Association of white matter hyperintensity measurements on brain MR imaging with cognitive status, medial temporal atrophy, and cardiovascular risk factors

BACKGROUND AND PURPOSE

White matter hyperintensities (WMHs) are frequently characterized as markers of cerebrovascular disease, whereas medial temporal atrophy (MTA) is a recognized marker of Alzheimer disease (AD). Our purpose was to test the reliability of a visual rating system (VRS) in evaluating WMHs and MTA and in distinguishing healthy from cognitively impaired subjects.

MATERIALS AND METHODS

Subjects (n = 192) enrolled in the Florida Alzheimer's Disease Research Center were diagnosed with no cognitive impairment, nonamnestic mild cognitive impairment (na-MCI), amnestic MCI (a-MCI), or probable AD. The severity of WMHs was assessed on T2-weighted fluid-attenuated inversion recovery axial MR images, and the severity of MTA was evaluated on 1.5-mm-thick coronal MR images by using a computer-based visual rating system. Cardiovascular risk factor scores were calculated as the sum of 10 independent cardiovascular risk factors.

RESULTS

WMH and MTA scores were greater in subjects with probable AD, relative to those with no cognitive impairment and na-MCI. MTA scores differentiated subjects with a-MCI from those with no cognitive impairment and na-MCI. The total WMH score was significantly related to MTA (r = 0.39; P < .001) but not to cardiovascular risk factor scores (r = 0.07; P = not significant). The overall correct classification rate of probable AD versus no cognitive impairment by using MTA scores was 81.8%, improving to 86.5% when combined with WMH scores.

CONCLUSIONS

Both MTA and WMH scores distinguished subjects with no cognitive impairment and probable AD. Combining MTA and WMH scores improved the correct classification rate, whereas WMH scores were significantly related to MTA scores, but not to cardiovascular risk factor scores. This finding suggests that among subjects with a-MCI and probable AD, WMHs on MR images are primarily associated with neurodegenerative disease.

Tannin-based rigid foams: a survey of chemical and physical properties

Tannin-based rigid foams, prepared from 95% natural material, are suggested for replacing synthetic phenol-formaldehyde foams in various applications. For that purpose, a few physical properties were measured and reported here: resistance to fire and chemicals, absorption of various liquids, permeability, thermal conductivity and mechanical (compressive and tensile) strength. Modifying the composition through the use of boric and/or phosphoric acid allowed substantial increase of fire resistance. The materials were also found to present good resistance to strong acid and bases, and to solvents. High affinity for water, but limited one for organic liquids, was also evidenced. Finally, slightly anisotropic mechanical properties were measured. The materials present a brittle behaviour, whether tested in compression or traction; nevertheless, their strengths, as well as their thermal conductivities, are fully comparable with those of their phenolic counterparts. We show that such materials of vegetable origins can compete with synthetic ones for most of traditional applications.

A novel HLA-B allele, B*4093, sharing sequences with B*4006 and B*0702 in an Asian Indian donor

A new HLA-B allele (B*4093) in a North Indian Hindu donor differing from B*4006 by four nucleotide substitutions in codon 41.1, codon 44.3, codon 45.1 and codon 50.3 has been identified. This novel allele was part of the A*0211-B*4093-Cw*1502-DRB1*15-DQB1*06 HLA haplotype.

Induction stage-dependent expression of vascular endothelial growth factor and aquaporin-1 in diethylstilbestrol-treated rat pituitary

The anterior pituitary gland undergoes tumourigenic changes in response to oestrogen treatment in several breeds of rats. We administered diethylstilbestrol (DES) to female Wistar rats and assessed whether the expression of vascular endothelial growth factor (VEGF) and aquaporin-1 (AQP-1) was altered at different time points following DES administration. In vivo magnetic resonance imaging (MRI) scans showed that the mass index corresponding to the mid-sagittal area of DES-treated pituitary was significantly higher than the vehicle-controlled pituitary (p<0.01) at three specific time points, accompanied by a significant reduction in body weight. Haematoxylin and eosin (HE) staining and immunohistochemical analysis demonstrated that during early stages of induction, DES increased cell proliferation and sprouting of endothelial cells, and VEGF expression transitioned from a vessel-surrounding pattern to a diffuse pattern. During later stages, angiogenesis was predominant, and VEGF expression decreased. In contrast to the early abundant expression of VEGF, endothelial expression of AQP- 1 increased during later stages. Our data indicated a dynamic scenario of biological alterations in DES-treated pituitary tissue, in which VEGF and AQP-1 exert their functions at different stages of induction, and we provide novel insights into understanding oestrogen-related tumourigenesis in the anterior pituitary gland.

Racial differences in acute toxicities of FEC 100 chemotherapy in patients with breast cancer

e11515

Background: Racial disparities in breast cancer outcomes are attributed to differences in baseline tumor characteristics, stage, and socioeconomic factors. However, little is known about racial differences in treatment-related toxicities. We hypothesized that racial and ethnic differences result in differential tolerance to chemotherapy and possibly compromise to the dose intensity of adjuvant/neoadjuvant chemotherapy. Methods: Data was collected from 4 international collaborating centers (University of Miami, JBCRG (Japan Breast Cancer Research Group), University of Hong Kong, and Tom Baker Cancer Center) at which patients of different ethnic background have been treated for non metastatic breast cancer with same adjuvant or neoadjuvant chemotherapy of FEC 100: fluorouracil 500 mg/m2, epirubicin 100 mg/m2, and cyclophosphamide 100 mg/m2). Racial/ethnic differences in toxicities were assessed by first episode of grade 2 or higher toxicity. Analysis of data was performed at the University of Miami. Results: Treatment-related toxicities are compared according to four race/ethnicity groups (120 Caucasian from USA and Canada (C), 16 African American (AA) from USA and Canada, 141 Japanese Asian (JA), and 23 Asian from Hong Kong (HKA)) (Table). JA and HKA had a significant higher rate of grade 3 or higher toxicity compared with C or AA women; 65%, 61%, 28%, and 31% respectively. However, there were no significant differences in chemotherapy dose intensity or density across the 4 race/ethnicity groups. Conclusions: This unique study noted racial differences in acute toxicity in women with breast cancer who were treated with FEC 100 chemotherapy. However, there are several limitations including the retrospective nature of our study, differences in practice across four countries, and different number of patients available for comparison. This study is ongoing and further statistical analyses are planned when a larger sample size is reached.

[Table: see text]

No significant financial relationships to disclose.

Stent-assisted embolization of wide-neck anterior communicating artery aneurysms: review of 21 consecutive cases

BACKGROUND AND PURPOSE

Anterior communicating artery (AcomA) aneurysm is the most frequent form of aneurysm. Stent placement is particularly difficult and of limited use for AcomA aneurysms. We report our experience with stent-assisted embolization for wide-neck AcomA aneurysms in 21 patients. Particular attention is given to the morphologic characteristics and strategy of stent deployment.

MATERIALS AND METHODS

Between January 2005 and February 2008, stent-assisted coiling was performed in 21 patients with wide-neck AcomA aneurysms. Patient demographics, aneurysm morphology, procedures, and clinical and angiographic outcomes were retrospectively reviewed.

RESULTS

Successful deployment of the stent in the targeted artery was achieved in all patients. Nineteen Neuroform 2 or Neuroform 3 stents and 2 LEO stents were used. The distal segment of the stent was positioned in the ipsilateral A2 in 12 patients, in the contralateral A2 across the AcomA in 5 patients, and into the aneurysm sac in 4 patients. Complete occlusion was achieved in 18 patients; near-complete occlusion, in 2 patients; and partial occlusion, in 1 patient. Intraoperative perforation of the aneurysm developed in 1 patient, which was secured by subsequent coiling. Angiographic follow-up in 12 patients for 6.9 months showed 1 recanalization and no in-stent stenosis.

CONCLUSIONS

Our preliminary results suggest that stent-assisted embolization for wide-neck AcomA aneurysms is technically feasible and safe. Further follow-up is needed for long-term efficacy of stent placement.

Neck injury is critical to elastase-induced aneurysm model

We modified the elastase-induced aneurysm model by use of a simple surgical technique in rabbits. A temporary arcuated aneurysm clip was placed at the origin of the right common carotid artery (RCCA), ascertaining the inner edge of the clip blade on the juncture of the RCCA and right subclavian artery (RSCA), and the elastase-induced aneurysm procedure was undertaken. We found elastase and location of the temporary arcuated aneurysm clip are critical to the success of this aneurysm model.

Exploring the relationship between physiological measures of cochlear and brainstem function

OBJECTIVE

Otoacoustic emissions and the speech-evoked auditory brainstem response are objective indices of peripheral auditory physiology that are used clinically for assessing hearing function. While each measure has been extensively explored, their interdependence and the relationships between them remain relatively unexplored.

METHODS

Distortion product otoacoustic emissions (DPOAEs) and speech-evoked auditory brainstem responses (sABRs) were recorded from 28 normal-hearing adults. Through correlational analyses, DPOAE characteristics were compared to measures of sABR timing and frequency encoding. Data were organized into two DPOAE (Strength and Structure) and five brainstem (Onset, Spectrotemporal, Harmonics, Envelope Boundary, and Pitch) composite measures.

RESULTS

DPOAE Strength shows significant relationships with sABR Spectrotemporal and Harmonics measures. DPOAE Structure shows significant relationships with sABR Envelope Boundary. Neither DPOAE Strength nor Structure is related to sABR Pitch.

CONCLUSIONS

The results of the present study show that certain aspects of the speech-evoked auditory brainstem responses are related to, or covary with, cochlear function as measured by distortion product otoacoustic emissions.

SIGNIFICANCE

These results form a foundation for future work in clinical populations. Analyzing cochlear and brainstem function in parallel in different clinical populations will provide a more sensitive clinical battery for identifying the locus of different disorders (e.g., language based learning impairments, hearing impairment).

Interferon therapy in chronic hepatitis B reduces progression to cirrhosis and hepatocellular carcinoma: a meta-analysis

Interferon (IFN) has been used in the treatment of chronic hepatitis B for decades. Beneficial effects including hepatitis B e antigen/HBV DNA seroclearance have been documented. However, the effect of treatment on the prevention of cirrhosis and hepatocellular carcinoma (HCC) development remains controversial. We conducted a meta-analysis of available literature to evaluate whether IFN reduces the incidence of liver cirrhosis and HCC in patients with chronic hepatitis B. Twelve clinical controlled trials, including 2082 patients and comparing IFN with no treatment, were selected. Data on the incidence of liver cirrhosis and HCC in IFN treated and untreated patients were extracted from each study. The evaluation of preventive effectiveness was performed with an intention-to-treat method. The relative risk (RR) and 95% confidence interval (CI) of the main outcomes as a measure of efficacy were used. Meta-analysis was performed using fixed-effect or random-effect methods, depending on absence or presence of significant heterogeneity. Analyses were performed with STATA version 9.0 and Review Manager Version 4.2. Five studies including the data on development of liver cirrhosis, and eleven studies including the data on development of HCC were analyzed. There was no evidence for publication bias on the funnel plot or by Egger's test, and the heterogeneity test indicated that the variation of trial-specific RR was not statistically significant. A different incidence of liver cirrhosis and HCC was observed between treated and untreated patients. The RR of liver cirrhosis and HCC was 0.65 (95% CI: 0.47, 0.91) and 0.59 (95% CI: 0.43, 0.81), respectively. In conclusion, the results of this meta-analysis indicate that IFN prevents or delays the development of liver cirrhosis and HCC in patients with chronic hepatitis B.

Induction stage-dependent expression of vascular endothelial growth factor and aquaporin-1 in diethylstilbestrol-treated rat pituitary

The anterior pituitary gland undergoes tumourigenic changes in response to oestrogen treatment in several breeds of rats. We administered diethylstilbestrol (DES) to female Wistar rats and assessed whether the expression of vascular endothelial growth factor (VEGF) and aquaporin-1 (AQP-1) was altered at different time points following DES administration. In vivo magnetic resonance imaging (MRI) scans showed that the mass index corresponding to the mid-sagittal area of DES-treated pituitary was significantly higher than the vehicle-controlled pituitary (p<0.01) at three specific time points, accompanied by a significant reduction in body weight. Haematoxylin and eosin (HE) staining and immunohistochemical analysis demonstrated that during early stages of induction, DES increased cell proliferation and sprouting of endothelial cells, and VEGF expression transitioned from a vessel-surrounding pattern to a diffuse pattern. During later stages, angiogenesis was predominant, and VEGF expression decreased. In contrast to the early abundant expression of VEGF, endothelial expression of AQP-1 increased during later stages. Our data indicated a dynamic scenario of biological alterations in DES-treated pituitary tissue, in which VEGF and AQP-1 exert their functions at different stages of induction, and we provide novel insights into understanding oestrogen-related tumourigenesis in the anterior pituitary gland.

Mammographic density and breast cancer risk factors in Chinese women

Abstract #4082

Background: Past studies have indicated that mammographic density is associated with not only breast cancer risk but also breast cancer risk factors in women living in western nations. However, to data, no such association has been shown among native Chinese women. The aim of this cross-sectional study was to investigate the effects of age, body mass index (BMI), age at menarche, parity, and menopausal status on mammographic patterns in women from a province of Northern China.&#x2028; Methods: Seven hundred and two women's mammograms and information of the breast cancer risk factors were obtained from Shanxi province cancer hospital in Northern China. Mammograms were assessed according to the Wolfe classification.&#x2028; Results: Age, BMI, parity, and menopause were inversely and independently related to high-risk mammographic parenchymal patterns. However, there was no statistically significant association between age at menarche and high mammographic density. Relative to subjects aged less than or equal to 35 years, subjects aged greater than 55 years had reduced 62% (OR = 0.38, 95% CI: 0.14 – 1.00) odds of having a high-risk pattern. In comparison to women whose BMI was less than or equal to 25, there was a 51% and 72% reduction in the odds of having high-risk mammographic patterns for those with BMI 25 to 30 and larger than or equal to 30 respectively (OR = 0.49, 95% CI: 0.32 - 0.74; OR = 0.28, 95% CI: 0.12 - 0.68 respectively). Women with more than three children had decreased 68% risk to have high mammographic density compared to those who were nulliparous (OR = 0.32, 95% CI: 0.1 – 1.0). Premenopausal women were more than four times likely to have a high-risk pattern than postmenopausal women (OR = 4.12, 95% CI: 2.17 – 7.87).&#x2028; Conclusion: Our findings demonstrated that mammographic parenchymal patterns are also associated with some risk factors of breast cancer in native Chinese women. This is consistent with most studies carried out in Western countries. Further studies are needed to determine the relationship between quantitative percentage density and breast cancer risk factors.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4082.

Awareness of breast cancer among women in an urban region of China

Abstract #2104

Introduction: Even though breast cancer can be cured if detected early and treated appropriately, it remains the most common cause of cancer mortality for women living in some major cities in China. Moreover, the incidence of this disease has increased steadily in China over the last two decades. The aim of this cross-sectional study was to investigate the knowledge about breast cancer concerning risk factors, signs and symptoms, effective screening methods, treatment choices and prognosis among native Chinese women.&#x2028; Method: Two hundred and seventy healthy women were invited to complete a self-administered questionnaire in Taiyuan city of China. Participants' characteristics, including age, education, occupation, and awareness of breast cancer diagnosis, treatment and prognosis were collected and analyzed.&#x2028; Results: Two hundred and thirty nine women had returned the questionnaire. The response rate was 88.5%. The median age of women in this study was 44 years old (range: 25 – 72). Among them, more than one third had received tertiary education, 6.7% had breast cancer family history, and one quarter ever had benign breast disease. Most of the participants (60.3%) did not know how to perform breast self-examination (BSE), whereas 61.5% never did BSE. Only 2.9% of those who had performed BSE did so regularly. As for effective screening methods, more than half of the participants chose clinical breast examination (CBE), and 21.8% regarded mammography as a reliable mean. Most of women considered breast cancer a curable disease and assumed that therapeutic approaches should include surgery, chemotherapy, endocrine therapy, radiotherapy, and in some cases, traditional Chinese medicine. Only 8.8% of the participants identified two or more of the eight breast cancer risk factors. The factors mostly identified included breast cancer family history (33.5%), late birth (10%), and early age at menarche (9.6%). The breast cancer signs and symptoms mostly indicated were breast lump (54.4%), breast pain (26.4%), and nipple discharge (23.9%). Women who received high level education appeared to be more likely to perform BSE and possessed more knowledge regarding to breast cancer risk factors and treatment.&#x2028; Conclusion: The study indicates that awareness of breast cancer among Chinese women needs to be improved, and that breast cancer early-detection measures needs to be enhanced in China.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2104.

Murine bone marrow mesenchymal stem cells cause mature dendritic cells to promote T-cell tolerance

Bone mesenchymal stem cells (BMSC) are attractive not only in regenerative medicine, but also for the treatment of autoimmune diseases and graft-versus-host disease. BMSC also play a role in enabling alloantigen tolerance. An in-depth mechanistic understanding of this phenomenon of tolerance could lead to novel cell-based therapies for autoimmune disease. We demonstrate here that co-culture of mature dendritic cells (DC) with BMSC in a transwell system (BMSC-DC) downregulated expression of the maturation marker, CD83 and CD80/86 co-stimulatory molecules on DC, while increasing their endocytic activity. This resulted in defective antigen presentation and co-stimulatory capacity of mature DC. Functionally, BMSC-DC have impaired T-cell stimulatory activity in a mixed lymphocyte reaction and orchestrate a shift from predominantly pro-inflammatory T-helper (Th)-1 to anti-inflammatory Th2 cells. While the expression of MHC II, CD80 and CD86 were upregulated on BMSC co-cultured with DC, these BMSC lacked the ability to stimulate T-cell proliferation. Taken together, these data suggest that the interaction between BMSC and DC modulates the immunoregulatory function of these cells in a coordinated manner, effectively skewing the immune response towards T-cell tolerance.

On-Road Exposure to Highway Aerosols. 1. Aerosol and Gas Measurements

On-road experiments were conducted to determine the sensitivities of rats to real-world aerosol. This article summarizes the on-road aerosol and gas measurements and provides background information for the companion paper on the rat exposures. Measurements were carried out over 10 days, 6 h/day, driving a route from Rochester to Buffalo. Aerosol instrumentation used in this study included two scanning mobility particle sizers (SMPS) to determine the aerosol size distribution from 10 to 300 nm, 2 stand-alone condensation particle counters to determine the total aerosol number concentration, and an electrical aerosol detector to determine the aerosol length concentration. A thermal denuder (TD) was used with one of the SMPS instruments to determine the size distribution of the non-volatile fraction. Filter samples were collected and analyzed for elemental carbon, and gas analyzers measured ambient levels of CO, CO(2), and NO. Average daily total aerosol number concentration ranged from 200,000 to 560,000 particles/cm(3). Past studies on urban highways have measured total number concentrations ranging between 10(4) and 10(6) particles/cm(3). The average daily NO concentration ranged from 0.10 to 0.24 ppm and the corresponding CO(2) concentration ranged from 400 to 420 ppm. The average daily geometric number mean particle size determined by the SMPS ranged from 15 to 20 nm. The TD reduced the average SMPS number concentration between 87 and 95% and the SMPS volume between 54 and 83%, suggesting that most of the particles consisted of volatile material. The TD also increased the geometric number mean diameter from 15 to 20 nm to 30 to 40 nm.