The usefulness of high pre-operative levels of serum type I collagen bone markers for the prediction of changes in bone mineral density after parathyroidectomy

BACKGROUND

Amino-terminal procollagen propeptide of type I collagen (P1NP) and cross-linked C-terminal telopeptide of type I collagen (βCTX) are two of the more sensitive bone markers for reflecting and monitoring patients with an increased bone turnover as observed in primary hyperparathyroidism (PHPT) patients.

AIM

The present study was performed to evaluate the trend of type I collagen markers one year after parathyroidectomy (PTX) and to examine the relationships between serum P1NP and βCTX levels and bone mineral density (BMD) change after PTX in PHPT Spanish patients.

MATERIALS AND METHODS

Fifty-three PHPT patients were enroled and were followed for one year by measuring lumbar BMD, lumbar t-score, lumbar z-score, PTH, calcium, phosphorus, P1NP and βCTX.

RESULTS

Pre-surgery concentrations of both markers were elevated (P1NP: 90.71±5.03; βCTX: 1.52±0.44). A significant decrease was observed in mean post-operative βCTX and P1NP concentrations (p<0.0001). Levels of BMD, t-score and z-score at lumbar spine were relatively low (BMD: 0.75±0.16; z-score -0.90±0.23; t-score -2.51±0.32); after PTX a significant increase was observed in the levels of these three parameters. P1NP and βCTX were correlated with lumbar BMD change one year after PTX (P1NP: r=0.79, p=0.016; βCTX: r=0.89, p=0.003).

CONCLUSIONS

Pre-surgery concentrations of both bone markers were elevated and a significant decrease after PTX was found. Serum βCTX and P1NP levels were potently related to lumbar BMD changes over one year after PTX. The measurement of βCTX and P1NP would be useful to predict long-term changes in lumbar BMD after PTX.

[Morbidity and mortality in a series of patients suffering from intraperitoneal neoplasia treated with peritoneal cytoreduction and hyperthermic intraperitoneal chemotherapy at the Fundación Santa Fe de Bogotá Teaching Hospital (ONCOLGroup--ATIA study)]

BACKGROUND

The procedure of radical peritonectomy followed by hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for peritoneal cancers.

AIMS

To evaluate various outcomes in a cohort of patients with peritoneal tumors treated with HIPEC.

METHODS

Twenty-four patients consecutively treated with radical peritonectomy plus HIPEC within the time frame of November 2007 to July 2010 were enrolled; 15 (62%) had tumors of appendicular origin, 4 (16.7%) had primary peritoneal tumors, 2 had ovarian carcinomas and there was one case of colon cancer, one carcinosarcoma and one hemangioendothelioma. Mean age was 53 years (range: 26-68) and median follow-up was 14.2 months (range: 1-32). Demographic data, histology, peritoneal cancer index (PCI), surgical procedure characteristics, recurrence-free survival (RFS), and overall survival (OS) were all evaluated. Short-term morbidity and mortality were also determined.

RESULTS

Complete cytoreduction was achieved in 18 patients (75%). Mean PCI was 15 (<10: 41% and >10: 58%), and the median (range) for surgery duration, length of stay in the Intensive Care Unit, parenteral nutritional support, and hospital stay were 12,5 (7-20) hours, 11,4 (2-74) days, 13,8 (12-65) days, and 29,1 (10-90) days, respectively. One patient (4%) died 6 months after the procedure, due to multiple associated complications. Considerable morbidity was seen in 52% of cases, including thromboembolic events (41%), catheter-related bacteremia (29%), fistulas (29%), and nephrotoxicity (25%). Six patients (25%) recurred after a median of 21 months of RFS.

CONCLUSIONS

Cytoreductive surgery plus HIPEC in well-selected patients presenting with tumors that affect the peritoneum is a procedure that can be carried out in Colombia with an adequate safety and effectiveness profile. Mortality was similar to that reported in the international literature.

Short-term heart rate dynamics of women during labor

We studied 10 minutes segments of heartbeat interval fluctuations from 18 young women in labor with normal outcome of pregnancy. Data of each studied case were classified into two distinct groups. One group involving segments where the uterine activity was observable (three or more contractions in ten minutes), and the other group of reference having segments with fewer uterine activity or not presenting contractions at all. For comparison, we also included segments collected during the last trimester of gestation prior to labor from a third group of women. Corresponding RR interval series were analyzed to estimate RR(mean), RMSSD, α(1), α(1(MAG)) and α(1(SIGN)) parameters. No significant differences among groups were identified in RMSSD, α(1) and α(1(MAG)) Nevertheless, α(1(SIGN)) did present significant differences in comparison with the last trimester results (p<0.007), revealing a subtle change in the temporal organization of maternal RR series during labor. Results of these parameters then suggest that during labor, despite preserving a concomitant non-linear influence, the maternal short-term autonomic cardiac regulation behaves with less antagonism.

Triticum vulgare mouthwashes (TVM) for patients (pts) with oral mucositis (OM) induced by chemotherapy and chemoradiotherapy (ONCOLGroup study)

e20570

Background: OM is a frequent complication of cancer therapy in Colombia. Triticum vulgare has been reported to effectively treat mucosal and skin disturbances. Methods: To evaluate the safety and efficacy of TVM for the control of OM induced by chemoradiotherapy in pts with head and neck cancer (HNC) and by chemotherapy in pts with haematological malignancies (HM). Thirty-one pts received TVM delivered in a spray four times daily to the whole oral cavity until the OM being resolved. The primary endpoint was the OM grade evaluated daily using the Nebraska scale (NS). Secondary endpoints were OM duration, weight loss, pain and TVM tolerance; the latter two were evaluated using a visual analogue scale (VAS). Results were compared with data from 42 pts with OM treated with saline mouthwashes (SM) in a previous clinical trial. Results: Nineteen pts had HM and 12 had HNC; those with HM developed OM on day 9 of chemotherapy (range, 7–14), whilst those having HNC did so towards day 17 of chemoradiation (range, 13–26). Using NS 38% of pts developed GI OM, 46% GII OM and 16% GIII OM. Moderate and severe OM occurred more frequently amongst HNC pts (8 vs 1, p = 0.047), mean OM duration in HNC pts was 12±4.5 days, whilst it was 7 ±3 days (p = 0.047) in pts with HM. Median OM duration in pts treated with TVM was 5.4 days (range, 2–9) vs 7 days (range 1–17) for pts treated with SM (p = 0.048). TVM appears to reduce weight loss, especially in pts with HNC (p = 0.058); however, no changes were documented regarding saliva characteristics and production, mucosal bleeding and voice properties. Evaluation of pain did not reveal differences between the groups (VAS 5.5 for the TV compared to VAS 6.2 for SM; p = 0.27) but the proportion of pts suffering from pain VAS≥7 differed between both populations (8% TV vs 23% SM; p = 0.043). There are no significant adverse events with TVM. Conclusions: TVM is safe and has therapeutic activity against OM. Further phase III study is needed to confirm these results.

No significant financial relationships to disclose.

Survival of patients (pts) with advanced lung adenocarcinoma (ALA) treated in four hospitals from Bogotá D.C., Colombia, and report of a novel alteration in the epidermal growth factor receptor (EGFR) (ONCOLGroup study)

e19097

Background: This study included 147 ALA pts treated between 2000 and 2007. Overall response rates (ORR), clinical benefit (CB), time to progression (TTP) and overall survival (OS) were estimated. EGFR E19 deletions were studied by length analysis fluorescently and the exon 21 L858R mutation by PCR Taqman assay. Results: Mean age was 66±12.8 years. Seventy- eight pts were women, 40% had never been exposed to tobacco smoke and PS was ≥70% in 119 pts. The brain was the dominant site for metastasis (38%) followed by the lungs (38%). Sixty-nine percent of the pts received a platinum doublet as first-line intervention and 32 pts (21.8%) had received erlotinib (E) as part of their treatment. Response to first-line treatment was available in 110 pts; ORR was 28%, CB 39% and TTP 4.2 mo. (range, 0.2–11). Second-line therapy was administered to 46 pts; ORR was 8%, CB 25% and TTP 3.7 mo. (range, 0.4–12). Twenty pts received third-line therapy, with an ORR of 35%, CB 50% and a TTP 3.9 mo. (range, 1.0–5.7). Median OS was 10.1 mo. (range, 6.3–19) and the PS, absence of tobacco exposure, and administration of E, positively influenced this outcome. EGFR mutational profile was assessed in 6 pts; 3 pts presented mutations in E19, one a 5-nucleotide deletion (E746_A750) and 2 pts had a 3 serine-rich nucleotide insertion (L747_S75) which has not been previously reported. The first patient had a partial response, and the last two, had survival greater than 16-mo. Conclusions: Outcomes for pts suffering from ALA in Colombia are similar to those described in other Latin American countries. Three pts with EGFR alterations were identified in this cohort; two presented a non- described change in E19 which may have corresponded to a novel alteration in our region, with possible increased sensitivity to E.

No significant financial relationships to disclose.

Trastuzumab (H) treatment in patients (pts) with metastatic breast cancer (MBC): An observational retrospective study in four hospitals from Bogotá, Colombia (ONCOLGroup study)

e12016

Background: Breast cancer is the second most common cancer diagnosed in Colombian women, and approximately 26% of MBC are HER-2-positive in our population. The purpose of this study was to assess the characteristics and outcome of pts with HER-2-positive MBC treated with H-based therapy in Bogotá. Methods: This retrospective study included 119 pts treated between 2000 and 2007. Overall response rates (ORR), clinical benefit (CB), time to progression (TTP), and overall survival (OS) were estimated. Most common grade 2/3 toxicities are reported as well as variables that influenced survival. Results: Median age was 62 years (range, 37 to 75). Eighty-seven (73%) pts had recurrent disease and the rest had de novo MBC. Performance status was ≥70% in 114 pts, 66% had ≤2 metastatic sites, and 58% had hormone receptor positive disease. Previous adjuvant therapy before H included antracyclines in 68% and taxanes in 39% of the pts. H was part of the first-line therapy for MBC in 86.5% of the pts, leading to a 54% ORR in 103 evaluable pts. CB was 81% and median TTP was 6.1 months. (range, 1.2 to 26 mo). The most common toxicities in this setting included neutropenia ≥G3 (9%) and neuropathy ≥G3 (7%). H was given as part of second line therapy to 54 (45%) pts, but only 41 had evaluable disease. A 56% ORR was found in this subgroup, 85% CB and 4.7-month median of TTP. Grade ≥G3 hand-foot syndrome was the main toxicity (14%). Median OS after the diagnosis of MBC was 23 months (range, 1.6–93 mo), being longer for pts with HR-positive disease (p = 0.036), in pts with loco-regional relapse (p = 0.029), and in those older than 50 (p = 0.0025). Only two variables independently predicted OS: age (HR: 0.4, 95% CI: 0.35–0.93, p = 0.046) and HR status (HR: 0.7, 95% CI: 0.60–0.86, p = 0.040). Two pts (1.7%) had H-induced heart failure. Conclusions: H in combination with chemotherapeutic agents has been proved to be an effective and safe treatment for HER-2-positive MBC. The results from our series agreed with those reported in the medical literature and guarantee the regular use of H in Colombia.

No significant financial relationships to disclose.

Wood-smoke exposure (WSE) as a predictor of response and survival in erlotinib-treated advanced lung adenocarcinoma (ALA) patients (pts) (ONCOLGroup study)

e19052

Background: There is consistent information suggesting that long-term WSE constitutes a risk factor for lung cancer. More than 50 years of WSE was associated with non-small cell lung cancer (NSCLC). In Colombia the prevalence of WSE in areas having less economic development is approximately 24%. The aim of the study was to evaluate WSE as a predictor of response and survival in ALA pts. Methods: This study included 168 pts with ALA treated between 2002 and 2007 in four referring hospitals of Bogotá. Retrospectively, we estimated overall response rates (ORR), time to progression (TTP) and overall survival (OS) in a subgroup of pts with significant WSE (exposure >5 years for at least 4 hours/day) treated with erlotinib, and compared them with the non-WSE population treated with the same compound. Results: Median age was 66 years (range, 29–96), 53% were female, 39% had never been smokers, 24% of all cohort pts had been considerably exposed to WS and 45 pts had received erlotinib during disease treatment (as 2nd or 3rd line). Sixteen of these pts (F11/M5, PS ≥70% 9 pts) had been exposed to WS and 29 not so (F17/M12, PS ≥70% 22 pts); 10 pts having WSE had been smoking for a mean of 14pk/yr history. ORR to erlotinib was 7% and 32% in pts with and without WSE respectively (p = 0.02). TTP was significantly higher in pts treated with erlotinib with no history of WSE (4.9 mo. vs 1.7 mo., p = 0.034). and in those who had received this compound as second-line (vs erlotinib used as third line, p = 0.044). Among pts with WSE history, OS was 6.6 mo. (range, 5.8–7.3) for those treated with Erlotinib and 12.7 mo. (range, 10.2–17) for those not treated with this compound (p = 0.04). Multivariate analysis was carried out for determining the factors influencing mortality between pts with WSE; only PS (HR: 4.6, 95%CI: 1.2–29, p = 0.050) and gender (HR: 3.6, 95%CI: 2.7–18, p = 0.036) were significant. Conclusions: WSE was associated with a poorer response and survival in ALA pts treated with erlotinib in Colombia.

No significant financial relationships to disclose.

Impact of specific sensitization on asthma and rhinitis in young Brazilian and Chilean adults

BACKGROUND

The pattern of associations and the attributable fractions (AF) of atopic conditions due to specific sensitizations vary between countries.

OBJECTIVE

To assess the level of associations and AF between sensitization to five allergens and atopic conditions in two settings.

METHODS

We studied 2063 Brazilians and 1231 Chileans of both sexes using representative samples selected at birth in the 1970s. Information on asthma and rhinitis was based on the European Community Respiratory Health Survey questionnaire. We assessed bronchial hyperresponsiveness (BHR) to methacholine and sensitization to Dermatophagoides pteronyssinus, cat, dog, grass blend and Alternaria alternata.

RESULTS

The prevalence of sensitization to one or more allergens was 50% in Brazilians and 22% in Chileans. The level of associations varied according to the outcome used. Strong associations between sensitization and asthma, defined as wheeze or awakening with breathlessness at night and positive BHR, were found for each of the five allergens in Chileans [varying from odds ratio (OR) 3.24, 95% confidence interval (CI) 1.47, 7.15 for D. pteronyssinus to 8.44, 95% CI 3.82, 18.66 for cat], whereas the level of associations was restricted to D. pteronyssinus, cat and dog in Brazilians and was somewhat weaker (highest OR 3.90, 95% CI 2.80-5.44). The AF of sensitization on asthma was 54% in Brazil and 44% in Chile. D. pteronyssinus and cat made an independent contribution to asthma in the two samples. The patterns of associations between sensitization and rhino-conjunctivitis were similar to those for asthma.

CONCLUSION

The associations between sensitization, and asthma and rhinitis were high in Chile and moderately high in Brazil, but the AF were higher in Brazil, reflecting a higher prevalence of sensitization. In Brazil, dust mite had the greatest impact on atopic conditions while in Chile several allergens had an impact. Sensitization is as serious a problem in Chile and Brazil as in developed countries.

Association of MSX1 with nonsyndromic cleft lip and palate in a Colombian population

OBJECTIVE

To evaluate the association between MSX1 CA polymorphism and nonsyndromic cleft lip with or without cleft palate (CL+/-P) in a group of patients from Operation Smile Colombia.

DESIGN

Four alleles from MSX1 CA microsatellite sequence were analyzed. Polymerase chain reaction was carried out. The amplifications were performed by Short Tandem Repeats (STRs) in ABI PRISM 310 genetic analyzer. Chi-square and odds ratio tests were used to determine the association between genotype frequencies and the risk to the cleft lip/palate in a Colombian group population.

SETTING

Operation Smile Colombia.

PARTICIPANTS

Ninety-four affected patients (49 men and 45 women with CL+/-P) and 93 control individuals (43 men and 50 women).

RESULTS

A significant statistical difference (p<.0106) was found between the patients who carried allele 3 and CL+/-P. In addition, allele 4 (heterozygous and homozygous form) was the most frequent in CL+/-P (74%) patients and in the control group (82%).

CONCLUSIONS

These findings show a positive association between the MSX1 CA polymorphism and CL+/-P in a Colombian group population.

Members of the ethylene signalling pathway are regulated in sugarcane during the association with nitrogen-fixing endophytic bacteria

Nitrogen-fixing bacteria have been isolated from sugarcane in an endophytic and beneficial interaction that promotes plant growth. In this work, for the first time, the involvement of ethylene signalling in this interaction was investigated by molecular characterizing members of this pathway in sugarcane. The expression pattern of a putative ethylene receptor (SCER1) and two putative ERF transcription factors (SCERF1 and SCERF2) show exclusive modulation in plants inoculated with the diazotrophic endophytes. The gene expression profile of SCER1, SCERF1, and SCERF2 is differentially regulated in sugarcane genotypes that can establish efficient or inefficient associations with diazotrophic micro-organisms, exhibiting high or low biological nitrogen fixation (BNF) rates, respectively. In addition, SCER1, SCERF1, and SCERF2 expression is different in response to interactions with pathogenic and beneficial micro-organisms. Taken together, that data suggest that SCER1, SCERF1, and SCERF2 might participate in specific ethylene signalling cascade(s) that can identify a beneficial endophytic association, modulating sugarcane responses toward the diazotrophic endophytes.