Estimation of the impact of genital warts on health-related quality of life

OBJECTIVES

One of the two new human papillomavirus (HPV) vaccines protects against HPV types 6 and 11, which cause over 95% of genital warts, in addition to protecting against HPV types 16 and 18. In anticipation of HPV vaccine implementation, the impact of genital warts on health-related quality of life (HRQoL) was measured to assess the potential benefits of the quadrivalent over the bivalent vaccine.

METHODS

Genitourinary medicine clinic patients aged 18 years and older with a current diagnosis of genital warts were eligible; 81 consented and were interviewed by a member of the research team. A generic HRQoL questionnaire, the EQ-5D (comprising EQ-5D index and EQ visual analogue scale (VAS) scores) and a disease-specific HRQoL instrument, the CECA10, were administered. Previously established UK population norms were used as a control group for EQ-5D comparisons.

RESULTS

Cases (with genital warts) had lower EQ VAS and EQ-5D index scores than controls. After adjusting for age a mean difference between cases and controls 30 years of age and under (n = 70) of 13.9 points (95% CI 9.9 to 17.6, p<0.001) for the EQ VAS and 0.039 points (95% CI 0.005 to 0.068, p = 0.02) on the EQ-5D index (also adjusted for sex) was observed. The difference between cases and controls for the EQ VAS was especially notable in young women.

CONCLUSIONS

Genital warts are associated with a significant detriment to HRQoL. The potential added benefit of preventing most cases of genital warts by HPV vaccination should be considered in decisions about which HPV vaccine to implement in the United Kingdom.

Androgen induces expression of the multidrug resistance protein gene MRP4 in prostate cancer cells

Multidrug resistance-associated proteins (MRPs) may mediate multidrug resistance in tumor cells. Using a gene array analysis, we have identified MRP4 as an androgen receptor (AR)-regulated gene. Dihydrotestosterone induced MRP4 expression in both androgen-dependent and -independent LNCaP cells, whereas there was little detectable expression in PC-3 or normal prostate epithelial cells. Disruption of MRP4 expression renders LNCaP cells more sensitive to the cytotoxic effects of methotrexate but not etoposide. Analysis of human tissues showed detectable MRP4 expression only in metastatic prostate cancer. These results suggest that AR induction of MRP4 mediates resistance of PC cells to nucleotide-based chemotherapeutic drugs.

Androgen regulation of soluble guanylyl cyclasealpha1 mediates prostate cancer cell proliferation

The growth and progression of prostate cancer are dependent on androgens and androgen receptor (AR), which act by modulating gene expression. Utilizing a gene microarray approach, we have identified the alpha1-subunit gene of soluble guanylyl cyclase (sGC) as a novel androgen-regulated gene. A heterodimeric cytoplasmic protein composed of one alpha and one beta subunit, sGC mediates the widespread cellular effects of nitric oxide (NO). We report here that, in prostate cancer cells, androgens stimulate the expression of sGCalpha1. A cloned human sGCalpha1 promoter is activated by androgen in an AR-dependent manner, suggesting that sGCalpha1 may be a direct AR target gene. Disruption of sGCalpha1 expression severely compromises the growth of both androgen-dependent and androgen-independent AR-positive prostate cancer cells. Overexpression of sGCalpha1 alone is sufficient for stimulating prostate cancer cell proliferation. Interestingly, the major growth effect of sGCalpha1 is independent of NO and cyclic guanosine monophosphate, a major mediator of the sGC enzyme. These data strongly suggest that sGCalpha1 acts in prostate cancer via a novel pathway that does not depend on sGCbeta1. Tissue studies show that sGCalpha1 expression is significantly elevated in advanced prostate cancer. Thus, sGCalpha1 may be an important mediator of the procarcinogenic effects of androgens.

Phase II trial of sequential temozolomide (TMZ) and high-dose bolus (HDB) IL-2 in patients with metastatic melanoma

8037

Background: Previous biochemotherapy (BCT) regimens for metastatic melanoma have utilized lower doses of IL-2 and multiple chemotherapeutic agents, adding to toxicity, but not to efficacy. Methods: We designed a 2-stage Simon phase II study testing a unique BCT approach of single agent chemotherapy with TMZ given in an extended schedule (75 mg/m² per day for 3 weeks PO) followed by HDB IL-2 (600,000 U/Kg/dose, maximum 14 doses administered over 5 days). Cycles were repeated every 28 days with a two-week interval between alternate cycles. The first stage accrued 20 patients with promising activity and safety permitting enrollment of additional patients. Results: Thirty-one patients (20 male, 11 female), age 27–74 (median 47) have been enrolled to date. All had AJCC stage IV melanoma (7 M1a, 5 M1b, 19 M1c) and had not previously received therapy for metastatic disease. Twelve had received prior adjuvant interferon. A total of 88 cycles of therapy have been administered (median of 2 cycles per patient; 5 patients continue on therapy). The median number of doses was 9 (range 7–12) during cycle 1, and 6 (range 4–11) during cycle 2. Three patients did not receive any IL-2 due to disease progression, and 6 patients received only one cycle of IL-2. Twenty two patients who received at least 2 cycles are evaluable for response. All 31 patients are evaluable for toxicity. Grade 3 toxicities included hepatic (8), hematologic (4 leukopenia, 2 thrombocytopenia), diarrhea (1). No grade 3–4 cardiovascular or renal toxicities were noted. Overall response rate is 22.7% (2 complete lasting 10.8 and 17+ months, 3 partial lasting 3.7 and 16+ months, 1+ month). Responses were seen in both M1a and M1c disease. Fourteen patients had stable disease after 2 cycles and 10 of these have progressed. As of 12/31/2005, the 4 month PFS rate is 74% [40%, 88%], median TTP is 24 weeks [11, 32] and median OS is 71 weeks (31.4, inf). Conclusions: HDB IL-2 can be safely administered in combination with single agent temozolomide in an extended schedule and appears to have promising efficacy and lower toxicity than previously used BCT regimens. Further follow-up will determine if durability of response exceeds that of single agent HDB IL-2.

[Table: see text]

Lung cancer in patients ≥ 80 years of age: Analysis of the national surveillance, epidemiology and end results (SEER) database

7156

Background: Lung cancer is a disease of the elderly with median age at diagnosis of 70 years. In spite of this, the very elderly (patients ≥ 80 years) group has not been well studied. We analyzed the national SEER database to evaluate outcome of the disease in this subgroup. Methods: All patients with primary lung cancer in the national SEER database from 1988–1997 were included, and grouped into those <80 yrs vs. those ≥80 yrs at the time of diagnosis. We compared the 2 groups for stage distribution, 3-yr & 5-yr survival, survival based on histology, sex, race, stage and treatment. The 5-yr relative survival rate, adjusted for the normal life expectancy, was utilized except for the 3-yr survival comparison. The SEER program, Stat 6.1.4, was used for analysis and all p-values were 2-sided. Results: Of the 129,003 cases of lung cancer registered over 10 years, 14,614 (11%) occurred in patients ≥80 yrs. Overall survival at 3 and 5yrs was inferior in the octogenarian group, {11.8% vs. 20% and 8.3% vs. 16.2%, respectively (p < 0.0001)}. The inferior survival was observed in both males and females {7.1% vs. 14.3% and 9.6% vs. 18.9%, respectively (p < 0.0001)} and with non-small cell histology {9.1% vs. 18.3% (p < 0.0001)}. Stage-specific analysis revealed the same trend {24.9% vs. 46.9% - stage I, 19.1% vs. 30.4% - stage II, 3.1% vs. 9.0% - stage III and 1.1% vs. 1.8% - stage IV (p < 0.0001 for all comparisons)}. Irrespective of race, elderly patients fared worse: 6.9% vs. 12.8% in blacks, 8.4% vs. 16.7% in white and 8.4% vs. 16.3% in other racial groups (p < 0.0001 for all comparisons). Although, therapy (surgery or radiation) benefited both groups, treated elderly group performed worse than younger group {4.9% vs. 8.1% (p < 0.0001) and 45% vs. 45.7% (p < 0.02) with radiation and surgery respectively}. However, only 58% of elderly patients received surgery or radiation therapy compared to 80% of patients <80 yrs. Conclusion: In general, very elderly patients with lung cancer have a worse clinical outcome than younger patients. This is irrespective of histology, stage of disease, sex, gender or race. The worse outcome in the elderly may be due to a larger proportion of them not receiving treatment.

No significant financial relationships to disclose.

Comparison of survival for non-small cell lung cancer (NSCLC) between premenopausal and postmenopausal women: An analysis of the National Surveillance, Epidemiology and End Results (SEER) Database

7038

Background: Estrogen signaling has been implicated in lung cancer formation and progression by pre-clinical studies. Estrogen receptor (ER) Beta is overexpressed in NSCLC. To understand the clinical impact of the estrogen pathway, we analyzed the national SEER database to compare the outcomes for NSCLC in premenopausal vs. postmenopausal women. Methods: Data from the national SEER registry between the years of 1988–2002 was analyzed. Women between the ages 40–44 were chosen as representative of the pre-menopausal group and 55–59 year-old women represented the post-menopausal group. To control the effect of age alone as a determinant of outcome, we compared the survival between 1,534 men with ages of 40–44 and 8,807 men with ages of 55–59. Survival rates were analyzed by Kaplan-Meier method and compared by Z-test through SEER*Stat software version 6.1.4. Results: A total of 7,150 women, premenopausal (1,171) and postmenopausal (5,979) were included. Adenocarcinoma (ADC) was more commonly seen in premenopausal than in postmenopausal women (58% vs 47%). Distribution by stage at diagnosis was similar between the two groups. Premenopausal women with squamous cell carcinoma (SCC) or bronchioalveolar carcinomas (BAC) had inferior overall survival than postmenopausal women. Differences in outcome between men in the two age groups were not significant. Conclusions: Premenopausal women with SCC or BAC, but not ADC have inferior survival compared to postmenopausal women. Smaller and non-significant differences were observed between males of the same aged-groups. The results suggest varying estrogen effects between the histological sub-types of NSCLC and support clinical strategies to block the ER pathway for the treatment of NSCLC.

[Table: see text]

No significant financial relationships to disclose.

Phase II study of gefitinib and docetaxel as salvage therapy in patients (pts) with advanced pancreatic adenocarcinoma (APC)

4120

Background: There is no standard-of-care second-line chemotherapy for APC. The combination of docetaxel and gefitinib, an inhibitor of epidermal growth factor receptor (EGFR) shows enhanced preclinical activity compared to docetaxel alone. Docetaxel alone has activity in APC, and this phase II trial is designed to evaluate the combination. The primary endpoint is survival with an accrual goal of 45 patients to detect an improvement to 5.25 months (mo) in median survival time by one-sided log-rank test at level α = 0.05. Methods: Patients with APC and one prior chemotherapy regimen are eligible for study; EGFR over-expression is not required. Gefitinib is administered at the dose of 250 mg/day orally without interruption. The initial dose of docetaxel was 75 mg/m2 every three weeks (one cycle), but was reduced to 60 mg/m2 due to a high incidence of febrile neutropenia. Results: 31 pts, all with prior gemcitabine therapy, have been enrolled on study to date, with 26 evaluable for toxicity. Patient characteristics: 62% male; 92 % with ECOG performance status 0/1, 8% ECOG of 2; median age 64 years (range 47–82 years). The best response is stable disease (5 pts), median cycles administered 2 (range 1–12). Thus far the median survival time is 4.4 mo, with median time to progression of 2.5 mo. Grade (G) 3/4 febrile neutropenia occurred in 8 out of 18 pts treated at the 75 mg/m2 dose of docetaxel; none has been seen with the 60 mg/m2 dose. Other G 3/4 adverse events include: diarrhea (3.8%), rash (7.7%), constitutional symptoms (11.5%), and nausea (11.5%). Conclusion: The combination of gefitinib and docetaxel at 60 mg/m2 is tolerable, with interim results showing a median survival time of 4.4 mo at this point. If the protocol’s goal of median survival time of 5.25 mo is met upon study completion, the combination may be worthy of further investigation.

No significant financial relationships to disclose.

c-Jun enhancement of androgen receptor transactivation is associated with prostate cancer cell proliferation

Androgens and the androgen receptor (AR) are involved in the growth and progression of prostate cancer. Our previous studies suggest that the proto-oncoprotein c-Jun is an AR coactivator that stimulates AR transactivation by mediating receptor dimerization and subsequent DNA binding. To study the physiological relevance of this c-Jun activity on AR, we have generated stable LNCaP cell lines expressing different levels of c-Jun. These cell lines exhibit a direct correlation between endogenous c-Jun levels and AR transcriptional activity and expression of endogenous androgen-regulated genes. Disruption by antisense RNA of endogenous c-Jun expression in LNCaP cells strongly compromises the androgen-dependent proliferation of these cells. In contrast, expression of a c-Jun mutant, which is fully active in coactivation of AR but deficient in AP-1 transactivation, significantly enhances androgen-dependent proliferation. This finding indicates that the coactivation function of c-Jun is sufficient for regulating androgen-induced growth of LNCaP cells. c-Jun also enhances AR transactivtion in androgen-independent LNCaP cells, which closely mimic hormone-refractory prostate cancer cells in gene expression and growth behavior. Importantly, siRNA-mediated repression of endogenous c-Jun expression results in markedly reduced growth of these cells, strongly suggesting an important biological role for c-Jun in hormone-refractory prostate cancer.

Biological and conformational study of beta-substituted prolines in MT-II template: steric effects leading to human MC5 receptor selectivity

To investigate the molecular basis for the interaction of the chi-constrained conformation of melanotropin peptide with the human melanocortin receptors, a series of beta-substituted proline analogs were synthesized and incorporated into the Ac-Nle-C[Asp-His-D-Phe-Arg-Trp-Lys]-NH2 (MT-II) template at the His6 and D-Phe7 positions. It was found that the binding affinities generally diminished as the steric bulk of the p-substituents of the 3-phenylproline residues increased. From (2S, 3R)-3-phenyl-Pro6 to (2S, 3R)-3-(p-methoxyphenyl)-Pro6 analogs the binding affinity decreased 23-fold at the human melanocortin-3 receptor (hMC3R), 17-fold at the hMC4R, and eight-fold at the hMC5R, but selectivity for the hMC5R increased. In addition, the substitution of the D-Phe7 residue with a (2R, 3S)-3-phenyl-Pro resulted in greatly reduced binding affinity (10(3)-10(5)) at these melanocortin receptors. Macromodel's Large Scale Low Mode (LLMOD) with OPLS-AA force field simulations revealed that both MT-II and SHU-9119 share a similar backbone conformation and topography with the exception of the orientation of the side chains of D-Phe7/D-Nal (2')7 in chi space. Introduction of the dihedrally constrained phenylproline analogs into the His6 position (analogs 2-6) caused topographical changes that might be responsible for the lower binding affinities. Our findings indicate that hMC3 and hMC4 receptors are more sensitive to steric effects and conformational constraints than the hMC5 receptor. This is the first example for melanocortin receptor selectivity where the propensity of steric interactions in chi space of beta-modified Pro6 analogs of MT-II has been shown to play a critical role for binding as well as bioefficacy of melanotropins at hMC3 and hMC4 receptors, but not at the hMC5 receptor.

Cultivation of aerobic granules in a sequential batch shaking reactor

Aerobic granular sludge is a promising biotechnology for wastewater treatment system. In this report, aerobic granular sludge was successfully cultivated in a sequential batch shaking reactor in which horizontal circular flow could be formed by shaking. In this way, granulation and aeration could be simultaneously achieved. In comparison with sequential batch airlift reactor, more homogeneous circular flow was formed in the sequential batch shaking reactor. The aerobic granules obtained in the reactor were smooth, 1.2 mm in average diameter, and had a settling velocity of 50-52 m h(-1). In addition, an increase in the hydrophobicity of the cell surface of granules indicated that granulation could be related to the change in cell hydrophobicity. Finally, microbial observation showed that rod-shape and coccoid bacteria were the dominant species in mature granules. Results of this study have important implications on the mechanism of the granulation process and further practical application.

Immunoscreening of Schistosoma japonicum egg cDNA library

AIM

To screen and identify genes encoding vaccine candidates and molecules with diagnostic potential from S. japonicum (S. j) egg cDNA library.

METHODS

S. j egg cDNA library was screened by sera from SEA-immunized rabbits. Positive clones were identified after three rounds of screening and were excised automatically in vivo with helper phage. Products of PCR were used to detect insert sizes by agarose gel electrophoresis. DNA samples were obtained by purification using mini-prep kit. Automatic sequencing was carried out and the sequence data were analysed using GCG software.

RESULTS

Twelve clones were identified as positive and the inserts were around 1.2 kb in size. Compared with DNA sequences in GenBank, eight clones were homologous to a 70 kDa S. j heatshock protein(S. j HsP70). C18 exhibited 97.8% homology with S. j23. C22 and C23 shared 82.4% and 89.5% homology with S. j calreticulin, respectively. C12 was homologous to S. mansoni(S. m.) immunophilin.

CONCLUSION

This paper first reported the results of immunoscreening S. j egg cDNA library by anti-SEA sera. Twelve positive clones were found to be related to protective immunity and/or immunodiagnosis of schistosomiasis.

[Schistosoma japonicum: protective immunity induced in mice immunized with SjGST-Sj32]

Schistosoma japonicum glutathione-s-transferase (SjGST), Schistosoma japonicum 32,000 protein (Sj32) and SjGST - Sj32 were expressed and purified to study on protective immunity against Schistosoma japonicum. The result showed that compared with the adjuvant control group, the worm burden was decreased significantly in mice immunized with recombinant SjGST - Sj32, Sj32 and Sj32 + SjGST (P < 0.05). At the same time, the liver egg per gram(EPG) was decreased in mice immunized with SjGST - Sj32, Sj32, Sj32 + SjGST and SjGST. It is concluded that Sj32 significantly induces both protective immunity and anti-fecundity immunity, but SjGST only has an anti-fecundity effect.

Recombinant paramyosin (rec-Sj-97) tested for immunogenicity and vaccine efficacy against Schistosoma japonicum in mice and water buffaloes

A primary vaccine candidate antigen against schistosomiasis is paramyosin (pmy), a myofibrillar protein found exclusively in invertebrates. Here we report the results of vaccine trials against the Asian schistosome undertaken on inbred and outbred mice and water buffaloes using a bacterially expressed and purified form of Schistosoma japonicum pmy (rec-Sj-97). Vaccination of the mice resulted in high levels of specific anti-pmy IgG antibodies when compared with adjuvant controls and significant reduction in worm burdens and in liver eggs. Furthermore, a significant reduction in liver eggs was recorded in two of the three water buffalo vaccine trials undertaken and, in all three trials, high levels of specific anti-pmy IgG antibodies were generated. There was no evidence of any toxic effects and the vaccine preparations and Quil A adjuvant were clearly well tolerated. The development of a vaccine intended for livestock animals such as bovines would be beneficial in two ways; directly by blocking transmission of schistosomiasis to humans and economically by contributing to healthier livestock. We are encouraged by the consistent efficacy in the mouse and the buffalo vaccine trials that resulted in a significant decrease in liver eggs. Indeed, predictions from mathematical models indicate that an egg reduction effect of 42-45% in buffaloes would be sufficient when combined with human treatment to control schistosomiasis japonica in the marshes and lakes along the middle and upper reaches of the Yangtze River, the most highly endemic areas for the disease in China.

Protection of xenogeneic cells from human complement-mediated lysis by the expression of human DAF, CD59 and MCP

CD59 and membrane cofactor protein (MCP, CD46) are widely expressed cell surface glycoproteins that protect host cells from the effect of homologous complement attack. cDNAs encoding human CD59 and MCP cloned from Chinese human embryo were separately transfected into NIH/3T3 cells resulting in the expression of human CD59 and MCP protein on the cell surface. The functional properties of expressed proteins were studied. When the transfected cells were exposed to human serum as a source of complement and naturally occurring anti-mouse antibody, they were resistant to human complement-mediated cell killing. However, the cells remained sensitive to rabbit and guinea pig complement. Human CD59 and MCP can only protect NIH/3T3 cells from human complement-mediated lysis. These results demonstrated that complement inhibitory activity of these proteins is species-selective. The cDNAs of CD59 and MCP were also separately transfected into the endothelial cells (ECs) of the pigs transgenic for the human DAF gene to investigate a putative synergistic action. The ECs expressing both DAF and MCP proteins or both DAF and CD59 proteins exhibited more protection against cytolysis by human serum compared to the cells with only DAF expressed alone.

[Cricohyoidoepiglottopexy: a report of 21 cases]

OBJECTIVE

To assess the indications, function preserving and long term results of cricohyoidoepiglottopexy (CHEP) in the treatment of laryngeal carcinoma.

METHOD

Twenty-one patients were underwent this procedure during the period from 1993 to 1999 in our department. There were 20 glottic cancers (7 T1N0M0, 10 T2N0M0, 3 T3N0M0) and 1 supraglottic type (T2N1M0) according to the 1997 UICC system. In these cases, 15 were the aged over 60 years.

RESULT

First decannulation rate was 95.24%, and majority completed in 28 days post-operation. No patient was with cannula all his life. All cases could finally take food by mouth without aspiration. Speech was also satisfactory. The overall 3-year and 5-year survival rates were 87.50% and 75.00% respectively. No patient experienced local recurrence.

CONCLUSION

This procedure is presented as a useful alternative to partial vertical laryngectomy and total laryngectomy in select cases of laryngeal carcinoma.

Mesoscopic correlation of supramolecular chirality in one-dimensional hydrogen-bonded assemblies

The ordering of 4-[trans-2-(pyrid-4-yl-vinyl)] benzoic acid, a two-dimensional chiral species, was studied by scanning tunneling microscopy at noble metal surfaces. Homochiral molecules self-assemble in supramolecular chiral hydrogen-bonded twin chains, which order in nanogratings where the supramolecular chirality is strictly correlated over the entire microm domains without intimate molecular contact. Model simulations indicate that the underlying mesoscopic chiral resolution is associated with twin chains acting as chiroselective templates for transient molecular attachment, which process mediates the gratings' evolution.

Multivariate curve resolution of wavelet and Fourier compressed spectra

The multivariate curve resolution method SIMPLe to use Interactive Self-Modeling Mixture Analysis (SIMPLISMA) was applied to Fourier and wavelet compressed ion-mobility spectra. The spectra obtained from the SIMPLISMA model were transformed back to their original representation, that is, uncompressed format. SIMPULSMA was able to model the same pure variables for the partial wavelet transform, although for the Fourier and complete wavelet transforms, satisfactory pure variables and models were not obtained. Data were acquired from two samples and two different ion mobility spectrometry (IMS) sensors. The first sample was thermally desorbed sodium gamma-hydroxybutyrate (GHB), and the second sample was a liquid mixture of dicyclohexylamine (DCHA) and diethylmethylphosphonate (DEMP). The spectra were compressed to 6.3% of their original size. SIMPLISMA was applied to the compressed data in the Fourier and wavelet domains. An alternative method of normalizing SIMPLISMA spectra was devised that removes variation in scale between SIMPLISMA results obtained from uncompressed and compressed data. SIMPLISMA was able to accurately extract the spectral features and concentration profiles directly from daublet compressed IMS data at a compression ratio of 93.7% with root-mean-square errors of reconstruction < 3%. The daublet wavelet filters were selected, because they worked well when compared to coiflet and symmlet. The effects of the daublet filter width and compression ratio were evaluated with respect to reconstruction errors of the data sets and SIMPLISMA spectra. For these experiments, the daublet 14 filter performed well for the two data sets.