Optimierung der Bestrahlungsplanung beim nicht-kleinzelligen Bronchialkarzinom (NSCLC) mit Hilfe von 18FDG-PET

Ziel: Die FDG-PET-Untersuchung hat in den vergangenen Jahren bei onkologischen Fragestellungen insbesondere beim Staging des Bronchialkarzinoms wachsende Bedeutung erlangt. In der vorliegenden retrospektiven Untersuchung wurde der Einfluss der PET auf die Strahlentherapieplanung bei Patienten mit non-small-cell lung cancer (NSCLC) untersucht. Methoden: Die Untersuchung umfasste 39 Patienten mit einem NSCLC, die zwecks Staging mit PET untersucht worden waren. Sie wurden über (anhand der CT- und Bronchoskopiebefunde geplante) anterior/posteriore Gegenfelder bestrahlt, die den Primärtumor und das Mediastinum einschlossen. Die Ergebnisse der PET-Untersuchung wurden bei der Bestrahlungsplanung zunächst nicht berücksichtigt. Retrospektiv wurden anhand der FDG-Anreicherungen die Bestrahlungsfelder unter Berücksichtigung der Größe und Lokalisation des Primärtumors neu definiert, weiterhin wurde die Ausdehnung des mediastinalen Anteils der Feldkonturen auf PET-Aktivitäten außerhalb des Bestrahlungsfelds überprüft. Ergebnisse: Bei 15 von 39 Patienten unterschieden sich die CT- von den CT/PET-geplanten Bestrahlungsfeldern. In den meisten Fällen (n = 12) war das CT/PET-Feld kleiner als das CT-Feld. Die mediane Größe der Bestrahlungsfelder betrug 179 cm2 und nach Neudefinition durch PET 166 cm2. Bei 20 Patienten mit Tumor-verursachten Belüftungsstörungen (Atelektasen, Dystelektasen) wurde die Änderung des Bestrahlungsfelds signifikant häufiger (p = 0,03) als bei den übrigen Patienten vorgeschlagen. Schlussfolgerung: Unsere Ergebnisse zeigen den Synergismus von topographischer (CT) und metabolischer (FDG-PET) Information, die in der Bestrahlungsplanung des Bronchialkarzinoms insbesondere bei Patienten mit Belüftungsstörungen von Nutzen sein könnte.

Somatic mutation, copy number and transcriptomic profiles of primary and matched metastatic estrogen receptor-positive breast cancers

BACKGROUND

Estrogen receptor-positive (ER+) breast cancers (BCs) constitute the most frequent BC subtype. The molecular landscape of ER+ relapsed disease is not well characterized. In this study, we aimed to describe the genomic evolution between primary (P) and matched metastatic (M) ER+ BCs after failure of adjuvant therapy.

MATERIALS AND METHODS

A total of 182 ER+ metastatic BC patients with long-term follow-up were identified from a single institution. P tumor tissue was available for all patients, with 88 having matched M material. According to the availability of tumor material, samples were characterized using a 120 mutational hotspot qPCR, a 29 gene copy number aberrations (CNA) and a 400 gene expression panels. ESR1 mutations were assayed by droplet digital PCR. Molecular alterations were correlated with overall survival (OS) using the Cox proportional hazards regression models.

RESULTS

The median follow-up was 6.4 years (range 0.5-26.6 years). Genomic analysis of P tumors revealed somatic mutations in PIK3CA, KRAS, AKT1, FGFR3, HRAS and BRAF at frequencies of 41%, 6%, 5%, 2%, 1% and 2%, respectively, and CN amplification of CCND1, ZNF703, FGFR1, RSF1 and PAK1 at 23%, 19%, 17%, 12% and 11%, respectively. Mutations and CN amplifications were largely concordant between P and matched M (>84%). ESR1 mutations were found in 10.8% of the M but none of the P. Thirteen genes, among which ESR1, FOXA1, and HIF1A, showed significant differential expression between P and M. In P, the differential expression of 18 genes, among which IDO1, was significantly associated with OS (FDR < 0.1).

CONCLUSIONS

Despite the large concordance between P and matched M for the evaluated molecular alterations, potential actionable targets such as ESR1 mutations were found only in M. This supports the importance of characterizing the M disease. Other targets we identified, such as HIF1A and IDO1, warrant further investigation in this patient population.

Comparison of polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) in the serum of hypothyroxinemic and euthyroid dogs

OBJECTIVE

To determine the profile of 14 polybrominated diphenyl ethers (PBDEs) and 23 polychlorinated biphenyls (PCBs) in serum of domestic canines and whether this was predictive of thyroid hormone status.

SAMPLES

Serum samples were collected from 51 client-owned dogs visiting the University of California Davis William R. Pritchard Veterinary Medical Teaching Hospital during 2012 to 2016 for routine appointments. Fifteen dogs were diagnosed with hypothyroxinemia while 36 were euthyroid.

PROCEDURES

Concentrations of PBDEs and PCBs in canine serum samples were measured by gas chromatography mass spectrometry. Logistic regression analysis was used to determine the association between the presence/absence of canine hypothyroxinemia and the serum concentration of individual PBDE or PCB congeners.

RESULTS

The median concentrations of total PBDE and PCB congeners in the hypothyroxinemic group were 660 and 1,371 ng/g lipid, respectively, which were higher than concentrations detected in the control group. However, logistic regression analysis determined that current concentrations of PBDEs and PCBs in canines were not significantly associated with hypothyroxinemia. BDE 183 was the only congener showing near significance (p = 0.068).

CONCLUSIONS

PBDE and PCB congeners were detected in all canine samples confirming ongoing exposure to these pollutants. Because household dogs share the human environment, they may serve as biosentinels of human exposure to these contaminants.

Comparison of polybrominated diphenyl ethers (PBDEs) and polychlorinated biphenyls (PCBs) in the serum of hypothyroxinemic and euthyroid dogs

OBJECTIVE

To determine the profile of 14 polybrominated diphenyl ethers (PBDEs) and 23 polychlorinated biphenyls (PCBs) in serum of domestic canines and whether this was predictive of thyroid hormone status.

SAMPLES

Serum samples were collected from 51 client-owned dogs visiting the University of California Davis William R. Pritchard Veterinary Medical Teaching Hospital during 2012 to 2016 for routine appointments. Fifteen dogs were diagnosed with hypothyroxinemia while 36 were euthyroid.

PROCEDURES

Concentrations of PBDEs and PCBs in canine serum samples were measured by gas chromatography mass spectrometry. Logistic regression analysis was used to determine the association between the presence/absence of canine hypothyroxinemia and the serum concentration of individual PBDE or PCB congeners.

RESULTS

The median concentrations of total PBDE and PCB congeners in the hypothyroxinemic group were 660 and 1,371 ng/g lipid, respectively, which were higher than concentrations detected in the control group. However, logistic regression analysis determined that current concentrations of PBDEs and PCBs in canines were not significantly associated with hypothyroxinemia. BDE 183 was the only congener showing near significance (p = 0.068).

CONCLUSIONS

PBDE and PCB congeners were detected in all canine samples confirming ongoing exposure to these pollutants. Because household dogs share the human environment, they may serve as biosentinels of human exposure to these contaminants.

Abstract PD6-03: High prevalence and clonal heterogeneity of ESR1 mutations (mt) in circulating tumor DNA (ctDNA) from patients (pts) enrolled in FERGI, a randomized phase II study testing pictilisib (GDC-0941) in combination with fulvestrant (F) in pts that failed a prior aromatase inhibitor (AI)

Background: Mutations in the ligand binding domain of the estrogen receptor gene (ESR1) have been associated with resistance to AI therapy in pts with ER+ breast cancer. To assess if ESR1 status has prognostic or predictive significance in the post-AI metastatic setting ESR1 mutation status was analyzed in circulating tumor DNA (ctDNA) from 168 pts enrolled on the FERGI study (NCT01437566; Krop et al., SABCS 2014).

Methods: Baseline and longitudinal mutational analysis for hotspot mutations in ESR1 (E380Q, S463P, V534E, P535H, L536R/H/P, L536Q, Y537N/S/C, D538G) and PIK3CA (C420R, E542K, E545K/G, Q546K, M1043I, H1047Y/R/L) was performed using droplet digital PCR (ddPCR) on ctDNA derived from plasma. Archival tissue was analyzed via RT-PCR and ddPCR.

Results: Baseline ctDNA analysis demonstrated a total of 62/156 (40%) and 57/153 (37%) pts with PIK3CA and ESR1 mutations, respectively. The most common ESR1 mutations are D538G, Y537S, and E380Q, representing 54%, 33% and 26% of the pts with a detectable ESR1 mutation at baseline, respectively. There was a numeric increase of ESR1 mutations in patients with LumA (41/99, 41%) vs LumB disease (14/44, 31%). PIK3CA mutations in asynchronously collected archival tissue were 85% concordant with plasma ctDNA mutations (sensitivity 78%, specificity 91%). PIK3CA mutations in baseline ctDNA showed a higher median allele frequency (AF) than ESR1 mutations (3.6% vs 0.46%), consistent with PIK3CA being an early event and ESR1 mutations occurring later in pts with recurrent disease. Of the pts with a detectable ESR1 mutation at baseline (n=57), 23 (40%) pts had multiple ESR1 mutations and 10 (18%) had ≥3 ESR1 mutations. The PFS outcomes for patients with and without ESR1 mutations detected at baseline are summarized below, indicating no obvious prognostic or predictive effect for combination of F with pictilisib compared with F in these underpowered subsets.

ArmESR1 MT - mPFS (mo)ESR1 WT - mPFS (mo)HR (95% CI)F + placebo5.4 (30 pts, 24 events)3.7 (40 pts, 31 events)1.06 (0.62, 1.81)F+pictilisib5.8 (27 pts, 20 events)6.7 (56 pts, 34 events)1.36 (0.78, 2.38)

PIK3CA and ESR1 ctDNA analysis on serial plasma samples from 40 pts and the assessment of ESR1 mutation status in the patient's tumor sample by ddPCR is currently in progress and will be reported.

Conclusions: Mutations in ESR1 detected by ddPCR in patient plasma samples occur in nearly 40% of pts that failed a prior AI. The polyclonal nature of ESR1 mutations is consistent with the convergent evolution of multiple AI resistant subclones. While these conclusions should be interpreted with caution due to the relatively small sample size and post hoc nature of the analysis, this data does not support a prognostic or predictive PFS hypothesis for ESR1 mutations with F or in combination with pictilisib.

Citation Format: Spoerke J, Gendreau S, Johnston S, Schmid P, Krop I, Qui J, Derynck M, Chan I, Walter K, Amler L, Hampton G, Lackner M. High prevalence and clonal heterogeneity of ESR1 mutations (mt) in circulating tumor DNA (ctDNA) from patients (pts) enrolled in FERGI, a randomized phase II study testing pictilisib (GDC-0941) in combination with fulvestrant (F) in pts that failed a prior aromatase inhibitor (AI). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD6-03.

Identification of Endoglin as an epigenetically regulated tumour-suppressor gene in lung cancer

Background:

The transforming growth factor-beta (TGF- β) pathway has been implicated in proliferation, migration and invasion of various cancers. Endoglin is a TGF-β accessory receptor that modulates signalling. We identified Endoglin as an epigenetically silenced tumour-suppressor gene in lung cancer by means of a genome-wide screening approach, then sought to characterise its effect on lung cancer progression.

Methods:

Methylation microarray and RNA sequencing were carried out on lung cancer cell lines. Epigenetic silencing of Endoglin was confirmed by methylation and expression analyses. An expression vector and a 20-gene expression panel were used to evaluate Endoglin function. Pyrosequencing was carried out on two independent cohorts comprising 112 and 202 NSCLC cases, respectively, and the impact of Endoglin methylation on overall survival (OS) was evaluated.

Results:

Methylation in the promoter region resulted in silencing of Endoglin, which could be reactivated by demethylation. Increased invasion coupled with altered EMT marker expression was observed in cell lines with an epithelial-like, but not those with a mesenchymal-like, profile when Endoglin was absent. Methylation was associated with decreased OS in stage I but not in stages II–III disease.

Conclusions:

We show that Endoglin is a common target of epigenetic silencing in lung cancer. We reveal a link between Endoglin silencing and EMT progression that might be associated with decreased survival in stage I disease.

Laser Tandem Mass Spectrometry in a Time of Flight Instrument

We present a new laser tandem mass spectrometry technique in a reflectron time of flight (TOF) instrument. A first pulsed laser performs the multiphoton ionization and the primary photodissociation. A newly designed ion source permits a high mass resolution in the space focus of the 12 cm long first linear TOF, where then the secondary excitation can take place. For high resolution applications the pure secondary or pure metastable mass spectrum of a preselected precursor ion can be recorded using a new reflectron scanning technique. It is also possible to obtain the whole secondary mass spectrum with one cycle using a new postacceleration method. Several techniques for ejection of interfering ions are shown. The features of our techniques are demonstrated at various primary fragments of benzene.

Propionic acidemia: neonatal versus selective metabolic screening

BACKGROUND

Whereas propionic acidemia (PA) is a target disease of newborn screening (NBS) in many countries, it is not in others. Data on the benefit of NBS for PA are sparse.

STUDY DESIGN

Twenty PA patients diagnosed through NBS were compared to 35 patients diagnosed by selective metabolic screening (SMS) prompted by clinical findings, family history, or routine laboratory test results. Clinical and biochemical data of patients from 16 metabolic centers in Germany, Austria, and Switzerland were evaluated retrospectively. Additionally, assessment of the intelligent quotient (IQ) was performed. In a second step, the number of PA patients who have died within the past 20 years was estimated based on information provided by the participating metabolic centers.

RESULTS

Patients diagnosed through NBS had neither a milder clinical course regarding the number of metabolic crises nor a better neurological outcome. Among NBS patients, 63% were already symptomatic at the time of diagnosis, and <10% of all patients remained asymptomatic. Among all PA patients, 76% were found to be at least mildly mentally retarded, with an IQ <69. IQ was negatively correlated with the number of metabolic decompensations, but not simply with the patients' age. Physical development was also impaired in the majority of patients. Mortality rates tended to be lower in NBS patients compared with patients diagnosed by SMS.

CONCLUSION

Early diagnosis of PA through NBS seems to be associated with a lower mortality rate. However, no significant benefit could be shown for surviving patients with regard to their clinical course, including the number of metabolic crises, physical and neurocognitive development, and long-term complications.

Mutation analysis in 54 propionic acidemia patients

Deficiency of propionyl CoA carboxylase (PCC), a dodecamer of alpha and beta subunits, causes inherited propionic acidemia. We have studied, at the molecular level, PCC in 54 patients from 48 families comprised of 96 independent alleles. These patients of various ethnic backgrounds came from research centers and hospitals in Germany, Austria and Switzerland. The thorough clinical characterization of these patients was described in the accompanying paper (Grünert et al. 2012). In all 54 patients, many of whom originated from consanguineous families, the entire PCCB gene was examined by genomic DNA sequencing and in 39 individuals the PCCA gene was also studied. In three patients we found mutations in both PCC genes. In addition, in many patients RT-PCR analysis of lymphoblast RNA, lymphoblast enzyme assays, and expression of new mutations in E.coli were carried out. Eight new and eight previously detected mutations were identified in the PCCA gene while 15 new and 13 previously detected mutations were found in the PCCB gene. One missense mutation, p.V288I in the PCCB gene, when expressed in E.coli, yielded 134% of control activity and was consequently classified as a polymorphism in the coding region. Numerous new intronic polymorphisms in both PCC genes were identified. This study adds a considerable amount of new molecular data to the studies of this disease.

STATISTICAL INFORMATION CHARACTERIZATION OF CONSERVED NON-CODING ELEMENTS IN VERTEBRATES

Recently, a set of highly conserved non-coding elements (CNEs) has been derived from a comparison between the genomes of the puffer fish, Takifugu or Fugu rubripes, and man. In order to facilitate the identification of these conserved elements in silico, we characterize them by a number of statistical features.

We found a pronounced information pattern around CNE borders; although the CNEs themselves are AT rich and have high entropy (complexity), they are flanked by GC-rich regions of low entropy (complexity). We also identified the most abundant motifs within and around of CNEs, and identified those that group around their borders. Like in human promoter regions, the TBP, NF-Y and some other binding motifs are clustered around CNE boundaries, which may suggest a possible transcription regulatory function of CNEs.

Tumour epithelial vimentin expression and outcome of pancreatic ductal adenocarcinomas

PURPOSE

Tumour epithelial vimentin expression is a marker of mesenchymal differentiation and may be a useful marker of carcinomas with more aggressive behaviour. The aim of this study was to determine the extent and prognostic significance of vimentin expression in pancreatic ductal adenocarcinomas.

METHODS

Vimentin expression was detected by immunohistochemistry on tissue microarrays of surgically resected pancreatic ductal adenocarcinomas from 387 patients. The percentage of vimentin-immunolabelled neoplastic cells was correlated with outcome and with clinico-pathological factors using the Kaplan-Meier method and Cox multivariate survival models.

RESULTS

In all, 45% of primary pancreatic adenocarcinomas contained neoplastic cells that expressed vimentin, and in 27.5% of the cancers >10% of cells expressed vimentin. Vimentin expression was correlated with poor histological differentiation. By both uni- and multivariate survival analysis, neoplastic vimentin expression (P<0.01, HR 1.52, 95% confidence interval 1.14-2.04) was an indicator of a shorter postsurgical survival independent of other clinico-pathological variables.

CONCLUSION

The presence of vimentin-expressing tumour epithelial cells in surgically resected pancreatic adenocarcinomas independently predicted a shorter postsurgical survival.

Balloon valvuloplasty in the treatment of congenital aortic valve stenosis--a retrospective multicenter survey of more than 1000 patients

BACKGROUND

The value of balloon valvuloplasty of the aortic valve in childhood is still under debate.

OBJECTIVE

To evaluate the results of the procedure in a retrospective multicenter survey of a large cohort over a long time interval.

METHODS

Retrospective analysis of 1004 patients with balloon valvuloplasty of the aortic valve performed between 9/1985 and 10/2006 at 20 centers in Germany, Austria and Switzerland. Amongst others, the following parameters were evaluated before and after the procedure as well as at the end of follow-up or before surgery: clinical status, left ventricular function, transaortic pressure gradient, degree of aortic regurgitation, freedom from re-intervention or surgery.

PATIENTS

Patients from 1 day to 18 years of age with aortic valve stenosis were divided into four groups: 334 newborns (1-28 days); 249 infants (29-365 days); 211 children (1-10 years), and 210 adolescents (10-18 years).

RESULTS

Median follow-up was 32 months (0 days to 17.5 years). After dilatation the pressure gradient decreased from 65 (± 24)mm Hg to 26 (± 16)mm Hg and remained stable during follow-up. The newborns were the most affected patients. Approximately 60% of them had clinical symptoms and impaired left ventricular function before intervention. Complication rate was 15% in newborns, 11% in infants and 6% in older children. Independently of age, 50% of all patients were free from surgery 10 years after intervention.

CONCLUSIONS

In this retrospective multicenter study, balloon valvuloplasty of the aortic valve has effectively postponed the need for surgery in infants, children and adolescents up to 18 years of age.

Imaging findings in a 3-year-old girl with type III pleuropulmonary blastoma

Pleuropulmonary blastoma (PPB) is a rare dysembryonic intrathoracic neoplasm in children. It is a malignant tumour originating from the mesenchyme with a poor prognosis. We report on a 3-year-old girl who presented with respiratory symptoms and was diagnosed as having a type III PPB according to histological results attained by open biopsy. Imaging by CT and MRI revealed the exact size of the tumour involving the left lower lobe with displacement of the mediastinum and the diaphragm. Additional FDG-PET was important to evaluate tumour vitality and to decide the time of surgery, which was performed after 12 weeks of chemotherapy with the CWS2002P protocol. After R0 resection without complications and postoperative chemotherapy, the child continues to be in complete remission. This case underlines the importance of radical surgery of the aggressive neoplasm in combination with chemotherapy and the usefulness of multimodal imaging for the optimal planning of local therapy.

[Fabry disease: demographic data since introduction of enzyme replacement therapy]

BACKGROUND AND OBJECTIVE

Fabry's disease is a rare, X-chromosome linked recessive lysosomal storage disorder. In its course multiple organ damage occurs, e.g. in skin, nerves, kidneys and heart. The disease not only markedly impairs the quality of life but also shortens life expectancy if untreated. As it is a rare and not widely known disease with considerable variability of its symptoms it is often not or only belatedly diagnosed. Since 2001, enzyme replacement has become available as an option in the causal treatment. It was the aim of this study to analyse the demography and clinical expression of the disease.

PATIENTS AND METHODS

Data were obtained from the Fabry Outcome Survey (FOS), a Europe-wide data bank for the documentation of the disease's clinical course, on 262 patients (130 males, 132 females; mean age 37.5 and 34 years, respectively on entry in the FOS) in Germany, Switzerland and Austria.

RESULTS

Typical symptoms - acroparesthesias, joint pain, hypohidrosis, fever and angiokeratoma - have their onset in childhood (mean age nine years). Symptoms start significantly earlier in males than females. The interval between onset of the first symptoms and establishment of the diagnosis is about 15 years. The severity of the clinical picture, as measured in the POS Mainz severity score index (MSSI), correlates significantly with the person's age (p = 0.0001). Main causes of morbidity and death in Fabry's disease are involvement of the kidneys or heart, the one or other occurring in 75% of patients. 171 patients (38 [65.3%]: 92 males, 79 females) are at present being continually treated with enzyme-replacement (ERT), agalsidase-a, i.e. 70.8% of all male and 59.8 of all female patients in the FOS.

CONCLUSIONS

It is of great importance for the prognosis and quality that Fabry's disease is diagnosed as early as possible and treated adequately before the onset of organ damage. If the listed symptoms by themselves remain unexplained, Fabry's disease should be considered in the differential diagnosis. National and international observational studies, such as the FOS, significantly contribute to gaining important clinical data on this heterogeneous disease.

Non-invasive assessment of tumor proliferation using triple quantum filtered 23/Na MRI: technical challenges and solutions

We address the development of triple-quantum-filtered sodium MRI as a non-invasive surrogate measure for cell proliferation in brain tumors. We demonstrate that through careful consideration of the theoretical description of the signal, triple-quantum-filtered sodium images of adequate signal-to-noise ratio (SNR) can be acquired in clinically acceptable imaging times.

[Combined extract of Sabal palm and nettle in the treatment of patients with lower urinary tract symptoms in double blind, placebo-controlled trial]

A multicenter, prospective clinical trial was performed to study efficacy and tolerance of a compound drug PRO 160/120 in the elderly men with lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH). A total of 257 patients were randomized into two groups. Group 1 of 129 patients received PRO 160/120; group 2 of 128 patients received placebo. In 2-week induction blind phase of placebo the patients received for 24 weeks 1 capsule of the drug or placebo twice a day in conditions of double blind study. The double blind phase was followed by an open control period for 24 weeks when all the patients received PRO 160/120. Treatment efficacy evaluation was based on I-PSS, quality of life index, urodynamic and ultrasonography evidence. PRO 160/120 was superior to placebo by attenuating LUTS assessed by I-PSS, improved obstructive and irritative symptoms, was effective in patients with moderate and severe symptoms. Tolerance of the plant extract was good.

[Organization and role of the German public health service]

The article describes the organization and role of the public health service in Germany. Health is not a federal but a state issue; sta-te health regulations are subject to state legislation. The role of the public health service may therefore differ among the federal sta-tes of Germany. In recent years there ha-ve been considerable changes in the main features of the role of the public health ser-vice. Prevention and health reporting have become top issues, as well as hygiene, control of epidemics, medical certificates, and physical and dental examinations for schoolchildren. The public health service has developed into an up-to-date and customer-focused organization. Using modern management methods and employing well-trained doctors and other highly skilled health professionals, the public health service will full-fill its role in working for the benefit of the citizens of Germany providing the necessary resources are available. The generational change in the public health service will be marked in the coming years, especially in the east of Germany. Many physicians will reach retirement age and need replacing. Physicians with postgraduate professional education in public health are rare; training in this area of expertise must be fostered.

Variants in Apaf-1 segregating with major depression promote apoptosome function

APAF1, encoding the protein apoptosis protease activating factor 1 (Apaf-1), has recently been established as a chromosome 12 gene conferring predisposition to major depression in humans. The molecular phenotypes of Apaf-1 variants were determined by in vitro reconstruction of the apoptosome complex in which Apaf-1 activates caspase 9 and thus initiates a cascade of proteolytic events leading to apoptotic destruction of the cell. Cellular phenotypes were measured using a yeast heterologous expression assay in which human Apaf-1 and other proteins necessary to constitute a functional apoptotic pathway were overexpressed. Apaf-1 variants encoded by APAF1 alleles that segregate with major depression in families linked to chromosome 12 shared a common gain-of-function phenotype in both assay systems. In contrast, other Apaf-1 variants showed neutral or loss-of-function phenotypes. The depression-associated alleles thus have a common phenotype that is distinct from that of non-associated variants. This result suggests an etiologic role for enhanced apoptosis in major depression.

Transparenz in der Pflege - Dekubituserfassung auf Landkreisebene als Instrument der Qualitätssicherung

The medical diagnosis of bedsores often applies to open wounds. These wounds are caused by constant pressure to the skin of seniors who cannot change their position in bed or wheelchair without help. In severe cases these wounds extend through all layers of the skin with involvement of muscle and underlying bone. These ulcers can be very painful, so the mobility and quality of life of seniors is thoroughly reduced. Treatment of ulcers costs annually millions of Euro in Germany alone. Primary prevention of bedsores has not yet been established neither in Germany nor in Europe. The first step to improve the situation in a scientific manner has been to set up a comparable database. In order to change that, the German community of Ostalbkreis (part of the German Federal state of Baden-Wurttemberg) developed a process of nursing quality assurance as a project of the local agenda 21, initiated and supported by the health office of the community. Annual networked and anonymous survey from 2001 to 2003, each lasting three months every year, proved that the rate of non stratified prevalence could be reduced. For example the rate of all day spent with bedsores within the community could be reduced from 1.96 % in 2001, to 1.74 % in 2002 and finally to 1.62 % in 2003. During the survey as an additional bonus cooperation of community-organized nursing was optimised and quality assurance in nursing became a pole position of the community. During the QM-process a software was developed to process the survey: it is internet-based, published in the nursing-guide of Ostalbkreis, easy to manage and to establish in any nursing institution or community.

Clinical significance of anti-multiple nuclear dots/Sp100 autoantibodies

BACKGROUND

Autoantibodies against discrete variable-sized dots observed in HEp2 cells by indirect immunofluorescence (IIF) test, called multiple nuclear dots (MND), have been closely associated with primary biliary cirrhosis (PBC). Some authors have argued that this antibody is also present in connective tissue diseases or liver diseases other than PBC as autoimmune chronic active hepatitis, particularly of the cholestatic type. We studied an unselected group of patients routinely tested for autoantibodies and positive for the MND pattern and tried to establish the correlation between the presence of this antibody and their diagnosis.

METHODS

A commercial ELISA test, using a recombinant 26 kD truncated sequence of the Sp100 protein, corresponding to an immunodominant molecular region, was used to assess the clinical correlation of these autoantibodies in 110 patients showing an anti-MND immunofluorescence pattern.

RESULTS

One-hundred-and-ten patients were MND positive by IIF. Of these, 100 were Sp100 positive by ELISA. In the Sp100 positive group, 34 had a diagnosis of PBC (30 definite and 4 suspected) while 15 patients had a non-PBC hepatopathy. Unexpectedly, 13 of the MND/Sp100 positive pattern corresponded to systemic lupus erythematosus (SLE) patients and 5 cases to collagen diseases. Another divergence with previous reports was that 34 of the positive patients showed very heterogeneous clinical pictures, different from hepatopathies or collagen diseases.

CONCLUSIONS

Anti-Sp100 antibodies can be found in many clinical conditions. Testing for MND/Sp100 positivity is useful for the diagnosis of PBC, but only when the right clinical context is present. Other diseases cannot be excluded in first line SLE.

Complement component C7 deficiency in a Spanish family

Different genetic mutations have been described in complement component C7 deficiency, a molecular defect which is clinically associated with an increased susceptibility to neisserial recurrent infections, although some cases remain asymptomatic. In this work we report the genetic bases of C7 deficiency in one Spanish family. Exon-specific PCR and sequencing revealed a novel point mutation at nucleotide 615 (exon 6) leading to a stop codon (UGG to UGA) in the patient, his mother, and sister. This transversion causes the premature truncation of the C7 protein (W183X). Additionally, we detected a missense mutation at position 1135 (exon 9) located in the first nucleotide of the codon GGG (CGG), resulting in an amino acid change (G357R) in the patient, his father, as well as in his sister. This latter mutation had been previously described in individuals from Moroccan Sephardic Jewish ancestry. Since both heterozygous mutations were found in the patient as well as in his asymptomatic sister, we analyse other meningococcal defence mechanisms such as polymorphisms of the opsonin receptors on polymorphonuclear cells. Results showed that the patient and his sister bore identical combinations of FcgammaRIIA-H/R131 and FcgammaRIIIB-NA1/2 allotypes. Our results provide further evidence that the molecular pathogenesis of C7 deficiency as well as susceptibility to meningococcal disease are heterogeneous, since different families carry different molecular defects, although many of the C7 defects appear to be homogeneous in individuals from certain geographical areas. The missense mutation G357R would make an interesting topic of analysis with regard to meningococcal disease susceptibility in the Spanish population.