Bevacizumab in patients (pts) with advanced hepatocellular carcinoma (HCC): Preliminary results of a phase II study with circulating endothelial cell (CEC) monitoring

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Background: Effective therapy for pts with advanced HCC is still lacking. This phase II trial was designed to define efficacy of bevacizumab in HCC pts. Methods: Pts with unresectable HCC received bevacizumab at 5–10 mg/kg bimonthly. Prior treatment for HCC was allowed. Main ineligibility criteria included Child-Pugh score > 7; CLIP score > 3; recent (< 6 months) thromboembolic event; and anticoagulation or anti-platelet therapy. Propranolol had to be prescribed in case of large esogastric varices. CEC, identified by a CD45- CD31+CD146+7AAD- phenotype by four-color flow cytometry, were measured at day (D) 1,3,15 and 46 after start of treatment. Results: Overall, 30 pts (27 men; median age, 65.5 years [range, 23–84]; histologically proven cirrhosis, 20 pts [Child-Pugh A5/A6/B7: 12/15/3; CLIP 0/1/2/3/4: 1/6/14/6/3] received a median of 6 cycles (range, 2–25; total, 234). As progressive disease (PD) was observed within 16 weeks in 12 pts after inclusion of the first 23 pts treated at 5mg/kg, subsequent pts (n=7) were treated at 10 mg/kg as planned by the protocol design. Of the 30 pts treated at either dose, 6 (20%) discontinued bevacizumab because of variceal hemorrhage (variceal banding successful in every case) (n=3); grade 3 transient ischemic attack (n=1); grade 3 hemorrhagic ascites (n=1); and grade 3 proteinuria (n=1). Grade 1–2 toxicities included fatigue, epistaxis, hypertension, and proteinuria. Among the 24 pts evaluable for efficacy, 3 (12.5%) had partial response (PR), and 13 (54%) had stable disease (SD) (> 16 weeks in 7 pts) (disease control rate (DCR), 67%). Median baseline CEC level (n=21) was 14/ml (range, 0- 71), as compared to 5.5/ml (range, 0–15) in healthy subjects (n=20) and 16/ml (range, 0–179) in pts with various metastatic cancers (n=80). CEC levels increased more than two-fold at D3 in 11 (52%) among 21 pts; a dramatic drop was observed in all PR pts, as well as in a fraction (25%) of SD pts. Conclusions: Bevacizumab is relatively safe and provides an encouraging DCR in patients with HCC and compensated cirrhosis. Accrual is ongoing at the dose of 10 mg/kg. The predictive value of CEC will be presented at the meeting.

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Overexpression of human wildtype torsinA and human DeltaGAG torsinA in a transgenic mouse model causes phenotypic abnormalities

Primary torsion dystonia is an autosomal-dominant inherited movement disorder. Most cases are caused by an in-frame deletion (GAG) of the DYT1 gene encoding torsinA. Reduced penetrance and phenotypic variability suggest that alteration of torsinA amino acid sequence is necessary but not sufficient for development of clinical symptoms and that additional factors must contribute to the factual manifestation of the disease. We generated 4 independent transgenic mouse lines, two overexpressing human mutant torsinA and two overexpressing human wildtype torsinA using a strong murine prion protein promoter. Our data provide for the first time in vivo evidence that not only mutant torsinA is detrimental to neuronal cells but that also wildtype torsinA can lead to neuronal dysfunction when overexpressed at high levels. This hypothesis is supported by (i) neuropathological findings, (ii) neurochemistry, (iii) behavioral abnormalities and (iv) DTI-MRI analysis.

[Guidelines for the sociomedical assessment of performance in patients suffering from breast cancer]

The following guidelines were developed for the medical assessment services of the German Pension Insurance Federal Institution. Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in breast cancer were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent, e. g., for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of breast cancer and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions, the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.

Reentrant superconductivity in Nb/Cu1-xNix bilayers

We report on the first observation of a pronounced reentrant superconductivity phenomenon in a superconductor/ferromagnet layered system. The results were obtained using a superconductor/ferromagnetic-alloy bilayer of Nb/Cu(1-x)Ni(x). The superconducting transition temperature T(c) drops sharply with increasing thickness dCuNi) of the ferromagnetic layer, until complete suppression of superconductivity is observed at d(CuNi) approximately equal to 4 nm. Increasing the Cu(1-x)Ni(x) layer thickness further, superconductivity reappears at d(CuNi) > or =13 nm. Our experiments give evidence for the pairing function oscillations associated with a realization of the quasi-one-dimensional Fulde-Ferrell-Larkin-Ovchinnikov-like state in the ferromagnetic layer.

Unconventional anisotropic superexchange in alpha'-NaV2O5

The strong line broadening observed in electron spin resonance on NaV2O5 is found to originate from an unusual type of the symmetric anisotropic exchange interaction with simultaneous spin-orbit coupling on both sites. The microscopically derived anisotropic exchange constant is almost 2 orders of magnitude larger than the one obtained from conventional estimations. Based on this result we systematically evaluate the anisotropy of the ESR linewidth in terms of the symmetric anisotropic exchange only, and we find microscopic evidence for precursor effects of the charge ordering already below 150 K.

[Guidelines for the sociomedical assessment of performance in patients suffering from inflammatory bowel disease]

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemization of the sociomedical assessment of performance in inflammatory bowel disease (Crohn's disease, ulcerative colitis) were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent -- e. g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of inflammatory bowel disease and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.

Restoration of SHIP activity in a human leukemia cell line downregulates constitutively activated phosphatidylinositol 3-kinase/Akt/GSK-3beta signaling and leads to an increased transit time through the G1 phase of the cell cycle

The inositol 5-phosphatase SHIP (SHIP-1) is a negative regulator of signal transduction in hematopoietic cells and targeted disruption of SHIP in mice leads to a myeloproliferative disorder. We analyzed the effects of SHIP on the human leukemia cell line Jurkat in which expression of endogenous SHIP protein is not detectable. Restoration of SHIP expression in Jurkat cells with an inducible expression system caused a 69% reduction of phosphatidylinositol 3,4,5-trisphosphate (PtdIns(3,4,5)P(3)) and a 65% reduction of Akt kinase activity, which was associated with reduced phosphorylation of glycogen synthase kinase 3beta (GSK-3beta) (Ser-9) without changing the phosphorylation of Bad (Ser-136), FKHR (Ser-256) or MAPK (Thr-202/Tyr-204). SHIP-expressing Jurkat cells showed an increased transit time through the G1 phase of the cell cycle, but SHIP did not cause a complete cell cycle arrest or apoptosis. Extension of the G1 phase was associated with an increased stability of the cell cycle inhibitor p27(Kip1) and reduced phosphorylation of the retinoblastoma protein Rb at serine residue 780. Our data indicate that restoration of SHIP activity in a human leukemia cell line, which has lost expression of endogenous SHIP, downregulates constitutively activated phosphatidylinositol 3-kinase/Akt/GSK-3beta signaling and leads to an increased transit time through the G1 phase of the cell cycle.

[Guidelines for the sociomedical assessment of performance in patients suffering from chronic obstructive lung diseases (COPD) and bronchial asthma. II: Sociomedical assessment of performance, Annex Part B, bibliography see Part I, Gesundheitswesen 2004, 66: 263f]

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in chronic obstructive pulmonary diseases (COPD) and bronchial asthma were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e. g. for the assessment of applications for decreased earning capacity benefits. Part II outlines assessment of the individual's capacity, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual.

Spin dynamics and charge order in beta-Na1/3V2O5

We present detailed electron-spin resonance investigations on single crystals of the one-dimensional vanadium-oxide bronze beta-Na(1/3)V2O5. From the angular dependence of the g value it can be concluded that the electrons are primarily located on the V1 zigzag chains. The anisotropy of the linewidth, which is determined by the intrachain symmetric anisotropic exchange interaction, favors statistic electron distribution in the metallic and blockwise charge-order in the insulating phase. The temperature dependence of the linewidth indicates the opening of a charge gap at the metal-to-insulator transition at T(MI)=132 K.

[Guidelines for the sociomedical assessment of performance in patients suffering from chronic obstructive lung diseases (COPD) and bronchial asthma]

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systematization of the sociomedical assessment of performance in chronic obstructive pulmonary diseases (COPD) and bronchial asthma were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e. g. for the assessment of applications for decreased earning capacity benefits. Part I of the guidelines gives information on the classification of chronic obstructive pulmonary diseases (COPD) and bronchial asthma and on the number of pensions due to limited earning capacity. The guidelines summarise typical manifestations of chronic obstructive pulmonary diseases (COPD) and bronchial asthma and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated.

Molluscum contagiosum de la paupière inférieure

A 6-year-old girl had a single molluscum contagiosum of the lower eyelid. Clinically, the tumor had grown slowly since it had been discovered 8 months before the child was seen at our consultation. It appeared as a nodular lesion on the middle part of the eyelid. Its surface was irregular and its color was the same as the epidermis. It was surgically excised, using the shaving biopsy technique. Its histopathological study showed a papillomatous lesion with the typical features of a molluscum contagiosum. The patient was lost to follow-up soon after the surgery.

[Guidelines for the sociomedical assessment of performance in patients suffering from discopathy or associated diseases]

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice, criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in discopathy or associated diseases were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent -- e. g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of discopathy or associated diseases and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination, and for diagnostic tests are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally, inferences are drawn regarding the occupational capacity of the individual. Guidelines for the sociomedical assessment of performance in coronary heart disease (CHD) have been published in Gesundheitswesen 2002, 64: 451-465.

Improving outcomes for patients hospitalized with CHF

Congestive Heart Failure is a costly debilitating medical condition that affects millions of elderly people. This Clinical Practice Improvement study was under taken to determine how variation in patient characteristics and clinical processes impact patient outcomes including length of stay, total charges, and increased severity of illness during hospitalization. The AHCPR Guideline for Heart Failure was used to evaluate clinical care. Data on patient characteristics including severity of illness and process of care were analyzed to determine which variables had the greatest impact on outcomes of care. Results showed that patient characteristics including comorbidities, severity of illness, and noncompliance with diet were significantly related to longer lengths of stay, higher charges, and/or increased severity (all covariates, p < .05). In addition, process of care variables including medication use and patient education significantly (p < .05) impacted outcomes of care. Findings have implications for the development of practice guidelines designed to improve patient outcomes associated with CHF hospitalizations.

[Guidelines for the sociomedical assessment of performance in patients suffering from coronary heart disease (CHD)]

The following guidelines were developed for the medical assessment services of the German Federal Insurance Institute for Salaried Employees (BfA). Starting from day-to-day practice criteria and attributes to guide decisions for a systemisation of the sociomedical assessment of performance in coronary heart disease (CHD) were compiled. The guidelines aim at standardising the sociomedical assessment of performance and help to make the decision-making process more transparent - e.g. for the assessment of applications for decreased earning capacity benefits. The guidelines summarise typical manifestations of CHD and describe the necessary medical information for the sociomedical assessment of performance. Relevant assessment criteria for the medical history, clinical examination and for diagnostic tests - especially of myocardial functioning - are illustrated. The assessment of the individual's capacity is outlined, taking occupational factors into account. Following the determination of dysfunctions the remaining abilities and disabilities, respectively, are deduced and compared with occupational demands. Finally inferences are drawn regarding the occupational capacity of the individual.

Expression of a mutated form of the p85alpha regulatory subunit of phosphatidylinositol 3-kinase in a Hodgkin's lymphoma-derived cell line (CO)

Phosphatidylinositol (PI) 3-kinase plays an important role in a variety of biological processes, including proliferation and apoptosis. PI3-kinase is a heterodimer consisting of an 85 kDa adapter protein (p85) containing one SH3 domain and two SH2 domains and a 110 kDa catalytic subunit (p110). Recently an oncogenic form of p85 named p65-PI3K lacking the C-terminal SH2 domain has been cloned from an irradiation-induced murine thymic lymphoma and transgenic mice expressing p65-PI3K in T lymphocytes develop a lymphoproliferative disorder. Here we describe the cloning of a C-terminal truncated form of p85 expressed in a human lymphoma cell line (CO) with a T cell phenotype derived from a patient with Hodgkin's disease. As a result of a frame-shift mutation at amino acid 636, p76 is lacking most of the C-terminal SH2 domain, but contains the inter-SH2 domain and is associated with an active form of PI3-kinase. A PI3-kinase-dependent constitutive activation of Akt was detected in CO cells which was only partially reduced after serum starvation. Treatment of CO cells with the PI3-kinase inhibitor wortmannin resulted in a concentration-dependent inhibition of cell proliferation associated with an increased number of apoptotic cells. This is the first detection of a mutated form of the p85 subunit of PI3-kinase in human hematopoietic cells further underlining a potential role of PI3-kinase/Akt signaling in human leukemogenesis.

Transfection of E-cadherin cDNA in human lung tumor cells reduces invasive potential of tumors

Lung cancer is a major health-care problem in industrialized countries. With reference to its therapeutic consequences and major histological variations, it is divided into two subgroups - SCLC (small-cell lung cancer) and NSCLC (non-small-cell lung cancer). As an important factor of cell-cell and cell-substratum interaction, cell adhesion molecules (CAMs) seem to play a key role in tumor-cell migration and invasion that lead to metastases. We investigated human lung tumor cell lines established from histologically documented neoplastic lesions taken in our operating theater. Immunohistological screening showed differences in E-cadherin expression with no clear predominance of SCLC or NSCLC cell lines. Using an invasion model with Matrigel Matrix and a migration assay, we could demonstrate a more aggressive behavior pattern in E-cadherin-negative cell lines. We transfected E-cadherin cDNA into a formerly negative cell line showing strong invasive behavior in the initial tests in order to investigate the role of E-cadherin in this process. In this study, we examined E-cadherin cDNA transfection in human bronchial carcinoma cells. At present, transfection is stable with a follow-up time of one year. We could demonstrate that cell lines were remarkably less invasive after transfection of E-cadherin in the invasion model with Matrigel Matrix. These results indicate that the E-cadherin CAM plays an important role in lung tumor invasion and metastasis. Further studies are in progress to confirm these findings and to describe a possible role of this CAM in tumor therapy.