Chorionic villus sampling for early prenatal diagnosis: Experience at a mainland Chinese hospital

The aim of this study was to describe the experience of transabdominal chorionic villus sampling (CVS) at a mainland Chinese hospital. During a 7-year period, 1,172 pregnant women chose to have CVS for prenatal diagnosis. Details and outcome of all of these cases were reviewed. The median maternal age was 29 years (range 19-45). The median gestational age was 12 weeks (range 10-14). Fetal karyotyping and thalassaemia couples were the main indications (97.2%). Overall, 112 (9.7%) chromosomal abnormalities were identified. There were 91 (7.8%) major chromosomal abnormalities, including autosomal trisomy in 70 patients, sex chromosomal abnormalities in 17, triploidy in two and unbalanced chromosomal rearrangement abnormality in two. Additionally, 137 fetuses with severe thalassaemia syndrome were found, including 86 homozygous β-thalassaemia, and 51 homozygous α-thalassaemia or non-deletional haemoglobin H disease. The procedure failed to obtain an adequate sample in four (0.3%) patients. There were 229 pregnancies terminated for medical indications after CVS. There were three (0.3%) potentially procedure-related fetal losses. CVS is a safe and reliable prenatal diagnostic technique. It should be one of the options available to pregnant women who require prenatal diagnosis.

Efficacy and safety profile of combining vandetanib with chemotherapy in patients with advanced non-small cell lung cancer: a meta-analysis

Objective

To evaluate the efficacy and safety profile of combining vandetanib with chemotherapy in patients with advanced non-small cell lung cancer (NSCLC).

Methods

MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), ASCO Abstracts, ESMO Abstracts, Wanfang Database, CNKI were searched. Eligible studies were the randomized clinical trials (RCTs) that compared the efficacy and safety profile of adding vandetanib to chemotherapy with single chemotherapy in patients with advanced NSCLC. The outcomes included overall survival (OS), progression-free survival (PFS), overall response rate (ORR) and toxicities. All meta-analysis were performed using Review Manager 5.1. The fixed-effect model weighted by the Mantel-Haenszel method was used. When considerable heterogeneity was found (p<0.1, or I²>50%), further analysis (subgroup analysis, sensitivity analysis or random-effect model) was performed to identify potential cause.

Results

Results reported from 5 RCTs involving 2284 patients were included in the analysis. Compared to chemotherapy alone, the addition of vandetanib resulted in a significant longer PFS (HR 0.79 [0.72–0.87], p<0.00001) and a higher ORR (RR 1.75 [1.43–2.15], p<0.00001), but failed to show advantage on OS (HR 0.96 [0.87–1.06], p = 0.44).

Conclusion

Vandetanib has activity in NSCLC. Identification of predictive biomarkers is warranted in future trials to select a subset of patients with advanced NSCLC who may benefit from vandetanib.

Brg1 governs a positive feedback circuit in the hair follicle for tissue regeneration and repair

Hair follicle stem cells (bulge cells) are essential for hair regeneration and early epidermal repair after wounding. Here we show that Brg1, a key enzyme in the chromatin-remodeling machinery, is dynamically expressed in bulge cells to control tissue regeneration and repair. In mice, sonic hedgehog (Shh) signals Gli to activate Brg1 in bulge cells to begin hair regeneration, whereas Brg1 recruits NF-κB to activate Shh in matrix cells to sustain hair growth. Such reciprocal Brg1-Shh interaction is essential for hair regeneration. Moreover, Brg1 is indispensable for maintaining the bulge cell reservoir. Without Brg1, bulge cells are depleted over time, partly through the ectopic expression of the cell-cycle inhibitor p27(Kip1). Also, bulge Brg1 is activated by skin injury to facilitate early epidermal repair. Our studies demonstrate a molecular circuit that integrates chromatin remodeling (Brg1), transcriptional regulation (NF-κB, Gli), and intercellular signaling (Shh) to control bulge stem cells during tissue regeneration.

Abstract 4989: Conditional NFAT activation promotes prostate oncogenesis through cell autonomous and non-cell autonomous effects

Although the activation of nuclear factor of activated T Cells (NFAT) has been linked to cellular transformation and its upregulation has been found in multiple tumor types, its potential role in prostate cancer (PCa) is unknown. We have recently found that NFATc1 activation in prostate epithelium results in prostatic intraepithelial neoplasia (PIN) that progresses to prostate adenocarcinoma in a Doxycycline (Dox)-inducible murine model. The adenocarcinoma primarily consists of Cytokeratin 8 (CK8)+, Androgen receptor (AR)+ luminal epithelial cells and reactive stroma with features similar to the most common types of human PCa. Both cells with NFATc1 activation and neighboring cells without NFATc1 activation have significant upregulation of c-Myc and activation of Stat3. Besides known and suspected NFATc1 targets, such as Spp1, we have revealed the early upregulation of a number of cytokines and cytokine receptors, as key molecular components of an inflammatory and pro-mitogenic microenvironment that promotes both NFATc1+ and NFATc1− cells to participate in tumor formation. Thus, NFATc1 activation has cell autonomous effects on the NFATc1+ cells and non-cell autonomous effects on neighboring cells through secreted factors, resulting in eciprocal prostatic epithelial-stromal interactions for promoting PCa development. Our studies present the first direct in vivo evidence that NFATc1 activation can induce PCa resembling human PCa and provide a versatile platform to further study the pathogenic mechanism of PCa.

Citation Format: Kalyan Reddy Manda, Piyush Tripathi, Yinqiu Wang, Peter A. Humphrey, Minggui Pan, Feng Chen. Conditional NFAT activation promotes prostate oncogenesis through cell autonomous and non-cell autonomous effects. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 4989. doi:10.1158/1538-7445.AM2013-4989

Improving detection of Lynch syndrome using a reflex immunohistochemistry algorithm for all patients with newly diagnosed colorectal cancer

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Background: Identifying patients with Lynch syndrome has profound impact on the clinical care of patients and their families. Previous guidelines based on family history alone have shown low sensitivity. In our medical center, the detection rate of Lynch syndrome was <1% among colorectal cancer cases. Methods: We have developed a system-based algorithm using centralized testing by immunohistochemistry (IHC) for four mismatched repair (MMR) proteins (MLH1, MSH2, MSH6, and PMS2) as a screening method for all newly diagnosed colorectal cancer patients, followed by step wise testing of BRAF mutation, MLH1 promoter hypermethylation, +/- microsatellite instability, and germline mutation. Results: From April 1, 2011, to July 11, 2012, we have screened 116 patients. IHC detected absent expression of at least one of the MMR proteins in 18 cases. Three cases showed missing expression of MSH2/MSH6 and the presence of a germline mutation in MSH6 was confirmed in two cases. The newest case is still being investigated for germline mutation. Of the remaining 15 cases, 10 showed the presence of BRAF V600E mutation, two showed hypermethylation of the MLH1 promoter, and one showed germline MLH1 mutation. Two cases showed no BRAF V600E mutation, no MLH1 promoter hypermethylation or germline gene mutation. Overall, of 116 cases, three cases have confirmed Lynch syndrome with the detection of a germline mutation, two cases most likely have Lynch syndrome but without any detectable germline mutation of MLH1 or PMS2 using the current detecting methods. Conclusions: Our system-based screening algorithm using reflex immunohistochemistry of four MMR proteins has resulted in excellent detection rate of approximately 4% to 5% (5 out of 116 cases), consistent with the expected Lynch syndrome prevalence rate in the population. This represents a marked improvement over our previous family history-based approach in Lynch syndrome screening.

Impact of early engagement of patients with clinical trial information in a system-based multidisciplinary breast cancer clinic on clinical trial enrollment

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Background: Cancer clinical trial enrollment is low at approximately 3% in the U.S., and there is an urgent need for improvement. Informing patients clinical trial information early at their initial appointment after the diagnosis of cancer may improve clinical trial enrollment. To this goal, we have developed a system-based multidisciplinary breast cancer clinic (MDBCC) that evaluates all newly diagnosed breast cancer cases and discuss with all patients eligible clinical trials at their initial appointment. Methods: Our MDBCC team consists of a medical and radiation oncologist, breast surgeon, mammographer, pathologist, geneticist, and breast cancer coordinators, who review all newly diagnosed cases in the tumor board (multidisciplinary breast cancer tumor board) prior to patient’s MDBCC appointment. During the MDBCC visit, each individual patient meets separately with a medical oncologist, a radiation oncologist, and a surgeon to discuss their treatment options. Eligible clinical trials are discussed and presented to patients with informed consent. Clinical trial nurses are dedicated for patients to call and meet for further discussion on the eligible trials after the MDBCC visit. Results: The average annual clinical trial enrollment for breast cancer was 9 cases (approximately 3%) between 2000 and 2006 prior to initiating the MDBCC, improved to 53 (approximately 17%) between 2007 and 2011 after the MDBCC was formed. The enrollment into the NSABP and SWOG trials accounts for the large portion of the accrual. Conclusions: Early engagement of patients with clinical trial information in a system-based MDBCC for all newly diagnosed breast cancer patients dramatically improves clinical trial enrollment.

Effects of genistein and daidzein on hippocampus neuronal cell proliferation and BDNF expression in H19-7 neural cell line

OBJECTIVES

Estrogen replacement therapy (ERT) reduces the risk of Alzheimer's disease and symptoms in postmenopausal and elderly women. However, ERT is associated with increased risk of uterine and breast cancer. Dietary phytoestrogens have been suggested as a potential alternative to ERT, while little information is available regarding the effects and the underlying mechanisms of such treatment on central neuron function. The present study aimed to determine the effects of phytoestrogens including genistein and daidzein on the proliferation and survival of the hippocampus neural cells, which are of importance in learning and memory function.

MEASUREMENTS

H19-7/IGF-IR neural cell line was cultured in DMEM absented of serum for 72 h, and treated with various concentrations of genistein, daidzein or 17β-estradiol. Neuronal cell viability and proliferation were determined by MTT and BrdU assay, respectively Cell cycle analysis was performed using flow cytometry. The effects of genistein and daidzein on brain-derived neurotrophic factor (BDNF) mRNA and protein expression were determined by RT-PCR and ELISA, respectively. The effect of Trk receptors inhibitor on genistein and daidzein - induced hippocampus neuronal cell proliferation was also examined.

RESULTS

17β-estradiol, genistein and daidzein ranged from 20 nM to 2000 nM significantly promoted hippocampus neuronal cell viability and proliferation. Similar to the effect of 17β-estradiol, genistein and daidzein induced an increase in the percentage of cells in S phase. Genistein and daidzein significantly increased the expression of BDNF mRNA and protein levels. The effect of genistien and daidzein on hippocampus neuronal proliferation was blocked by K252a, a selective Trk receptors inhibitor.

CONCLUSION

This study concluded that genistein and daidzein improved hippocampus neuronal cell viability and proliferation in vitro. These neuroprotective effects might be mediated by BDNF-Trk pathway.

The pathogenic role of autoantibodies in pemphigus vulgaris

Pemphigus vulgaris (PV) is a severe autoimmune bullous disease involving both the skin and mucosal areas, and characterized by intraepithelial flaccid blisters and erosions. The pathogenesis of this disease is not yet completely understood, but novel insights into desmoglein biology and autoantibody pathogenesis have recently been published. Acantholysis in PV seems to result from a collective action of autoantibodies against various keratinocyte self antigens, of which desmogleins 1 and 3 are the most important. Additional antigens including desmocollins and nondesmosome components, such as the mitochondrion, might take part in disease activation. Recently, apoptosis was reported as a possible underlying mechanism of acantholysis. Furthermore, apoptolysis is believed to be the link between suprabasal acantholytic and cell-death pathways. We review the possible hypotheses of the pathogenesis of PV: the desmoglein compensation theory, the antibody-induced apoptosis theory, the basal-cell shrinkage hypothesis and the newly published apoptolysis theory.

Electron Microscopy Characterization Of Epitaxial Growth Of Ag Deposited On Mgo Microcubes

The crystalline structure, the morphology and the chemistry of small Ag particles vacuum-deposited on preheated MgO microcubes were characterized by in situ and ex situ electron microscopy and surface analysis techniques. Observations were made of the nucleation and growth of Ag clusters on MgO surfaces and along surface steps. It is found that Ag particles deposited onto clean MgO crystals have an epitaxial orientation relationship of (100)Agll(100)MgO with [100]Agll[00]MgO. Prior to air exposure Ag particles are stable under the electron beam but they become unstable upon exposure to air. During electron irradiation on air-exposed samples terraces are formed on the surfaces of MgO cubes, preferentially near Ag particles and at their interfaces with the substrate. The stability of vacuum-deposited Ag particles and the growth of the terraces on MgO microcubes seem to depend on air exposure of the sample.

Activation of NFAT signaling in podocytes causes glomerulosclerosis

Mutant forms of TRPC6 can activate NFAT-dependent transcription in vitro via calcium influx and activation of calcineurin. The same TRPC6 mutants can cause FSGS, but whether this involves an NFAT-dependent mechanism is unknown. Here, we generated mice that allow conditional induction of NFATc1. Mice with NFAT activation in nascent podocytes in utero developed proteinuria and glomerulosclerosis postnatally, resembling FSGS. NFAT activation in adult mice also caused progressive proteinuria and FSGS. Ultrastructural studies revealed podocyte foot process effacement and deposition of extracellular matrix. NFAT activation did not initially affect expression of podocin, synaptopodin, and nephrin but reduced their expression as glomerular injury progressed. In contrast, we observed upregulation of Wnt6 and Fzd9 in the mutant glomeruli before the onset of significant proteinuria, suggesting a potential role for Wnt signaling in the pathogenesis of NFAT-induced podocyte injury and FSGS. These results provide in vivo evidence for the involvement of NFAT signaling in podocytes, proteinuria, and glomerulosclerosis. Furthermore, this study suggests that NFAT activation may be a key intermediate step in the pathogenesis of mutant TRPC6-mediated FSGS and that suppression of NFAT activity may contribute to the antiproteinuric effects of calcineurin inhibitors.

Color Doppler twinkling artifact in fetuses with echogenic intracardiac foci: echocardiographic observation and clinical significance

OBJECTIVE

To evaluate echocardiographic characteristics and clinical relevance of color Doppler twinkling artifacts in fetuses with isolated echogenic intracardiac foci (EIF).

METHODS

This study included 50 fetuses with EIF, at 18-38 weeks of gestation. Echocardiographic examination, which was performed using a 1.0-5.0-MHz phased array probe, included gray-scale, color and spectral Doppler imaging. Twinkling artifacts were assessed using fetal color Doppler echocardiography on isolated EIF situated in the left and/or right ventricles. The prevalence, appearance and clinical relevance of the color Doppler twinkling artifacts were analyzed.

RESULTS

Eight of 50 fetuses with EIF (16%) showed color Doppler twinkling artifacts, which appeared as a rapidly changing color complex seen persistently behind the EIF. The spectra obtained in all eight with color Doppler artifacts were composed of straight vertical bands occurring in mid to late systole and early diastole. After birth, none of 50 fetuses with EIF had structural heart diseases or showed clinical signs of cardiac failure.

CONCLUSIONS

Color Doppler twinkling artifacts from isolated EIF occur in some fetuses and may be considered as an additional echocardiographic feature of EIF. Attention should be paid to the identification and interpretation of these artifacts so that they may be accurately distinguished from true color flow generated by atrioventricular valvular regurgitation jets.

Unusual amplification pattern by SSP HLA-B typing led to discovery of a novel HLA-C allele

We report here the unique sequence of a novel human leucocyte antigen (HLA)-C allele resulted in amplification of a product with a primer pair used in sequence-specific primer (SSP) HLA-B typing, which led subsequently to identification of a new allele of Cw*0339 by sequence-based typing method. This new allele is closely related to Cw*031101 with only two nucleotide changes from T to G at position 97, and T to C at position 105 in the exon 2 region of HLA-C locus. The first nucleotide substitution causes an amino acid alteration from tyrosine to aspartic acid at amino acid residue 9 (Y to D), while the second one keeps alanine at residue 11 unchanged. Most interestingly, the nucleotide change from T to G at position 97 makes it identical to the 3' end sequence of one SSP of the commercial HLA-B SSP typing kit we were using. In this specific case, it resulted in amplification of a product of HLA-C gene instead of B gene.

Time-frequency characterization of atrial fibrillation from surface ECG based on Hilbert-Huang transform

In this paper, based on Hilbert-Huang transform (HHT), we develop a new non-invasive time-frequency analysis method to characterize the dynamic behaviour of atrial fibrillation (AF) from surface ECG. We first extract f waves from single-lead ECG records of AF patients using PCA analysis. To capture the non-stationary behaviours of AF signals at different time scales, we use HHT to find the Hilbert spectrum and instantaneous frequency (IF) distribution of residual signals from principal component analysis. Two important feature variables, namely mean IF (mIF) and index of frequency stability over time (IS), are derived from the IF distribution, and in combination will be able to effectively discriminate two different AF types: self-terminating and non-terminating termination. The proposed AF signal decomposition and analysis method will help us efficiently differentiate individual AF patients, advance our understanding of AF mechanisms, and provide useful guidelines for improving administration of AF patients, especially paroxysmal AF.