Study of matrix metalloproteinases and their tissue inhibitors in ductal in situ carcinomas of the breast

AIMS

To analyse the expression of metalloproteinases (MMPs) and their inhibitors (TIMPs) in ductal carcinoma in situ of the breast (DCIS).

METHODS AND RESULTS

An immunohistochemical study was performed in 56 patients with pure DCIS, in 39 with DCIS adjacent to invasive carcinoma (IDC) and 63 patients with T1 IDC, using tissue microarrays and specific antibodies against MMPs and TIMPs. Immunohistochemical results were categorized using a specific software program. The data were analysed by unsupervised hierarchical cluster analysis by each cellular type. IDC showed a higher expression rate of MMP-7 and TIMP-1 than pure DCIS, as well as a higher expression rate of MMP-9 and TIMP-3 than the DCIS component of mixed cases, whereas pure DCIS showed a higher rate of expression of MMP-9 and -11 and TIMP-3 than in the DCIS component of mixed cases. Pure DCIS with a periductal inflammatory infiltrate showed significantly higher MMP-2, -14 and TIMP-1. Dendograms identified two cluster groups with distinct MMP/TIMP expression profiles in neoplastic cells and fibroblastic or mononuclear inflammatory cells surrounding the neoplastic ducts of pure DCIS.

CONCLUSIONS

The results indicate the distinct variability in MMP/TIMP expression by DCIS, which may be of potential biological and clinical interest in breast cancer.

Clinical efficacy of a triclosan/copolymer/NaF dentifrice and a commercially available breath-freshening dentifrice on hydrogen sulfide-forming bacteria

OBJECTIVE

The objective of this randomized, cross-over clinical study was to compare the 4-h and overnight effects of a triclosan/copolymer/fluoride (TCF-AF) dentifrice and a commercially available breath freshening (CBF) dentifrice containing fluoride for their ability to control H(2)S-forming bacteria.

METHODS

Following a 1 week washout period of brushing with a regular fluoride dentifrice, subjects reported to the clinical site without performing oral hygiene, eating or drinking in preparation for baseline saliva sampling. After providing a baseline saliva sample, subjects were randomly assigned a test dentifrice and instructed to brush their teeth for 1 min, twice a day for 1 week. On the morning of the eighth day, subjects returned to the test site having refrained from oral hygiene, eating and drinking for overnight sampling. Subjects then brushed for 1 min with the assigned dentifrice, and returned for 2 and 4 h postbrushing evaluations. Following a second 1 week washout, subjects repeated the same regimen, but now using the other dentifrice. Oral micro-flora samples were collected by subjects rinsing with 10 ml of sterile water for 10 s. Each collected sample was serially diluted and plated in duplicate onto lead acetate agar. After incubating for 72 h, dark colonies were counted, expressed as log colony-forming units/ml, and reductions from baseline were calculated.

RESULTS

Compared with baseline, the TCF-AF dentifrice reduced H2S-forming bacteria 0.82, 0.80 and 0.22 log units at the 2 and 4 h and overnight time points compared with 0.60, 0.43 and 0.07 log units for the CBF dentifrice. The TCFAF dentifrice was statistically significantly better (P < 0.05) than the CBF dentifrice at 4 h and overnight after brushing the teeth.

CONCLUSION

The results of this randomized study indicate that the TCF-AF dentifrice is effective in controlling H2S-producing bacteria.

Assessment of velocity fields through open-channel flows with an empiric law

Most sewer managers are currently confronted with the evaluation of the water discharges, that flow through their networks or go to the discharge system, i.e. rivers in the majority of cases. In this context, the Urban Hydraulic Systems laboratory of the ENGEES is working on the relation between velocity fields and metrology assessment through a partnership with the Fluid and Solid Mechanics Institute of Strasbourg (IMFS). The responsibility is clearly to transform a velocity profile measurement, given by a Doppler sensor developed by the IMFS team, into a water discharge evaluation. The velocity distribution in a cross section of the flow in a channel has attracted the interests of many researchers over the years, due to its practical applications. In the case of free surface flows in narrow open channels the maximum velocity is below the free surface. This phenomenon, usually called "dip-phenomenon", amongst other things, raises the problem of the area explored in the section of measurements. The work presented here tries to create a simple relation making possible to associate the flow with the velocity distribution. This step allows to insert the sensor position into the flow calculation.

Enantioselective Conjugate Addition ofN,N-Dialkylhydrazones to α-Hydroxy Enones‡

The activation of alpha-hydroxy enones by the Zn(OTf)2/tBuBOX catalyst enables the enantioselective conjugate addition of 1-methyleneaminopyrrolidine as a neutral d1 synthon. Experimental evidence supports a stereochemical model where a triflate ligand controls the geometry of the catalyst-substrate complex by means of a OH-OTf hydrogen bond. The synthesis of beta-cyano acids illustrates the potential of the methodology.

[Effectiveness of high pressure balloon dilatation in the treatment of postsurgical strictures of urinary tract in children]

INTRODUCTION

Endoscopic dilatation using a high pressure balloon is a widely used technique for the treatment of strictures of the urinary tract secondary to surgery in adult patient. Several studies have evaluated its usage in the treatment of primary and secondary strictures of the urinary tract of child with a disparity of results.

GOAL

Evaluate Effectiveness and Safetiness of high pressure balloon dilatation and double "J" implantation in the treatment of postsurgical strictures of urinary tract in children.

PATIENTS AND METHODS

Retrospective study of endoscopic dilatation of secondary to surgery strictures performed in our unit during the last past 18 months. Demographical data, surgical records, symptoms, renal function, dilatation technique, postsurgery complications and ultrasonography and isotopic data (pre and post dilatation) were evaluated.

RESULTS

Six children, aged 13 months-9 years (media = 4.3 years) were treated in our unit. Four presented ureteropelvic junction obstruction (UPO) after Anderson-Hynes pyeloplasty and 2 vesico-ureteral junction stenosis (VUO) in 3 reimplants units, (one with Cohen tecnique and two with Politano tecnique). All 6 patients showed dilatation of urinary tract and isotopic diuretic renogram prior to dilatation that showed for all cases an obstructed pattern with T1/2 > 20 minutes. Two of the children presented lumbar pain and one of them had suffered an urine infection. Time interval between surgery and dilatation varied between 23 and 118 months. Surgical technique used for all cases was high pressure retrograde balloon dilatation and placement of double "J" before retrograde pielography. In all patients a double J catheter was implanted and left in place for 4 to 9 weeks. Technical inability to place the catheter after the expansion forced to the accomplishment of a percutaneus nephrostomy echo guided in one case. One of the children showed hematuria up to 7 days after dilatation procedure. Hospilatization varied between 24 hours to 10 days being (moda = 3 days). The patient that needed nephrostomy underwent ulterior sucessful dilatation 4 months after first procedure. The 2 children presenting vesico-ureteral junction stricture underwent calibration 10 and 12 months after dilatation, showing both good caliber. Diuretic renogram curve Improvement was confirmed for all patients but one of the VUO children that showed renal function deterioration after dilatation procedure. Lumbar pain disappear for both 2 children that had referred it.

CONCLUSIONS

Endoscopic dilatation of strictures of urinary tract using balloon in children that were previously sommeted to surgical interventions is technically available and shows good results in the short-medium term with low index of post procedural complications, so, it should be considered as initial treatment for these patients.

Prostate cancer: Vaccine Sentinel Immunized Node (SIN) target for adjuvant locoregional chemotherapy in autologous vaccine

13500

Background: In cancer patients, the systemic immune response elicited by Tumor Associated Antigens is started by a locoregional immune response at the microenvironment constituted by the antigen source (the tumor) and the draining sentinel lymph node (SLN). The locoregional immune response is decisional because it starts a systemic immune response configured as the SLN response: tolerogenic or protective (AJ Cochran, Nat Rev Immunol, 2006). Cancer vaccines reproduce this locoregional immune response: the vaccination site as the tumor antigen source and the draining SIN as the SLN (ML Disis, Blood, 1996). In experimental models, several chemotherapy drugs, especially Etoposide, injected in the vaccination site switch the locoregional immune response from tolerogenic to protective (RJ Scheper, Invest New Drugs, 1984). This study explores Etoposide as a locoregional adjuvant of the previously described Autologous Thermostable Hemoderivative-Cancer Vaccine ATH-CV (E Lasalvia-Prisco, ASCO, 2006). Methods: Thirty three M1 prostate cancer patients, hormone and chemotherapy resistant, performance status = 2, and PSA rising level, were included in this prospective, IRB-approved phase I/II trial. Patients were 3-group (G) randomized (11 each), submitted to different treatments: G1, no additional oncology treatment; G2, ATH-CV; G3, ATH-CV plus Etoposide 200 μg at vaccination site days 1–4 after vaccine. Statistic assessment (Student’s t-test) was performed at the 30-day end point: ATH sensitization by Delayed Type Hypersensibility test (DTH) and Lymphocyte Proliferative Assay (LPA); PSA serum level and cells immunophenotyping in biopsies of SIN scintigraphy-localized. Results: Statistical significant (p<0.05): DTH test > 5 mm: G1, 0/11; G2, 4/11 and G3, 8/11. LPA > 2.0: G1, 0/11; G2, 5/11 and G3, 9/11. Immunophenotyping: CD4+ CD25+ (Treg): G1>G2>G3. 30 days PSA increase: G1>G2>G3. No relevant toxicity was evidenced. Conclusions: In advanced prostate cancer, when all other treatments are exhausted, the sensitization and tumor antiprogressive effect of ATH-CV were potentiated by Etoposide as local adjuvant. SIN depletion of tolerogenic cells is suggested as mechanism of action.

No significant financial relationships to disclose.

Medical treatment for early fetal death (less than 24 weeks)

BACKGROUND

In most pregnancies that miscarry, arrest of embryonic or fetal development occurs some time (often weeks) before the miscarriage occurs. Ultrasound examination can reveal abnormal findings during this phase by demonstrating anembryonic pregnancies or embryonic or fetal death. Treatment before 14 weeks has traditionally been surgical but medical treatments may be effective, safe, and acceptable, as may be waiting for spontaneous miscarriage.

OBJECTIVES

To assess the effectiveness, safety and acceptability of any medical treatment for early pregnancy failure (anembryonic pregnancies or embryonic and fetal deaths before 24 weeks).

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2005).

SELECTION CRITERIA

Randomised trials comparing medical treatment with another treatment (e.g. surgical evacuation), or placebo, or no treatment for early pregnancy failure. Quasi-random studies were excluded.

DATA COLLECTION AND ANALYSIS

Data were extracted unblinded.

MAIN RESULTS

Twenty four studies (1888 women) were included. Vaginal misoprostol hastens miscarriage (complete or incomplete) when compared with placebo: e.g. miscarriage less than 24 hours (two trials, 138 women, relative risk (RR) 4.73, 95% confidence interval (CI) 2.70 to 8.28), with less need for uterine curettage (two trials, 104 women, RR 0.40, 95% CI 0.26 to 0.60) and no significant increase in nausea or diarrhoea. Lower-dose regimens of vaginal misoprostol tend to be less effective in producing miscarriage (three trials, 247 women, RR 0.85, 95% CI 0.72 to 1.00) with similar incidence of nausea. There seems no clear advantage to administering a 'wet' preparation of vaginal misoprostol or of adding methotrexate, or of using laminaria tents after 14 weeks. Vaginal misoprostol is more effective than vaginal prostaglandin E in avoiding surgical evacuation. Oral misoprostol was less effective than vaginal misoprostol in producing complete miscarriage (two trials, 218 women, RR 0.90, 95% CI 0.82 to 0.99). Sublingual misoprostol had equivalent efficacy to vaginal misoprostol in inducing complete miscarriage but was associated with more frequent diarrhoea. The two trials of mifepristone treatment generated conflicting results. There was no statistically significant difference between vaginal misoprostol and gemeprost in the induction of miscarriage for fetal death after 13 weeks.

AUTHORS' CONCLUSIONS

Available evidence from randomised trials supports the use of vaginal misoprostol as a medical treatment to terminate non-viable pregnancies before 24 weeks. Further research is required to assess effectiveness and safety, optimal route of administration and dose. Conflicting findings about the value of mifepristone need to be resolved by additional study.

Ovarian cancer: Autologous immunotherapy optimized by remote adjuvancy of a silicate-induced granuloma

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Background: Advanced ovarian cancer has been included in several studies about an immunotherapy procedure using an Autologous Thermostable Hemoderivative Vaccine (ATHV) with anti-progressive tumor effect in metastatic malignant disease from different primary tumors (Cancer Biol Ther 2003). Like in most cancer vaccines, the net anti-tumoral effect of ATHV has low intensity despite the addition of several adjuvant steps: immune response enhancement by GM-CSF, immune tolerance break by cyclophosphamide or interference with CD4+CD25+ regulatory cells (E. Lasalvia-Prisco et al. ASCO 2003–2005). The inclusion of another adjuvant immunomodulatory step to ATHV in patients with advanced ovarian cancer was explored in this study. The tested adjuvancy was the local and remote immune-stimulation elicited by a subcutaneous silicate-granuloma (SSG), a phenomenon well proven in preclinical models (RM Fauve et al. Immune Lett 1987; E Fontan et al Proc Nat Acad of Sci 1983). Methods: Twenty four metastasic ovarian cancer patients, chemotherapy resistant, performance status ≤ 2 and CA-125 progressing serum level, were included in this institutional-IRB approved phase I/II trial. The patients were 3-group randomized, submitted to 3 different treatments: I only sympthomatic; II the previously reported ATHV and III ATHV + SSG. Tumor Growth was assessed in each case by the tumor size increase (RECIST measured). Mean difference in the 3 groups was statistically assessed (Student’s test). Results: Tumor Growth was slower in Group II and III than in Group I (p<0.02, p<0.005). Tumor growth was slower in Group III than in Group II (p<0.02). No relevant toxicities were detected. Conclusions: The results support that in advanced ovarian cancer an additional subcutaneous silicate granuloma as adjuvant agent optimizes the tumor growth inhibition through immunotherapy with an autologous thermostable hemoderivative vaccine. The bypass of the immune-ignorance could be discussed as its mechanism of action.

No significant financial relationships to disclose.

Expression and prognostic value of EGFR in invasive breast cancer

Epidermal growth factor receptor (EGFR) is a membrane receptor expressed in a variety of solid human cancers and directly related with poor prognosis. The objective of this work was to evaluate the EGFR content in breast carcinomas, its possible relationship with different clinical-pathological parameters, and its potential prognostic significance and predictive value. EGFR levels were examined by radioligand binding assays in 846 patients with invasive breast cancer. The median follow-up period was 50 months. There was a wide variability of EGFR levels among the studied tumors (0.01-403 fmol/mg protein). Statistical analysis showed that EGFR levels were significantly higher in younger patients (p=0.0001). EGFR were also notably higher in ER-negative or PgR-negative tumors than in ER-positive (p=0.0001) or PgR-positive tumors (p=0.001). In addition, the presence of high intratumoral EGFR levels (cut-off: 6 fmol/mg protein) was associated with both shorter relapse-free survival (p=0.04) and overall survival (p=0.01) in the group of patients as a whole, as well as with overall survival in the subgroup of patients without any type of systemic adjuvant treatment (p=0.02). However, EGFR levels did not achieve significance as independent prognostic factor in the multivariate analysis. There is a wide variability of intratumoral EGFR levels in breast carcinomas, and these protein levels correlated positively with a poor prognosis in the t univariate analysis. However, further studies are necessary in order to assess the possible clinical value of EGFR in combination with other essential components of the EGFR family network.

Interactions in Biofilms of Lactococcus lactis ssp. cremoris and Pseudomonas fluorescens Cultured in Cold UHT Milk

Three Lactococcus lactis ssp. cremoris isolates from refrigerated bulk raw milk were cultured separately and in association with a known psychrotrophic dairy Pseudomonas fluorescens strain, in skim UHT milk for 72 h at 7 degrees C, to determine mutual influences in both the planktonic and biofilm phases. Two levels of inoculum of each culture partner were combined. Protocooperation and commensalism cases were found, all of them in the biofilm phase. Type and intensity of the interactions depended on Lactococcus strain and on the cell density of each partner. Maximum enhancement of attachment was observed to be approximately 100-fold for P. fluorescens and 20,000-fold for one of the L. lactis strains. Confocal scanning laser microscopy images show compact masses of Pseudomonas trapping lactococci cells in cooperative biofilms.

International, open-label, noncomparative, clinical trial of micafungin alone and in combination for treatment of newly diagnosed and refractory candidemia

Candida spp. are the fourth leading cause of bloodstream infections, and non-albicans species are increasing in importance. Micafungin is a new echinocandin antifungal agent with excellent in vitro activity against Candida spp. Pediatric, neonatal, and adult patients with new or refractory candidemia were enrolled into this open-label, noncomparative, international study. The initial dose of micafungin was 50 mg/d (1 mg/kg for patients <40 kg) for infections due to C. albicans and 100 mg/d (2 mg/kg for patients <40 kg) for infections due to other species. Dose escalation was allowed. Maximum length of therapy was 42 days. A total of 126 patients were evaluable (received at least five doses of micafungin). Success (complete or partial response) was seen in 83.3% patients overall. Success rates for treatment of infections caused by the most common Candida spp. were as follows: C. albicans 85.1%, C. glabrata 93.8%, C. parapsilosis 86.4%, and C. tropicalis 83.3%. Serious adverse events related to micafungin were uncommon. Micafungin shows promise as a safe and effective agent for the treatment of newly diagnosed and refractory cases of candidemia. Large-scale, randomized, controlled trials are warranted.

Gestion en temps réel d'un réseau d'assainissement : vérification de l'optimalité et de l'applicabilité de la théorie des graphes par rapport à la programmation linéaire mixte

Dans le cas de la gestion en temps réel des réseaux d'assainissement, la première étape peut, par exemple, consister à vérifier qu'une manipulation des organes de contrôle tels que les vannes et pompes est capable de minimiser les déversements vers le milieu naturel. Cette gestion, que l'on appellera " gestion de référence ", permet de déterminer les stratégies de commande sur toute la durée de l'événement pluvieux connu à l'avance. Ce calcul se fait donc à la fin de l'événement pluvieux et permet de dire ce qui aurait pu être fait avec les organes de régulation en terme de minimisation des volumes déversés. La programmation linéaire par les graphes et la programmation linéaire mixte permettent de déterminer une solution optimale. Cet article s'intéresse à la vérification de l'optimalité et à l'applicabilité de la programmation linéaire par les graphes comparée à la programmation linéaire mixte dans le cas de la " gestion de référence " sur le réseau d'assainissement de Saverne (France). En comparant les volumes déversés par ces deux techniques d'optimisation sur 34 événements pluvieux, nous pouvons confirmer que l'approche par les graphes ne donne pas toujours le minimum global. Les résultats ont montré que la programmation linéaire mixte fournit des temps de calcul qui peuvent atteindre plus de 24 heures. Par contre, l'approche par les graphes permet un temps de calcul de l'ordre de 5 minutes en moyenne avec un minimum global en terme de volume déversé atteint qui n'excède pas 5% par rapport à la solution fournie par la programmation linéaire mixte.