Noncardiac vascular toxicities of vascular endothelial growth factor inhibitors in advanced cancer: a review

The introduction of molecularly targeted anticancer therapies has brought the promise of longer survival times for select patients with cancers previously considered untreatable. However, it has also brought new toxicities that require understanding and management, sometimes for long periods of time. Vascular endothelial growth factor inhibitors are associated with a broad range of adverse effects, with vascular toxicity being particularly serious. This review focuses on the current understanding of the pathophysiology and mechanisms of macrovascular toxicities (hypertension, hemorrhage, and thromboembolism), their incidence and severity, the current clinical management, and implications in the advanced cancer setting. Movement of these agents into the early disease setting will alter the impact of these toxicities. Search Strategy and Selection Criteria. Information for this review was collected by searching PubMed/Medline and American Society of Clinical Oncology abstract databases. The medical subject heading terms used included toxicity, hypertension, thromboembolism, hemorrhage, intestinal perforation, risk factors, pharmacokinetics, and metabolism, combined with free text search terms including, but not limited to, VEGF inhibitor*, bevacizumab, sunitinib, and sorafenib. Articles published in English before March 2010 were included, in addition to information from case reports and pharmaceutical agent package inserts.

Type 2 diabetes does not worsen prognosis in hepatocellular carcinoma

INTRODUCTION

Type 2 diabetes (T2DM) is associated with liver inflammation and carcinogenesis. The prevalence of T2DM among patients with liver cirrhosis and hepatocellular carcinoma is increasing. However, the effect of T2DM on the natural history of hepatocellular carcinoma is not known.

AIM

To examine the effect of T2DM on hepatocellular carcinoma (HCC) survival in treated and untreated disease.

METHODS

Retrospective analysis was performed on HCC cases diagnosed during 2000-2005, and prospectively during 2006-August 2007. Demographics, HCC staging, response to treatment, and survival were collected. A comparison was made between patients with T2DM and without T2DM.

RESULTS

One hundred and thirty-five patients were recruited in total; 58 (43%) had T2DM. Seventy (37 diabetic) patients were treated with percutaneous radiological therapies, with 168 treatments given. Treatment was determined by AASLD guidelines and patient tolerance, there was no randomisation. There was no significant difference in survival between diabetic and nondiabetic patients. There was a nonsignificant trend towards greater survival in diabetic patients (overall median survival diabetics 21 mths vs nondiabetics 5 mths, P=0.355).

CONCLUSIONS

T2DM does not negatively impact on the natural history of treated or untreated HCC.

Characterization of 1D photonic crystal nanobeam cavities using curved microfiber

We investigate high-Q, small mode volume photonic crystal nanobeam cavities using a curved, tapered optical microfiber loop. The strength of the coupling between the cavity and the microfiber loop is shown to depend on the contact position on the nanobeam, angle between the nanobeam and the microfiber, and polarization of the light in the fiber. The results are compared to a resonant scattering measurement.

Response to first line HAART using CD4 cell counts experience in a university hospital in Kingston

OBJECTIVES

To assess the extent to which the current practice for first line therapy concurs with the recommended guidelines and to examine the response of treatment naïve patients to first line Highly Active Antiretroviral Therapy (HAART) at the University Hospital of the West Indies, using CD4 cell counts.

METHODS

Over a three-month period, a cross-sectional study design was instituted and data were collected on all patients on HAARTat the University Hospital of the West Indies (UHWI) outpatient HIV clinic. Information was collected by reviewing patient medical records using data collection sheets. The data obtained from the medical records included: age, gender date of diagnosis of HIV date at which HAART was commenced, CD4 cell counts prior to the commencement of antiretrovirals, the initial HAART regimes and subsequent CD4 cell counts.

RESULTS

A total of 165 persons who met the criteria of being on HAART therapy were enrolled in the study The average time span between diagnosis of HIV and commencement of antiretroviral therapy was 1.92 years and the range for this was 0 to 12.29 years. The average CD4 count prior to initiation of HAART was 186 cells/mm3. The most common regime used at the UHWI for first line therapy was combivir and efavirenz, n = 78 (47.3%), followed by combivir and nevirapine, n = 29 (17.6%). The average difference between the initial CD4 count prior to the initiation of HAART and first repeated CD4 count was 102 cells/mm3. The mean time between the first and repeated CD4 cell counts was 376 days.

CONCLUSION

The recommended guidelines were adhered to for the majority of patients initiated on antiretrovirals at the UHWI. The treatment outcomes achieved at the UHWI were similar to those achieved in developed countries. This gives substantial evidence in support of international efforts to make antiretroviral therapy available in developing countries.

Disclosure of HIV status among HIV clinic attendees in Jamaica

OBJECTIVE

This study aimed to examine factors related to disclosure of HIV serostatus among clinic attendees in an outpatient HIV clinic at the University Hospital of the West Indies (UHWI).

METHODS

This was a cross-sectional survey of 107 attendees to a HIV clinic at the University Hospital of the West Indies. Participants were selected on a convenience basis. The instrument was developed for this study and covered socio-demographic data and self-report of disclosure and other variables related to HIV experience such as perceptions of family support. Data were analysed using nonparametric tests.

RESULTS

Findings demonstrate a 49% disclosure rate among males and 60% among females. The results further indicate that age, sexual orientation, mode of transmission, and perception of family support were significantly associated with disclosure. Age and perception of family support were found to be significantly associated with consistent condom use. Age and perception of family support were the factors demonstrating the most significant correlations with age being significantly associated with disclosure to partner. Perception of family support was significantly associated with disclosure to family.

CONCLUSION

Findings from this study demonstrate a low disclosure rate among HIV clinic attendees. Given that disclosure of HIV serostatus is critical in the control of the spread of HIV this report highlights the need for the development of prevention interventions focussed on de-stigmatization for both infected and non-infected persons.

An audit of the implementation of the international consensus group's guidelines on reporting of blood films

Aims

This study was carried out as part of the Pathology Benchmarking Review and it audits the implementation of the guidelines for the reporting of blood films published by the International Consensus Group for Haematology Review.

Methods

Each laboratory completed a questionnaire about the number of blood counts and blood films performed. Information was collected on the criteria that were used for preparing a blood film and whether they had followed the guidelines of the International Consensus Group.

Results

74 National Health Service organisations (151 laboratory sites) participated in the study. 24 laboratories had implemented the guideline, 21 with local modification, and 3 without modification. The reasons that prevented the full implementation of the guideline included the inability of laboratory information systems to be modified to include the guideline rules, the laboratory not agreeing with the guideline criteria, and the staff time required to implement the guide to justify the perceived local benefits of implementation.

Conclusion

This is the first study that has assessed the implementation of the International Consensus Guidelines at a national level. Many laboratories had experienced difficulty in implementing the consensus guideline partly due to the complexity of the guideline. As a result 21 of the 24 laboratories that had attempted to implement the guideline had made local modification to the guideline. Since it was not possible to estimate the impact that local modification of the guideline would have on the percentage of blood films it was not possible to establish a benchmark of practice following implementation of the guideline.

Flexibility in the colouration of the meninx (brain covering) in the guppy (Poecilia reticulata): investigations of potential function

Many organisms can change the apparent colour of their bodies by altering the aggregation of pigment in chromatophores in a process known as physiological colour change. In this study, we investigate a previously unstudied example of physiological colour change, from clear to black, of a brain covering, or meninx, in the guppy ( Poecilia reticulata Peters, 1859). UV protection in bright light was our primary hypothesis for the function of the meningeal colour, with a cost of increased conspicuousness to avian predators selecting for plasticity in the trait. An alternate hypothesis was that this flexible trait could be a physiological by-product of stress. Thus, we investigated the response of meningeal colour to light, stress, and simulated predator attacks, and also whether the black meninx affected conspicuousness to potential predators. Meningeal response to higher light levels did not differ from baseline responses. However, we did find that stress induced a sex-biased, rapid darkening of the meninx; this darkening then declined over time. These results suggest that meningeal blackness could be used as a novel, noninvasive indicator of stress level in guppies. We found no evidence for a role of predation in meningeal colour: meninx colour did not respond to the presence of a predator model and human “predators” detected similar numbers of guppies with black meninges and guppies with clear meninges.

Do differences in food web structure between organic and conventional farms affect the ecosystem service of pest control?

While many studies have demonstrated that organic farms support greater levels of biodiversity, it is not known whether this translates into better provision of ecosystem services. Here we use a food-web approach to analyse the community structure and function at the whole-farm scale. Quantitative food webs from 10 replicate pairs of organic and conventional farms showed that organic farms have significantly more species at three trophic levels (plant, herbivore and parasitoid) and significantly different network structure. Herbivores on organic farms were attacked by more parasitoid species on organic farms than on conventional farms. However, differences in network structure did not translate into differences in robustness to simulated species loss and we found no difference in percentage parasitism (natural pest control) across a variety of host species. Furthermore, a manipulative field experiment demonstrated that the higher species richness of parasitoids on the organic farms did not increase mortality of a novel herbivore used to bioassay ecosystem service. The explanation for these differences is likely to include inherent differences in management strategies and landscape structure between the two farming systems.

Association between magnesium : iron intake ratio and diabetes in Chinese adults in Jiangsu Province

BACKGROUND

The intake of iron is positively related to the risk of diabetes, whilst magnesium intake is inversely related. However, it is unknown whether there is an interaction between dietary magnesium and iron expressed as a ratio and diabetes.

METHODS

This is a cross-sectional household survey carried out in 2002 in Jiangsu Province, China. A total of 2849 men and women aged >or = 20 years participated (participation rate 89.0%). Iron and magnesium intake was assessed by 3-day weighed food records. Fasting plasma glucose, serum ferritin and haemoglobin were measured.

RESULTS

The mean intake of iron and magnesium was 25 mg/day and 332 mg/day, respectively. The prevalence of diabetes was 3.0% in men and 2.6% in women. Magnesium intake was negatively associated with diabetes when adjusted for age and sex, but not in a fully adjusted model. A strong inverse association between magnesium : iron intake ratio and diabetes was observed. In the fully adjusted model, the odds ratios of diabetes across quartiles of magnesium : iron intake ratio were: 1.0, 0.63 [95% confidence interval 0.32-1.25], 0.36 (0.16-0.81) and 0.48 (0.20-1.14) (P for trend 0.038). There was an interaction between central obesity and magnesium : iron ratio.

CONCLUSION

Magnesium : iron intake ratio is an independent risk marker for diabetes in Chinese adults. As this is a cross-sectional study, we cannot establish any causal relationship.