Smart investments in sustainable food production: revisiting mixed crop-livestock systems

Farmers in mixed crop-livestock systems produce about half of the world's food. In small holdings around the world, livestock are reared mostly on grass, browse, and nonfood biomass from maize, millet, rice, and sorghum crops and in their turn supply manure and traction for future crops. Animals act as insurance against hard times and supply farmers with a source of regular income from sales of milk, eggs, and other products. Thus, faced with population growth and climate change, small-holder farmers should be the first target for policies to intensify production by carefully managed inputs of fertilizer, water, and feed to minimize waste and environmental impact, supported by improved access to markets, new varieties, and technologies.

The limits and potential of community development for personal and social change

Some health and welfare workers are making claims for community development which are both unrealistic and misleading. By tracing the history and public policy use of community development and by defining its characteristics, much of the mystique which surrounds this intervention is eliminated. Community development is revealed in this paper to have potential in the areas of personal and planned social change. However, community development's contribution to fundamental social change is circumscribed by the nature of government sponsorship and by its very process which emphasizes parochialism and the generation of self reliance.

Inflammatory effects of nutritional stimuli: further support for the need for a big picture approach to tackling obesity and chronic disease

The discovery of a form of low-grade systemic inflammation (called 'metaflammation'), and the close evolutionary link between the immune and metabolic systems, poses questions about the supposed antigens (inducers) of such an immune reaction. Initially, this was thought to be mediated through obesity. However, we have identified a number of lifestyle or environmentally related inducers that may cause metaflammation, even in the absence of obesity. In this paper, the third of a series linking obesity with broad environmental and evolutionary factors, we identify nutritional stimuli with evidence of an involvement in metaflammation. From this we propose that components of certain foods and beverages with which humans have not evolved, are more often the inducers of an inflammatory effect in the body than those with which humans have become more familiar, and to which a neutral, or anti-inflammatory response may be expected to have developed. The implications of such a finding are considered in relation to broader aspects of the environment, economic growth, policy change and current global financial issues.

Early Assessment of Proliferation by the Genomic Grade Index (GGI) Predicts Response to Neo-Adjuvant Letrozole

Background: Expression of the proliferation antigen Ki-67 after short-term pre-surgical endocrine treatment is predictive of long-term relapse free survival in post-menopausal women with estrogen-receptor (ER) positive breast cancer (Dowsett et al., JNCI 2007). There are no established predictive markers of clinical response to neo-adjuvant endocrine therapy.Methods: Whole genome expression profiles (Affymetrix HG-U133A) from paired tumor biopsies before and after 10 to 14 days of neo-adjuvant letrozole were compared to tumor volume changes over 3 months of treatment for 52 post-menopausal women with hormone receptor positive breast cancer to evaluate early predictive markers of clinical response.Results: Clinical response was observed in 80% Luminal A (24/30) and 59% Luminal B (13/22) tumors (p=0.1). Baseline tumor proliferation assessed by GGI or Ki-67 mRNA expression were not predictive of clinical response (p=0.29 and p=0.73 respectively). The absolute value of GGI at Day 10 to 14 was predictive of clinical response (p=0.001), particularly for luminal B (p=0.001) but not luminal A (p=0.35) tumors. The change in GGI from baseline to Day 10 to 14 was marginally predictive of response (p=0.063). Absolute day 10 to 14 Ki67 mRNA expression and the change in Ki67 mRNA were not associated with clinical response (p=0.54 and p=0.58 respectively). Baseline, absolute Day 10 to 14, and change in the expression of the ER gene (ESR1) or an integrative gene module reflecting ER signaling were not predictive of clinical response.Conclusion: Expression of GGI after 10 to 14 days of neo-adjuvant letrozole and the change in GGI with short-term treatment are predictive of clinical response observed after 3 months of therapy. Early assessment of GGI may be useful to determine which post-menopausal patients with highly-proliferative ER-positive disease benefit from endocrine therapy.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2016.

miRNA Profiling of Endocrine-Resistant Breast Tumours

RationalemiRNAs are a relatively recently discovered class of molecules with major implications in cellular biology, including tumorigenesis; yet little is known about their possible involvement in the development of endocrine resistance in breast cancer. The aim of this study was to identify sub-groups of endocrine-resistant tumours with distinctive miRNA profiles.Methods and ResultsFrozen biopsies were obtained from a series of 51 breast cancers, which were either progressing primary tumours, local recurrences or contra-lateral breast lesions developed while patients received endocrine treatment. Hormonal treatment included aromatase inhibitors or tamoxifen, most of the patients reached post-menopausal age, miRNA profiles were obtained using Illumina DASL® Sentrix Array Matrix.Un-supervised hierarchical clustering split 51 studied endocrine resistant tumours into two major groups, distinctive in their miRNA profiles. Several of miRNAs discriminating between the clusters have already been implemented in breast cancer (mir7, mir10a, mir205, mir206, mir 210). Most of the other miRNAs associated with the main tumour clusters are yet to be studied in relation to breast cancer biology (e.g. mir192, mir625, mir941, mir145 and mir512 among others). The miRNA-based tumour clusters were not clearly associated with a specific treatment or type of resistance. The miRNAs most clearly able to discriminate between tumours resistant to AIs and Tamoxifen included mir186, mir196a, mir196b and miR-594:9.1 (p<0.05, fold change >1.2).DiscussionThe results show heterogeneity of miRNA profiles in endocrine resistant breast cancers, for the first time suggesting that endocrine resistant tumours can be split into two major molecular sub-groups basing on their miRNA profiles. The results suggest that (i) miRNA-mediated gene expression regulation may be involved in the mechanisms of endocrine resistance and (ii) miRNA profiling allows different molecular sub-classes of endocrine-resistant tumours to be distinguished.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5130.

Effectiveness of Neoadjuvant Letrozole of Invasive Lobular Cancers

Background:Invasive lobular cancers are poorly responsive to neoadjuvant chemotherapy. They are commonly hormone sensitive. This study set out to investigate the efficacy of neoadjuvant letrozole in post-menopausal women with large operable or locally advanced breast cancers.Patients and Methods:48 consecutive patients with large operable or locally advanced invasive lobular ER positive (Allred score 8 = 38, 7 =8, 6=1, 5=1) were treated in a single Breast Unit by neoadjuvant letrozole for 3 months or longer. The mean age was 76.7 years with a range of 55 to 91 years. 6 tumours measured >2-4 cm (T2), 26 tumours measured >4 cm (T2, T3) and 16 were locally advanced (T4). Response was assessed by a single observer at 3 months.Results:Response to TreatmentThe mean reduction in clinical volume at 3 months was 60% (95% CI 50-79%) with a median of 67% (95% CI 60-79%). Responses were classified as 1 Complete Response (CR), 25 Partial Response (PR), 16 Minimal Response (MR), 4 Stable Disease (SD) and 2 Progression.The mean USS in volume was 69% (60-78%), with a median of median 80% (66-84%). Response was classified as CR= 12, PR = 25, MR = 7, SD = 3 and Progression = 1.Surgery and Outcome32 have come to surgery and 16 have continued on letrozole.24 patients were considered suitable for breast conserving surgery (WLE) of whom 16 successful had WLE (67% with Clear Margins), 4 had a WLE and then a successful re- excision of margins and 4 had a WLE followed by mastectomy. The final rate of successful breast conservation was thus 20/24 (83%).8 patients with locally advanced breast cancer became operable and were treated by mastectomy.SummaryThis is the largest series of invasive lobular carcinomas treated by neoadjuvant letrozole ever reported.Invasive lobular carcinomas are often large at diagnosis.They are mainly ER rich.In post-menopausal women they respond well to endocrine therapy with letrozole.Neoadjuvant therapy with letrozole allows many women with large invasive lobular carcinomas to be treated successfully with breast conservation.This contrasts with the poor results obtained with neoadjuvant chemotherapy.ConclusionNeoadjuvant letrozole therapy is an effective treatment for shrinking invasive lobular ER positive breast cancers in post-menopausal women.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 1085.

Gene Expression Profiles of Endocrine Resistant Breast Tumours

AimTo identify molecular sub-classes of endocrine-resistant breast tumours.MethodsWhole genome expression profiles of 55 endocrine-resistant tumours were obtained using Illumina HT-12 BeadChip arrays. Endocrine resistance was defined as either (i) tumour increased in size during hormonal treatment or (ii) appearance of local recurrence or (iii) contra-lateral breast lesion (metastases or new cancers) during hormonal treatment. Most of the treated patients were post-menopausal. Hormonal treatment included either aromatase inhibitors (letrozole, anastrazole, arimidex) or tamoxifen.ResultsUnsupervised hierarchical clustering using 500 most variable genes split tumours into three major clusters of approximately equal size. The genes discriminating between these clusters included oestrogen receptor- and proliferation- associated set of genes (ESR1, TFF1, TFF3, FOXA1, AGR2, AGR3, XBP1, GATA3, PRAD6B, MYB, CCND1), and stroma-related genes (DCN, COL1A1, COL1A2, COL3A1, COL5A2). Initial analysis of the studied tumours was unable to identify genes associated with clinical features. Sub-division of the dataset may be required to identify these genes more clearly. Genes that tended to separate between tumours resistant to AI and Tamoxifen included MYB, GPR137B, RNF19A, FRMD6, ZNF217 and RPS12. More detailed analysis of the data is underway.DiscussionUnderstanding and overcoming of endocrine resistance will improve treatment results for the majority of breast cancer patients. This abstract reports a new gene expression dataset to compare molecular features of biopsies collected from tumours growing while on endocrine treatment. The initial analysis demonstrates diversity of the resistance mechanisms, enhancing development of individual approaches to endocrine-resistant tumours.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5132.

A Randomised Study Comparing the Effects of Adjuvant Anastrozole (A), Letrozole (L) and Exemestane (E) on Lipid Metabolism

Background:Aromatase inhibitors (AIs) reduce circulating oestrogen which may have a detrimental effect on lipid metabolism and subsequently ↑ cardiovascular risk. This study compares the effects of adjuvant A, L and E on lipid metabolism.Patients and Methods:This was an open, randomised pharmacodynamic study. Plasma lipids were measured in 120 postmenopausal women with invasive ER +ve breast cancer. As part of their adjuvant hormone therapy, patients were randomized to receive either:• 4 months of A or• 4 months of L or• 4 months of EFasting blood and urine samples were collected at the same time of day on each of (a) the day of entry, (b) after 3 months and (c) after 4 months. Patients were then switched to tamoxifen (T) and further samples collected after 12 months.• Triglycerides, cholesterol, ApoB and cLDL were measured.↑ levels are associated with ↑ cardiovascular risk.• ApoA-1 and HDL were also measured.↑ levels are associated with ↓ cardiovascular risk.Analyses were performed using repeated measures or analysis of covariance.ResultsDifferences between A vs L vs ETriglycerides E significantly ↓ triglycerides. There was a borderline significant difference between the drugs (p=0.055).Cholesterol E significantly ↓ cholesterol (p=0.03).ApoB No significant changes were detected.cLDL No significant changes were detected.ApoA-1 There were no significant differences detected between A or L although the fall with E was less but not significantly different to A or L (p=0.08).HDL E significantly ↓ HDL (p=0.008).Differences between steroidal vs non-steroidal AIsTriglyceride and ApoA-1 levels fell significantly more with E compared to the non-steroidal A+L (p=0.02, p=0.045 respectively).Effects of tamoxifenChanges from baseline after treatment on AIs and subsequent treatment with TFollowing T there was no evidence to suggest that the changes from baseline were influenced by the type of AI that patients received.Changes from end of treatment on AIs and subsequent treatment with TT increased HDL by a statistically significant greater amount following E than it did after A or L (p=0.009). From the end of treatment with AIs, T produced significant rises in triglyceride (p=0.0001), HDL (p=0.006) and ApoA1 (p=0.0003), and significant falls in cholesterol (p=0.03) and cLDL (p<0.0001).Conclusions:There were no significant differences between letrozole, anastrozole and exemestane and their effects on cholesterol, HDL, cLDL or ApoB.There was a significant difference between steroidal and non-steroidal in their effect on triglycerides and ApoA1.Tamoxifen had significant effects on lipids lowering cholesterol and cLDL and increasing triglycerides HDL and ApoA-1.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4086.

Adiposopathy and bariatric surgery: is 'sick fat' a surgical disease?

OBJECTIVE

To review how bariatric surgery in obese patients may effectively treat adiposopathy (pathogenic adipose tissue or 'sick fat'), and to provide clinicians a rationale as to why bariatric surgery is a potential treatment option for overweight patients with type 2 diabetes, hypertension, and dyslipidaemia.

METHODS

A group of clinicians, researchers, and surgeons, all with a background in treating obesity and the adverse metabolic consequences of excessive body fat, reviewed the medical literature regarding the improvement in metabolic disease with bariatric surgery.

RESULTS

Bariatric surgery improves metabolic disease through multiple, likely interrelated mechanisms including: (i) initial acute fasting and diminished caloric intake inherent with many gastrointestinal surgical procedures; (ii) favourable alterations in gastrointestinal endocrine and immune responses, especially with bariatric surgeries that reroute nutrient gastrointestinal delivery such as gastric bypass procedures; and (iii) a decrease in adipose tissue mass. Regarding adipose tissue mass, during positive caloric balance, impaired adipogenesis (resulting in limitations in adipocyte number or size) and visceral adiposity are anatomic manifestations of pathogenic adipose tissue (adiposopathy). This may cause adverse adipose tissue endocrine and immune responses that lead to metabolic disease. A decrease in adipocyte size and decrease in visceral adiposity, as often occurs with bariatric surgery, may effectively improve adiposopathy, and thus effectively treat metabolic disease. It is the relationship between bariatric surgery and its effects upon pathogenic adipose tissue that is the focus of this discussion.

CONCLUSIONS

In selective obese patients with metabolic disease who are refractory to medical management, adiposopathy is a surgical disease.

Cost and clinical consequence of antibiotic non-adherence in acute exacerbations of chronic bronchitis

OBJECTIVE

To quantify the impact of non-adherence on the clinical effectiveness of antibiotics for acute exacerbations of chronic bronchitis (AECB) and to estimate the economic consequences for Spain, Italy and the United States.

METHODS

Standard systematic reviewing procedures were followed to identify randomised controlled clinical trials of antibiotic treatment for acute respiratory tract infection for which adherence was reported. A decision-analytic model was then constructed to evaluate the impact of non-adherence to antibiotic treatment on clinical effectiveness and costs per AECB episode. The model compared the total treatment costs, cure rates and incremental costs per cure for a poor compliance group (PCG) against a good compliance group (GCG). Clinical and resource use estimates were from the published literature and physician surveys.

RESULTS

Twenty-five articles met the criteria of the systematic review, although only one reported treatment success by adherence status. The relative risk of clinical effectiveness if non-adherent was 0.75 (95%CI 0.73-0.78). Based on this single study, the model predicted that 16-29% more patients would be cured in the GCG vs. the PCG, and payers would save up to euro122, euro179 and US$141 per AECB episode in Spain, Italy and the United States, respectively.

CONCLUSIONS

Non-adherence to antibiotics for AECB may have an impact on clinical effectiveness, which is associated with increased costs.

An assessment of the Down syndrome antenatal screening policies of East and West Gloucestershire between 1993 and 1999

This retrospective observational study of registered pregnancies in Gloucestershire between 1 April 1993 and 31 March 1999 compares the impact of different Down syndrome antenatal screening policies on detection and amniocentesis rates. The screening policies in East and West Gloucestershire are based on early second-trimester maternal serum and maternal age screening, respectively. Maternal serum screening can identify a greater proportion of pregnancies affected by Down syndrome than a programme founded on age-based amniocentesis and 20 weeks' ultrasound. In addition, maternal serum screening of women older than 34 approximately halves the number of amniocenteses performed to detect one affected fetus. However, the proportion of pregnant women who have amniocentesis is nearly doubled by offering serum screening to women aged over 24 years. These findings of the impact of established second-trimester screening policies in low-risk populations provides an useful benchmark to compare the performance of screening procedures that will be introduced in the United Kingdom over the next 3 years.

Evaluation of static and dynamic postural stability in established rheumatoid arthritis: exploratory study

BACKGROUND

It has been proposed that people with rheumatoid arthritis experience difficulties in postural control and activities of daily living such as walking. The aim of the study is to evaluate postural stability in rheumatoid arthritis patients.

METHOD

A convenience sample of 19 rheumatoid arthritis patients (mean duration 13.1+/-9.2 years) were aged matched with a non-rheumatoid group (n=21). Postural stability was measured using a force plate for anterior-posterior and mediolateral centre of pressure excursion for 30s with eyes closed and open. Patients also performed three walks at a self-selected speed and mean temporal-spatial parameters were recorded.

FINDINGS

Significant differences were observed between the groups in anterior-posterior centre of pressure excursion during the eyes open task and the eyes closed task (P<0.05). No significant differences were found in the mediolateral centre of pressure excursion during either condition (P>0.05). The rheumatoid group displayed a significantly slower mean walking velocity, double support, cadence and cycle time than the non-rheumatoid group (P<0.05).

INTERPRETATION

The results from this study showed that rheumatoid arthritis patients displayed a significantly larger centre of pressure excursion in the anterior-posterior direction during quiet standing, when compared to a non-rheumatoid arthritis control group suggesting that postural control mechanisms such as ankle strategies are impeded by the rheumatoid process.

Should obesity be the main game? Or do we need an environmental makeover to combat the inflammatory and chronic disease epidemics?

There is a link between obesity and chronic disease. However, the causal relationship is complicated. Some forms of obesity are associated with low-level systemic inflammation, which is linked to disease. But lifestyle behaviours that may not necessarily cause obesity (poor diet, inadequate sleep, smoking, etc.) can independently cause inflammation and consequent disease. It is proposed here that it is the environment driving modern lifestyles, which is the true cause of much chronic disease, rather than obesity per se, and that obesity may be a marker of environmental derangement, rather than the primary cause of the problem. Attempts to clinically manage obesity alone on a large scale are therefore unlikely to be successful at the population level without significant lifestyle or environmental change. Environmental factors influencing obesity and health have now also been implicated in ecological perturbations such as climate change, through the shift to positive energy balance in humans caused by the exponential use of fossil fuels in such areas as transport, and consequent rises in carbon emissions into the atmosphere. It is proposed therefore that a more policy-based approach to dealing with obesity, which attacks the common causes of both biological and ecological 'dis-ease', could have positive effects on both chronic disease and environmental problems. A plea is thus made for a greater health input into discussions on environmental regulation for chronic disease control, as well as climate change.

Body mass index and health-related behaviours in a national cohort of 87,134 Thai open university students

BACKGROUND

Thailand is undergoing a health-risk transition with overweight and obesity emerging as an important population health problem. This paper reports on a study of the transition, focusing on "lifestyle" factors such as diet (fried foods, soft drinks, Western-style fast foods) and physical activity (mild, moderate, strenuous exercise, housework/gardening and screen time).

METHODS

A baseline survey was administered to 87 134 adult students from all regions of Thailand attending an open university.

RESULTS

54% of the cohort was female. Participants' median age was 29 years. By self-reported Asian standards, 16% of the sample was obese (body mass index (BMI)>or=25) and 15% overweight at risk (BMI>or=23-24.9). Men were twice as likely as women to be overweight (21% vs 9%) or obese (23% vs 10%). Obesity was associated with urban residence and doing little housework or gardening and with spending more than 4 hours a day watching television or using computers. The latter occurred among 30% of the cohort, with a population attributable fraction (PAF) suggesting that it accounts for 11% of the current problem. Daily consumption of fried food was associated with obesity, and eating fried foods every second day or daily had a PAF of nearly 20%.

CONCLUSIONS

These health-related behaviours underpinning the Thai health transition are associated with increasing obesity. They are modifiable through policies addressing structural issues and with targeted health promotion activities to prevent future obesity gains. Insights into future trends in the Thai health transition can be gained as this student cohort ages.

A randomised study comparing the effects of anastrozole (A), letrozole (L), exemestane (E) and tamoxifen (T) on coagulation

Abstract #1132

Background:&#x2028; Aromatase inhibitors (AIs) reduce circulating oestrogens and so should have either no or a positive effect on coagulation . This study compares the effects of the non-steroidal aromatase inhibitors, A and L and the steroidal inactivator, E on coagulation.&#x2028; Patients and Methods:&#x2028; This was an open, randomized pharmacodynamic study. Plasma coagulation factors were measured in 120 postmenopausal women with invasive ER +ve breast cancer. As part of their adjuvant hormone therapy, patients were randomized to receive upfront therapy with either:&#x2028; 16 weeks of A, 16 weeks of L or 16 weeks of E.&#x2028; Fasting blood samples were collected at entry and after 12 and 16 weeks of each drug. AI patients were then switched to T and further samples measured after 8 months on T.&#x2028; Plasminogen activator inhibitor (PAI) antigen, von Willebrand's Factor (vWF) antigen, antithrombin III (AT111), protein C, protein S total, protein S free, activated protein C, resistance (APCR), factor VIII and fibrinogen were measured.&#x2028; Results:&#x2028; Results expressed as % change from baseline.&#x2028; E vs A vs L&#x2028; Protein C. E caused a significant fall compared to A and L (-15.75 (-21.48, -10.02) vs -3.80 (-10.77, 3.16) vs -3.63 (-10.50, 3.25)) respectively. p = 0.008.&#x2028; ATIII. E caused a significant fall from baseline (-8.55 (-13.33, -3.79))&#x2028; Protein S Free. E + A caused a significant increase from baseline (E 6.90 (1.98, 11.82), A 7.36 (1.37, 13.34).&#x2028; Steroidal vs non-steroidal:&#x2028; Protein C. A significantly greater fall was seen with E than A+L (-15.75 (-21.45, -10.05) vs -3.71 (-8.58, 1.15)) p = 0.002.&#x2028; vWF A+L caused a significant increase from baseline (6.52 (0.66, 12.38) but this was not statistically different to E 5.02 (-1.88, 11.91)).&#x2028; ATIII A significant decrease from baseline was seen with A + L, -4.54 (-8.64, -0.43) but no difference from E 8.55 (13.31, -3.70) p=0.21.&#x2028; Protein S Free There was a significant increase from baseline in both groups (A+L: 5.70 (1.47, 9.92), E: 6.90 (1.98, 11.81), but no difference between the groups p=0.72.&#x2028; T effect:&#x2028; AT111 and protein C levels fell significantly on T whereas protein S free increased on T. Prior A, E or L had no significant impact on post-tamoxifen results.&#x2028; Conclusions:&#x2028; No significant differences in any coagulation factors were seen between A and L&#x2028; E caused a significant fall in protein C and ATIII.&#x2028; The non-steroidal AIs caused a significant increase in vWF.&#x2028; T caused a significant fall in protein C and ATIII and a significant increase in protein S free.&#x2028; No AI significantly influenced post-tamoxifen results.&#x2028; These drugs have significant effects on coagulation which helps to explain their clinical effects on thrombotic and thromboembolic disease.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1132.

Computational inference of gene expression signatures differentiating between breast cancers responsive or resistant to letrozole

Abstract #3024

Introduction:Genes which have been shown either to be differentially expressed or differentially changed between responders and non-responders to the neoadjuvant treatment with the aromatase inhibitor letrozole have been described. However, their network structure and interconnectivity have not been formally analysed.Bayesian network (BN) inference algorithms have demonstrated promise in the analysis of genomics data to recover fragments of biological pathways due to their ability to capture many types of relationships between variables and to handle noisy data.An inference score (4), normalized to be between -1 and 1, is a measure of the strength of the interaction (either positive or negative) between different nodes in the recovered network.&#x2028; Materials and methods:This computational study uses BN methodology to elucidate any possible network structure and refine a gene expression signature distinguishing responders from non-responders groups to letrozole treatment. It has been applied to 205 covariables (69 baseline expression, 45 day 14 expression and 91 changes in expression with treatment), identified via Random Forests as being differentially expressed between 37 tumours responding to neoadjuvant letrozole and 15 non-responders. The number of false positive relationships was limited by considering 4 different sub-sets of the original data 1) all 205 variables, but allowing for limited connectivity between them; 2) only the baseline variables 3) only the change variables with treatment and 4) only day 14 post-treatment variables. It was conjectured that the variables linking significantly to response status would appear in the overlap between lists 1) and 2), lists 1) and 3) and lists 1) and 4).&#x2028; Results:The analysis of the overall dataset highlighted the importance and the interconnectivity of ribosomal proteins. More specifically, the BN algorithm found two connected networks of 20 genes each with 13 and 14 ribosomal proteins and an average inference score of 0.65. In addition, BN links patient type (responder vs. non-responder) directly to genes that have been implicated in the natural history of breast cancer such as BCL-2 and KIAA0101 with inference scores of 0.4 and 0.45, respectively. The inferred network also contained a link with inference score of 0.4 between patient type and phosphatidylinositol glycan, whose oncogenic role has been suggested by others. The preliminary network analysis of the baseline covariables did not yield any meaningful pattern that differentiates the two patient types, except for the involvement of the cyclin E2 pathway with a “composite” inference score of 0.33.&#x2028; Conclusions: With initial encouraging results, further refinement of the BN analysis, as well as enrichment of the data should facilitate the discovery of a predictive baseline gene expression pattern.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3024.

Prolonged human chorionic gonadotrophin stimulation as a tool for investigating and managing undescended testes

OBJECTIVE

To observe the outcome in a group of children with undescended testes (UDT) given prolonged human chorionic gonadotrophin (hCG) stimulation as part of their management.

STUDY DESIGN

Retrospective review of 16 prepubertal boys given intramuscular hCG, 1500 U, on Days 1, 2 and 3 and then twice a week for 2 weeks with assessment of serum testosterone (T), SHBG, dihydrotestosterone (DHT) and androstenedione (A) on Days 1, 4 and 22.

RESULTS

In seven boys (44%), peak rise in T was by Day 4; in 5 boys (31%), the rise was by Day 22 and in the remainder, serum T stayed low. The median Day1 testosterone : androstenedione (T : A) ratio rose from 0.4 (range 0.2-1.5) to 1.7 (range 0.2-5.3) at Day 4 (P < 0.05) with no further rise by Day 22. The median dihydrotestosterone : testosterone ratio (DHT : T) at Day 1 and Day 4 remained unchanged. SHBG levels were more likely to be lower at Day 22 than at Day 4. The mean testosterone : SHBG (T : SHBG) ratio as a marker of androgen sensitivity was 0.2 (1SD 0.1). Bilateral testicular descent deemed immediate surgery unnecessary in 3 out of 15 (20%) boys where outcome data were available.

CONCLUSION

Whilst a 3-day hCG stimulation regimen may exclude 17beta-hydroxysteroid dehydrogenase-3 and 5alpha-reductase deficiencies, some boys with cryptorchidism may require more prolonged stimulation to assess androgen production and sensitivity. The possibility that this regimen leads to a reduced need for orchidopexy requires further exploration.

Histological progression of non-alcoholic fatty liver disease: a critical reassessment based on liver sampling variability

BACKGROUND

In non-alcoholic fatty liver disease, histological lesions display a significant sampling variability that is ignored when interpreting histological progression during natural history or therapeutic interventions.

AIM

To provide a method taking into account sampling variability when interpreting crude histological data, and to investigate how this alters the conclusions of available studies.

METHODS

Natural history studies detailing histological progression and therapeutic trials were compared with the results of a previously published sampling variability study.

RESULTS

Natural history studies showed an improvement in steatosis, which was significantly higher than expected from sampling variability (47% vs. 8%, P < 0.0001). In contrast, no study showed a change in activity grade or ballooning higher than that of sampling variability. There was only a marginal effect on fibrosis with no convincing demonstration of a worsening of fibrosis, a conclusion contrary to what individual studies have claimed. Some insulin sensitizing drugs and anti-obesity surgery significantly improved steatosis, while most did not significantly impact on fibrosis or activity.

CONCLUSIONS

Sampling variability of liver biopsy is an overlooked confounding factor that should be considered systematically when interpreting histological progression in patients with non-alcoholic fatty liver disease.

FBN1, TGFBR1, and the Marfan-craniosynostosis/mental retardation disorders revisited

The recent identification of TGFBR2 mutations in Marfan syndrome II (MFSII) [Mizuguchi et al. (2004); Nat Genet 36:855-860] and of TGFBR1 and TGFBR2 mutations in Loeys-Dietz aortic aneurysm syndrome (LDS) [Loeys et al. (2005); Nat Genet 37:275-281] [OMIM 609192] has provided direct evidence of abnormal signaling in transforming growth factors beta (TGF-beta) in the pathogenesis of Marfan syndrome (MFS). In light of this, we describe the phenotypes and genotypes of five individuals. Patient 1 had MFS and abnormal cranial dura. Patient 2 had severe early onset MFS and an abnormal skull. Patients 3 and 4 had probable Furlong syndrome (FS). Patient 5 had marfanoid (MD) features, mental retardation (MR), and a deletion of chromosome 15q21.1q21.3. All patients had a condition within the MFS, MD-craniosynostosis (CS) or MD-MR spectrum. The names of these entities may become redundant, and instead, come to be considered within the spectrum of TGF-beta signaling pathway disorders. Two recurrent heterozygous FBN1 mutations were found in Patients 1 and 2, and an identical novel heterozygous de novo TGFBR1 mutation was found in Patients 3 and 4, in whom altered fibrillin-1 processing was demonstrated previously [Milewicz et al. (2000); Am J Hum Genet 67:279]. A heterozygous FBN1 deletion was found in Patient 5. These findings support the notion that perturbation of extracellular matrix homeostasis and/or remodeling caused by abnormal TGF-beta signaling is the core pathogenetic mechanism in MFS and related entities including the MD-CS syndromes.