CT imaging correlates of genomic expression for oral cavity squamous cell carcinoma

BACKGROUND AND PURPOSE

Imaging correlates of genetic expression have been found for prognostic and predictive biomarkers of some malignant diseases, including breast and brain tumors. This study tests the hypothesis that imaging findings correlate with relevant genomic biomarkers in oral cavity squamous cell carcinoma.

MATERIALS AND METHODS

Surplus frozen tissue from 27 untreated patients with oral cavity squamous cell carcinoma who underwent preoperative CT imaging was analyzed for gene expression. A team of neuroradiologists blinded to the genomic analysis results reviewed an extensive list of CT findings. The imaging correlated with genomic expression for cyclin D1, angiogenesis-related genes (vascular endothelial growth factor receptors and ligands), which relate to enhancement on the basis of other tumor types; and epidermal growth factor receptor, which may relate to proliferation and mass effect.

RESULTS

Expression of vascular endothelial growth factor receptors 1 and 2 correlated with the enhancement of the primary tumor (P = .018 and P = .025, respectively), whereas the epidermal growth factor receptor correlated with mass effect (P = .03). Other exploratory correlations included epidermal growth factor receptor to perineural invasion (P = .05), and certain vascular endothelial growth factor receptors and ligands to mass effect (P = .03) and increased (P = .01) or decreased (P = .02) primary tumor size.

CONCLUSIONS

We report that CT imaging correlates with gene expression in untreated oral cavity squamous cell carcinoma. Enhancement of the primary tumor and degree of mass effect correlate with relevant genomic biomarkers, which are also potential drug targets. Eventually, treatment decisions may be aided by combining imaging findings into meaningful phenotypes that relate directly to genomic biomarkers.

Mathematical modelling to restore circulating IGF-1 concentrations in children with Crohn's disease-induced growth failure: a pharmacokinetic study

OBJECTIVES

Children with Crohn's disease grow poorly, and inflammation depresses the response of insulin-like growth factor-1 (IGF-1) to growth hormone. Correcting the inflammation normalises growth velocity; however, removing inflammation cannot be achieved in all children. Our lack of understanding of IGF-1 kinetics has hampered its use, particularly as high IGF-1 concentrations over long periods may predispose to colon cancer. We hypothesised that mathematical modelling of IGF-1 would define dosing regimes that return IGF-1 concentrations into the normal range, without reaching values that risk cancer.

DESIGN

Pharmacokinetic intervention study.

SETTING

Tertiary paediatric gastroenterology unit.

PARTICIPANTS

8 children (M:F; 4:4) entered the study. All completed: 5 South Asian British; 2 White British; 1 African British.

INCLUSION CRITERIA

Children over 10 years with active Crohn's disease (C reactive protein >10 mg/l or erythrocyte sedimentation rate >25 mm/h) and height velocity <-2 SD score.

EXCLUSION CRITERIA

closed epiphyses; corticosteroids within 3 months; neoplasia or known hypersensitivity to recombinant human IGF-1 (rhIGF-1).

INTERVENTIONS

Subcutaneous rhIGF-1 (120 μg/kg) per dose over two admissions: the first as a single dose and the second as twice daily doses over 5 days.

PRIMARY OUTCOME

Significant increase in circulating IGF-1.

SECONDARY OUTCOMES

Incidence of side effects of IGF-1. A mathematical model of circulating IGF-1 (Ac) was developed to include parameters of endogenous synthesis (Ksyn); exogenous uptake (Ka) from the subcutaneous dose (As): and IGF-1 clearance: where dAc/dt=Ksyn - Kout×Ac+Ka×As.

RESULTS

Subcutaneous IGF-1 increased concentrations, which were maintained on twice daily doses. In covariate analysis, disease activity reduced Ksyn (p<0.001). Optimal dosing was derived from least squares regression fitted to a dataset of 384 Crohn's patients, with model parameters assigned by simulation.

CONCLUSIONS

By using age, weight and disease activity scaling in IGF-1 dosing, over 95% of children will have normalised IGF-1 concentrations below +2.5 SDs of the normal population mean, a level not associated with cancer risk.

Improving imaging diagnosis of persistent nodal metastases after definitive therapy for oropharyngeal carcinoma: specific signs for CT and best performance of combined criteria

BACKGROUND AND PURPOSE

Criteria for detection of persistent nodal metastases in treated oropharyngeal tumors are sensitive but nonspecific, leading to unnecessary nodal dissections. Developing specific imaging criteria for persistent nodal metastases could improve diagnosis while decreasing patient morbidity.

MATERIALS AND METHODS

Patients with oropharyngeal squamous cell carcinoma with nodal metastases treated by definitive radiation therapy and subsequent nodal dissection were retrospectively evaluated. One hundred thirty-eight patients had pre- and posttherapy contrast-enhanced CTs evaluated by radiologists blinded to the status of pathologically proved hemineck persistent nodal metastases. Composite scoring criteria for CT, combined from individual parameters, were compared with radiologists' opinions, previous multiparameter criteria, and outcome data.

RESULTS

New low-attenuation areas and a lack of size change (<20% cross sectional area) were both highly specific for persistent nodal metastases (99%; P = .0004). Extranodal disease on pretherapy imaging was moderately specific (86%; P = .001). The CSC correctly placed 29 patients in a low-risk category compared with 14 by previously reported criteria and radiologist reports. With good second-rater reliability, the CSC cutoff values stratified patients at highest risk of persistent nodal metastases, thereby improving specificity while maintaining sensitivity.

CONCLUSIONS

Comparing pre- and posttherapy examinations improves specificity by discriminating focal findings and size change compared with a single time point. The CSC can categorize the risk of persistent nodal metastases more accurately than previous CT methods. This finding has the potential to improve resource use and reduce surgical morbidity.

Crown dilaceration

Dilaceration of teeth can occur as a result of trauma to its primary predecessors. Root dilaceration is more common than crown dilacerations. A rare case of crown dilaceration of maxillary permanent central incisor has been reported in this article. Health Renaissance, January-April 2013; Vol. 11 No.1; 86-88 DOI: http://dx.doi.org/10.3126/hren.v11i1.7609

Integration of clinical information and gene expression profiles for prediction of chemo-response for ovarian cancer

Ovarian cancer is the fifth leading cause of cancer death among women in the United States and western Europe. Platinum drugs are the most active agents in epithelial ovarian cancer therapy. In order to improve the prediction of response to platinum-based chemotherapy for advanced-stage ovarian cancers, we describe an integrated model which combines clinical information tumor and treatment information, with gene expression profile. This integrated modeling framework is based on the support vector machine classifier that evaluates the contributions of both clinical and gene expression data. The results show that the integrated model combining clinical information and gene expression profiles improve the prediction accuracy compared to those made by using gene expression predictor alone.

Increased growth inhibition of human chronic myelogenous leukemic cells by a combination of c-myb antisense oligonucleotide and 4-hydroxyperoxycyclophosphamide in vitro

Human chronic myelogenous leukemia (CML) is a unique malignancy in its cellular and molecular phenotypes. High dose therapy followed by stem cell transplantation seems to be one of the most effective treatment modalities for CML. However, allogeneic stem cell transplantation, a curative treatment modality, is limited due to the availability of matched siblings. On the other hand, the autologous stem cell harvests are contaminated with leukemic cells, and therefore a significant reduction of leukemic cells is desired before using the harvest for transplantation. Therefore in the present study, effects of a combination of a suboptimal concentration of 4-hydroxyperoxycyclophosphamide (4HC) and an optimal concentration of c-myb antisense oligonucleotide on the growth of K562 human chronic myelogenous leukemic cells in vitro were determined. The combination significantly (p<0.05) inhibited the growth of K562 cells in vitro when compared to the effects of c-myb oligonucleotide or 4HC alone. The c-myb oligonucleotide alone or in combination with low dose 4HC decreased the expression of c-myb gene as determined by RT-PCR techniques. Cellular uptake and retention of fluoresceinated oligonucleotide in control and treated K562 cells was studied using plain field laser microscopy and flow cytometry. There was an increase in cellular uptake of c-myb oligonucleotide in K562 cells as measured by plain field laser microscopy in the presence of 4HC. The combination of oligonucleotides and 4HC did not significantly decrease the number of hematopoietic stem/progenitor cells from normal hematopoietic stem cell harvests as determined by in vitro colony assays. The combination of low dose 4HC and c-myb antisense oligonucleotides can potentially be applied in CML patients, particularly for purging leukemic cells present in their hematopoietic stem cell harvests.

Evaluation of resistance of teeth subjected to fracture after endodontic treatment using different root canal sealers: an in vitro study

AIMS

The aim of this study was to compare the ex-vivo effects of different root canal sealers on the fracture resistance of endodontically treated teeth.

MATERIALS AND METHODS

Seventy-five freshly extracted human mandibular premolars were used for the study. The length was standardized to 14 mm and all the teeth were biomechanically prepared and divided into five different groups based on the type of root canal sealers used. Group I:- Roeko seal + gutta percha, Group II: AH plus ® root canal sealer + gutta percha, Group III: PULPDENT root canal sealer + gutta percha, Group IV: Zinc oxide-eugenol sealer + gutta percha, Group V: Control (unobturated teeth). The teeth were embedded in acrylic resin blocks and compressive strengths were measured using universal testing machine (Instron).

STATISTICAL ANALYSIS USED

One-way ANOVA, unpaired t- test.

RESULTS

Data obtained were statistically evaluated using one-way ANOVA and unpaired t-test. All groups showed a statistically significant result (P < 0.05). Teeth obturated with Group I and Group II showed higher resistance to fracture than teeth obturated with other three Groups. It was seen that the teeth obturated with group III showed a better fracture resistance than Group IV and there was no statistical significance found between Group and Group V.

CONCLUSIONS

From this study, it has been concluded that both the resin based sealers that were used in this study were equally effective compared to that of the zinc oxide-based sealers and the control group. However, no significant results were obtained when the comparison was made between zinc oxide-eugenol and gutta-percha and the control group.

Study of clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo undergoing melanocyte transplantation

BACKGROUND

Stability is considered the most important parameter before performing any melanocyte transplantation procedure in vitiligo; however, current criteria rely on the history given by the patients.

OBJECTIVE

This study was undertaken to determine the clinical, biochemical and immunological factors determining stability of disease in patients with generalized vitiligo to facilitate better patient selection for melanocyte transplantation and to understand immunological mechanisms for disease activity.

METHODS

Thirty-three patients with generalized vitiligo with < 10% body surface area involved were allocated to three clinical stability groups: Group 1 (stability > 3 months but < 1 year), Group 2 (≥ 1 year but < 2 years) and Group 3 (≥ 2 years). Melanocyte transplantation was done using suction blister epidermal grafting (SBEG) on a single patch. Blood was drawn for catalase estimation from all patients and from 10 healthy control subjects. A 3-mm punch biopsy was taken on the day of transplantation from the margin of the macule in the first five patients in each group for the immunohistochemistry of CD4, CD8, CD45RO, CD45RA and FoxP3. Those with ≥ 75% repigmentation at 6 months were labelled as responders.

RESULTS

The success rate was 0% in Group 1, 37·5% in Group 2 and 77·8% in Group 3. The difference in the success rate between the groups was statistically significant (P = 0·005). The median period of stability was significantly higher in the responders compared with that in the nonresponders (P = 0·001). Catalase levels were not significantly different between patients in the three groups of cases and in controls, or between responders and nonresponders. Lesional CD8 cells were significantly higher in Group 1 compared with Group 3. The percentages of CD8 and CD45RO cells were significantly higher in the nonresponders compared with the responders.

CONCLUSION

Along with clinical stability, the proportion of CD8 and CD45RO cells in skin biopsies might help to determine the stability of the disease and thereby predict the success of transplantation.