Cancer spectrum and frequency among children with Noonan, Costello, and cardio-facio-cutaneous syndromes

Background:

Somatic mutations affecting components of the Ras-MAPK pathway are a common feature of cancer, whereas germline Ras pathway mutations cause developmental disorders including Noonan, Costello, and cardio-facio-cutaneous syndromes. These ‘RASopathies' also represent cancer-prone syndromes, but the quantitative cancer risks remain unknown.

Methods:

We investigated the occurrence of childhood cancer including benign and malignant tumours of the central nervous system in a group of 735 individuals with germline mutations in Ras signalling pathway genes by matching their information with the German Childhood Cancer Registry.

Results:

We observed 12 cases of cancer in the entire RASopathy cohort vs 1.12 expected (based on German population-based incidence rates). This corresponds to a 10.5-fold increased risk of all childhood cancers combined (standardised incidence ratio (SIR)=10.5, 95% confidence interval=5.4–18.3). The specific cancers included juvenile myelomonocytic leukaemia=4; brain tumour=3; acute lymphoblastic leukaemia=2; rhabdomyosarcoma=2; and neuroblastoma=1. The childhood cancer SIR in Noonan syndrome patients was 8.1, whereas that for Costello syndrome patients was 42.4.

Conclusions:

These data comprise the first quantitative evidence documenting that the germline mutations in Ras signalling pathway genes are associated with increased risks of both childhood leukaemia and solid tumours.

Comment on "Intensifying weathering and land use in Iron Age Central Africa"

Bayon et al. (Reports, 9 March 2012, p. 1219) interpreted unusually high aluminum-potassium ratio values in an Atlantic sediment core as indicating anthropogenic deforestation around 2500 years before the present (B.P.). We argue that there is no terrestrial evidence for forest destruction by humans and that the third millennium B.P. rainforest crisis can be clearly attributed mostly to climatic change.

The function of alpha- and beta-adrenoceptors of the saphenous artery in caveolin-1 knockout and wild-type mice

BACKGROUND AND PURPOSE

Adrenoceptors can associate with cardiac caveolae. To investigate the function of vascular caveolae, adrenoceptor-mediated effects were compared in the saphenous artery of caveolin-1 knockout (cav-1KO) and wild-type (WT) mice.

EXPERIMENTAL APPROACH

Electronmicroscopy was used to detect caveolae. Real-Time quantitative PCR was used for adrenoceptor subtypes. Catecholamine-evoked contractions and relaxations were studied in arterial segments.

KEY RESULTS

Caveolae were found in arterial smooth muscle from WT but not from cav-1KO mice. Arterial mRNA levels for the adrenoceptors alpha1A, alpha1B, alpha1D, beta1, beta2 and beta3 were similar in cav-1KO and WT. (-)-Noradrenaline contracted cav-1KO (-log EC50M=7.1) and WT (-log EC50M=7.3) arteries through prazosin-sensitive receptors. Maximum (-)-noradrenaline-evoked contractions were greater in cav-1KO than WT arteries. (-)-Isoprenaline relaxed WT arteries (-log EC50M=7.3) more potently than cav-1KO arteries (-log EC50M=6.8); the effects were antagonized partially and similarly by the beta2-selective antagonist ICI118551 (50 nM). The (-)-isoprenaline-evoked relaxation was partially antagonized by the beta1-adrenoceptor-selective antagonist CGP20712 (300 nM) in WT but not cav-1KO arteries. The beta3-adrenoceptor-selective antagonist L748337 (100 nM) partially antagonized the relaxant effects of (-)-isoprenaline in cav-1KO but not in WT arteries. BRL37344 partially relaxed arteries through beta3-adrenoceptors in cav-1KO but not WT. The relaxant effects of BRL37344 were decreased by the NO synthase inhibitor OmegaL-nitroarginine.

CONCLUSIONS AND IMPLICATIONS

The function of arterial alpha1- and beta2-adrenoceptors is similar in cav-1KO and WT mice. beta1-adrenoceptor-mediated relaxation in WT is lost in cav-1KO and replaced by the appearance of beta3-adrenoceptors.

Pharmacokinetics of pinokalant, a new nonselective cation channel blocker in the rat

The pharmacokinetics of 1-isoquinolineacetamide, 3,4-dihydro-6,7-dimethoxy-alpha-phenyl-N,N-bis [2-(2,3,4-trimethoxyphenyl)ethyl]-, monomethanesulfonate (pinokalant, salt form of the active entity LOE 908 BS, CAS 143482-63-7), a nonselective cation channel blocker, was studied in rats. Drug plasma levels declined rapidly in a polyphasic manner after intravenous bolus administration of 8.8 mg/kg LOE 908 BS. The disposition of LOE 908 BS was governed by a rapid elimination (clearance Cl = 47.7 ml/min/kg) and an extensive distribution into tissues (volume of distribution Vss = 7.21 l/kg). A dose-proportional increase of AUC and steady state concentration up to doses of 194 mg/kg (6 h infusion) was observed suggesting linear pharmacokinetics. The protein binding was very high with 99.4% to 99.7% bound to plasma proteins in the concentration range 0.26 to 2.6 micrograms/ml. The LOE 908 BS concentration-time profile in brain tissue after intravenous infusion (4.4 mg/kg/h over 4 h) paralleled those measured in plasma indicating a rapid but also low penetration of the blood-brain-barrier. The concentration-time profile of drug-related radioactivity after intravenous (bolus) administration of [14C]LOE 908 BS dropped also rapidly to approximately 16% within the first hour compared to the initial 2-min value. The drug exhibited a high biliary excretion (84% during 5 h) and, accordingly, faecal excretion was the main route of excretion (> 90%). The mass balance was complete after 96 h indicating no persistence of radioactivity in the animals. The relevance of these findings with respect to results obtained with LOE 908 BS in animal models for stroke and traumatic brain injury is discussed.

The closo-[Sn9M(CO)314- Zintl ion clusters where M = Cr, Mo, W: two structural isomers and their dynamic behavior

The closo-[Sn9M(CO)3]4-ions where M = Cr (1), Mo (2), W (3) were prepared from [LM(CO)3] precursors (L=mesitylene, cycloheptatriene), K4Sn9. and 2,2,2-cryptand in ethylenediamine/toluene solvent mixtures. The [K(2,2,2-cryptand)]+ salts are very air and moisture sensitive and have been characterized by IR, 119Sn, and 13C NMR spectroscopy and single-crystal X-ray diffraction studies. Complexes 1-3 form bicapped square-antiprismatic 10-vertex 22-electron closo structures in which the [M(CO)3] units occupy cluster vertices. For 1 and 2, the clusters have C4. symmetry in the solid state in which the [M(CO)A] fragments occupy capping positions with Sn9(4-) ions that are bound to the metal in an 4 fashion. For 3, the [M(CO)3] fragment occupies a position in the square plane with an eta/5-Sn9(4-) ion and C(s) point symmetry. For 1-3, a dynamic equilibrium exists between the eta4 and eta5 structures yielding three 119Sn NMR signals that reflect the three chemically distinct Sn environments of the higher symmetry C(4v) structure. The 119Sn NMR chemical shifts and coupling constants show solvent and temperature dependencies due to the equilibrium process. A triangular-face rotation mechanism is proposed to describe the dynamic behavior.

Hydrothermal synthesis of the first organically templated open-framework uranium phosphate

[(C2H5)2NH2]2[(UO2)5(PO4)4] was prepared from U3O8, HONEt2 and phosphoric acid under hydrothermal conditions (180 degrees C, 5 days) and represents the first three-dimensional open-framework uranium phosphate prepared to date.

Pharmacokinetics and tissue distribution of the anticholinergics tiotropium and ipratropium in the rat and dog

Ipratropium, a current treatment for chronic obstructive pulmonary disease (COPD) and tiotropium, a longer acting anticholinergic bronchodilator currently being developed for COPD are structurally related to atropine. In this study, the intravenous (i.v.), oral (p.o.) and intratracheal (i.tr.) single dose pharmacokinetics (PK) of tiotropium and ipratropium were determined in rat and dog. In rats, concentration-time profiles of tiotropium and ipratropium after single i.v. bolus administration of 7-8 mg kg(-1) are similar. Both drugs are highly cleared (Cl between 87 and 150 ml min(-1) kg(-1)) and extensively distributed into tissues (volume of distribution V(ss) between 3 and 15 l kg(-1)). In dogs, this holds also true for both drugs (Cl between 34 and 42 ml min(-1) kg(-1), V(ss) between 2 and 10 l kg(-1)), although different dose regimen were applied (i.v. bolus of 0.08 mg kg(-1) vs. infusion of 0.1 mg kg(-1) h(-1) for 3 h). Tiotropium plasma concentrations increased linearly in rats over a wide dose range following single i.v. administration. Both ipratropium and tiotropium showed a comparable terminal elimination half-life in rat urine (21-24 h) after single i.v. administration, which was much longer than the corresponding half-life in plasma (6-8 h). Whole body autoradiography in rats revealed a broad and rapid tissue distribution of [(14)C]tiotropium radioactivity after single i.v. administration. A comparable distribution pattern has also been reported earlier for ipratropium.

[Intraoperative facial nerve monitoring in parotid surgery]

Neurophysiological monitoring of cranial motor nerves has proved to be of value in cerebellopontine and skull base surgery. Unfortunately, facial nerve monitoring has been used infrequently for routine parotid gland surgery because suspicion of expense, possible unreliability and the requirement for extra personnel. This study presents clinical experience at the University of Erlangen with facial nerve monitoring during parotid gland surgery done by residents. Advantages are also emphasized for the experienced ENT-surgeon for use during revision parotidectomy. In 35 consecutive patients with benign parotid gland tumors intraoperative monitoring of the facial nerve was done using two different two-channel electromyography units. Bipolar coaxial electrical stimulation was superior to the monopolar stimulation mode. The average operative time and postoperative functional results were compared with those of a control group consisting of 24 patients without monitoring. Findings demonstrated a reduction is operative time and better functional outcome in the patient group with monitoring. Additionally four patients had to undergo total revision parotidectomy because of recurrent benign tumors, while one patient suffered from chronic parotitis due to sialolithiasis and required complete parotidectomy for relief of symptoms. No patient developed permanent facial paresis and nerve monitoring proved to be very helpful for identification and protection of the facial nerve in scar tissue.

Reduction of nightwork by re-designing of shift-rotas

The reduction of nightwork is an important preventive measure to limit possible negative effects of night shifts on well-being, health and social life. An example of a gradual reduction of nightwork in a group of transport workers at an airport is presented. After having carefully analysed the real number of persons needed during nighttime for loading and unloading aircrafts the number of shiftworkers who had to work between 02.00 and 06.00 h was reduced in a first step from 104 to 66 and in a second step to 38 persons.

[The mixing index in the argon breath holding test for the demonstration of pharmacologically induced airways reactions. A comparison with other methods (author's transl)]

In 42 patients with obstructive airways diseases the behavior of the mixing index (delta argon %/1 during phase III of the argon-volume diagram) was studied after beta2 stimulation or after provocation by acetylcholine. Changes in airways resistance resp. conductance (GAW), FEV1.0 and residual volume (RV) were also determined for comparison. In an inhomogeneous subgroup with obstructive airways disease of various aetiology the mixing index (MI) and FEV1.0 indicated changes in the airways system with about equal frequency. Distinct discrepancies between the two tests, observed in a few cases, suggest that the two methods register different pathophysiological reactions. These differences could be confirmed statistically in a more homogeneous subgroup with extrinsic bronchial asthma. A correlation could be established between MI and RV on the one hand and between FEV1.0 or GAW and RV on the other hand. The results indicate that the mixing index as a test of distribution of ventilation reflects mainly the reactions of the small airways. Its use offers the possibility of a more differentiated pharmacodynamic evaluation.