A cross-sectional study of well water arsenic and child IQ in Maine schoolchildren

BACKGROUND

In recent studies in Bangladesh and elsewhere, exposure to arsenic (As) via drinking water is negatively associated with performance-related aspects of child intelligence (e.g., Perceptual Reasoning, Working Memory) after adjustment for social factors. Because findings are not easily generalizable to the US, we examine this relation in a US population.

METHODS

In 272 children in grades 3-5 from three Maine school districts, we examine associations between drinking water As (WAs) and intelligence (WISC-IV).

RESULTS

On average, children had resided in their current home for 7.3 years (approximately 75% of their lives). In unadjusted analyses, household well WAs is associated with decreased scores on most WISC-IV Indices. With adjustment for maternal IQ and education, HOME environment, school district and number of siblings, WAs remains significantly negatively associated with Full Scale IQ and Perceptual Reasoning, Working Memory and Verbal Comprehension scores. Compared to those with WAs < 5 μg/L, exposure to WAs ≥ 5 μg/L was associated with reductions of approximately 5-6 points in both Full Scale IQ (p < 0.01) and most Index scores (Perceptual Reasoning, Working Memory, Verbal Comprehension, all p's < 0.05). Both maternal IQ and education were associated with lower levels of WAs, possibly reflecting behaviors (e.g., water filters, residential choice) limiting exposure. Both WAs and maternal measures were associated with school district.

CONCLUSIONS

The magnitude of the association between WAs and child IQ raises the possibility that levels of WAs ≥ 5 μg/L, levels that are not uncommon in the United States, pose a threat to child development.

Abstract P5-09-11: BP1, a homeoprotein, regulates estrogen receptor alpha and induces estrogen independence

Introduction: BP1 is a member of the homeobox gene family of transcription factors. Our recent studies have shown that BP1 may play a role in breast cancer cell survival, aggressiveness and metastasis. BP1 protein (pBP1) is expressed in 80% of invasive ductal breast tumors. Moreover, 100% of inflammatory breast tumors are BP1 positive. These data led us to define the mechanism of BP1-related tumorigenesis and aggressiveness in breast cancer.

Materials and Methods: MCF-7/O1, O2 and O4 cells overexpressing BP1 and control V1 and V2 cells were tested for growth in estrogen free media, malignant potential and invasiveness using cell viability assays, soft agar assays and matrigel assays, respectively. To determine the influence of BP1 overexpression on tumor characteristics, empty vector cells (V1) and overexpressor cells (O2 and O4) were injected into the fat pads of athymic nude mice. Mice were supplemented with estrogen pellets or were unsupplemented. Chromatin immunoprecipitation assays (ChIP) were used to validate the binding of pBP1 to ERa and EP300. The effects of BP1 expression on ERα and EP300 were investigated using immunoblotting and qRT-PCR. Effects of BP1 overexpression on tamoxifen sensitivity were measured using the MTT assay.

Results: Cells overexpressing BP1 showed higher viability (p&lt;0.05) when grown in the absence of serum, greater invasive potential (p&lt;0.05) and formed larger and more rapidly growing colonies (p&lt;0.0001) compared with cells containing the empty vector. Tumors were larger in mice receiving O1, O2 or O4 cells than in mice receiving V1 or V2 cells (p&lt;0.0001). There was also a positive correlation between BP1 mRNA levels and tumor size in patients (p = 0.01). 20% of mice injected with O2 or O4 developed tumors in the absence of estrogen, in contrast to control mice which did not develop tumors. Several mechanisms of estrogen independence related to BP1 were established: (1) an indirect mechanism, in which BP1 stabilizes ERα protein by transcriptional activation of p300, and (2) a direct mechanism, in which BP1 binds to the first intron of ERα and upregulates ERα RNA and protein expression. In addition, breast cancer anti-estrogen resistance 1 (BCAR1) RNA expression was higher in O2 as compared to V1 cells. Consistent with these findings, O2 cells exhibited increased proliferation when treated with tamoxifen, while V1 cells showed growth inhibition.

Conclusion: High BP1 levels can lead to estrogen independence in ER positive breast cancer cells and tumors in mice by at least two mechanisms, indirect and direct, and are associated with resistance to tamoxifen. These results suggest that BP1 may be an important therapeutic target in ER positive breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-11.

Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial

Our randomized controlled trial in prematurely menopausal breast cancer survivors showed that impact + resistance training prevented increases in percentage of body fat compared with controls and also improved BMD at the hip and prevented BMD loss at the spine among exercise-trained women who were menopausal for >1 year.

INTRODUCTION

Cancer treatment-related menopause worsens bone health and body composition in breast cancer survivors (BCS). We investigated whether impact + resistance training could improve bone mineral density (BMD), reduce bone turnover, build muscle, and decrease fat mass in BCS with premature menopause.

METHODS

We conducted a randomized controlled trial in 71 BCS (mean age, 46.5 years) within 5 years of treatment-related menopause. Women were randomly assigned to one of two groups: (1) impact + resistance training (prevent osteoporosis with impact + resistance (POWIR)) or (2) exercise placebo (FLEX) 3×/week for 1 year. Outcomes were hip and spine BMD (in grams per square centimeter) and body composition (percent body fat (%BF) and lean and fat mass (in kilograms)) by DXA and bone turnover markers (serum osteocalcin (in nanograms per milliliter) and urinary deoxypryrodinoline (in nanomoles per milliliter).

RESULTS

There were no significant group × time interactions for bone outcomes when using an intent-to-treat approach on the full sample. In analyses restricted to BCS who were menopausal for ≥1 year, POWIR increased BMD at the hip and slowed BMD loss at the spine compared with FLEX (femoral neck-POWIR, 0.004 ± 0.093 g/cm(2) vs. FLEX, -0.010 ± 0.089 g/cm(2); p < 0.01; spine-POWIR, -0.003 ± 0.114 g/cm(2) vs. FLEX, -0.020 ± 0.110 g/cm(2); p = 0.03). POWIR prevented increases in %BF (POWIR, 0.01 % vs. FLEX, 1.3 %; p < 0.04). Women with attendance to POWIR at ≥64 % had better improvements in %BF than women attending less often (p < 0.03).

CONCLUSION

Impact + resistance training may effectively combat bone loss and worsening body composition from premature menopause in BCS.

Outcome after laparoscopic gastric bypass for super-super obese patients

GOAL

The surgical treatment of the super-super obese (SSO), defined by a body mass index (BMI) superior or equal to 60 kg/m2, is difficult. The goal of this study was to evaluate the results of laparoscopic gastric bypass (LGBP) in this setting.

PATIENTS AND METHODS

Between June 2005 and December 2011, 20 SSO patients underwent LGBP by one surgeon. Postoperative complications, weight loss, evolution of co-morbidities and quality of life were analyzed. The Bariatric Analysis and Reporting Outcome System (BAROS) was used to classify outcomes.

RESULTS

There were 15 women and five men (median age: 37.5 years). Median BMI was 63 kg/m2. Median duration of operation was 180 minutes. One patient was converted to laparotomy. Three complications occurred: one grade I, one grade II and one grade V. The median excess weight loss was 47.1% at 12 months, 55.3% at 24 months, 53.3% at 36 months and 55.3% at 48 months. Among the patients with a follow-up of at least 12 months (n=17), the median quality of life score was 1.75 and the median BAROS score was 5.75. Arterial hypertension and type II diabetes resolved or improved in all patients and sleep apnea resolved in almost half of patients (43%).

CONCLUSIONS

LGBP appears feasible and effective for SSO, both in terms of weight loss and improvement of co-morbidities and quality of life as well, with a low rate of postoperative complications.

Tubulovillous adenoma of the appendix: a case report and review of the literature

We report the case of a young woman hospitalized for a chronic appendicular syndrome. The histological examination of the resected specimen revealed a rare tumor: tubulovillous adenoma, discovered in 0.02% of all appendectomy procedures. Treatment is most often limited to appendectomy, but in the event of incomplete excision or associated adenocarcinoma, right hemicolectomy may be required. After surgery, a follow-up colonoscopy is recommended due to the higher risk of second gastrointestinal neoplasms in patients with appendicular tumors.

Relative changes in resting energy expenditure during weight loss: a systematic review

A more comprehensive understanding of the effects of weight loss on the changes in resting energy expenditure (EE) is relevant. A MEDLINE search was performed to identify studies with information relevant to this systematic review. From this search, the mean rate of resting EE decrease relative to weight loss was calculated from 90 available publications. A decrease of resting EE relative to weight loss of -15.4 +/- 8.7 kcal kg(-1) was observed from 2977 [corrected] subjects. No sex differences were noted in the overall resting EE decrease relative to weight loss. However, a significant sex differences was seen with pharmacological interventions, which seemed to depress the resting EE relative to weight loss to a greater extent in men than in women (P < 0.05). A greater drop in resting EE relative to weight loss was observed for short interventions (more than 2 but less than 6 weeks) when compared with long interventions (<6 weeks) (-27.7 +/- 6.7 vs. -12.8 +/- 7.1 kcal kg(-1)) (P < 0.001). Men and women have a similar decrease in resting EE relative to weight loss except in the case of pharmacological interventions. Short interventions also produced greater resting EE losses relative to weight loss.

Experimental infection of monkeys with bunyamwera and germiston viruses

Clinical and serological responses investigated in rhesus and cynomolgus monkeys infected with either Bunyamwera or Germiston viruses were generally minimal or absent. A febrile reaction occurred in one of eight monkeys, and another monkey died unexplainably among those given Bunyamwera virus. All monkeys infected with Germiston virus by subcutaneous, intravenous, or intracerebral routes developed fevers, and all infections were relatively consistent in time of onset, duration, and level of viremia. Rhesus monkeys were also susceptible to infection by exposure to aerosolized Germiston virus, although viremias were irregular in these animals, and no fevers were detected. Serological responses to infections by Bunyamwera and Germiston viruses (hemagglutination inhibition, complement fixation, and neutralization tests) provided more reliable indications of infection than clinical response.

[Sarcoidosis presenting as a splenic pseudotumour]

INTRODUCTION

Multinodular splenomegaly is a rare form of extrathoracic sarcoidosis. It may be the presenting feature of the disease. It poses problems of differential diagnosis, in particular with lymphoma, tuberculosis and other granulomatous diseases. In the absence of typical associated lesions, particularly thoracic, histological roof is essential.

CASE REPORT

We report the case of a 55-year-old caucasian woman with multinodular pseudotumoural splenomegaly, associated with some small mediastinal lymph nodes and some non-specific parenchymatous pulmonary nodules. The diagnosis of sarcoidosis was made on the basis of splenectomy after eliminating other causes of granulomatosis.

CONCLUSION

This case report describes a rare presentation of sarcoidosis and discusses the differential diagnosis of multinodular splenomegaly. It underlines the necessity of an exhaustive aetiological investigation of splenic granulomatosis as the diagnosis of sarcoidosis remains one of elimination.

Effects of environmental parameters and irrigation on the turgor pressure of banana plants measured using the non-invasive, online monitoring leaf patch clamp pressure probe

Turgor pressure provides a sensitive indicator for irrigation scheduling. Leaf turgor pressure of Musa acuminate was measured by using the so-called leaf patch clamp pressure probe, i.e. by application of an external, magnetically generated and constantly retained clamp pressure to a leaf patch and determination of the attenuated output pressure P(p) that is highly correlated with the turgor pressure. Real-time recording of P(p) values was made using wireless telemetric transmitters, which send the data to a receiver base station where data are logged and transferred to a GPRS modem linked to an Internet server. Probes functioned over several months under field and laboratory conditions without damage to the leaf patch. Measurements showed that the magnetic-based probe could monitor very sensitively changes in turgor pressure induced by changes in microclimate (temperature, relative humidity, irradiation and wind) and irrigation. Irrigation effects could clearly be distinguished from environmental effects. Interestingly, oscillations in stomatal aperture, which occurred frequently below turgor pressures of 100 kPa towards noon at high transpiration or at high wind speed, were reflected in the P(p) values. The period of pressure oscillations was comparable with the period of oscillations in transpiration and photosynthesis. Multiple probe readings on individual leaves and/or on several leaves over the entire height of the plants further emphasised the great impact of this non-invasive turgor pressure sensor system for elucidating the dynamics of short- and long-distance water transport in higher plants.

Feline extranodal lymphoma: response to chemotherapy and survival in 110 cats

OBJECTIVE

To determine response to treatment, survival and prognostic factors for feline extranodal lymphoma in the UK.

METHODS

Records of cats diagnosed with lymphoma of extranodal sites at seven referral centres were reviewed and information on signalment, tumour location, prior treatment and chemotherapy protocol recorded. Factors influencing response to treatment and survival were assessed.

RESULTS

One hundred and forty-nine cases met inclusion criteria. Sixty-nine cats had nasal lymphoma, 35 renal, 15 central nervous system, 11 laryngeal and 19 miscellaneous locations. Sixty-six cats received cyclophosphamide, vincristine, prednisolone, 25 Wisconsin-Madison doxorubicin-containing multi-agent protocol, 10 prednisolone alone and nine other combinations. The response rate for the 110 treated cats was 85.5 per cent. Of cyclophosphamide, vincristine, prednisolone treated cats 72.7 per cent achieved complete remission, median survival 239 days. Sixty-four per cent of Wisconsin-Madison treated cats achieved complete remission, median survival 563 days. Cats with nasal lymphoma achieving complete remission had the longest survival (749 days) and cats with central nervous system lymphoma the shortest (70 days). If complete remission was achieved, prior treatment with corticosteroids significantly reduced survival time.

CLINICAL SIGNIFICANCE

Cats with extranodal lymphoma respond to chemotherapy and achieve survival times comparable to other locations. Corticosteroid pretreatment reduced survival time in cats achieving complete remission.

Role of BP1, a Novel Transcription Factor, in Antiestrogen Resistance

Background: Breast cancer patients with early stage, estrogen receptor (ER) positive tumors generally respond well to adjuvant treatment with the antiestrogen tamoxifen. The result is a 40-50% decrease in annual risk of recurrence. However, almost all patients with metastatic breast cancer and about half of the patients who receive tamoxifen exhibit recurrence due to resistance to antiestrogens. Through a better understanding of the mechanisms of resistance to antiestrogen therapy, it may be possible to design more effective treatment for those women with ER positive tumors who develop resistance, and possibly for those women with ER negative tumors, who do not respond to antiestrogen therapy. We are studying a homeotic transcription factor, BP1, that may be involved in antiestrogen resistance. BP1 is upregulated in 80% of invasive ductal breast tumors and is associated with aggressive tumors: 100% of ER negative tumors were BP1 positive, compared with 73% of ER positive tumors. We have evidence that BP1 protein (pBP1) is involved in both genomic and non-genomic ER signaling.Materials and Methods: MCF-7 derivatives overexpressing BP1, called O2 and O4 cells, were grown in serum free medium for 48 hr., followed by Western blot analysis to assess the level of phosphorylated Akt and phosphorylated ER. An electrophoretic mobility shift assay (EMSA) was performed with pBP1 transcribed and translated in wheat germ extract to demonstrate pBP1 binding to a specific DNA sequence. Cell lines were immunostained to determine levels of ER protein.Results: (1) Genomic signaling: There is a consensus DNA binding site in an intron of the ER. pBP1 binds to that site, shown by EMSA. Immunostaining of O2 and O4 cell lines overexpressing pBP1 demonstrates that there is reduced ER protein on cells overexpressing BP1, consistent with the idea that BP1 directly represses the ER and that BP1 is more frequently expressed in ER negative tumors than in ER positive tumors. (2) Non-genomic signaling: phosphorylation of Akt was examined in O2 cells after growth in phenol red-free, serum free medium. Using a phosphorylation-specific antibody, we observed phosphorylation of Akt in O2 cells. In contrast, there was little or no phosphorylation of Akt in empty vector control cells. Phosphorylation of the ER was assessed in O4 cells, where there was a detectable increase in ER phosphorylation in the cells overexpressing BP1 compared with empty vector controls.Discussion: Our data support the hypothesis that pBP1 binds to the ER, directly repressing its activity, which could lead to estrogen independence. Moreover, we have evidence that high levels of pBP1 lead to increased phosphorylation of both Akt and the ER, part of a non-genomic signaling pathway that causes estrogen independence. Moreover, in collaboration with Dr. Barbara Vonderhaar, we have shown that 20% of the tumors in mice injected with O2 or O4 cells are estrogen independent, consistent with these data. Thus, we hypothesize that BP1 is intimately involved in antiestrogen resistance, making it a strong potential therapeutic target.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5144.

[Negative pressure therapy in precarious situations. Part 1: abdomen and perineum]

Negative pressure therapy (NPT) is a proven safe and effective technique to promote healing of complex adominoperineal wounds using either an open or closed approach. Specifically designed devices are available in industrialized countries but high cost is a limiting factor for their use in developing countries. The purpose of this report is to describe a simple, easy-to-use technique that is suitable for austere environments. In addition to low-cost, the main advantage of this technique is that it can be performed by anyone using resources readily available in any operating room.

A non-invasive probe for online-monitoring of turgor pressure changes under field conditions

An advanced non-invasive, field-suitable and inexpensive leaf patch clamp pressure probe for online-monitoring of the water relations of intact leaves is described. The probe measures the attenuated output patch clamp pressure, P(p), of a clamped leaf in response to an externally applied input pressure, P(clamp). P(clamp) is generated magnetically. P(p) is sensed by a pressure sensor integrated into the magnetic clamp. The magnitude of P(p) depends on the transfer function, T(f), of the leaf cells. T(f) consists of a turgor pressure-independent (related to the compression of the cuticle, cell walls and other structural elements) and a turgor pressure-dependent term. T(f) is dimensionless and assumes values between 0 and 1. Theory shows that T(f) is a power function of cell turgor pressure P(c). Concomitant P(p) and P(c) measurements on grapevines confirmed the relationship between T(f) and P(c). P(p) peaked if P(c) approached zero and assumed low values if P(c) reached maximum values. The novel probe was successfully tested on leaves of irrigated and non-irrigated grapevines under field conditions. Data show that slight changes in the microclimate and/or water supply (by irrigation or rain) are reflected very sensitively in P(p).