Predictors of long-term survival after liver transplantation for metastatic endocrine tumors: an 85-case French multicentric report

Liver transplantation (LTx) for metastatic endocrine tumors (MET) remains controversial due to the lack of clear selection criteria. From 1989 to 2005, 85 patients underwent LTx for MET. The primary tumor was located in the pancreas or duodenum in 40 cases, digestive tract in 26 and bronchial tree in five. In the remaining 14 cases, primary location was undetermined at the time of LTx. Hepatomegaly (explanted liver > or =120% of estimated standard liver volume) was observed in 53 patients (62%). Extrahepatic resection was performed concomitantly with LTx in 34 patients (40%), including upper abdominal exenteration (UAE) in seven. Postoperative in-hospital mortality was 14%. Overall 5-year survival was 47%. Independent factors of poor prognosis according to multivariate analysis included UAE (relative risk (RR): 3.72), primary tumor in duodenum or pancreas (RR: 2.94) and hepatomegaly (RR: 2.63). After exclusion of cases involving concomitant UAE, the other two factors were combined into a risk model. Five-year survival rate was 12% for the 23 patients presenting both unfavorable prognostic factors versus 68% for the 55 patients presenting one or neither factor (p < 10(-7)). LTx can benefit selected patients with nonresectable MET. Patients presenting duodeno-pancreatic MET in association with hepatomegaly are poor indications for LTx.

Drug reactions - new observations

This Macro-Micro-Dermatology-contribution with the theme innovative drugs and drug reactions illustrates two new observations of practical interest: 1. Follicular eruption after Everolimus and 2. Atrophy of sebaceous glands after Sirolimus.

[Neutralizing antibodies in hepatitis C virus infection]

Hepatitis C virus (HCV) results in persistent infection in more than 70% of infected individuals despite the development of humoral and cellular immune responses. Following infection, although antibodies targeting epitopes of both structural and non structural proteins are elicited, the virus evades antibody-mediated neutralization. Studies of host neutralizing responses against HCV have been limited by the lack of a convenient tissue culture system for HCV infection. In the past five years in vitro models have been developed to characterize interaction of HCV glycoproteins with host cell entry factors and detect antibodies interfering with HCV entry and infection. These models have been used to characterize targets of neutralizing responses and better understand their impact on the pathogenesis of infection.

Transmissions within the tarsal gearbox

BACKGROUND

The dependence of the movements of the calcaneus, cuboid, navicular, and talus on each other have been described as the tarsal gearbox. To provide a basis of its modeling, data on transmissions between tarsal joint rotations within this gearbox are required. The feasibility of tibiocalcaneal rotations to predict tarsal joint rotations is of interest because a meaningful relation would allow the use of common motion analysis with skin markers to investigate rearfoot kinematics.

METHODS

We performed linear regression analyses between tarsal joint and tibiocalcaneal rotations on the basis of magnetic resonance imaging of tibia and tarsal bone positions during quasi-static foot pronation and supination.

RESULTS

In the frontal plane and transverse planes, linear models were found to predict tarsal joint rotations quite well (r(2) = 0.83-0.97 for the frontal plane and r(2) = 0.73-0.95 for the transverse plane). For each degree of talocalcaneal rotation, there was 1.8 degrees of talonavicular rotation in the frontal plane and 1.6 degrees in the transverse plane; each degree of talocalcaneal rotation resulted in 0.6 degrees of calcanealcuboid rotation in the frontal plane and 0.7 degrees in the transverse plane; each degree of calcaneocuboid rotation resulted in 3 degrees of talonavicular rotation in the frontal plane and 2.8 degrees in the transverse; each degree of tibiocalcaneal rotation resulted in 0.9 degrees of talocalcaneal rotation in the frontal plane and 0.9 degrees in the transverse plane; and each degree of tibiocalcaneal rotation resulted in 1.6 degrees of talonavicular rotation in the frontal plane and 1.3 degrees in the transverse plane.

CONCLUSION

The present study provides a basis on which the tarsal gearbox in the frontal and the transverse planes under quasi-static conditions can be modeled. Furthermore, it is concluded that tibiocalcaneal rotations are practical for predicting tarsal joint rotations during quasi-static motions.

The angiotensin-converting enzyme insertion/deletion and the endothelin -134 3A/4A gene polymorphisms in patients with chronic plaque psoriasis

BACKGROUND

Psoriasis is a common chronic inflammatory skin disease. Vasoactive peptides such as endothelin-1 (ET-1) and bradykinin have previously been implicated in the pathogenesis of chronic plaque psoriasis. The angiotensin-converting enzyme (ACE) gene carries a 287-base pair insertion/deletion (I/D) gene polymorphism, which is associated with plasma concentrations of bradykinin-degrading ACE. A functional polymorphism (EDN1 -134 3A/4A) in the gene encoding ET-1 has been shown to affect ET-1 expression. The purpose of the present study was thus to investigate a hypothesized association between these gene polymorphisms and the presence of chronic plaque psoriasis.

METHODS

The present case-control study comprised 207 patients with chronic plaque psoriasis (136 with early onset and 71 with late onset disease) and 182 control subjects. Genotypes of EDN1 and ACE were determined by a 5' exonuclease assay (Taqman).

RESULTS

The prevalence of the homozygous ACE II genotype was significantly higher in patients with early-onset psoriasis than among control subjects (30.9% vs 19.2%, P = 0.016), yielding an odds ratio of 1.88 [95% confidence interval (CI): 1.12-3.15] for early-onset disease. For late-onset psoriasis, presence of the ACE II genotype was associated with a non-significant odds ratio 1.54 (95% CI: 0.81-2.92). As for the EDN1 -134 3A/4A gene polymorphism, no significant differences in genotype distributions were found between patients with either early- or late-onset psoriasis and control subjects (EDN1 -134 4A/4A: 9.6% in early-onset and 5.6% late-onset psoriasis vs 7.7% in controls; P > 0.05).

CONCLUSIONS

Our data suggest that homozygosity for the ACE I allele may affect susceptibility to early-onset psoriasis.

Rachitis bei einem Alpakafohlen

Gegenstand und Ziel: Ein im April 2007 in der Klinik für kleine Klauentiere vorgestelltes dunkelbraun pigmentiertes Alpakafohlen war dem Besitzer durch vermehrtes Liegen und mäßige Futteraufnahme aufgefallen. Das Tier stammte aus einer Herde mit sechs Alpakas, die in einer Offenstallhaltung gehalten wurden. Die Futterration bestand aus konfektioniertem Kraftfutter für Alpakas, Rübenschnitzeln und Heu. Material und Methoden: Die klinischen Symptome und Befunde wurden erhoben und durch labordiagnostische, röntgenologische, pathomorphologische und histopathologische Untersuchungen und eine Analyse des Futters und der Knochenmineralisierung ergänzt. Ergebnisse: Bei der klinischen Untersuchung konnten hochgradige Verbiegungen aller Gliedmaßen mit gestaucht erscheinenden Fesseln festgestellt werden. Die biochemische Blutuntersuchung ergab eine erhöhte Aktivität der alkalischen Phosphatase (1065 IU/l) sowie eine hochgradige Hypophosphatämie (0,37 mmol/l). Röntgenologisch zeigte sich an allen vier Gliedmaßen eine Verbreiterung der Epiphysenfugen. Bei der Sektion des verendeten Tieres wurde eine Rosenkranzbildung im Bereich der Knorpel-Knochen-Grenze des Sternums festgestellt. Histopathologisch ließ sich eine mangelhafte Kalzifizierung und Degeneration des Säulenknorpels und als Folge davon eine unregelmäßige Verbreiterung der Epiphysenknorpelzone nachweisen. Die Analyse der Knochenmineralisation ergab einen normalen Status im Gewebe des Röhrenknochens. In der analysierten Kraftfutterprobe war der Kalziumgehalt mit 4,8 g/kg Futter geringgradig erniedrigt, der Phosphorgehalt lag mit 3,37 g/kg Futter im Referenzbereich. Schlussfolgerung und klinische Relevanz: Die Summe der Befunde führte zur Diagnose Vitamin-D3-Mangel-Rachitis aufgrund mangelnden UV-Lichts. Daraus ergibt sich die Empfehlung für die Praxis, keine Fohlungen im Spätherbst oder Winter in Europa zu planen sowie für eine ausreichende Exposition mit UV-Strahlen und Versorgung der Muttertiere bzw. der Fohlen mit Vitamin D3 zu sorgen.

Clusterin associates with altered elastic fibers in human photoaged skin and prevents elastin from ultraviolet-induced aggregation in vitro

Clusterin is a secreted glycoprotein with stress-induced expression in various diseased and aged tissues. It shares basic features with small heat shock proteins because it may stabilize proteins in a folding-competent state. Besides its presence in all human body fluids, clusterin associates with altered extracellular matrix proteins, such as beta-amyloid in Alzheimer senile plaques in the brain. Because dermal connective tissue alterations occur because of aging and UV radiation, we explored the occurrence of clusterin in young, aged, and sun-exposed human skin. Immunohistochemical analysis showed that clusterin is constantly associated with altered elastic fibers in aged human skin. Elastotic material of sun-damaged skin (solar elastosis), in particular, revealed a strong staining for clusterin. Because of the striking co-localization of clusterin with abnormal elastic material, we investigated the interaction of clusterin with elastin in vitro. A chaperone assay was established in which elastin was denatured by UV irradiation in the absence or presence of clusterin. This assay demonstrated that clusterin exerted a chaperone-like activity and effectively inhibited UV-induced aggregation of elastin. The interaction of both proteins was further analyzed by electron microscopy, size exclusion chromatography, and mass spectrometry, in which clusterin was found in a stable complex with elastin after UV exposure.

Spontaneously occurring alimentary osteofluorosis associated with proliferative gastroduodenopathy in rabbits

Growing rabbits from two rabbitries, fed with commercial concentrates and hay, developed painful thickenings of the extremities. Four rabbits from each farm were clinically examined and necropsied. All animals showed multiple moderate to severe osseous proliferations of extremities and mandibles and a mild to severe proliferative gastroduodenopathy. Histologically, periosteal and endosteal hyperostosis and a mild to severe proliferation of the gastric and duodenal mucosa were noted. Bone analyses revealed 12,700 and 15,000 microg fluoride per gram of bone ash in affected rabbits, compared with 550 microg fluoride in a control animal. A highly elevated fluoride content was found in concentrates. Vitamin A levels were moderately increased only in one concentrate, and copper levels were normal. Results indicate that alimentary fluoride intoxication caused prominent bony proliferations in the examined rabbits. Whether the proliferative gastroduodenopathy is related to the elevated fluoride intake or represents an incidentally occurring secondary disease remains to be determined.

Five-Year Follow-up of a Randomized, Prospective Trial of Topical Methyl Aminolevulinate Photodynamic Therapy vs Surgery for Nodular Basal Cell Carcinoma

OBJECTIVE

To compare 5-year lesion recurrence rates in primary nodular basal cell carcinoma treated with topical methyl aminolevulinate photodynamic therapy (PDT) or simple excision surgery.

DESIGN

Prospective, randomized, multicenter study.

SETTING

University hospital dermatology departments.

PATIENTS

A total of 97 patients, 50 with 53 lesions treated with methyl aminolevulinate PDT and 47 with 52 lesions treated by excision surgery, were included in the per protocol analysis. Of the lesions treated with methyl aminolevulinate PDT and surgery, 49 and 52, respectively, showed complete clinical response at 3 months after treatment and were observed for long-term outcome evaluation.

INTERVENTIONS

Topical methyl aminolevulinate cream, 160 mg/g, applied for 3 hours before illumination (75 J/cm(2) of red light at 570 to 670 nm) on 2 or 4 occasions (12 [23%] of 53 lesions); or excision surgery.

MAIN OUTCOME MEASURES

Histologically confirmed lesion recurrence, sustained lesion complete response rate (time-to-event analysis), and investigator assessment of cosmetic outcome, 5 years after the last treatment.

RESULTS

At 5 years, recurrence was documented in 7 (14%) of 49 lesions (95% confidence interval [CI], 6%-27%) treated with methyl aminolevulinate PDT vs 2 (4%) of 52 lesions (95% CI, 1%-13%) treated with excision surgery (P = .09). Estimated sustained lesion complete response rates were 76% (95% CI, 59%-87%) and 96% (95% CI, 84%-99%), respectively (P = .01). More patients treated with methyl aminolevulinate PDT than surgery had an excellent or good cosmetic outcome: 27 (87%) of 31 patients (95% CI, 70%-96%) vs 19 (54%) of 35 patients (95% CI, 37%-71%) (P = .007).

CONCLUSIONS

Long-term follow-up indicates superior efficacy of surgery to methyl aminolevulinate PDT in nodular basal cell carcinoma. However, methyl aminolevulinate PDT is also an effective treatment for this indication and exhibits a more favorable cosmetic outcome.

Reliability of tarsal bone segmentation and its contribution to MR kinematic analysis methods

The purpose of this study was to determine the reliability of tarsal bone segmentation based on magnetic resonance (MR) imaging using commercially available software. All tarsal bones of five subjects were segmented five times each by two operators. Volumes and second moments of volume were calculated and used to determine the intra- as well as interoperator reproducibility. The results show that these morphological parameters had excellent interclass correlation coefficients (>0.997) indicating that the presented tarsal bone segmentation is a reliable procedure and that operators are in fact interchangeable. The consequences on differences in MR kinematic analysis methods of segmentation due to repetition were also determined. It became evident that one analysis method--fitting surface point clouds--was considerable less affected by repeated segmentation (cuboid: up to 0.2 degrees, other tarsal bones up to 0.1 degrees) compared to a method using principal axes (cuboid up to 6.7 degrees, other tarsal bones up to 0.8 degrees). Thus, the former method is recommended for investigations of tarsal bone kinematics by MR imaging.

Tests of relativity by complementary rotating Michelson-Morley experiments

We report relativity tests based on data from two simultaneous Michelson-Morley experiments, spanning a period of more than 1 yr. Both were actively rotated on turntables. One (in Berlin, Germany) uses optical Fabry-Perot resonators made of fused silica; the other (in Perth, Australia) uses microwave whispering-gallery sapphire resonators. Within the standard model extension, we obtain simultaneous limits on Lorentz violation for electrons (5 coefficients) and photons (8) at levels down to 10(-16), improved by factors between 3 and 50 compared to previous work.

Topical methyl aminolevulinate photodynamic therapy for the treatment of folliculitis

Photodynamic therapy (PDT) has been found to be effective for the treatment of acne vulgaris. We now wish to present a case series of seven patients who were successfully treated for chronic folliculitis with PDT after photosensitization with topical methyl aminolevulinate. The folliculitis had occurred in areas of acne-prone skin of the patients, mainly after long-term administration of antibiotics.

Narrowband UV-B Phototherapy, Alefacept, and Clearance of Psoriasis

OBJECTIVE

To determine whether the addition of 311-nm narrowband UV-B (NB UV-B) phototherapy accelerates and improves the therapeutic efficacy of alefacept, a biological antipsoriatic drug approved for the treatment of moderate to severe psoriasis.

DESIGN

Randomized half-body comparison study.

SETTING

Ambulatory section of a university hospital photodermatology unit.

PATIENTS

Fourteen patients with moderate to severe psoriasis.

INTERVENTIONS

All patients were treated with 7.5 mg of intravenous alefacept once weekly for 12 weeks. Three times each week, a randomly selected body half (left or right) was treated with NB UV-B light until complete remission, defined as a reduction in the Psoriasis Area Severity Index (PASI) to 3 or lower, was achieved on the irradiated body half.

MAIN OUTCOME MEASURES

Modified PASI, self-assessed visual analogue scale rating of skin lesions, and self-assessed therapeutic efficacy.

RESULTS

After 12 weeks of treatment, the mean PASIs on UV-irradiated and nonirradiated body halves were significantly reduced by 81% and 62%, respectively (P < .001). From week 3 to week 12, the mean PASI was significantly lower on UV-irradiated body halves than on nonirradiated body halves (P < .001). At week 12, PASI reductions of greater than 75% had been achieved significantly more often on UV-irradiated body halves (86%, 12 of 14) than on nonirradiated body halves (43%, 6 of 14), and complete remission had been achieved significantly more often on UV-irradiated body halves (43%, 6 of 14) than on nonirradiated body halves (0 of 14) (McNemar test P = .03).

CONCLUSIONS

In this randomized half-side comparison of alefacept with and without phototherapy for psoriasis, alefacept with NB UV-B phototherapy accelerated and improved the clearance of psoriasis. This suggests a promising future for this combination as antipsoriatic therapy.

Does a specific MR imaging protocol with a supine-lying subject replicate tarsal kinematics seen during upright standing? / Bildet ein spezifisches MR-Verfahren mit rücklings liegendem Probanden die tarsale Kinematik unter stehenden Bedingungen nach?

Magnetic resonance (MR) imaging is becoming increasingly important in the study of foot biomechanics. Specific devices have been constructed to load and position the foot while the subject is lying supine in the scanner. The present study examines the efficacy of such a newly developed device in replicating tarsal kinematics seen during the more commonly studied standing loading conditions. The results showed that although knee flexion and the externally applied load were carefully controlled, subtalar and talo-navicular joint rotations while lying during MR imaging and when standing (measured opto-electrically with markers attached to intracortical pins) did not match, nor were they systematically shifted. Thus, the proposed MR protocol cannot replicate tarsal kinematics seen during upright standing. It is concluded that specific foot loading conditions have to be considered when tarsal kinematics are evaluated. Improved replication of tarsal kinematics in different postures should comprehensively consider muscle activity, a fixed hip position, and a well-defined point of load application.

UV fingerprints predominate in the PTCH mutation spectra of basal cell carcinomas independent of clinical phenotype

Basal cell carcinoma (BCC) shows a wide interpatient variation in lesion accrual. To determine whether certain tumorigenic fingerprints and potentially predisposing patched (PTCH) tumor suppressor single-nucleotide polymorphisms (SNPs) are distributed differently among sporadic BCC patients, we compared the PTCH mutation spectra in early-onset BCC (first lesion at age < 35 years), regular BCC (first lesion at age > or = 35 years and < 10 lesions), and multiple BCC (> or = 10 lesions). The PTCH gene was mutated in 29 of 60 cases (48%). Most of the PTCH mutations bore the UV fingerprint (i.e., C --> T or tandem CC --> TT transitions at dipyrimidine sites). However, neither the proportion nor the spectra of exonic PTCH mutations differed significantly among the three groups. A large number of SNPs (IVS10+99C/T, IVS11-51G/C, 1665T/C, 1686C/T, IVS15+9G/C, IVS16-80G/C, IVS17+21G/A, and 3944C/T or its combinations) were also detected, but again their incidence did not differ significantly among the groups. Interestingly, expression of the IVS16-80G/C and the IVS17+21G/A genotype did not achieve the Hardy-Weinberg equilibrium in patients with regular and/or early-onset BCC. These data suggest that a (UV-) mutated PTCH gene is important for sporadic BCC formation independent of clinical phenotype and that the IVS16-80G/C and/or IVS17+21G/A SNP site might be important for tumorigenesis in certain BCC patients.

A bispecific diabody directed against prostate-specific membrane antigen and CD3 induces T-cell mediated lysis of prostate cancer cells

Background

Although cancer of the prostate is one of the most commonly diagnosed cancers in men, no curative treatment currently exists after its progression beyond resectable boundaries. Therefore, new agents for targeted treatment strategies are needed. Cross-linking of tumor antigens with T-cell associated antigens by bispecific monoclonal antibodies have been shown to increase antigen-specific cytotoxicity in T-cells. Since the prostate-specific membrane antigen (PSMA) represents an excellent tumor target, immunotherapy with bispecific diabodies could be a promising novel treatment option for prostate cancer.

Methods

A heterodimeric diabody specific for human PSMA and the T-cell antigen CD3 was constructed from the DNA of anti-CD3 and anti-PSMA single chain Fv fragments (scFv). It was expressed in E. coli using a vector containing a bicistronic operon for co-secretion of the hybrid scFv V_HCD3-V_LPSMA and V_HPSMA-V_LCD3. The resulting PSMAxCD3 diabody was purified from the periplasmic extract by immobilized metal affinity chromatography (IMAC). The binding properties were tested on PSMA-expressing prostate cancer cells and PSMA-negative cell lines as well as on Jurkat cells by flow cytometry. For in vitro functional analysis, a cell viability test (WST) was used. For in vivo evaluation the diabody was applied together with human peripheral blood lymphocytes (PBL) in a C4-2 xenograft-SCID mouse model.

Results

By Blue Native gel electrophoresis, it could be shown that the PSMAxCD3 diabody is mainly a tetramer. Specific binding both to CD3-expressing Jurkat cells and PSMA-expressing C4-2 cells was shown by flow cytometry. In vitro, the diabody proved to be a potent agent for retargeting PBL to lyze C4-2 prostate cancer cells. Treatment of SCID mice inoculated with C4-2 tumor xenografts with the diabody and PBL efficiently inhibited tumor growth.

Conclusions

The PSMAxCD3 diabody bears the potential for facilitating immunotherapy of prostate cancer and for the elimination of minimal residual disease.