Therapy of desmoid tumors, fibromatosis, and related neoplasms

Forty-seven patients with unresectable desmoid tumors and 32 patients with unresectable fibromatosis were treated with various anti-neoplastic agents including methotrexate, vinblastine, etoposide, actinomycin D, and fluorouracil. A combination of methotrexate with either vinblastine or etoposide was found to be effective in yielding long-term control to both groups of patients. Fluorouracil and actinomycin D were less effective. Other than a significant but slowly reversible peripheral neuropathy in 6 patients, therapy was well tolerated and no long-term hematologic, pulmonary, hepatic, or cardiac toxicity was noted in any patient.

Hormone supplementation during aging: how much and when?

Circulating levels of dehydroepiandrosterone, a major adrenal steroid, show a marked age-related decrease in both humans and nonhuman primates. Because this decrease has been implicated in age-related cognitive decline, we administered supplementary dehydroepiandrosterone to perimenopausal rhesus macaques (Macaca mulatta) to test for cognitive benefits. Although recognition memory improved, there was no benefit to spatial working memory. To address the limitations of this study we developed a hormone supplementation regimen in aged male macaques that more accurately replicates the 24-hr androgen profiles of young animals. We hypothesize that this more comprehensive physiological hormone replacement paradigm will enhance cognitive function in the elderly.

A high-throughput screen to identify inhibitors of SOD1 transcription

Amyotrophic lateral sclerosis (ALS) is a fatal degenerative motor neuron disease. Approximately 20 percent of familial ALS cases are caused by mutations in the Cu/Zn superoxide dismutase (SOD1) gene. Rodents expressing mutant SOD1 transgenes develop progressive, fatal motor neuron disease and disease onset and progression is dependent on the level of SOD1. We investigated the possibility that a reduction in SOD1 protein may be of therapeutic benefit in ALS and screened 30,000 compounds for inhibition of SOD1 transcription. The most effective inhibitor identified was N-{4-[4-(4-methylbenzoyl)-1-piperazinyl]phenyl}-2-thiophenecarboxamide (Compound ID 7687685), which in PC12 cells showed an EC50 of 10.6 microM for inhibition of SOD1 expression and an LD50 more than 30 microM. This compound was subsequently shown to reduce endogenous SOD1 levels in HeLa cells and to exhibit a modest reduction of SOD1 protein levels in mouse spinal cord tissue. These data suggest that the efficacy of compound 7687685 as an inhibitor of SOD1 gene expression is not likely to be clinically useful, although the strategy reported could be applied broadly to screening for small molecule inhibitors of gene expression.

Enhanced beta cell proliferation in mice overexpressing a constitutively active form of Akt and one allele of p21Cip

AIMS/HYPOTHESIS

The ability of pancreatic beta cells to proliferate is critical both for normal tissue maintenance and in conditions where there is an increased demand for insulin. Protein kinase B(Akt) plays a major role in promoting proliferation in many cell types, including the insulin-producing beta cells. We have previously reported that mice overexpressing a constitutively active form of Akt(caAkt (Tg)) show enhanced beta cell proliferation that is associated with increased protein levels of cyclin D1, cyclin D2 and cyclin-dependent kinase inhibitor 1A (p21(Cip)). In the present study, we sought to assess the mechanisms responsible for augmented p21(Cip) levels in caAkt(Tg) mice and test the role of p21(Cip) in the proliferative responses induced by activation of Akt signalling.

METHODS

To gain a greater understanding of the relationship between Akt and p21(Cip), we evaluated the mechanisms involved in the modulation of p2(Cip) by Akt and the in vivo role of reduced p21(Cip) in proliferative responses induced by Akt.

RESULTS

Our experiments showed that Akt signalling regulates p21(Cip) transcription and protein stability. caAkt(Tg) /p21(Cip+/-) mice exhibited fasting and fed hypoglycaemia as well as hyperinsulinaemia when compared with caAkt(Tg) mice. Glucose tolerance tests revealed improved glucose tolerance in caAkt(Tg)/p21(Cip+/-) mice compared with caAkt (Tg). These changes resulted from increased proliferation, survival and beta cell mass in caAkt(Tg)/p21(Cip+/-) compared with caAkt(Tg) mice.

CONCLUSIONS/INTERPRETATION

Our data indicate that increased p21(Cip) levels in caAkt(Tg) mice act as a compensatory brake, protecting beta cells from unrestrained proliferation. These studies imply that p21(Cip) could play important roles in the adaptive responses of beta cells to proliferate in conditions such as in insulin resistance.

Empty follicle syndrome: successful treatment in a recurrent case and review of the literature

Empty follicle syndrome is a condition in which no oocytes are retrieved after an apparently adequate ovarian response to stimulation and meticulous follicular aspiration. It is a rare condition of obscure etiology. A patient with primary infertility who underwent seven assisted reproductive technique cycles is described. In spite of a satisfactory ovarian response, aspiration yielded no oocytes in four cycles and 1-4 low quality oocytes in three cycles. In the index treatment cycle, ovulation was triggered using GnRH agonist 40 h prior to ovum pickup and hCG was added 6 h after the first trigger. Eighteen oocytes were recovered, of which 16 were mature and were inseminated by ICSI. Two embryos were transferred 48 h after aspiration and nine embryos were cryopreserved. The patient conceived and delivered a healthy boy at 38 weeks of gestation. The literature is reviewed and possible etiologies and treatment options of this enigmatic syndrome are suggested.

An instrumented timed up and go: the added value of an accelerometer for identifying fall risk in idiopathic fallers

The Timed Up and Go (TUG) test is a widely used measure of mobility and fall risk among older adults that is typically scored using a stopwatch. We tested the hypothesis that a body-fixed accelerometer can enhance the ability of the TUG to identify community-living older adults with a relatively high fall risk of unknown origin. Twenty-three community-living elderly fallers (76.0 ± 3.9 years) and 18 healthy controls (68.3 ± 9.1 years) performed the TUG while wearing a 3D-accelerometer on the lower back. Acceleration-derived parameters included Sit-to-Stand and Stand-to-Sit times, amplitude range (Range), and slopes (Jerk). Average step duration, number of steps, average step length, gait speed, acceleration-median, and standard-deviation were also calculated. While the stopwatch-based TUG duration was not significantly different between the groups, acceleration-derived TUG duration was significantly higher (p = 0.007) among the fallers. Fallers generally exhibited lower Range and Jerk (p < 0.01). While TUG stopwatch duration successfully identified 63% of the subjects, an accelerometer-derived three-measure-combination correctly classified 87% of the subjects. Accelerometer-derived measures were generally not correlated with TUG duration. These findings demonstrate that fallers have difficulty with specific TUG aspects that can be quantified using an accelerometer. Without compromising simplicity of testing, an accelerometer can apparently be combined with TUG duration to provide complementary, objective measures that allow for a more complete, sensitive TUG-based fall risk assessment.

Multidisciplinary Canadian consensus recommendations for the management and treatment of hepatocellular carcinoma

Globally, hepatocellular carcinoma (hcc) is the third most common cause of death from cancer, after lung and stomach cancer. The incidence of hcc in Canada is increasing and is expected to continue to increase over the next decade. Given the high mortality rate associated with hcc, steps are required to mitigate the impact of the disease. To address this challenging situation, a panel of 17 hcc experts, representing gastroenterologists, hepatologists, hepatobiliary surgeons, medical oncologists, pathologists, and radiologists from across Canada, convened to provide a framework that, using an evidence-based approach, will assist clinicians in optimizing the management and treatment of hcc. The recommendations, summarized here, were developed based on a rigorous methodology in a pre-specified process that was overseen by the steering committee. Specific topics were identified by the steering committee and delegated to a group of content experts within the expert panel, who then systematically reviewed the literature on that topic and drafted the related content and recommendations. The set of recommendations for each topic were reviewed and assigned a level of evidence and grade according to the levels of evidence set out by the Centre for Evidence-based Medicine, Oxford, United Kingdom. Agreement on the level of evidence for each recommendation was achieved by consensus. Consensus was defined as agreement by a two-thirds majority of the 17 members of the expert panel. Recommendations were subject to iterative review and modification by the expert panel until consensus could be achieved.

Invited article: millimeter-wave bolometer array receiver for the Atacama pathfinder experiment Sunyaev-Zel'dovich (APEX-SZ) instrument

The Atacama pathfinder experiment Sunyaev-Zel'dovich (APEX-SZ) instrument is a millimeter-wave cryogenic receiver designed to observe galaxy clusters via the Sunyaev-Zel'dovich effect from the 12 m APEX telescope on the Atacama plateau in Chile. The receiver contains a focal plane of 280 superconducting transition-edge sensor (TES) bolometers instrumented with a frequency-domain multiplexed readout system. The bolometers are cooled to 280 mK via a three-stage helium sorption refrigerator and a mechanical pulse-tube cooler. Three warm mirrors, two 4 K lenses, and a horn array couple the TES bolometers to the telescope. APEX-SZ observes in a single frequency band at 150 GHz with 1' angular resolution and a 22' field-of-view, all well suited for cluster mapping. The APEX-SZ receiver has played a key role in the introduction of several new technologies including TES bolometers, the frequency-domain multiplexed readout, and the use of a pulse-tube cooler with bolometers. As a result of these new technologies, the instrument has a higher instantaneous sensitivity and covers a larger field-of-view than earlier generations of Sunyaev-Zel'dovich instruments. The TES bolometers have a median sensitivity of 890 μK(CMB)√s (NEy of 3.5 × 10(-4) √s). We have also demonstrated upgraded detectors with improved sensitivity of 530 μK(CMB)√s (NEy of 2.2 × 10(-4) √s). Since its commissioning in April 2007, APEX-SZ has been used to map 48 clusters. We describe the design of the receiver and its performance when installed on the APEX telescope.

CT-guided biopsies: quality, complications and impact on treatment: a retrospective initial quality control

PURPOSE

To retrospectively evaluate the quality and complications of CT-guided biopsies and their impact on treatment.

MATERIALS AND METHODS

A total of 265 CT-guided interventions performed during a 6-month period were extracted by digital database query. These included 127 CT-guided biopsies, which were classified by patient age, organ/body area, histopathological biopsy diagnosis, complications, and performing physician.

RESULTS

In 51 % of cases (65 / 127), CT-guided biopsies led to a malignant diagnosis and a change in the patient's treatment. Retrospectively, complications were to be expected in a range of 12 - 26 %, given a 95 % confidence interval. In terms of organ/body area, most complications occurred in lung biopsies (23 / 56; 41 %). 80 % of CT-guided biopsies were performed without complications. 2 of the 11 physicians performed 66 % of all biopsies (84 / 127) and had significantly fewer complications than the others. Patient age was a statistically significant factor for complications (p < 0.018) as well as for a malignant biopsy diagnosis (p < 0.009).

CONCLUSION

Our initial quality control assessment suggests that frequent use of CT-guided biopsy by the performing physician rather than the general level of experience is associated with fewer complications for patients. Age is a significant factor for complications of CT-guided biopsies, thus leading to an increased risk/benefit ratio. As expected, age also significantly increases the risk of a malignant biopsy result. Complications and malignant biopsy results were not significantly associated. CT-guided biopsies triggered a change in treatment in over 50 % of cases.

Relationship between active inflammatory lesions in the spine and sacroiliac joints and new development of chronic lesions on whole-body MRI in early axial spondyloarthritis: results of the ESTHER trial at week 48

AIM

To investigate the relationship between active inflammatory lesions on whole-body MRI (wb-MRI) and new development of chronic lesions on T1 MRI in patients with early axial spondyloarthritis (SpA) treated either with etanercept (ETA) or sulfasalazine (SSZ).

METHODS

Wb-MRIs of 65 patients treated either with ETA (n=35) or SSZ (n=30) over 1 year were scored for active inflammation, fatty lesions, erosions and ankylosis in the 23 vertebral units (VUs) of the spine and in the sacroiliac joints (SI joints). Scoring was performed by two blinded radiologists.

RESULTS

If there was no previous inflammation in the bone no new fatty lesions occurred in SI joint quadrants and only a few (0.6%) in spine VUs. There was a significant relationship between disappearance of inflammation and the appearance of fatty lesions: if baseline inflammation resolved fatty lesions occurred in 10.5% of SI joint quadrants and 17.9% of VUs. If inflammation did not resolve over 1 year, fatty lesions occurred less frequently: 2.4% (SI joint quadrants) and 7.2% (VUs). There was a significantly higher increase of the mean fatty lesion score between baseline and week 48 in the ETA (4.0 vs 4.8 for the SI joints and 1.9 vs 2.7 for the spine) compared to the SSZ (3.0 vs 3.2 for the SI joints and 1.1 vs 1.2 for the spine, respectively) group (p=0.001 and p=0.020 for the differences). No significant changes in the erosion or ankylosis score were observed in any of the two groups during this time.

CONCLUSIONS

These data indicate that there is a close interaction between inflammation, tumour necrosis factor blockade and the development of fatty lesions in subchondral bone marrow of patients with axial SpA.