An unusual case of aldosterone- and norepinephrine-secreting retroperitoneal leiomyosarcoma

A case of retroperitoneal leiomyosarcoma (LMS) in a 38-year-old woman who had a tumor in the retroperitoneum with severe hypertension and hypokalemia is presented. Further investigation revealed an elevated serum aldosterone and norepinephrine level. After tumorectomy, the levels of serum aldosterone and norepinephrine successfully normalized; hypertension and hypokalemia were also cured. The tumor was diagnosed as being a LMS by pathologic examination. We suggested that this was the first case of retroperitoneal LMS shown to be associated with increased levels of serum aldosterone and norepinephrine.

Segmentation of lung lobes in volumetric CT images for surgical planning of treating lung cancer

Study has shown that three-dimensional (3D) visualization of lung cavities has distinct advantages over traditional computed tomographic (CT) images for surgical planning. A crucial step for achieving 3D visualization of lung cavities is the segmentation of lung lobes by identifying lobar fissures in volumetric CT images. Current segmentation algorithms for lung lobes rely on manually placed markers to identify the fissures. This paper presents an autonomous algorithm that effectively segments the lung lobes without user intervention. This algorithm applies a two-stage approach: (a) adaptive fissure sweeping to coarsely define fissure regions of lobar fissures; and (b) watershed transform to refine the location and curvature of fissures within the fissure regions. We have tested this algorithm on 4 CT data sets. Comparing with visual inspection, the algorithm provides an accuracy of 85.5-95.0% and 88.2-92.3% for lobar fissures in the left and right lungs, respectively. This work proves the feasibility of developing an automatic algorithm for segmenting lung lobes.

Effect of Rosiglitazone on Cardiac Fibroblast Proliferation, Nitric Oxide Production and Connective Tissue Growth Factor Expression Induced by Advanced Glycation End-products

This study investigated the effects of the peroxisome proliferator-activated receptor-γ agonist rosiglitazone (RGZ) on cardiac fibroblast proliferation, nitric oxide content and connective tissue growth factor (CTGF) expression following incubation with advanced glycation end-products (AGEs). Cultured neonatal rat cardiac fibroblasts were incubated with various concentrations of AGEs for 48 h. Cells were also incubated with 200 mg/l AGEs plus various concentrations of RGZ. Cardiac fibroblast proliferation and cell cycle status were detected using a 3-(4, 5dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide (MTT) assay and flow cytometry. Western blotting was used to measure the expression of CTGF and nitric oxide content was evaluated using a nitrate reductase assay. AGEs significantly accelerated proliferation, increased CTGF expression and decreased nitric oxide production in cardiac fibroblasts. These effects of AGEs were inhibited by RGZ in a dose-dependent manner. Treatment with RGZ could be a valuable therapeutic approach in diabetic patients with myocardial fibrosis.

E2A-ZNF384 and NOL1-E2A fusion created by a cryptic t(12;19)(p13.3; p13.3) in acute leukemia

A 5-year-old boy who initially presented with ALL and relapsed 4 months later with AML was found to have an add(19) in the leukemia cells. FISH revealed that the add(19) was really a cryptic t(l2;l9)(p13.3;p13.3) interrupting E2A (TCF3). Nucleotide sequences of cloned genomic fragments with the E2A rearrangements revealed that the der(12) contained E2A joined to an intron of the NOLI (p120) gene. Reverse transcriptase (RT)-PCR of patient lymphoblast RNA showed expression of in-frame fusion cDNAs consisting of most of NOL1 fused to the 3' portion of E2A that encoded part of the second transcriptional activation domain and the DNA binding and protein dimerization motifs. The reciprocal der(19) E2A genomic rearrangements included 5' regions of E2A joined to an intron of the ZNF384 (NMP4, CIZ) gene, located approximately 450 kb centromeric to NOL1 on chromosome 12. RT-PCR showed expression of in-frame E2A-ZNF384 fusion cDNAs. To our knowledge, this is the second report of a chromosome translocation in leukemia resulting in two different gene fusions. This is the first report of expression of E2A fusion protein that includes the DNA binding and protein dimerization domains due to a more proximal break in E2A compared to those described previously.

Common tumour p53 mutations in immortalized cells from Hupki mice heterozygous at codon 72

Codon72 of human p53 gene is polymorphic, encoding arginine or proline. Here we report construction of a human p53 knock-in (Hupki) mouse encoding the codon72^pro variant. The new strain was crossed with the original Hupki mice (codon72^arg/arg) to obtain primary embryonic fibroblasts polymorphic at codon72 or homozygous for codon72^pro. The fibroblasts, cultured under standard conditions, immortalized within 12 weeks and acquired p53 mutations similarly to Hupki codon72^arg/arg cells investigated previously. Sequencing of human p53 exons 4–9 in immortalized cultures revealed missense mutations found repeatedly in human tumours. In cell lines ensuing from benzo(a)pyrene-treated cultures the combined p53 mutation pattern from experiments with the 3 codon72 genotypes showed a predominance of strand-biased G to T transversions (18 of 36 mutations), and mutations recurring at smokers’ lung tumour hotspot codons 157 and 273, supporting involvement of tobacco carcinogens in shaping the mutation signature in lung cancers of smokers. Mutations in cell lines from unexposed cultures did not cluster at these codons and G to T transversions were uncommon (2 of 52 mutations) [Fisher’s exact test P<0.0001]. Most mutations (13/16) in cell lines derived from cells polymorphic at codon72 were found on the proline allele, with loss of the arginine allele.

Development of silver carp (Hypophthalmichthys molitrix) and bighead carp (Aristichthys nobilis) genetic maps using microsatellite and AFLP markers and a pseudo-testcross strategy

Silver carp (Hypophthalmichthys molitrix) and bighead carp (Aristichthys nobilis) are two of the four most important pond-cultured fish species inhabiting the major river basins of China. In the present study, genetic maps of silver carp and bighead carp were constructed using microsatellite and AFLP markers and a two-way pseudo-testcross strategy. To create the maps, 60 individuals were obtained from a cross of a single bighead carp (female) and a single silver carp (male). The silver carp map consisted of 271 markers (48 microsatellites and 223 AFLPs) that were assembled into 27 linkage groups, of which 22 contained at least four markers. The total length of the silver carp map was 952.2 cM, covering 82.8% of the estimated genome size. The bighead carp map consisted of 153 markers (27 microsatellites and 126 AFLPs) which were organized into 30 linkage groups, of which 19 contained at least four markers. The total length of the bighead carp map was 852.0 cM, covering 70.5% of the estimated genome size. Eighteen microsatellite markers were common to both maps. These maps will contribute to discovery of genes and genetic regions controlling traits in the two species of carp.

Phase I/II trial of docetaxel plus oxaliplatin and 5-fluorouracil (D-FOX) in patients with untreated, advanced gastric or gastroesophageal cancer

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Background: Docetaxel combined with cisplatin/5-fluouracil resulted in significantly longer time-to-progression and survival but also 30% rate of complicated neutropenia (JCO 2006; 24:4991). To improve the safety profile of docetaxel-based therapy, we studied docetaxel with oxaliplatin/5-fluorouracil (D-FOX) to establish the first-cycle MTD (phase II trial to follow). Methods: Patients with histologic proof of gastric or gastroesophageal adenocarcinoma with untreated stage IV cancer were eligible. ECOG PS of <2, near-normal organ function, and written consent were other eligibility criteria. The initial doses of oxaliplatin (85mg/m2) and 5-fluorouracil (2.2g/m2 as 48-hour infusion), given every 2 weeks, were kept constant. Docetaxel was started at 20mg/m2 (Level 1) every 2 weeks in a typical 3x3 phase I design. Subsequent levels (+5mg/m2 every 4 weeks) were added. Fatigue, incompletely treated nausea, and oxaliplatin/5-flurouracil-related toxicities were excluded to determine the MTD. Results: A total of 36 patients have been treated. Currently, docetaxel dose is 47.5mg/m2 every 2 weeks (Level 11). MTD was not reached at Level 10. Overall, grade 3 or 4 first-cycle toxicities have occurred in <5% of patients and without complicated neutropenia. Fifteen of 34 patients have had a confirmed partial response, 13 had stability, and 6 patients had progression. Conclusions: The MTD of D-FOX has not yet been established but its safety profile (D-FOX with 45mg/m2 of docetaxel every 2 weeks) is excellent and the regimen is quite active against untreated gastric or gastoresophageal cancer. Translation studies and additional clinical data will be presented. Supported in part by sanofi-aventis pharma.

[Table: see text]

Long-term effects of pre-surgical stress management for men with early stage prostate cancer undergoing radical prostatectomy (RP)

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Background: We conducted a randomized trial to examine pre-surgical stress management for men undergoing RP. We previously reported on the short-term benefits in reducing mood disturbances before and after surgery. Methods: One hundred and fifty- eight men were randomly assigned to one of three conditions. Men in the stress management (SM) group discussed their fears and concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery, an imaginal exposure to the day of surgery, and exposure to adaptive coping skills. Men in the supportive attention (SA) group discussed their fears and concerns about the upcoming surgery and then a semi-structured interview was conducted. Men in the SM and SA groups met with a clinical psychologist two times prior to surgery, a brief session just prior to surgery, and then again prior to discharge. Men in the usual care (UC) group had no meetings with a psychologist. Men completed psychosocial and quality of life (QOL) measures including distress (BSI-GSI), intrusive thoughts (IES), and QOL (SF-36), at baseline and 6 and 12 months later. Results: Men were primarily Caucasian (78%), married (85%) and highly educated (80% some college or higher). Mixed model analyses, controlling for ethnicity, age, martial status, stage, baseline PSA, Gleason score, and the respective baseline measure, indicated a significant group main effect for SF-36 Role Physical (SF-RP)(p=0.01). Post-hoc analyses revealed significantly higher SF-RP scores for the SM (86) vs. UC (63) group and marginally higher scores for the SM (86) vs. SA (73) group. There was a marginally significant group main effect for pain scores (SF-BP) (p=0.12) with the SM group reporting significantly better pain scores than the UC group (80 vs. 71), and neither group differed from the SA group (77). There was also a group by time effect for general health scores (SF-GH) revealing by 12 months after surgery that the SM (74) and SA (76) groups both reported higher SF-GH scores than the UC group (68). There were no group differences on any of the other outcomes. Conclusions: Results suggest that even a brief pre-surgical stress management intervention is beneficial in terms of improving aspects of QOL 6 and 12 months after RP. Funding: NIMH/NCI RO1MH59432

No significant financial relationships to disclose.

Nijmegen breakage syndrome 1 (NBS1) gene polymorphism and chemotherapy-induced neutropenic fever in breast cancer patients

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Background: Neutropenic fever (NF) is a serious complication of the chemotherapies given to breast cancer patients and often limits their use. Hence, identifying which patients are at increased risk to develop NF is very important. The NBS1 gene product is important for the repair of double-strand DNA breaks and is activated by chemotherapy. The objective of this study was to determine if genetic variations of NBS1 polymorphisms predict the risk of chemotherapy-induced NF in breast cancer patients. Methods: Blood from 306 newly diagnosed breast cancer patients treated with chemotherapy were prospectively collected on a study approved by the institutional review board. The relationship of chemotherapy administration (e.g. dose, timing) and growth factor use were correlated with the absolute neutrophil count (ANC) and NF development. For each patient, we assessed three polymorphisms (924T>C, 8360G>C, and 30537G>C) of NBS1 gene using polymerase chain reaction-restriction fragment length polymorphism method. Two-sided Chi-square test was used for univariate analysis and a multivariable logistical regression analysis was used to calculate odds ratios. Results: In total, 167 (55%) patients experienced ANC less than 1,000 cells/microliter (CIN1000) and 30 (10%) patients developed NF. For 8360G>C polymorphism, 9.7% of patients had a 8360CC variant genotype and these patients had increased risk of NF than the other genotypes (NF in CC 20.7% vs. in others 8.1%; Odds Ratio [OR] = 3.0; 95% confidence interval [CI] = 1.1 - 8.0, p = 0.034). In multivariable logistic regression model, 8360CC genotype (OR = 5.0, 95% CI = 1.6 - 16.1, p = 0.007) and growth factor support (OR = 19.6, 95% CI = 4.4 - 87.6, p < 0.001) were significantly associated with NF development. No genotypes of 924T>C and 30537G>C polymorphisms increased the risk of NF and there was no statistical association between the three NBS1 gene polymorphisms and CIN1000. Conclusions: Breast cancer patients with 8360CC variant polymorphism in NBS1 gene have increased risk in developing NF with systemic chemotherapy. Analysis of polymorphisms of NBS1 and other DNA repair genes could potentially help identify who will develop chemotherapy-induced bone marrow toxicities.

No significant financial relationships to disclose.

The pathological role of Bax in cisplatin nephrotoxicity

Nephrotoxicity induced by cisplatin involves tubular cell necrosis and apoptosis; the latter of which may be initiated by multiple mechanisms including activation of the intrinsic mitochondrial pathway. In cultured tubular epithelial cells, cisplatin can activate the proapoptotic protein Bax resulting in cytochrome c release, caspase activation, and apoptosis. Definitive evidence for the involvement of Bax in cisplatin nephrotoxicity in vivo, however, is lacking. We analyzed Bax regulation during cisplatin nephrotoxicity in wild-type mice and determined the pathological role of Bax using mice in which this gene was knocked out. In wild-type mice, cisplatin induced Bax in renal tubular cells which became active, accumulated in the mitochondria, and was accompanied by acute kidney injury. Compared with the wild-type mice renal function, as measured by blood urea nitrogen and serum creatinine, was partially but significantly preserved in Bax knockout mice. The number of apoptotic cells was decreased as was general tissue damage. Additionally, cisplatin-induced cytochrome c release was attenuated in the Bax-deficient mice. This significant decrease in apoptosis and in cytochrome c release was also mirrored in primary cultures of proximal tubular cells prepared from Bax knockout animals. Collectively, our results provide compelling evidence for a role of Bax and its related apoptotic pathway in cisplatin nephrotoxicity.

Ultrastructure and morphology of spermatozoa in Chinese sturgeon (Acipenser sinensis Gray 1835) using scanning and transmission electron microscopy

The Chinese sturgeon (Acipenser sinensis Gray 1835) is an endangered anadromous sturgeon inhabiting the Yangtze River in China. In this study, the ultrastructure and morphology of spermatozoa was studied using transmission and scanning electron microscopy with a cryo-holder. The spermatozoon consisted of an elongated head with a distinct acrosome and nucleus region, a midpiece and a flagellum. The mean length of the head and midpiece, the flagellum and total length of spermatozoon were 4.48, 33.3 and 37.8 microm, respectively. The nucleus was an elongated trapezoid shape with anterior (acrosome) end narrower than the posterior. Granular material and an actin filament were observed within the anterior acrosome. Three to five endonuclear canals were present. The midpiece was eudipleural along its longitudinal axis. Compared to other sturgeon species, the data from the present study suggest a more recent evolutionary linkage between Chinese sturgeon and white sturgeon (Acipenser transmontanus Richardson 1836).

An inverse methodology for high frequency RF head coil design with preemphasized B/sub 1/ field in MRI

An inverse methodology to assist in the design of radio-frequency (RF) head coils for high field MRI application is described in this work. Free space time-harmonic electromagnetic Green's functions and preemphasized B/sub 1/ field are used to calculate the current density on the coil cylinder. With B/sub 1/ field preemphasized and lowered in the middle of the RF transverse plane, the calculated current distribution can generate an internal magnetic field that can reduce the EM field/tissue interactions at high frequencies. The current distribution of a head coil operating at 4 T is calculated using inverse methodology with preemphasized B/sub 1/ fields. FDTD is employed to calculate B/sub 1/ field and signal intensity inside a homogenous cylindrical phantom and human head. A comparison with conventional RF birdcage coil is reported here and demonstrated that inverse-method designed coil with preemphasized B/sub 1/ field can help in decreasing the notorious bright region caused by EM field/tissue interactions in the human head images at 4 T.

An equivalent distributed magnetic current based FDTD method for the calculation of E-fields induced by gradient coils in MRI

This paper evaluates a low-frequency FDTD method applied to the problem of induced E-fields/eddy currents in the human body resulting from the pulsed magnetic field gradients in MRI. In this algorithm, a distributed equivalent magnetic current (DEMC) is proposed as the electromagnetic source and is obtained by quasistatic calculation of the empty coil's vector potential or measurements therein. This technique circumvents the discretizing of complicated gradient coil geometries into a mesh of Yee cells, and thereby enables any type of gradient coil modeling or other complex low frequency sources. The proposed method has been verified against an example with an analytical solution. Results are presented showing the spatial distribution of gradient-induced electric fields in a multilayered spherical phantom model and a complete body model.

An object-oriented designed finite-difference time-domain simulator for electromagnetic analysis and design in MRI

This paper presents a finite-difference time-domain (FDTD) simulator for electromagnetic analysis and design applications in magnetic resonance imaging (MRI). It is intended to be a complete FDTD model of an MRI system including all RF and low frequency field generating units and electrical models of the patient. The framework has been constructed with the assistance of object-oriented concepts. The detailed design procedure is described and the numerical method has been verified against analytical solutions for simple cases and also applied to real field calculations. The simulated results demonstrated that the proposed FDTD scheme can be used to analyze large-scale computational electromagnetic problems in MRI engineering.