Newly Diagnosed Mental Health Disorders in Patients with Breast Cancer Receiving Radiation Therapy

PURPOSE/OBJECTIVE(S)

Patients with a mental health disorder (MHD) have higher age-adjusted mortality compared to the general population. There are few reports investigating the factors that contribute to newly diagnosed MHD following the diagnosis and treatment of breast cancer. Here, we report the incidence of acquired MHD after the diagnosis and treatment of breast cancer in patients who received radiation therapy.

MATERIALS/METHODS

A database query of a single institution, prospectively maintained database identified patients diagnosed with breast cancer who received whole or partial breast irradiation (WB/PBI) or post-mastectomy radiotherapy (PMRT). A second query of the patients' electronic medical record cross-referenced those patients with ICD-10 mental health diagnosis codes (F1-F99) that were newly acquired following the diagnosis of breast cancer. Univariable and multivariable analyses were performed, analyzing the effect of multiple factors on new mental health diagnoses. Odds ratios (OR) were calculated with a linear regression model, examining demographic characteristics, cancer stage, surgery type, receipt of chemotherapy or hormone therapy, insurance type, and substance use.

RESULTS

We identified 1129 patients, aged 26 - 92 years at the time of breast cancer diagnosis, who were treated at our institution between 2012 and 2017. 136 patients had a pre-existing MHD and were excluded from the analysis. 714 (74%) received WB/PBI, and 254 (26%) received PMRT with a median follow up of 63 months. 318 patients (33%) were diagnosed with MHD following breast cancer diagnosis. Median time to diagnosis of MHD was 30 months following the initial breast biopsy. On univariable (UVA) and multivariable analysis (MVA), N+ disease (UVA OR = 1.70, p<0.001), mastectomy (UVA OR = 1.55, p<0.01), receipt of chemotherapy (MVA OR = 1.77, p<0.0001), divorced relationship status (MVA OR = 2.38, p = 0.007), and retired employment status (MVA OR = 1.93, p<0.0001) conferred an increased risk of developing MHD. The primary new MHD identified following completion of radiation therapy included anxiety related disorders (44.4%), depression related disorders (19.4%), tobacco use disorder (12.9%), and dementia related disorders (6.2%).

CONCLUSION

One in three patients treated with radiation therapy developed a new MHD following the diagnosis of breast cancer in this cohort. The majority of acquired MHD in this study were depression and anxiety related disorders. Patients who received chemotherapy, were divorced, or were retired were at a higher risk of developing MHD following breast cancer diagnosis. Further prospective studies are needed to identify potential interventions that would benefit this at-risk population.

Stereotactic Body Radiotherapy (SBRT) for Adrenal Metastases: Practice Patterns at Community-Based Radiotherapy Centers

PURPOSE/OBJECTIVE(S)

To analyze SBRT of adrenal metastases at free-standing centers within a large network in the USA, in order to guide institutional recommendations.

MATERIALS/METHODS

We interrogated records of patients treated with SBRT to adrenal metastases from January 2019 to June 2022 from a database of 13,363 patients who were treated with SBRT at 21 community-based centers clustered into five regions within a network. We reported patient characteristics, frequency, survival rate, and biologically effective dose (BED10) prescribed, respiratory motion capture according to region and treatment year. Survival was calculated by Kaplan-Meier estimates.

RESULTS

A total of 271 patients were treated to metastatic adrenal lesions (2.0% of all SBRT patients). Median age was 69.8 years (range 32-96). Frequency of treatment increased by an average of 4.5% per year over the period. Table 1 gives the frequency of primary tumor sites, histological types, and dose fractionations. It also shows the range of BED10 used. 91% received five fractions, and 6% received 3 fractions. Median BED10 was 72 Gy (mean 68.0 Gy SD = 18.7). The most common regimen was 8 Gy x 5 (n = 75, 28%), but ranged from 5 Gy x 5 (n = 20) to 10 Gy x 5 (n = 34). BED10 varied according to geographic region ranging from 61.2 Gy to 73.0 Gy (p = 0.01). Median BED was 72 or above in 2 of 5 regions and less than 72 in 3 regions. Respiratory motion capture simulation was done in 65.1% of cases and frequency varied across the 5 locations as shown in Table1 from 93.3% in region 1 to 41.7% in region 5 (p<.0001). 4D CT simulation was used in 46.2% of cases and use was relatively stable over time: 52.8% in July to December 2020 and 40.9% from January to June 2022 with no trend over time: p = .7635 At median follow-up 6.6 months (range 0.3-48.5), 203 (74.9%) of patients were alive with a median overall survival of 24.3 months. 1-year and 2-year survival was 72.7% and 51.5% respectively. Use of respiratory motion simulation was not significantly associated with survival p = 0.47.

CONCLUSION

Despite variation in BED10 and respiratory motion management, 2-year overall survival was over 50% in patients treated with SBRT for adrenal metastases in a large community network. Further study will address refinement of recommendations regarding dose and other treatment characteristics and expansion of clinical research in this setting.

Spectrum of opportunistic fungal lung co-infections in COVID-19: What the radiologist needs to know

Fungal lung co-infections associated with COVID-19 may occur in severely ill patients or those with underlying co-morbidities, and immunosuppression. The most common invasive fungal infections are caused by aspergillosis, mucormycosis, pneumocystis, cryptococcus, and candida. Radiologists integrate the clinical disease features with the CT pattern-based approach and play a crucial role in identifying these co-infections in COVID-19 to assist clinicians to make a confident diagnosis, initiate treatment and prevent complications.

POS1163 PHARMACOKINETICS OF PEGLOTICASE AND METHOTREXATE POLYGLUTAMATE(S) IN PATIENTS WITH UNCONTROLLED GOUT RECEIVING PEGLOTICASE AND CO-TREATMENT WITH METHOTREXATE

Background

In a prior open-label, single-arm trial in adults with uncontrolled gout (MIRROR open-label [OL] trial), methotrexate (MTX) co-treatment with pegloticase suggested improved efficacy of pegloticase by reducing its immunogenicity.1,2 The current randomized, controlled trial (MIRROR RCT) confirmed that pegloticase-MTX co-therapy markedly increased pegloticase response rate (response defined as serum uric acid <6 mg/dL during ≥80% of Month 6) compared to pegloticase-placebo (PBO) co-therapy (71.0% vs. 38.5%) with a decreased infusion reaction rate and no new safety signals reported.

Objectives

To evaluate systemic exposures of pegloticase and its immunogenicity in uncontrolled gout patients receiving pegloticase with and without MTX as part of the MIRROR RCT; and to determine exposure of methotrexate polyglutamate(s) (MTX-PGs) in uncontrolled gout patients through Month 6 of treatment.

Methods

In MIRROR RCT, MTX (15 mg/wk) or matching PBO was given orally 4 weeks prior to the first pegloticase dose and continued weekly, in combination with pegloticase 8 mg given intravenously every 2 weeks, over a 52-week treatment period. Pre-infusion blood samples were collected to measure MTX polyglutamates (MTX-PGs, including MTX-PG1-5) in red blood cells and pre- and post-infusion serum samples were obtained to measure trough (Cmin) and peak (Cmax) concentrations of pegloticase, respectively, at multiple visits. MTX-PG and pegloticase concentrations were summarized by visit and by treatment group. Pre-infusion serum samples for anti-polyethylene glycol (PEG) antibody (Ab) measurement were also collected at multiple pre-defined time points. Anti-PEG Ab incidence and titer were summarized by visit and by treatment group.

Results

Overall, higher Cmax and Cmin of pegloticase were observed in the pegloticase + MTX group than in the pegloticase + PBO group (Figure 1). At Week 14, median (first quartile [Q1], third quartile [Q3]) Cmin was 1.32 (0.73, 1.74) µg/mL and 0.63 (0.30, 1.28) µg/mL for the pegloticase + MTX and pegloticase + PBO groups, respectively. Median (Q1, Q3) Cmax was 3.01 (1.94, 3.94) µg/mL and 2.66 (1.45, 3.20) µg/mL for the pegloticase + MTX and pegloticase + PBO groups, respectively. Improved pegloticase response was associated with higher pegloticase concentrations. At Week 14, Cmin was below the quantitation limit (0.6 µg/mL) for 8 of 10 non-responders and 1.26 (0.72, 1.71) µg/mL for responders. MTX co-administration reduced the incidence of new anti-PEG antibody formation. The proportion of subjects with an increase from baseline in anti-PEG Ab titers or who were negative at baseline and developed an anti-PEG Ab response at ≥1 post-dose time point during pegloticase treatment was 29.5% and 51.0%, for the pegloticase + MTX and pegloticase + PBO groups, respectively. The pegloticase + MTX group had overall lower titer levels than those in the pegloticase + PBO group. Positive anti-PEG Ab status was associated with a lower pegloticase Cmin. Concentrations of MTX-PGs were maintained during the treatment course in the pegloticase + MTX group, suggesting compliance with MTX administration. There was no apparent difference in concentrations of MTX-PGs (including MTX-PG3, the predominant form of MTX-PGs4) between responders and non-responders. MTX-PG concentrations were in the same range as those reported for low-dose oral MTX use in patients with rheumatoid arthritis,3 suggesting no impact of pegloticase on MTX PK.

Conclusion

Pegloticase 8 mg IV every 2 weeks with MTX co-treatment (oral 15 mg weekly) reduced anti-PEG Ab incidence and resulted in higher pegloticase exposures compared to pegloticase administered with PBO, consistent with the increased clinical efficacy observed with pegloticase + MTX co-administration.

References

[1]Botson J, et al. J Rheumatol 2021;48:767-74

[2]Song Y, et al. Arthritis Rheum 2020;72(suppl 10)

[3]Dervieux T, et al. Ann Rheum Dis 2013;72:908-10

[4]Choi R. J Pharm Biomed Anal 2021;201:114124

Disclosure of Interests

Yan Xin Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Yang Song Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Michael E. Weinblatt Consultant of: Horizon Therapeutics, Jason Chamberlain Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Jennifer Zarzoso Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Katie Obermeyer Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Stephen Sainati Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Colleen Canavan Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics, Srini Ramanathan Shareholder of: Horizon Therapeutics, Employee of: Horizon Therapeutics

Bilateral vision loss as the initial presentation for central nervous system involvement of mantle cell lymphoma: A case series

Purpose

Mantle cell lymphoma is a rare aggressive subtype of non-Hodgkins B cell lymphoma. It typically presents with asymptomatic monoclonal lymphocytosis, lymphadenopathy or bulky extranodal disease. Mantle cell lymphoma rarely affects the central nervous system. We present two cases in which vision loss was the initial symptom of central nervous system involvement by the malignancy.

Observations

Both patients initially received high dose intravenous steroids with notable improvement in their vision.

Conclusions and importance

Early detection and management of optic nerve infiltration by mantle cell lymphoma is essential as it improves visual outcomes and enables prompt management of the patient's systemic disease.

POS1136 PHARMACOKINETICS OF PEGLOTICASE AND METHOTREXATE POLYGLUTAMATE(S) IN PATIENTS WITH UNCONTROLLED GOUT RECEIVING PEGLOTICASE AND CO-TREATMENT OF METHOTREXATE

Background:

In an open-label, single-arm trial in adult patients with uncontrolled gout (MIRROR open-label [OL] trial) evaluating pegloticase co-treatment with methotrexate (MTX); 78.6% patients were responders, defined as maintenance of serum uric acid <6 mg/dL for at least 80% of the time during month 6 [weeks 20, 22, and 24]. In comparison, 42% patients achieved a response during month 3 and 6 in historical Phase 3 monotherapy trials of pegloticase (C0405 and C0406)1. MTX co-treatment is shown to improve the pharmacokinetics (PK) of biologics by attenuating the formation of anti-drug antibodies2.

Objectives:

To determine the systemic exposures of pegloticase and methotrexate polyglutamate(s) (MTX-PGs) in uncontrolled gout patients receiving pegloticase and MTX; to evaluate the effect of MTX on the PK of pegloticase in comparison to historical pegloticase monotherapy trials (C0405 and C0406)3, 4; and to evaluate the immunogenicity of pegloticase in co-treatment with MTX.

Methods:

In the MIRROR OL trial, MTX (15 mg/week) was given orally 4 weeks prior to the first pegloticase dose and continued weekly, in combination with pegloticase 8 mg given intravenously every 2 weeks, for a treatment duration of up to 52 weeks. Pre-infusion samples were collected to measure MTX-PGs in red blood cells. Pre- and post-infusion blood samples were obtained to measure the peak (Cmax) and trough (Cmin) concentrations of pegloticase at multiple visits. Anti-drug antibody blood samples were collected at multiple visits. The impact of MTX on pegloticase PK was evaluated by comparing pegloticase exposures with MTX from this trial to historical monotherapy data (C0405 and C0406)3, 4. The observed pegloticase concentrations with MTX were also overlaid with the 90% prediction interval based on the population PK model5 from C0405 and C0406.

Results:

Pegloticase and MTX-PG levels were determined in 14 patients. The 11 responders were generally associated with higher pegloticase exposures than the non-responders, especially Cmin (Figure 1). Concomitant treatment of MTX resulted in fewer patients with Cmin below quantitation limit (BQL) (5/14 [36%] with MTX vs 63/82 [77%] without MTX), and higher overall Cmin (median: 1.03 µg/ml with MTX vs BQL without MTX); Cmax was slightly higher (median [Q1, Q3]: 2.11 [1.65, 2.59] µg/mL with MTX vs 1.51 [BQL, 2.48] µg/mL without MTX). Pegloticase co-treatment with MTX resulted in more concentrations above the predicted median value of pegloticase, compared to monotherapy. ADA data is consistent with pegloticase PK and efficacy. Significant increase in ADA titers were only observed in 2 subjects (both were non-responders) at time corresponding to the loss of pegloticase exposure and increases in sUA levels. Concentrations of MTX-PGs were maintained during the treatment course, suggesting compliance of MTX administration. There was no apparent difference in concentrations of MTX-PGs between responders and non-responders.

Conclusion:

Pegloticase 8 mg IV every 2 weeks co-treatment with MTX 15 mg weekly resulted in fewer patients with pegloticase Cmin below the quantification limit (BQL) and gave higher overall trough concentrations (Cmin) compared to pegloticase monotherapy in the phase 3 studies.

Pegloticase 8 mg IV every 2 weeks co-treatment with MTX 15 mg weekly was associated with an improved response rate for pegloticase in association with improved drug levels in these patients with uncontrolled gout compared to pegloticase monotherapy in the phase 3 studies.

References:

[1]Botson J., et al. J Rheumatol. 2020; doi: 10.3899/jrheum.200460

[2]Goss S. L., et al. Clin Ther;2018, 40 (2).

[3]Lipsky P. E., et al. Arthritis Res Ther;2014, 16 (2).

[4]Sundy J. S., et al. JAMA;2011, 306 (7).

[5]Yue C. S., et al. ASCPT, Atlanta, 2010.

Disclosure of Interests:

Yang Song Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Yan Xin Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Michael E. Weinblatt Shareholder of: Canfite, Inmedix, Lycera, Vorso, Scipher, Grant/research support from: Crescendo Bioscience, Bristol Myers Squibb, Sanofi, Eli Lilly, Amgen, Jason Chamberlain Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Katie Obermeyer Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Lin Zhao Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Colleen Canavan Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Paul M. Peloso Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc, Srini Ramanathan Shareholder of: Horizon Therapeutics plc, Employee of: Horizon Therapeutics plc.

Uveitis and optic perineuritis in the context of myelin oligodendrocyte glycoprotein antibody seropositivity

BACKGROUND AND PURPOSE

Antibodies to myelin oligodendrocyte glycoprotein (MOG) have been identified in both children and adults with demyelination, with a strong association with bilateral or recurrent optic neuritis (ON). However, the full clinical spectrum of this newly described condition is unknown. We sought to describe non-ON inflammatory ophthalmological presentations such as uveitis and optic perineuritis in the context of MOG antibody seropositivity.

METHODS

Using a live cell-based assay analysed by flow cytometry, we identified seropositive patients referred for MOG antibody testing in Australasia between 2014 and 2017. We identified four MOG antibody-positive patients with non-ON inflammatory ophthalmological presentations and present their detailed clinical information in this case series.

RESULTS

Three patients had uveitis either in association with, or remote from, ON. One patient had optic perineuritis and peripheral ulcerative keratitis. We describe the presentation, examination, investigation findings and clinical course of these four patients.

CONCLUSIONS

Recognition of these novel clinical associations may expand the clinical spectrum of MOG antibody-associated presentations. An expedited diagnosis may guide the management of these complex patients.

Coronary Artery Disease-Reporting and Data System (CAD-RADS): strengths and limitations

A new standardised reporting system was introduced recently for coronary computed tomography (CT) angiography interpretation called CAD-RADS (Coronary Artery Disease-Reporting and Data System). Like any other new reporting platform, CAD-RADS has both advantages and disadvantages. Consistency in reporting, better clarity of communication, and more streamlined clinical recommendations are the major strengths of CAD-RADS. It has many limitations such as misinterpretation of CT angiography findings inherent to any CT angiography examination and unique disadvantages like misclassification of abnormalities, potential to misguide the referring physicians by suggesting management based on a single score. In addition, CAD-RADS does not include the details on location and extent of disease in the coronary arteries, coronary anomalies and other cardiac and extra cardiac findings.

Familial transient financial difficulties during infancy and long-term developmental concerns

BACKGROUND

Socioeconomic difficulties affect the cognitive and emotional development of children. However, the focus of prior studies has largely been on poverty and material hardship. This study expands on the existing literature by examining the impact of familial transient financial difficulties during infancy on long-term cognitive and behavioral outcomes.

METHODS

The National Longitudinal Surveys of Youth (79) were used to assess the association between a transient drop in family income by 50% or more (called transient income decline or TID) during the first 3 years of life and later-life Peabody Individual Achievement Math and Reading scores and behavior problem index (BPI) scores (N = 8272-17 348; median assessment age = 9 years). A subsample of matched siblings (N = 2049-4238) was examined to tease out maternal and intra-familial effects.

RESULTS

Exposure to TID predicted increased total and externalizing BPI scores (std. coefficients of 0.10 and 0.09, respectively, p < 0.01) in the overall sample. Among matched siblings, exposure to TID predicted increased total, externalizing, and internalizing BPI scores (std. coefficients of 0.27, 0.25, and 0.23, respectively, p < 0.01).

CONCLUSION

Familial transient financial difficulties can have long-lasting behavioral effects for infants. The study identifies an early risk factor and at-risk children, thus providing insight into developing early intervention measures for infants to avoid long-term behavioral problems.

Carbonic Anhydrase in Mammalian Vascular Smooth Muscle

Carbonic anhydrase (CA) is ubiquitously expressed and plays a pivotal role in acid-base balance, ion transport, and gas exchange. Limited observations by others, derived from functional, pharmacological, and histochemical studies, suggest that CA is present in vascular smooth muscle and is involved in vasoregulation. The present study, using measurements of bioactivity, inhibition characteristics, and immunohistochemical analysis, was undertaken to more fully evaluate CA in vascular smooth muscle. In isolated bovine aortic smooth muscle, which is devoid of erythrocytes, CA is present in low concentrations with a CO2 hydration activity (at 0C) of 3.5 ± 2.7 U/g. The I50 for acetazolamide inhibition is 0.07 ± 0.01 μM. Results with dorzolamide and bromopyruvate, selective inhibitors of the CA II and I isozymes, respectively, show that roughly 75% of the CA activity is accounted for by CA I, with 20% due to CA II. These results accord qualitatively with immunocytochemical staining with specific CA I and II antibodies, showing that both isozymes are present and that their staining co-localizes with cells positive for smooth muscle α-actin. These data establish the activity, inhibition, and isozyme pattern of carbonic anhydrase expression in mammalian vascular smooth muscle.

Suppressor of cytokine signaling 1-dependent regulation of the expression and oncogenic functions of p21(CIP1/WAF1) in the liver

The SOCS1 gene coding for suppressor of cytokine signaling 1 is frequently repressed in hepatocellular carcinoma (HCC), and hence SOCS1 is considered a tumor suppressor in the liver. However, the tumor-suppressor mechanisms of SOCS1 are not yet well understood. SOCS1 is known to inhibit pro-inflammatory cytokine production and signaling and to promote activation of the p53 tumor suppressor. However, we observed that SOCS1-deficient mice developed numerous and large liver tumor nodules following treatment with the hepatocarcinogen diethylnitrosamine (DEN) without showing increased interleukin-6 production or activation of p53. On the other hand, the livers of DEN-treated Socs1-null mice showed elevated levels of p21(CIP1/WAF1) protein (p21). Even though p21 generally functions as a tumor suppressor, paradoxically many cancers, including HCC, are known to express elevated levels of p21 that correlate with poor prognosis. We observed elevated p21 expression also in the regenerating livers of SOCS1-deficient mice and in cisplatin-treated Socs1-null hepatocytes, wherein the p21 protein showed increased stability. We show that SOCS1 interacts with p21 and promotes its ubiquitination and proteasomal degradation. Besides, the DEN-treated livers of Socs1-null mice showed increased nuclear and cytosolic p21 staining, and the latter was associated with growth factor-induced, phosphatidylinositol 3-kinase-dependent phosphorylation of p21 in SOCS1-deficient hepatocytes. Cytosolic p21 is often associated with malignancy and chemo-resistance in many cancers. Accordingly, SOCS1-deficient hepatocytes showed increased resistance to apoptosis that was reversed by shRNA-mediated p21 knockdown. In the regenerating livers of Socs1-null mice, increased p21 expression coincided with elevated cyclinD levels. Correspondingly, SOCS1-deficient hepatocytes showed increased proliferation to growth factor stimulation that was reversed by p21 knockdown. Overall, our findings indicate that the tumor-suppressor functions of SOCS1 in the liver could be mediated, at least partly, via regulation of the expression, stability and subcellular distribution of p21 and its paradoxical oncogenic functions, namely, resistance to apoptosis and increased proliferation.

Regulation of MET receptor tyrosine kinase signaling by suppressor of cytokine signaling 1 in hepatocellular carcinoma

Suppressor of cytokine signaling 1 (SOCS1) is considered as a tumor suppressor protein in hepatocellular carcinoma (HCC), but the underlying mechanisms remain unclear. Previously, we have shown that SOCS1-deficient hepatocytes displayed increased responsiveness to hepatocyte growth factor (HGF) due to enhanced signaling via the MET receptor tyrosine kinase. As aberrant MET activation occurs in many tumors including HCC, here we elucidated the mechanisms of SOCS1-mediated regulation. SOCS1 attenuated HGF-induced proliferation of human and mouse HCC cell lines and their growth as tumors in NOD.scid.gamma mice. Tumors formed by SOCS1 expressing HCC cells showed significantly reduced MET expression, indicating that SOCS1 not only attenuates MET signaling but also regulates MET expression. Mechanistically, SOCS1 interacted with MET via the Src homology 2 domain and this interaction was promoted by MET tyrosine kinase activity. The SOCS1-mediated reduction in MET expression does not require the juxtamembrane Y1003 residue implicated in Cbl-mediated downmodulation. Moreover, the proteasome inhibitor MG-132, but not the inhibitors of lysosomal degradation bafilomycin and chloroquine, reversed the SOCS1-mediated reduction in MET expression, indicating that this process is distinct from Cbl-mediated downmodulation. Accordingly, SOCS1 promoted polyubiquitination of MET via K48-dependent but not K63-mediated ubiquitin chain elongation. Furthermore, siRNA-mediated downmodulation of Cbl did not abolish SOCS1-mediated reduction in MET expression in HCC cells. SOCS1-dependent ubiquitination of endogenous MET receptor occurred rapidly following HGF stimulation in HCC cells, leading to proteasomal degradation of phosphorylated MET receptor. These findings indicate that SOCS1 mediates its tumor suppressor functions, at least partly, by binding to MET and interfering with downstream signaling pathways as well as by promoting the turnover of the activated MET receptor. We propose that loss of this control mechanism due to epigenetic repression of SOCS1 could contribute to oncogenic MET signaling in HCC and other cancers, and that MET inhibitors might be useful in treating these patients.

Anti-infective potential of caffeic acid and epicatechin 3-gallate isolated from methanol extract of Euphorbia hirta (L.) against Pseudomonas aeruginosa

Euphorbia hirta (L.) plant is traditionally used in Malaysia for the treatment of gastrointestinal, bronchial and respiratory ailments caused by nosocomial infectious agents. Bioactivity-guided fractionation of the methanol extract of the aerial parts of E. hirta and analysis using high-performance liquid chromatography have led to the isolation of two antibacterial compounds. These compounds were identified as caffeic acid (CA) and (-)-epicatechin 3-gallate (ECG) based on spectroscopic analyses and comparison with previously published data. Using broth microdilution method, both ECG and CA had demonstrated significant minimum inhibitory concentration of 15.6 and 31.3 μg/mL respectively, against Pseudomonas aeruginosa. Time-kill assessment of ECG and CA displayed bactericidal effect on P. aeruginosa cells.

Role of the humic acid for sorption of radionuclides by synthesized titania

Present work reports on synthesis, characterization and application of titania powder (anatase) for sorption of 137Cs (monovalent), 133Ba (divalent) and 154Eu (trivalent) radionuclides in the presence and absence of humic acid (Aldrich). In order to obtain a detailed sorption behavior of all the three aforementioned radionuclides, a series of experiments were conducted with respect to effect of pH, humic acid (HA), and concentration of radionuclides. Sorption studies of 137Cs, 133Ba and 154Eu onto synthesized titania have been carried out over a wide range of pH scale varying from 3 to 11 in the presence and absence of Aldrich Humic acid (2 mg/L). Sorption of all the three radionuclides rises sharply with the pH of the suspension with saturation value of ∼ 70%, 80% and 85% respectively for monovalent, bivalent and trivalent radionuclides. Humic acid could not make any influence for sorption of 137Cs, but significantly altered with respect to 133Ba and 154Eu sorption. The sorption data at various concentrations were fitted with Freundlich isotherm model.

The Mysterious Organ. Spectrum of Focal Lesions within the Splenic Parenchyma: Cross-Sectional Imaging with Emphasis on Magnetic Resonance Imaging

Incidental splenic lesions are frequently encountered at imaging performed for unrelated causes. Splenic cysts, hemangiomas, and lymphomatous involvement are the most frequently encountered entities. Computed tomography and sonography are commonly used for initial evaluation with magnetic resonance imaging reserved as a useful problem-solving tool for characterizing atypical and uncommon lesions. The value of magnetic resonance imaging lies in classifying these lesions as either benign or malignant by virtue of their signal-intensity characteristics on T1- and T2-weighted imaging and optimal depiction of internal hemorrhage. Dynamic contrast-enhanced sequences may improve the evaluation of focal splenic lesions and allow characterization of cysts, smaller hemangiomas, and hamartomas. Any atypical or unexplained imaging feature related to an incidental splenic lesion requires additional evaluation and/or follow-up. Occasionally, biopsy or splenectomy may be required for definitive assessment given that some of tumours may demonstrate uncertain biologic behavior.

Motivational interviewing improves exclusive breastfeeding in an Australian randomised controlled trial

AIM

To increase maintenance of breastfeeding through improved primary care support.

METHOD

A cluster randomised controlled trial recruited 15 rural family doctor's offices and 330 women who were currently breastfeeding took part. Eight practices formed the intervention group (154 women) and seven formed the control group (176 women). The practice nurses who provided the intervention used a specially designed motivational flowchart to speak to the mothers when they brought their child for immunisation at 2, 4 and 6 months. The nurses also attended preparatory workshops on breastfeeding management, counselling skills, motivational interviewing and reflective practice and were given resources and support. Breastfeeding rates were measured at 4 and 6 months.

RESULTS

Randomisation equally distributed all measured variables except prenatal intentions to rejoin employment within 12 months (70% intervention, 56% control, p < 0.05). After adjustment, the 4-month figures showed significantly higher rates of exclusive breastfeeding (OR 1.88; 95%CI 1.01-3.50; p = 0.047) and full breastfeeding (water/juice allowed) (OR 1.95; 95%CI 1.03-3.69; p = 0.04) in the intervention group. There were no differences at 6 months.

CONCLUSION

A motivational interviewing intervention by primary care health professionals who have undertaken a replicable training programme is feasible and effective in increasing exclusive breastfeeding and full/predominant breastfeeding at 4 months.

Induction of autoimmune diabetes in non-obese diabetic mice requires interleukin-21-dependent activation of autoreactive CD8⁺ T cells

Non-obese diabetic (NOD) mice lacking interleukin (IL)-21 or IL-21 receptor do not develop autoimmune type 1 diabetes (T1D). We have shown recently that IL-21 may promote activation of autoreactive CD8(+) T cells by increasing their antigen responsiveness. To investigate the role of IL-21 in activating diabetogenic CD8(+) T cells in the NOD mouse, we generated IL-21-deficient NOD mice expressing the highly pathogenic major histocompatibility complex (MHC) class-I-restricted 8.3 transgenic T cell receptor (TCR). IL-21 deficiency protected 8.3-NOD mice completely from T1D. CD8(+) T cells from the 8.3-NOD.Il21(-/-) mice showed decreased antigen-induced proliferation but displayed robust antigen-specific cytolytic activity and production of effector cytokines. IL-21-deficient 8.3 T cells underwent efficient homeostatic proliferation, and previous antigen stimulation enabled these cells to cause diabetes in NOD.Scid recipients. The 8.3 T cells that developed in an IL-21-deficient environment showed impaired antigen-specific proliferation in vivo even in IL-21-sufficient mice. These cells also showed impaired IL-2 production and Il2 gene transcription following antigen stimulation. However, IL-2 addition failed to reverse their impaired proliferation completely. These findings indicate that IL-21 is required for efficient initial activation of autoreactive CD8(+) T cells but is dispensable for the activated cells to develop effector functions and cause disease. Hence, therapeutic targeting of IL-21 in T1D may inhibit activation of naive autoreactive CD8(+) T cells, but may have to be combined with other strategies to inhibit already activated cells.

Ultrasonographic evaluation of oral submucous fibrosis in habitual areca nut chewers

OBJECTIVES

To characterize the sonographic features of the buccal mucosa in patients with oral submucous fibrosis (OSF).

METHODS

Three groups (controls with areca-related habits, controls without areca-related habits and clinically diagnosed OSF cases), each comprising 30 subjects, were included in the study. After a thorough clinical examination, transcutaneous B-mode ultrasonography was performed with a multifrequency linear transducer (5-10 MHz) for anterior and posterior buccal mucosa bilaterally. Both clinical and ultrasound findings were recorded by three independent observers. One-way analysis of variance and Tukey's honestly significant difference post-hoc tests were used for statistical comparisons between groups and Pearson χ(2) tests to compare the proportions. Kappa statistics was used to determine the interobserver agreement.

RESULTS

The submucosa that appeared hypoechoic in the control groups had significantly increased echogenicity in the case group (hypo- to isoechoic in 46.7% and isoechoic in 53.3%). The differentiation between the submucosa and the muscle layer appeared distinct in the control groups while it was not clear in the case group (indistinct in 50% and completely lost in 50%). The number of sites found positive on the ultrasound was significantly greater than the number of clinically positive sites. There was a very good interobserver consistency in clinical and ultrasound findings.

CONCLUSIONS

Ultrasonography of the buccal mucosa demonstrates increased submucosal echogenicity and reduced echo differentiation between submucosa and muscle layer in OSF cases. Hence, it can be used as a non-invasive imaging modality to assess the disease extent and severity across the entire buccal mucosa to supplement clinical evaluation.