Elevated levels of ferritin in the cerebrospinal fluid of amyotrophic lateral sclerosis patients

OBJECTIVES

The aim of the study was to detect changes in the levels of ferritin heavy chain (FHC), ferritin light chain (FLC), and transferrin in the cerebrospinal fluid (CSF) and serum of amyotrophic lateral sclerosis (ALS) patients and to analyze the correlations between the levels of these proteins and various clinical parameters.

METHODS

Cerebrospinal fluid and serum samples were obtained from 54 ALS patients and 46 non-inflammatory neurological disease control (non-INDC) patients. CSF and serum FHC, FLC, and transferring levels were measured via the enzyme-linked immunosorbent method using a commercial ELISA kit, and the times from onset (durations), ALS functional rating scale-revised (ALSFRS-r) scores, and disease progression rates (DPRs) were analyzed by registered neurologists. Statistical analysis was performed via Prism software.

RESULTS

Compared with controls, ALS patients exhibited significantly increased FHC and FLC levels in CSF, which were positively correlated with DPR and negatively correlated with duration. Serum transferrin levels were significantly increased in ALS patients but were not correlated with disease progression. FHC and FLC in CSF rapidly increased as the disease worsened.

CONCLUSIONS

This study demonstrated that the clinical measurement of FHC and FLC in CSF may be beneficial for disease differentiation and evaluating progression in patients with ALS. Compared with levels in serum, the levels of FHC and FLC in CSF might be more reliable for diagnosing and assessing the progression of ALS.

Increased levels of MIP-1α in CSF and serum of ALS

OBJECTIVES

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disease with complicated pathogenesis. No effective diagnostic test and cure exists for the disease at present. We detected the levels of MIP-1α in cerebrospinal fluid (CSF) and serum and then further evaluated whether MIP-1α levels correlate with the severity and progression of ALS.

METHODS

We used ELISAs to detect MIP-1α levels from 58 patients with ALS and 45 age- and gender-matched controls. The patients with ALS were also clinically evaluated with the revised ALS functional rating scale (ALSFRS-r). Moreover, we followed up with 40 cases of ALS by way of call or clinic visit 4 years after enrollment in this study. Finally, we assessed the correlations between MIP-1α levels and various clinical parameters.

RESULTS

We found that the levels of MIP-1α in patients with ALS significantly increased compared to controls and they were positively correlated with duration. MIP-1α showed negative correlations with disease progression rate and the decrease in ALSFRS-r. Furthermore, the cumulative survival of patients with ALS with high levels of MIP-1α exceeded patients with low MIP-1α levels.

CONCLUSIONS

MIP-1α levels increased in both CSF and serum of patients with ALS, and it may be a potential neuroprotective biomarker in ALS.

bFGF in the CSF and serum of sALS patients

OBJECTIVES

Amyotrophic lateral sclerosis is a fatal neurodegenerative disease characterized by selective motor neuron loss in the brain and spinal cord. The cause of this selective death of motor neurons is still unclear, but among several pathomechanisms that have been discussed, the loss of neurotrophic factors is one hypothesis. Basic fibroblast growth factor 2 (bFGF) may be a potential neurotrophic factor for slowing various neurodegenerative diseases, but its potential role in the prognosis of ALS is not known.

METHODS

To explore the role of bFGF in ALS, we investigated changes in bFGF in the CSF and serum from patients with sALS and from the control group. Furthermore, we analyzed the correlations between bFGF, disease duration, disease progression rate, ALSFRS-r score and survival.

RESULTS

The level of bFGF increased in both the CSF and serum in sALS patients. It was higher in patients with longer durations. It was negatively correlated with disease progression rates, especially in the later stages of sALS, but showed no linear correlation with ALSFRS-r. In an analysis of the relationship between bFGF and survival, we found that sALS patients with high levels of bFGF had significantly higher cumulative survival rates than patients with low levels of bFGF.

DISCUSSION AND CONCLUSION

In conclusion, endogenous bFGF increased both in the CSF and serum of sALS patients and it may be a useful biomarker that could predict disease progression and survival.

A phase II trial of erlotinib in combination with gemcitabine and capecitabine in previously untreated metastatic/recurrent pancreatic cancer: Combined analysis with translational research

4607

Background: To confirm the efficacy and toxicity of erlotinib (E) in combination with gemcitabine (G) and capecitabine (C) when used as a first-line therapy in patients (pts) with metastatic/recurrent pancreatic cancer Methods: Pts with advanced pancreatic adenocarcinoma, with measurable lesion were eligible for the study. Other eligibility criteria included: no previous palliative chemotherapy, Karnofsky performance status (PS)≥50, adequate organ function. Locally advanced pancreatic cancer was excluded. E was given at a dose of 100mg daily from D1 to D28. G was given at a dose of 1000mg/m2 on D1,8,15 and C was given at a dose of 1660mg/m2/d from D1 to 21, repeated every 4 weeks. Response was assessed every 8 weeks. Tumor tissue and blood sample was analyzed for the translational research. Results: A total of 47 pts were enrolled between Feb 2007 and Feb 2008. (median age: 58 y, Karnofsky PS100/90/80/70/60 (6/26/9/5/1)). Forty three pts were evaluable for response. Partial responses were achieved in 14 patients, resulting in response rate of 32.6%. Twenty two pts (51.2%) had stable disease. Overall disease control rate was 83.7%. The PFS was 6.5 months (95% CI, 3.4–9.7) and the overall survival was 12.0 months (95% CI, 8.6–15.9). The Gr 3/4 hematologic toxicities were: neutropenia (6.8%), thrombocytopenia (3.2%), anemia (1.6%). The major Gr 3/4 nonhematologic toxicities were: nausea (1.6%), vomiting (1.6%), anorexia (5.3%), rash (0.5%). EGFR, pEGFR, TS, TP, DPD was overexpressed in 77.4%, 17.1%, 82.4%, 53.6% and 61.3% of tumor tissues respectively. EGFR amplification was not detected. Among these, the EGFR expression was significantly associated with shorter PFS and OS (p=0.029, p=0.005 respectively). K-RAS mutation was detected in 47.5%. PFS and OS were not different according to K-RAS mutation. RRM1 2455G>A, RRM1 2464G>A, CDA 79A>C, CDA 435C>T polymorphism did not influence on the PFS and OS. Conclusions: Erlotinib in combination with gemcitabine and capecitabine showed promising efficacy and good tolerability in metastatic pancreatic cancer. This efficacy was observed irrespective of K-RAS mutation, and the EGFR expression was poor prognostic factor for PFS and OS.

No significant financial relationships to disclose.

A randomized multi-center phase II trial of capecitabine (X) versus S-1 (S) as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer

4546

Background: Although the combination chemotherapy is the standard of care for young patients (pts) with advanced gastric cancer (AGC), single agent chemotherapy may be a good alternative for elderly pts. Recent introduction of two new generation oral fluoropyrimidines, capecitabine and S-1, prompted us to investigate the activity and safety of these agents in elderly pts with AGC in a randomized multi-center phase II design. ( NCT00278863 ) Methods: Elderly chemo-naïve pts (= 65 years) with measurable metastatic or recurrent gastric cancer were randomly assigned to receive capecitabine (1,250 mg/m2 bid, D1–14 every 3 weeks, arm X) or S-1 (40∼60 mg bid according to BSA, D1–28 every 6 weeks, arm S). The primary endpoint was the response rate (RR). Results: From Oct 2004 to Apr 2006, 96 pts were enrolled. Excluding 5 pts who did not fit inclusion criteria, 91 pts were randomized to arm X (N=46) or arm S (N=45). Median age was 70.5 years for arm S and 71.0 years for arm X. Other clinical and tumor characteristics were well balanced across the two treatment arms. Among 44 assessable pts in arm X, 13 attained partial response (PR, 29.5%), 17 stable disease (SD, 38.6%) and 10 progressive disease (PD); 4 pts were not evaluable (NE). The corresponding disease responses in the 45 assessable pts in arm S were: 1 complete response (2.2%), 12 PR (26.7%), 18 SD (40.0%), 10 PD, and 4 NE. The incidence of grade 3–4 granulocytopenia was 6.8% in arm X and 4.8% in arm S. One episode of febrile neutropenia was observed in arm X. Grade 3–4 non-hematologic toxicities were as follows (arm X vs. S): asthenia (0% vs. 7.2%), anorexia (6.8% vs. 9.5%), diarrhea (2.3% vs. 0%), and HFS (6.8% vs. 0%). With a median follow up of 13.5 months (mo) for survivors (range, 8.1∼21.9), median time to progression and time to treatment failure were 4.8 mo (95% CI, 3.0–6.5) and 4.4 mo (3.6–5.3) for arm X and 4.2 mo (1.5–6.9) and 3.0 mo (1.5–4.5) for arm S. Median overall survival was 10.0 mo (8.0–12.0) for arm X and 7.9 mo (4.1–11.7) for arm S. Conclusions: Both treatments were active and tolerable as a 1st line treatment for elderly pts with AGC.

No significant financial relationships to disclose.

A phase II study with gemcitabine and split-dose cisplatin in patients with advanced non-small cell lung cancer

17115

Background: The combination of gemcitabine and cisplatin is among the most active regimens for the treatment of NSCLC. However, the optimal dose and schedule for administration of the two drugs has not yet been determined. We investigated the activity and toxicity of a gemcitabine and split-dose cisplatin regimen in an outpatient setting for patients with advanced non-small cell lung cancer (NSCLC). Methods: From June 2004 to May 2005 patients with stage IIIB or IV who had not had prior chemotherapy entered the study. Treatment consisted of gemcitabine 1,250 mg/m2 and cisplatin 35 mg/m2, both given intravenously on days 1 and 8 every 21 days. Results: Forty-three patients were entered this study. Patient characteristics were as follows: male/female, 32/11; median age (range), 63 (30–76) years; ECOG PS 0/1/2, 7/28/8; stage IIIB/IV, 17/26. A total of 160 cycles were delivered, with a median of 4 cycles (range, 1–6). All patients were evaluable for toxicity. Grade 3 & 4 toxicities according the NCI toxicity criteria included included neutropenia in 7 patients (17%), anemia in 3 (7%), thrombocytopenia in 6 (14%), and emesis in 1 (2%). Of 40 patients assessable for response, one (2.5%) had CR and 22 (55%) had PR. On intent-to-treat basis, the overall response rate was 53% (95% CI, 39–68%). Median time to progression was 6.0 months (range, 1.2–12.0 months) and median overall survival was 13.1 months (range, 1.4–17 months). Conclusions: This regimen with gemcitabine and split-dose cisplatin using a 21-day schedule appears to be active and very well-tolerated in an outpatients setting for patients with advanced NSCLC.

No significant financial relationships to disclose.

"Refusal to treat under six conditions", the earliest medical and ethical code in ancient China

In the paper the principle of physician's "Refusal to treat under six cases" was reviewed. It was the first ethical code for physician in ancient China. The emergence of ethical code for physician was the result of medical professionalism and the formation of the professional groups. The principle proposed by the famous physician Bian-Que in ancient China, like Hippocratic Oath, was an ethics of outer achievement rather than one of inner intention. It provided a framework of medical behavior, and emerges as a powerful tool seeking to safeguard the reputation of the profession for its own sake rather than, in main, seeking to promote the patients' good.

[Clinical application of soft-tissue flap with an intercostal vascular pedicle from the chest wall in the trachea surgery]

Between 1976 and 1995, 11 cases of side-wall defect repairment or circumferential reconstruction of trachea were performed using chest-wall tissue flap with an intercostal vascular pedicle. The indications were benign or malignant tumors of the tracheal side wall, lung cancers of the right upper lobe involving the side wall of the trachea and/or carina. The transverse diameter of the tracheal defect after removing the tumor was less than half of the tracheal circumference. Furthermore, we foun it feasible to reconstruct the trachea by using a tissue tube created by wrapping a chest-wall tissue flap over a temporary stent in case of long-segment tracheal resection of tracheal tumor or benign stenosis where. The defect was too long to be repaired by end-to-end anastomosis. The surgical technique & instructions were described.

Variation of sapflow velocity in Eucalyptus globulus with position in sapwood and use of a correction coefficient

Sapflow sensors were used to investigate variation in sapflow velocity at different positions in the sapwood of three-year-old Eucalyptus globulus ssp. globulus Labill. trees. Sapflow velocity was measured at 5-mm intervals across the sapwood by moving two probe sets simultaneously on two opposite radii. Another probe set placed in a fixed position at right angles to the first two sets acted as a control. A sapflow velocity ratio was defined as the velocity given by each moving sensor divided by that given by the static sensor. Correlation between observations of sapflow velocity at different positions exceeded 95%, and the ratio of velocity between any pair of sensors was constant. We observed radial variation in sapflow velocity across the sapwood with the lowest velocities at the center of the tree. Variation due to sensor position was high implying the need for large numbers of sensors for accurate estimates of sap flux. To overcome this need, we used a correction coefficient, namely a simple weighted average of the sapflow ratios with depth in the sapwood, for each fixed sensor. We recommend the use of three probe sets to estimate the correction coefficient. Subsequently, two probe sets can be placed at two fixed positions for routine measurements of sap flux.