Survival among women with triple receptor-negative breast cancer and brain metastases

BACKGROUND

The purpose of this study was to determine the incidence of and survival following brain metastases among women with triple receptor-negative breast cancer.

PATIENTS AND METHODS

In all, 679 patients with nonmetastatic triple receptor-negative breast cancer diagnosed from 1980 to 2006 were identified. Cumulative incidence of brain metastases was computed. Cox proportional hazards models were fitted to explore factors that predict for development of brain metastases. Survival was computed using the Kaplan-Meier product limit method.

RESULTS

Median follow-up was 26.9 months. In all, 42 (6.2%) patients developed brain metastases with a cumulative incidence at 2 and 5 years of 5.6% [95% confidence interval (CI) 3.8% to 7.9%] and 9.6% (95% CI 6.8% to 13%), respectively. A total of 24 (3.5%) patients developed brain metastases as the first site of recurrence with cumulative incidence at 2 and 5 years of 2.0% (95% CI 2.6% to 6.0%) and 4.9% (95% CI 3.2% to 7.0%), respectively. In the multivariable model, no specific factor was observed to be significantly associated with time to brain metastases. Median survival for all patients who developed brain metastases and those who developed brain metastases as the first site of recurrence was 2.9 months (95% CI 2.0-7.6 months) and 5.8 months (95% CI 1.7-11.0 months), respectively.

CONCLUSION

In this single-institutional study, patients with nonmetastatic triple receptor-negative breast tumors have a high early incidence of brain metastases associated with poor survival and maybe an ideal cohort to target brain metastases preventive strategies.

Imatinib mesylate (Gleevec) in advanced breast cancer-expressing C-Kit or PDGFR-beta: clinical activity and biological correlations

BACKGROUND

Novel molecular therapies for metastatic breast cancer (MBC) are necessary to improve the dismal prognosis of this condition. Imatinib mesylate (Gleevec) inhibits several protein tyrosine kinases, including platelet-derived growth factor receptor (PDGFR) and c-kit, which are preferentially expressed in tumor cells. We tested the activity of imatinib mesylate in MBC with overexpression of PDGFR or c-kit. Additionally, we sought to determine the biological correlates and immunomodulatory effects.

PATIENTS AND METHODS

Thirteen patients were treated with Imatinib administered orally at 400 mg p.o. b.i.d. (800 mg/day), until disease progression. All patients demonstrated PDGFR-beta overexpression and none showed c-kit expression.

RESULTS

No objective responses were observed among the 13 patients treated in an intention-to-treat analysis. All patients experienced disease progression, with a median time to progression of 1.2 months. Twelve patients have died, and the median overall survival was 7.7 months. No patient had a serious adverse event. Imatinib therapy had no effect on the plasma levels of the angiogenesis-related cytokines, vascular endothelial growth factor, PDGF, b-fibroblast growth factor, and E-selectin. Immune studies showed imatinib inhibits interferon-gamma production by TCR-activated CD4(+) T cells.

CONCLUSION

Imatinib as a single agent has no clinical activity in PDGFR-overexpressing MBC and has potential immunosuppressive effects.

Expression of growth factor and chemokine receptors: new insights in the biology of inflammatory breast cancer

PURPOSE

Recent studies have indicated that expression of chemokine receptors CXCR4 and CCR7 could be an indicator of the metastatic potential of breast cancer. Expression of CXCR4 and CCR7 along with the biomarkers HER2-neu and epidermal growth factor receptor (EGFR) was investigated in inflammatory breast cancer (IBC) to evaluate their prognostic implications.

EXPERIMENTAL DESIGN

CXCR4, CCR7, and EGFR were evaluated by immunohistochemical staining (IHC) of paraffin-embedded tissue sections. HER2-neu amplification was assessed by FISH and/or IHC. All patients received chemotherapy, surgery, and radiation.

RESULTS

Forty-four cases diagnosed with IBC from 1994 to 2002 were included in the study. In all, 18 (40.9%) patients had positive CXCR4, 10 (22.7%) had positive CCR7, 21 (47.7%) had positive HER2-neu, and EGFR was positive in 12 of 40 patients (30%). The 5-year overall survival (OS) was 24.8% for CXCR4-positive disease versus 42.3% for CXCR4-negative patients (P = 0.53) and 20.0% for CCR7-positive disease versus 41.9% for CCR7-negative patients (P = 0.24). EGFR-positive disease had significantly worse OS compared with EGFR-negative disease (P = 0.01).

CONCLUSIONS

These data demonstrate the expression of growth factor and chemokine receptors in IBC. The expression of these receptors is associated with increased risk of recurrence and death, and thus, they may represent potential therapeutic targets in IBC.

Regioselective synthesis of biologically interesting pentacyclic polyheterocycles by sequential thio-Claisen and AlCl3 catalyzed oxy-Claisen rearrangement of 4-(4′-aryloxybut-2′-ynylthio)-1-phenyl-1,8-naphthyridin-2(1H)-one

A number of 4-aryloxymethyl-6-phenyl-2H-thiopyrano[3,2-c][1,8]naphthyridin-5(6H)-ones were regio selectively synthesized in 82%–95% yields by the thermal Claisen rearrangement of 4-(4′-aryloxybut-2′-ynylthio)-1-phenyl-[1,8]naphthyridin-2(1H)-ones. These products were then subjected to a second Claisen rearrangement in the presence of a Lewis acid catalyst, anhyd. AlCl3, to give hitherto unreported pentacyclic heterocycles in 75%–90% yields. The same final products were also obtained in low yield upon refluxing 4-aryloxymethyl-6-phenyl-2H-thio pyrano-[3,2-c][1,8]naphthyridin-5(6H)-ones in N,N-diethyl aniline for 12–14 h. This method was found to be more effective than thermal Claisen rearrangement.Key words: [3,3] sigmatropic rearrangement, regioselective synthesis, phase transfer catalysis, sequential Claisen rearrangement, Lewis acid catalyzed Claisen rearrangement, single crystal X-ray.

Formate synthesis by Clostridium thermocellum during anaerobic fermentation

We have detected formate synthesis by Clostridium thermocellum 27405 cultured in both cellobiose and alpha-cellulose. While formate synthesis has been reported for one strain of C. thermocellum (strain I-1-B), numerous studies of C. thermocellum 27405 fermentation, conducted under different growth conditions, failed to detect the presence of formate. Thus, the status of formate synthesis as a fermentation end product by C. thermocellum has been uncertain. Formate synthesis competes with the synthesis of hydrogen (H2) as a fermentation end product, and thus would negatively impact H2 yields in processes designed to generate H2 from biomass. Understanding the mechanism of formate synthesis is the first step in devising means of mitigating its production. Transcription of putative pfl, fnr, and adhE genes, encoding pyruvate formate-lyase (PFL), PFL-activating enzyme (PFL-AE), and alcohol dehydrogenase E (ADH-E) enzymes, respectively, were detected by reverse transcriptase polymerase chain reactions using total RNA extracted from stationary phase C. thermocellum cultured on cellobiose. The PCR products observed correspond to the expected amplicon sizes. Nucleotide sequence analysis of the cloned PCR products followed by BLAST analyses confirmed their identity. Formate production was detected throughout growth, and PFL enzyme activity was detected in late log and stationary phase (OD600 = 0.7 and 0.9, respectively) in extracts of C. thermocellum cultured on cellobiose. BLAST analyses revealed that C. thermocellum PFL and PFL-AE have greater amino acid sequence identity with equivalent enzymes from Bacillus and Thermocynechococcus species than with other Clostridium species, but C. thermocellum ADH-E has greater amino acid sequence identity with Clostridium species.

Synthesis of spiro-pyridopyridine analogues by Grubbs' catalyst mediated alkene and enyne metathesis reaction

A practical synthesis of spiro-naphthyridinone derivatives is described by the combination of the Claisen rearrangement and ring-closing metathesis/ring-closing enyne metathesis process. The RCM or RCEM proceeded smoothly in the presence of Grubbs' first generation catalyst at room temperature under a nitrogen atmosphere.

Effect of substrate loading on hydrogen production during anaerobic fermentation by Clostridium thermocellum 27405

We have investigated hydrogen (H2) production by the cellulose-degrading anaerobic bacterium, Clostridium thermocellum. In the following experiments, batch-fermentations were carried out with cellobiose at three different substrate concentrations to observe the effects of carbon-limited or carbon-excess conditions on the carbon flow, H2-production, and synthesis of other fermentation end products, such as ethanol and organic acids. Rates of cell growth were unaffected by different substrate concentrations. H2, carbon dioxide (CO2), acetate, and ethanol were the main products of fermentation. Other significant end products detected were formate and lactate. In cultures where cell growth was severely limited due to low initial substrate concentrations, hydrogen yields of 1 mol H2/mol of glucose were obtained. In the cultures where growth ceased due to carbon depletion, lactate and formate represented a small fraction of the total end products produced, which consisted mainly of H2, CO2, acetate, and ethanol throughout growth. In cultures with high initial substrate concentrations, cellobiose consumption was incomplete and cell growth was limited by factors other than carbon availability. H2-production continued even in stationary phase and H2/CO2 ratios were consistently greater than 1 with a maximum of 1.2 at the stationary phase. A maximum specific H2 production rate of 14.6 mmol g dry cell(-1) h(-1) was observed. As cells entered stationary phase, extracellular pyruvate production was observed in high substrate concentration cultures and lactate became a major end product.

Bortezomib (VELCADE®) in metastatic breast cancer: pharmacodynamics, biological effects, and prediction of clinical benefits

BACKGROUND

Bortezomib (VELCADE) is a potent inhibitor of the 26S proteasome with broad antitumor activity. We performed a phase II study of bortezomib to evaluate its clinical effects in patients with metastatic breast cancer.

PATIENTS AND METHODS

Twelve patients with metastatic breast cancer were treated with bortezomib (VELCADE) at a dosage of 1.5 mg/m(2) administered biweekly for 2 weeks with 1 week of rest in a 21-day cycle. The primary objective was clinical response rate. Toxicity and pharmacodynamics data were also obtained.

RESULTS

No objective responses were observed. One patient had stable disease, and 11 others experienced disease progression. The median survival time was 4.3 months (range, 0.9-37 months). The most common grade 3 or 4 toxicities included fatigue (58%; n = 7) and skin rash (33%; n = 4). The mean inhibition of specific chymotryptic activity was 53.1% (+/- 13.33%). A statistically significant reduction in the plasma interleukin-6 level was seen (P = 0.0354).

CONCLUSION

Bortezomib was well tolerated but showed limited clinical activity against metastatic breast cancer when used as a single agent. The future development of this agent for the treatment of breast cancer should be guided by in vivo models that optimize activity in combination with other antitumor agents.

Holmium YAG laser treatment of superficial bladder carcinoma

Holmium YAG laser is one of the new modalities of treatment of urinary bladder tumor. Thirty patients of superficial bladder carcinoma were selected from the Urology out patient department of Dhaka Medical College Hospital from January 2004 to July 2004. Among thirty cases, 18 were recurrent and 12 were primary superficial bladder carcinoma. Out of thirty patients, 24 were male and six were female. Patients were treated with Holmium YAG laser under spinal anesthesia. Before resection, cold cup biopsy were taken from the apex and after resection of the tumor, another cold cup biopsy were taken from the base of the tumor. Holmium YAG laser therapy was given with a 550 micron end firing quartz laser fiber through the working element of resectoscope. Small tumors (< 1 cm) were ablated and large tumors (1-4 cm) were resected. The initial laser setting was 0.5 to 0.8 J and 10 Hz. For resection of the tumor, a slightly higher energy of 1 to 1.2 J was used at 10 to 12 Hz. After resection, bleeding vessels were coagulated. The resected tumor was evacuated by Elik's evacuator. All cases were followed for 6 to 12 months by history, physical examination, urine analysis, sonogram and cystoscopy three monthly. Bleeding was minimum during the procedure and no transfusion was required. Complications like obturator jerk, clot retention or perforation were not developed. No recurrence was found during the 6 to 12 months follow up period. The procedure was found safe, effective, and acceptable. The study was conducted to evaluate the initial result of Holmium YAG laser for the treatment of superficial bladder carcinoma. We warrants further studies in this regard.

Biological screening of Bangladeshi mango mistletoe bark extracts

The ethyl acetate extract of the Bangladeshi mango mistletoe (Loranthus globosus) bark was found to be most effective against both Gram (+) and Gram (-) bacteria and it also showed good cytotoxicity with a LC50 10.83 microg/ml.

Antimicrobial and cytotoxic constituents of Loranthus globosus

(+)-Catechin, 3,4-dimethoxycinnamyl alcohol and 3,4,5-trimethoxycinnamyl alcohol were isolated from the barks of Loranthus globosus. All compounds showed significant antimicrobial and cytotoxic activities.

A prospective study of prenatal and postnatal development of thymus of Deshi chicken

Thymus was one of the primary lymphoid organs along with the bursa in birds. The growth of the thymus of deshi chicken (Gallus Domesticus) from prenatal embryonic day fifteen (ED15) to postnatal day ninety (D90) were studied. In macroscopic study, it was found as a paired, lobulated gland, one half of which was located on either side of the neck. Each half consists of six to eight, flattened, ovoid to elongated, pale white to yellowish white lobes of varing size and shape of lymphoid tissue lying in the sub-dermal connective tissue of the neck. Histologically, the thymus of deshi chicken at embryonic day fifteen was covered by a very thin connective tissue capsule from which septa arises and divides the gland into lobes and lobules. The lobules were homogenous, small in size and the cortex and medulla were demarcated. Lobules have developing Hassall's corpuscles and they were of uniform shape and size. The lobules become well developed with advancing age. The cortex gradually becomes thicker and was packed with large lymphocytes. Hassall's corpuscles became larger and there number increases at postnatal period (D90) in the medulla of the thymus. The growth and development of thymus at each stage of the study period were found to be significantly high. The present finding of thymus of deshi chicken was found similar to the adult hybrid chicken. The study also indicates that the chicken thymic cell population, structure & functions was similar to the human thymus histologically. It was also found that the chicken embryo allows easy experimental access to all the stages of the thymic development so the present study will be helpful for experimentation on lymphoid organs and to understand pathophysiology of immunological diseases of human.

Effects of age in the structure of the bursa of Fabricius of deshi chicken of Bangladesh

The bursa of Fabricius of deshi chicken from prenatal ED15 to postnatal D90 were studied. The growth and development at each stage of the study period were highly significant.

Public perceptions of child abuse and neglect in a midwestern urban community

This study found that the majority of urban adults did not believe that any of the characteristics of children posed to them predisposed a child to abuse. In contrast, 40% of respondents claimed child abuse could not occur in a family like the one in which they grew up. The majority perceived only one characteristic, alcohol abuse, as a characteristic of child abusers. Few respondents (10%) believed that child abusers could not be helped, and 25% were not sure. Adults' perceptions of child abuse and abusers varied by sex, age, socioeconomic status, and whether the respondents had children. The data indicate that there are significant deficits in the respondents' knowledge of child abuse and neglect.

Selected ethical issues in research and publication: perceptions of health education faculty

A national random sample of 195 university health education faculty at graduate degree-granting programs completed a 31-item survey with regard to their perceptions of ethical issues in research and publishing. Most respondents were male (57%), tenured (75%), had graduate faculty status (92%), had presented original research at conferences (85%), and had published articles in health education journals (89%). Faculty members were requested to assess whether 21 scenarios dealing with ethical issues in research and publishing were ethical, unethical, questionable, or not an ethical issue. Of the scenarios, 3 were considered ethical and 7 unethical by the majority of respondents. The perceptions of how ethical the remaining 11 scenarios were varied considerably. Perceptions of the ethical scenarios did not differ among respondents by sex, academic rank, years taught as a faculty member, whether the department taught units/classes on research ethics, or whether the respondents were from doctoral-level versus master's-level programs.