosed between 1988 and 2003. Pts who were male, did not have microscopic confirmation of disease, had more than one primary, and who had a prior malignancy were excluded. Pts were divided into three groups based on their year of diagnosis separated into 5-year intervals: 1988 - 1993, 1994 - 1998, and 1999 -2003. Overall survival (OS) and BC specific survival (BCS) were calculated from the date of diagnosis to the date of death, last follow-up, or 12/31/03. Survival outcomes were estimated by the Kaplan-Meier method, and Cox models were fit to determine the characteristics that were independently associated with survival. Follow-up time was censored at 3 years for Cox analyses. Results: 15,438 pts were identified. 3796 pts were diagnosed from 1988–1993, 3954 from 1994–1998, and 7688 from 1999–2003. Median age was 62 years. Median follow-up was 16 months (mos) (range 0–191), 18 mos (range 0–199), and 11 mos (range 0–59) in periods 1988 - 1993, 1994 - 1998, and 1999 - 2003 respectively. Median OS was 18 mos overall and 16, 18, and 20 mos respectively for each time period. Median BCS was 23 mos overall and 20, 21, and 25 mos for each time period. In the multivariable model, more distant year of diagnosis, Grade 3 disease, higher number of positive LN, increasing age, being unmarried, ER- disease, PR- disease, and no surgery were all independently associated with worse BCS. The interaction term between ER and year of diagnosis was of borderline significance, indicating that over time, pts with ER+ disease had decreasing risk of death compared to patients with ER- disease (HR 0.98, 95% CI 0.96–1.00). An interaction term between race and year of diagnosis was significant, such that with each increasing year of diagnosis AA pts had increasing risk of death compared to whites (HR 1.04, 95% CI 1.01–1.07). Conclusions: The survival of de novo stage IV BC pts has modestly improved over time. Of concern, survival disparities between AA and white patients increased rather than diminished over time.

No significant financial relationships to disclose.

Defective ubiquitinylation of EGFR mutants of lung cancer confers prolonged signaling

Several distinct mutations within the kinase domain of the epidermal growth factor receptor (EGFR) are associated with non-small cell lung cancer, but mechanisms underlying their oncogenic potential are incompletely understood. Although normally ligand-induced kinase activation targets EGFR to Cbl-mediated receptor ubiquitinylation and subsequent degradation in lysosomes, we report that certain EGFR mutants escape this regulation. Defective endocytosis characterizes a deletion mutant of EGFR, as well as a point mutant (L858R-EGFR), whose association with c-Cbl and ubiquitinylation are impaired. Our data raise the possibility that refractoriness of L858R-EGFR to downregulation is due to enhanced heterodimerization with the oncogene product HER2, which leads to persistent stimulation.

Lichen and moss bags as monitoring devices in urban areas. Part II: trace element content in living and dead biomonitors and comparison with synthetic materials

Lobes of the lichen Pseudevernia furfuracea (L.) Zopf and shoots of the moss Hypnum cupressiforme Hedw. were subjected to different treatments (water washing, oven drying, HNO3 washing, NH4-oxalate extraction) to assess the influence of vitality on accumulation efficiency, during a 6-week exposure in bags in two Italian cities, Trieste and Naples. No trend emerged between treatments, in terms of accumulation ability, for major and trace elements. Only water-washed lichens showed an increased C and N content after exposure in both cities. Element concentrations generally reached higher values in mosses than in lichens, especially for Al, Fe, and Zn (both cities), and for Cu, Mg and Na (Naples). Surface development strongly influenced accumulation capacity of the biomonitors. Quartzose and cation exchange filters revealed, on a weight basis, a poor performance. In urban environments, surface interception of atmospheric particulate seems to play a major role in accumulation, irrespective of organism vitality.