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.

Mental representations of obligatory and prohibitory traffic signs

Every traffic sign conveys a single proposition about traffic conditions. Drivers must integrate this proposition with their goals and other known facts to decide on an appropriate action in what amounts to a deduction task. For example, imagine that you are driving a car and you want to turn right at an intersection but there is a 'no right turn' sign. You have to assess the options and make a decision (reach a conclusion). Theoretical accounts from research about reasoning can be applied to how we understand traffic signs and make inferences from them. This study includes two experiments that analysed how people decide whether a situation is allowed or not, taking into account the information provided by one sign--obligatory or prohibitory--or two signs--two obligatory or two prohibitory signs. The number of signs, that is, the complexity of the driving scene, was a key factor in this study. The two experiments differ in the presentation format of the two-sign experimental condition. In the first experiment, the signs were presented as two isolated signs. In the second experiment, the two signs were embedded in one. Equivalent results were found whether two isolated signs or two embedded signs were shown. When an obligatory sign was used at the junction, faster responses were obtained for allowed manoeuvres than for those not allowed. When a prohibitory sign was used, the results were the opposite. However, the advantage of prohibitory signs in the not-allowed situation was not replicated when people had to collect information from two prohibitory signs. Results showed that people integrate two obligatory sign messages--informing where one can go--more easily than two prohibitory sign messages--informing where not to go. Therefore, it could be said that each traffic sign elicits an internal mental model elaboration in which forbidden actions are explicitly labelled by means of attached "mental footnotes" indicating the epistemic status of "prohibitory information."

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.

Is the Berg axillary lymph node categorization useful in the 3D Era

10643

Background: The Berg muscle-based categorization of axillary lymph node location has been used extensively by pathologists and surgeons to describe the extent of axillary node dissection in breast cancer patients, but its reproducibility with different arm positions and its utility in 3-D radiation treatment planning have not been tested. Methods: CT scans were obtained in 16 patients in 2 positions: historic position (HP), arms 90 degrees to the body axis; standard position (SP), arms above head. The volume, contents, and location of each Berg lymph node level (LNL) and the location of lymph nodes, surgical clips, pectoral muscles, and vascular structures relative to reference points were compared between the two scans. Results: Relative to T3, the LNL positions in SP were shifted from HP as follows: Level I, 23.1 mm anteriorly, p < 0.01; Level II, 7.5 mm medially, p = 0.04; Level III, 18.8 mm medially, p = 0.05. The pectoralis major and minor muscles were displaced medially (23.9 mm, p < 0.01 and 7.5 mm, p = 0.09) and anteriorly (18.2 mm, p < 0.01 and 11.2 mm, p < 0.01). At Level I, the axillary vessels (18.0 mm, p < 0.01), subscapular artery (25.4mm, p < 0.01) and lateral thoracic artery (8.4 mm, p < 0.01) were displaced anteriorly. With arm position change, lymph node position moved with vessel position rather than muscle position. Discrepancies were also observed in the number and location of lymph nodes (60%) and clips (66%) in given LNL’s between arm positions. Conclusions: Surgeons, radiologists, and radiation oncologists alike should be aware that lymph node position relative to muscle boundaries will vary significantly with arm position changes, making objective comparisons of information collected in different arm positions unreliable. This has significant implications for radiation treatment planning.

No significant financial relationships to disclose.

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features

The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) > or =10, Gleason Score (GS) > or =7, or T stage > or =T2b), 560 received no NAD (n=308) or NAD for < or =6 months (n=252). Median dose to the prostate from RT and HDR was 42 and 23 Gy, respectively. Average total biologic equivalent prostate dose was >100 Gy (alpha/beta=1.2). Median follow-up was 4.3 years. Pretreatment characteristics were similar on chi(2) tables for all 560 patients treated with or without NAD including pretreatment PSA (P=0.11), GS (P=0.4), and clinical T stage (P=0.2). Outcomes worsened for patients receiving NAD (5-year distant metastasis (DM) 10 vs 5% (P=0.04); cause-specific survival (CSS), 93 vs 98% (P=0.005)). Higher 5-year DM rates and lower CSS occurred in NAD patients with a GS between 8 and 10 (n=112 (P=0.03, P=0.02)), pretreatment PSA> or =15 (n=136 (P=0.03, P=0.008)), and palpable disease > or =T2a (n=434 (P=0.04, P=0.02)). The only two significant risk factors for DM on Cox multivariate analysis were GS (P=0.003, HR 2.8) and NAD (P=0.03, HR 2.7). AD given before definitive high-dose RT did not benefit prostate cancer patients with intermediate- and high-risk features. We favor the use of concurrent/adjuvant AD over prolonged NAD for prostate cancer patients for whom AD is clinically indicated.

A New Nonsymmetric As(OH)3 Species. Comparison with the Known C3 Species and Themochemistry at the HF, DFT(B3LYP), MP2, MP4, and CCSD(T) Levels of Theory

A new nonsymmetric As(OH)(3) species that is more stable than the C(3) structure is found at HF, Density Functional Theory (B3LYP), MP2, MP4 and CCSD(T) levels with the Stuttgart RECP-basis for As and the aug-cc-pvdz/pvtz extended basis sets. Transition state (TS) geometries are close to the C(3) one. Energy differences and interconversion barriers become smaller with increasing inclusion of electronic correlation. However, for MP4 and CCSD(T) descriptions, these differences increase by more than 100% when basis set goes from the AVDZ to AVTZ quality. Zero point energy (ZPE) corrections are essential and have been taken into account at all levels of theory; although this leads to barrier collapse at the B3LYP, MP2, MP4 and CCSD(T) levels, the C(1) isomer remains more stable than the C(3) one. MP2/AVTZ infrared spectra are also given for the C(1) and C(3) isomers as guiding data for future IR studies in the gas phase.

Isolated 3-methylcrotonyl-coenzyme A carboxylase deficiency in a child with metabolic stroke

We report a 3-year-old boy with isolated 3-methylcrotonyl-coenzyme A deficiency with unexpectedly severe presentation, seizures and history of cerebral ischae-mic episode.

Compensatory and mimetic conditioned responses to effects of heroin in addicted persons

Study 1: The aim of this study was to analyze in persons detoxified of heroin, compensatory conditioned responses (CCRs) that are opposite to the unconditioned physiological, and subjective effects that are induced by this substance. The procedure consisted in presenting slides with images of neutral stimuli (NSs) and conditioned stimuli (CSs) of heroin to both non-addicted and detoxified addicted persons. The evaluated responses were heart rate (HR) and desire for heroin (DH). Study 2: The aim was to facilitate the emission of mimetic conditioned responses (MCRs) to the unconditioned physiological, and subjective effects of heroin in detoxified heroin addicts. Three different stimulus series were manipulated: SA, during which the participant remained alone; SB, administration of a needle prick given by the researcher; SC, performance of the "pump" ritual without drug by the participants. The responses measured were HR and DH. The results of both studies are considered, respectively, to be indicators of compensatory and mimetic conditioned responses.

SHR5: a novel plant receptor kinase involved in plant-N2-fixing endophytic bacteria association

Endophytic nitrogen-fixing bacteria have been isolated from graminaceous plants such as maize, rice, and sugarcane. They are thought to promote plant growth, not only by fixing nitrogen, but also by the production of plant hormones. The molecular mechanisms involved in this interaction are not yet clear. In this work, the identification of a receptor-like kinase (RLK), named SHR5, which may participate in signal transduction involved in the establishment of plant-endophytic bacteria interaction is described for the first time. SHR5 seems to be part of a novel subclass of RLKs present in a wide range of plant species. The expression of this gene is down-regulated in sugarcane plants associated exclusively with beneficial endophytic bacteria and is not a general response caused by micro-organisms or abiotic stress. In addition, more successful sugarcane-endophytic bacteria associations have a more pronounced decrease in SHR5 expression, suggesting that SHR5 mRNA levels in plant cells are inversely related to the efficiency of the association.

Ectoines as compatible solutes and carbon and energy sources for the halophilic bacterium Chromohalobacter salexigens

AIMS

To investigate the catabolism of ectoine and hydroxyectoine, which are the major compatible solutes synthesized by Chromohalobacter salexigens.

METHODS AND RESULTS

Growth curves performed in M63 minimal medium with low (0.75 mol l(-1) NaCl), optimal (1.5 mol l(-1) NaCl) or high (2.5 mol l(-1) NaCl) salinity revealed that betaine and ectoines were used as substrate for growth at optimal and high salt. Ectoine transport was maximal at optimal salinity, and showed 3- and 1.5-fold lower values at low and high salinity respectively. The salt-sensitive ectA mutant CHR62 showed an ectoine transport rate 6.8-fold higher than that of the wild type. Incubation of C. salexigens in a mixture of glucose and ectoine resulted in a biphasic growth pattern. However, CO(2) production due to ectoine catabolism was lower, but not completely abolished, in the presence of glucose. When used as the sole carbon source, glycine betaine effectively inhibited ectoine and hydroxyectoine synthesis at any salinity.

CONCLUSIONS

The catabolic pathways for ectoine and hydroxyectoine in C. salexigens operate at optimal and high (although less efficiently) salinity. Endogenous ectoine(s) may repress its own transport. Ectoine utilization was only partially repressed by glucose. Betaine, when used as carbon source, suppresses synthesis of ectoines even under high osmolarity conditions.

SIGNIFICANCE AND IMPACT OF THE STUDY

This study is a previous step to the subsequent isolation and manipulation of the catabolic genes, so as to generate strains with enhanced production of ectoine and hydroxyectoine.