First clinical data of a natural immunomodulator in colorectal cancer

BACKGROUND/AIMS

MSC (trade-name AVEMAR) is a per os applicable complex of multiple, biologically active molecules obtained from fermented wheat-germ extract. Preclinical studies suggest potent anti-metastatic activity and it has a favorable toxicity profile. It has been aimed in a pilot-scale, phase II clinical study to document whether or not MSC as a support to surgery or plus chemotherapy adds any therapeutic benefit compared to the same combination without MSC in colorectal cancer.

METHODOLOGY

From 1998 to June 1999, 18 control patients and 12 consecutive colorectal cancer patients respectively, were enrolled into this study. All patients underwent curative surgery. The control group (18 patients) received no other therapy or adjuvant chemotherapy alone. The MSC group (12 patients) received MSC alone or plus adjuvant chemotherapy. Until now, the median follow-up has been 9 months.

RESULTS

Interim data of the study document that in the MSC group no new metastases, neither hepatic nor other, have occurred, so far. On the contrary, several new metastases have developed in the control group.

CONCLUSIONS

Orally administered MSC is a potent candidate to be regarded as a supportive therapy to surgery or plus chemotherapy for colorectal cancer patients.

Phosphatidylinositol 4,5-bisphosphate regulates two steps of homotypic vacuole fusion

Yeast vacuoles undergo cycles of fragmentation and fusion as part of their transmission to the daughter cell and in response to changes of nutrients and the environment. Vacuole fusion can be reconstituted in a cell free system. We now show that the vacuoles synthesize phosphoinositides during in vitro fusion. Of these phosphoinositides, phosphatidylinositol 4-phosphate and phosphatidylinositol 4,5-bisphosphate (PI(4,5)P(2)) are important for fusion. Monoclonal antibodies to PI(4,5)P(2), neomycin (a phosphoinositide ligand), and phosphatidylinositol-specific phospholipase C interfere with the reaction. Readdition of PI(4, 5)P(2) restores fusion in each case. Phosphatidylinositol 3-phosphate and PI(3,5)P(2) synthesis are not required. PI(4,5)P(2) is necessary for priming, i.e., for the Sec18p (NSF)-driven release of Sec17p (alpha-SNAP), which activates the vacuoles for subsequent tethering and docking. Therefore, it represents the kinetically earliest requirement identified for vacuole fusion so far. Furthermore, PI(4,5)P(2) is required at a step that can only occur after docking but before the BAPTA sensitive step in the latest stage of the reaction. We hence propose that PI(4,5)P(2) controls two steps of vacuole fusion.

Dopamine and senescence in Drosophila melanogaster

Five-day-old Drosophila melanogaster males, when exposed to 2-h-old males, will perform courtship rituals; the intensity and duration of this behavior rapidly diminishes with time. The ability of the older males to habituate to the attractive signals given off by the younger males is a dopaminergic-modulated experience-dependent modification of behavior that is abolished with increasing age. Dopamine-depleted females show increased resistance to copulation; 20-day-old females demonstrated an increase in copulation avoidance compared with younger (5-15-day-old) females. These changes in dopaminergic-modulated behaviors observed during aging parallel declines in whole body levels of dopamine. Immunocytochemical analysis of adult brains using an antibody raised against Drosophila tyrosine hydroxylase to visualize catecholaminergic cell bodies revealed increased degeneration of the cell bodies with aging. These results suggest that the deficits seen in dopaminergic-modulated behaviors may arise as a consequence of degenerative changes within the aging brain.

Assessment of the protection efficiency and comfort of personal protective equipment in real conditions of use

The lack of scientific and technical knowledge in certain complex fields, together with schedule constraints, have lead to adopt in EN standards insufficiently validated tests, relying sometimes on an empirical approach. Thus, even personal protective equipment (PPE) with positive results in tests required by the standards can nevertheless prove to be unsatisfactory when used at work. Several research projects have already been carried out on equipment, fall arresting systems, protective clothing, and gloves by several health and safety institutes in Europe. The results would suggest practical solutions to improve the representativity of several European Committee for Standardization (CEN) test methods and to focus more on informing and training workers on the manner of wearing PPE, in particular respiratory protective equipment or hearing protectors.

[Surgical management of reflux disease--laparoscopy: renaissance of fundoplication?]

The importance of the surgical treatment of the gastroesophageal reflux disease have been increased in recent years. After the medical treatment has spread, the minimally invasive procedures were developed. Testing these procedures clinically and applying them on several numbers of patients, the surgical solution has become conspicuous again and the good results proved reason for the existence of the surgical methods that are effective, safe, cost-effective and load to limited complications. The goal of this article is to sum up the advance of the antireflux-surgery, to give a summary about the tendencies of surgical therapies and representating the new results on this topic.

Taking engineered anti-CEA antibodies to the clinic

There is a need to improve on existing targeting technologies in order to develop effective cancer therapy. We have investigated this for colorectal cancer using antibodies directed against carcinoembryonic antigen (CEA). Chemical and molecular protein engineering has been used to produce antibody molecules which differ in molecular weight, affinity, valency and specificity. These have been characterised and tested in animal tumour models and clinical trials to test the parameters important for optimising tumour penetration, increasing residence time in viable areas of the tumour, accelerating clearance from normal tissues and improving therapeutic efficacy.

Group theory used to improve the efficiency of transfer-matrix computations

Transfer-matrix methodology is frequently used to deal with elastic scattering problems that require a solution of Schrödinger or homogeneous Maxwell equations in the continuous part of their spectra. As predicted by group theory, the basic states used for the expansion of the solutions can be separated into independent sets, thus enabling the scattering problem to be solved with a drastically improved efficiency. Depending on the peculiar symmetry in the problem, the basic states can present pairs of "conjugate sets," whose associated characters are complex conjugate of each other. When the potential energy takes strict real values, the transfer matrices corresponding to these conjugate sets have well-defined relationships that enable the transfer matrices of both conjugate sets to be computed from a single propagation step. This results in a further reduction of up to 50% of the total computation time. This paper presents the way group theory can be used systematically to improve the efficiency of transfer-matrix computations. In a first part, the basic states are separated into independent sets. Relationships between the transfer matrices corresponding to conjugate sets are then derived. The theory is finally illustrated by a simulation of electronic scattering by a C60 molecule in a projection configuration.

Changes in leptin, insulin and body composition in obese children during a weight reduction program

BACKGROUND

Girls have higher leptin concentrations than boys at all stages of biological development and this is also seen in the state of obesity. Little is known about whether gender and biological development of obese children influence changes in leptin associated with a short-term weight reduction program.

OBJECTIVE

To study whether leptin concentration, body composition and insulin levels in obese children were influenced by a 3-week intervention program including diet and sports.

STUDY DESIGN

Sixty-two obese children (32 boys and 30 girls) were examined before and after the intervention program. Body composition was measured by bioelectrical impedance and BMI-SDS was calculated. Serum leptin and serum insulin were determined by RIA.

RESULTS

Girls had higher leptin levels than boys, before and after the weight reduction program. Body mass, fat mass (FM), leptin and insulin were decreased after the intervention in both sexes. We found a greater change in serum leptin in girls but the change in FM was of greater magnitude in boys. However, percentage changes in leptin were not significantly different between the sexes. Before the intervention, leptin concentrations were correlated with %FM, FM and moderately with BMI-SDS in all children. Only in pubertal boys did correlation of leptin with %FM increase after the intervention (from r=0.57 to r=0.75, p<0.01). Changes in leptin were found to be associated with initial leptin values in boys (r=0.95, p<0.01) and in girls (r=0.93, p<0.01), independent of Tanner stages.

CONCLUSION

Serum leptin levels were positively correlated with adiposity in obese children and a diet and sports intervention program decreased serum leptin, insulin and body fat in all children. Changes in leptin were best described by the initial leptin concentration. The increase in correlation of leptin with %FM in obese pubertal boys after the intervention could have its underlying mechanism in an increased sensitivity to leptin and anabolic hormones.

Targeting head and neck cancer by GM-CSF-mediated gene therapy in vitro

BACKGROUND

The prognosis for patients with squamous cell carcinoma of the head and neck (SCCHN) has remained poor during the last decades, emphasizing the need for new treatment modalities. Consequently, the objective of our study was to evaluate the feasibility and efficacy of cytokine-mediated gene therapy in SCCHN in vitro.

MATERIALS AND METHODS/RESULTS

The SCCHN cell line PCI-1 was transduced by lipofection with a plasmid encoding the human granulocytemacrophage colony-stimulating factor (GM-CSF). Transfection of PCI-1 resulted in the production of significant amounts of GM-CSF as tested by ELISA. Enhanced proliferation of a GM-CSF sensitive cell line, TF-1, after incubation with supernatants of GM-CSF-transduced tumor cells demonstrated the release of biological active GM-CSF from these PCI-1 cells. In addition, GM-CSF-secreting PCI-1 cells enhanced antitumor cytotoxicity of allogeneic peripheral blood mononuclear cells, as tested in 24h-MTT-cytotoxicity assays.

CONCLUSIONS

Our data demonstrate the feasibility and efficacy of GM-CSF-mediated stimulation of the antitumor immune response against SCCHN in vitro and may help to define new strategies in the treatment of this malignancy.

[Radiotherapy at the turn of the millennium]

The radiotherapy of the turn of the millenium has arisen as a result of continuous technical development, having taken place during the past 100 years. In the first 60 years it was, above all, a development of apperatures in the field of mechanics and radiophysics, originating a succession of different generations of megavolttherapy from the orthovolt one, radium being substituted in brachytherapy by surrogating nuclides. The motives for the development in the last 40 years have been microelectronics, computer technology and informatics. Owing to them, it became possible the digitalization of CT scans and CT assisted 3 dimension radiotherapy planningsystem. At the turn of the millenium, megavolttherapy and brachytherapy can only be remoted if computerized and perhaps with record and verify system a built-in on-line with portal imaging. In radiotherapy, technical development can motivate better therapeutic results only if treatments are given on tumorbiological-radiobiological basis which can essentially determine the totaldose and fractiondoses of radiotherapy and the total time and volume of radiation. A further task for radiotherapy is to examine how tumorregression can be influenced by alterated fractionation, by hyperthermia, by the oxigenization of the target volume eventually by chemotherapy and radioprotection of sourranding tissues.

Control of the terminal step of intracellular membrane fusion by protein phosphatase 1

Intracellular membrane fusion is crucial for the biogenesis and maintenance of cellular compartments, for vesicular traffic between them, and for exo- and endocytosis. Parts of the molecular machinery underlying this process have been identified, but most of these components operate in mutual recognition of the membranes. Here it is shown that protein phosphatase 1 (PP1) is essential for bilayer mixing, the last step of membrane fusion. PP1 was also identified in a complex that contained calmodulin, the second known factor implicated in the regulation of bilayer mixing. The PP1-calmodulin complex was required at multiple sites of intracellular trafficking; hence, PP1 may be a general factor controlling membrane bilayer mixing.

Intracellular membrane fusion: SNAREs only?

The past two years have seen vigorous attempts to elucidate the mechanism driving intracellular membrane fusion. Much attention was focused on the role of SNARE complexes. Their crystal structure was solved and fusion was reconstituted using proteoliposomes with purified SNAREs suggesting them to be the minimal machinery for fusion. Work on physiological membranes, however, points in another direction and has spurred a hot debate on the function of SNAREs.

Unusual manifestation of an osteoid osteoma of the capitate

A case of osteoid osteoma of the capitate in a 29-year-old male is reported. The patient suffered from unspecific clinical findings and a 3-year history of uncharacteristic wrist pain. Conventional radiographs of the wrist revealed a circumscribed sclerosis in the proximal part of the capitate bone beside a diffuse demineralisation of the carpal bones. Magnetic resonance imaging demonstrated a circumscribed, tumorous lesion with marked enhancement after IV administration of contrast agent and a highly calcified nidus, which was sharply demarcated by a small rim of granulation tissue from the surrounding spongious bone. Based on MRI findings, the diagnosis of an osteoid osteoma was established and confirmed after operation and histologic analysis.

Mapping of semantic, phonological, and orthographic verbal working memory in normal adults with functional magnetic resonance imaging

Twelve neurologically normal participants (4 men and 8 women) performed semantic, phonological, and orthographic working memory tasks and a control task during functional magnetic resonance imaging. Divergent regions of the posterior left hemisphere used for decoding and storage of information emerged in each working memory versus control task comparison. These regions were consistent with previous literature on processing mechanisms for semantic, phonological, and orthographic information. Further, working memory versus control task differences extended into the left frontal lobe, including premotor cortex, and even into subcortical structures. Findings were consistent with R. C. Martin and C. Romani's (1994) contention that different forms of verbal working memory exist and further suggest that a reconceptualization of premotor cortex functions is needed.

The relationship between peripheral T cell reactivity to insulin, clinical remissions and cytokine production in type 1 (insulin-dependent) diabetes mellitus

Antigenic proliferative responses of peripheral blood mononuclear cells (PBMC) to insulin were studied in 44 type 1 new-onset diabetic subjects. Of them, 14 (32%) had a stimulation index (> or =3) above the mean + 3 SD of 39 healthy controls and of 7 of 15 (47%) diabetic patients of long duration (P = 0.001). Responses to insulin were not dictated by specific major histocompatibility complex class II association and were not observed in normal subjects with diabetes-associated human leukocyte antigen-DR/DQ alleles. Whereas no relation of PBMC reactivity with insulin autoantibodies was found, there was a positive correlation with the presence of at least one of the four autoantibodies tested and with IA-2 antibody. An interesting finding was that the proportion of patients with subsequent low insulin requirement, up to 24 months, was significantly higher in patients who showed PBMC reactivity to insulin (8 of 8) than in those who did not (10 of 24, 42%; P = 0.004). The former had a higher mean stimulation index than the latter (3.3+/-2.6 vs. 1.5+/-0.6; P = 0.006). Furthermore, interleukin-4 (IL-4) production was lower in type 1 diabetic patients who proliferated to insulin than in those who did not (23+/-15 vs. 64+/-47 pg/mL; P = 0.04), but interferon-gamma, IL-2, and IL-10 productions were similar. In conclusion, these results suggest that proliferation to insulin may reflect the presence of an higher residual beta-cell mass.

[Osteoid osteoma of the capitate: diagnosis and therapy of a rare cause for wrist pain. Case report and review of the literature]

Occasionally, bone tumors are the source of wrist pain. This is particularly true of osteoidosteoma, which are easily overlooked or diagnosed very late. We present a case report including clinical and radiological findings as well as MRI, surgical treatment, and a review of the current literature.

T cell response pattern to glutamic acid decarboxylase 65 (GAD65) peptides of newly diagnosed type 1 diabetic patients sharing susceptible HLA haplotypes

Autoantibodies and autoreactive T lymphocytes directed against several pancreatic beta cell proteins such as GAD65 have been identified in the circulation before and at the onset of clinical type 1 (insulin-dependent) diabetes. Using GAD65 synthetic peptides, we studied the proliferative response of peripheral blood mononuclear cells (PBMC) either from recently diagnosed type 1 diabetic patients, of whom the majority share the disease-associated HLA class II haplotype (DR4-DQB1*0201 or DR3-DQB1*0302), or from HLA-matched control subjects. We found that 67% (14/21) of the type 1 diabetic patients and 39% (9/23) of the control subjects exhibited a positive proliferative response. Compared with control subjects, however, PBMC from diabetic patients proliferated more frequently (P < 0.05) in the presence of peptide pools from the C-terminal region of GAD65 (amino acids 379-585). Diabetic patients with the same HLA-DQ or HLA-DR alleles showed partially identical T cell reactivity, but no clear correlation could be made between MHC class II specificity and T cell epitopes because of multiple combinations of class II alleles. In addition, by flow cytometry, we studied the direct binding of GAD65 peptides to MHC class II molecules of Epstein-Barr virus (EBV)-transformed B (EBV-B) cells obtained from a diabetic patient. We found that 11 GAD peptides were able to bind to the highly susceptible haplotype DRB1*0301/0401-DQA1*0301/0501-DQB1*0302/0201 on the surface of EBV-B cells in partial correlation with the results obtained in the proliferation assays.

Extending a teleradiology system by tools for 3D-visualization and volumetric analysis through a plug-in mechanism

This paper describes ongoing research concerning interactive volume visualization coupled with tools for volumetric analysis. To establish an easy to use application, the 3D-visualization has been embedded in a state of the art teleradiology system, where additional functionality is often desired beyond basic image transfer and management. Major clinical requirements for deriving spatial measures are covered by the tools, in order to realize extended diagnosis support and therapy planning. Introducing the general plug-in mechanism this work exemplarily describes the useful extension of an approved application. Interactive visualization was achieved by a hybrid approach taking advantage of both the precise volume visualization based on the Heidelberg Raytracing Model and the graphics acceleration of modern workstations. Several tools for volumetric analysis extend the 3D-viewing. They offer 3D-pointing devices to select locations in the data volume, measure anatomical structures or control segmentation processes. A haptic interface provides a realistic perception while navigating within the 3D-reconstruction. The work is closely related to research work in the field of heart, liver and head surgery. In cooperation with our medical partners the development of tools as presented proceed the integration of image analysis into clinical routine.

Technical aspects of virtual liver resection planning

Operability of a liver tumor is depending on its three dimensional relation to the intrahepatic vascular trees which define autonomously functioning liver (sub-)segments. Precise operation planning is complicated by anatomic variability, distortion of the vascular trees by the tumor or preceding liver resections. Because of the missing possibility to track the deformation of the liver during the operation an integration of the resection planning system into an intra-operative navigation system is not feasible. So the main task of an operation planning system in this domain is a quantifiable patient selection by exact prediction of post-operative liver function and a quantifiable resection proposal. The system quantifies the organ structures and resection volumes by means of absolute and relative values. It defines resection planes depending on security margins and the vascular trees and presents the data in visualized form as a 3D movie. The new 3D operation planning system offers quantifiable liver resection proposals based on individualized liver anatomy. The results are visualized in digital movies as well as in quantitative reports.

An audit of breast cancer pathology reporting in Australia in 1995

To measure the quality of pathology reporting of breast cancer and establish a baseline against which future changes can be measured, we audited item completeness in breast cancer reports in Australia in 1995 before the release of specific recommendations from the Australian Cancer Network. Tumour type and size were given in reports of invasive breast cancer for 93% of women, 70% had, in addition, grade and clearance of the margins while only 28% had all recommended information. The most complete items in reports were histological type of breast cancer (99.6% of cases), tumour size (94%, 95% confidence interval (CI) 92-95) and margins of excision (87%, 95% CI 85-89). Histological grade (84%, 95% CI 82-86 of cases) and presence or absence of ductal carcinoma in situ (DCIS) (79%, 95% CI 77-81) were less complete and vessel invasion (61%, 95% CI 58-63) and changes in non-neoplastic breast tissue adjacent to the breast cancer (68%, 95% CI 66-71) the least complete. Less than half the reports of DCIS reported on tumour size (49%, 95% CI 42-57), presence or absence of necrosis (41%, 95% CI 34-49) or nuclear grade (39%, 95% CI 31-46). Around 1500 reports were identified as issued by 147 laboratories and 392 pathologists; 69% of pathologists issued fewer than two reports a month in the audit. We concluded that infrequency of reporting may have contributed to incompleteness of reporting. In addition, we found significant variation across Australian states with some indication that reporting was consistently poor in one state. The audit highlighted areas for improvement for breast cancer reporting in Australia. Research evidence suggests that multifaceted strategies are needed to assist practitioners with implementing more uniform reporting standards.

Holding on to success: a case study in mental health care reform

This article analyzes the changes experienced by a mental health care organization in response to environmental threats and fluctuating expectations. On a general, more theoretical level, the article demonstrates how processes of environmental selection as well as organizational adaptation shape organizational forms. On a concrete, applied level, those administrative practices are articulated that can help ensure that reform efforts are successful. Administrators also must be aware of the inertial forces operating upon stable organizational forms and work to ensure that the organization remains vital and open to change.

Effect of interferon alpha-2a on hormone receptor status in patients with advanced breast cancer

The aim of this study was to assess the effect of recombinant interferon alpha-2a (rh-IFN) on estrogen (ER) and progesterone (PR) receptor expression in patients with advanced breast cancer and the evaluation of the effect of rh-IFN pretreatment on response to endocrine therapy with tamoxifen (TAM). Between June 1990 and November 1992, 20 patients with disseminated breast cancer and with metastatic skin nodules suitable for biopsy were entered into this study. Eighteen assessable patients underwent biopsy before and 2 weeks after treatment with rh-INF. rh-INF 3 x 10(6) IU were administered subcutaneously per day. Patients with ER expression at second biopsy were subsequently treated with 20 mg TAM daily. One patient had rapid disease progression and died before rebiopsy could be performed, and an additional patient refused second biopsy. All other patients were considered assessable. Thirteen patients showed ER expression before rh-IFN treatment, and 5 PR presented with expression. Rh-IFN increased ER expression in three patients and PR in four patients. No change was observed in 8 patients for ER and in 12 patients for PR. ER expression decreased in seven patients and PR expression decreased in two patients, respectively. Two patients showed a partial remission after subsequent treatment with TAM. Adverse reactions caused by rh-IFN were mainly flu-like symptoms. In this trial we found no systematic impact of rh-IFN on hormone receptor expression and, subsequently, on the response rate in patients with advanced breast cancer.

Mapping of semantic, phonological, and orthographic verbal working memory in normal adults with functional magnetic resonance imaging

Twelve neurologically normal participants (4 men and 8 women) performed semantic, phonological, and orthographic working memory tasks and a control task during functional magnetic resonance imaging. Divergent regions of the posterior left hemisphere used for decoding and storage of information emerged in each working memory versus control task comparison. These regions were consistent with previous literature on processing mechanisms for semantic, phonological, and orthographic information. Further, working memory versus control task differences extended into the left frontal lobe, including premotor cortex, and even into subcortical structures. Findings were consistent with R. C. Martin and C. Romani's (1994) contention that different forms of verbal working memory exist and further suggest that a reconceptualization of premotor cortex functions is needed.

High performance medical image processing in client/server-environments

As 3D scanning devices like computer tomography (CT) or magnetic resonance imaging (MRI) become more widespread, there is also an increasing need for powerful computers that can handle the enormous amounts of data with acceptable response times. We describe an approach to parallelize some of the more frequently used image processing operators on distributed memory architectures. It is desirable to make such specialized machines accessible on a network, in order to save costs by sharing resources. We present a client/server approach that is specifically tailored to the interactive work with volume data. Our image processing server implements a volume visualization method that allows the user to assess the segmentation of anatomical structures. We can enhance the presentation by combining the volume visualizations on a viewing station with additional graphical elements, which can be manipulated in real-time. The methods presented were verified on two applications for different domains.