[Prospective multi-center study of one-step nucleic acid amplification assay for the detection of sentinel lymph nodes metastases in breast cancer patients]

OBJECTIVE

To evaluate the roles of Sysmex RD100i one-step nucleic acid amplification (OSNA) assay in the intraoperative assessments of breast cancer sentinel lymph nodes (SLNs).

METHODS

A total of 552 consecutive prospective patients were enrolled from five centers nationwide from February to December 2010. And SLNs were sliced into alternating 2 mm blocks. The odd blocks were tested by the OSNA assay intraoperatively and the even ones assessed by postoperative histology. In addition, intraoperative histological assessments were performed on the even blocks of 211 patients by frozen section and all blocks by touch imprint cytology.

RESULTS

A total of 1188 SLNs were removed. The mean turnaround time of the assay was 37.3 min. There was no significant difference of turnaround time at each center (P = 0.074). As compared to postoperative histology, the overall performance of the assay had an accuracy of 91.4% (1086/1188), a sensitivity of 83.7% (159/190) and a specificity of 92.9% (927/998). The sensitivity of the assay was higher than frozen section (77.6% (59/76) vs 69.7% (53/76), P = 0.286) and was significantly higher than touch imprint cytology (83.6% (158/189) vs 76.2% (144/189), P = 0.044). For nodes with micro-metastases, the sensitivity of the assay was higher than frozen section (8/17 vs 4/17, P = 0.289) and was significantly higher than touch imprint cytology (62.5% (30/48) vs 35.4% (17/48), P = 0.007).

CONCLUSION

As an accurate and rapid intraoperative assay for assessing breast SLNs, the OSNA assay may replace frozen section and touch imprint cytology for clinical applications.

Association of maternal education with the neuroblastoma susceptibility in children: a meta-analysis

Maternal education might be an important factor for the neuroblastoma risk in children, but it was conflicting. This meta-analysis was performed to evaluate the relationship between maternal education and neuroblastoma susceptibility and to explore whether maternal education was an important indicator to be associated with the neuroblastoma risk in children. The association studies were identified from the databases of PubMed, and Cochrane Library as of June 1, 2012, and eligible investigations were synthesized using meta-analysis method. Results were expressed with odds ratios (OR) for dichotomous data, and 95% confidence intervals (CI) were also calculated. Six literatures were identified for the analysis of association between maternal education and neuroblastoma susceptibility in children, consisting of 2063 patients with cancer and 13,925 controls. There was no a marked association between maternal education and neuroblastoma susceptibility when the maternal education was less than high school (OR = 0.66, 95% CI: 0.43-1.01, P = .06). We also found that maternal education was not associated with the neuroblastoma susceptibility when the maternal education was high school (OR = 0.74, 95% CI: 0.31-1.75, P = .49) and more than high school (OR = 0.78, 95% CI: 0.33-1.85, P = .58). In conclusion, maternal education is not associated with the neuroblastoma susceptibility in children. However, more investigations are required to further clarify the association of maternal education with the neuroblastoma susceptibility in children.

GeneSearch™ BLN Assay could replace frozen section and touch imprint cytology for intra-operative assessment of breast sentinel lymph nodes

BACKGROUND

Breast cancer sentinel lymph node (SLN) biopsy has become a common procedure. The GeneSearch™ Breast Lymph Node Assay is a real-time reverse-transcriptase polymerase chain reaction assay for detecting nodal metastases larger than 0.2 mm. The trial is a prospective multi-center clinical trial conducted to validate the assay in China.

METHODS

Four hundred and seventy-nine consecutive prospective patients were enrolled from six centers. SLNs were sectioned along the short axis into multiple blocks. Odd blocks were tested by the assay intra-operatively, and even blocks were assessed by post-operative histology. Six 4- to 6-μm-thick sections were taken every 150 μm per block. In addition, intra-operative histological assessments were performed on the even blocks of 214 patients by frozen section (FS) and all blocks of 156 patients by touch imprint cytology (TIC).

RESULTS

A total of 1046 SLNs were excised. Overall performance of the assay compared to post-operative histology was accuracy of 91.4 %, sensitivity of 87.5 %, and specificity of 92.9 %. There were no significant differences in assay performance of each center. After a learning curve of about 10 cases, the assay could be performed in a median time of about 35 min. The sensitivity of the assay was similar to the FS (84.9 %, P = 0.885) and was significantly higher than the TIC (70.0 %, P = 0.007) while the specificity of all were comparable.

CONCLUSION

The GeneSearch™ Breast Lymph Node Assay is an accurate and rapid intra-operative assay for breast SLNs and it can replace FS and TIC for application.

Protective effect of oleanolic acid against beta cell dysfunction and mitochondrial apoptosis: crucial role of ERK-NRF2 signaling pathway

Pancreatic beta cell dysfunction is a hallmark of diabetes. Our previous results have shown that oleanolic acid (OA) has anti-diabetic potential. However, there is little literature reporting the effect of OA on beta cell dysfunction. The present study was designed to investigate the protective effect of OA against lipotoxicity and the underlying mechanisms. Lepr (db/db) diabetic mice were subjected to fasting blood glucose measurement, intraperitoneal glucose tolerance test after the administration of OA for two weeks. Histopathological observation was conducted by HE staining and transmission electron microscopy assay. Pancreatic islets were isolated from db/db diabetic mice and C57BL/6J mice. Palmitic acid (PA) was used to induce lipotoxicity in vitro. Apoptosis was evaluated in pancreatic islets in diabetic mice and in isolated pancreatic islets and beta-TC3 cells by TUNEL assay. Cellular ATP content, mitochondrial function and redox balance were examined. Phosphorylation of c-Jun NH2-terminal kinase (JNK) and extracellular signal-regulated kinase (ERK) and the activation of nuclear erythroid factor 2 p45-related factor 2 (Nrf2) signaling were evaluated by western blotting. In db/db mice, OA significantly protects beta cell function against lipotoxicity, evidenced by inhibition of apoptosis and improvement of glucose tolerance. In cells, OA administration may protect against PA-induced apoptosis and decrease of GSIS, in which process the activation of Nrf2 is essential. Once Nrf2 is activated, OA could induce GCLc expression, promote the production of GSH, and thus inhibit JNK phosphorylation and solid the antioxidant defense of mitochondria, leading to the inhibition of mitochondrial apoptosis. ERK signaling pathway is responsible for OA-induced activation of Nrf2 and the protective effect of OA. Overall, our study enhances the understanding of the protective effect of OA on beta cell and provides clues for further studies on the underlying mechanisms.

Comparative study of one-step nucleic acid amplification assay, frozen section, and touch imprint cytology for intraoperative assessment of breast sentinel lymph node in Chinese patients

Conventional procedures for the intraoperative assessment of breast cancer sentinel lymph nodes (SLNs) are frozen section (FS) and touch imprint cytology (TIC). The one-step nucleic acid amplification (OSNA) assay is a novel molecular technique. The aim of this study was to evaluate the optimal approach by comparing OSNA assay, FS, and TIC. Five hundred and fifty-two consecutive patients were enroled from five study centers in China. The SLNs were cut into alternating 2 mm blocks. The odd blocks were tested by the OSNA assay intraoperatively, and the even ones were assessed by postoperative histology (four 4- to 6-μm-thick sections were taken every 200 μm per block). In addition, intraoperative histological assessments were carried out on the even blocks of 211 patients by FS and all blocks of 552 patients by TIC. Overall performance of the assay compared to postoperative histology was: accuracy 91.4%; sensitivity 83.7%; and specificity 92.9%. The sensitivity of the assay was higher than FS (211 patients, 77.6% vs 69.7%; not significant, P = 0.286) and was significantly higher than TIC (552 patients, 83.6% vs 76.2%; P = 0.044). When assessing nodes with micrometastases, the sensitivity of the assay was higher than FS (17 nodes, 47.1% vs 23.5%; not significant, P = 0.289) and was significantly higher than TIC (48 nodes, 62.5% vs 35.4%; P = 0.007). The study indicated that the OSNA assay is an accurate and rapid intraoperative assay for assessing breast SLNs and it can replace FS and TIC for application in general medical practice. The trial was registered as: OSNA assay China Registration Study.

CLINICAL TRIAL REGISTRATION NUMBER

China Breast Cancer Clinical Study Group 001c.

Tau expression correlated with breast cancer sensitivity to taxanes-based neoadjuvant chemotherapy

The purpose of this study was to investigate the correlation between tau expression in primary breast cancer and sensitivity to taxanes during neoadjuvant chemotherapy in patients with breast cancer. We used immunohistochemistry to examine tau expression in breast cancer biopsies from 113 primary breast cancer patients and evaluated the correlation between tau expression and taxane sensitivity. Twenty-eight (24.78 %, 28/113) patients were positive for tau expression. After taxanes-based neoadjuvant chemotherapy, 40 patients achieved pathological complete response (pCR) (35.4 %). Among the 40 patients with pCR, five (12.5 %) were positive for tau expression. In univariate analysis, estrogen receptor (ER), progesterone receptor, human epidermal growth factor receptor 2 (HER2), and tau were found to be significantly predictive of a pCR (P = 0.001, 0.030, 0.002, and 0.025, respectively). Tau, ER, and HER2 status were significant for pCR on multivariate analysis (P = 0.025, 0.005, and 0.043, respectively). Tau expression was positively related to ER (P = 0.007) and progestin receptor (P = 0.008). In conclusion, tau protein expression correlated with breast cancer sensitivity to taxanes-based neoadjuvant chemotherapy; patients negative for tau expression were more likely to achieve pCR.

Accuracy and axilla sparing potentials of sentinel lymph node biopsy with methylene blue alone performed before versus after neoadjuvant chemotherapy in breast cancer: a single institution experience

INTRODUCTION

The timing of sentinel lymph node biopsy (SLNB) of breast cancer in the neoadjuvant setting is still controversial. We retrospectively analyzed a Chinese patient cohort with neoadjuvant chemotherapy (NAC) to evaluate the accuracy and axilla sparing potentials of different SLNB timings with methylene blue alone for lymphatic mapping.

MATERIALS AND METHODS

Patients with NAC and axillary lymph node dissection (ALND) and either pre- or post-NAC SLNB were eligible. Clinicopathological characteristics, identification rate (IR), false-negative rate (FNR), accuracy, and positive-predictive value were calculated and compared between the pre- and post-NAC SLNB group using appropriate statistical methods. Axilla sparing potentials of different SLNB timings were evaluated and compared.

RESULTS

One hundred and fifteen eligible cases were included, and 58 had pre-NAC SLNB while the other 57 had post-NAC SLNB. Both groups were comparable in clinicopathological characteristics, neoadjuvant treatments and pathologic complete response rate. IR, FNR, and accuracy of SLNB, as pre-NAC versus post-NAC, were 100 versus 98.2 % (P = 0.496), 0 versus 8.0 % (P = 0.181), and 100 versus 96.4 % (P = 0.239), respectively. Post-NAC SLNB had significantly higher positive-predictive value for ALNs than pre-NAC SLNB (70.0 vs. 36.4 %, P = 0.014), suggesting as high as 63.6 % of ALND performed in the pre-NAC group could have been avoided while only 30 % of ALND in the post-NAC group were theoretically unnecessary.

CONCLUSIONS

Both SLNB timings of breast cancer patients with NAC were feasible and accurate. Although pre-NAC SLNB tends to be better in accuracy, post-NAC SLNB is significantly superior in terms of axilla sparing.

Association between tumor necrosis factor-α-308G/A polymorphism and obstructive sleep apnea: a meta-analysis

BACKGROUND AND OBJECTIVE

The tumor necrosis factor (TNF)-α-308G/A polymorphism has been implicated in susceptibility to obstructive sleep apnea (OSA). However, results from previous studies are inconsistent. A systematic review and meta-analysis of the published studies was performed to investigate this association.

METHOD

We searched PubMed, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), and Weipu databases for published studies evaluating the association between -308G/A polymorphism and OSA. Data were extracted using standardized forms and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

RESULTS

Four case-control studies involving a total of 419 cases and 460 controls were included in the meta-analysis. Combined data indicated that individuals carrying the -308A allele had a 65% increased risk of developing OSA when compared with the GG homozygotes (OR=1.65, 95% CI=1.02-2.68, p=0.04). In adults, the risk was even higher, elevated by 100% (OR=2.00, 95% CI=1.26-3.18, p=0.003).

CONCLUSION

The TNF-α-308G/A polymorphism contributes to the risk of OSA, especially in adults.

[Intra-operative GeneSearch(TM) BLN assay for detecting breast cancer metastases in sentinel lymph nodes]

OBJECTIVE

To evaluate the clinical value of GeneSearch(TM) BLN Assay as an intra-operative diagnostic method of sentinel lymph node (SLN) for breast cancer patients.

METHODS

A total of 479 consecutive patients from six centers were involved in this prospective study. The SLNs were identified, dissected and then sectioned along the short axis into multiple blocks. The odd blocks were tested intra-operatively by the above-mentioned assay and the even blocks assessed post-operatively by histopathologic examination. The 4 - 6 µm thick stepwise sectioning permanent HE slides were prepared every 150 µm and one block yielded 6 slides. In addition, the even blocks of 136 patients were prepared for frozen section (FS) and all blocks of 156 patients evaluated intra-operatively by touch imprint cytology (TIC).

RESULTS

In the node basis analysis, its accuracy, sensitivity, specificity, positive predict value (PPV) and negative predict value (NPV) were 93.0%, 85.6%, 94.6%, 76.6% and 96.9% respectively. Its sensitivity was similar to that of FS (84.9%, P = 0.885) and significantly higher than that of TIC (70.0%, P = 0.007). When assessing nodes with macro-metastases, its sensitivity was similar to that of FS (93.6% vs 95.6%, P = 0.558) and significantly higher than that of TIC (93.6% vs 80.9%, P = 0.011). When assessing nodes with micro-metastases, it had a higher sensitivity than that of FS (57.5% vs 44.4%, P = 0.356) and TIC (57.5% vs 30.8%, P = 0.094). In the patient basis analysis, the accuracy, sensitivity, specificity, PPV and NPV were 91.4%, 87.5%, 92.9%, 81.8% and 95.3% respectively. Its sensitivity was similar to that of FS (84.5%, P = 0.576) and significantly higher than that of TIC (75.0%, P = 0.049). After adjustment, it had the accuracy, sensitivity, specificity, PPV and NPV of 91.7%, 83.5%, 95.2%, 88.3% and 93.0% respectively. Its sensitivity was higher than that of FS (72.1%, P = 0.054) and significantly higher than that of TIC (66.7%, P = 0.011). The two had no significant difference in the sensitivity and specificity. After a learning curve of around 10 cases, it could be performed in a median time of around 35 min. The threshold cycle time values of MG and CK-19 were 36 and 31 respectively. The type of metastases could be estimated approximately according to the cycle time values. The cycle time values of MG under 33 indicated SLN macro-metastases and those of 33-36 denoted micro-metastases. The values of CK-19 under 29 indicated SLN macro-metastases and those of 29-31 denoted micro-metastases.

CONCLUSION

As an accurate and rapid intra-operative assay for breast sentinel lymph nodes, the GeneSearch(TM) BLN Assay may replace FS and TIC in general medical practice.

HER2-positive status is an independent predictor for coexisting invasion of ductal carcinoma in situ of the breast presenting extensive DCIS component

DCIS of the breast with coexisting invasion is commonly seen, and no consensus on any biomarker capable of discriminating this subgroup has been reached yet. We retrospectively examined the receptor status and the histological grade in Chinese DCIS patients to identify any independent predictor in order to discriminate a subgroup with coexisting invasion from pure DCIS patients. A consecutive Chinese DCIS patient cohort registered at a single institution was included for ER, PR, and HER2 status, as well as for evaluation of the histological grade. Patients with invasion foci >1cm in diameter were excluded. The HER2 gene amplification status was further examined by FISH when the IHC result was HER2 (2+). Molecular subtypes were also profiled. Age, histological grade, ER, PR, and HER2 status were included in association analyses. In total, 183 patients were included. A hundred and forty patients had pure DCIS, and 43 patients had DCIS with invasion. The luminal A subtype accounted for 49.7% of all cases, the HER2-positive subtype for 27.9%, and only 10.4% and 12.0% represented the luminal B and basal-like subtypes, respectively. Univariate analyses showed that histological Grade 2, Grade 3, and HER2-positive status were associated with DCIS with invasion, odds ratios 5.1 (P = 0.017), 5.2 (P = 0.01) and 3.34 (P = 0.001), respectively. However, only the HER2-positive status was of statistical significance in the multivariate logistic regression analyses after adjustment for other markers, odds ratio 3.8 (95%CI 1.4-10, P = 0.008). The 43 cases with invasion were further stratified into extensive or small DCIS components according to the percentage of DCIS to total tumor area using 25% as the cutoff point. Multinomial logistic regression with pure DCIS cases as reference showed that the HER2-positive status was associated only with the group showing an extensive DCIS component, odds ratio 6.2 (95%CI 1.8-21, P = 0.003), but not with the group having a small DCIS component. Our study demonstrates that HER2-positive status is an independent predictor for DCIS, with invasion presenting an extensive DCIS component, and favors the hypothesis that HER2 overexpression or gene amplification is involved in the transition from DCIS to invasive disease.

[Efficacy and safety assessment of neoadjuvant paclitaxel and trastuzumab in Chinese women with Her-2 positive operable breast cancer]

OBJECTIVE

To assess the efficacy and safety of neoadjuvant 3-weekly paclitaxel plus trastuzumab (TH) in Chinese women with Her-2 overexpressing operable breast cancer.

METHODS

This is a single center open-label phase II clinical trial. The included patients underwent 4 cycles of neoadjuvant 3-weekly TH before surgery. The primary endpoint was pathologic complete response rate (pCR rate) and the secondary endpoint was overall response rate (OR rate). Patients were also stratified according to hormone receptor status, and pCR rate and OR rate were compared between subgroups. Adverse events were graded according to CTCAE v3.0.

RESULTS

There were 40 eligible patients entering this study with median age of 49 years. All patients completed 4 cycles of neoadjuvant treatment. pCR rate was 52.5% and OR rate was 87.5%. The differences of pCR and OR rates between subgroups were of no statistical significance. No cardiac toxicity event severer than grade 2 was recorded.

CONCLUSION

3-weekly TH regimen has satisfactory pCR rate and OR rate in Chinese patients with Her-2 overexpressing operable breast cancer and reliable safety.

China Validation Study of GeneSearchTM Breast Lymph Node Assay for the Diagnosis of Sentinel Lymph Nodes of Breast Cancer – CBCSG-001a Interim Results

Background: The use of sentinel lymph node (SLN) biopsy is becoming the standard of care in China. With the adoption of this technique there is an increasing need for rapid and accurate detection of metastases in the SLNs. Histological intra-operative techniques such as touch imprint and frozen section offer limited sensitivity, increasing the risk of intra-operatively missing relevant SLN metastases (>0.2 mm). Post-operative histology (H&E) also risks missing metastases due to tissue sampling limitations and being partially dependent on pathologist expertise. A real-time RT-PCR assay, GeneSearchÔ Breast Lymph Node (BLN) Assay, may offer a standardized intra-operative way to evaluate larger portions of the SLN. CBCSG-001a is a prospective multicenter trial to validate the GeneSearchÔ BLN Assay in China.Methods: Started from February 2009, CBCSG-001a is being conducted at 6 centers with a total enrollment of 540 cases by the end of June 2009. SLNs are cut into alternating ∼2mm sections. One half of the sections are sampled for H&E. The other half is fully tested with the BLN assay. The assay detects the presence of cytokeratin-19 and mammaglobin to assess if metastases are in SLNS. Predetermined cutoffs are calibrated so only metastases >0.2 mm are detected. Each assay run has internal and external controls to confirm a valid result.About 40% cases would receive axillary lymph node dissection (ALND) in spite of the status of SLN in 3 of the 6 centers. Intraoperative frozen section for SLN diagnosis was conducted in 4 of the 6 centers, and intraoperative touch imprint cytological diagnosis for all sections was conduced in 2 of the 6 centers.Results: Interim results are based on 20% (114/540) of the planned breast cancer patients for the study. Current histology positive rate is 30%. The BLN assay shows high performance as compared to H&E. The results are also very similar to those seen in the larger US clinical validation trial.Discussion: Interim results indicate that the BLN assay has high performance as compared to H&E, and allows same surgery ALND avoiding the need to wait for a second surgery. In addition the performance is equivalent to the results seen in the larger US clinical validation trial, indicating the assay performance is fairly robust. So there is clinical potential of using the assay for performance similar to H&E with the advantage of being an intra-operative, objective and standardized test that examines a larger portion on the nodal tissue. The final results of 550 cases will be updated at the SABCS.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1023.

Post-Neoadjuvant Chemotherapy Sentinel Lymph Node Biopsy Is Reliable in Breast Cancer: A Prospective Study in Chinese Patients

Background: Sentinel lymph node biopsy (SLNB) for breast cancer patients before chemotherapy is currently being practiced in a world wide scale. However, obvious disadvantage of a second surgical procedure after neoadjuvant chemotherapy (NAC) has been noted. Considering that metastasis in axillary lymph node would probably be eradicated by NAC making axillary lymph node dissection (ALND) completely unnecessary, SLNB performed after NAC could be a choice. Nonetheless, it is still controversial for a fear of impaired detection rate and accuracy. Therefore we carried out a prospective study by one single surgical team to compare SLNB between post-NAC patients and non-NAC patients.Methods: Operable invasive breast cancer patients confirmed by core needle biopsy before treatment with clinical N0 or N1 axilla were enrolled. Exclusion criteria included noninfiltrating cancer, inflammatory carcinoma and clinically fixed axillary lymph node. SLNB followed by ALND was performed in one single operation by the same surgical team for all patients either afer NAC or without NAC. Single methylene blue was used for SLN tracing with 2ml injected subcutaneously into the areola area and the mapping procedure was started 5 minutes later. SLN and ALND specimens were examined by 2 independent pathologists under standard pathological procedures.Results: From Dec 2007 to May 2009, 50 patients without NAC and 49 patients after NAC were prospectively enrolled. SLNB and ALND were performed as scheduled. In the post-NAC group, 19 had clinical N0 axilla and 30 had N1 axilla before treatment. SLNB was successful in 46 patients with 1.6 SLNs detected on average (range 1 to 5) and the average number of lymph nodes taken out in ALND was 15.4 (range 7 to 33). We found 9 with SLN(+)/ALN(+), 5 with SLN(+)/ALN(-), 2 with SLN(-)/ALN(+), and 29 with SLN(-)/ALN(-). In the non-NAC group, 40 had clinical N0 axilla and 10 had N1 axilla before surgery. SLNB was successful in 48 patients with 1.7 SLNs detected on average (range 1 to 6) and the average number of lymph nodes taken out in ALND was 16.8 (range 8 to 38). We found 4 with SLN(+)/ALN(+), 10 with SLN(+)/ALN(-), 1 with SLN(-)/ALN(+), and 33 with SLN(-)/ALN(-). Detection rate, accuracy, and false negative rate was 93.9% (46 of 49), 95.7% (44 of 46) and 11.8% (2 of 17) in post-NAC group and 96% (48 of 50), 97.9% (44 of 46) and 6.7% (1 of 15) in non-NAC group, respectively. There was no statistical difference between post-NAC group and non-NAC group in either detection rate (p=0.409), accuracy (p=0.525) or false negative rate (p=0.548).Conclusions: This prospective study in Chinese breast cancer population shows that post-NAC SLNB has both satisfactory detection rate and accuracy with acceptable false negative rate, being comparable to non-NAC patients. Our results also showed that using methylene blue only in SLNB for breast cancer is an ideal choice where radio detection method is not available.Summary of pathological resultsGrouppost-NAC (N=49)non-NAC (N=50)SLNB successful4648Average SLNs detected1.6 (range 1 to 5)1.7 ( range 1 to 6)Average ALNs taken out15.4 (range 7 to 33)16.8 (range 8 to 38)SLN+ / ALN-94SLN+/ ALN+510SLN- / ALN+21SLN- / ALN-2933 

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1014.

[A meta-analysis of neoadjuvant chemotherapy combined with trastuzumab for HER2-positive breast cancers]

OBJECTIVE

To evaluate the efficacy and safety of neoadjuvant chemotherapy combined with trastuzumab for HER2 positive breast cancers.

METHODS

PubMed online database, ASCO abstract database, SABCS abstract database, ESMO abstract database and CBMdisc database were searched for literatures related to trastuzumab in neoadjuvant chemotherapy for breast cancers. A meta-analysis was performed for retrieved literatures meeting the inclusion criteria.

RESULTS

Three clinical trials were included. Meta-analysis showed that compared to chemotherapy only, regimens combined with trastuzumab could significantly improved the pCR rate of HER2-positive breast cancers (RR=1.65, 95% CI 1.28-2.13, P<0.0001) without increasing the frequencies of cardiac toxicity (RR=1.16, 95% CI 0.82-1.64, P=0.41).

CONCLUSION

In neoadjuvant chemotherapy for HER2-positive breast cancers, chemotherapy combined with trastuzumab is superior to exclusive chemotherapy.

[Efficacy and prognosis analysis in 188 children with acute lymphoblastic leukemia of China]

OBJECTIVE

To analyze the therapeutic effect and the influencing factors of event-free survival (EFS) of childhood acute lymphoblastic leukemia (ALL) in Xiangya Hospital of Central South University and the First Affiliated Hospital of Guangxi Medical University.

METHODS

All the patients adopted chemotherapy according to therapeutic guideline revised by the Subspecialty Group of Hematology, The Society of Pediatrics, Chinese Medical Association for the second-time in 1998 (the Rongcheng ALL-98 Protocol). Kaplan-Meier method was used to estimate the survival rates of 188 patients who received therapy with good compliance. The differences of EFS between groups were assessed by Log-rank test. The independent influencing factors on EFS were analyzed by the Cox proportional hazards regression model.

RESULTS

After receiving inductive treatment, 354 of 374 (93.6%) patients demonstrated a complete remission; 188 patients who received complete courses of treatment with good compliance showed (68.1 +/- 5.6)% five-year EFS. Meanwhile, the five-year EFS in standard-risk (SR) group and high-risk (HR) group were (75.2 +/- 6.0)% and (47.6 +/- 11.6)%, respectively. The total relapse rate was 10.6% and the median time to relapse was 13 months. Twenty-nine of 188 patients (15.4%) were dead, and 13 patients (7.0%) died from treatment-related complications. Independent adverse prognostic factors included risk grouping, t (9; 22)/bcr-abl gene and leukocyte count.

CONCLUSIONS

The total EFS of childhood ALL patients treated with Rongcheng ALL-98 Protocol in two hospitals was close to 70%. Therefore, it is necessary to evaluate risk factors and consider the grouping in more detail to reduce the treatment-related mortality and to increase the compliance of treatment which can ultimately improve the EFS.

Assigning the protonation states of the key aspartates in β-Secretase using QM/MM X-ray structure refinement

β-Secretase, a.k.a. β-APP cleaving enzyme (BACE), is an aspartyl protease that has been implicated as a key target in the pathogenesis of Alzheimer's disease (AD). The identification of the protonation states of the key aspartates in β-secretase is of great interest both in understanding the reaction mechanism and in guiding the design of drugs against AD. However, the resolutions of currently available crystal structures for BACE are not sufficient to determine the hydrogen atom locations. We have assigned the protonation states of the key aspartates using a novel method, QM/MM X-ray refinement. In our approach, an energy function is introduced to the refinement where the atoms in the active site are modeled by quantum mechanics (QM) and the other atoms are represented by molecular mechanics (MM). The gradients derived from the QM/MM energy function are combined with those from the X-ray target to refine the crystal structure of a complex containing BACE and an inhibitor. A total number of 8 protonation configurations of the aspartyl dyad were considered and QM/MM X-ray refinements were performed for all of them. The relative stability of the refined structures was scored by constructing the thermodynamic cycle using the energetics calculated by fully quantum mechanical self-consistent reaction field (QM/SCRF) calculations. While all 8 refined structures fit the observed electron density about equally well, we find the mono-protonated configurations to be strongly favored energetically, especially the configuration with the inner oxygen of Asp32 protonated and the hydroxyl of the inhibitor pointing towards Asp228. It was also found that these results depend on the constraints imposed by the X-ray data. We suggest that one of the strengths of this approach is that the resulting structures are a consensus of theoretical and experimental data and remark on the significance of our results in structure based drug design and mechanistic studies.

[Surveillance of filariasis in some vulnerable areas in Guangxi after filariasis elimination]

OBJECTIVE

To explore the measures for continuing surveillance of filariasis.

METHODS

Selecting some vulnerable spots for focal surveillance, double-slide biood sampling for microfilaria examination, dissecting vectors for detecting the mosquitoes infected with filarial larva, using IFAT for detecting antifilarial antibody.

RESULTS

27,938 persons were examined for microfilaria and 4,454 mosquitoes were dissected for filaria larva, all were negative. 3,606 serum samples were examined for antifilarial antibody average positive rate was 1.35%(0.39-4.97%).

CONCLUSION

The results of surveillance showed that the achievement of filariasis control in Guangxi after filariasis elimination is consolidated.

[Color measurements of 1,944 anterior teeth of people in southwest of China-discreption]

OBJECTIVE

To study the color distribution space of natural anterior tooth crowns of people in southwest China and effects of sex and age on tooth color.

METHODS

The subjects studied consisted of 162 persons aged from 20 to 73 years and born in southwest China. A total of 1,944 healthy anterior teeth were measured in-vivo with a fiber-optical spectrophotometry system.

RESULTS

Statistical analysis showed that the color distribution space of Chinese tooth crowns was wide. The value of L* varied from 42.383 to 67.428, the value of a* from -4.750 to 1.371, the value of b* from 1.88 to 20.268, the value of x from 0.298 to 0.393, the value of y from 0.332 to 0.392, and the value of Y from 19.383 to 34.025. The color difference between the upper and lower limits of 95% confidence was 31.667 CIE delta E units. The difference in colorimetry between male and female was not significant. The results showed that in three sections of teeth (incisal, middle and cervical) the values of L* and a* were negatively related to age (r < 0, P < 0.01); the value of b* was positively related to age just at the cervical and middle sites of teeth (r > 0, P < 0.01) and was not related to age at the incisal site of teeth (P > 0.05).

CONCLUSION

The color distribution space of Chinese anterior tooth crowns is wide. There is no difference in the anterior tooth color between male and female subjects. The values of L* and a* and negatively related to age except the value of b*.

Transgenic mice expressing surface markers for IFN-gamma and IL-4 producing cells

The detection of T(H)1-type and T(H)2-type cells directly in situ would be of great value in the study of T(H) development and function in vivo. Transgenic mice expressing human Thy1 and mouse Thy1.1 under the control of the murine IFN-gamma and IL-4 promoters, respectively, have been generated. The hThy1(+) cells represent (with some temporal lag) most of the IFN-gamma-producing CD4(+) T-cells, while the mThy1.1(+) cells represent only a percentage of IL-4 secreting cells. This may be due to mono-allelic expression of the IFN-gamma and IL-4 genes. Since permeabilization is not required for the detection of the transgenic surface markers, these transgenic mice can facilitate the detection of T(H)1-type and T(H)2-type cells by flow cytometry with surface immunofluorescent staining. These surface markers should permit isolation of viable cells according to their T(H) type for adoptive transfer experiments, and may serve as a model system for tracing the development of T(H)1 and T(H)2-type cells in vivo.

Applications of genetic algorithms on the structure-activity relationship analysis of some cinnamamides

Quantitative structure-activity relationships (QSARs) for 35 cinnamamides were studied. By using a genetic algorithm (GA), a group of multiple regression models with high fitness scores was generated. From the statistical analyses of the descriptors used in the evolution procedure, the principal features affecting the anticonvulsant activity were found. The significant descriptors include the partition coefficient, the molar refraction, the Hammet sigma constant of the substituents on the benzene ring, and the formation energy of the molecules. It could be found that the steric complementarity and the hydrophobic interaction between the inhibitors and the receptor were very important to the biological activity, while the contribution of the electronic effect was not so obvious. Moreover, by construction of the spline models for these four principal descriptors, the effective range for each descriptor was identified.

Modulation of cytokine responses of murine CD8+ alphabeta intestinal intraepithelial lymphocytes by IL-4 and IL-12

The immune responses of the intestine mucosa feature the noninflammatory type, such as IgA production and oral tolerance. Th2 type cytokines have been implicated in the induction of these noninflammatory responses. In the present study, cytokine responses of CD8+ and CD4+ TCRalphabeta+ intestinal intraepithelial lymphocyte (alphabeta iIEL) subsets to TCR stimulation under the influence of IL-12, IL-4, or CD28 costimulation were examined. IL-12 enhanced production of IL-10 and IFN-gamma by the CD8alphabeta+ alphabeta iIEL significantly but only marginally affected the CD8alphaalpha+ subset, whereas IL-4 induced IL-4, IL-5, and IL-10 production and augmented TGF-beta production by both subsets. CD28 costimulation induced production of Th2 cytokines by CD4+ iIEL in the absence of exogenous IL-4. Unlike lymph node CD4+ cells, the CD28 costimulation-induced Th2 differentiation of CD4+ iIEL was not inhibited by IFN-gamma. These results demonstrate active cytokine production by CD4+, CD8alphabeta+, as well as CD8alphaalpha+ alphabeta iIEL. The Th2- skewed cytokine profile of CD8alphaalpha+ alphabeta iIEL and the IFN-gamma-resistance of Th2 differentiation of the CD4+ alphabeta iIEL suggest that both iIEL subsets contribute to the induction of noninflammatory mucosal immune responses.

Crystal-induced neutrophil activation VI. Involvment of FcgammaRIIIB (CD16) and CD11b in response to inflammatory microcrystals

The inflammatory reaction associated with the deposition of monosodium urate (MSU) crystals in synovial spaces is known to be due to interactions with polymorphonuclear neutrophils mediated by presently unidentified surface structures. In this study, we have observed that antibodies directed against CD16 (VIFcRIII) and CD11b (VIM12) selectively and potently inhibit the activation of neutrophils by MSU crystals. The responses affected include the stimulation of tyrosine phosphorylation, activation of the tyrosine kinase syk, tyrosine phosphorylation of the proto-oncogene Cbl, mobilization of calcium, and stimulation of the activity of phospholipase D and of the production of superoxide anions. Tyrosine phosphorylation responses to MSU crystals develop during the Me2SO4-induced differentiation of HL-60 cells in parallel with the surface expression of CD16. These data strongly support the hypothesis that inflammatory microcrystals interact opportunistically with CD16 initially, and that the signal transduction pathways activated thereby depend on CD11b. An examination of the relevance of the hypothesis that an uncontrolled activation of CD16/CD11b may play a role in inflammatory reactions associated with a dysregulation of neutrophil function (other than crystal arthropathies) appears warranted on the basis of the present results.

Neuroanatomical connections between corticotropin-releasing factor (CRF) and somatostatin (SRIF) nerve endings and thyrotropin-releasing hormone (TRH) neurons in the paraventricular nucleus of rat hypothalamus

In order to investigate the possible involvement of corticotropin-releasing factor (CRF) and somatostatin (SRIF) on thyrotropin-releasing hormone (TRH) neuronal cell activity in the rat hypothalamic paraventricular nucleus, we have proceeded to the simultaneous localization of CRF or SRIF and TRH. For this purpose, we used a dual immunostaining procedure that employed antibodies to CRF and SRIF and peroxidase-labeled goat anti-rabbit IgG as a first sequence, and antibodies to a cryptic fragment (Phe178-Glu199) of pro-TRH (to label TRH neurons) and alkaline phosphatase-labeled goat anti-rabbit IgG as the second sequence. A rich innervation of the paraventricular nucleus by immunoreactive CRF and SRIF fibers was observed. A large number of CRF and SRIF nerve endings were seen intimate anatomic proximity and often appeared to surround TRH-containing cell bodies. These results strongly suggest that TRH neurons might be regulated by both CRF and SRIF. These interactions might be the neuroanatomical basis for the already observed inhibitory effects of CRF and SRIF on TRH release.

Anatomical interactions of proopiomelanocortin (POMC)-related peptides, neuropeptide Y (NPY) and dopamine beta-hydroxylase (D beta H) fibers and thyrotropin-releasing hormone (TRH) neurons in the paraventricular nucleus of rat hypothalamus

In order to determine the nature of afferent fibres contacting thyrotropin-releasing hormone (TRH)-synthesizing neuronal cell bodies in the rat hypothalamic paraventricular nucleus, we used dual immunostaining procedures which employed antibodies to ACTH (to label proopiomelanocortin (POMC) neurons), neuropeptide Y (NPY) and dopamine-beta-hydroxylase (D beta H) and peroxidase-labeled goat anti-rabbit IgG as a first sequence and antibodies to a cryptic fragment (Phe178-Glu199) of pro-TRH (to label TRH neurons) and alkaline phosphatase-labeled goat anti-rabbit IgG as the second sequence. A rich innervation of the paraventricular nucleus by immunoreactive POMC, NPY and D beta H fibres was observed. Numerous NPY and POMC fibres were in intimate anatomic proximity and often appeared to surround in remarkable density TRH-containing cell bodies. Less frequent appositions between D beta H fibres and TRH cell bodies were detected. These results strongly suggest that TRH neurons might be regulated by POMC, NPY as well as adrenergic and/or noradrenergic systems. These interactions might be the neuroanatomical basis for the already observed effects of opiate peptides, NPY and catecholamines on TSH secretion.

Release of pro-thyrotropin-releasing hormone connecting peptides PS4 and PS5 from perifused rat hypothalamic slices

Thyrotropin-releasing hormone prohormone contains five copies of the thyrotropin-releasing hormone progenitor sequence Gln-His-Pro-Gly, each flanked by pairs of basic amino acids and separated by intervening sequences (connecting peptides). Using a perifusion system for rat hypothalamic slices, we have studied the ionic mechanisms underlying the release of two connecting peptides originating from the thyrotropin-releasing hormone precursor: prepro-thyrotropin-releasing hormone-(160-169) (Ps4) and prepro-thyrotropin-releasing hormone-(178-199) (Ps5). Quantification of these two peptides in the effluent fluid was performed using sensitive and highly specific radioimmunoassay procedures. Reverse phase high performance liquid chromatography analysis of the effluent perifusate showed that released peptides co-eluted with synthetic Ps4 and Ps5. The secretion of Ps4 and Ps5 was stimulated by depolarizing agents such as (i) high potassium concentrations, (ii) ouabain, an Na+/K(+)-ATPase inhibitor, and (iii) veratridine, a stimulator of voltage-operated Na+ channels. The response to potassium (70 mM) was not affected by the specific Na+ channel blocker tetrodotoxin. The K+ channel blocker tetraethylammonium did not modify K(+)-evoked release of Ps4 and Ps5. These data suggest that voltage-operated Na+ channels are not involved in the stimulatory effect of high K+ on the release of Ps4 and Ps5. The lack of effect of picrotoxin, a Cl- channel blocker, on the secretion of the connecting peptides indicates that chloride ions play a minor role in the release process. In contrast, deprivation of Ca2+ in the perifusion medium suppressed K(+)-evoked release of the two peptides, indicating that voltage-operated Ca2+ channels are implicated in the release process. Taken together, the present results show that non-thyrotropin-releasing hormone peptides originating from the thyrotropin-releasing hormone precursor are secreted by mediobasal hypothalamic fragments. The release of these peptides is stimulated by depolarization through a calcium-dependent process. These data indicate that Ps4 and Ps5 may be released at the level of the median eminence into the portal circulation, suggesting that these peptides may play a role in the control of anterior pituitary cells.

Immunoelectron microscopic localization of thyrotropin-releasing hormone (TRH) precursor in the rat raphe nuclei

Using antisera to two pro-thyrotropin-releasing hormone (pro-TRH)-derived cryptic peptides, we have studies by immunocytochemistry the ultrastructural localization of pro-TRH in the rat raphe nuclei. The same results were obtained with both antisera. Immunostaining was found in cell bodies, dendrites and endings. In cell bodies, the reaction product was restricted to Golgi saccules and dense core vesicles which were very few in number. In dendrites, the staining was rather diffuse without any association with specific organelles. These results suggest that the Golgi apparatus might be involved in pro-TRH processing.

Thyroid hormone regulation of neurons staining for a pro-TRH-derived cryptic peptide sequence in the rat hypothalamic paraventricular nucleus

The influence of thyroid hormones on neurons staining for a pro-TRH-derived cryptic peptide sequence in the rat hypothalamic paraventricular nucleus was assessed by using quantitative immunocytochemistry. The antiserum used for immunocytochemical studies recognized a cryptic fragment of pro-TRH located in the Phe 178-Ser 186 region of the precursor. Hypothyroid female rats obtained following 1 month administration of 6-n-propyl-2-thiouracil (PTU) as well as euthyroid animals were treated with a low (3 micrograms/kg/day) or high (67 micrograms/kg/day) dose of L-thyroxine (T4) for 4-10 days before sacrifice. All the animals received an intraventricular injection of colchicine 2 days prior to perfusion with 4% paraformaldehyde. PTU treatment induced an increase (45% over control) in the number of immunostained neurons. The administration of a low dose of T4 to hypothyroid animals slightly increased the number of staining for a pro-TRH-derived cryptic sequence neurons, while being uneffective in euthyroid rats. In hypothyroid animals, a 4-day treatment with the high dose of T4 did not produce any changes whereas the 7-day treatment reduced the number of positive cells to 42% of control. In euthyroid rats treated with the high dose of T4 for 4 and 7 days, the number of stained neurons was reduced to 60 and 37% of control, respectively. These results indicate that thyroid hormones can modify the amounts of staining for a pro-TRH-derived cryptic sequence in hypothalamic paraventricular neurons.(ABSTRACT TRUNCATED AT 250 WORDS)

Chemoattractant-induced cytoplasmic pH changes and cytoskeletal reorganization in human neutrophils. Relationship to the stimulated calcium transients and oxidative burst

The relationships between the chemotactic factor-stimulated mobilization of calcium, activation of the NADPH-oxidase, changes in cytosolic pH, and in the level of polymerized actin in human neutrophils have been examined. The approach taken was to use intracellular calcium chelators, and pharmacologic modulators (both positive and negative) of the NADPH-oxidase to measure the aforementioned responses under conditions where the calcium transients were abrogated and/or the generation of superoxide anions was either inhibited or augmented. The decrease in cytosolic pH induced by chemoattractants was inhibited by the calcium chelator BAPTA and by the diglyceride kinase inhibitor 6-[2-(4-[(4-fluorophenyl)phenylmethylene]-1-piperidinylethyl ]-7-methyl-5H-thiazolo[3,2-alpha]pyriimidin-5-one (R59022) (this latter compound enhanced the oxidative response of the cells). Furthermore, a specific inhibitor of the NADPH-oxidase (diphenyleneiodonium) had no significant effect on the cytosolic acidification induced by FMLP or leukotriene B4. These results indicate that the initiation of the cytosolic acidification induced by chemotactic factors is a calcium-dependent event that is not directly linked to the activation of the NADPH-oxidase. In contrast, the stimulated polymerization of actin was insensitive to BAPTA, R59022, and diphenyleneiodonium. Thus, neither the calcium transients nor the oxidative burst play a signaling role in the initiation of actin polymerization elicited by chemoattractants. These data indicate that additional investigations are needed to uncover the biochemical basis of the signals initiated in human neutrophils by chemotactic factors that lead to the polymerization of actin and to the cytosolic acidification.

Chemoattractant-induced cytoplasmic pH changes and cytoskeletal reorganization in human neutrophils. Relationship to the stimulated calcium transients and oxidative burst

The relationships between the chemotactic factor-stimulated mobilization of calcium, activation of the NADPH-oxidase, changes in cytosolic pH, and in the level of polymerized actin in human neutrophils have been examined. The approach taken was to use intracellular calcium chelators, and pharmacologic modulators (both positive and negative) of the NADPH-oxidase to measure the aforementioned responses under conditions where the calcium transients were abrogated and/or the generation of superoxide anions was either inhibited or augmented. The decrease in cytosolic pH induced by chemoattractants was inhibited by the calcium chelator BAPTA and by the diglyceride kinase inhibitor 6-[2-(4-[(4-fluorophenyl)phenylmethylene]-1-piperidinylethyl ]-7-methyl-5H-thiazolo[3,2-alpha]pyriimidin-5-one (R59022) (this latter compound enhanced the oxidative response of the cells). Furthermore, a specific inhibitor of the NADPH-oxidase (diphenyleneiodonium) had no significant effect on the cytosolic acidification induced by FMLP or leukotriene B4. These results indicate that the initiation of the cytosolic acidification induced by chemotactic factors is a calcium-dependent event that is not directly linked to the activation of the NADPH-oxidase. In contrast, the stimulated polymerization of actin was insensitive to BAPTA, R59022, and diphenyleneiodonium. Thus, neither the calcium transients nor the oxidative burst play a signaling role in the initiation of actin polymerization elicited by chemoattractants. These data indicate that additional investigations are needed to uncover the biochemical basis of the signals initiated in human neutrophils by chemotactic factors that lead to the polymerization of actin and to the cytosolic acidification.

Mapping of estrogen receptor-producing cells in the rat brain by in situ hybridization

The localization of cells which produce estrogen receptors in the rat central nervous system was performed using an in situ hybridization technique. For this, we used a synthetic oligonucleotide probe labeled with 35S complementary to the mRNA coding for a fragment (1-24) of estradiol receptor which is not common to the other steroid receptors so far characterized. Radioautography revealed that labeling was present in discrete brain areas. The results obtained with the in situ hybridization agree well with previous results obtained with other techniques. This approach should be very useful to study the effects of different factors on estrogen receptor gene expression in specific brain nuclei and individual neurons.

Electron microscope immunocytochemical localization of thyrotropin-releasing hormone (TRH) prohormone in the rat hypothalamus

Using an antiserum to a synthetic peptide corresponding to the sequence Phe-178-Ser-199 of the precursor of thyrotropin-releasing hormone (pro-TRH), we have studied by immunoelectron microscopy the ultrastructural localization of pro-TRH in the rat hypothalamus. In the paraventricular nucleus neuronal cell bodies, dendrites and axons were labelled. The dense core vesicles were strongly immunoreactive. Immunostained cell bodies, dendrites and endings were frequently observed in contact with unidentified neuronal elements. In the median eminence, numerous endings containing positive dense core vesicles were detected. These results suggest that pro-TRH and/or fragment(s) of pro-tRH could play a neuromodulator/neurotransmitter role in the hypothalamus and could also be released into the pituitary portal plexus.

Distribution of estrogen receptors in the rat pituitary as studied by in situ hybridization

The localization of estrogen receptors in the rat pituitary gland was performed by in situ hybridization. The probe used was a synthetic oligonucleotide probe labelled with 35S complementary to the mRNA coding for a fragment (1-24) of estrogen receptor. Strong labelling was observed in cells of the anterior and intermediate lobes whereas the posterior lobe remains unlabelled. These results suggest that not only the anterior lobe but also the intermediate lobe is a target for estrogens.

Immunocytochemical distribution of neurons containing a peptide derived from thyrotropin-releasing hormone precursor in the rat brain

Using an antiserum to a 22-amino acid synthetic peptide corresponding to sequence 178-199 of the precursor of thyrotropin-releasing hormone (pro-TRH), we have studied by immunocytochemistry the distribution of immunoreactive pro-TRH in the rat brain. Immunostaining found in several regions of the brain had a distribution similar to that previously reported for TRH. Reaction product was found in both neuronal cell bodies and processes. These results indicate that peptide(s) derived from pro-TRH are transported along the axons with TRH itself. Moreover, the presence of immunoreactive nerve endings in different areas including the median eminence suggests that this material might have a neuromodulator/neurotransmitter role in the central nervous system and could also be released into the pituitary portal plexus.