Identifying therapeutic candidates for endometriosis through a transcriptomics-based drug repositioning approach

Existing medical treatments for endometriosis-related pain are often ineffective, underscoring the need for new therapeutic strategies. In this study, we applied a computational drug repurposing pipeline to stratified and unstratified disease signatures based on endometrial gene expression data to identify potential therapeutics from existing drugs, based on expression reversal. Of 3,131 unique genes differentially expressed by at least one of six endometriosis signatures, only 308 (9.8%) were in common; however, 221 out of 299 drugs identified, (73.9%) were shared. We selected fenoprofen, an uncommonly prescribed NSAID that was the top therapeutic candidate for further investigation. When testing fenoprofen in an established rat model of endometriosis, fenoprofen successfully alleviated endometriosis-associated vaginal hyperalgesia, a surrogate marker for endometriosis-related pain. These findings validate fenoprofen as a therapeutic that could be utilized more frequently for endometriosis and suggest the utility of the aforementioned computational drug repurposing approach for endometriosis.

Human neuronal cells: epigenetic aspects

Histone acetyltransferases (HATs) and histone deacetylases (HDACs) promote histone posttranslational modifications, which lead to an epigenetic alteration in gene expression. Aberrant regulation of HATs and HDACs in neuronal cells results in pathological consequences such as neurodegeneration. Alzheimer's disease is the most common neurodegenerative disease of the brain, which has devastating effects on patients and loved ones. The use of pan-HDAC inhibitors has shown great therapeutic promise in ameliorating neurodegenerative ailments. Recent evidence has emerged suggesting that certain deacetylases mediate neurotoxicity, whereas others provide neuroprotection. Therefore, the inhibition of certain isoforms to alleviate neurodegenerative manifestations has now become the focus of studies. In this review, we aimed to discuss and summarize some of the most recent and promising findings of HAT and HDAC functions in neurodegenerative diseases.

Risk factors that may adversely modify the natural history of the pediatric pronated foot

Flatfoot is one of the most common conditions seen in pediatric podiatry practice. There is no universally accepted definition for flatfoot. Flatfoot is a term used to describe a recognizable clinical deformity created by malalignment at several adjacent joints. Clinically, a flatfoot is one that has a low or absent longitudinal arch. Determining flexibility (physiologic) or rigidity (pathologic) is the first step in management. A flexible flat foot will have an arch that is present in open kinetic chain (off weight-bearing) and lost in closed kinetic chain (weight-bearing). A rigid flatfoot has loss of the longitudinal arch height in open and closed kinetic chain. According to Mosca, "The anatomic characteristics of a flatfoot are excessive eversion of the subtalar complex during weight-bearing with plantarflexion of the talus, plantarflexion of the calcaneus in relation to the tibia, a dorsiflexed and abducted navicular and a supinated forefoot." Normally developing infants have a flexible flatfoot and gradually develop a normal arch during the first decade of life. When evaluating an infant for a pronated condition, the examiner must also consider other risk factors that may affect the foot in its overall development. These contributing factors will play a role in the development of a treatment plan. The risk factors include ligamentous laxity, obesity, rotational deformities, tibial influence, pathological tibia varum, equinus, presence of an os tibiale externum, and tarsal coalitions. The authors realize other less significant factors exist but are not as detrimental to the foot as the primary ones discussed in depth. The primary risk factors that affect the pronated foot have been outlined. The clinician should always examine for these conditions when presented with a child exhibiting pronatory changes. A thorough explanation to the parents as to the consequential effects of these risk factors and their effects on the pediatric pronated foot is paramount to providing an acceptable comprehensive treatment program. Children often are noncompliant with such treatments as stretching and orthotic maintenance. The support of the parents is crucial to maintaining an effective treatment program continued at home.

Mucormycosis: a case study

Throughout the history of mucormycosis, from the first case in humans reported in 1885 by Paltauf, through publication by Gregory et al of the first observation of rhino-orbital cerebral mucormycosis in 1943, to the report by Harris in 1955 of the first known survivor, little has changed in the diagnosis and outcome of this disease. Although mucormycosis of any form--cerebral, cutaneous, rhinocerebral, intestinal, or pulmonary--is still a rarity, it should be suspected in patients who are diabetic or immunocompromised. Administration of amphotericin B, surgical debridement of infected tissue, correction of the underlying cause, and use of adjunctive HBO therapy remain the standard treatments.

Mucormycosis: a case study

Throughout the history of mucormycosis, from the first case in humans reported in 1885 by Paltauf, through publication by Gregory et al of the first observation of rhino-orbital cerebral mucormycosis in 1943, to the report by Harris in 1955 of the first known survivor, little has changed in the diagnosis and outcome of this disease. Although mucormycosis of any form--cerebral, cutaneous, rhinocerebral, intestinal, or pulmonary--is still a rarity, it should be suspected in patients who are diabetic or immunocompromised. Administration of amphotericin B, surgical debridement of infected tissue, correction of the underlying cause, and use of adjunctive HBO therapy remain the standard treatments.

Teaching family practice residents breast cyst aspiration

OBJECTIVE

To conduct the first study of teaching family practice residents the technique of breast cyst aspiration (BCA) using the Toronto Breast Cyst Aspiration Model (TBCAM) in a workshop. To determine whether this training increases their likelihood of performing the procedure in the future. To discover how residents evaluate the workshop as a teaching method.

DESIGN

Prospective parallel-group trial from August to November 1997. Baseline questionnaires were given to both experimental and control groups in August. The experimental group was given a 1.5-hour workshop and a postworkshop questionnaire. Both groups were then given 3-month follow-up questionnaires.

SETTING

Family practice residency program at the University of Toronto.

PARTICIPANTS

The experimental group consisted of 15 family practice residents from one university-affiliated hospital site. The control group consisted of 54 family practice residents selected from the remaining sites.

MAIN OUTCOME MEASURES

Confidence score, likelihood of performing BCA, and effectiveness of the workshop rated on a Likert scale ranging from 1-low to 5-high; and knowledge of BCA rated from 0 to 7.

RESULTS

Three months after the workshop, 62% of study subjects and 31% of controls were above the median confidence score of 3.2 (chi 2 3.4, P > .05); 76% of subjects but only 11% of controls were above the median knowledge score of 4 (chi 2 16.67, P < .001); and 75% of subjects and 34% of controls were above the median likelihood to perform score of 3 (chi 2 5.37, P < .05). Most (95%) workshop effectiveness scores were 4s or 5s.

CONCLUSIONS

Workshop training resulted in higher confidence, greater knowledge, and more likelihood of performing BCA. The workshop using the TBCAM was evaluated as a highly effective way to teach BCA.

Management of palpable breast lumps. Consensus guideline for family physicians

OBJECTIVE

To describe an approach to managing women who present with palpable breast lumps.

QUALITY OF EVIDENCE

Databases were searched from 1990 to 1998 using the search terms breast lumps, breast diseases, and breast cysts. Bibliographies of the articles obtained were searched for further relevant titles. Most evidence on management of breast cysts was obtained from cohort studies. Evidence on family physicians' approach to managing breast lumps is based on a review of the 1998 Canadian consensus guidelines and a review of a 1998 consensus guideline by 12 University of Toronto surgical oncologists (U of T guidelines).

MAIN MESSAGE

Family physicians can manage women presenting with breast lumps if they have skill in breast cyst aspiration. Most breast cysts can be cured in minutes, thus avoiding unwarranted anxiety and eliminating unnecessary additional investigations and referrals. Women presenting with solid lesions should be referred to a surgeon.

CONCLUSIONS

Breast cyst aspiration is a simple technique family physicians can use to either cure breast lumps or define appropriate cases for referral.

Breast cyst aspiration

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Elevated levels of plasma triglycerides are associated with histologically defined premenopausal breast cancer risk

Lipids and lipoproteins have been associated with breast cancer risk; however, published results have been inconsistent. To clarify these associations, we measured fasting lipids in women undergoing breast biopsies. A case-control study examined the association of fasting levels of lipids with histologically defined breast cancer risk. Four groups of premenopausal women were assembled on the basis of histological appearance of breast tissue: 1) no epithelial proliferation (n = 102), 2) proliferation without atypia (n = 53), 3) atypical hyperplasia or carcinoma in situ (n = 53), and 4) node-negative invasive cancer (n = 102). A postoperative fasting blood specimen was analyzed for cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglycerides. Demographics, risk factors, diet, physical activity, fasting weight, and skin-fold thickness were measured. Triglyceride levels were significantly higher in women with node-negative invasive cancer (0.94 +/- 1.04 mg/ml) than in those with no epithelial proliferation (0.83 +/- 1.04 mg/ml, p = 0.03). This association persisted after adjustment for age, body size, lipids, reproductive and familial risk factors, and previous benign breast problems (p < 0.01), in keeping with an independent association of elevated triglycerides with breast cancer risk.

Coping styles in identifiers and nonidentifiers of a breast lump as a problem

One hundred patients referred to a teaching hospital breast clinic for as yet undiagnosed breast masses were interviewed during their first visits and prior to assessment by a surgeon. Baseline measures of mental state and coping style were obtained. Despite the purpose of their visits, 74 of the patients were "nonidentifiers" of the breast lump as a problem on their initial contact with the clinic. All patients who were non-identifiers also used denial as a coping mechanism. Nonidentifiers used more than three times the number of avoidant coping mechanisms than "identifiers." Patients with a family history of breast cancer were more likely to be identifiers than those without a family history.

Nitrous oxide: cardiovascular effects in infants and small children during halothane and isoflurane anesthesia

Two-dimensional and pulsed Doppler echocardiography were used to measure cardiovascular function in 31 unmedicated infants and small children. In 15 patients, the cardiovascular effects of equipotent levels of halothane were compared with and without N2O. In 16 patients, the cardiovascular effects of isoflurane with and without N2O were compared. Prior to anesthesia induction, cardiovascular measurements of heart rate (HR), mean blood pressure (MBP), and two-dimensional and pulsed Doppler echocardiography were recorded. The echocardiographic measurements were used to determine cardiac output (CO), stroke volume (SV), ejection fraction (EF), and left ventricular end-diastolic and end-systolic volume (LVEDV and LVESV). Twenty minutes after mask inhalation induction with halothane or isoflurane with N2O and O2 (3:2 liters/min), cardiovascular measurements were repeated with end-expired halothane or isoflurane maintained at 0.9 MAC. A third set of cardiovascular data was collected 10 minutes after the discontinuation of N2O, with inspired isoflurane or halothane levels in O2 (5 liters/min) increased to maintain 1.5 MAC end-expired levels. Ventilation was controlled throughout the study period and the study was completed before intubation and the start of elective surgery. Heart rate and MBP decreased to similar degrees below awake levels in both patient groups during N2O with halothane or isoflurane. When N2O was discontinued and end-expired levels of halothane or isoflurane increased, MBP remained at levels observed during N2O-O2 with halothane or isoflurane. Heart rate increased during isoflurane in O2. Cardiac output decreased significantly and similarly below awake levels during both halothane of isoflurane with and without N2O.

Effect of a low-fat high-carbohydrate diet on symptoms of cyclical mastopathy

21 patients with severe persistent cyclical mastopathy of at least 5 years' duration were randomised to a control group who received general dietary advice or to an intervention group who were taught how to reduce the fat content of their diet to 15% of calories while increasing complex carbohydrate consumption to maintain caloric intake. Both groups were followed for 6 months with food records and measurement of plasma hormone and lipid levels. Severity of symptoms was recorded with daily diaries and patients were assessed at the beginning and end of the study by a physician who was unaware of their dietary regimen. After 6 months there was a significant reduction in the intervention group in the severity of premenstrual breast tenderness and swelling. Physical examination showed reduced breast swelling, tenderness, and nodularity in 6 of 10 patients in the intervention group and 2 of 9 patients in the control group.

Methods for detecting locally recurrent and contralateral second primary breast cancer

The author has studied the roles of thermography, mammography and breast self-examination in detecting recurrent primary cancer or a second primary in the contralateral breast. Of 273 patients whose primary cancer was treated by lumpectomy, recurrence developed in 52 (19%); 51 were detected on clinical examination and 1 by mammography alone. None were detected by thermography alone. Of the 51 patients with a local recurrence detected clinically, 35 had undergone repeat mammography before biopsy. A change suggestive of a malignant condition was noted in only 15 (43%). Thirty-seven had adequately stable postoperative thermograms for review. Only 9 (25%) of these thermograms showed a change in pattern before or at the time the recurrence was detected. Similar results were found in the detection of a secondary primary in the contralateral breast in these patients and also in a further 193 women whose primary cancers were treated by total mastectomy during the same period. Close clinical supervision is the most efficient method of detecting local recurrence and contralateral second primary breast cancer.

Intraoperative localization of occult breast tumours

Mammographic examination of the clinically normal breast can identify some breast masses before they become palpable. In order to remove them successfully, a surgeon requires the help of some localization procedure. The only method recommended to date has been preoperative needle localization under radiologic control by a radiologist. A technique of intraoperative needle localization by the surgeon without radiologic control has been developed at St. Michael's Hospital, Toronto. The method saves time, avoids complications and is very accurate. Because of the possibility that the mass is malignant, the excisional biopsy is performed as a definitive lumpectomy. Of 112 consecutive occult tumours so localized, only 3 required removal at a second operation. Twenty-six (23%) of the lesions proved to be cancer (16% invasive, 7% noninvasive).

Use and abuse of mammography in the early diagnosis of breast cancer

In the 8 years before 1980, 3958 women were examined in the St. Michael's Hospital breast clinic in Toronto. Of 302 women with breast cancer, 87 (29%) had normal mammograms. Breast cancer was found in 34 after at least one clinical and mammographic examination had given normal results. Of these, 6 (18%) cancers were detected only by mammography while, paradoxically, 23 (68%) were detected only by clinical examination. Normal mammograms are significantly (p less than 0.001) more frequent in young women with breast cancer and in those with small palpable breast cancers. Mammography is most productive when used as a routine study in older women who have clinically normal breasts. All women should start having them around the age of 40 to 45 years. How often they should be repeated is debatable. There is no evidence that they should be repeated annually. Under 35 years of age mammography for any reason is unrewarding. Biopsy of a breast lump that is solid on aspiration should never be delayed because of a normal mammogram. Biopsy of a radiologically suspicious lesion in the breast should never be delayed because the findings on clinical examination are normal.

Tubular adenoma of breast

A recent classification of adenomas of the breast included tubular adenoma. This uncommon lesion can be distinguished from fibroadenoma by the predominance of epithelium and relative lack of stroma. This is, to our knowledge, the first report of a tubular adenoma studied by aspiration cytology as well as light and electron microscopy. A 4-cm, slightly tender mass was found in the upper outer quadrant of the breast of a 26-year-old woman. Aspiration cytology showed abundant epithelial fragments, similar to those seen in fibroadenoma, but without the spindle cell component often seen in aspirates of that lesion. Light microscopic study of the excised mass showed a well-demarcated tumor of tubular glands and scanty stroma. By electron microscopy, the epithelial stromal junction was intact. This contrasts with the findings in fibroadenoma, and confirms that this difference can distinguish these lesions.

Efficiency of palpation in clinical detection of breast cancer

An annual clinical screening test for breast cancer must be simple, brief and efficient. The traditional physical examination of the breast is time-consuming, mainly because of the complicated maneuvers necessary to inspect for retraction. Palpation with the patient supine, however, can be performed quickly. Of 286 primary breast cancers 96% (275) were palpable as a lump, and this was the only clinical sign in 55%. Retraction was the sole clinical sign in only 1%. The combination of retraction and a solid lump is a very specific but not very sensitive test for breast cancer. Retraction in this series was not related to the size of the primary tumour but among the women with a cancerous breast lump was significantly more likely to be found in those over 44 years of age, being present in 52% of these women but only 10% of the younger women. Inspection of the breast can therefore safely be detected from screening breast examinations, whether performed by the physician or the patient.

Cardiac rhabdomyoma simulating pulmonic stenosis

The angiographic and echocardiographic findings of a right ventricular pedunculated rhabdomyoma prolapsing through the pulmonic valve which mimicked the hypoxic spells of tetralogy of Fallot are presented. A dense mass of echoes was seen within the pulmonic valve during systole. The presence of right ventricular tumor was confirmed by angiography and surgery. The abnormal echoes were no longer seen following surgical excision of the tumor.