Combination chemotherapy with irinotecan and cisplatin in elderly patients (≥65 years) with extensive-disease small-cell lung cancer

18135

Background: Combination chemotherapy with irinotecan and cisplatin is one of the standard treatments for patients with small-cell lung cancer (SCLC). In elderly patients, however, its efficacy and toxicity has not been well documented. In this Phase II study, we assessed the efficacy and toxicity of combination chemotherapy with irinotecan and cisplatin and examined whether advanced age compromises it in elderly patients with previously untreated extensive-disease small-cell lung cancer (ED-SCLC). Methods: In this study, 43 previously untreated elderly patients (65 years or older) with ED-SCLC were given combination chemotherapy consisting of irinotecan 60mg/m2 on days 1, 8 and 15 and cisplatin 60mg/m2 on days 1. The treatment was repeated every four weeks until patients completed the maximum six cycles. Results: Patients consisted of 34 men and 9 women, whose median age was 70 years (range 65 - 81 years). A complete response and a partial response were observed in 23.3% (10/43) and 58.1% (25/43), respectively. The overall response rate was 81.4% (95% C.I; 69.7 - 93.0%). The overall median survival was 10.3 months (range 7.8 - 12.7 months). The 1-year and 2- year survival rates were 31.8% and 3.4%, respectively. The median progression-free survival was 8.32 months (range 6.8 - 9.8 months). Major toxicities included neutropenia (grade 3 to 4, 55.9%), leukopenia (grade 3 to 4, 46.5%), infection (grade 3 to 4, 37.3%) and diarrhea (grade 3 to 4, 30.3%). Incidence of febrile neutropenia was significantly higher in patients with ECOG performance status 2 compared with ECOG performance 1 (70.7% vs. 5.2%; p < 0.001). There were two treatment related deaths in patients ECOG performance status 2. Conclusions: Our results indicate that combination chemotherapy with irinotecan and cisplatin is an effective treatment for elderly patients with ED-SCLC. However, physicians should be aware of the mortality and morbidity due to myelosuppression following this treatment in elderly ED-SCLC patients with ECOG performance status 2.

No significant financial relationships to disclose.

Preoperative level of VEGF and IL-6 are associated with lymph node invasion and stage in gastric cancer

4626

Introduction: Angiogenesis plays an important role in growth, progression, and metastasis of tumors, and various cytokines are associated with the spread of cancer cell. In this study, we evaluate the role of VEGF and IL-6 in predicting the spread of gastric cancer. Methods: Preoperative one hundred twenty seven gastric cancer patients and 88 healthy subjects’ specimens were examined. The association of VEGF and IL-6 level with clinical and pathological findings was evaluated Results: Serum VEGF and IL-6 level in gastric cancer patients were higher than those in control (P<0.001, P=0.006, respectively). VEGF and IL-6 level were associated with presence of LN metastasis (P=0.003, P=0.041, respectively). IL-6 level was correlated with stage (P=0.012) and depth of invasion (P=0.018). VEGF level was correlated with invasion of lympho-vascular structure (P=0.021). VEGF and IL-6 level was not related to differentiation, size or CEA level. Conclusions: Serum VEGF and IL-6 levels in gastric cancer patients are higher than those in control. Preoperative VEGF and IL-6 levels could be a predictive marker of tumor invasion and LN metastasis.

No significant financial relationships to disclose.

Cyberknife stereotactic radiosurgery in patients with primary hepatocellular carcinoma

4645

Background: Conventional radiotherapy has historically played a limited role in the primary treatment of hepatocellular carcinoma (HCC). This study evaluated the effect of Cyberknife stereotactic radiosurgery (SRS) with for both for small primary non-resectable HCC, and for advanced HCC with portal vein tumor thrombosis (PVTT). Methods: From March 2004 to March 2005, thirty one patients with HCC were treated Cyberknife SRS was used for 32 lesions in patients with SRS for primary HCC. There was performed in 22 patients (23 lesions) with targeting to the primary HCC was treated (Group A), and in 9 patients with targeting to the PVTT was treated (Group B). The total SRS doses treated were 30–39 Gy (median, 36 Gy) to the 70–85%, 3 fractions and the target volume was of 3.6–57.3 cc (median, 25.2 cc). Results: The median follow up was 10.5 months. A complete response (CR) was achieved in 10 lesions, a partial response (PR) in 13 lesions, stable disease was noted in 6 lesions, and disease progression in 3 lesions. The response rate (CR+PR) was 71.9% (group A: 82.6%, group B: 44.4%). The level of serum alpha-fetoprotein after the treatment was decreased significantly in 17 patients (54.8%) (group A: 54.5%, group B: 55.5%). Complications were observed in 15 patients, among them, greater than grade 3 complication was observed in two patients of group A (gastric ulcer bleeding (1), liver necrosis (1)). Conclusions: These results suggest that Cyberknife SRS could be considered as an effective and safe treatment for primary HCC. For PVTT, Cyberknife SRS as the only curative tool, and produced acceptable local control in this study.

No significant financial relationships to disclose.

Induction chemotherapy with paclitaxel and cisplatin followed by concurrent chemoradiation therapy for Stage IIIB non-small cell lung cancer

17090

Background: We conducted a phase II study of Induction chemotherapy with paclitaxel and cisplatin followed by concurrent chemoradiation in patients with stage IIIB non-small-cell lung cancer to evaluate the response and toxicity profiles. Methods: All enrolled patients were scheduled to receive 2 cycles of induction chemotherapy with paclitaxel (175 mg/m2) intravenous infusion on day 1 and cisplatin (75 mg/m2) intravenously on day 1 every 3 weeks. All non-progressing patients were subsequently treated with concurrent chemoradiation. Concurrent chemoradiation included paclitaxel (60 mg/m2) plus cisplatin (25 mg/m2) intravenously for 6 weeks on day 43, 50, 57, 71, 78, and 85 and once-daily thoracic irradiation. Results: Between July 2000 and October 2005, 39 patients diagnosed as stage IIIB non-small cell lung cancer were enrolled in this study. Four patients achieved a complete response (10.3%) and 21 patients achieved a partial response (53.8 %), for an overall response rate of 64.1% [95% C.I. (49.4%–79.2 %)]. The 1, 2, and 3 year overall survival rate of all 39 patients were 66.7%, 40.6%, and 27.4% respectively, with a median survival time of 20 months. The median progression free survival was 10.7 months [95% C.I. (4.5%–16.9%)]. Esophagitis was the principal toxicity. Grade 3 or 4 esophagitis occurred in 18 patients (45%). Conclusions: Induction chemotherapy with paclitaxel and cisplatin followed by concurrent chemoradiation for stage IIIB non-small cell lung cancer seems to be effective treatment. However, Physicians should also be aware of severe esophagitis to require inpatient parenteral nutrition support and pain control.

No significant financial relationships to disclose.

Notch1 confers thymocytes a resistance to GC-induced apoptosis through Deltex1 by blocking the recruitment of p300 to the SRG3 promoter

One notable phenotypic change during the differentiation of immature thymocytes into either mature CD4 or CD8 single-positive lineages is the acquisition of a resistance to glucocorticoid (GC)-induced apoptosis. We have previously reported that SRG3 is critical in determining the sensitivity for the GC-induced apoptosis in developing thymocytes. We report here that Notch signaling downregulates the transcriptional activation of SRG3 through N-box and/or E-box elements on its promoter. RBP-J represses SRG3 transcription through the N-box motif. On the other hand, Deltex1 competitively inhibits the binding of p300 to E2A/HEB protein bound to the E-box elements and represses the SRG3 promoter activity. Moreover, enforced expression of Deltex1 restored double-positive (DP) thymocyte survival from the GC-induced apoptosis. Our results suggest that Notch signaling confers differentiating DP thymocytes resistance to GCs by regulating the SRG3 expression through Deltex1, and that Deltex1 and SRG3 may play a significant role during DP thymocyte maturation.

Fabrication of Polypyrrole- Poly(N-vinylcarbazole) Core-Shell Nanoparticles with Excellent Electrical and Optical Properties

Polypyrrole-poly(N-vinylcarbazole) (PPy-PVK) core-shell nanoparticles have been fabricated by nanoparticle-seeded dispersion polymerization. The monodisperse PPy nanoseeds are fabricated by micelle templating, and the PVK shell thickness is easily tuned by varying the amount of N-vinylcarbazole monomer. The PPy core and PVK shell produce superior conductivity and fluorescence, respectively.

Characterization of crystallographic properties of SMC poly Si using electron backscattered diffraction

Crystallographic properties of silicide mediated crystallization (SMC) polycrystalline silicon (poly Si) and excimer laser annealing (ELA) poly Si were studied by electron backscattered diffraction. Large-grain sized poly Si with a large fraction of low-angle grain boundaries was acquired by SMC, and small-grain sized poly Si with high-angle grain boundaries especially around 60 degrees was acquired by ELA. The thin film transistor (TFT) device characteristics were investigated in view of short-range crystallinity (pattern quality) and long-range crystallinity (misorientation distribution) of the specimens. Short-range crystallinity did not significantly affect the TFT device characteristics, and long-range crystallinity considering the low energy level of special boundaries could be better related to the TFT device characteristics of poly Si.

Anomalous surface diffusion in nanoscale direct deposition processes

We report the first observation of anomalous diffusion in nanometer scale direct deposition processes utilizing dip-pen nanolithography (DPN). DPN permits quite general nanostructure patterns to be drawn on flat surfaces. Here we demonstrate experimentally, and discuss theoretically, the situation in which the molecular ink in DPN binds weakly to the surface. We observe, for the weak-binding case of 1-dodecylamine on mica, that anomalous diffusion occurs, leading to nearly fractal deposition patterns.

Preparation and solubility in acid and water of partially deacetylated chitins

Partially deacetylated chitins with different degrees of deacetylation (DD) were prepared by alkaline treatment under homogeneous conditions, and the effect of DD on their solubility was discussed in terms of crystal structure and mode of hydrogen bonding. With an increase in the treatment time, the DD of chitin increased proportionally. The chitin became soluble in dilute acetic acid at the DD of ca. 28% or over and soluble in water at the DD of ca. 49%. The solubility of the partially deacetylated chitins had a close relationship with their crystal structure, crystallinity, and crystal imperfection as well as the glucosamine content. The wide-angle X-ray diffractometry (WAXD) revealed that the chitin with ca. 28% DD retained the crystal structure of alpha-chitin with significantly reduced crystallinity and perfection of the crystallites. The water-soluble chitin of ca. 49% DD had a new crystal structure similar to that of beta-chitin rather than either alpha-chitin or chitosan, suggesting that the homogeneous deacetylation transformed the crystal structure of chitin from the alpha to the beta form. Some hydrogen bonds existing in raw alpha-chitin were found to be missing at a DD of ca. 49%.

Comparative studies of various run buffers for chiral capillary electrophoresis using chiral crown ether as a chiral selector

In the capillary electrophoretic separation of primary amine enantiomers using (+)-(18-crown-6)-tetracarboxylic acid (18C6H4) as a chiral selector, the presence of run buffer constituents such as tris(hydroxymethyl)aminomethane (Tris) or Na+ competing with analytes for 18C6H4, diminishes the effectiveness of 18C6H4. In order to determine appropriate buffer systems for 18C6H4, various run buffer cationic components including Tris, 1,3-bis[tris(hydroxymethyl)methylamino]propane, bis(2-hydroxyethyl)iminotris(hydroxymethyl)methane, triethanolamine, tetramethylammonium, and Na+ were compared. Quantitative studies of the effects of the competitive constituents were carried out by measuring the electrophoretic mobilities of histidine as a function of the 18C6H4 concentration. We also derived a simple equation to estimate the optimal chiral selector concentration for a maximum mobility difference in the presence of a competitive inhibitor.

Synthesis of (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-amines

trans-Metanicotine, a subtype (alpha4beta2)-selective ligand for neuronal nicotinic acetylcholine receptor, is under clinical phase for Alzheimer's disease. An efficient synthetic route for (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-amines, derivatives of trans-metanicotine, was explored. Allylation reaction of aryl aldimines with allylmagnesium bromide in THF gave (+/-)-methyl-(1-aryl-but-3-enyl)-amines. Protection of the amines with the Boc group and following Heck reaction of the N-Boc amines with 3-bromopyridine gave (+/-)-methyl-(1-aryl-4-pyridin-3-yl-but-3-enyl)-carbamic acid tert-butyl esters. Deprotection of the N-Boc group in aqueous 1N-HCI solution gave the titled amines in good yields. Thus, trans-metanicotine analogues modified at the a-position of the methylamino group with aryl groups were obtained in 5 steps.

Acinic cell carcinoma of the lacrimal gland with intracranial extension: a case report

PURPOSE

To describe a patient with acinic cell carcinoma of the lacrimal gland presenting with atypical manifestations including erosion of the orbital roof and intracranial extension. We compare his clinical manifestations with two previously reported cases.

METHODS

Case report.

RESULTS

A 51-year-old man presented with a firm, tender, palpable mass in the superior temporal portion of his right orbit. CT scan demonstrated a large homogeneously enhancing mass displacing the globe inferiorly and eroding the roof of the orbit. MRI of the orbit showed intracranial extension of tumor. Biopsy revealed an acinic cell carcinoma of the lacrimal gland.

CONCLUSIONS

Acinic cell carcinoma is a rare neoplasm occurring primarily in the major and minor salivary glands.

Promoter analysis of the Drosophila melanogaster gene encoding the pterin 4alpha-carbinolamine dehydratase

Pterin-4alpha-carbinolamine dehydratase (PCD) is a key enzyme in the regeneration pathway of tetrahydrobiopterin. Previously, we isolated and reported the Drosophila melanogaster gene encoding PCD. In the present study, we isolated and characterized the Drosophila virilis gene encoding PCD. The Drosophila virilis PCD gene has two introns and an open reading frame to encode a protein of 101 amino acids. The amino acid sequence of Drosophila virilis PCD shows a 83% homology to that of the Drosophila melanogaster PCD protein. From the alignment of the nucleotide sequence in the 5'-flanking region of the Drosophila melanogaster and Drosophila virilis PCD genes, we found four conserved sequences. Using a transient transfection assay, we showed that one of the conserved sequences (-127 to approximately -115) is critical for expression, also the minimal promoter region between -127 and +51 is necessary for the efficient expression of Drosophila melanogaster PCD.

Notch1 confers a resistance to glucocorticoid-induced apoptosis on developing thymocytes by down-regulating SRG3 expression

We previously have reported that SRG3 is required for glucocorticoid (GC)-induced apoptosis in the S49.1 thymoma cell line. Activation of Notch1 was shown to induce GC resistance in thymocytes. However, the specific downstream target of Notch1 that confers GC resistance on thymocytes is currently unknown. We found that the expression level of SRG3 was critical in determining GC sensitivity in developing thymocytes. The expression of SRG3 also was down-regulated by the activated form of Notch1 (NotchIC). The promoter activity of the SRG3 gene also was down-regulated by NotchIC. Expression of transgenic SRG3 resulted in the restoration of GC sensitivity in thymocytes expressing transgenic Notch1. These results suggest that SRG3 is the downstream target of Notch1 in regulating GC sensitivity of thymocytes.

Protein kinase Cdc15 activates the Dbf2-Mob1 kinase complex

Exit from mitosis in budding yeast requires inactivation of cyclin-dependent kinases through mechanisms triggered by the protein phosphatase Cdc14. Cdc14 activity, in turn, is regulated by a group of proteins, the mitotic exit network (MEN), which includes Lte1, Tem1, Cdc5, Cdc15, Dbf2/Dbf20, and Mob1. The direct biochemical interactions between the components of the MEN remain largely unresolved. Here, we investigate the mechanisms that underlie activation of the protein kinase Dbf2. Dbf2 kinase activity depended on Tem1, Cdc15, and Mob1 in vivo. In vitro, recombinant protein kinase Cdc15 activated recombinant Dbf2, but only when Dbf2 was bound to Mob1. Conserved phosphorylation sites Ser-374 and Thr-544 (present in the human, Caenorhabditis elegans, and Drosophila melanogaster relatives of Dbf2) were required for DBF2 function in vivo, and activation of Dbf2-Mob1 by Cdc15 in vitro. Although Cdc15 phosphorylated Dbf2, Dbf2-Mob1, and Dbf2(S374A/T544A)-Mob1, the pattern of phosphate incorporation into Dbf2 was substantially altered by either the S374A T544A mutations or omission of Mob1. Thus, Cdc15 promotes the exit from mitosis by directly switching on the kinase activity of Dbf2. We propose that Mob1 promotes this activation process by enabling Cdc15 to phosphorylate the critical Ser-374 and Thr-544 phosphoacceptor sites of Dbf2.

Fast spiking and regular spiking neural correlates of fear conditioning in the medial prefrontal cortex of the rat

In order to investigate whether and how medial prefrontal cortex (mPFC) of the rat is involved in processing of information related to fear conditioning, we recorded from single units in the prelimbic and infralimbic cortex of fear-conditioned rats in response to an explicit conditional stimulus (CS; an auditory tone) or contextual cues (conditioning box). The majority of units changed their activities significantly in response to the CS in a delay or trace conditioning paradigm. Both transient and tonic activity changes, including delay cell activity, were observed as in other behavioral tasks. When exposed to the context without CS delivery, most units changed their activities as well. These results show that both tone and contextual information are processed in the rat mPFC in expectation of the delivery of an aversive stimulus (electric foot shock). Interestingly, fast spiking cells (putative inhibitory interneurons) and regular spiking cells (putative projection neurons) showed different patterns of responses. Fast spiking cells tended to show transient responses and increased their firing rates following CS presentation, whereas a complementary pattern was observed in the regular spiking cells. Our results enhance our understanding of the neural mechanisms underlying prediction of an aversive stimulus in the mPFC.

"Malgun" (clear) cell change of gastric epithelium in chronic Helicobacter pylori gastritis

To characterize the Helicobacter pylori gastritis-associated epithelial change, we analyzed 251 randomly selected gastric biopsies. The "malgun" (clear) cell change of the gastric epithelium was noted in 229 biopsies (91.2%). Malgun cells were characterized by large, pale nuclei with a euchromatin pattern, enlarged nucleoli, and clear cytoplasm. In the proliferative zone, individual malgun cells and small clusters were often in close contact with infiltrating neutrophils, suggesting that they had developed individually in the background of acute foveolitis. Mitotic figures of malgun cells were not infrequent, including atypical ones. In the surface epithelium, most malgun cells were in clusters that were often large enough to occupy wide epithelial segments. With Warthin-Starry triple staining, they were distinguished by the absence of silver impregnation, while other cells showed staining of the heterochromatin. They displayed prominent immunostaining for low molecular weight cytokeratin (No. 8). Most malgun cells were PCNA-positive in both surface and proliferative zones, whereas Ki67-positive cells were found only in the proliferative zone. It was suggested that a population of malgun cells, which were positive for PCNA only, were in the process of active DNA repair. The malgun cell change may represent a "cellular pattern of activation" in a population which had significant DNA damage, but somehow escaped the detection by the apoptosis system. The notion of "damage at the genetic level" was supported by the observation that these cells remained at least for 8 weeks after eradication of the H. pylori infection.

Haloperidol and clozapine increase neural activity in the rat prefrontal cortex

Haloperidol and clozapine have been widely used to alleviate schizophrenic symptoms, but their physiological effects in the prefrontal cortex (PFC) are not known. Effects of haloperidol and clozapine on single unit activity were investigated in the medial PFC of anesthetized rats. Injection (intraperitoneal) of haloperidol (1 mg/kg) or clozapine (20 mg/kg) significantly elevated discharge rates of PFC neurons. Considering that hypofrontality is one characteristic of schizophrenic symptoms, these results raise the possibility that enhancement of PFC neural activity contributes to therapeutic effects of haloperidol and clozapine.