Objective and Subjective Assessment of Edema during Adjuvant Chemotherapy Using Taxane-Containing Regimens in a Randomized Controlled Trial: National Surgical Adjuvant Study of Breast Cancer (NSAS-BC) 02

Background: Taxanes are frequently used in treatment of breast cancer (BC) patients. However, some patients treated with taxanes, especially docetaxel (DTX), experience severe edema during and following the treatment. We prospectively assessed body weight and health-related quality of life (HRQOL) related to edema in a randomized controlled trial (RCT) comparing four taxane-containing regimens in an adjuvant setting.Patients and Method: We conducted NSAS BC02 trial in which postoperative patients with node positive BC were randomly assigned to receive one of the following four adjuvant chemotherapeutic regimens; (1) ACP regimen: 4 cycles of doxorubicin 60mg/m2 plus cyclophosphamide 600mg/m2 q3weeks (AC) followed by 4 cycles of paclitaxel (PTX) 175 mg/m2 q3weeks, (2) ACD regimen: 4 cycles of AC followed by 4 cycles of DTX 75mg/m2 q3weeks, (3) PTX regimen: 8 cycles of PTX, (4) DTX regimen: 8 cycles of DTX. During the study we recorded body weight at baseline (at study entry), on day 1 of each cycle and at 8 months, and every 6 months thereafter. And we asked the patients to answer FACT-B, and -Taxane at baseline, on day 1 of cycle 3, 5, and 7, and at 8 and 12 months. We compared the change of weight and the scores of 4 items regarding edema in FACT-B (B8) (change in weight) and FACT-Taxane (Tax1 [anasarca], Tax2 [edema of hands], and Tax3 [edema of legs]) among the four regimens. Data were analyzed on an intent-to-treat basis. The statistical significance of the differences among the regimens was examined with analysis of covariance and t-test.Results: Of 1060 patients who entered N-SAS BC 02 trial, first 300 patients participated in this HRQOL study (ACP 74 patients, ACD 75, PTX 76, and DTX 75). The weight increased markedly and recovered by 8 months in the patients of DTX regimen, increased slightly in those of ACD regimen, and was almost stable in those of ACP and PTX regimens. The difference in the change of weight from the baseline to the 8th cycle between the patients of DTX plus ACD regimens and those of ACP plus PTX regimens was statistically significant (P< .0001). The compliance of FACT-B, and -Taxane was high throughout the study period (> 85 % at each point). The scores of B8, Tax1, Tax2, or Tax3 were relatively stable in ACP, ACD, and PTX regimens over the study period, but those of DTX regimen became lower (indicating worse HRQOL) up to 8 months, then recovered to the baseline except the scores of Tax2 which were still lower than those of other 3 regimens at 12 months. When the scores of the patients of DTX regimen were compared with those of other 3 regimens combined, the differences were statistically significant in all items of B8 (P= .0450), Tax1 (P= .0016), Tax2 (P< .0001), and Tax3 (P< .0001).Discussion: The patients who received 8 cycles of DTX were agonized by chemotherapy (CT)-related edema. However, the agony seemed to disappear by 6 months after the completion of CT except for that of edema of hands. The reason why only the scores of Tax2 did not recover at 12 months in the patients of DTX regimen is suspected to be the ipsilateral hand and arm edema affected by axillary dissection which might have lasted for a long time.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2090.

Platelet vascular endothelial growth factor is a useful predictor for prognosis in Kawasaki syndrome

Kawasaki syndrome (KS) is an acute febrile vasculitis of childhood. Coronary artery abnormalities (CAA) are a significant problem in KS patients. High dose intravenous immunoglobulin (IVIG) is effective for reducing the occurrence of CAA. Clinical and histopathological findings suggest that vascular endothelial growth factor (VEGF) is involved in CAA. In circulating blood, newly activated platelets are the major source of VEGF, which is released in large amounts in vascular inflammation. The present study analysed 80 KS patients (69 IVIG responders and 11 IVIG non-responders) and evaluated the role of platelet VEGF in KS vasculitis. Serum VEGF and platelet VEGF levels were significantly higher in KS patients than controls (P < 0.001). Platelet VEGF reflected the reactivity of IVIG treatment and was decreased in responders (P < 0.001), but remained increased in non-responders (P = 0.01). Platelet VEGF levels, but not serum VEGF levels, before IVIG were significantly correlated with the maximum CAA z-score (r = 0.524, P = 0.02). Our findings demonstrate that platelet VEGF may reflect the severity of vasculitis related to the pathological development of CAA in KS. Platelet VEGF may be an important feature of KS pathophysiology.

Tunable enhancement of high harmonic emission from laser solid interactions

Coherent wake emission is a unique source of extreme ultraviolet radiation and has been recently shown to provide the basis for intense attosecond light. Here we present a novel scheme, supported by particle-in-cell simulations, demonstrating that enhancement and spectral control of the coherent wake emission signal can be achieved by modifying the interaction plasma density ramp. Significant tunable enhancement of harmonic emission is verified experimentally, with factors of >50 in relative signal increase achieved in a narrow band of harmonics at the cutoff frequency.

Health-related quality-of-life and psychological distress of postmenopausal breast cancer patients after surgery during the randomized trial, N-SAS BC 03, comparing further tamoxifen with switching to anastrozole after adjuvant tamoxifen for 1 to 4 years: the final results

Abstract #1136

Backgroud: Three years ago, we reported the interim results regarding heath-related quality of life (HRQOL) outcomes of the patients who switched their adjuvant endocrine therapy from several years of tamoxifen (TAM) to anastrozole (ANA) and those who had TAM for a total of 5 years in the randomized trial, National Surgical Adjuvant Study of Breast Cancer (NSAS BC) 03. We present the final results of HRQOL and psychological distress in the NSAS BC 03.&#x2028; Patients and Methods: Recurrence-free postmenopausal breast cancer patients who had received definitive surgery for hormone receptor positive breast cancer, and had been taking TAM for 1 to 4 years after the surgery were enrolled in the randomized trial: N-SAS BC 03. They were randomly assigned to continue TAM for the remaining periods of a total of 5 years or to switch from TAM to ANA and take the latter for the remaining periods. Primary endpoints of the N-SAS BC 03 trial were disease-free survival and adverse events. HRQOL and psychological distress were evaluated as secondary endpoints. They were asked to answer patient-administered instruments to assess HRQOL (FACT-B [breast cancer scale] and FACT-ES [endocrine symptom scale]) and psychological distress (CES-D: Center for Epidemiologic Studies Depression scale) at the randomization (baseline), 3 months, 1 and 2 years after the randomization. HRQOL and psychological distress scores during this period were compared using t-test and the general linear model with correlated errors.&#x2028; Results: There was no difference in demographic and medical characteristics between the two treatment groups. The response rates of the questionnaires were 98.6%, 97.2%, 90.9% and 78.5% at baseline, 3 months, 1 and 2 years after the randomization, respectively. At baseline 694 patients (346 in the TAM group and 348 in the ANA group) answered them. The total scores of FACT-G, and FACT-ES and the scores of FACT-G physical well-being (PWB) subscale were statistically significantly better in the TAM group than in the ANA group (P = 0.042, 0.038, and 0.005, respectively) after the randomization, while those of FACT-B in the former were marginally better than those in the latter (P= 0.066). However, there were no statistically significant differences between the two treatment groups for the scores of CES-D, and subscales other than PWB of FACT-G, FACT-B, and FACT-ES.&#x2028; Conclusions: Further TAM treatment after adjuvant TAM for 1 to 4 years may provide postmenopausal breast cancer patients with slightly better HRQOL comparing with switching to ANA.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 1136.

Immunohistological studies on the distribution of learning-related peptides in the central nervous system of conditioned Lymnaea

Behavioral conditioning in Lymnaea increased the amount of immunolabeling in the central nervous system for the memory-associated protein calexcitin. The staining level of anti-calexcitin positive neurons was always stronger in conditioned animals than in naive animals. In the visuo-vestibular conditioned animals, right-parietal and visceral group neurons as well as withdrawal-related neurons were positively stained with anti-calexcitin antibody. In taste-aversion conditioned animals, right-parietal visceral G-group neurons and withdrawal-related neurons were selectively stained. These neurons are candidate neurons for modulation by these conditioning paradigms.

Early diagnosis of Kawasaki disease in patients with cervical lymphadenopathy

BACKGROUND

Among typical patients with Kawasaki disease (KD), a few KD patients present with only fever and cervical lymphadenopathy at admission (KDL). These patients have a significant risk for misdiagnosis, delay in treatment for KD, and development of coronary artery abnormalities. Therefore, the development of an easy tool for early diagnosis in these patients is desirable.

METHODS AND RESULTS

Patients who presented with only fever and cervical lymphadenopathy at admission were studied. Of these, 14 patients were eventually diagnosed with KD (KDL) and 24 patients were successfully treated using antibiotics (control). KDL patients were significantly older than control patients (P > 0.022). Among the laboratory findings, neutrophil counts (P > 0.003), C-reactive protein (CRP; P < 0.001), and aspartate aminotransferase (AST; P > 0.018) were significantly different between the groups. To discriminate KDL patients from controls, cut-off points of the aforementioned parameters (KDL indices) were determined using the receiver operating characteristic curves in order to maximize sensitivity and accuracy (age, 5.0 years; neutrophil counts, 10,000 /microL; CRP, 7.0 mg/dL; AST, 30 IU/L). One point was assigned if a subject exceeded the cut-off point in a KDL index. If a patient with three or four KDL indices was considered to have KD, the sensitivity was 78% and the specificity 100%. None of the patients with one or zero KDL index developed KD.

CONCLUSIONS

KDL indices may be helpful in discriminating KDL from lymphadenitis at admission. It is important to monitor the symptoms of KD in a patient with three or four KDL indices at admission.

The Immunohistochemical Evaluation of Estrogen Receptor-α and Progesterone Receptors of Normal, Hyperplastic, and Neoplastic Endometrium in 88 Pet Rabbits

The expression of estrogen receptor-α (ER) and progesterone receptor (PR) in normal, hyperplastic, and neoplastic endometrium in rabbits was evaluated by immunohistochemistry. The tissues evaluated were 27 normal uteri, 19 cases with endometrial hyperplasia, and 42 adenocarcinomas. Sixteen of 27 cases of normal uteri (59.3%) and 13 out of 19 hyperplasias (68.4%) stained positive with both ER-α and PR. Adenocarcinomas were further subdivided into 26 papillary and 16 tubular/solid adenocarcinomas. Papillary adenocarcinoma infiltrated the myometrium late in the disease and caused attenuation of the myometrium. In contrast, tubular/solid adenocarcinoma invaded into the deep myometrium early in the disease without thinning of the myometrium. Twenty-one cases out of 26 (80.8%) cases of papillary adenocarcinoma were both ER-α and PR negative, whereas 15 out of 16 (93.8%) of the tubular/solid adenocarcinomas were positive for ER-α, PR, or both. The total immunoreactive scores of ER-α, PR, and mode of myometrial invasion were significantly different between histopathologic types. This suggests that there may be 2 different developmental pathways for uterine adenocarcinomas in the rabbit.

Expression of MMP-13 in osteoblast cells and rat tibia after exposure to gamma rays or accelerated carbon ions

In past research, we found that carbon ion irradiation increased bone volume in rats, and a significant amount of cartilage remained inside the carbon ion-irradiated trabeculae. The amounts of matrix metalloproteinase 13 (MMP-13) mRNA in osteoblast-like MC3T3-E1 cells tended to decrease after carbon ion irradiation. The level of MMP-13 mRNA in non-irradiated cells was stable during the experimental period, but in gamma ray-irradiated cells it tended to increase. When localization of MMP-13 in locally irradiated experimental rats was investigated, it was found in the marginal trabeculae in both non-irradiated and gamma ray-irradiated animals. MMP-13 was detected in osteoid and neogenetic bone in the trabeculae surface. The trabeculae in carbon ion-irradiated bone remained cartilaginous. Carbon ion-irradiated rats exhibited weak expression of MMP-13 around the cartilage inside the trabeculae. We conclude that carbon ion irradiation reduced expression of MMP-13, thus suppressing both chondrocyte maturation and cartilage resorption. Increases in hyperplasia of the bone trabeculae and of bone volume were caused by ongoing bone addition and calcification in the absence of sufficient cartilage resorption.

Intracortical inhibition of the motor cortex in Segawa disease (DYT5)

BACKGROUND

Segawa disease (autosomal dominant guanosine triphosphate cyclohydrolase I [GTP-I] deficiency, DYT5) is a hereditary dopa-responsive generalized dystonia.

OBJECTIVE

To investigate the pathophysiologic mechanisms for dystonia in Segawa disease, we studied intracortical inhibition of the primary motor cortex in patients with Segawa disease.

METHODS

We studied 9 patients with Segawa disease (8 genetically confirmed patients and 1 with abnormally low GTP-I activity) and 12 age-matched normal control subjects. We studied the active motor threshold (AMT) using single pulse transcranial magnetic stimulation (TMS) and the short-interval intracortical inhibition (SICI) of the motor cortex using the previously reported paired pulse TMS method. Responses were recorded from the first dorsal interosseous (FDI) and tibialis anterior (TA) muscles.

RESULTS

The AMT was not significantly different between the patients and normal subjects. For both studied muscles, in Segawa disease, normal amount of SICI was evoked at interstimulus intervals (ISIs) of 1 to 4 msec even though they had dystonia in those muscles.

CONCLUSION

Normal SICI of the motor cortex in Segawa disease stands in remarkable contrast to the previously reported reduction of SICI in focal dystonia. This suggests that the gamma-aminobutyric acid A system of the motor cortex is intact in Segawa disease. The pathophysiologic mechanisms for dystonia must be partly different between Segawa disease and focal dystonia.

Involvement of cyclooxygenase-1, prostaglandin E2 and EP1 receptors in acid-induced HCO3- secretion in stomach

We investigated the cyclooxygenase (COX) isoforms as well as prostaglandin E receptor EP subtypes responsible for acid-induced gastric HCO(3)(-) secretion in rats and EP receptor-knockout (-/-) mice. Under urethane anesthesia, a chambered stomach (in the presence of omeprazole) was perfused with saline, and HCO(3)(-) secretion was measured at pH 7.0 using a pH-stat method and by adding 2 mM HCl. Mucosal acidification was achieved by exposing the stomach for 10 min to 50 or 100 mM HCl. Acidification of the mucosa increased the secretion of HCO(3)(-) in the stomach of both rats and WT mice, in an indomethacin-inhibitable manner. The acid-induced gastric HCO(3)(-) secretion was inhibited by prior administration of indomethacin and SC-560 but not rofecoxib in rats and mice. Acidification increased the PGE(2) content of the rat stomach, and this response was significantly attenuated by indomethacin and SC-560 but not rofecoxib. This response was also attenuated by ONO-8711 (EP1 antagonist) but not AE3-208 (EP4 antagonist) in rats and disappeared in EP1 (-/-) but not EP3 (-/-) mice. PGE(2) increased gastric HCO(3)(-) secretion in both rats and WT mice, and this action was inhibited by ONO-8711 and disappeared in EP1 (-/-) but not EP3 (-/-) mice. These results support a mediator role for endogenous PGs in the gastric response induced by mucosal acidification and clearly indicate that the enzyme responsible for production of PGs in this process is COX-1. They further show that the presence of EP1 receptors is essential for the increase in the secretion of HCO(3)(-) in response to mucosal acidification in the stomach.