Endoscopy in inflammatory bowel disease

Small bowel imaging and endoscopy in inflammatory bowel disease (IBD) underwent a lot of change and advancement in the recent years. Modalities have shifted from gastroscopy, colonoscopy and small bowel follow through, to ileo-colonoscopy, computed tomography (CT) or magnetic resonance (MR), enteroscopy, wireless video capsule endoscopy and balloon assisted enteroscopy. Nowadays endoscopy has a major role in the diagnosis of IBD, assessing its extent, treating some of its complications (stricture, bleeding), assessing the success of various treatments (mucosal healing), and as a predictor of disease course. Wireless capsule endoscopy (WCE) is a relatively new "toy" allowing direct, patient friendly, visualization of the entire small bowel mucosa. It has gained a substantial role in the evaluation of patients with suspected Chron's Disease (CD) and indeterminate colitis. WCE has a high positive predictive value in patients with suspected CD, when one uses more than two of the International Conference on Capsule Endoscopy (ICCE) criteria, and not less important, a very high negative predictive value in patients with suspected CD. Its role in patients with known CD, assessing their disease activity and extent, its role in assessing postsurgical small bowel recurrence and its role in the evaluation of mucosal healing are still unclear. Balloon assisted enteroscopy has established its role as a complementary tool in cases where there is need of biopsies or treatment (dilatation of strictures). The present review will summarize the role of endoscopy in the diagnosis of IBD, in assessing its activity, its management, interventional endoscopy and cancer surveillance.

Espinha bífida aberta em bovino: primeiro relato no estado de Minas Gerais

Relatou-se um caso de espinha bífida aberta em uma bezerra de seis dias de idade que apresentava decúbito lateral permanente, pescoço em posição de opistótono, membros torácicos estendidos, impotência funcional dos membros pélvicos e fístulação na região lombar. Todos os achados clínicos, radiográficos e necroscópicos, descritos neste trabalho, são compatíveis com um quadro de espinha bífida aberta, sendo este o primeiro relato no estado de Minas Gerais.

Phase IB study of the EpCAM antibody adecatumumab combined with docetaxel in patients with EpCAM-positive relapsed or refractory advanced-stage breast cancer

BACKGROUND

Targeted therapy options in HER2-negative breast cancer are limited. This open-label, multicenter phase IB dose-escalation trial was conducted to determine safety, tolerability, and antitumor activity of a combination of docetaxel (Taxotere) and increasing doses of adecatumumab, a human IgG1 antibody targeting epithelial cell adhesion molecule (EpCAM), in EpCAM-positive relapsed or primary refractory advanced-stage breast cancer.

PATIENTS AND METHODS

Patients pretreated with up to four prior chemotherapy regimens received increasing adecatumumab doses either every 3 weeks (q3w) or weekly (qw) combined with docetaxel (100 mg/m(2) q3w). Primary end points were safety and tolerability. Antitumor activity was evaluated according to RECIST. Clinical benefit was defined as complete or partial response or stable disease for ≥24 weeks.

RESULTS

Thirty-one evaluable patients were treated. Most adverse events were mild to moderate in severity. Neutropenia, leukocytopenia, lymphopenia, and diarrhea (dose-limiting) were the most frequent toxic effects. Maximum tolerated doses of adecatumumab given in combination with docetaxel were 550 mg/m(2) q3w and 360 mg/m(2) qw. Clinical benefit was observed in 44% of patients treated with q3w adecatumumab and docetaxel, increasing to 63% in patients with high EpCAM-expressing tumors.

CONCLUSION

Combination therapy of adecatumumab and docetaxel is safe, feasible, and potentially active in heavily pretreated advanced-stage breast cancer.

Polidactilismo unilateral incomum em equino: relato de caso

A polidactilia é um defeito genético caracterizado pela duplicação parcial ou completa de um dígito. Estudos em humanos, bovinos, cães e gatos indicam que um gene autossômico dominante de penetração incompleta é o responsável por essa alteração. A polidactilia é rara em equinos e, nessa espécie, sua causa ainda não foi esclarecida. Entretanto, quando ocorre, está relacionada à má formação congênita da falange. Este trabalho descreve, por meio da observação de exames físico, radiográfico e ultrassonográfico, a ocorrência de polidactilia unilateral, com características incomuns, em um equino de nove anos de idade. O animal, com um histórico de claudicação intensa, apresentava, desde o nascimento, divisão completa do dígito do membro torácico direito, com simetria entre as duas porções distais. Ao exame radiográfico, identificou-se a presença de dois dígitos separados e de dimensões semelhantes, sendo esta uma manifestação incomum de polidactilia na espécie equina.

Axillary Dissection in the Case of Positive Sentinel Lymph Nodes: Results of the Innsbruck Consensus Conference

The prognosis of breast cancer is most heavily influenced by the status of the axillary nodes. Until a few years ago, this knowledge was gained through radical axillary lymph node clearance. In the meantime, sentinel lymph node clearance has become an established part of the surgical treatment of breast cancer. With the development of this procedure, the morbidity caused by axillary dissection has been reduced significantly. Although comprehensive prospective, randomised data regarding the safe use of the sentinel concept are only now available, the focus currently, however, is on the question of whether in the case of positive sentinel lymph nodes, an axillary dissection can be done away with altogether without having any negative impact on the risk of loco-regional recurrence or on progression-free survival and overall survival. The results of the American ACOSOG-Z001 study have changed the fundamental perspective of this. In this study on the advantages of axillary dissection following the confirmation of tumour tissue in the sentinel lymph nodes, there were no statistically significant advantages from axillary dissection for women with a favourable overall risk profile who had received radiotherapy and systemic therapy. If this concept takes hold, the surgical treatment of node-positive breast cancer, at least in the axilla, would be reduced to a minimum, and the focus of treatment would in future lie more on the systemic treatment of this condition. As part of an interdisciplinary consensus meeting, a standardised approach for Austria with regard to this question was decided upon.

Association of a common genetic variant of the IGF1 gene with clinical outcome in patients with HER2-positive breast cancer

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Background: Insulin-like growth factor 1 (IGF1) stimulates mitosis and inhibits apoptosis. Circulating IGF1 levels may be linked with an increased risk of colorectal and breast cancer. Further, IGF1 single nucleotide polymorphisms (SNPs), especially variant rs2946834, recently have been associated with a poor clinical outcome in patients with colorectal cancer. However, the influence of IGF1 SNPs on the prognosis of patients with breast cancer is unknown. Therefore, we aimed at investigating the influence of IGF1 tagging polymorphisms associated with IGF1 levels on event-free survival in patients with HER2-positive breast cancer.

Methods: The present study included 161 consecutive white patients with HER2-positive breast cancer treated between 2000 and 2010 at the Department of Gynecology and Obstetrics, Medical University of Innsbruck, Austria. Event-free survival was calculated as the time from cancer diagnosis to either relapse or death from any cause. Genomic DNA was extracted from archived formalin-fixed paraffin embedded tumor tissue samples; five IGF1 tagging polymorphisms (rs2946834, rs6220, rs1520220, rs5742694, and rs5742678) were genotyped by SNaPshot assays.

Results: Mean follow up period was 4.3 (± 2.5) years. Kaplan-Meier analysis showed a poorer clinical outcome for carriers of the rare allele of SNP rs2946834 (log-rank test, p = 0.029). Concordantly, in univariate Cox regression analyses the rare allele of SNP rs2946834 was significantly associated with a decreased event-free survival (HR = 2.87 [1.07 –7.70]; p = 0.036). Multivariate analysis adjusted for age and tumor stage confirmed this result (HR = 2.86 [1.06 –7.71]; p = 0.038). Thus, our results are in concordance with a recent report that the same SNP is associated with poorer clinical outcome in colorectal cancer patients. Other investigated genetic variants of the IGF1 gene were not significantly associated with event-free survival (all p-values > 0.05).

Conclusions: For the first time, our study investigates the influence of IGF1 tagging polymorphisms on the clinical outcome of HER2-positive breast cancer patients suggesting SNP rs2946834 as a predictor for reduced event-free survival.

Enhanced MDM2 Oncoprotein Expression in Soft Tissue Sarcoma: Several Possible Regulatory Mechanisms

Purpose. MDM2 is an oncogene whose protein product may promote tumorigenesis by blocking wild-type p53 tumor suppressor mediated G ₀/G₁ cell cycle arrest, thereby inhibiting repair of damaged DNA prior to cell division. While MDM2 DNA amplification is frequently observed in human sarcoma, the mechanisms linking this amplification to MDM2 oncoprotein over-production as well as its functional significance have not been well characterized in patients with soft tissue sarcoma.

Methods. A tissue bank of resected soft tissue sarcomas and autologous normal tissues was assembled; all specimens were snap frozen within 15 min of resection. DNA and RNA were extracted from tissues using isoamyl alcohol and phenol chloroform extraction methods, respectively; cell lysates were prepared using PBSTDS lysis buffer. DNA and mRNA were confirmed as being non-degraded and were then examined for MDM2 DNA amplification (Southern blots) and mRNA over-expression (Northern blots) using actin (DNA) and glyceraldehyde-3-phosphate dehydrogenase (mRNA) as loading controls. The MDM2 protein was examined on Western blots using the MDM2-specific monoclonal antibody IF2 (Oncogene Science, Inc). The presence of p53 DNA and expression of p53 mRNA was examined by rehybridizing the Southern and Northern filters using a p53-specific cDNA probe.

Results. Soft tissue sarcomas and autologous normal tissues were screened for MDM2 DNA amplification, which was detected in 10 of 30 tumors screened. After screening, there was sufficient biomaterials from six specimens for subsequent Northern and Western analysis to see whether MDM2 gene amplification correlated with over-expression of MDM2 mRNA and MDM2 protein. In addition, we examined whether other mechanisms may lead to over-expression of the MDM2 oncoprotein. Several possible mechanisms of MDM2 oncoprotein over-expression were identified. These most commonly included MDM2 DNA amplification, MDM2 mRNA over-expression and MDM2 oncoprotein over-expression. However, some soft tissue sarcoma patient specimens had no evidence of MDM2 mRNA over-expression yet had MDM2 oncoprotein over-production in the tumor relative to autologous normal tissue, implying possible post-transcriptional regulation. Of functional relevance, MDM2 oncoprotein over-production by tumors was associated with large decreases in the percentage of cells in the ₀/G₁ cell cycle interface compared with autologous normal tissue cells.

Discussion. It is likely that there are multiple mechanisms underlying human soft tissue sarcoma MDM2 oncoprotein over-production. Consequently, strategies that decrease MDM2 over-production, such as transcriptional repression to inhibit MDM2 promoter activity or RNA antisense approaches, may ultimately offer the best therapeutic efficacy.

New chloroplast primers for intraspecific variation in Dicranum scoparium Hedw. (Dicranaceae) and amplification success in other bryophyte species

Primers for four loci that amplify cpDNA regions have been designed for population genetic analyses in Dicranum scoparium Hedw. and compared with trnL(UAA)5'exon-trnF. All loci showed intraspecific variation with a number of haplotypes ranging between two and six. trnH-psbA(Dic) showed an intercontinental disjunction, but no variability within the four Swiss populations surveyed, whereas the three remaining loci displayed intrapopulation variability in at least one population (rps19-rpl2, rpoB, trnT-rps4). These primers were additionally tested on 22 bryophytes and three fern species. The primers amplified mostly in mosses and liverworts, but less well in ferns, pointing to their evolutionary distance from the bryophytes.