Repeated low-dose skin exposure is an effective sensitizing stimulus, a factor to be taken into account in predicting sensitization risk

BACKGROUND

Contact sensitization by ingredients in personal products is an important clinical problem. It is not clear how sensitization is induced by the generally low concentrations at which they occur but it might be the result of repeated exposure.

OBJECTIVES

To compare the strength of contact sensitization induced by a single exposure to 2,4-dinitrochlorobenzene (DNCB) (60 microg cm(-2)) or three repeated exposures to a subsensitizing dose (10 microg cm(-2)).

METHODS

Two groups (n = 10) of healthy adult volunteers were randomized to receive either a single patch of DNCB 60 microg cm(-2) or three once-weekly applications to the same site of 10 microg cm(-2) DCNB. Four weeks after the last application, sensitization was quantified by measurement of responses (skinfold thickness) to a graded series of four challenge doses.

RESULTS

All the volunteers were sensitized and the strength of the responses was virtually identical between the groups.

CONCLUSIONS

The same degree of sensitization was induced by three exposures to DNCB 10 microg cm(-2) as by one exposure to 60 microg cm(-2) of DNCB. Thus repeated exposure to low doses of contact sensitizers may increase the sensitizing potency. This must be taken into account in future risk assessments.

Analysis of neuronal proliferation, migration and differentiation in the postnatal brain using equine infectious anemia virus-based lentiviral vectors

Ongoing neurogenesis in discrete sectors of the adult central nervous system depends on the mitotic activity of an elusive population of adult stem cells. The existence of adult neural stem cells provides an alternative approach to transplantation of embryonic stem cells in cell-based therapies. Owing to the limited intrinsic fate of adult stem cells and inhibitory nature of the adult brain for neurogenesis, accommodation for circuit replacement in the brain will require genetic and epigenetic manipulation. Here, we show that a replication-incompetent Equine Infectious Anemia Virus (EIAV) is highly suitable for stable and persistent gene transfer to adult neural stem cells. The transduced regions were free of long-lasting neuroimmune responses to EIAV. Transduction in the subventricular zone was specific to the stem cell niche, but spared the progeny of adult neural stem cells that includes transit amplifying progenitors (TAPs) and migrating neuroblasts. With time, EIAV-transduced stem cells passed on the transgene to TAPs and migrating neuroblasts, which ultimately differentiated into neurons in the olfactory bulbs. We show that EIAV is highly suitable for discovery and assessment of mechanisms that regulate proliferation, migration and differentiation in the postnatal brain.

An exploration of Pap smear history and behavior of patients with newly diagnosed cervical cancer in Taiwan

e20582

Background: The national health insurance policy has provided a yearly Pap smear for women >= 30 years old since 1994 in Taiwan, yet the coverage rate is still unsatisfactory. The purpose of this study is (1) to investigate the Pap smear screening history of women newly diagnosed with cervical cancer and (2) to examine factors that influence participation in Pap smear screening program in these women. Methods: Patients primarily treated for cervical cancer at Chang Gung Memorial Hospital between November 2006 and June 2007 were enrolled into this prospective study. Questionnaires included (1) socio-demographic data, and (2) knowledge on Pap smear and cervical cancer. Results: Two hundred sixty-nine patients were eligible for analysis. The median age was 51 years old (range, 25–83). Of the 269 patients, 147 (54.6%) had never had a Pap smear before diagnosis, and 35 (13.0%) did not know about Pap smear. Socio-demographic factors that significantly influenced number of previous Pap smear screening (0 vs >=1) were education level, income less than 600 U.S. dollars per month, menopaused, multiple sexual partners, and increase number of sexual partners of the male consort. Of the 147 never received Pap women, the most common reasons were thought that Pap smear screening was not necessary (46.3%), embarrassment (42.0%), busy (43.5%), and worry about the screening findings (20.4%). Of the 122 patients who have received Pap smear, 56.6% patients thought that Pap smear screening was necessary, 35.2% patients worried about the disease, 24.6% were alert on their check-ups, and 20.5% did the screening for the convenience to nearby clinics. Conclusions: Public health organizations in Taiwan should put more efforts to provide women in low education level, low income and multiple sexual partners with information on Pap smear.

No significant financial relationships to disclose.

Phase 1 study of LY317615 (enzastaurin) and temozolomide in patients with gliomas - EORTC trial 26054

e13005

Background: Enzastaurin (Enz) is a small selective inhibitor of protein kinase C (PKC). Synergy with temozolomide (TMZ) has been demonstrated in vitro. This phase I trial investigated optimal dosing and toxicity when Enz was combined with a standard TMZ regimen. Methods: Patients (pts) with recurrent high-grade glioma or newly diagnosed disease not amenable to radiotherapy (RT) and WHO PS 0–1 were eligible. Pts on EIAEDs were excluded. Two dose levels (DL) of Enz were explored. DL1: Loading dose 500 mg followed by 250 mg daily. DL2: Loading dose 1,125 mg followed by 500 mg daily. TMZ was given at 150 mg/m2 d1-d5 every 28 days in cycle 1, escalating to 200 mg/m2 in subsequent cycles. Dose-limiting toxicity (DLT) was defined by CTCAE 3.0 criteria in the first two cycles as (1) any non haematological toxicity grade 3/4 (2) ANC < 500/mm3 (3) thrombocytopenia grade 3/4 (4) any toxicity reducing drug dose intensity to <80%. Results: 15 pts were included, three at DL1, 12 at DL2. 13 pts had received prior RT, seven prior chemotherapy, and two were newly diagnosed. Median number of cycles was four (range 2–8).Treatment is ongoing in five pts. TMZ dose was escalated in all pts with no DLT. Modest and reversible thrombocytopenia was the most frequent toxicity, occurring in seven pts (3 @ Gd 1, 3 @ Gd2, 1 @ Gd 3) and led to TMZ dose reduction in two pts and treatment delays in four pts (multiple in 2). One pt discontinued after three cycles due to persistent thrombocytopenia. Five pts developed neutropenia not requiring dose modification. Two pts developed hyperbilirubinemia. Six SAE's (3 at each DL) were recorded, and one death (DL2). None was considered treatment related. Two pts showed a partial response, six pts stable disease. Conclusions: Enz can be safely combined with standard TMZ regimen. Results of the just completed phase I part with Enz 250 mg twice daily dosing will also be presented at the meeting.

[Table: see text]

Low uptake of treatment for hepatitis C virus infection in a large community-based study of inner city residents

Despite the availability of effective therapy for hepatitis C virus (HCV) infection, there are little data on the uptake of treatment. We evaluated factors associated with HCV infection and the uptake of HCV treatment in a large community-based inner city cohort in Vancouver, Canada. The Community Health and Safety Evaluation is a cohort study of inner city residents recruited from January 2003 to June 2004. HIV and HCV status and information on prescriptions for HCV treatment were determined through linkage with provincial databases. HCV prevalence was calculated and factors associated with HCV infection were identified. HCV treatment uptake and incidence of HCV infection from January 2000 to December 2004 were expressed in terms of person-years of observation. Among 2913 individuals, HCV antibody testing was performed in 2118 and the HCV seroprevalence was 64.2% (1360 of 2118). In total, 1.1% of HCV antibody-positive individuals (15 of 1360) initiated treatment for HCV infection from January 2000 to December 2004 [0.28 cases per 100 person-years (95% CI, 0.15-0.46)]. Three of 15 (20.0%) treated individuals achieved a sustained virological response. During the same period, the incidence of HCV infection was 7.26 cases (95% CI, 5.72-8.80) per 100 person-years. Overall, the rate of new HCV seroconversions in this cohort in the study period was about 25 times the rate of HCV treatment uptake. There are extremely low rates of HCV treatment initiation and very limited effectiveness, despite a high prevalence of HCV infection in this large community-based cohort of inner city residents with access to universal healthcare.

Pulmonary hypertension associated with lung transplantation obliterative bronchiolitis and vascular remodeling of the allograft

Pathologic obliterative bronchiolitis (OB)/Bronchiolitis obliterans syndrome (pathologic OB/BOS) is the major obstacle to long-term survival post-lung transplantation (LT). Our group has demonstrated that pulmonary hypertension (PH) complicates the course of chronic inflammatory lung diseases that have similarities to pathologic OB/BOS and that vascular remodeling of the bronchial circulation occurs during BOS. Consequently, we hypothesized that PH is associated with pathologic OB/BOS and may result from a vasculopathy of the allograft pulmonary circulation. We conducted a single-center, retrospective study and examined the presence of PH and vasculopathy in patients with pathologic OB/BOS. Fifty-two pathologic specimens post-LT were recovered from January 10, 1997 to January 5, 2007 and divided into two groups, those with and without pathologic OB/BOS.PH was defined as a mean pulmonary artery pressure (mPAP) > 25 mmHg by right heart catheterization (RHC) or right ventricular systolic pressure (RVSP) > or = 45 mmHg by transthoracic echocardiogram (TTE). PH was more prevalent in those LT recipients with pathologic OB/BOS (72% vs. 0%, p = 0.003). Furthermore, pulmonary arteriopathy and venopathy were more prevalent in patients with pathologic OB/BOS (84% vs. 4%, p < 0.0001, and 77% vs. 35%, p = 0.004, respectively). PH is common in LT recipients with pathologic OB/BOS and is associated with a vasculopathy of the allograft pulmonary circulation.

Epidural infusion of levobupivacaine and sufentanil following thoracotomy

A prospective, randomised, double-blind study was conducted to compare the efficacy of two doses of levobupivacaine combined with sufentanil for continuous epidural infusion following thoractomy. A total of 72 patients undergoing lobectomy or pneumonectomy were enrolled. An epidural catheter was inserted between the levels of T4 and T6 before induction of anaesthesia and a loading dose of levobupivacaine and sufentanil was administered. At the end of surgery an epidural infusion was commenced at 5 mlxh(-1) and continued for 48 h. Patients were randomly allocated to receive either levobupivacaine 0.125% (group A) or 0.0625% (group B) and all patients also received sufentanil (1 microgxml(-1)). Visual analogue pain scores after coughing (VASi) were always higher in group B (p < 0.05); VAS pain scores at rest were higher for the first 4 h and at 16 and 28 h in group B (p < 0.05). Total morphine consumption and requests number was lower in group A (p < 0.05). Better pain relief was achieved using epidural 0.125% levobupivacaine.

White matter tractography by diffusion tensor imaging plays an important role in prognosis estimation of acute lacunar infarctions

The aim of this study was to evaluate the anatomical and clinical relationship between lacunar infarction and the corticospinal tract (CST) in patients with acute lacunar infarction and predict clinical outcome. We examined 28 pyramidal tract stroke patients in the acute phase or early subacute phase (<3 days) with a marked motor deficit. The anatomical location and the extent of CST involvement within the infarcts were visualized on three-dimensional colour-coded diffusion tensor tractography (DTT). With regard to the CST, all patients were divided into three clinical subgroups: Group 1 (intact type), Group 2 (partial involvement type) and Group 3 (whole involvement type). Subsequently, the severity of the motor deficit of each patient was determined according to the National Institutes of Health Stroke Scale (NIHSS) scores at the acute/early subacute phase (<3 days after onset of symptoms), early chronic phase (8-14 days) and outcome (30-60 days). NIHSS scores of Group 1 (12/28) were significantly lower than those of Group 2 (9/28) at the acute phase or early subacute phase (U = -2.816, p<0.01), and those of Group 2 were significantly lower than those of Group 3 (7/28) (U = -3.136, p<0.01). At outcome,NIHSS scores of Group 1 were significantly lower than those of Group 2 (U = -2.846, p<0.01), and scores of Group 2 were significantly lower than those of Group 3 (U = -3.130, p<0.01). At the same time, the NIHSS scores of each group gradually decreased from acute phase to outcome, Neurological improvement was statistically different among the three topographical types of infarction (H = 26.15, p<0.01; H = 11.03, p<0.01; H = 10.05, p<0.01). In conclusion, the three-dimensional colour-coded DTT allows in vivo differentiation of distinct CST stroke subtypes and may help in better establishing the prognosis for patients after CST stroke.

Localization and signaling of the receptor protein tyrosine kinase Tyro3 in cortical and hippocampal neurons

Protein phosphorylation serves as a critical biochemical regulator of short-term and long-term synaptic plasticity. Receptor protein tyrosine kinases (RPTKs) including members of the trk, eph and erbB subfamilies have been shown to modulate signaling cascades that influence synaptic function in the central nervous system (CNS). Tyro3 is one of three RPTKs belonging to the "TAM" receptor family, which also includes Axl and Mer. Tyro3 is the most widely expressed of these receptors in the CNS. Despite recent advances suggesting roles for members of this receptor family in the reproductive and immune systems, their functions in the CNS remain largely unexplored. In an effort to elucidate the roles of Tyro3 and its ligand, the protein growth arrest-specific gene6 (Gas6) in the hippocampus and cortex, we performed a detailed study of the localization and signaling of Tyro3 polypeptides in rat hippocampal and cortical neurons. Tyro3 was readily detected in dendrites and in the soma where it was distributed in a punctate pattern. Tyro3 exhibited only a limited level of co-localization with postsynaptic density protein-95 (PSD-95), suggesting that while located within dendrites, it was not confined to the postsynaptic compartment. In addition, Tyro3 was also identified in the axons and growth cones of immature neurons. The prominent expression of Tyro3 in dendrites suggested that it may be capable of modulating signaling pathways triggered by synaptic transmission. We have provided evidence in support of this role by demonstrating that Gas6 induced the phosphorylation of Tyro3 in cortical neurons in vitro, resulting in the recruitment of the mitogen-activated protein kinase (MAPK) and the phosphoinositide-3 kinase (PI(3)K) signaling pathways. As these pathways play critical roles in the induction of hippocampal long-term potentiation (LTP), these findings suggest that Tyro3 signaling may influence synaptic plasticity in the dendritic compartment of hippocampal and cortical neurons.

Expression of hepatoma-derived growth factor in early-stage cervical adenocarcinoma

16002

Background: Hepatoma-derived growth factor (HDGF) is a unique nuclear/growth factor and plays an important role in the progression of different types of cancer. The current study was designed to elucidate the role of HDGF expression during the development of. early-stage cervical adenocarcinoma. Methods: A total of 63 patients with early-stage cervical adenocarcinoma were enrolled in this retrospective study. The HDGF expression in cervical adenocarcinoma was determined by immunohistochemistry. The HDGF immunostaining in the nuclei and cytoplasm of clinical samples was scored and expressed as labeling index to correlate with the clinical parameters of patients with early-stage cervical adenocarcinoma using SPSS software. Results: HDGF immunostaining was detected in both cytoplasm and nucleus of cervical adenocarcinoma. Compared with adjacent non-tumor tissue samples, HDGF expression was significantly increased in either nuclear or cytoplasmic compartment in cervical adenocarcinoma samples (P < 0.001). Moreover, elevated nuclear HDGF levels were correlated with lymph-vascular space invasion (P < 0.05), lymph node metastasis (P < 0.001), recurrence (P < 0.001), advaced grade(P < 0.001). Conclusions: HDGF overexpression is involved in the carcinogenesis of cervical adenocarcinoma.

[Table: see text]

No significant financial relationships to disclose.

Serum magnesium profile in heroin addicts: according to psychiatric comorbidity

Psychiatric comorbidity in heroin addiction can modify both the biological pattern and clinical course of this disorder. Because of the role of magnesium in neurotransmission and its specific patterns in some psychiatric conditions, such as depression and schizophrenia, we studied a sample of heroin dependent subjects, with and without psychiatric comorbidity. A sample of 162 drug addicts (123 men and 39 women, mean age 32.3 +/- 6.7) was diagnosed for the presence of psychiatric comorbidity with DSM IV criteria. They were subsequently divided in 4 subgroups: No comorbidity, Anxiety Disorders, Mood Disorders, Personality Disorders. Differences in serum magnesium level between the groups were analysed with the Anova method, with age as covariate. Results show that serum Mg++ levels are significantly higher in patients with heroin dependence and personality disorders compared to patients with depression comorbidity and without comorbidity. Psychiatric codiagnosis significantly modifies Mg++ levels in this drug dependent sample. Gender modifies Mg levels in no comorbid subjects so that females show significantly lower Mg++ levels compared to males. The presence of psychiatric comorbidity abates this difference.

SUV in pelvic lymph node is a significant prognostic factor in previously untreated squamous carcinoma of the uterine cervix

5051

Background: The aim of this prospective study was to identify prognostic factors (including 18F-fluorodeoxyglucose positron emission tomography [FDG-PET] parameters) in previously untreated squamous carcinoma of the uterine cervix with MRI- or CT-defined pelvic or para-aortic lymph node (PLN or PALN) metastasis. Methods: This study included pooled patients selected from two prospective studies who had untreated squamous cell cervical cancer and PLN or PALN metastasis (diagnostic score 3 or 4) by CT-MRI and additional FDG-PET scans were performed for primary staging. Recurrence-free and overall survivals (RFS and OS) were evaluated using the Kaplan-Meier method. Prognostic variables were assessed by the log-rank test and Cox proportional hazards regression method. Optimal cut-offs of standardized uptake value (SUV) in primary tumor, PLN and PALN were determined by receiver operating characteristic and area under the curve analysis. Results: A total of 70 patients were eligible for analysis. The follow-up time ranged 16–59 months (mean ± SD: 38 ± 18). In univariate analyses, FIGO stage ≥ III, PET defined bilateral PLN-positive, PET defined PLN-positive, PET defined PALN-positive and SUV cut-off of 3.04 at PLN and 4.18 at PALN were significant for RFS. FIGO stage ≥ III, SUV cut-offs of 2.94–3.15 at PLN and SUV cut-offs of 2.61–4.91 at PALN were significant for OS. Multivariate analysis showed only SUVmax cut-off of 3.04 at PLN was a significant adverse factors for RFS (RR: 10.1 95% CI 2.2–46.0; P = 0.003) and OS (RR: 11.7 95% CI 1.5–92.6; P = 0.019), while SUVmax cut-off of 4.18 at PALN (P = 0.062) was marginally significant for OS. Conclusions: SUVmax cut-off of 3.04 at PLN was a significant adverse factor for RFS and OS in previously untreated squamous carcinoma of the uterine cervix with MRI- or CT-defined PLN or PALN metastasis.

No significant financial relationships to disclose.