Efficacy and safety of Wilate in paediatric VWD patients under 6 years of age - results of a prospective multicentre clinical study including recovery information

Treatment with exogenous von Willebrand factor (VWF) is indicated in patients with von Willebrand disease (VWD) in whom treatment with 1-deamino-8-d-arginine vasopressin/desmopressin is contraindicated. Wilate is a new generation plasma-derived concentrate of native VWF and coagulation factor VIII (FVIII) (in a physiological 1:1 ratio) developed for the treatment of VWD. This is the first study to report safety, efficacy and in vivo recovery (IVR) data from 15 paediatric patients less than 6 years of age who received Wilate for either prophylaxis, on-demand treatment or for treatment in surgical procedures during a prospective open-label trial (VWD type 1: 5, type 2A: 1, type 2B: 2, type 3: 6, unknown type: 1 patients). Analysis of IVR for VWF and FVIII suggested an appropriate and consistent rise in coagulation activity after Wilate administration. Overall efficacy was rated as excellent or good for 99.7% [prophylactic infusions] and 100% [bleeding episodes/surgical procedures]. More than 82% of bleeding episodes resolved after 1 day of treatment, and a Wilate dosage of 20-50 IU kg(-1) was sufficient to achieve haemostasis in 97% of bleeding episodes. All surgical procedures were successfully managed with Wilate. No thromboembolic events were observed during the study, and no patient developed anti-VWF antibodies or FVIII inhibitors. In conclusion, this study confirms both the expected IVR profile in paediatric patients and the excellent efficacy, tolerability and safety profile of Wilate observed previously in adults. Wilate showed excellent efficacy in the treatment of bleeding when used prophylactically or on-demand, and in the treatment of surgical procedures.

CCL: an algorithm for the efficient comparison of clusters

The systematic comparison of the atomic structure of solids and clusters has become an important task in crystallography, chemistry, physics and materials science, in particular in the context of structure prediction and structure determination of nanomaterials. In this work, an efficient and robust algorithm for the comparison of cluster structures is presented, which is based on the mapping of the point patterns of the two clusters onto each other. This algorithm has been implemented as the module CCL in the structure visualization and analysis program KPLOT.

Structure prediction of binary pernitride MN2 compounds (M=Ca, Sr, Ba, La, and Ti)

Metal-pernitride compounds belong to a class of chemical systems in which both the complex ions and the non-bonding electrons may play roles in the formation of their modified crystalline structures. To investigate this issue, the energy landscapes of pernitrides of metals with different maximum valence (M=Ca, Sr, Ba, La, and Ti) were globally explored on the ab initio level at standard and high pressures, thereby yielding possible (meta)stable modifications in these systems together with information on how the landscape changed as function of the valence of the metal cation. For all of the systems in which no compounds had been synthesized so far, we predicted the existence of kinetically stable modifications that should, in principle, be experimentally accessible. In particular, TiN2 should crystallize in a new structure type, TiN2-I.

Structural phase transitions on AgCuS stromeyerite mineral under compression

The structural behavior of mineral Stromeyerite, AgCuS, has been studied by means of angle-dispersive X-ray diffraction measurements up to 13 GPa and ab initio total-energy calculations. Two high-pressure phase transitions are found at 1.4 and 5.7 GPa, from the initial distorted Ni(2)In-type phase (AuRbS-type, RP, space group Cmc2(1)) through an anti-PbClF-type phase (HP1, space group P4/nmm) to a monoclinic distortion of this latter phase (HP2, space group P2(1)/m). The collapse of the metal-metal interatomic distances at the RP-HP1 transition suggests a stronger metallic behavior of the high-pressure phase. The compressibility of the lattice parameters and the equation of state of the first pressure-induced phase have been experimentally determined. First-principles calculations present an overall agreement with the experimental results in terms of the high-pressure sequence and provide chemical insight into the AgCuS behavior under hydrostatic pressure.

Inefficient cerebral recruitment as a vulnerability marker for schizophrenia

BACKGROUND

Patients with schizophrenia and their first-degree relatives exhibit both abnormally diminished and increased neural activation during cognitive tasks. In particular, excessive task-related activity is often observed when tasks are easy, suggesting that inefficient cerebral recruitment may be a marker of vulnerability for schizophrenia. This hypothesis might best be tested using a very easy task, thus avoiding confounding by individual differences in task difficulty.

METHOD

Eighteen people with schizophrenia, 18 unaffected full siblings of patients with schizophrenia and 26 healthy controls performed an easy auditory target-detection task in a 3-T magnetic resonance imaging (MRI) scanner. Groups were matched for accuracy on the task. Blood oxygen level-dependent (BOLD) responses to non-target stimuli in participants with vulnerability for schizophrenia (siblings and patients) were compared with those of healthy controls, and those of patients with those of unaffected siblings. BOLD responses to targets were compared with baseline, across groups.

RESULTS

Subjects with vulnerability for schizophrenia showed significant hyperactivation to non-targets in brain areas activated by targets in all groups, in addition to reduced deactivation to non-targets in areas suppressed by targets in all groups. Siblings showed greater activation than patients to non-targets in the medial frontal cortex. Patients exhibited significantly longer reaction times (RTs) than unaffected siblings and healthy controls.

CONCLUSIONS

Inefficient cerebral recruitment is a vulnerability marker for schizophrenia, marked by reduced suppression of brain areas normally deactivated in response to task stimuli, and increased activation of areas normally activated in response to task stimuli. Moreover, siblings show additional activation in the medial frontal cortex that may be protective.

A new pulsed laser deposition technique: scanning multi-component pulsed laser deposition method

The scanning multi-component pulsed laser deposition (PLD) method realizes uniform depositions of desired coatings by a modified pulsed laser deposition process, preferably with a femto-second laser-system. Multi-component coatings (single or multilayered) are thus deposited onto substrates via laser induced ablation of segmented targets. This is achieved via horizontal line-scanning of a focused laser beam over a uniformly moving target's surface. This process allows to deposit the desired composition of the coating simultaneously, starting from the different segments of the target and adjusting the scan line as a function of target geometry. The sequence and thickness of multilayers can easily be adjusted by target architecture and motion, enabling inter/intra layer concentration gradients and thus functional gradient coatings. This new, simple PLD method enables the achievement of uniform, large-area coatings. Case studies were performed with segmented targets containing aluminum, titanium, and niobium. Under the laser irradiation conditions applied, all three metals were uniformly ablated. The elemental composition within the rough coatings obtained was fixed by the scanned area to Ti-Al-Nb = 1:1:1. Crystalline aluminum, titanium, and niobium were found to coexist side by side at room temperature within the substrate, without alloy formation up to 600 °C.

Gain of chromosome arm 1q in atypical meningioma correlates with shorter progression-free survival

AIMS

Atypical (World Health Organization grade II) meningiomas have moderately high recurrence rates; even for completely resected tumours, approximately one-third will recur. Post-operative radiotherapy may aid local control and improve survival, but carries the risk of side effects. More accurate prediction of recurrence risk is therefore needed for patients with atypical meningioma. Previously, we used high-resolution array comparative genomic hybridization to identify genetic variations in 47 primary atypical meningiomas and found that approximately 60% of tumours show gain of 1q at 1q25.1 and 1q25.3 to 1q32.1 and that 1q gain appeared to correlate with shorter progression-free survival. This study aimed to validate and extend these findings in an independent sample.

METHODS

Eighty-six completely resected atypical meningiomas (with 25 recurrences) from two neurosurgical centres in Ireland were identified and clinical follow-up was obtained. Utilizing a dual-colour interphase fluorescence in situ hybridization assay, 1q gain was assessed using Bacterial Artificial Chromosome probes directed against 1q25.1 and 1q32.1.

RESULTS

The results confirm the high prevalence of 1q gain at these loci in atypical meningiomas. We further show that gain at 1q32.1 and age each correlate with progression-free survival in patients who have undergone complete surgical resection of atypical meningiomas.

CONCLUSIONS

These independent findings suggest that assessment of 1q copy number status can add clinically useful information for the management of patients with atypical meningiomas.

Nanostructured gold microelectrodes for extracellular recording from electrogenic cells

We present a new biocompatible nanostructured microelectrode array for extracellular signal recording from electrogenic cells. Microfabrication techniques were combined with a template-assisted approach using nanoporous aluminum oxide to develop gold nanopillar electrodes. The nanopillars were approximately 300-400 nm high and had a diameter of 60 nm. Thus, they yielded a higher surface area of the electrodes resulting in a decreased impedance compared to planar electrodes. The interaction between the large-scale gold nanopillar arrays and cardiac muscle cells (HL-1) was investigated via focused ion beam milling. In the resulting cross-sections we observed a tight coupling between the HL-1 cells and the gold nanostructures. However, the cell membranes did not bend into the cleft between adjacent nanopillars due to the high pillar density. We performed extracellular potential recordings from HL-1 cells with the nanostructured microelectrode arrays. The maximal amplitudes recorded with the nanopillar electrodes were up to 100% higher than those recorded with planar gold electrodes. Increasing the aspect ratio of the gold nanopillars and changing the geometrical layout can further enhance the signal quality in the future.

Direct observation of charge order in triangular metallic AgNiO2 by single-crystal resonant X-ray scattering

We report resonant x-ray scattering measurements on a single crystal of the orbitally degenerate triangular metallic antiferromagnet 2H-AgNiO2 to probe the spontaneous transition to a triple-cell superstructure at temperatures below T(S)=365  K. We observe a strong resonant enhancement of the supercell reflections through the Ni K edge. The empirically extracted K-edge shift between the crystallographically distinct Ni sites of 2.5(3) eV is much larger than the value expected from the shift in final states, and implies a core-level shift of ∼1  eV, thus providing direct evidence for the onset of spontaneous honeycomb charge order in the triangular Ni layers. We also provide band-structure calculations that explain quantitatively the observed edge shifts in terms of changes in the Ni electronic energy levels due to charge order and hybridization with the surrounding oxygens.

[Protective ileostoma versus protective transverse stoma. What evidence is available?]

The clinical outcome of anastomotic leakage in colorectal and coloanal anastomoses necessitates a loop stoma for fecal diversion. Controversy remains of the most suitable position of the stoma. In this respect a loop ileostomy or loop colostomy can be performed. The aim of this study was to determine the advantages and disadvantages of both surgical strategies from the literature and to derive possible recommendations. Both methods provide a good operative outcome with low complication rates. Overall there is a trend towards ileostomy because of lower complication rates after stoma creation and the incidence of sepsis and stoma prolapse in particular is significantly reduced after ileostomy. Concerning stoma reversal both methods seem to be equivalent. As long as no large evidenced-based, randomized studies are available loop ileostomy seems to be the most appropriate surgical procedure.

Studies on the Formation of Tin(IY) Oxygen Compounds by Sol-Gel-Process

Solutions of Sn(OR)4 and R'Sn(OR)3 with different amounts of alkali and alkaline earth metal alkoxides, MI(OR) and MII(OR)2 respectively, have been prepared. Slow evaporation of the solvent resulted in the crystallization of mixed metal alkoxide compounds. Solid state structures have been determined for two examples: K3H[Sn(O/Pr)6]2 and Na2[iPrSn(OiPr)5]·5iPrOH. Solutions as well as solids have been hydrolyzed by moisture. The thermal behaviour of the resulting amorphous powders was investigated by TG, DTA and XRD up to 1000°C in argon atmosphere. The structural evolution during the solid state step mainly depends on the nature and amount of the mono- and bivalent cations. The different influence of both parameters is described.

Synthesis of Advanced Ceramics in the Systems Si-B-N and Si-B-N-C Employing Novel Precursor Compounds

The reaction of Cl3Si-NH-Si(CH3)3 with BCl3 yields the novel compounds Cl3Si-NH-BCl2 and (Cl3SiNH)2-BCl. The ammonolysis of these monomeric precursors in liquid ammonia gives rise to highly crosslinked borosilicon imides. Pyrolysis of the polymeric imides in a stream of ammonia at 1250°C yields amorphous borosilicon nitrides with formal compositions of Si3B3N7 and Si6B3Nu respectively. MAS-NMR, DTA/TG, SEM and TEM investigations reveal that the resulting materials are single phase.

The reaction of the novel precursors with primary amines yields meltable and soluble polymers suitable for producing fibers or coatings. Subsequent pyrolysis in NH3 leads also to amorphous borosilicon nitride. The physical and chemical properties of the new materials will be discussed.

Abstract P4-02-16: High miRNA26A1 and Low EZH2 Expression Levels Are Associated with Favorable Outcome to Tamoxifen in Advanced Breast Cancer through Similar Molecular Pathways

Background: We showed that decreased expression levels of EZH2 are associated with a favorable outcome to tamoxifen in advanced breast cancer. Furthermore, EZH2 knockdown in MCF7 cells resulted in estrogen receptor (ER) upregulation and increased sensitivity to anti-estrogens. Recently, EZH2 has been identified as a target of miRNA26A1 and miRNA101.

Objective: To associate miRNA26A1 and miRNA101 expression levels with: A) EZH2 and B) molecular pathways and C) outcome to first-line tamoxifen monotherapy for advanced disease.

Materials & Methods: Expression levels of miRNA26A1, miRNA101, EZH2 and references (miRNA-132 and miRNA-374) were measured using quantitative Real-Time Polymerase Chain Reaction (qRT-PCR) in 235 ER-positive primary breast cancer specimens from patients with advanced disease. The levels of expression were related to clinicopathologic factors and disease outcome. Pathway analysis was performed in a subset of 65 ER-positive tumors with available gene expression microarray data available. Computations were performed with STATA and P-values <0.05 were considered statistically significant.

Results: The miRNA26A1 levels were significantly associated with levels of ER, progesterone (PgR), HER2 and EGFR, whereas miRNA101 levels showed significant relations with PgR expression and menopausal status. The miRNA26A1 and miRNA101 levels showed an inverse relation with EZH2 mRNA levels (Spearman Rank Correlation of -0.21 and -0.15, respectively, P<0.05). As continuous variable in univariate analysis, miRNA26A1 (Hazard Ratio (HR) =0.13, 95 % CI: 0.06-0.28) correlated with Time to Progression (TTP), while miRNA101 did not (HR=0.87, 95% CI: 0.70-1.07). In multivariate analysis including traditional predictive factors, the third with highest miRNA26A1 levels (HR=0.49, 95% CI: 0.34-0.72) alone, or combined with the third with lowest EZH2 levels (HR=0.56, 95% CI: 0.35-0.88) were associated with a favorable TTP independently of traditional factors. Pathway analyses identified 2 overlapping, cell cycle, related pathways with two genes (CCNE1and CDC2) differentially expressed (P<0.05) between tumors with high and low levels of miRNA26A1 and EZH2, respectively. Levels of CCNE1 and CDC2 were tested in the 235 tumors and showed as continuous variables also a significant association with TTP (HR=1.27, 95% CI: 1.12-1.45 and HR=1.53, 95% CI: 0.129-1.81).

Conclusions: The miRNA26A1 and miRNA101 levels have an inverse relation with levels of EZH2, however, only miRNA26A1 has predictive value in advanced breast cancer. Pathways comparison between miRNA26A1 and EZH2 identified 2 overlapping cell cycle related pathways and the genes CCNE1 and CDC2. Low levels of EZH2, CCNE1 and CDC2 and high levels of miRNA26A1 are associated with a favorable outcome to tamoxifen therapy.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-02-16.

A neutron diffraction study of structural and magnetic transformations in AFeO(2) (A = K, Rb and Cs)

In continuation of our recent x-ray study of the structural phase transitions in the AFeO(2) (A = K, Rb, Cs) family, we have systematically investigated the respective structural and magnetic phase transitions by neutron powder diffraction. While the temperatures of the first-order structural phase transitions are strongly different for the three compounds (~1003, ~737 and ~350 K for A = K, Rb, Cs) and systematically decrease with increasing ionic radius of the A-cation, the magnetic transition temperatures in all three compounds have been found to be almost the same-slightly above 1000 K. The magnetic ordering type is similar in all three compounds-antiferromagnetic ordering of magnetic Fe(3 + ) ions within the system of the three-dimensional Fe-O-Fe linkages such that the Fe-Fe exchange between the nearest neighboring ions is always antiferromagnetic. The directions of magnetic Fe moments were found to be parallel to the crystallographic axis c in RbFeO(2) and CsFeO(2) and parallel to the axis b in KFeO(2) in notations of their low-temperature orthorhombic modifications.

Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined vicryl plug and fibrin glue

The incidence of clinically significant anastomotic leaks after upper gastrointestinal surgery is approximately 4 % - 20 %, and the associated mortality can be as high as 80 %. Depending on the clinical presentation, the treatment options are surgery, conservative treatment with external drainage, or endoscopic treatment. This report presents 39 cases of clinically apparent anastomotic leaks or fistulas after surgery for upper gastrointestinal cancers that were treated by endoscopy with insertion of fibrin glue alone (n = 24) or with a combination of Vicryl plug and fibrin glue (n = 15). Thirteen of the 15 patients who underwent Vicryl/fibrin treatments showed complete healing of the anastomotic leak or fistula after one to four sessions. Long-term follow-up results are presented. Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with low morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repeated major surgery and its associated risks.

Methanogenic conversion of 3-s-methylmercaptopropionate to 3-mercaptopropionate

Anaerobic metabolism of dimethylsulfoniopropionate, an osmolyte of marine algae, in anoxic intertidal sediments involves either cleavage to dimethylsulfide or demethylation to 3-S-methylmercaptopropionate (MMPA) and subsequently to 3-mercaptopropionate. The methanogenic archaea Methanosarcina sp. strain MTP4 (DSM 6636), Methanosarcina acetivorans DSM 2834, and Methanosarcina (Methanolobus) siciliae DSM 3028 were found to use MMPA as a growth substrate and to convert it stoichiometrically to 3-mercaptopropionate. Approximately 0.75 mol of methane was formed per mol of MMPA degraded; methanethiol was not detected as an intermediate. Eight other methanogenic strains did not carry out this conversion. We also studied the conversion of MMPA in anoxic marine sediment slurries. Addition of MMPA (500 (mu)M) resulted in the production of methanethiol which was subsequently converted to methane (417 (mu)M). In the presence of the antibiotics ampicillin, vancomycin, and kanamycin (20 (mu)g/ml each), 275 (mu)M methane was formed from 380 (mu)M MMPA; no methanethiol was formed during these incubations. Only methanethiol was formed from MMPA when 2-bromoethanesulfonate (25 mM) was added to a sediment suspension. These results indicate that in natural environments MMPA could be directly or indirectly a substrate for methanogenic archaea.

The role of biopsy in the diagnosis of infections of the central nervous system

CNS infections require prompt appropriate therapy, but do not usually require tissue biopsy for diagnosis. We performed a 5 year audit of CNS infections which required brain or spinal biopsy to determine or confirm a diagnosis of CNS infection. Sixteen cases were identified in which clinical, radiological or additional investigations including culture, serology or PCR for the suspected specific infective agents were not diagnostic. 6 (37.5%) were bacterial abscesses presenting as space-occupying intracerebral lesions with a differential diagnosis of neoplasm. There were 3 (18.7%) cases of toxoplasmosis and 2 (12.5%) cases of aspergillosis. There was one case (6.2%) of herpes simplex encephalitis, one cysticercosis and one progressive multifocal leucoencephalopathy, all biopsied as possible neoplasms. There were 2 (12.5%) cases of spinal tuberculosis, one multifocal, mimicking neurofibromatosis. This review highlights the usefulness of targeted biopsy in the rapid diagnosis of CNS infections. It also emphasizes the lack of specificity of 'negative' culture and serology in certain cases, especially in the setting of immune-compromise.

Integrated Genomic Profiling of Endocrine Therapy Response in Advanced Breast Cancer

PurposeIn hormone receptor positive breast cancer the response rates for endocrine treatment, i.e. tamoxifen (TAM) or aromatase inhibitors (AIs), are only 50 to 70% in the advanced disease setting. The overall aim of this retrospective study is to identify a molecular signature using integrated genomic profiling to improve prediction of endocrine treatment outcome in the advanced disease setting.ObjectivesA) To compare mRNA expression profiles of TAM- and AI-treated patients and to identify genes and pathways associated with treatment outcome.B) To discover miRNA and mRNA signatures predictive for AI response.Patients and MethodsFresh frozen Estrogen Receptor (ER)-positive primary breast cancer specimens from patients with advanced disease treated with first-line AIs (N=55) or TAM (N=109) were analyzed. Expression profiles of 670 miRNAs and 44K mRNAs were generated using multiplex qRT-PCR and microarrays. Profiles were related to clinical response and time to progression (TTP). Statistical and bio-informatic tools were applied to discover and combine markers into an integrated genomic predictive signature. The nearest centroid prediction method of BRB-ArrayTools (Version3.7.0) was used to assess the predictive value.ResultsThe quality controlled and informative expression profiles of 277 miRNAs and 14112 mRNAs in 50 AI-treated tumors and 10433 mRNAs in 101 TAM-treated tumors were included for further analysis in the discovery phase.Global testing of mRNAs linked to Biocarta pathways demonstrated the involvement of the interferon pathway in endocrine therapy response in both AI- and TAM-treated patients. Using BRB-ArrayTools survival analysis to find genes associated with TTP (P<0.05), we identified 1002 mRNAs in AI-treated and 662 mRNAs in TAM-treated tumors to be significantly related with TTP.The overlap of 40 mRNAs between AI- and TAM-treatment was defined as a mRNA signature for endocrine treatment outcome. In TAM-treated patients this classifier has a 69% accuracy (63% sensitivity, 74% specificity), an odds ratio for clinical benefit of 4.69 (95% CI 1.99-11.05, P<0.001) and a hazard ratio for TTP of 0.17 (95% CI 0.10-0.29, P<0.001). In AI-treated patients, this 40mRNA signature has a performance of 78% accuracy (84% sensitivity, 62% specificity) and significantly predicts clinical benefit (odds ratio = 8.27, 95% CI 2.00-34.3, P=0.004) and TTP (hazard ratio = 0.07, 95% CI 0.02-0.22, P<0.001).After statistical analysis a 16 miRNAs classifier for AI-treatment outcome was identified with a performance of 78% accuracy (89% sensitivity, 46% specificity). This classifier significantly predicts clinical benefit (Odds ratio = 7.07, 95% CI 1.57-31.9, P=0.011) and TTP (hazard ratio = 0.24, 95% CI 0.09-0.61, P=0.003).The genomic mRNA and miRNA signatures are currently integrated and validated in additional samples as well as “in silico” on tumors treated with neo-adjuvant AI (Miller et al, JCO 2009).ConclusionThis is the first study that combines miRNA and mRNA profiling in an attempt to define an integrated genomic signature for endocrine treatment outcome. Additional prospective multicenter studies are needed to confirm the predictive value of this signature.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3029.