The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer

Clinical stage, Gleason score and serum prostate specific antigen (PSA) levels are used separately to predict pathological stage in patients with localized prostate cancer. Because the degree of tumor differentiation has a profound influence on the expression of serum PSA, serum PSA levels alone do not reflect tumor burden accurately. To overcome this obstacle we tested these 3 variables alone and in combinations as predictors of final pathological stage in 703 men with clinically localized prostate cancer at our institution. All patients were assigned a clinical stage by 1 urologist. The Gleason score was determined from preoperative needle biopsy and serum PSA levels were measured on an ambulatory basis. Final pathological stage was determined to be either organ confined, established capsular penetration, seminal vesicle involvement or lymph node involvement. Logistic regression analysis with the likelihood ratio chi-square test determined that serum PSA, Gleason score and clinical stage all predicted final pathological stage well. The results were improved with combinations of the 3 variables (serum PSA, Gleason score and clinical stage) and the combination provided the best separation. From these analyses probability plots and nomograms have been constructed to assist urologists in the preoperative prediction of final pathological stage for patients with clinically localized prostate cancer.

A genetic linkage map for cattle

We report the most extensive physically anchored linkage map for cattle produced to date. Three-hundred thirteen genetic markers ordered in 30 linkage groups, anchored to 24 autosomal chromosomes (n = 29), the X and Y chromosomes, four unanchored syntenic groups and two unassigned linkage groups spanning 2464 cM of the bovine genome are summarized. The map also assigns 19 type I loci to specific chromosomes and/or syntenic groups and four cosmid clones containing informative microsatellites to chromosomes 13, 25 and 29 anchoring syntenic groups U11, U7 and U8, respectively. This map provides the skeletal framework prerequisite to development of a comprehensive genetic map for cattle and analysis of economic trait loci (ETL).

Radioiodine ablation of thyroid remnants after preparation with recombinant human thyrotropin in differentiated thyroid carcinoma: results of an international, randomized, controlled study

CONTEXT

After surgery for differentiated thyroid carcinoma, many patients are treated with radioiodine to ablate remnant thyroid tissue. This procedure has been performed with the patient in the hypothyroid state to promote endogenous TSH stimulation and is often associated with hypothyroid symptoms and impaired quality of life. OBJECTIVE AND INTERVENTION: This international, randomized, controlled, multicenter trial aimed to compare the efficacy and safety of recombinant human TSH (rhTSH) to prepare euthyroid patients on L-thyroxine therapy (euthyroid group) to ablate remnant thyroid tissue with 3.7 GBq (100 mCi) 131I, compared with that with conventional remnant ablation performed in the hypothyroid state (hypothyroid group). Quality of life was determined at the time of randomization and ablation. After the administration of the 131-I dose, the rate of radiation clearance from blood, thyroid remnant, and whole body was measured.

RESULTS

The predefined primary criterion for successful ablation was "no visible uptake in the thyroid bed, or if visible, fractional uptake less than 0.1%" on neck scans performed 8 months after therapy and was satisfied in 100% of patients in both groups. A secondary criterion for ablation, an rhTSH-stimulated serum thyroglobulin concentration less than 2 ng/ml, was fulfilled by 23 of 24 (96%) euthyroid patients and 18 of 21 (86%) hypothyroid patients (P = 0.2341). Quality of life was well preserved in the euthyroid group, compared with the hypothyroid group, as demonstrated by their lower pretreatment scores on the Billewicz scale for hypothyroid signs and symptoms, 27 +/- 7 vs. 18 +/- 4 (P < 0.0001) and their significantly higher Short Form-36 Health Assessment Scale scores in five of eight categories. Euthyroid patients had a statistically significant one third lower radiation dose to the blood, compared with patients in the hypothyroid group.

CONCLUSIONS

This study demonstrates comparable remnant ablation rates in patients prepared for 131I remnant ablation with 3.7 GBq by either administering rhTSH or withholding thyroid hormone. rhTSH-prepared patients maintained a higher quality of life and received less radiation exposure to the blood.

Arrhythmia in heart and brain: KCNQ1 mutations link epilepsy and sudden unexplained death

Sudden unexplained death is a catastrophic complication of human idiopathic epilepsy, causing up to 18% of patient deaths. A molecular mechanism and an identified therapy have remained elusive. Here, we find that epilepsy occurs in mouse lines bearing dominant human LQT1 mutations for the most common form of cardiac long QT syndrome, which causes syncopy and sudden death. KCNQ1 encodes the cardiac KvLQT1 delayed rectifier channel, which has not been previously found in the brain. We have shown that, in these mice, this channel is found in forebrain neuronal networks and brainstem nuclei, regions in which a defect in the ability of neurons to repolarize after an action potential, as would be caused by this mutation, can produce seizures and dysregulate autonomic control of the heart. That long QT syndrome mutations in KCNQ1 cause epilepsy reveals the dual arrhythmogenic potential of an ion channelopathy coexpressed in heart and brain and motivates a search for genetic diagnostic strategies to improve risk prediction and prevention of early mortality in persons with seizure disorders of unknown origin.

Glycation impairs high-density lipoprotein function

AIMS/HYPOTHESIS

To examine the effects of incubation of high-density lipoprotein (HDL) under hyperglycaemic conditions on several functions of HDL in vitro.

METHODS

Human HDL (5 mg protein) was incubated for 1 week at 37 degrees C in the presence or absence of 25 mmol/l glucose. Additional samples of human HDL were incubated in butylated hydroxytoluene to control for oxidation.

RESULTS

High-density lipoprotein incubated for 1 week in 25 mmol/l glucose had significant increases in the glycation product, fructoselysine and in the advanced glycation end product, N epsilon-(carboxymethyl)-lysine. High-density lipoprotein apolipoprotein AI and AII concentrations were not altered but glycated HDL had a 65% reduction in paraoxonase enzymatic activity. Glycated HDL did not inhibit monocyte adhesion to human aortic endothelial cells in response to oxidised low-density lipoprotein in vitro (43 +/- 4 monocytes bound vs 21 +/- 2 monocytes for control HDL, p < 0.0001). Hepatic lipase-mediated non-esterified fatty acid release from HDL lipids was enhanced in glycated HDL compared with control HDL (25 +/- 1 vs 16 +/- 1 nmol non-esterified fatty acid hydrolysed/min, respectively, p < 0.0001). Direct glycation of purified paraoxonase protein by incubation in 25 mmol/l glucose caused a 40% reduction in enzymatic activity. This glycated paraoxonase did not inhibit monocyte adhesion to human aortic endothelial cells in vitro (68 +/- 3 monocytes vs 49 +/- 2 monocytes bound for control paraoxonase, respectively, p < 0.001). We also measured a 40% reduction in paraoxonase activity in patients with Type II (non-insulin-dependent) diabetes mellitus and documented coronary artery disease compared with non-diabetic subjects, p < 0.0001.

CONCLUSIONS/INTERPRETATION

Alterations in function of HDL caused by exposure to hyperglycaemic conditions could contribute to the accelerated atherosclerosis observed in Type II diabetes.

Influence of Anterior Cervical Plate Design on Dysphagia

OBJECTIVE

To compare the incidence, prevalence, and rate of improvement of dysphagia in patients undergoing anterior cervical spine surgery with two different anterior instrumentation designs.

METHODS

The study subjects were 156 consecutive patients undergoing anterior cervical spine surgery with plate fixation. We compared the incidence of dysphagia among the two different plate groups both produced by the same manufacturer (Medtronic Danek); the Atlantis plate has thicker and wider plate dimensions than the Zephir plate. Dysphagia evaluations were performed prospectively by telephone interviews at 1, 2, 6, 12, and 24 months following the procedure. Risk factors such as gender, revision surgery, and number of surgical levels were compared between the groups and were not statistically different.

RESULTS

Overall incidences of dysphagia were 49%, 37%, 20%, 15.4%, and 11% at 1, 2, 6, 12, and 24 months, respectively. Severe and disabling dysphagia is reported to be a relatively uncommon complication of anterior cervical surgery. However, a significant number of patients report mild to moderate discomfort including double-swallowing and catching sensation. Except at the 2-month follow-up point, the Atlantis plate group had higher incidences of dysphagia than the Zephir group at all time points (57% vs 50%, 36% vs 4%, 23% vs 14%, 17% vs 7%, 14% vs 0% at 1, 2, 6, 12, and 24 months, respectively). The Atlantis plate group had a 14% incidence of dysphagia at 2 years compared with the Zephir group, which had a 0% incidence at 2 years (P < 0.04). For primary surgeries, there was a higher incidence of dysphagia at all time points in the Atlantis group when compared with the Zephir group (58% vs 43%, 35% vs 30%, 22% vs 10%, 17% vs 0%, and 13% vs 0% at 1, 2, 6, 12, and 24 months, respectively) (P < 0.04 at 1 year). A regression analysis was performed. The resulting formulas predict the permanent rate of dysphagia for the Atlantis group is 13.6% and for the Zephir group is 3.58%.

CONCLUSIONS

The use of a smaller and smoother profile plate such as the Zephir does reduce the incidence of dysphagia as compared with a slightly larger and less smooth plate such as the Atlantis.

Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study

BACKGROUND CONTEXT

Severe and disabling dysphagia is a relatively uncommon complication of anterior cervical spine surgery. However, the incidence of dysphagia ranges widely (2% to 60%). Furthermore, risk factors that contribute to the development of dysphagia have not been well identified.

PURPOSE

The purpose of this study was to evaluate the prevalence of dysphagia after anterior cervical spine surgery, and to identify any risk factors associated with increased dysphagia.

STUDY DESIGN

This study is a prospective cohort study designed to evaluate the prevalence of dysphagia at 1, 2, 6, 12, and 24 months. Patients were prospectively interviewed at 1, 2, 6, 12, and 24 months regarding the presence and subjective severity of dysphagia.

PATIENT SAMPLE

Between the period of 1999 and 2002, 348 cervical spine surgeries were performed using the anterior Smith Robinson approach. 310 of these patients were available for 2-year follow-up.

OUTCOMES MEASURE

Using the dysphagia grading system defined by Bazaz et al. (Spine 2002), we prospectively evaluated patients' postoperative dysphagia.

METHODS

The presence and severity of dysphagia were reported during the telephone interviews performed at 1, 2, 6, 12, and 24 months after the procedure. Proportion analysis (chi-square or a Fisher Exact Test), prevalence ratios, and 95% confidence intervals were used to compare the prevalence of dysphagia with age, gender, type of surgery (eg, discectomy vs. corpectomy, primary vs. revision), use of instrumentation, number and location of surgical levels.

RESULTS

The overall prevalences for dysphagia at 1, 2, 6, 12, and 24 months were 54.0%, 33.6%, 18.6%, 15.2%, and 13.6%. The prevalence of dysphagia was found to be significantly higher in women (18.3%) than men (9.9%) 2 years after the surgery. Revision surgery patients (27.7%) also had a significantly higher prevalence of dysphagia than primary surgery (11.3%) patients 2 years after the surgery. Patients who underwent more than two-level surgery (19.3%) also had significantly higher rates of dysphagia 2 years after their procedures than patients who had two or less levels (9.7%) operated on.

CONCLUSION

Overall the incidence of dysphagia 2 years after anterior cervical spine surgery was 13.6%. Risk factors for long-term dysphagia after anterior cervical spine surgery include gender, revision surgeries, and multilevel surgeries. The use of instrumentation, higher levels, or corpectomy versus discectomy did not significantly increase the prevalence of dysphagia.

Single-molecule magnets: a new class of tetranuclear manganese magnets

The preparation, X-ray structure, and detailed physical characterization are presented for a new type of single-molecule magnet [Mn4(O2CMe)2(pdmH)6](ClO4)2 (1). Complex 1.2MeCN.Et2O crystallizes in the triclinic space group P1, with cell dimensions at 130 K of a = 11.914(3) A, b = 15.347(4) A, c = 9.660(3) A, alpha = 104.58(1) degree, beta = 93.42(1) degree, gamma = 106.06(1) degree, and Z = 1. The cation lies on an inversion center and consists of a planar Mn4 rhombus that is mixed-valent, MnIII2MnII2. The pdmH- ligands (pdmH2 is pyridine-2,6-dimethanol) function as either bidentate or tridentate ligands. The bridging between Mn atoms is established by either a deprotonated oxygen atom of a pdmH- ligand or an acetate ligand. The solvated complex readily loses all acetonitrile and ether solvate molecules to give complex 1, which with time becomes hydrated to give 1.2.5H2O. Direct current and alternating current magnetic susceptibility data are given for 1 and 1.2.5H2O and indicate that the desolvated complex has a S = 8 ground state, whereas the hydrated 1.2.5H2O has a S = 9 ground state. Ferromagnetic interactions between MnIII-MnII and MnIII-MnIII pairs result in parallel spin alignments of the S = 5/2 MnII and S = 2 MnIII ions. High-frequency EPR spectra were run for complex 1.2.5H2O at frequencies of 218, 328, and 436 GHz in the 4.5-30 K range. A magnetic-field-oriented polycrystallite sample was employed. Fine structure is clearly seen in this parallel-field EPR spectrum. The transition fields were least-squares-fit to give g = 1.99, D = -0.451 K, and B4 degrees = 2.94 x 10(-5) K for the S = 9 ground state of 1.2.5H2O. A molecule with a large-spin ground state with D < 0 can function as a single-molecule magnet, as detected by techniques such as ac magnetic susceptibility. Out-of-phase ac signals (chi'' M) were seen for complexes 1 and 1.2.5H2O to show that these complexes are single-molecule magnets. A sample of 1 was studied by ac susceptibility in the 0.4-6.4 K range with the ac field oscillating at frequencies in the 1.1-1000 Hz range. A single peak in chi'' M vs temperature plots was seen for each frequency; the temperature of the chi'' M peak varies from 2.03 K at 995 Hz to 1.16 K at 1.1 Hz. Magnetization relaxation rates were evaluated in this way. An Arrhenius plot gave an activation energy of 17.3 K, which, as expected, is less than the 22.4 K value calculated for the thermodynamic barrier for magnetization direction reversal for an S = 8 complex with D = -0.35 K. The 1.2.5H2O complex with an S = 9 ground state has its chi'' M peaks at higher temperatures.

Mixed-valence tetranuclear manganese single-molecule magnets

The preparations, X-ray structures, and detailed physical characterizations are presented for two new mixed-valence tetranuclear manganese complexes that function as single-molecule magnets (SMM's): [Mn4(hmp)6Br2(H2O)2]Br2-4H2O (2) and [Mn4(6-me-hmp)6Cl4]-4H2O (3), where hmp(-) is the anion of 2-hydroxymethylpyridine and 6-me-hmp(-) is the anion of 6-methyl-2-hydroxymethylpyridine. Complex 2-4H2O crystallizes in the space group P2(1)/c, with cell dimensions at -160 degrees C of a = 10.907(0) A, b = 15.788(0) A, c = 13.941(0) A, beta = 101.21(0) degrees, and Z = 2. The cation lies on an inversion center and consists of a planar Mn4 rhombus that is mixed-valence, Mn2(III)Mn2(II). The hmp(-) ligands function as bidentate ligands and as the only bridging ligands in 2-4H2O. Complex 3-4H2O crystallizes in the monoclinic space group C2/c, with cell dimensions at -160 degrees C of a = 17.0852(4) A, b = 20.8781(5) A, c = 14.835(3) A, beta = 90.5485(8) degrees, and Z = 4. This neutral complex also has a mixed-valence Mn2(III)Mn2(II) composition and is best described as having four manganese ions arranged in a bent chain. A mu2-oxygen atom of the 6-me-hmp(-) anion bridges between the manganese ions; the Cl(-) ligands are terminal. Variable-field magnetization and high-frequency and -field EPR (HFEPR) data indicate that complex 2-4H2O has a S = 9 ground state whereas complex 3.4H(2)O has S = 0 ground state. Fine structure patterns are seen in the HFEPR spectra, and in the case of 2.4H(2)O it was possible to simulate the fine structure assuming S = 9 with the parameters g = 1.999, axial zero-field splitting of D/k(B) = -0.498 K, quartic longitudinal zero-field splitting of B4(omicron)/k(B) = 1.72 x 10(-5) K, and rhombic zero-field splitting of E/k(B) = 0.124 K. Complex 2-4H2O exhibits a frequency-dependent out-of-phase AC magnetic susceptibility signal, clearly indicating that this complex functions as a SMM. The AC susceptibility data for complex 2-4H2O were measured in the 0.05-4.0 K range and when fit to the Arrhenius law, gave an activation energy of DeltaE = 15.8 K for the reversal of magnetization. This DeltaE value is to be compared to the potential-energy barrier height of U/k(B) = absolute value DSz(2) = 40.3 K calculated for 2-4H2O.

Engineering of osteochondral tissue with bone marrow mesenchymal progenitor cells in a derivatized hyaluronan-gelatin composite sponge

The aim of this study was to investigate the potential of a composite matrix, containing esterified hyaluronic acid and gelatin, to facilitate the osteochondral differentiation of culture-expanded, bone marrow-derived mesenchymal progenitor cells. The cell loading characteristics and the effects of the matrix on cell differentiation were examined in vitro and in vivo. Empty and cell-loaded composites were cultivated for up to 28 days in a chemically defined medium with or without transforming growth factor-beta1 (TGF-beta1). A type II collagen-rich extracellular matrix was produced by cells loaded in the matrix and cultured in the presence of TGF-beta1. Empty and cell-loaded matrices were also implanted subcutaneously in immunodeficient mice. Three types of implant were used: empty (group I), cell-loaded matrices (Group II), and cell-loaded matrices cultured for 14 days in vitro in defined medium with TGF-beta1 (group III). No osteochondral differentiation was found in implanted empty matrices; however, the matrix supported osteochondrogenic cell differentiation in the cell-loaded implants. Preculture in vitro in a chondrogenic medium increased the percentage of osteochondral tissue found in the constructs after 3 weeks. These results indicate the potential use of this composite matrix for delivery of bone marrow-derived mesenchymal progenitor cells for the repair of chondral and osseous defects. The results also indicate that this composite matrix is useful for in vitro tissue engineering.

The PROCLIPI international registry of early-stage mycosis fungoides identifies substantial diagnostic delay in most patients

BACKGROUND

Survival in mycosis fungoides (MF) is varied and may be poor. The PROCLIPI (PROspective Cutaneous Lymphoma International Prognostic Index) study is a web-based data collection system for early-stage MF with legal data-sharing agreements permitting international collaboration in a rare cancer with complex pathology. Clinicopathological data must be 100% complete and in-built intelligence in the database system ensures accurate staging.

OBJECTIVES

To develop a prognostic index for MF.

METHODS

Predefined datasets for clinical, haematological, radiological, immunohistochemical, genotypic, treatment and quality of life are collected at first diagnosis of MF and annually to test against survival. Biobanked tissue samples are recorded within a Federated Biobank for translational studies.

RESULTS

In total, 430 patients were enrolled from 29 centres in 15 countries spanning five continents. Altogether, 348 were confirmed as having early-stage MF at central review. The majority had classical MF (81·6%) with a CD4 phenotype (88·2%). Folliculotropic MF was diagnosed in 17·8%. Most presented with stage I (IA: 49·4%; IB: 42·8%), but 7·8% presented with enlarged lymph nodes (stage IIA). A diagnostic delay between first symptom development and initial diagnosis was frequent [85·6%; median delay 36 months (interquartile range 12-90)]. This highlights the difficulties in accurate diagnosis, which includes lack of a singular diagnostic test for MF.

CONCLUSIONS

This confirmed early-stage MF cohort is being followed-up to identify prognostic factors, which may allow better management and improve survival by identifying patients at risk of disease progression. This study design is a useful model for collaboration in other rare diseases, especially where pathological diagnosis can be complex.

Risk factors for the development of perioperative complications in elderly patients undergoing lumbar decompression and arthrodesis for spinal stenosis: an analysis of 166 patients

STUDY DESIGN

Retrospective review.

OBJECTIVE

To quantify and describe perioperative complication rates in a large series of well-matched elderly patients who underwent lumbar decompression and arthrodesis.

SUMMARY OF BACKGROUND DATA

Posterior lumbar decompression and fusion is frequently performed to treat lumbar stenosis with instability. An increasing number of elderly patients are undergoing operative treatment for degenerative lumbar disease. The reported morbidity of performing decompression and arthrodesis in this population varies widely in the literature, with recent reports showing a high rate of major complications.

METHODS

A total of 166 patients age 65 or older that underwent primary posterior lumbar decompression and fusion with (group 1; n = 75) or without (group 2; n = 91) instrumentation were included. Hospital records were reviewed for the occurrence of any complications (major and minor), the need for transfusion, estimated length of stay, and disposition at discharge. Logistic regression (with the presence/absence of major complications as the dependent variable) was used to identify risk factors for the occurrence of a complication.

RESULTS

Five major complications (3%) occurred (group 1, 1; group 2, 4). Minor complications developed in 30.7% of group 1 and 31.9% of group 2. There were no deaths, and only one perioperative complication was attributable to the use of instrumentation. Decompression/fusion of 4 or more segments was significantly associated with the occurrence of a major complication. Advanced age, the presence of medical comorbidities, or the use of instrumentation did not increase the rate of major or minor complications. The occurrence of either a major or minor complication prolonged hospital stay.

CONCLUSIONS

Posterior lumbar decompression and fusion can be safely performed in elderly patients, with a low rate of major complications. The addition of instrumentation does not increase the complication rate. These results differ from those previously reported in the literature, which describe a significantly higher rate of complications in this age group, with a prolonged rate of hospitalization.

Protective effects of green tea extracts (polyphenon E and EGCG) on human cervical lesions

We investigated clinical efficacy of green tea extracts (polyphenon E; poly E and (-)-epigallocatechin-3-gallate [EGCG]) delivered in a form of ointment or capsule in patients with human papilloma virus (HPV) infected cervical lesions. Fifty-one patients with cervical lesions (chronic cervicitis, mild dysplasia, moderate dysplasia and severe dysplasia) were divided into four groups, as compared with 39 untreated patients as a control. Poly E ointment was applied locally to 27 patients twice a week. For oral delivery, a 200 mg of poly E or EGCG capsule was taken orally every day for eight to 12 weeks. In the study, 20 out of 27 patients (74%) under poly E ointment therapy showed a response. Six out of eight patients under poly E ointment plus poly E capsule therapy (75%) showed a response, and three out of six patients (50%) under poly E capsule therapy showed a response. Six out of 10 patients (60%) under EGCG capsule therapy showed a response. Overall, a 69% response rate (35/51) was noted for treatment with green tea extracts, as compared with a 10% response rate (4/39) in untreated controls (P<0.05). Thus, the data collected here demonstrated that green tea extracts in a form of ointment and capsule are effective for treating cervical lesions, suggesting that green tea extracts can be a potential therapy regimen for patients with HPV infected cervical lesions.

Single-molecule magnets: site-specific ligand abstraction from [Mn12O12(O2CR)16(H2O)4] and the preparation and properties of [Mn12O12(NO3)4(O2CCH2Bu(t))12(H2O)4]

Site-selective carboxylate abstraction has been achieved from [Mn(12)O(12)(O(2)CR)(16)(H(2)O)(4)] complexes by treatment with HNO(3) in MeCN. The reaction of the R = Ph or CH(2)Bu(t)() complexes with 4 equiv of HNO(3) gives [Mn(12)O(12)(NO(3))(4)(O(2)CR)(12)(H(2)O)(4)] (R = CH(2)Bu(t) (6) or Ph (7)) in analytical purity. Complex 6.MeNO(2) crystallizes in monoclinic space group C2/c with the following cell parameters at -168 degrees C: a = 21.280(5), b = 34.430(8), c = 33.023(8) A, beta = 104.61(1) degrees, V = 23413 A, and Z = 8. The four NO(3)(-) groups are not disordered and are bound in bridging modes at axial positions formerly occupied by bridging carboxylate groups. (1)H NMR spectroscopy in CD(2)Cl(2) and CDCl(3) shows retention of the solid-state structure on dissolution in these solvents. DC magnetic susceptibility (chi(M)) and magnetization (M) studies have been carried out in the 2.00-300 K and 1.0-7.0 T ranges. Fits of M/Nmu(B) versus H/T plots gave S = 10, g = 1.92, and D = -0.40 cm(-1), where D is the axial zero-field splitting parameter. AC magnetic susceptibility studies on 6 have been performed in the 1.70-10.0 K range in a 3.5 Oe field oscillating at frequencies up to 1500 Hz. Out-of-phase magnetic susceptibility (chi(M)' ') signals were observed in the 4.00-8.00 K range which were frequency-dependent. Thus, 6 displays the slow magnetization relaxation diagnostic of a single-molecule magnet (SMM). The data were fit to the Arrhenius law, and this gave the effective barrier to relaxation (U(eff)) of 50.0 cm(-1) (72.0 K) and a pre-exponential (1/tau(0)) of 1.9 x 10(8) s(-1). Complex 6 also shows hysteresis in magnetization versus DC field scans, and the hysteresis loops show steps at regular intervals of magnetic field, the diagnostic evidence of field-tuned quantum tunneling of magnetization. High-frequency EPR (HFEPR) spectroscopy on oriented crystals of complex 6 shows resonances assigned to transitions between zero-field split M(s) states of the S = 10 ground state. Fitting of the data gave S = 10, g = 1.99, D = -0.46 cm(-1), and B(4)(0) = -2.0 x 10(-5), where B(4)(0) is the quartic zero-field coefficient. The combined results demonstrate that replacement of four carboxylate groups with NO(3)(-) groups leads to insignificant perturbation of the magnetic properties of the Mn(12) complex. Complex 6 should now be a useful starting point for further reactivity studies, taking advantage of the good leaving group properties of the NO(3)(-) ligands.

Transoral robotic surgery vs. radiotherapy for management of oropharyngeal squamous cell carcinoma - A systematic review of the literature

BACKGROUND

Intensity-modulated radiation therapy (IMRT) with or without concurrent chemotherapy is widely utilized for the treatment of oropharyngeal squamous cell carcinoma (OPSCC). However, due to significant acute and late toxicities there has been increasing interest in minimally invasive surgical approaches, particularly transoral robotic surgery (TORS) in an attempt to preserve patient quality of life while maintaining oncologic outcomes. The aim of this study was to review the current literature in order to compare primary IMRT versus TORS in the management of OPSCC.

METHODS

A MEDLINE search was conducted to identify studies reporting on the outcomes of TORS or IMRT in the treatment of OPSCC. Reference lists were also reviewed for relevant articles. Oncologic, functional, and quality of life data is summarized and discussed.

RESULTS

One hundred-ninety papers were identified through the MEDLINE search. An additional 52 papers were retrieved by hand searching the reference lists. Ultimately, 44 papers were identified that discussed outcomes after IMRT or TORS for OPSCC. No outcomes from randomized trials were identified.

CONCLUSION

No randomized trials comparing TORS versus IMRT to each other were identified. Uncontrolled reports from the current literature suggest comparable oncologic outcomes with TORS compared to IMRT and functional outcomes may be superior. However, the median follow-up was relatively short and the TORS studies included patients with earlier stage OPSCC on average compared to IMRT studies. Prospective, randomized controlled trials and direct, well-matched comparisons are needed to further elucidate the role for TORS in the treatment of oropharyngeal squamous cell carcinoma.

Recipient vessels in head and neck microsurgery: radiation effect and vessel access

Historical cohort analysis compared free-flap survival rates in 226 irradiated and 108 nonirradiated head and neck reconstructions. The failure rate for the irradiated flaps (3.5 percent) did not differ significantly from that for the nonirradiated group (2.9 percent). A case-control study of the failed irradiated flaps revealed infection and lag time between radiotherapy and surgery as the only factors significantly associated with free flap failure. Salvage techniques (vein grafting, cephalic transposition, and Corlett looping) for recruiting recipient vessels into radically ablated head and neck beds are reviewed.

Stem cell based tissue engineering for meniscus repair

Defects of the meniscus greatly alter knee function and predispose the joint to degenerative changes. The purpose of this study was to test a recently developed cell-scaffold combination for the repair of a critical-size defect of the rabbit medial meniscus. A bilateral, complete resection of the pars intermedia of the medial meniscus was performed in 18 New Zealand White rabbits. A hyaluronan/gelatin composite scaffold was implanted into the defect of one knee of 6 rabbits and the contralateral defect was left untreated. Scaffolds loaded with autologous marrow-derived mesenchymal stem cells and cultured in a chondrogenic medium for 14 days were implanted in a second series of 12 rabbits. Empty scaffolds were implanted in the contralateral knees. Meniscii were harvested at 12 weeks. Untreated defects had a muted fibrous healing response. Defects treated with cell-free implants showed also predominantly fibrous tissue whereas fibrocartilage was present in some scaffolds. The cross-sectional width of the repair tissue after treatment with cell-free scaffolds was significantly greater than controls (p < 0.05). Pre-cultured implants integrated with the host tissue and 8 of 11 contained meniscus-like fibrocartilage, compared with 2 of 11 controls (p < 0.03). The mean cross-sectional width of the pre-cultured implant repair tissue was greater than controls (p < 0.004). This study demonstrates the repair of a critical size meniscal defect with a stem cell and scaffold based tissue engineering approach.

A new high-density (25 electrodes/mm²) penetrating microelectrode array for recording and stimulating sub-millimeter neuroanatomical structures

OBJECTIVE

Among the currently available neural interface devices, there has been a need for a penetrating electrode array with a high electrode-count and high electrode-density (the number of electrodes/mm(2)) that can be used for electrophysiological studies of sub-millimeter neuroanatomical structures. We have developed such a penetrating microelectrode array with both a high electrode-density (25 electrodes/mm(2)) and high electrode-count (up to 96 electrodes) for small nervous system structures, based on the existing Utah Slanted Electrode Array (USEA). Such high electrode-density arrays are expected to provide greater access to nerve fibers than the conventionally spaced USEA especially in small diameter nerves.

APPROACH

One concern for such high density microelectrode arrays is that they may cause a nerve crush-type injury upon implantation. We evaluated this possibility during acute (<10 h) in vivo experiments with electrode arrays implanted into small diameter peripheral nerves of anesthetized rats (sciatic nerve) and cats (pudendal nerve).

MAIN RESULTS

Successful intrafascicular implantation and viable nerve function was demonstrated via microstimulation, single-unit recordings and histological analysis. Measurements of the electrode impedances and quantified electrode dimensions demonstrated fabrication quality. The results of these experiments show that such high density neural interfaces can be implanted acutely into neural tissue without causing a complete nerve crush injury, while mediating intrafascicular access to fibers in small diameter peripheral nerves.

SIGNIFICANCE

This new penetrating microelectrode array has characteristics un-matched by other neural interface devices currently available for peripheral nervous system neurophysiological research.

The epidemic of human papillomavirus and oropharyngeal cancer in a Canadian population

BACKGROUND

Sexually transmitted infection with the human papillomavirus (hpv) is responsible for a significant burden of human cancers involving the cervix, anogenital tract, and oropharynx. Studies in the United States and Europe have demonstrated an alarming increase in the frequency of hpv-positive oropharyngeal cancer, but the same direct evidence does not exist in Canada.

METHODS

Using the London Health Sciences Centre pathology database, we identified tonsillar cancers diagnosed between 1993 and 2011. Real-time polymerase chain reaction was then used on pre-treatment primary-site biopsy samples to test for dna from the high-risk hpv types 16 and 18. The study cohort was divided into three time periods: 1993-1999, 2000-2005, and 2006-2011.

RESULTS

Of 160 tumour samples identified, 91 (57%) were positive for hpv 16. The total number of tonsillar cancers significantly increased from 1993-1999 to 2006-2011 (32 vs. 68), and the proportion of cases that were hpv-positive substantially increased (25% vs. 62%, p < 0.002). Those changes were associated with a marked improvement in 5-year overall survival (39% in 1993-1999 vs. 84% in 2006-2011, p < 0.001). When all factors were included in a multivariable model, only hpv status predicted treatment outcome.

INTERPRETATION

The present study is the first to provide direct evidence that hpv-related oropharyngeal cancer is increasing in incidence in a Canadian population. Given the long lag time between hpv infection and clinically apparent malignancy, oropharyngeal cancer will be a significant clinical problem for the foreseeable future despite vaccination efforts.

Effect of pre-treatment on the surface and electrochemical properties of screen-printed carbon paste electrodes

The effect of various electrochemical pre-treatment methods on the surface and electrochemical properties of screen-printed carbon paste electrodes (SPCE) prepared with three different commercial products was examined. It was observed that a positively charged redox couple, e.g., hexaammineruthenium(III), exhibited quasi-reversible behavior at the untreated SPCE. However, the cyclic voltammograms (CVs) of the SPCE prepared with general-purpose carbon inks did not exhibit clear redox peaks to other representative redox couples [e.g., hexacyanoferrate(III), hexachloroiridate(IV), dopamine, and hydroquinone] without activation. Electrochemical pre-treatment methods were sought in four different aqueous solutions, i.e., sulfuric acid, potassium chloride, sodium hydrogencarbonate, and sodium carbonate, applying various activation potentials. It was found that the pre-treatment procedure in saturated Na2CO3 solution at 1.2 V provides a mild and effective condition for activating the SPCE. By measuring the water contact angles at the SPCE surfaces and recording their SEM images, it was confirmed that the electrochemical pre-treatment effectively removes the organic binders from the surface carbon particles. A prolonged period of activation (> 5 min) or the use of high potentials (> 1.2 V) increased the capacitance of the electrode over 20 microF cm(-2). The pre-treated SPCE behaved like a random array microelectrode, exhibiting a sigmoidal-shaped CV at a slow scan rate. The short pre-anodization method in Na2CO3 solution was generally applicable to most SPCE prepared with general-purpose carbon inks.

Advances in histone demethylase KDM4 as cancer therapeutic targets

The KDM4 subfamily H3K9 histone demethylases are epigenetic regulators that control chromatin structure and gene expression by demethylating histone H3K9, H3K36, and H1.4K26. The KDM4 subfamily mainly consists of four proteins (KDM4A-D), all harboring the Jumonji C domain (JmjC) but with differential substrate specificities. KDM4A-C proteins also possess the double PHD and Tudor domains, whereas KDM4D lacks these domains. KDM4 proteins are overexpressed or deregulated in multiple cancers, cardiovascular diseases, and mental retardation and are thus potential therapeutic targets. Despite extensive efforts, however, there are very few KDM4-selective inhibitors. Defining the exact physiological and oncogenic functions of KDM4 demethylase will provide the foundation for the discovery of novel potent inhibitors. In this review, we focus on recent studies highlighting the oncogenic functions of KDM4s and the interplay between KDM4-mediated epigenetic and metabolic pathways in cancer. We also review currently available KDM4 inhibitors and discuss their potential as therapeutic agents for cancer treatment.

Single-Molecule Magnets: Structure and Properties of [Mn18O14(O2CMe)18(hep)4(hepH)2(H2O)2](ClO4)2 with Spin S = 13

The reaction of 2-(hydroxyethyl)pyridine (hepH) with a 2:1 molar mixture of [Mn3O(O2CMe)6(py)3]ClO4 and [Mn3O(O2CMe)6(py)3] in MeCN afforded the new mixed-valent (16Mn(III), 2Mn(II)), octadecanuclear complex [Mn18O14(O2CMe)18(hep)4(hepH)2(H2O)2](ClO4)2 (1) in 20% yield. Complex 1 crystallizes in the triclinic space group P. Direct current magnetic susceptibility studies in a 1.0 T field in the 5.0-300 K range, and variable-temperature variable-field dc magnetization studies in the 2.0-4.0 K and 2.0-5.0 T ranges were obtained on polycrystalline samples. Fitting of magnetization data established that complex 1 possesses a ground-state spin of S = 13 and D = -0.18 K. This was confirmed by the value of the in-phase ac magnetic susceptibility signal. Below 3 K, the complex exhibits a frequency-dependent drop in the in-phase signal, and a concomitant increase in the out-of-phase signal, consistent with slow magnetization relaxation on the ac time scale. This suggests the complex is a single-molecule magnet (SMM), and this was confirmed by hysteresis loops below 1 K in magnetization versus dc field sweeps on a single crystal. Alternating current and direct current magnetization data were combined to yield an Arrhenius plot from which was obtained the effective barrier (U(eff)) for magnetization reversal of 21.3 K. Below 0.2 K, the relaxation becomes temperature-independent, consistent with relaxation only by quantum tunneling of the magnetization (QTM) through the anisotropy barrier via the lowest-energy MS = +/-13 levels of the S = 13 spin manifold. Complex 1 is thus the SMM with the largest ground-state spin to display QTM.