Resistance training and aerobic exercise alters immune function (87.25)

Exercise affects various components of the immune system that could be clinically beneficial or deleterious. Accordingly, moderate exercise stimulates the immune system, while intense exercise suppresses certain immune cell activities. Some of the immune-regulation observed may be due to the regulatory T cells. This could also explain the difference between moderate and strenuous exercisers and the probable reason for lower incidence of autoimmunity in active individuals. Intense exercisers (Trained -regular) and Moderate exercisers (untrained- occasional) were recruited as volunteers from of our university community after IRB approval. Blood samples were collected. PBMCs were used for immune cell profile analysis and the plasma was used for cytokine estimation. Results suggest recruitment of all lymphocyte subpopulations to the vascular compartment: CD4, CD8, B, and Natural killer (NK) cells. Depending on intensity of exercise, the CD4-to-CD8 ratio decreased, reflecting the greater increase in CD8s than CD4s. Both memory and naive phenotype were found, while memory type prevailed. The number of Tregs was increased in all subjects and inversely correlated with IL-6 concentration. Resistant training associated initiation of inflammatory cytokine suggest metabolic link between skeletal muscles and the lymphoid system. It is therefore to be expected that moderate exercise protects against malignancy or infection whereas exhaustive exercise is linked to increased pathology.

Baicalein inhibits the enhancing effects of cigarette smoke extract (CSE) on inflammatory cytokine production in IL-1beta activated mast cells (35.5)

Human mast cells play a role in the pathogenesis of inflammatory airway diseases. We have reported that CSE increased IL-6 and IL-8 production in IL-1beta activated human mast cells (HMC-1). Baicalein (BAI) has been shown to have anti-inflammatory properties. This study aimed to examine the effect of BAI on IL-6 and IL-8 production in HMC-1. Two ml of HMC-1 at 1 x 106 cells/ml were cultured either with or without IL-1beta (10 ng/ml), and in the presence or absence of mainstream (Ms) or sidestream (Ss) CSE (0.25 mg/ml or 0.125 mg/ml), and BAI (30 μM). Treated HMC-1 were incubated for 24 hours and culture supernatants were collected and analyzed for the levels of IL-6 and IL-8 by ELISA. Both concentrations of Ms and Ss CSE significantly increased production of both IL-6 (p < 0.0001) and IL-8 (p < 0.0005) in IL-1beta activated HMC-1. BAI (30 μm) decreased IL-6 and IL-8 production in the Ms CSE (0.25 mg/ml) + IL-1beta treated HMC-1 culture from 2615 ± 38 to 251 ± 19 pg/ml (p < 0.0000001) and from 583 ± 37 to 179 ± 7 pg/ml (p < 0.0005), respectively. A similar inhibitory effect of BAI was also observed in the Ss CSE + IL-1beta treated HMC-1 culture. Our results show that BAI inhibits the enhancing effects of CSE on inflammatory cytokine production in IL-1beta activated mast cells. It suggests that BAI may be a novel candidate for treatment of smoking related inflammatory airway disease (Supported by the Ruth R. Harris Endowment and RDC of ETSU).

Nomogram for predicting 5-year survival after primary surgery for epithelial ovarian cancer

5523

Background: Nomograms have been shown to be superior to traditional staging systems for predicting an individual's probability of long-term survival. Our objective was to develop a nomogram based on established prognostic factors to predict the probability of 5-year disease-specific survival (DSS) after primary surgery for patients with epithelial ovarian cancer (EOC) and to compare its predictive accuracy with the currently used FIGO staging system. Methods: We identified all pts with EOC who had their primary staging/cytoreductive surgery at our institution from January 1996-December 2004. DSS was estimated using the Kaplan-Meier method. We analyzed 28 clinical and pathologic factors for prognostic significance. Significant factors on univariate analysis were then included in the Cox proportional hazards regression model, which identified the factors to be used to construct the nomogram. The concordance index (CI) was used as an accuracy measure, with bootstrapping to correct for optimistic bias. Calibration plots were constructed. Results: There were 478 evaluable pts on the study. The median age was 58 years (range 25–96). The primary surgeon in all cases was an attending gynecologic oncologist. All patients received platinum-based systemic chemotherapy postop. DSS at 5 years was 52%. The most predictive nomogram was constructed using the following 7 predictor variables: age, ASA status, family history suggestive of hereditary breast/ovarian cancer syndrome, preoperative serum albumin level, FIGO stage, tumor histology, and residual disease status after primary surgery. This nomogram was internally validated using bootstrapping and shown to have excellent calibration with a bootstrap-corrected CI of 0.721. The CI for FIGO staging alone was significantly less at 0.62 (p = 0.002). Conclusions: We developed a nomogram to predict 5-year DSS after primary surgery for EOC. The nomogram uses 7 variables that are readily accessible, assigns a point value to each variable, and then predicts the probability of 5-year survival based on the total point value for an individual patient. This tool is more accurate than FIGO staging and should be useful for patient counseling, clinical trial eligibility determination, postop management, and follow-up.

No significant financial relationships to disclose.

Biochemical failure after radiation therapy for prostate cancer: Racial differences

e16071

Background: Many guidelines for prostate cancer treatment are based on clinical trials with predominantly white patient (pt) populations. The generalizability of these results assumes similar tumor biology among all races. We set out to examine biochemical failure (PSA failure) rates in a cohort of pts after definitive external beam radiation (EBRT) in the racially diverse population at our institution. Methods: We conducted an IRB-approved retrospective review of pts treated with definitive EBRT from January 2000 to April 2008. We excluded from analysis pts who received brachytherapy, salvage, adjuvant or palliative radiation. Race, country of origin, diagnostic data, pre- and post-treatment PSA, Gleason score (GS), clinical stage (CS), and treatment history were reviewed. CS was based on the original clinician's assessment at time of diagnosis. PSA failures were defined using 1996 ASTRO criteria. Two cohorts were grouped by race: white and nonwhite. Statistical analysis was performed using Fisher's Exact test. Results: One hundred seventy-four pts were treated with definitive EBRT. Forty-four pts were white and 130 were nonwhite. Both cohorts demonstrated similar distributions in GS and CS (see Table ). The white cohort had a high proportion of pts with a pretreatment PSA <10 ng/ml (66%) as compared to the nonwhite cohort (46%). Distribution of race/region of origin is: White 44 (25%), Black-American 78 (45%), Black-Caribbean 28 (16%), Black-African 2 (1%), Hispanic 21 (12%), Asian 1 (1%). Just under 50% of each group received neoadjuvant androgen deprivation therapy. PSA failure rate was 7% for the white cohort and 13% for nonwhite (p = 0.41). Conclusions: In this retrospective analysis, there was no statistical difference among races with regard to PSA failure rates. The PSA and Gleason trends in each cohort were consistent with published data on this topic. Dedicated evaluation of the prognostic value of traditional risk stratification in nonwhite pt populations in a prospective trial is warranted. [Table: see text]

No significant financial relationships to disclose.

p53, epidermal growth factor, and platelet-derived growth factor in uterine leiomyosarcoma and leiomyomas

Uterine leiomyosarcoma (ULMS) is an aggressive gynecological disease. Although ULMS are often found in association with benign leiomyoma (LMA), little is known regarding the relationship between these benign and malignant smooth muscle neoplasms. The objective of this study was to evaluate the expression of epidermal growth factor (EGFR), platelet-derived growth factor (PDGFR), and p53 in ULMS specimens, their prognostic relevance, and the expression of these molecular markers when compared to benign LMA specimens. Between 1991 and 2001, 25 patients were identified with high-grade primary ULMS and for whom tissue was available. Tissue microarray was created with three representative cores from each of the ULMS cases as well as from 19 patients with benign uterine leiomyomata. Immunohistochemical (IHC) staining was performed for EGFR, PDGFR, and p53. Negative and positive IHC staining was scored for each marker. Outcome analysis was performed only for ULMS. Survival was determined from the time of initial diagnosis to last follow-up. Twelve (48%) ULMS expressed p53 compared to none of the LMA (P < 0.001), and 15 (60%) ULMS cases showed PDGFR expression compared to 32% of LMA samples (P= 0.08). EGFR expression did not differ between ULMS and LMA groups. ULMS patients with p53 expression had a poorer survival compared to ULMS patients with negative expression (P= 0.07). ULMS tumor stage had the strongest association with overall survival (P= 0.05). Our study supports previous investigations indicating that p53 expression may serve as a prognostic marker for ULMS patients. The difference in PDGFR expression between ULMS and LMA demonstrated a trend toward significance. EGFR was not commonly expressed in ULMS. These uniquely expressed markers may assist in stratifying patients by survival and identify novel therapeutic markers. Clearly, further investigation is needed.

Milk and milk products consumption in relationship to serum lipid levels: a community-based study of middle-aged and older population in Japan

The authors examined the association of milk and milk products consumption (MMPC) with serum lipid profiles including total cholesterol (TC), triacylglycerols (TG), HDL cholesterol (HDLC), LDL cholesterol (LDLC), and TC/HDLC ratio in a community-based sample. The study population comprised 461 men and 834 women aged 40-79 years who, in 2001, participated in an annual healthy examination and a lifestyle related survey Consumption frequency of 17 foods, including milk and milk products, was determined by a self-administered questionnaire. The participants were asked by "Do you drink cow's milk or eat milk products such as yoghurt and cheese everyday?", and two groups ("Yes" and "No") of MMPC were classified. Multiple linear regression analyses were conducted to examine the relationships between MMPC and 5 serum lipid profile levels adjusted for sex, age, body mass index (BMI), alcohol consumption, smoking, physical activity, and fat intake. Univariate and multivariate analyses indicated inverse associations of MMPC with TC, HDLC, and LDLC, and that the "Yes" group had higher adjusted means of serum TC by 7.133 mg/100 ml (p < 0.001), HDLC by 1.844 mg/100 ml (p < 0.05), LDLC by 5.459 mg/100 ml (p < 0.001). We suggested that MMPC has an association with serum lipid and lipoprotein levels and that MMPC may have an unfavorable effect on hypercholesterolaemia in the Japanese population.

The costs and efficacy of liposomal doxorubicin in platinum-refractory ovarian cancer in heavily pretreated patients

OBJECTIVE

In clinical practice, chemotherapy agents demonstrating modest second-line activity against platinum-refractory epithelial ovarian cancer (PROC) are frequently used in patients who have received multiple prior chemotherapy agents. Whether the response rates reported in selected patients can be expected in heavily pretreated patients is not known. Similarly, the costs of palliative chemotherapy are not known. We sought to determine the response, survival, and predictors of response in an unselected cohort of PROC patients receiving liposomal doxorubicin (LD) for relapsed disease, and the overall costs of delivering liposomal doxorubicin in this setting.

METHODS

In a cohort of 62 consecutive patients who initiated LD as second- or greater-line therapy for PROC, the following variables were examined: age, number of prior regimens for relapse disease, duration of first clinical remission, time from last prior treatment, dose intensity of LD received, response/clinical benefit, time to progression, toxic effects, and survival. Multivariate analyses were used to identify predictors of clinical benefit and overall survival. Direct medical charges were calculated and converted to costs, and major cost drivers determined.

RESULTS

Sixty-two patients received a total of 174 cycles of LD. The mean number of cycles per patient was 2 (range, 1-8); the median number of prior regimens for recurrent PROC was 2 (range, 0-8); and the median duration of the first clinical remission was 6 months. Median dose intensity of LD delivered was 11.4 mg/m(2)/week (range, 2.8-16.7 mg/m(2)/week). Nine of sixty-two patients (14.5%) had an objective clinical response by CA-125 and/or CT scan (95% confidence interval, 6-23%). Grade 3/4 toxicity occurred in 11% of patients. In the full cohort, median time to progression was 2.2 months, and median overall survival, 9.6 months (range, 0.2-26 months). Dose intensity was the only independent predictor of overall response. Duration of first clinical remission and number of prior salvage regimens were associated with longer overall survival. The mean total direct medical cost per cycle of LD was $5763, and the major cost drivers were hospitalizations and drug acquisition/delivery costs.

CONCLUSION

LD is an active agent in PROC, even when used as greater-than-second-line therapy. Among heavily pretreated patients, delivering a dose intensity of at least 9.0 mg/m(2)/week was associated with a higher probability of response. The cost per cycle of LD is driven by hospitalizations and drug acquisition/delivery costs.

Radical surgical resection and high-dose intraoperative radiation therapy (HDR-IORT) in patients with recurrent gynecologic cancers

OBJECTIVE

To determine the outcome for patients with recurrent gynecologic tumors treated with radical resection and combined high-dose intraoperative radiation therapy (HDR-IORT).

METHODS AND MATERIALS

Between November 1993 and June 1998, 17 patients with recurrent gynecologic malignancies underwent radical surgical resection and high-dose-rate brachytherapy. The mean age of the study group was 49 years (range 28-72 years). The site of the primary tumor was the cervix in 9 (53%) patients, the uterus in 7 (41%) patients, and the vagina in 1 (6%) patient. The treatment for the primary disease was surgery with or without adjuvant radiation in 14 (82%) patients and definitive radiation in 3 (18%) patients. The current surgery consisted of exenterative surgery in 10 (59%) patients and tumor resection in 7 (41%) patients. Complete gross resection was achieved in 13 (76%) patients. The mean HDR-IORT dose was 14 Gy (range 12-15). Additional radiation in the form of permanent Iodine-125 implant was given to 3 of 4 patients with gross residual disease. The median peripheral dose was 140 Gy.

RESULTS

With a median follow-up of 20 months (range 3-65 months), the 3-year actuarial local control (LC) rate was 67%. In patients with complete gross resection, the 3-year LC rate was 83%, compared to 25% in patients with gross residual disease, p < 0.01. The 3-year distant metastasis disease-free and overall survival rates were 54% and 54%, respectively. The complications were as follows: gastrointestinal obstruction, 4 (24%); wound complications, 4 (24%); abscesses, 3 (18%); peripheral neuropathy, 3 (18%); rectovaginal fistula, 2 (12%); and ureteral obstruction, 2 (12%).

CONCLUSION

Radical surgical resection and combined IORT for patients with recurrent gynecologic tumors seems to provide a reasonable local-control rate in patients who have failed prior surgery and/or definitive radiation. Patient selection is very important, however, as only those patients with complete gross resection at completion of surgery appear to benefit most from this radical approach in the salvage setting.

Identification of Risk Factors for Requiring Transfusion during Front-Line Chemotherapy for Ovarian Cancer

OBJECTIVE

Anemia requiring red blood cell (RBC) transfusion is common in ovarian cancer (OC) patients receiving post-debulking surgery chemotherapy. Erythropoietin use has been shown to decrease transfusion requirements in patients receiving chemotherapy. We sought to identify pretreatment risk factors that could identify patients at increased risk for requiring RBC transfusion during first-line treatment for ovarian cancer.

METHODS

One hundred seventy-five consecutive patients who received chemotherapy with either carboplatin-paclitaxel or cisplatin-paclitaxel following debulking surgery for epithelial OC from 1993 to 1996 were identified. No patient received erythropoietin. Patient characteristics recorded included: age, stage, prechemotherapy hemoglobin, nadir hemoglobin, number of cycles and doses of chemotherapy received. The outcome was requiring RBC transfusion. Independent predictors of requiring RBC transfusion were identified using multivariate analyses.

RESULTS

Median age of the cohort was 62 years (range, 28-86). Seventy-one and four-tenths percent had FIGO stage III/IV disease. Median prechemotherapy hemoglobin was 11 g/dL (range, 7.1-15.4); median nadir hemoglobin was 9.3 g/dL (range, 6.6-11.1). One hundred nineteen (66%) patients received cisplatin-paclitaxel, and 61 (34%) received carboplatin-paclitaxel. Of 175 patients, 31 (18%, 95% CI = 12-23%) required RBC transfusion. Independent risk factors for RBC transfusion were prechemotherapy hemoglobin <10 g/dL (P < 0.01, odds ratio = 3.78, 95% CI = 1.52-9.44) and carboplatin-paclitaxel versus cisplatin-paclitaxel treatment (P = 0.01, odds ratio = 3.14, 95% CI = 1.27-7.76). Of 175 patients, 40 (22.8%) had a prechemotherapy hemoglobin <10 g/dL. Fifty percent of patients with prechemotherapy hemoglobin <10 g/dL who received carboplatin-paclitaxel required RBC transfusion, compared with 7.7% of patients with hemoglobin >10 g/dL who received cisplatin-paclitaxel.

CONCLUSION

Ovarian cancer patients frequently require RBC transfusion during postdebulking platinum-paclitaxel chemotherapy. Patients with prechemotherapy hemoglobin <10 g/dL and those receiving carboplatin-paclitaxel are at increased risk of requiring RBC transfusion. Early initiation of erythropoietin use in such patients may reduce transfusion needs.

The effects of HIV infection on endothelial function

Endothelial dysfunction and/or injury is pivotal to the development of cardiovascular and inflammatory pathology. Endothelial dysfunction and/or injury has been described in Human Immunodeficiency Virus (HIV) infection. Elaboration of circulating markers of endothelial activation, such as soluble adhesion molecules and procoagulant proteins, occurs in HIV infection. Certain endothelial cells, such as those lining liver sinusoids, human umbilical vein endothelial cells, bone marrow stromal endothelial cells or brain microvascular endothelial cells, have been shown to be variably permissive for HIV infection. Entry of virus into endothelial cells may occur via CD4 antigen or galactosyl-ceramide receptors. Other mechanisms of entry including chemokine receptors have been proposed. Nevertheless, endothelial activation may also occur in HIV infection either by cytokines secreted in response to mononuclear or adventitial cell activation by virus or else by the effects of the secreted HIV-associated proteins, gp 120 (envelope glycoprotein) and Tat (transactivator of viral replication) on endothelium. Enhanced adhesiveness of endothelial cells, endothelial cell proliferation and apoptosis as well as activation of cytokine secretion have all been demonstrated. Synergy between select inflammatory cytokines and viral proteins in inducing endothelial injury has been shown. In HIV infection, dysfunctional or injured endothelial cells potentiate tissue injury, inflammation and remodeling, and accelerate the development of cardiovascular disease.

[Biological characteristics and occurrence regularity of Phassus excrescens Bulter]

The biological characterisitics and occurrence regularity of Phassus excrescens were studied from 1997 to 2000 in the eastern part of Heilongjiang Province and Jilin Province. In this area, most of its individuals took two years to finish one generation, and over-wintered two times with eggs and larvae, respectively. At the end of June or the first ten days of July, larvae transferred to damage Fraxinus mandshurica. Feeding with artificial diet indoor, the larvae finished 6 instars before pupation. In artificial Manchurican ash forest, the larva mainly damaged the truck basal(below 20 cm) or truck of 2 to 20 years old Fraxinus mandshurica. The occurrence amount of this species was closely related to the forest age and the stand structure. Usually, pure artificial Fraxinus mandshurica stands and Fraxinus mandshurica-Pinus koraiensis mixed stands were damaged seriously, while Fraxinus mandshurica-Larix mixed forests were damaged lightly.

Continent urinary diversion and low-rectal anastomosis in patients undergoing exenterative procedures for recurrent gynecologic malignancies

OBJECTIVE

The aim of this study was to review the complications associated with continent urinary diversion and associated procedures in patients with gynecologic malignancies.

METHODS

We retrospectively reviewed the medical records of all patients who underwent construction of a continent urinary conduit between October 1991 and October 1998 on the Gynecology Service at Memorial Sloan-Kettering Cancer Center.

RESULTS

Thirty-three patients were identified, of whom 22 underwent total pelvic exenteration, 8 underwent anterior exenteration, and 3 underwent urinary diversion procedures only. Complications associated with the urinary diversion procedure included ureteral strictures (2), pouch leakage (2), mild hydronephrosis, (6), pyelopnephritis (2), nocturnal incontinence (5), and difficulty with self-catheterization (2). Additional procedures performed concomitantly with continent urinary diversion and exenteration included pelvic reconstruction (18), low-rectal anastomosis (13), and intraoperative radiation therapy (9). The most significant morbidity was seen in patients undergoing concomitant low-rectal anastomosis, in whom the rate of anastomotic leaks was 54% (7 of 13 patients).

CONCLUSIONS

Continent urinary diversion can successfully be accomplished at the time of exenteration in patients with recurrent gynecologic malignancies. The rate of major complications related to the urinary diversion is small and most complications can be managed nonsurgically. The greater than 50% rate of anastomotic leaks in patients undergoing concomitant low-rectal anastamosis suggests that such anastomosis should not be undertaken in this group of patients.

Long-term effects of antidepressants on balance, equilibrium, and postural reflexes

To assess the long-term effects of antidepressant medication on balance, equilibrium, and postural reflexes, we studied 30 patients, ages 20-76 years, who had a diagnosis of depressive disorder (as defined by DSM-III-R criteria) and had been treated with tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs) for > or = 1 year. They were assessed by a Balance Master System. The assessment included three tasks: static balance, rhythmic weight shift, and limits of stability. When compared with 30 nonhospitalized healthy controls (of comparable age and the same sex), patients who took TCAs showed impaired balance function in all main indices. The results suggest that the impairment of balance function includes motor coordination, fine-motor control, postural reflexes, maintaining equilibrium, and reaction time. No obvious impairment of balance function was observed in patients who took SSRIs.

Single missense mutation in the tyrosine kinase catalytic domain of the RET protooncogene is associated with multiple endocrine neoplasia type 2B

Multiple endocrine neoplasia type 2B (MEN 2B) is a human cancer syndrome characterized by medullary thyroid carcinoma (MTC), pheochromocytomas, mucosal neuromas, ganglioneuromas of the intestinal tract, and skeletal and ophthalmic abnormalities. It appears both as an inherited disorder and as de novo disease. Sequence analysis of germ-line DNA from MEN 2B patients revealed the existence of the same point mutation in the RET protooncogene in 34 unrelated individuals. This sequence difference was not observed in 93 unaffected individuals, including the normal parents of 14 de novo MEN 2B patients. The mutation (ATG-->ACG) results in the replacement of methionine with threonine within the catalytic core region of the tyrosine kinase domain. We propose that this amino acid replacement effects substrate interactions and results in dominant oncogenic activity by the RET protein. Missense mutations in the extracellular ligand-binding domain of the RET protooncogene previously have been associated with two other disorders [MEN 2A and familial MTC (FMTC)] in which MTC is observed. MEN 2B represents the third form of heritable MTC known to be an allele of RET. Alterations in two different functional domains of the putative receptor protein tyrosine kinase are implicated in development of MTC.

Lymphocytes infiltrating rat cardiac allografts express a limited repertoire of T cell receptor V beta genes

The T cell response to many self-MHC-restricted nominal Ag involves limited use of the TCR repertoire. The status of the TCR repertoire in allogeneic responses remains unclear. In this report, we have studied the TCR V beta gene repertoire involved in the rejection of cardiac allografts disparate for major and minor histocompatibility Ag in rats. Graft-infiltrating lymphocytes (GIL) were isolated from rejecting heart allografts and analyzed for the expression of the V beta repertoire using a cDNA library and a semiquantitative polymerase chain reaction (PCR). We report here that GIL isolated at early stages of the rejection reaction preferentially use the V beta 4 gene. First, V beta 4 comprised 36.4% (8/22) of randomly sequenced cDNA clones isolated from a TCR-beta chain-specific cDNA library established from GIL harvested 3 days posttransplantation. The V beta 4 gene in these clones was found in conjunction with several different J beta and N regions, suggesting a dominant role for the V beta 4 encoded domains in the recognition of allograft Ag. Second, the V beta 4 message comprised 56.6 to 65.7% of the transcripts expressed by the 20 rat V beta genes in three T cell lines established from GIL isolated 2 days posttransplantation. Third, fresh, unmanipulated GIL harvested at days 2 and 3 posttransplantation predominantly expressed the V beta 4 gene. Fourth, the expression of V beta 4 in naive splenocytes constituted only 5.4% of the V beta detected, suggesting that the predominant use of the V beta 4 gene by GIL was not a consequence of its high level of expression in the periphery. The limited use of the TCR repertoire in allograft rejection may provide the opportunity to interrupt the rejection process and induce donor-specific tolerance by targeting a select population of T cells for inactivation or elimination.