FES kinases are required for oncogenic FLT3 signaling

The closely related non-receptor tyrosine kinases FEline Sarcoma (FES) and FEs Related (FER) are activated by cell surface receptors in hematopoietic cells. Despite the early description of oncogenic viral forms of fes, v-fes, and v-fps, the implication of FES and FER in human pathology is not known. We have recently shown that FES but not FER is necessary for oncogenic KIT receptor signaling. Here, we report that both FES and FER kinases are activated in primary acute myeloid leukemia (AML) blasts and in AML cell lines. FES and FER activation is dependent on FLT3 in cell lines harboring constitutively active FLT3 mutants. Moreover, both FES and FER proteins are critical for FLT3-internal tandem duplication (ITD) signaling and for cell proliferation in relevant AML cell lines. FER is required for cell cycle transitions, whereas FES seems necessary for cell survival. We concluded that FES and FER kinases mediate essential non-redundant functions downstream of FLT3-ITD.

Metabotropic glutamate 7 receptor subtype modulates motor symptoms in rodent models of Parkinson's disease

Metabotropic glutamate (mGlu) receptors modulate synaptic transmission in the central nervous system and represent promising therapeutic targets for symptomatic treatment of Parkinson's disease (PD). Among the eight mGlu receptor subtypes, mGlu7 receptor is prominently expressed in the basal ganglia, but its role in restoring motor function in animal models of PD is not known. The effects of N,N'-dibenzhydrylethane-1,2-diamine dihydrochloride (AMN082), the first selective allosteric activator of mGlu7 receptors, were thus tested in different rodent models of PD. Here, we show that oral (5 mg/kg) or intrastriatal administration (0.1 and 0.5 nmol) of AMN082 reverses haloperidol-induced catalepsy in rats. AMN082 (2.5 and 5 mg/kg) reduces apomorphine-induced rotations in unilateral 6-hydroxydopamine (6-OHDA)-lesioned rats. In a more complex task commonly used to evaluate major akinetic symptoms of PD patients, 5 mg/kg AMN082 reverses the increased reaction time to respond to a cue of bilateral 6-OHDA-lesioned rats. In addition, AMN082 reduces the duration of haloperidol-induced catalepsy in a mGlu7 receptor-dependent manner in wild-type but not mGlu7 receptor knockout mice. Higher doses of AMN082 (10 and 20 mg/kg p.o.) have no effect on the same models of PD. Overall these findings suggest that mGlu7 receptor activation can reverse motor dysfunction associated with reduced dopamine activity. Selective ligands of mGlu7 receptor subtypes may thus be considered as promising compounds for the development of antiparkinsonian therapeutic strategies.

DcR1 expression in endometrial carcinomas

The tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) is a member of the TNF family, which mediates apoptosis by the extrinsic pathway. Up-regulation of decoy receptors, DcR1 and DcR2, may result in diminished binding of TRAIL to their functional receptors. DcR1 expression was assessed in normal endometrial tissue (NE) and endometrial carcinoma (EC) samples by immunohistochemistry (IHC) and quantitative real-time polymerase chain reaction (PCR). IHC was performed in two tissue microarrays; one composed of 80 samples of NE and a second one constructed from paraffin-embedded blocks of 62 EC. For quantitative real-time RT-PCR analysis, RNA was obtained from 19 NE and 28 EC samples using Trizol. mRNA expression of DcR1 was assessed with Taqman-based assays in an Abi-Prism 700 SDS. Results were correlated with stage, histological type, and grade. By IHC, cytoplasmic expression of DcR1 was frequently seen in NE (79.6%) and varied according to the menstrual cycle. Positive DcR1 immunostaining was also detected in EC (98.1% of the cases) without any specific statistical association with histological type, grade, and stage. By quantitative real-time PCR, all NE had similar levels of DcR1expression (0.8-1.7 RQ), which were considered the basal levels of DcR1 expression in NE. Increased DcR1 expression (> or =5-fold higher than the basal levels) was detected in 13 of 28 EC (46.4%). High DcR1 expression levels were found in ECs of different stages: IA, four of 12 (33%); IB, two of four (50%); IC, four of six (66%); and IIA and IIB three of six (50%). Results suggest that DcR1 expression occurs in a subset of EC and may contribute to resistance to TRAIL-induced apoptosis.

A review of the applications of tissue microarray technology in understanding the molecular features of endometrial carcinoma

OBJECTIVE

To review the literature regarding the use of tissue microarray (TMA) technology in understanding the biology, diagnosis and prognosis of endometrial carcinoma (EC).

STUDY DESIGN

This review of TMA technology in EC was based on a large number of published articles. We focused on the use of TMA technology as a tool to gain insight in endometrial carcinogenesis and to validate data obtained from DNA microarrays, proteomics and cellular models.

RESULTS

We summarized the technical aspects of the 37 articles that were reviewed. The number of EC cases in each series varied from 32-485 (median, 128). The number of cores ranged from 1-4 (median, 2), and the size of the cores ranged from 0.6-2 mm (median, 0.6 mm). Only 3 studies applied fluorescence in situ hybridization technology, while the remaining 34 studies used immunohistochemistry.

CONCLUSION

TMA can help to establish new prognostic markers and to define protein biomarkers that help in differential diagnosis.

Evaluation of supportive care needs: Comparison between patients and physicians’ perception

e20649

Background: In order to optimize supportive care for cancer patients, we proposed them to fill a short questionnaire evaluating their potential complaints and we evaluated the concordance of their answers with the perception of their referent physician. Methods: Patients seen in consultation in an oncology unit were proposed to answer anonymously to 7 questions designed to identify potential social, psychological, nutritional problems or uncontrolled pain. Their physician answered to a similar questionnaire. Physicians were blinded to patients’ answers. Results: 155 patients accepted to complete the questionnaire. Median age was 60 yrs [21–85], 45% of patients were in metastatic setting. 70% of patients reported at least one problem, especially in the field of potential social problems (35%) or sleep disorders (25%). Concordance between patients and physicians was high for psychological support need (81%) or nutritional problems (87%) but was lower for social problems (62%) or uncontrolled pain (69%). Physicians tended to underestimate patients’ problems and missed social issues for 30% of patients or sleep disorders for 18% of patients. On the contrary and surprisingly, physicians overestimate patients’ complaints about uncontrolled pain (underestimation in 9% of cases but overestimation in 20% of cases for the item). Conclusions: Discordance between physicians and patients’ perception of supportive care needs emphasizes the importance of extending the use of screening tolls in daily practice.

No significant financial relationships to disclose.

A rare case of silicone mammary implant infection by Streptomyces spp. in a patient with breast reconstruction after mastectomy: taxonomic characterization using molecular techniques

A Streptomyces sp. isolated from a patient who had had breast reconstruction after a mastectomy was identified at the species level by comparative sequence analysis of 16S ribosomal DNA (rDNA) and the hypervariable alpha-region of the 16S rDNA.

Neurocognitive Predictors of Functioning in Schizophrenia: Five Years Follow Up Study

Aims:

Verbal memory and processing speed are two of the proposed neurocognitive predictors in schizophrenia. the objective is to determinate neurocognitive predictors of functioning in one five years follow-up period on ambulatory schizophrenia patients.

Method:

We conduct one cohort study on 30 schizophrenia out-patients (19 male; age mean: 32.8 years; SD:7.2). at the moment of inclusion it was applied one neuropsychological battery sensitive to neuropsychological deficit in schizophrenia: WAIS-III, BADS, WCST, Colour Trails, Trail Making A and B, BVRT, California Verbal Learning Test (Spanish version: TAVEC). Variables was summarized determining Z values and principal components. the cohort was prospectively studied for up to five years. as result variables it were considered: time to the first antipsychotic-drug change, time to the first psychiatric admission, and average five-years annual score in the Strauss-Carpenter Outcome Scale. It was constructed Cox and Linear Regression Models to determinate the better predicting neurocognitive components.

Results:

The better global outcome was directly related with WAIS-III processing speed index (corrected R square: 0.19; p = 0.02; beta constant= 0.469; beta WAIS-III processing speed= 0.125). None predictor was selected for the outcome variable change of antipsychotic. Psychiatric admission was predicted (p=0.006) by implicit learning (beta= -2.19), executive functioning (beta= 1.02), WAIS-III Total IQ (beta= 0.45) and WAIS-III Perceptual Organization Index (beta= -0.20).

Conclusion:

Higher processing speed index predicts one better functioning outcome during five-years follow-up. the risk for psychiatric admission was heterogeneously related with neurocognitive predictors. Verbal memory did not predict functional outcome.

CK2beta is expressed in endometrial carcinoma and has a role in apoptosis resistance and cell proliferation

Protein kinase CK2 (CK2) is a serine/threonine kinase that participates in important cellular processes. We have recently demonstrated that CK2 plays a role in resistance to TRAIL/Fas-induced apoptosis in endometrial carcinoma (EC) by regulating FLIP. Here, we assessed the immunohistochemical expression of CK2beta in EC and checked its role in cell proliferation and anchorage-independent cell growth. CK2beta immunostaining was assessed in two tissue microarrays, one constructed from paraffin-embedded blocks of 95 ECs and another from 70 samples of normal endometrium. CK2beta expression was correlated with histological type; grade and stage; cell proliferation (Ki-67) and apoptotic index; immunostaining for cyclin D1, PTEN, AKT, beta-catenin, and FLIP. Moreover, the Ishikawa EC cell line was subjected to down-regulation of CK2 by shRNA. CK2beta expression was frequent in EC (nuclear, 100%; cytoplasmic, 87.5%). The staining was more intense in EC than in normal endometrium (P = 0.000), and statistically correlated with AKT, PTEN, beta-catenin, and FLIP. In EC, CK2beta expression correlated with cell proliferation. Knock-down of CK2beta blocked colony formation of EC in soft agar, and also resulted in decreased expression of cyclin D1 and ERK phosphorylation. The results confirm that CK2beta is widely expressed in EC, and suggest a role in cell proliferation and anchorage-independent cell growth.

[Should elderly patients with glioblastoma be proposed to radiotherapy?]

In glioblastoma multiform-patients, advanced age has been associated with poor prognosis and decreased tolerance to treatments. The optimal management, especially with irradiation, was not definitively determined in the eighth and ninth decades. The Association of French-speaking neuro-oncologists (Anocef) has recently conducted a randomized clinical trial comparing radiotherapy plus supportive care versus supportive care alone in such patients. Patients aged 70-years and older with newly diagnosed glioblastoma and a Karnofsky performance score of 70 or above were randomly assigned to receive focal irradiation in daily fraction of 1.8 Gy given five days per week for a total dose of 50 Gy plus supportive care or supportive care only. Radiotherapy resulted in a modest but significant improvement in overall survival without reducing quality of life or cognition. However, the optimal regimen of radiotherapy in this fragile population remains uncertain. Abbreviated course of radiotherapy (40 Gy in 15 fractions over 19 days) has been proposed. Analysis of preliminary results showed that efficacy and safety of this hypofractionated accelerated regimen compared favourably with those of classically fractionated treatments. Finally, the potential contribution of surgery and chemotherapy should be evaluated in prospective clinical trials.

Physician-initiated courtesy MODS testing for TB and MDR-TB diagnosis and patient management

SETTING

Laboratorio de Investigación de Enfermedades Infecciosas, Universidad Peruana Cayetano Heredia (UPCH) and government health centres, Lima, Peru.

OBJECTIVE

To evaluate the contribution of unselected (courtesy) microscopic observation drug susceptibility (MODS) testing to the diagnosis and/or drug susceptibility testing (DST) of tuberculosis and their subsequent impact upon patient management.

DESIGN

Retrospective database analysis and case note review of MODS culture-positive cases.

RESULTS

Mycobacterium tuberculosis was isolated in 28.9% of 225 samples (209 patients); 22.2% of 63 positive cases were multidrug-resistant. In 58 MODS culture-positive cases with follow-up data available, MODS provided culture confirmation of diagnosis, DST or both in 82.8%, before any standard method. In 41.4%, this result should have prompted a modification in patient management. Delays between laboratory result and initiation or change of treatment, where applicable, took on average 42 and 64 days, respectively, of which a delay of respectively 17 and 48 days occurred after the receipt of results by the health facility.

CONCLUSION

MODS provides important data for clinical management within a meaningful timeframe and should contribute positively to patient outcomes due to earlier initiation of appropriate therapy. Although clinicians may successfully select patients likely to benefit from MODS, ongoing work is required to identify optimal implementation of the assay and to reduce logistical and health system derived delays.

Monitoring non-immediate allergic reactions to iodine contrast media

Non-immediate reactions to iodine contrast media (ICM) affect 2-5% of patients receiving these agents. We studied the immunological mechanisms involved in patients with a confirmed non-immediate reaction, maculopapular exanthema, after administration of ICM. The diagnosis was carried out by skin testing or drug provocation test. The immunological study was performed in sequential peripheral blood mononuclear cells taken from the onset of the reaction by flow cytometry and in skin biopsy by immunohistochemistry, with specific recognition by the lymphocyte transformation test (LTT) with different ICM. Flow cytometry showed an increase in the different activation markers [CD69, CD25 and human leucocyte antigen D-related (HLA-DR)] and the skin homing receptor [cutaneous lymphocyte-associated antigen (CLA)] in CD4 lymphocytes, whereas perforin was higher in the CD8 lymphocytes. The skin biopsy showed a perivascular mononuclear infiltrate composed of CD4 lymphocytes, expressing CD25, HLA-DR and CLA, with eosinophils. Intradermal skin tests and the LTT were positive to several ICM, including the culprit agent in four and three patients, respectively, with negative results in all 10 tolerant controls. We showed that a specific immunological mechanism was implicated in patients with non-immediate reactions to ICM. Moreover, the positive results in skin tests and lymphocyte proliferation tests indicated that an important cross-reactivity exists.

Comparative evaluation of mathematical functions to describe growth and efficiency of phosphorus utilization in growing pigs

Success of pig production depends on maximizing return over feed costs and addressing potential nutrient pollution to the environment. Mathematical modeling has been used to describe many important aspects of inputs and outputs of pork production. This study was undertaken to compare 4 mathematical functions for the best fit in terms of describing specific data sets on pig growth and, in a separate experiment, to compare these 4 functions for describing of P utilization for growth. Two data sets with growth data were used to conduct growth analysis and another data set was used for P efficiency analysis. All data sets were constructed from independent trials that measured BW, age, and intake. Four growth functions representing diminishing returns (monomolecular), sigmoidal with a fixed point of inflection (Gompertz), and sigmoidal with a variable point of inflection (Richards and von Bertalanffy) were used. Meta-analysis of the data was conducted to identify the most appropriate functions for growth and P utilization. Based on Bayesian information criteria, the Richards equation described the BW vs. age data best. The additional parameter of the Richards equation was necessary because the data required a lower point of inflection (138 d) than the Gompertz, with a fixed point of inflexion at 1/e times the final BW (189 d), could accommodate. Lack of flexibility in the Gompertz equation was a limitation to accurate prediction. The monomolecular equation was best at determining efficiencies of P utilization for BW gain compared with the sigmoidal functions. The parameter estimate for the rate constant in all functions decreased as available P intake increased. Average efficiencies during different stages of growth were calculated and offer insight into targeting stages where high feed (nutrient) input is required and when adjustments are needed to accommodate the loss of efficiency and the reduction of potential pollution problems. It is recommended that the Richards and monomolecular equations be included in future growth and nutrient efficiency analyses.

Our Experience in Lower Limb Reconstruction With Perforator Flaps

The application of Taylor's concept about body angiosomes, referred to tissue transfers, has meant that the development of the perforator flaps and muscles is no longer needed as a carrier of skin flap vascularity. In this paper, we revise 59 lower limb reconstructions with local and free perforator flaps performed in the last 5 years, and a basic reconstructive algorithm is also suggested to help with the management of the lower limb soft tissue reconstruction with perforator flaps. The advantages of the perforator flaps are (1) muscles and their function are preserved; (2) the main vascular trunks are spared; (3) it is possible to make a more specific reconstruction, replacing "like with like" (even performing compound or chimeric flaps); (4) the donor site can often be closed primarily; (5) the general morbidity is reduced; (6) a better cosmetic result can be achieved.

Meta-analysis of phosphorus balance data from growing pigs

Many studies have highlighted concerns over current methods of determining endogenous P losses and P requirements in growing pigs. Therefore, a database containing observations on 350 pigs was assembled from various studies. Four functions for analyzing P balance data were considered: 1) a straight line, 2) a diminishing returns function (monomolecular), 3) a sigmoidal function with a fixed point of inflection (Gompertz), and 4) a sigmoidal function with a flexible point of inflection (Richards). The nonlinear functions were specifically reparameterized to assign biological meaning to the parameters. Meta-analysis of the data was conducted to estimate endogenous P excretion, maintenance requirement, and efficiency of utilization. Phosphorus retention was regressed against either available P intake or total P intake [all variables scaled by metabolic BW (BW(0.75))]. There was evidence of non-linearity in the data, and the monomolecular function provided the best fit to the data. The Richards equation did not fit the data well and appeared overparameterized. Estimates of endogenous P excretion of 14 and 17 mg/kg of BW(0.75) x d based on available and total P analysis, respectively, were predicted by the monomolecular equation, which were within the range reported in the literature. Maintenance requirement values of 15 mg of available P/kg of BW(0.75) x d and 37 mg of total P/kg of BW(0.75) x d were obtained, based on the monomolecular equation. Average efficiencies of conversion of dietary P to retained P were 65 and 36% for available and total P, respectively, with greater efficiency values calculated for low P intakes. Although the monomolecular equation fitted the data best, more observations at high P intakes/kg of BW(0.75) are required to determine conclusively whether P retention scaled by metabolic BW is linearly related to available or total P intake.