Managing Difficulties of Microsatellite Instability Testing in Endometrial Cancer-Limitations and Advantages of Four Different PCR-Based Approaches

Microsatellite instability (MSI), a common alteration in endometrial cancers (EC) is known as a biomarker for immune checkpoint therapy response alongside screening for Lynch Syndrome (LS). However, former studies described challenging MSI profiles in EC hindering analysis by using MSI testing methods intensively validated for colorectal cancer (CRC) only. In order to reduce false negatives, this study examined four different PCR-based approaches for MSI testing using 25 EC samples already tested for mismatch repair deficiency (dMMR). In a follow up validation set of 75 EC samples previously tested both for MMR and MSI, the efficiency of a seven-marker system corresponding to the Idylla system was further analyzed. Both Bethesda and Promega marker panels require trained operators to overcome interpretation complexities caused by either hardly visible additional peaks of one and two nucleotides, or small shifts in microsatellite repeat length. Using parallel sequencing adjustment of bioinformatics is needed. Applying the Idylla MSI assay, an evaluation of input material is more crucial for reliable results and is indispensable. Following MMR deficiency testing as a first-line screening procedure, additional testing with a PCR-based method is necessary if inconclusive staining of immunohistochemistry (IHC) must be clarified.

Modern day screening for Lynch syndrome in endometrial cancer: the KEM experience

PURPOSE

Current guidelines for Lynch syndrome detection in endometrial cancer (EC) patients rely either on risk evaluation, based on personal/family history, or detection of mismatch repair (MMR) deficiency on tumor tissue. We present a combined screening algorithm for Lynch syndrome.

METHODS

In this study, 213 consecutive patients treated for EC at Kliniken Essen-Mitte between 2014 and 2018 were included. Personal/family history was evaluated by the Amsterdam II, revised Bethesda/German-DKG criteria and prediction model PREMM₅. MMR testing was performed by immunohistochemistry (IHC) and/or polymerase chain reaction (PCR) based microsatellite analysis on tumor tissue. MLH1 promoter methylation analysis was performed in case of MLH1 loss or microsatellite instability.

RESULTS

Based on personal/family history 2/213 (Amsterdam II), 31/213 (revised Bethesda/German-DKG) and 149/213 (PREMM₅) patients were identified as at risk for Lynch syndrome. MMR analysis was performed by IHC in 51.2%, by PCR in 32.4%, and in 16.4% of patients both methods were used. MMR deficiency was detected in 20.6% (44/213). Methylation analysis was performed in 27 patients of whom, 22 (81.4%) showed MLH1 promoter hypermethylation. Only 9% of MMR deficient patients were identified as at risk for Lynch syndrome by the revised Bethesda/German-DKG criteria. A pathogenic germline mutation was discovered in 3 out of 20 patients that underwent genetic testing. None of these patients were younger than 50 years or had a family history of Lynch syndrome-associated malignancies.

CONCLUSION

General MMR assessment is a feasible strategy to improve the detection of Lynch Syndrome in patients with EC.

Prevalence of BRCA1 and BRCA2 Mutations in Patients with Primary Ovarian Cancer - Does the German Checklist for Detecting the Risk of Hereditary Breast and Ovarian Cancer Adequately Depict the Need for Consultation?

BackgroundBRCA1/2 mutations are the leading cause of hereditary epithelial ovarian cancer (EOC). The German Consortium for Hereditary Breast and Ovarian Cancer has defined inclusion criteria, which are retrievable as a checklist and facilitate genetic counselling/testing for affected persons with a mutation probability of ≥ 10%. Our objective was to evaluate the prevalence of the BRCA1/2 mutation(s) based on the checklist score (CLS).

Methods A retrospective data analysis was performed on EOC patients with a primary diagnosis treated between 1/2011 – 5/2019 at the Central Essen Clinics, where a BRCA1/2 genetic analysis result and a CLS was available. Out of 545 cases with a BRCA1/2 result (cohort A), 453 cases additionally had an extended gene panel result (cohort B).

Results A BRCA1/2 mutation was identified in 23.3% (127/545) in cohort A, pathogenic mutations in non- BRCA1/2 genes were revealed in a further 6.2% in cohort B. In cohort A, 23.3% (127/545) of patients had a BRCA1 (n = 92) or BRCA2 (n = 35) mutation. Singular EOC (CLS 2) was present in 40.9%. The prevalence for a BRCA1/2 mutation in cohort A was 10.8%, 17.2%, 25.0%, 35.1%, 51.4% and 66.7% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively. The mutation prevalence in cohort B was 15.9%, 16.4%, 28.2%, 40.4%, 44.8% and 62.5% for patients with CLS 2, 3, 4, 5, 6 and ≥ 7 respectively.

Conclusions The BRCA1/2 mutation prevalence in EOC patients positively correlates with a rising checklist score. Already with singular EOC, the prevalence of a BRCA1/2 mutation exceeds the required 10% threshold. Our data support the recommendation of the S3 guidelines Ovarian Cancer of offering genetic testing to all patients with EOC. Optimisation of the checklist with clear identification of the testing indication in this population should therefore be aimed for.

Optical properties of molybdenum in the ultraviolet and extreme ultraviolet by reflection electron energy loss spectroscopy

Optical properties of polycrystalline molybdenum are determined from ultraviolet up to extreme ultraviolet by reflection electron energy loss spectroscopy (REELS). Calculations are performed within the dielectric response theory by means of the quantitative analysis of electron energy losses at surfaces QUEELS-ϵ(k,ω)-REELS software [Surf. Interface Anal.36, 824 (2004)SIANDQ0142-242110.1002/sia.1774] that allows the simulation of inelastic scattering cross sections, using a parametric energy loss function describing the optical response of the material. From this energy loss function, the real and imaginary parts of the dielectric function, the refractive index, and the extinction coefficient are deduced and compared with previously published results.

Low-grade Serous Tumors: Are We Making Progress?

PURPOSE OF REVIEW

This review provides an overview of the current clinical standard in low-grade serous ovarian cancer (LGSOC). The available evidence for surgery and standard treatments is elaborated. In addition, we discuss recent findings and novel treatments for LGSOC.

RECENT FINDINGS

Two large multicenter trials studying MEK inhibitors in LGSOC have been presented in the last year. Binimetinib demonstrated an activity in LGSOC, especially in KRAS-mutated disease. Trametinib was associated with an improved progression-free survival in relapsed LGSOC. Based on the current results, MEK inhibitors could be an alternative treatment for LGSOC. Surgery is an important step in the treatment of LGSOC. Hormonal therapy and bevacizumab can be beneficial, next to chemotherapy. Targeted treatments, such as the MEK-inhibitor trametinib, seem to be efficient and should be introduced into clinical practice.

Characterization of VIM-1-Producing E. coli Isolated From a German Fattening Pig Farm by an Improved Isolation Procedure

A few reports indicate that livestock might represent a new reservoir for carbapenemase-producing Enterobacteriaceae (CPE). In 2015, VIM-1-producing Escherichia coli were detected at slaughter in colon contents of animals from a German fattening pig farm within the national monitoring on ESBL-producing E. coli. In this study, pooled faces samples from pigs, as well as samples from the barn surrounding environment of this fattening farm were taken, to evaluate the dissemination of CPEs. Several modifications of the culture-dependent detection procedure were investigated for their potential to improve the sensitivity of the CPE isolation method. The current reference procedure was adapted by adding a real-time PCR pre-screening and additional enrichment steps. It was possible to isolate 32 VIM-1-producing E. coli from four fecal samples of three different barns using two serial enrichment steps in combination with real-time PCR and selective agar plates. By genetic typing, we confirmed the presence of two E. coli clonal lineages circulating on this particular farm: one was harboring the bla_VIM–1 on an IncHI2 plasmid while the second lineage carried the gene on the chromosome. Despite its different locations, the bla_VIM–1 gene was harbored on a class 1 integron in both clonal lineages. Whole-genome sequencing revealed that the VIM-1-carrying plasmids exhibited only slight variability in its compositions and sizes. We assume that the prevalence of CPEs in animal production in Germany and other European countries might be underestimated and there is a concern of further spread of VIM-1-producing bacteria in German livestock and food.

Detection and quantification of methicillin-resistant Staphylococcus aureus in fresh broiler meat at retail in Germany

The aim of this study was to detect, to quantify and to characterize MRSA in broiler meat samples with skin. Furthermore, we compared an isolation method using a second selective enrichment step (method A) with a simpler method omitting this step (method B). For quantification we used a direct plating method on selective agar plates and a "Most probable number" (MPN) technique for estimation of low numbers of MRSA. Presumptive MRSA colonies were confirmed by MALDI-TOF and by PCR. After confirmation the isolated MRSA were characterized by spa-typing and, if necessary, by multi-locus sequence typing. Method B detected more MRSA-positive samples (16.7%, n = 215) than method A (12.1%). However, method B also produced more false positive results (28.4%).The highest estimated number of MRSA in fresh broiler meat with skin was 1100 MPN/g, but in most positive samples (80.1%) the estimated numbers of MRSA were lower than 10 MPN/g. Thus, the numbers of MRSA in the samples were too low to detect using the spread plate technique. Ten different spa-types were identified. Six of these with 69% of the isolates were assigned to the clonal complex CC398 (t034; t011; t2576; t571; t5452; t1457). Spa-types t1430, t13177 and t899 can be assigned to CC9. Spa-type t304 was identified as MLST-type ST6. In conclusion, we provide quantitative data on low level contamination of fresh broiler meat with MRSA. Most isolated MRSA were from livestock associated spa-types. Omitting the second enrichment step was associated with an increase in sensitivity but lower specificity of the cultural method.

Instrumentation effects on U and Pu CBNM standards spectra quality measured on a 500 mm3 CdZnTe and a 2×2 inch LaBr3 detectors

Nowadays, there is interest in developing gamma-ray measuring devices based on the room temperature operated medium resolution detectors such as semiconductor detectors of the CdZnTe type and scintillators of the LaBr3 type. This is true also for safeguards applications and the International Atomic Energy Agency (IAEA) has launched a project devoted to the assessment of medium resolution gamma-ray spectroscopy for the verification of the isotopic composition of U and Pu bearing samples. This project is carried out within the Non-Destructive Assay Working Group of the European Safeguards Research and Development Association (ESARDA). In this study we analyze medium resolution spectra of U and Pu standards with the aim to develop an isotopic composition determination algorithm, particularly suited for these types of detectors. We show how the peak shape of a CdZnTe detector is influenced by the instrumentation parameters. The experimental setup consisted of a 500 mm3 CdZnTe detector, a 2×2 inch LaBr3 detector, two types of measurement instrumentation – an analogue one and a digital one, and a set of certified samples – a 207Bi point source and U and Pu CBNM standards. The results of our measurements indicate that the lowest contribution to the peak asymmetry and thus the smallest impact on the resolution of the 500 mm3 CdZnTe detector was achieved with the digital MCA. Analysis of acquired spectra allowed to reject poor quality measurement runs and produce summed spectra files with the least impact of instrumentation instabilities. This work is preliminary to further studies concerning the development of an isotopic composition determination algorithm particularly suited for CZT and LaBr3 detectors for safeguards applications.

Optical properties and electronic transitions of zinc oxide, ferric oxide, cerium oxide, and samarium oxide in the ultraviolet and extreme ultraviolet

Optical properties and electronic transitions of four oxides, namely zinc oxide, ferric oxide, cerium oxide, and samarium oxide, are determined in the ultraviolet and extreme ultraviolet by reflection electron energy loss spectroscopy using primary electron energies in the range 0.3-2.0 keV. This technique allows the evaluation of the optical response in these ultraviolet spectral regions of a thin layer of material, and the analysis is straightforward. It is performed within the dielectric response theory by means of the QUEELS-ε(k, ω)-REELS software developed by Tougaard and Yubero [Surf. Interface Anal.36, 824 (2004)SIANDQ0142-242110.1002/(ISSN)1096-9918]. The method consists basically in the fitting of experimentally determined single-scattering electron energy loss cross sections with a parametric energy loss function of the corresponding material, to the one calculated within a dielectric response formalism. The obtained refractive index and extinction coefficients, as well as the identified electronic transitions are compared, when available, with previously published results.

Neutron H*(10) inside a proton therapy facility: comparison between Monte Carlo simulations and WENDI-2 measurements

Inside an IBA proton therapy centre, secondary neutrons are produced due to nuclear interactions of the proton beam with matter mainly inside the cyclotron, the beam line, the treatment nozzle and the patient. Accurate measurements of the neutron ambient dose equivalent H*(10) in such a facility require the use of a detector that has a good sensitivity for neutrons ranging from thermal energies up to 230 MeV, such as for instance the WENDI-2 detector. WENDI-2 measurements have been performed at the Westdeutsches Protonentherapiezentrum Essen, at several positions around the cyclotron room and around a gantry treatment room operated in two different beam delivery modes: Pencil Beam Scanning and Double Scattering. These measurements are compared with Monte Carlo simulation results for the neutron H*(10) obtained with MCNPX 2.5.0 and GEANT4 9.6.

Comparing Geant4 hadronic models for the WENDI-II rem meter response function

The WENDI-II rem meter is one of the most popular neutron dosemeters used to assess a useful quantity of radiation protection, namely the ambient dose equivalent. This is due to its high sensitivity and its energy response that approximately follows the conversion function between neutron fluence and ambient dose equivalent in the range of thermal to 5 GeV. The simulation of the WENDI-II response function with the Geant4 toolkit is then perfectly suited to compare low- and high-energy hadronic models provided by this Monte Carlo code. The results showed that the thermal treatment of hydrogen in polyethylene for neutron <4 eV has a great influence over the whole detector range. Above 19 MeV, both Bertini Cascade and Binary Cascade models show a good correlation with the results found in the literature, while low-energy parameterised models are not suitable for this application.

[Basis for the calcium specificity in the plant response to extracellular stimulation]

The Ca2+ cation is fully recognized as an important intracellular second messenger coupling a wide range of extracellular stimuli to characteristic responses in plant cells. Such a pleiotropic effect raises questions regarding the mechanisms by which the signalling pathways, all of then involving an increase in intracellular calcium concentration, can be specific to a given stimulus. Here, we present recent results which shed light into different concepts which may explain the response specificity in signalling processes, such as "the cross-talk between signalling pathways", "the Ca2+ signatures" and "the compartmentation of Ca(2+)-signalling".

The nucleus together with the cytosol generates patterns of specific cellular calcium signatures in tobacco suspension culture cells

Plant cell suspension cultures respond to osmotic changes by alterations in levels of free cellular calcium. Using the aequorin recombinant method, we have measured the spatial and temporal characteristics of calcium signatures in the nucleus and the cytosol of BY-2 tobacco suspension cells challenged with hypo- or hyper-osmotic shock. We show here that the nuclear compartment contributes together with the cytosol to produce calcium signal patterns that discriminate hypo- from hyper-osmotic treatments, i.e. turgor from tension. We also demonstrate that calcium responses in the nucleus and the cytosol are differentially modulated by the strength and the nature of hyper-osmotic treatments. We conclude that qualitative and quantitative changes in the parameters of an external stimulus such as osmotic changes are converted into calcium signatures, distinctive in their temporal and subcellular characteristics, involving both the nucleus and the cytosol. Our results illustrate the versatility of calcium signaling in plant cells. In addition to the physiological 'address' of the cell, the compartmentation of the calcium signal is probably an important parameter in encoding response specificity.

Construction of two ordered cDNA libraries enriched in genes encoding plasmalemma and tonoplast proteins from a high-efficiency expression library

We constructed a high-efficiency expression library from Arabidopsis cDNA clones by introducing a poly (dC) stretch at the 5' end of the clones. This library enables the synthesis of proteins from all the cDNA clones present. We have screened the high-efficiency expression library with antibodies raised against total proteins from Arabidopsis plasmalemma and tonoplast. With the positive clones, we have constructed two cDNA ordered libraries enriched in genes encoding plasmalemma (522 clones) and tonoplast proteins (594 clones). Partial sequencing of both libraries shows that a high proportion (47%) of the clones encoded putative membrane proteins, or membrane-associated proteins. When sequenced, 55% of the cDNAs were new EST sequences for Arabidopsis, 26% were similar to genes present in other plants or organisms, and 29% were not referenced in any databank. Immunoscreening of the two cDNA ordered libraries with antibodies raised against proteins from Arabidopsis cells submitted to osmotic stress allows the selection of genes over- and under-expressed in stress conditions.

Effect of renal function on the pharmacokinetics and pharmacodynamics of trandolapril

1. The pharmacokinetics and pharmacodynamics of a single dose of trandolapril, an angiotensin converting enzyme (ACE) inhibitor with an active metabolite, trandolaprilat, which is in part further metabolised prior to renal elimination, were evaluated in 31 subjects with a wide range of renal function (creatinine clearance 4-112 ml min-1 1.73 m-2). 2. The pharmacokinetics of trandolapril were unaffected by differences in renal function. 3. In contrast, there was a close correlation between the renal clearance (0-96 h) of trandolaprilat and creatinine clearance (r = 0.95, P = 0.0001). The maximum plasma concentration of trandolaprilat, and the area under the concentration curve (0-96 h) correlated inversely with creatinine clearance (r = -0.59, P < 0.001; and r = -0.61, P < 0.001 respectively). 4. Significant changes in plasma trandolaprilat concentrations were seen only in patients with creatinine clearances of 30 ml min-1 1.73 m-2 or less, suggesting that a dose reduction in trandolapril might be advisable in severe renal impairment. 5. However, the majority of parameters of ACE inhibition were unrelated to creatinine clearance, although area under the curve for ACE inhibition (0-336 h) showed a weak negative correlation (r = -0.49, P < 0.01). Similarly, weighted mean changes in blood pressure were not influenced by renal function. 6. Therefore, while the pharmacokinetic parameters of trandolaprilat correlated with creatinine clearance, pharmacodynamic measurements (ACE inhibition and blood pressure changes) in general showed no such relationship, indicating that dose adjustment of ACE inhibitors in renal impairment should be based on pharmacokinetic results only in conjunction with pharmacodynamic data.

Reactive hyperreninemia is a major determinant of plasma angiotensin II during ACE inhibition

The new ACE inhibitor trandolapril was administered to normal volunteers at daily doses of 0.5, 2, and 8 mg for 10 days. Twenty-one volunteers, aged 21-30 years, were included in the study. To randomly selected groups of seven subjects, each dose was administered in a single-blind fashion. None of the doses induced a consistent fall in blood pressure. Angiotensin-converting enzyme activity (ACE) was measured in vitro using three different synthetic substrates (i.e., Hip-Gly-Gly, Z-Phe-His-Leu, or angiotensin I). Although the degree of ACE inhibition assessed with the three methods varied widely, all methods clearly indicated dose-dependent ACE inhibition. These in vitro results were confirmed by measuring ACE inhibition in vivo using the ratio of plasma angiotensin II (ANG II) to blood angiotensin I (ANG I). The dose-dependent ACE inhibition was paralleled by a dose-dependent rise in active renin and blood angiotensin I levels, most evident on day 10. In contrast, plasma ANG II levels on day 10 were not different whether the volunteers received 0.5 or 8 mg trandolapril. Thus, whereas increasing doses of this new ACE inhibitor progressively enhanced the blockade of ACE activity, this was not reflected by additional reductions of plasma ANG II levels. The progressive enhancement of ACE inhibition seemed to be offset by the accentuation of the compensatory rise in renin and ANG I, which was still partially converted to ANG II.(ABSTRACT TRUNCATED AT 250 WORDS)

Almitrine improves oxygenation when both awake and asleep in patients with hypoxia and carbon dioxide retention caused by chronic bronchitis and emphysema

Patients with chronic bronchitis and emphysema who are hypoxic when awake become more hypoxic during sleep, with a further rise in their preexisting pulmonary hypertension. Almitrine, a respiratory stimulant, improves arterial blood gas tensions in such patients when they are awake. We have used a double-blind, placebo-controlled, cross-over study to compare the effects of 50 mg almitrine given orally twice a day for 14 days on oxygen saturation (SaO2), respiratory movements, and sleep quality in 9 patients with hypoxic chronic bronchitis and emphysema (FEV1, 0.4 to 1.0 L; PaO2, 51 +/- (SEM) 2 mmHg; PaCO2, 49 +/- 1 mmHg). Almitrine improved arterial blood gas tensions when awake, mean PaO2 rising by 8 mmHg (p less than 0.001) and PaCO2 falling by 4 mmHg (p less than 0.01). Almitrine improved nocturnal oxygenation, mean SaO2 when awake rising from 83 +/- 4% to 89 +/- 3% (p less than 0.01), and the lowest SaO2 during sleep rising on average from 65 +/- 6% to 77 +/- 3% (p less than 0.02). The number of hypoxemic episodes (SaO2 falling by greater than or equal to 10% from the preceding stable baseline during sleep) and the time when SaO2 was below 80% (135 +/- 53 versus 46 +/- 35 min; p less than 0.01) also improved. Almitrine did not improve sleep quality. We conclude that almitrine improves arterial gas tensions when awake and reduces the frequency and severity of nocturnal hypoxemia without impairing sleep quality in patients with chronic bronchitis and emphysema who are both hypoxemic and hypercapnic when awake.(ABSTRACT TRUNCATED AT 250 WORDS)

Increased respiratory chemosensitivity induced by infusing almitrine intravenously in healthy man

The respiratory effects of intravenously infused almitrine were evaluated in healthy volunteers. In the dose range 0.25-1.0 mg/kg/hour it caused large and dose-dependent increases in hypoxic chemosensitivity, which were longlasting and more persistent than the drug's retention in the plasma. Increases in sensitivity to hypercapnia were much less and were detected only when the plasma almitrine exceeded 200 ng/ml. Small increases in resting ventilation and metabolic rate with a decrease in mixed venous carbon dioxide tension occurred only at the highest infusion rate. The findings accord with an action of almitrine in the peripheral chemoreceptors, which may be of therapeutic value in managing some cases of respiratory failure.

Effects of almitrine bismesylate on chemosensitivity in patients with chronic airways obstruction

The effects of 100 mg doses of almitrine bismesylate given orally were compared with placebo on separate test days in twelve hypoxaemic patients with chronic airways obstruction. The drug caused significant increases in ventilation and arterial O2 tension with a fall in CO2 tension. Assessed by rebreathing techniques it augmented their ventilatory response to hypercapnia and even more to hypoxia. Only minimal changes occurred with placebo. The results are consistent with the drug's known action of sensitising the peripheral chemoreceptors.

[Evaluation of sino-atrial function using the method of extrasystole induced by constant-relative premature impulses. 2. Application in 50 normal and abnormal studies]

The total immediate sino-atrial conduction time (SACT) as calculated by constant relative pacing, 40 or 50% of the immediate sinus cycle (SC), normally varies inversely with the SC. 50 patients were investigated by this method. In 38 patients without sino-atrial block (SAB) on the surface ECG, it was found that the mean slope of correlation between SACT and SC varied with the shape of the curve of Strauss and with the presence or absence of a post-pacing depression. The smallest slope was found in the group in which the curve of Strauss was horizontal in zone II, and in which there was no depression. In the groups with a rising zone II, comparative use of pacing with a fixed relationship in milliseconds suggested a phenomenon of decreasing retrograde conduction. In cases with sinus arrhythmia and a Strauss curve with scattered coordinates, the relationship between SACT and SC was maintained. 1st degree right-sided SAB should therefore be defined as a function of the immediate SC. In 12 other patients with SAB on the surface ECG, the immediate SACT was greatly lengthened so as to be immeasurable, and bore no relationship to the SC.

[Evaluation of sino-atrial function using the method of extrasystole induced by constant-relative premature impulses. 1. Method and normal results]

Atrial pacemaking under conditions of relative constancy (40 or 50% of the preceding cycle) enables us to calculate the immediate sino-atrial conduction time (retrograde and antegrade) (SACT). 17 patients were chosen for their normal sino-atrial function under spontaneous changes of the sinus cycle (SC). In each case, a significant inverse linear relationship was found between SACT and the corresponding SC. The mean correlation slope was -0.36 in 10 patients with no post-pacing depression (PPD). The slope was greater in 7 patients with a PPD (-0.89); if this depression is taken into account when the SACT is calculated, the slope decreases. In 5 patients, atropine (1 mg I.V. reduced the mean value of SC, and shortened (constant relative value) the SACT. The mechanisms for the spontaneous and induced variations in the sinus output are discussed; it may be that there are substitute pacemakers within the cells of the sino-artrial node, which are affected by variations in sympathetic or parasympathetic activity or by pacing. In clinical practice, automatism and conduction with the sinus node should be interpreted as inter-related functions, both under normal conditions and after vagal block.