Predictors of hepatitis B screening among patients with cancer

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Background: Patients with hepatitis B virus (HBV) infection are at risk of reactivation after chemotherapy. It is unclear whether all patients or only those with certain risk factors should be screened for HBV before chemotherapy. The purpose of our study was to determine the clinical predictors of HBV screening in a single institution.

Methods: In this retrospective, cross-sectional study, we evaluated new patients who received chemotherapy between 1/1/04 and 9/30/07. We collected data on patients' demographics, types of cancer and chemotherapy, and HBV risk factors such as a previous ICD-9 code for hepatitis C or other liver conditions. We searched for HBV screening as defined by an HBsAg or anti-HBc test ordered prior to chemotherapy. In univariate analyses, we examined the association between each of the patient-related variables and HBV screening. We then determined predictors of HBV screening in a multivariable logistic regression model.

Results: We found 10,729 patients who had chemotherapy during the study period. Overall, 16.7% had HBV screening. All of the following predictors in the univariate analysis were significant for HBV screening at the p<0.01 level: age, gender, ethnicity, U.S. residence, cancer type, chemotherapy type, and having a HBV risk factor. In multivariable logistic regression examining predictors for screening using HBsAg, we found that Asian ethnicity (OR 1.75; 1.16-2.66), hematologic malignancies (OR 22.65; 19.3-26.31), and the receipt of rituxamab (OR 3.71; 3.03-4.48) were significant predictors at the p<0.01 level. Women were less likely to be screened than men (OR 0.68; 0.59-0.78). We repeated the analyses using the anti-HBc screening test, and the results were similar. Overall, 1.5% of the screened patients had a positive HBV test.

Conclusions: We found that ethnicity, cancer types, and chemotherapy drugs predict physician-driven HBV screening. Future research is needed to study the predictors of a positive HBV screening test and reactivation of HBV after chemotherapy.

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Far-infrared conductivity measurements of pair breaking in superconducting Nb 0.5 Ti 0.5 N thin films induced by an external magnetic field

We report the complex optical conductivity of a superconducting thin film of Nb 0.5 Ti 0.5 N in an external magnetic field. The field was applied parallel to the film surface and the conductivity extracted from far-infrared transmission and reflection measurements. The real part shows the superconducting gap, which we observe to be suppressed by the applied magnetic field. We compare our results with the pair-breaking theory of Abrikosov and Gor'kov and confirm directly the theory's validity for the optical conductivity.

Phase II trial of sagopilone, a novel epothilone analog in metastatic melanoma

BACKGROUND

Sagopilone is a novel fully synthetic epothilone with promising preclinical activity and a favourable toxicity profile in phase I testing.

METHODS

A phase II pharmacokinetic and efficacy trial was conducted in patients with metastatic melanoma. Patients had measurable disease, Eastern Cooperative Oncology Group performance status 0-2, adequate haematological, and organ function, with up to 2 previous chemotherapy and any previous immunotherapy regimens. Sagopilone, 16 mg m⁻², was administered intravenously over 3 h every 21 days until progression or unacceptable toxicity.

RESULTS

Thirty-five patients were treated. Sagopilone showed multi-exponential kinetics with a mean terminal half-life of 64 h and a volume of distribution of 4361 l m⁻² indicating extensive tissue/tubulin binding. Only grade 2 or lower toxicity was observed: these included sensory neuropathy (66%), leukopenia (46%), fatigue (34%), and neutropenia (31%). The objective response rate was 11.4% (one confirmed complete response, two confirmed partial responses, and one unconfirmed partial response). Stable disease for at least 12 weeks was seen in an additional eight patients (clinical benefit rate 36.4%).

CONCLUSION

Sagopilone was well tolerated with mild haematological toxicity and sensory neuropathy. Unlike other epothilones, it shows activity against melanoma even in pretreated patients. Further clinical testing is warranted.

Increased prevalence of white matter hyperintensities in patients with panic disorder

The aim of the current study is to compare the prevalence, severity and location of cerebral white matter hyperintensities (WMH) between patients with panic disorder (PD) and healthy control subjects. Patients with PD (n = 24) and matched healthy control subjects (n = 24) were scanned using a 3.0 Tesla whole-body magnetic resonance scanner. Axial T2-weighted and fluid-attenuated inversion recovery images were acquired and evaluated for the prevalence, severity and location of WMH using the modified composite scale of Fazekas and Coffey and coded separately for deep and periventricular WMH. Logistic regression analyses were used to assess the association between WMH and the diagnosis of PD. A greater severity of total WMH was associated with a diagnosis of PD in a dose-dependent pattern (odds ratio [OR] = 8.8, P = 0.005 for mild WMH; OR = 27.7, P = 0.007 for moderate to severe WMH). Deep WMH, where most group differences originated, were predominantly located in the frontal region of the brain (n = 16 in PD, n = 1 in control). The current report is the first study to report an increased prevalence of WMH in patients with PD.

Persistence of ferroelectricity in BaTiO3 through the insulator-metal transition

The ferroelectric BaTiO(3) is a band-gap insulator. Itinerant electrons can be introduced in this material by doping, for example, with oxygen vacancies. Above a critical electron concentration of n(c) approximately 1 x 10(20) cm(-3), BaTiO(3-delta) becomes metallic. This immediately raises a question: Does metallic BaTiO(3-delta) still retain ferroelectricity? One may expect itinerant electrons to destroy ferroelectricity as they screen the long-range Coulomb interactions. We followed the phase transitions in BaTiO(3-delta) as a function of n far into metallic phase. Although their stability range decreases with n, the low-symmetry phases in metallic BaTiO(3-delta) are still retained up to an estimated concentration of n* approximately 1.9 x 10(21) cm(-3). Moreover, it appears that the itinerant electrons partially stabilize the ferroelectric phases in metallic BaTiO(3-delta) by screening strong crystal field perturbations caused by oxygen vacancies.

Bronchial anthracofibrosis and tuberculosis in immigrants to Canada from the Indian subcontinent

BACKGROUND

Bronchial anthracofibrosis is a condition of proximal airway narrowing or obliteration and hyperpigmentation in persons with or without a history of occupational dust exposure. It is a bronchoscopic finding that is not uncommonly associated with pulmonary tuberculosis (PTB) in residents of South Korea, Iran and India. It is largely unrecognized in the Western world.

METHODS

We report the frequency of anthracofibrosis in foreign-born PTB patients who underwent bronchoscopy in two cities of Canada. We describe the composition of the pigment in the lungs of patients and speculate on the pathogenesis of anthracofibrosis-associated PTB.

RESULTS

Anthracofibrosis was present in 10/60 (16.7%) foreign-born patients who underwent bronchoscopy and had PTB between 2002 and 2006. Compared to patients from other Asian countries, patients from the Indian subcontinent were more likely to have anthracofibrosis (9/18, 50.0% vs. 1/26, 3.7%, P < 0.001). Carbonaceous particles, silica and silicates predominated in tissue specimens. Proximal airway narrowing appeared to be secondary to mixed dust- and smoke-related anthracofibrosis, PTB, or both.

CONCLUSIONS

Anthracofibrosis is not uncommon in immigrants to Canada from the Indian subcontinent with PTB. PTB may be a responsible or complicating condition in patients with anthracofibrosis.

SQUID-based microwave cavity search for dark-matter axions

Axions in the microeV mass range are a plausible cold dark-matter candidate and may be detected by their conversion into microwave photons in a resonant cavity immersed in a static magnetic field. We report the first result from such an axion search using a superconducting first-stage amplifier (SQUID) replacing a conventional GaAs field-effect transistor amplifier. This experiment excludes KSVZ dark-matter axions with masses between 3.3 microeV and 3.53 microeV and sets the stage for a definitive axion search utilizing near quantum-limited SQUID amplifiers.

Albumin-Binding and Angiogenic Domains of SPARC Located at Its C-Terminus

Background: SPARC (Secreted Protein Acidic and Rich in Cysteine) is an albumin-binding glycoprotein overexpressed in breast cancer and is associated with poor prognosis and shorter overall survival. We have previously shown that SPARC expression appeared to correlate with response to nanoparticle albumin-bound (nab) paclitaxel (Abraxane) in head-and-neck and pancreatic-cancer patients. To further define the role of SPARC, recombinant-human SPARC (rhSPARC) was characterized to identify its albumin-binding and angiogenic domain.Materials and methods: The albumin-binding site on SPARC was defined by testing the binding of Alexa 488-labeled BSA to immobilized rhSPARC in a solid-phase-binding assay and in a competitive-binding assay in presence of increasing concentration of various SPARC-derived peptides. The angiogenic activity of rhSPARC was evaluated using a HUVEC tube-formation assay.Results: The SPARC albumin-binding assay revealed a pattern of saturable and specific binding with an estimated Kd of 700 µM very near the known plasma concentration of albumin (600 µM). Competitive binding with Cathepsin K-digested SPARC and SPARC-derived peptides defined the albumin-binding domain to be amino acids 209-223 in the C-terminal region. In the HUVEC tube-formation assay, rhSPARC was pro-angiogenic at 10 µg/ml and anti-angiogenic at 100 µg/ml. The angiogenic domain of SPARC was located to the C-terminal of SPARC.Discussion: The albumin-binding domain of SPARC was located to residues aa209-223, supporting its role as a target for nab-technology-based drug delivery. We confirmed that SPARC can promote angiogenesis at physiological concentrations, contributing to the role of SPARC in a more aggressive tumor phenotype. The angiogenic domain of SPARC is located within a 54-aa sequence of its C-terminus. SPARC could be a potential therapeutic target and a biomarker for predicting response to nab-paclitaxel.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2144.

Phenylephrine Attenuates Intra-Operative Hypothermia during Spinal Anaesthesia

Inadvertent hypothermia is common during spinal anaesthesia. This study was based on the hypothesis that phenylephrine might attenuate core hypothermia by inhibiting core-to-peripheral redistribution of body heat during spinal anaesthesia. In this prospective randomized study, 20 patients who underwent elective orthopaedic surgery under spinal anaesthesia were randomly assigned to receive either normal saline (control group) or continuously-infused phenylephrine 0.5 μg/kg per min (phenylephrine group). Core temperature, heart rate (HR) and mean arterial pressure (MAP) were monitored. Mean ± SE core temperature at the end of surgery was significantly higher in the phenylephrine-treated group compared with the control group (35.9 ± 0.1 °C versus 35.0 ± 0.1 °C, respectively), although there was no significant difference in baseline core temperature (both groups 36.3 ± 0.1 °C). Mean HR and MAP were not significantly different between the two groups. In conclusion, continuously-infused phenylephrine attenuated core hypothermia during spinal anaesthesia without any haemodynamic complications.

Diffusion-weighted MR imaging derived apparent diffusion coefficient is predictive of clinical outcome in primary central nervous system lymphoma

BACKGROUND AND PURPOSE

There is evidence that increased tumor cellular density within diagnostic specimens of primary central nervous system lymphoma (PCNSL) may have significant prognostic implications. Because cellular density may influence measurements of apparent diffusion coefficient (ADC) by using diffusion-weighted MR imaging (DWI), we hypothesized that ADC measured from contrast-enhancing regions might correlate with clinical outcome in patients with PCNSL.

MATERIALS AND METHODS

PCNSL tumors from 18 immunocompetent patients, treated uniformly with methotrexate-based chemotherapy, were studied with pretherapeutic DWI. Enhancing lesions were diagnosed by pathologic analysis as high-grade B-cell lymphomas. Regions of interest were placed around all enhancing lesions allowing calculation of mean, 25th percentile (ADC(25%)), and minimum ADC values. Histopathologic tumor cellularity was quantitatively measured in all patients. High and low ADC groups were stratified by the median ADC value of the cohort. The Welch t test assessed differences between groups. The Pearson correlation examined relationships between ADC measurements and tumor cellular density. Single and multivariable survival analysis was performed.

RESULTS

We detected significant intra- and intertumor heterogeneity in ADC measurements. An inverse correlation between cellular density and ADC measurements was observed (P < .05). ADC(25%) measurements less than the median value of 692 (low ADC group) were associated with significantly shorter progression-free and overall survival. Patients with improved clinical outcome were noted to exhibit a significant decrease in ADC measurements following high-dose methotrexate chemotherapy.

CONCLUSIONS

Our study provides evidence that ADC measurements within contrast-enhancing regions of PCNSL tumors may provide noninvasive insight into clinical outcome.