Pazopanib (GW786034) and cyclophosphamide in patients with platinum-resistant, recurrent, pre-treated ovarian cancer - Results of the PACOVAR-trial

PURPOSE

The prognosis is poor for patients with recurrent, platinum-resistant epithelial ovarian cancer (EOC). Evidence suggests that antiangiogenic treatment modalities could play a major role in EOC. A combined therapy consisting of the investigational oral antiangiogenic agent pazopanib and metronomic oral cyclophosphamide may offer a well-tolerable treatment option to patients with recurrent, previously treated EOC.

PATIENTS AND METHODS

This study was designed as a multicenter phase I trial evaluating the optimal dose as well as activity and tolerability of pazopanib with metronomic cyclophosphamide in the treatment of patients with recurrent, platinum-resistant, previously treated ovarian, peritoneal, or fallopian tube cancer. Here, 50mg cyclophosphamide were combined with 400 to 800mg pazopanib daily.

RESULTS

Sixteen patients were treated; mean age was 66years. At dose levels (DL) I and II, one instance of dose-limiting toxicity (DLT) was seen in one of 6 patients. At DL III, two of four patients showed a DLT, leading to a maximum tolerated dose (MTD) of 600mg pazopanib daily. Median number of administered cycles was 6 (2-13), with three patients being treated for at least 13months. Median progression-free survival (PFS) and overall survival (OS) were 8.35months and 24.95months, respectively. 155 adverse events (AE) occurred, most frequently elevation of liver enzymes, leukopenia, diarrhea and fatigue. Altogether, five serious adverse events (SAE) developed in four patients.

CONCLUSION

Pazopanib 600mg daily p.o. and metronomic cyclophosphamide 50mg daily p.o. is a feasible regimen for patients with recurrent platinum-resistant EOC and showed promising activity in this previously treated patient population.

TRIAL REGISTRATION

Clin.trial.gov registry no.: NCT01238770.

Das Zusammenwirken von Phasen- und Amplitudenkontrast in der elektronenmikroskopischen Abbildung

Die Abhängigkeit des Kontrastes in der elektronenmikroskopischen Abbildung von der Schärfe der Fokussierung wird für einige Objektmodelle mit vorgegebenen örtlichen Verteilungen des Streuabsorptionskoeffizienten und des Brechungsindex für Elektronen mittels der Kirchhoffschen Formel berechnet. Die gefundene Abhängigkeit des Kontrastes bestimmter Objektdetails vom Abstand zwischen Fokussierungsebene und Objektebene ist in guter qualitativer Übereinstimmung mit den Bildkontrasten, die an einer Reihe von bei verschiedener Defokussierung aufgenommener Abbildungen eines Dünnschnitts durch eine markhaltige Nervenfaser beobachtet wurden.

Die berechneten und im elektronenmikroskopischen Bild beobachteten Kontraständerungen durch Defokussierung werden an Hand eines lichtmikroskopischen Modellversuchs (Fokussierungsreihe eines Strichgitters) weiter veranschaulicht.

Anatomical Position of Four Different Transobturator Mesh Implants for Female Anterior Prolapse Repair

Purpose: Polypropylene mesh implants are frequently used for pelvic floor reconstruction in women. Yet they vary in size and fixation. The purpose of this study is to compare four mesh products with regard to their anatomical positioning and functionality within the pelvic floor, to determine whether each mesh fits equally well in a female cadaver. Methods: One female pelvis was dissected, opening the retropubic space exposing the endopelvic fascia and demonstrating the arcus tendineus fasciae pelvis (ATFP). Anatomical parameters were measured before and after implanting four meshes via the transobturator approach. Results: The anterior fixation of the ATFP was found to be 5 mm lateral to the symphysis in this cadaver. The endopelvic fascia covered 54.6 cm². The obturator nerve was located 35 mm from the white line. The distance of the proximal and lateral points of mesh fixation from the ischial spine or ATFP varied from 0 to 25 mm. The meshes varied in size and anatomical positioning. Conclusion: These observations demonstrate the necessity of developing optimally sized meshes and appropriate introducer techniques that can provide sufficient vaginal support. Surgeons, furthermore, need profound knowledge of anatomy, the patient's pelvic floor defect and the meshes available on the market.

Behavioral choice-related neuronal activity in monkey primary somatosensory cortex in a haptic delay task

The neuronal activity in the primary somatosensory cortex was collected when monkeys performed a haptic-haptic DMS task. We found that, in trials with correct task performance, a substantial number of cells showed significant differential neural activity only when the monkeys had to make a choice between two different haptic objects. Such a difference in neural activity was significantly reduced in incorrect response trials. However, very few cells showed the choice-only differential neural activity in monkeys who performed a control task that was identical to the haptic-haptic task but did not require the animal to either actively memorize the sample or make a choice between two objects at the end of a trial. From these results, we infer that the differential activity recorded from cells in the primary somatosensory cortex in correct performance reflects the neural process of behavioral choice, and therefore, it is a neural correlate of decision-making when the animal has to make a haptic choice.

Persistent Neuronal Firing in Primary Somatosensory Cortex in the Absence of Working Memory of Trial-specific Features of the Sample Stimuli in a Haptic Working Memory Task

Previous studies suggested that primary somatosensory (SI) neurons in well-trained monkeys participated in the haptic–haptic unimodal delayed matching-to-sample (DMS) task. In this study, 585 SI neurons were recorded in monkeys performing a task that was identical to that in the previous studies but without requiring discrimination and active memorization of specific features of a tactile or visual memorandum. A substantial number of those cells significantly changed their firing rate in the delay compared with the baseline, and some of them showed differential delay activity. These firing changes are similar to those recorded from monkeys engaged in active (working) memory. We conclude that the delay activity is not necessarily only observed as was generally thought in the situation of active memorization of different features between memoranda after those features have been actively discriminated. The delay activity observed in this study appears to be an intrinsic property of SI neurons and suggests that there exists a neural network in SI (the primary sensory cortex) for haptic working memory no matter whether the difference in features of memoranda needs to be memorized in the task or not. Over 400 SI neurons were also recorded in monkeys well-trained to discriminate two memoranda in the haptic–haptic DMS task for comparison of delay firing of SI neurons between the two different working memory tasks used in this study. The similarity observed in those two situations suggests that working memory uses already-existing memory apparatus by activating it temporarily. Our data also suggest that, through training (repetitive exposure to the stimulus), SI neurons may increase their involvement in the working memory of the memorandum.

Dipole source analyses of laser evoked potentials obtained from subdural grid recordings from primary somatic sensory cortex

The cortical potentials evoked by cutaneous application of a laser stimulus (laser evoked potentials, LEP) often include potentials in the primary somatic sensory cortex (S1), which may be located within the subdivisions of S1 including Brodmann areas 3A, 3B, 1, and 2. The precise location of the LEP generator may clarify the pattern of activation of human S1 by painful stimuli. We now test the hypothesis that the generators of the LEP are located in human Brodmann area 1 or 3A within S1. Local field potential (LFP) source analysis of the LEP was obtained from subdural grids over sensorimotor cortex in two patients undergoing epilepsy surgery. The relationship of LEP dipoles was compared with dipoles for somatic sensory potentials evoked by median nerve stimulation (SEP) and recorded in area 3B (see Baumgärtner U, Vogel H, Ohara S, Treede RD, Lenz FA. J Neurophysiol 104: 3029-3041, 2010). Both patients had an early radial dipole in S1. The LEP dipole was located medial, anterior, and deep to the SEP dipole, which suggests a nociceptive dipole in area 3A. One patient had a later tangential dipole with positivity posterior, which is opposite to the orientation of the SEP dipole in area 3B. The reversal of orientations between modalities is consistent with the cortical surface negative orientation resulting from superficial termination of thalamocortical neurons that receive inputs from the spinothalamic tract. Therefore, the present results suggest that the LEP may result in a radial dipole consistent with a generator in area 3A and a putative later tangential generator in area 3B.

Pelvic organ prolapse: does the postoperative course of mesh-repair surgery differ in elderly women when compared with younger patients?

Pelvic organ prolapse (POP) is a common disease in elderly women. Among a wide range of possibilities in POP surgery, the use of partially absorbable meshes appears to be very promising. The problem concerning POP therapy in elderly patients has not yet been not sufficiently investigated. We enrolled 64 patients with POP stages 3 and 4. All patients underwent mesh-repair surgery and afterwards were stratified into two age groups. Data obtained from anamnesis, pelvic organ prolapse quantification (POP-Q) scale, dynamic MRI and prolapse quality of life (P-QoL) questionnaire were analysed and compared between both age groups. A total of 64 patients completed the study protocol. Outcome of the surgery was promising and comparable between both age groups. One recurrence of prolapse and one mesh erosion was reported. P-QoL showed a good overall satisfaction. Our data show that the surgical correction of POP with use of polypropylene mesh in elderly women appears to be a successful method with an acceptable morbidity, adverse events rate and high satisfaction of the patients.

Tunable fermi acceleration in the driven elliptical billiard

We explore the dynamical evolution of an ensemble of noninteracting particles propagating freely in an elliptical billiard with harmonically driven boundaries. The existence of Fermi acceleration is shown thereby refuting the established assumption that smoothly driven billiards whose static counterparts are integrable do not exhibit acceleration dynamics. The underlying mechanism based on intermittent phases of laminar and stochastic behavior of the strongly correlated angular momentum and velocity motion is identified and studied with varying parameters. The diffusion process in velocity space is shown to be anomalous and we find that the corresponding characteristic exponent depends monotonically on the breathing amplitude of the billiard boundaries. Thus it is possible to tune the acceleration law in a straightforwardly controllable manner.

Long-term response of tomato plants to changing nutrient concentration in the root environment-the role of proline as an indicator of sensory fruit quality

The aim of the trial was to investigate the time course of changes in content of proline and organic compounds affecting sensory quality of ripe red tomatoes after nutrient concentration had been changed. Tomato (Lycopersicon esculentum Mill. cv. Counter) plants were grown in nutrient solutions containing equal nutrient ratios at either low or high concentration (N1=standard solution; N2=5.5 times the standard concentration). Immediately after first harvest of ripe tomatoes, half of the plants of each treatment were transferred to nutrient solutions of higher (from N1 to N2) or lower (from N2 to N1) nutrient concentration. Proline content in leaves of plants transferred to higher or lower nutrient concentration adjusted to control levels (N2 and N1, respectively) within 2 weeks. Growing and ripe fruit reached the corresponding control levels within the same time or 1-5 weeks later. Similar time courses were observed for sugar concentration and titratable acidity in fruit. Apart from leaves, proline content of young growing fruit also increased with increasing radiation intensity at high nutrient concentration. However, in ripe fruit, proline content increased only with low to moderate radiation intensity and decreased when a certain stress level was exceeded. Similar results were found for osmolality and sugar concentration of ripe fruit, while titratable acidity remained rather unaffected by radiation. The role of proline as an indicator of sensory fruit quality is discussed.

Changes in pulmonary venous Doppler parameters in fetal cardiac defects

OBJECTIVES

Recent observations in pediatric cardiological studies have prompted discussion on the possible role of intrauterine pulmonary venous changes in neonatal and postoperative outcome of infants with congenital heart defects. This study analyzes changes of Doppler blood flow velocity waveforms in the pulmonary veins of fetuses with different cardiac defects.

METHODS

Eighty fetuses (mean gestational age, 27 weeks) with prenatally diagnosed cardiac defects were classified into one of five groups: obstructed left atrium, other left ventricular outflow tract obstruction, right ventricular outflow tract obstruction, miscellaneous cardiac defects and total anomalous pulmonary venous drainage. Doppler examination of the pulmonary veins was performed and the time velocity integral (TVI), end-diastolic (A) velocity, and pulsatility index for veins (PIV) were compared with reference ranges.

RESULTS

Fetuses with infradiaphragmatic total anomalous pulmonary venous drainage showed a continuous Doppler flow pattern instead of the typical pulsatile waveform pattern. In fetuses with obstructed left atrium and restrictive foramen ovale, a reversed A-velocity and increased PIV were found. In five of the eight fetuses with left outflow tract obstruction but patent mitral valve, PIV was increased. In the other groups there were no obvious changes in Doppler parameters.

CONCLUSIONS

We suggest routine examination of the pulmonary veins with pulsed Doppler ultrasound in every fetus with a prenatally diagnosed heart defect. Such Doppler parameters could be used in future as cut-offs for the recently reported in-utero atrial septostomy to decompress an obstructed left atrium.

Sequential neural processes of tactile-visual crossmodal working memory

Working memory is essential to learning and performing sensory-motor behaviors that in many situations require the integration of stimuli of one modality with stimuli of another. In the present study, we focused on the neural mechanisms underlying crossmodal working memory. We hypothesized that in performance of the tactile crossmodal working memory task, there would be sequentially discrete task-correlated neural activities representing the processes of crossmodal working memory. Scalp-recorded event-related potentials were collected from 15 electrodes in humans performing each of four tasks: tactile-tactile unimodal delayed matching-to-sample task, tactile-visual crossmodal delayed matching-to-sample task, tactile unimodal control spatial task, and tactile crossmodal control spatial task. Two positive event-related potential peaks were observed during the delay of the task. One peak (late positive component-1) was at about 330 ms after the onset of the tactile stimulus, and the other (late positive component-2) was at about 600 ms. Late positive component-1 was observed in all four tasks. There was no significant difference in late positive component-1 either between the unimodal tasks, or between the crossmodal tasks, but late positive component-1 was significantly larger in the crossmodal tasks than that in the unimodal tasks, and showed a specific pattern of larger activity over parietal areas than activity over frontal areas. Late positive component-2 was not observed in the unimodal matching task but was observed in all other three tasks over parietal areas. During the late delay (1000 ms-1500 ms), significant differences in negative potentials (late negative component) were found between the tasks. The present study shows sequential changes in event-related potentials during the retention period of working memory tasks. It indicates that in performance of a crossmodal working memory task, there are sequentially discrete neural processes that may represent neural activities related to different cognitive functions, such as crossmodal transfer of information, and the working memory of the stimulus.

Transient unilateral hearing loss induced by electrocortical stimulation

A 32-year-old patient with seizures experienced decreased right-ear hearing during electrocortical stimulation mapping of the left lateral superior temporal gyrus. Audiometric testing under headphones confirmed a reversible, moderate unilateral hearing loss. Under binaural listening conditions, auditory comprehension was impaired at the same site, whereas word repetition, environmental sound recognition, naming, and spontaneous speech remained intact.

Surgery of the motor thalamus: problems with the present nomenclatures

The literature on thalamic surgery is difficult to read because different nomenclatures are in use. Neurosurgeons mostly use the stereotactic atlas of Schaltenbrand with Hassler's nomenclature of the thalamus. Neuroanatomists use different nomenclatures for the primate thalamus. The cytoarchitectonic definition of nuclei is difficult in the motor thalamus, and it would be best to define the nuclei based on their subcortical afferents. However, tracing studies are not available in humans. Thus, human thalamic nomenclature is based entirely on cytoarchitectonic subdivisions and transfer of knowledge by analogy from monkey to man. Problems arise when trying to transfer the detailed knowledge from monkey to the human brain. By doing so, different authors have come to different conclusions concerning the subcortical afferents of Hassler's motor nuclei, which inevitably leads to confusion when attempting neurophysiological interpretations of the surgical data. The present review draws attention to the discrepancies and open questions in the literature. There is a need to better define the limits of the sensory and cerebellar afferent receiving thalamic nuclei as well as those of the cerebellar and pallidal afferent receiving territories in humans.

Fetal pulmonary venous flow pattern is determined by left atrial pressure: report of two cases of left heart hypoplasia, one with patent and the other with closed interatrial communication

We report two cases of fetal left heart hypoplasia with extremes of size of interatrial communication, i.e. a closed foramen ovale and an atrial septal defect. Doppler examinations of the pulmonary veins showed almost to and fro flow in the fetus with the closed foramen ovale and, in contrast, a normal flow velocity waveform in the fetus with the atrial septal defect, despite mitral atresia. Our observations support the importance of left atrial pressure in the creation of a pulmonary venous flow pattern in the fetus.

[Taxane-based palliative chemotherapy for metastatic breast cancer: matched pair analysis to compare the efficacy and safety of docetaxel and paclitaxel]

OBJECTIVE

A retrospective comparison of the efficacy and toxicity of docetaxel and paclitaxel in the treatment of metastatic breast cancer (MBC) was conducted based on our institution's experience since 1992.

METHODS

Two groups of 43 patients who received a similar chemotherapy regimen containing either docetaxel or paclitaxel were matched for the number of prior treatments.

RESULTS

Toxicity was mild in both groups. Tumour growth control, defined as either objective response or stable disease for at least 6 months, was obtained in a significantly higher proportion of patients treated with docetaxel compared with paclitaxel (67 % vs. 44 %, p = 0.001). Moreover, fewer patients progressed during treatment with docetaxel (28 % vs. 53 %, p < 0.001). At a median follow-up of 17 months there was no significant difference between the groups in median progression-free survival (7 vs. 5 months, p = 0.123) or median overall survival (OS) (12 vs. 11 months, p = 0.211). According to the method of Kaplan and Meier estimated OS rates at 1 year (74 % vs. 62 %) and 2 years (50 % vs. 26 %), however, were in favour of docetaxel. In a multivariate analysis only a positive hormone receptor status was significantly associated with improved OS.

CONCLUSION

These results suggest that docetaxel may be superior to paclitaxel in the treatment of MBC.

Transcortical sensory aphasia: revisited and revised

Transcortical sensory aphasia (TSA) is characterized by impaired auditory comprehension with intact repetition and fluent speech. We induced TSA transiently by electrical interference during routine cortical function mapping in six adult seizure patients. For each patient, TSA was associated with multiple posterior cortical sites, including the posterior superior and middle temporal gyri, in classical Wernicke's area. A number of TSA sites were immediately adjacent to sites where Wernicke's aphasia was elicited in the same patients. Phonological decoding of speech sounds was assessed by auditory syllable discrimination and found to be intact at all sites where TSA was induced. At a subset of electrode sites where the pattern of language deficits otherwise resembled TSA, naming and word reading remained intact. Language lateralization testing by intracarotid amobarbital injection showed no evidence of independent right hemisphere language. These results suggest that TSA may result from a one-way disruption between left hemisphere phonology and lexical-semantic processing.

Pulmonary arterial Doppler velocimetry in fetuses with lung hypoplasia

OBJECTIVE

The aim of the study was to examine Doppler flow velocity waveforms in the main stems of the pulmonary arteries in fetuses with autopsy-proven lung hypoplasia and to find out whether in these conditions typical patterns can be found.

STUDY DESIGN

Doppler spectra were derived from the main stem of the right or left pulmonary artery in fetuses at high-risk for lung-hypoplasia. The following Doppler parameters were analyzed and compared to reference ranges: peak systolic velocity, acceleration time, time velocity integral, end-systolic reverse flow, pulsatility index (PI). Pulmonary hypoplasia was found in nine cases at autopsy after termination of pregnancy (19-23 weeks). According to etiology, three groups were considered: (A) bilateral renal malformations (n=4), (B) congenital diaphragmatic hernia (n=2), and (C) miscellaneous malformations including heart defects (n=3).

RESULTS

The following Doppler parameters were found: normal values in end-systolic reversal flow in all cases, decreased peak systolic velocity and acceleration time in 3/9, decreased time velocity integral in 4/9 and increased pulsatility index in 6/9. Considering the etiology of pulmonary hypoplasia the pulsatility index was found to be the most sensitive, since all fetuses in groups A and B had an abnormal PI.

CONCLUSIONS

Human fetuses with renal malformations and diaphragmatic hernia associated with lung hypoplasia show as early as 19-23 weeks of gestation an abnormal Doppler spectrum in the main stems of the pulmonary arteries. Increased PI is the best parameter to detect flow abnormality in this condition. Since the Doppler spectrum depends on cardiac anatomy and function, PI in lung hypoplasia seems to be reliable only when cardiac defects are absent.