Complex/cryptic EWSR1::FLI1/ERG Gene Fusions and 1q Jumping Translocation in Pediatric Ewing Sarcomas

Ewing sarcomas (ES) are rare small round cell sarcomas often affecting children and characterized by gene fusions involving one member of the FET family of genes (usually EWSR1) and a member of the ETS family of transcription factors (usually FLI1 or ERG). The detection of EWSR1 rearrangements has important diagnostic value. Here, we conducted a retrospective review of 218 consecutive pediatric ES at diagnosis and found eight patients having data from chromosome analysis, FISH/microarray, and gene-fusion assay. Three of these eight ES had novel complex/cryptic EWSR1 rearrangements/fusions by chromosome analysis. One case had a t(9;11;22)(q22;q24;q12) three-way translocation involving EWSR1::FLI1 fusion and 1q jumping translocation. Two cases had cryptic EWSR1 rearrangements/fusions, including one case with a cryptic t(4;11;22)(q35;q24;q12) three-way translocation involving EWSR1::FLI1 fusion, and the other had a cryptic EWSR1::ERG rearrangement/fusion on an abnormal chromosome 22. All patients in this study had various aneuploidies with a gain of chromosome 8 (75%), the most common, followed by a gain of chromosomes 20 (50%) and 4 (37.5%), respectively. Recognition of complex and/or cryptic EWSR1 gene rearrangements/fusions and other chromosome abnormalities (such as jumping translocation and aneuploidies) using a combination of various genetic methods is important for accurate diagnosis, prognosis, and treatment outcomes of pediatric ES.

HER2 amplification by next-generation sequencing to identify HER2-positive invasive breast cancer with negative HER2 immunohistochemistry

Background

Human epidermal growth factor receptor 2 (HER2) positive breast carcinomas due to HER2 amplification are associated with aggressive behavior and a poor prognosis. Anti-HER2-targeted therapies are widely used to treat HER2-positive breast carcinomas with excellent outcomes. Accurate identification of HER2 amplification status in breast carcinomas is of important diagnostic and treatment value. Currently, HER2 amplification status is routinely determined by immunohistochemistry (IHC) and/or fluorescence in situ hybridization (FISH) testing. This study will review our past HER2 data to determine and characterize discordant results between HER2 IHC and FISH. It will also determine a potential impact of HER2 amplification status by next-generation sequencing (NGS) on these patients.

Methods

We reviewed a total of 4884 breast carcinomas with coexisting HER2 IHC and HER2 FISH performed at our institution from 2010 to 2022. 57 cases also had a Next-Generation-Sequencing-based (NGS) gene panel performed. Given the advances in biostatic analysis pipelines, NGS methods were utilized to provide results on HER2 amplification status along with somatic mutations.

Results

While the majority (ranging from 98.5% with IHC score of 0 and 93.1% with IHC score of 1 +) of 4884 breast carcinomas had concordant results from HER2 IHC and HER2 FISH testing, a small percentage of patients (ranging from 1.5% in those with IHC score of 0, to 6.9% with IHC score of 1 +) had discordant results, with negative HER2 IHC and positive HER2 FISH results. These patients could be reported as HER2-negative breast carcinomas if only HER2 IHC testing has been performed according to a current cost-effective HER2 test strategy. 57 patients had HER2 amplification status determined by NGS, and all patients had concordant results between HER2 NGS and FISH tests. A HER2-amplified breast carcinoma by NGS had a negative IHC and a positive HER2 FISH result. This case was classified as a HER2-positive breast carcinoma, had anti-HER2-targeted therapy, and achieved a complete clinical response.

Conclusions

A small percentage of HER2-positive breast carcinomas are unidentified because of a negative HER2 IHC based on our current cost-effective HER2 test strategy. It is not feasible and affordable in routine clinical practice to perform HER2 FISH for the cases with negative HER2 IHC (IHC score 0 and 1 +). Therefore, NGS assays capable of simultaneously detecting both somatic mutations and HER2 amplification could provide a more comprehensive genetic profiling for breast carcinomas in a clinical setting. Identification of HER2 amplification by NGS in HER2-positive breast carcinomas with negative HER2 IHC results is important since these cases are concealed by our current cost-effective HER2 test strategy with IHC first (for all cases) and FISH reflex (only for cases with IHC score of 2 +), and would offer the opportunity for potentially beneficial anti-HER2-targeted therapies for these patients.

Diagnostic Utility of Gene Fusion Panel to Detect Gene Fusions in Fresh and Formalin-Fixed, Paraffin-Embedded Cancer Specimens

Somatic gene fusions are common in leukemias/lymphomas and solid tumors. The detection of gene fusions is crucial for diagnosis. NanoString fusion technology is a multiplexed hybridization method that interrogates hundreds of gene fusions in a single reaction. This study's objective was to determine the performance characteristics and diagnostic utility of NanoString fusion assay in a clinical diagnostics laboratory. Validation using 100 positive specimens and 15 negative specimens by a combined reference standard of fluorescence in situ hybridization (FISH)/RT-PCR/next-generation sequencing (NGS) assays achieved 100% sensitivity in leukemias/lymphomas and 95.0% sensitivity and 100% specificity in solid tumors. Subsequently, 214 consecutive clinical cases, including 73 leukemia/lymphoma specimens and 141 formalin-fixed, paraffin-embedded solid tumor specimens, were analyzed by gene fusion panels across 638 unique gene fusion transcripts. A variety of comparator tests, including FISH panels, conventional karyotyping, a DNA-based targeted NGS assay, and custom RT-PCR testing, were performed in parallel. The gene fusion assay detected 31 gene fusions, including 16 in leukemia/lymphoma specimens and 15 in solid tumor specimens. The overall sensitivity, specificity, and accuracy of gene fusions detected by the gene fusion panel in all 329 specimens (validation and consecutive clinical specimens) tested in this study were 94.8%, 100%, and 97.9%, respectively, compared with FISH/RT-PCR/NGS assays. The gene fusion panel is a reliable approach that maximizes molecular detection of fusions among both fresh and formalin-fixed, paraffin-embedded cancer specimens.

Clinical Utility of Targeted Next-Generation Sequencing Assay to Detect Copy Number Variants Associated with Myelodysplastic Syndrome in Myeloid Malignancies

Copy number variants (CNVs) and gene mutations are important for diagnosis and treatment of myeloid malignancies. In a routine clinical setting, somatic gene mutations are detected by targeted next-generation sequencing (NGS) assay, but CNVs are commonly detected by conventional chromosome analysis and fluorescence in situ hybridization (FISH). The aim of this proof-of-principle study was to investigate the feasibility of using targeted NGS to simultaneously detect both somatic mutations and CNVs. Herein, we sequenced 406 consecutive patients with myeloid malignancies by targeted NGS and performed a head-to-head comparison with the results from a myelodysplastic syndrome (MDS) FISH and conventional chromosome analysis to detect CNVs. Among 91 patients with abnormal MDS FISH results, the targeted NGS revealed all 120 CNVs detected by MDS FISH (including -5/5q-, -7/7q-, +8, and 20q-) and 193 extra CNVs detected by conventional chromosome analysis. The targeted NGS achieved 100% concordance with the MDS FISH. The lower limit of detection of MDS CNVs by the targeted NGS was generally 5% variant allele fraction for DNA, based on the lowest percentages of abnormal cells detected by MDS FISH in this study. This proof-of-principle study demonstrated that the targeted NGS assay can simultaneously detect both MDS CNVs and somatic mutations, which can provide a more comprehensive genetic profiling for patients with myeloid malignancies using a single assay in a clinical setting.

[Clinical study about anatomical and functional reconstruction for frontolateral vertical partial laryngectomy with ultrathin titanium mesh and fascia flap from the strap muscles]

Objective:To investigate the effect of laryngeal reconstruction in functional and anatomical aspect with ultrathin titanium mesh and myofascial flap in patients underwent frontolateral vertical partial laryngectomy with T2 and T3 glottic laryngeal carcinoma. Method:Ten patients with T2 and T3 glottic laryngeal carcinoma underwent frontolateral vertical partial laryngectomy in different range. The ultrathin titanium mesh was shaped up according to the form of thyroid cartilage in operation while the thyroid perichondrium membrane combined with straped myofascial flap was lined under the titanium mesh to restore the laryngeal cavity space. The pronunciation, swallowing capability and extubation rate were observed after surgery. Result:Nine patients underwent extubation within 2 to 4 weeks after surgery, one patients remove metal tube in two-stage after laryngeal dilation surgery with the Montgomery tube. Swallowing and voice function in these patients recovered well and no deglutition disorder was found. CT scan showed that the Titanium meshs were fixed well without displacement and deformity. Electronic laryngoscopy showed that the mucosa of laryngeal lumen was smooth without laryngeal stenosis, keloid contraction, tissue necrosis or titanium mesh exposure. Conclusion:In the cases of T2, T3 glottic laryngeal cancer patients, laryngeal framework reconstruction with the new type of ultrathin titanium mesh, thyroid cartilage membrane and pedicled fascia plap of strap muscles is a good choice after the vertical frontolateral partial laryngectomy. Even some elective T4 cases with the former part invasion in supra-glottic or infra-glottic region can receive this operation. It can reconstruct the physiological and anatomical structure of the larynx, restore laryngeal function with a sound decanulization rate.

[The anatomic characteristics and surgical treatment of congenital pyriform sinus fistula]

Objective:To discuss the clinical anatomic characteristics of congenital pyriform sinus fistula and summarize the experiences of open neck surgery. Method：The clinical data of 12 patients with congenital pyriform sinus fistula were retrospectively analyzed.Result:During the operation, all lesions were located below of superior laryngeal nerve. All fistulas were closely related with the supperior part of thyroid gland and laterally passed over the left recurrent laryngeal nerve just before merging into the apex of piriform sinus or beginning of aesophagus. Follow-up periods were ranging between 8 to 65 months. Two months after surgery,one patient showed lateral neck abscess again. After open drainage procedures and antibiotics treatment, there was no recurrence signs during 3 years of follow-up.Conclusion:We found that the congenital pyriform sinus fistula was closely related to the superior thyroid gland and recurrent laryngeal nerve,which was different from the popular theory.We had not encountered types descending into mediastinum and thoracic cavity or ascending along common carotid artery sheath. All fistulas passed over the left recurrent laryngeal nerve，and then merged into the apex of pyriform sinus or beginning of aesophagus.The key point for successful resection of fistulas in block was to remove the superior involvement part of the thyroid gland and exposure the recurrent laryngeal nerve. Based on our practical findings, the neck dissection procedure should not be taken in some patients that the anatomical structure is not clear for repeated infections.

[Primary malignant tumor of uvula: report of 3 cases and review of the literature]

We retrospectively analyzed 3 middle-aged male patients of primary malignant tumor of uvula. There was a long history of smoking and drinking for the patients. All of them came to the hospital with the syptoms of pharyngeal foreign body sensation and two of them had pharyngeal sore. The patients appeared well, new neoplasm at the apex of the uvula. Diameter of 2 cases were less than 1 cm without invading the midline of the soft palate. Another patient's diameter was more than 1 cm with invading the midline of the soft palate. Preoperative pathology diagnosis of 3 patients was squamous cell carcinoma of uvula. The pharyngeal CT of the patient with invading the midline of the soft palate showed nodules at the end of the soft palate, obviously enhancement and small lymph node in left neck.

[Primary ectopic meningioma of the middle ear:a case report]

Extracranial meningioma involving the middleear is extremely uncommon.We report a case of a primary ectopic meningioma of themiddle earand clinically presenting as tinnitus with hearing loss.This case report highlights important considerations and pitfalls in the diagnosisand treatment methods of this tumour.

Characterization of the microanatomy and histopathology of placentas from aborted, stillborn, and normally delivered alpacas (Vicugna pacos) and llamas (Lama glama)

From 2002 to 2007, 101 camelid abortions and stillbirths were submitted to the Veterinary Diagnostic Laboratory at Oregon State University (84 alpacas [Vicugna pacos], 13 llamas [Lama glama], 4 unknown). For most cases (n = 67), a cause was not determined by routine testing. Eighty-five submissions included placenta for microscopic examination, of which 55 were from abortions to unknown causes (idiopathic). Microscopic features of placentas from abortion/stillbirth were compared with those from 19 camelids delivered normally (6 alpacas, 12 llamas, 1 unknown) and with those from 4 alpaca fetuses of known gestational age collected during the dam's necropsy. The most common microscopic findings in abortion/stillbirth placentas were mineralization (n = 57) and mucinous edema (n = 27) of the chorioallantoic stroma. One or more of these features were also observed in 22 of 23 placentas from normal pregnancies/deliveries and therefore interpreted as incidental findings. The comparison of alpaca placentas after matching for gestational parameters (crown-rump length, weight, days of gestation; n = 41) revealed hypoplasia of placental villi in 5 of 22 idiopathic abortions and in 1 abortion due to umbilical torsion; hypoplasia was further suspected in an additional 6 abortions of unknown cause and 2 abortions of known cause. The identified villous hypoplasia is assumed to have resulted in placental insufficiency. When placental insufficiency is included as cause, idiopathic abortions are reduced from 66.2 to 47.9% of alpaca cases with histopathologic examination of placenta and from 66.3 to 52.5% of alpaca and llama abortions overall. This study also permitted the generation of a linear regression curve correlating alpaca fetal crown-rump length with fetal age.

A thermodynamically-based model for predicting microbial growth and community composition coupled to system geochemistry: Application to uranium bioreduction

'Bioimmobilization' of redox-sensitive heavy metals and radionuclides is being investigated as a way to remediate contaminated groundwater and sediments. In one approach, growth-limiting substrates are added to the subsurface to stimulate the activity of targeted groups of indigenous microorganisms and create conditions favorable for the microbially-mediated reductive precipitation ('bioreduction') of targeted contaminants. We present a theoretical framework for modeling this process that modifies conventional geochemical reaction path modeling to include thermodynamic descriptions for microbial growth and may be called biogeochemical reaction path modeling. In this approach, the actual microbial community is represented by a synthetic microbial community consisting of a collection of microbial groups; each with a unique growth equation that couples a specific pair of energy yielding redox reactions. The growth equations and their computed standard-state free energy yields are appended to the thermodynamic database used in conventional geochemical reaction path modeling, providing a direct coupling between chemical species participating in both microbial growth and geochemical reactions. To compute the biogeochemical reaction paths, growth substrates are reacted incrementally with the defined geochemical environment and the coupled equations are solved simultaneously to predict reaction paths that display changing microbial biomass, community composition (i.e. the fraction of total biomass in each microbial group), and the aqueous and mineral composition of the system, including aqueous speciation and oxidation state of the targeted contaminants. The approach, with growth equations derived from the literature using well-known bioenergetics principles, was used to predict the results of a laboratory microcosm experiment and an in situ field experiment that investigated the bioreduction of uranium. Predicted effects of ethanol or acetate addition on uranium concentration and speciation, major ion geochemistry, mineralogy, microbial biomass and community composition were in qualitative agreement with experimental observations although the available data precluded rigorous model testing. While originally developed for use in better understanding of bioimmobilization of heavy metals and radionuclides, the modeling approach is potentially useful for exploring the coupling of microbial growth and geochemical reactions in a variety of other basic and applied biotechnology research settings.

Utility of routine PET/CT and MRI staging in patients with sentinel lymph node positive melanoma

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Background: The utility of routine radiographic staging in sentinel lymph node (SLN) positive stage III melanoma is unclear. Although body computed tomography (CT) has proven unlikely to identify occult metastasis at the time of diagnosis, there is some suggestion that whole body positron emission tomography combined with computed tomography (PET/CT) may be more sensitive in the detection of clinically unsuspected metastatic melanoma. We evaluated the ability of routine PET/CT and brain MRI to detect occult metastatic disease at the time of diagnosis in patients with SLN positive stage III melanoma. Methods: All clinically node- negative patients with cutaneous melanoma and a positive SLN who completed staging with PET/CT from 2003 through 2008 were identified from a prospective, IRB-approved, single-institution database. Data were analyzed to determine the positive (PPV) and negative (NPV) predictive values of PET/CT in detecting occult metastatic disease. Results: 72 patients had a positive SLN and were staged with PET/CT and 61 with brain MRI. There were 41 men and 31 women. Median age was 55 years. Median Breslow depth was 2.50 mm. 5 patients were T1, 25 T2, 22 T3, and 20 T4. 46 % were ulcerated. MRI was negative in all 61 patients. PET/CT was interpreted as suspicious for metastasis in 8 patients (11%) and negative in 64 (92%). 6 (8%) of the suspicious PET/CT scans were subsequently proven to be negative for malignancy and 1 (1.4%) proven to be an incidental thyroid cancer. Only 1 patient (1.4%) was found to have metastatic melanoma, an in transit metastasis that was previously unrecognized. PPV was 13% and NPV 100% for PET/CT. No patients were found to have occult distant metastases by either brain MRI or PET/CT. Conclusions: Patients with SLN positive stage III melanoma are unlikely to have occult metastatic disease detected by PET/CT or brain MRI and should not have further therapy delayed to obtain imaging. These findings are consistent with prior reports of body CT alone and question the utility of routine staging with current imaging modalities in patients with SLN positive melanoma. Future research should be directed toward improved imaging techniques in order to detect early micrometastatic melanoma.

No significant financial relationships to disclose.

Signaling by mechanical strain involves transcriptional regulation of proinflammatory genes in human periodontal ligament cells in vitro

Intracellular signals generated by mechanical strain profoundly affect the metabolic function of osteoblast-like periodontal ligament (PDL) cells, which reside between the tooth and alveolar bone. In response to applied mechanical forces, PDL cells synthesize bone-resorptive cytokines to induce bone resorption at sites exposed to compressive forces and deposit bone at sites exposed to tensile forces in an environment primed for catabolic processes. The intracellular mechanisms that regulate this bone remodeling remain unclear. Here, in an in vitro model system, we show that tensile strain is a critical determinant of PDL-cell metabolic functions. Equibiaxial tensile strain (TENS), when applied at low magnitudes, acts as a potent antagonist of interleukin (IL)-1beta actions and suppresses transcriptional regulation of multiple proinflammatory genes. This is evidenced by the fact that TENS at low magnitude: (i) inhibits recombinant human (rh)IL-1beta-dependent induction of cyclooxygenase-2 (COX-2) mRNA expression and production of prostaglandin estradiol (PGE2); (ii) inhibits rhIL-1beta-dependent induction matrix metalloproteinase-1 (MMP-1) and MMP-3 synthesis by suppressing their mRNA expression; (iii) abrogates rhIL-1beta-induced suppression of tissue inhibitor of metalloprotease-II (TIMP-II) expression; and (iv) reverses IL-1beta-dependent suppression of osteocalcin and alkaline phosphatase synthesis. Nevertheless, these actions of TENS were observed only in the presence of IL-1beta, as TENS alone failed to affect any of the aforementioned responses. The present findings are the first to show that intracellular signals generated by low-magnitude mechanical strain interfere with one or more critical step(s) in the signal transduction cascade of rhIL-1beta upstream of mRNA expression, while concurrently promoting the expression of osteogenic proteins in PDL cells.

Tumor necrosis factor alpha-dependent proinflammatory gene induction is inhibited by cyclic tensile strain in articular chondrocytes in vitro

OBJECTIVE

To understand the intracellular mechanisms of the action of mechanical strain on articular chondrocytes during inflammation.

METHODS

One of the major mediators responsible for cartilage destruction in inflamed articular joints is tumor necrosis factor alpha (TNFalpha). Therefore, in this study we examined the intracellular mechanisms of actions of cyclic tensile strain (CTS) on the recombinant human TNFalpha (rHuTNFalpha)-induced proinflammatory pathways in primary cultures of chondrocytes. The expression of messenger RNA (mRNA) for TNFalpha-dependent proinflammatory proteins was examined by semiquantitative reverse transcriptase-polymerase chain reaction. The synthesis of proinflammatory proteins was examined by Western blot analysis in cell extracts, followed by semiquantitative measurement of bands using densitometric analysis. Nitric oxide production was measured by Griess reaction, and prostaglandin E2 production was assessed by radioimmunoassays. The proteoglycan synthesis in chondrocytes was assessed by incorporation of Na2(35)SO4 in chondroitin sulfate proteoglycans.

RESULTS

By exposing chondrocytes to CTS in the presence of TNFalpha in vitro, we showed that CTS is an effective antagonist of TNFalpha actions and acts as both an antiinflammatory signal and a reparative signal. CTS of low magnitude suppresses TNFalpha-induced mRNA expression of multiple proinflammatory proteins involved in catabolic responses, such as inducible nitric oxide synthase, cyclooxygenase 2, and collagenase. CTS also counteracts cartilage degradation by augmenting induction of tissue inhibitor of metalloproteinase 2. Additionally, CTS augments the reparative process via abrogation of TNFalpha-induced suppression of proteoglycan synthesis. Nonetheless, CTS acts on chondrocytes in a TNFalpha-dependent manner, since exposure of chondrocytes to CTS alone had no effect on these parameters.

CONCLUSION

CTS of low magnitude acts as an effective antagonist of TNFalpha not only by inhibiting the TNFalpha-dependent induction of proinflammatory proteins upstream of mRNA transcription, but also by augmenting the proteoglycan synthesis that is inhibited by TNFalpha.

Low magnitude of tensile strain inhibits IL-1beta-dependent induction of pro-inflammatory cytokines and induces synthesis of IL-10 in human periodontal ligament cells in vitro

Applied mechanical loading induces inflammation in the periodontal ligament (PDL). However, the mechanisms involved in bone deposition at tension sites in an inflammatory environment are not clear. Here, in an in vitro model system, we show that equibiaxial tensile strain of low magnitude (TENS) provokes potent anti-inflammatory signals in PDL cells. TENS inhibits IL-1beta-induced synthesis of IL-1beta, IL-6, and IL-8 by inhibiting their mRNA expression, and thus significantly suppresses the amplification of IL-1beta-induced inflammatory responses in PDL cells. Additionally, as an anti-inflammatory signal, TENS induces IL-10 synthesis in the presence and absence of IL-1beta. These observations are the first to demonstrate that TENS antagonizes IL-1beta actions on PDL cells by (i) inhibiting IL-1beta-induced transcriptional regulation of proinflammatory cytokines, and (ii) inducing synthesis of IL-10, which may post-transcriptionally suppress the synthesis of pro-inflammatory cytokines.

Cyclic tensile strain suppresses catabolic effects of interleukin-1beta in fibrochondrocytes from the temporomandibular joint

OBJECTIVE

To discern the effects of continuous passive motion on inflamed temporomandibular joints (TMJ).

METHODS

The effects of continuous passive motion on TMJ were simulated by exposing primary cultures of rabbit TMJ fibrochondrocyte monolayers to cyclic tensile strain (CTS) in the presence of recombinant human interleukin-1beta (rHuIL-1beta) in vitro. The messenger RNA (mRNA) induction of rHuIL-1beta response elements was examined by semiquantitative reverse transcriptase-polymerase chain reaction. The synthesis of nitric oxide was examined by Griess reaction, and the synthesis of prostaglandin E2 (PGE2) was examined by radioimmunoassay. The synthesis of proteins was examined by Western blot analysis of the cell extracts, and synthesis of proteoglycans via incorporation of 35S-sodium sulfate in the culture medium.

RESULTS

Exposure of TMJ fibrochondrocytes to rHuIL-1beta resulted in the induction of inducible nitric oxide synthase (iNOS) and cyclooxygenase 2 (COX-2), which were paralleled by NO and PGE2 production. Additionally, IL-1beta induced significant levels of collagenase (matrix metalloproteinase 1 [MMP-1]) within 4 hours, and this was sustained over a period of 48 hours. Concomitant application of CTS abrogated the catabolic effects of IL-1beta on TMJ chondrocytes by inhibiting iNOS, COX-2, and MMP-1 mRNA production and NO, PGE2, and MMP-1 synthesis. CTS also counteracted cartilage degradation by augmenting expression of mRNA for tissue inhibitor of metalloproteinases 2 that is inhibited by rHuIL-1beta. In parallel, CTS also counteracted rHuIL-1beta-induced suppression of proteoglycan synthesis. Nevertheless, the presence of an inflammatory signal was a prerequisite for the observed CTS actions, because fibrochondrocytes, when exposed to CTS alone, did not exhibit any of the effects described above.

CONCLUSION

CTS acts as an effective antagonist of rHuIL-1beta by potentially diminishing its catabolic actions on TMJ fibrochondrocytes. Furthermore, CTS actions appear to involve disruption/regulation of signal transduction cascade of rHuIL-1beta upstream of mRNA transcription.

Oesophageal transit, disintegration and gastric emptying of a film-coated risedronate placebo tablet in gastro-oesophageal reflux disease and normal control subjects

BACKGROUND

Risedronate sodium is a pyridinyl bisphosphonate, proven effective for the treatment and prevention of postmenopausal osteoporosis and glucocorticoid-induced osteoporosis and Paget's disease of the bone.

AIM

To compare the oesophageal transit, disintegration and gastric emptying of the commercial film-coated risedronate tablet in subjects with gastro-oesophageal reflux disease (GERD) and normal control subjects.

METHODS

A total of 30 subjects, 15 patients with GERD and 15 age- and sex-matched, normal control subjects, participated in a single-centre, open-label, comparative gamma scintigraphy study. The GERD subjects had active erosive oesophagitis within 4 weeks prior to dosing.

RESULTS

The mean oesophageal transit (GERD, 4.4 s; controls, 3.1 s), mean disintegration (GERD, 21.8 min; controls, 19.2 min) and mean gastric emptying (GERD, 15.9 min; controls, 15.0 min) were similar in the two subject groups. The oesophageal transit is rapid and given the rapid disintegration and gastric emptying, oesophageal contact occurring via reflux of risedronate was unlikely since most, if not all, of the dosage form exited from the stomach within 30 min.

CONCLUSIONS

The oval shape and film-coating on the commercial risedronate tablet promotes rapid oesophageal transit and minimizes oesophageal contact, even in the high-risk GERD population.

Genomic alterations in distal bile duct carcinoma by comparative genomic hybridization and karyotype analysis

We report genomic abnormalities identified in 14 human primary common bile duct carcinomas analyzed by cytogenetics or comparative genomic hybridization, or both. Combining the results of the two methods of analysis, 11 chromosomal arms were observed to be gained in whole or in part, and 9 chromosomal arms were lost in whole or in part in at least four tumors each. The most frequently lost chromosomal regions were, in decreasing order: 18q (eight tumors); 6q and 10p (seven tumors each); 8p, 12q, and 17p (six tumors each); and 7q, 12p, and 22q (four tumors each). The most frequently gained regions were 8q and 20q (six tumors each); 12p, 17q, and Xp (five tumors each); and 2q, 6p, 7p, 11q, 13q, and 19q (four tumors each). These results are similar to those we have previously reported in pancreatic cancer and suggest that carcinomas of the common bile duct and pancreas share a number of genetic changes.

Is the free androgen index a useful clinical marker in male patients?

The clinical relevance of the free androgen index (FAI), a ratio of total testosterone (T) to sex-hormone binding globulin (SHBG), was investigated in a regional population of men (n = 40) and women (n = 30). The FAI correlated well with free testosterone (T) in both men (r = 0.551, p < 0.001) and women (r = 0.454, p < 0.01). However, there was considerable variability among individual patients. Moreover, the FAI showed no association with sperm parameters in male patients, although total T and free T showed weak associations. The FAI may be a cost-effective alternative to free T measurement in the diagnosis of oligomenorrhea and hirsutism in women as previously shown, but may have little relevance in men.

Transjugular core liver biopsy with a 19-gauge spring-loaded cutting needle

One hundred and five sequential transjugular core liver biopsies (TJLBx) were performed in 101 patients with coagulopathy and/or ascites using the 19-gauge Quick-Core Biopsy (QCB) needle. Two-hundred and seventy-three cores were obtained in 295 passes (92. 5%). One-hundred and two of the 105 procedures (97.1%) led to a histopathologic diagnosis. One of the three nondiagnostic biopsies was done because of severe autolysis of the liver. There was one subcapsular hematoma, one hepatic arteriovenous fistula, and one liver capsular puncture. Two minor neck hematomas occurred. One death was reported (unrelated to the procedure). QCB needle TJLBx is an effective and relatively safe way to obtain core liver samples.

Cost-effective mass fabrication of multilevel diffractive optical elements by use of a single optical exposure with a gray-scale mask on high-energy beam-sensitive glass

We present a method for reproducing diffractive optical elements in quantity. The method is compatible with VLSI microfabrication techniques and involves generating a gray-scale mask. The gray-scale mask is employed in an optical aligner to expose an analog photoresist on any environmentally durable substrate, e.g., glass, quartz, semiconductor, or metal, one exposure for each diffractive optical element. After copies of the mask on the photoresist are developed, many substrates can be processed in parallel in a chemically assisted ion-beam etcher to transfer the microstructures on the analog resists simultaneously onto the surfaces of the substrates.

Plasmapheresis combined with somatostatin is a successful treatment of porphyrias

During acute attacks of hepatic porphyria, levels of polypeptides, vasoactive intestinal peptides, neurotensin, substance P, pancreatic polypeptide, gastrin releasing polypeptide, gastrin, and motilin increased in the circulation while the clinical symptoms were evident. However, somatostatin decrease was not detected. Somatostatin belongs to a group of regulatory peptides that antagonize the action of endogenous steroid hormones, and decreasing their bioavailability decreases the rate of synthesis of delta-aminolevulinate synthase, alpha-aminolevunilic acid (ALA), and polypeptides. Plasma exchange was conducted in courses for 2 consecutive days every 28 days (total of 6 courses), removing more than 100% of the patient plasma each time. Between the 2 courses of plasmapheresis, subcutaneous injections of somatostatin (100-500 mcg) were administered. A lasting disappearance of pain and complete remission were obtained in all 7 patients treated. Plasmapheresis combined with somatostatin may be considered as a treatment of porphyria exacerbation.

Delinquency during the transition to early adulthood: family and parenting predictors from early adolescence

This longitudinal study examines the prediction of delinquency in early adulthood by family variables and one type of maternal parenting skill during early adolescence. In 132 Caucasian families, family variables (marital status, interparental conflict, mother-adolescent relationship, and maternal depressive mood) and maternal communication/problem-solving skills were assessed through self-report measures and behavioral observations during subjects' early adolescence. Outcome measures (minor and severe delinquency, arrests/convictions) were assessed six years later during early adulthood. Regression analyses revealed relationships between the predictors and severe delinquency and arrests/convictions, but not minor delinquency. The interaction of low levels of maternal communication/problem-solving skills and negative family variables (i.e., high maternal depressive mood) was associated with higher rates of delinquency, whereas the interaction of higher levels of such maternal skills and positive family variables was associated with lower rates of delinquency.

Interaction between tacrolimus and erythromycin

A 40-year-old Asian man, 6 months post renal transplant and receiving tacrolimus therapy, presented to the emergency department with a complaint of sudden-onset left eye pain with blurred vision, headache on the left side, and nausea and vomiting. On being admitted, the patient was intubated for respiratory depression, and erythromycin was initiated for suspected atypical pneumonia. Tacrolimus concentrations (whole blood) drawn on the 3rd day of hospitalization were reported to be > 60.0 ng/ml. Before hospitalization, tacrolimus concentrations were reported to be 9.8 ng/ml on a maintenance dose of 7 mg twice daily. Six days after discontinuation of erythromycin and a decrease in tacrolimus dose, the concentration decreased to 11.5 ng/ml and the original dose of tacrolimus was restarted. It is recommended that concurrent administration of erythromycin and tacrolimus be avoided. However, if concomitant therapy is necessary, tacrolimus concentrations, serum creatinine, blood urea nitrogen, and urine output should be monitored.

Polypeptide levels increase during acute onset of hepatic porphyrias

Hepatic porphyrias are characterized by neurological symptoms manifested by abdominal pain, neuropathies and mental aberrations. Porphyrins are ubiquitous and essential biochemical constituents of living beings acting as mediators of oxidation reaction in the metabolism of the steroid, drugs, environmental chemicals or as a mean of exchanging gases, such as oxygen and carbon dioxide between the environment and the tissue of the body using endogenous polypeptide properties. The different porphyrins arising from the arrangement of normal heme synthesis are characterized by an accumulation and excretion of specific intermediate porphyrins and/or of precursors exerting toxic effect, initiating cascades of generations of polypeptides, neurotransmitters and gut-brain axis peptide responsible for the symptoms of clinical status. We studied polypeptide levels in 27 patients (19 females, 8 males) presenting acute attack of hepatic porphyria: 2 with ALA dehydratase-deficient porphyria; 9 with acute intermittent porphyria; 12 with porphyria cutanea tarda and 4 with variegate porphyria. During acute attacks of porphyria, polypeptides were found to be constantly increased: vasoactive intestinal polypeptide (VIP); neurotensin (NT); substance P; pancreatic polypeptide; gastrin-releasing peptide; gastrin and motilin. Administration of the somatostatin (antagonizing polypeptide), which was undetectable or low before treatment, apparently alleviated the acute symptomatology. Elevated levels of polypeptides, at least partly, contribute to appearance of acute symptoms in porphyria patients.

Conditioned taste aversions and latent inhibition in Egyptian spiny mice and Long-Evans rats

The acquisition and extinction of a conditioned taste aversion in Egyptian spiny mice and Long-Evans rats was compared during 20 posttest sessions using a cross-over design and double-blind control procedures. Spiny mice preexposed to a sucrose CS demonstrated more latent inhibition and a faster rate of extinction than did Long-Evans rats preexposed to the same CS. Preference indices did not differ between control animals or as a function of gender. The present results are the first report of the effects of latent inhibition on learning taste aversion in Egyptian spiny mice.

Signal-detection analysis of the Müller-Lyer and the Horizontal-Vertical illusions

Perceptual error in the Müller-Lyer and the Horizontal-Vertical illusions was quantified using nonparametric signal-detection measures of sensitivity and response bias. Sensitivity scores were positively related to signal strength with the greatest values observed for the strongest signals. Sensitivity at each signal strength did not differ between the two illusions. Response-bias scores were inversely related to signal strength, with the most conservative biases observed for the strongest signals. Response biases for each signal strength were significantly more conservative for the Horizontal-Vertical than for the Müller-Lyer illusion.

Cytogenetic and FISH analysis of endometrial carcinoma

Endometrial cancer is a common gynecologic tumor, yet reports of cytogenetic studies are few. We studied chromosomes from seven primary specimens of endometrial cancer. Six had abnormal chromosomes; five had a diploid-hyperdiploid modal number and one was triploid. One specimen had a normal karyotype. Chromosome 1 was frequently involved in abnormalities (five tumors) with i(1q) in two tumors, and one tumor each had der(7)t(1;7)(q12;p11) and +add (1)(p13). One additional tumor had trisomy 1 in the single cell which could be fully analyzed. Trisomy 7 was noted in two tumors, and trisomy 10 in one. Because trisomies of these chromosomes have been reported in other cases of endometrial cancer, we used fluorescent in situ hybridization (FISH) with centromere probes to determine the prevalence of trisomies 7 and 10 in these specimens. No additional tumors were found to have trisomies 7 or 10 by FISH. Our data, in combination with published literature, suggest that additional copies of 1q or portions of 1q constitute the primary change in this tumor. Extra copies of genes in this region may play an important role in tumorigenesis in endometrial carcinoma.

Does parent training with young noncompliant children have long-term effects?

The current study was a long-term follow-up (approx. 14 yr following treatment) of 26 late adolescents/young adults (17 yr and older) who had participated in parent training with their mothers when they were young (2-7 yr old) noncompliant children. Parent training, consisting of teaching mothers to use attends and rewards for appropriate behavior, clear commands and time-out, had reduced deviant behavior and increased compliance immediately following treatment. At this follow-up, these individuals were compared to a matched community sample on various measures of delinquency, emotional adjustment, academic progress and relationship with parents. No differences emerged between the two groups on any of the measures, suggesting that noncompliant children who participated in parent training during their early years are functioning as well as nonclinic individuals as they move into adulthood.

Bar-code technology applied to drug-use evaluation

Bar-code technology was used to determine: (1) patterns in histamine H2-receptor antagonist use and (2) the occurrence of adverse drug effects and drug interactions associated with the use of these agents in critically ill patients. Patients at Henry Ford Hospital (Detroit) receiving histamine H2-receptor antagonists over a two-month period were evaluated. Clinical information was collected in the intensive care units by using a bar-code system. The data-capture menu was based on drug-use-evaluation criteria for H2-receptor antagonists. Data collected in the scanning wands were uploaded into a computer database and were analyzed at the end of the study. Data were collected for 207 patients. Cimetidine was the predominant H2-receptor antagonist used, and the predominant indication was stress-ulcer prophylaxis. Dosing trends followed accepted guidelines for cimetidine dosage adjustment in renal and hepatic failure. Two drug interactions and six adverse drug reactions occurred. Pharmacists made 92 recommendations to the medical staff regarding modification in therapy, involving 32% of the patients. Data collection required an average of 10 minutes per day each for three pharmacists. H2-receptor antagonist use patterns were evaluated in intensive care units through the application of bar-code technology. The speed and efficiency of this automated tool facilitated collection of a large amount of data.

Cytogenetic analysis of intestinal polyps in polyposis syndromes: comparison with sporadic colorectal adenomas

Few cytogenetic studies of polyps from patients with polyposis syndromes have been reported. We studied 27 colonic adenomatous polyps from familial adenomatous polyposis (FAP), two polyps of the small bowel from Peutz-Jeghers syndrome (PJS), and four colorectal juvenile polyps from juvenile polyposis syndrome (JPS). The karyotypic results were compared with 32 sporadic colorectal adenomatous polyps. Nineteen colorectal adenomas had abnormal karyotypes; of these, five were from patients with FAP and 14 were sporadic adenomas. Numerical changes were the most frequent change (14 adenomas); additional copies of chromosome 7 (eight adenomas) and 13 (seven adenomas) occurred most often and were present in both FAP and sporadic adenomas. Only five adenomas, all sporadic, had structural chromosome abnormalities. Normal karyotypes were obtained from 32 adenomas, and chromosome counts but not karyotypes were obtained from eight polyps owing to poor chromosome morphology. The JPS and PJS polyps had normal karyotypes. These data indicate that adenomas from patients with FAP tend to have fewer structural abnormalities than sporadic adenomas and that numerical abnormalities are the most common chromosome abnormality in both FAP and sporadic polyps and suggest that the mechanism which causes loss of heterozygosity (LOH) in the adenoma to carcinoma sequence operates on a level below that of the whole chromosome.

Cutaneous infection caused by Mycobacterium malmoense in a patient with myelodysplastic syndrome

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Paralysie faciale périphérique et infection par le VIH. A propos de 2 observations

Two cases of peripheral facial paralysis in subjects with HIV infection are reported. On the basis of these two cases and data from the literature, the clinical and paraclinical features of this facial nerve lesion are described. The various aetiological hypotheses put forward are discussed, but it is probable that the paralysis results from a direct effect of the virus on the nerve. HIV-associated peripheral facial paralysis may occur irrespective of the number of CD4 lymphocytes and does not seem to have a prognostic significance. However, it appears by preference in stages I, II and III and may then reveal the HIV infection.

Alcohol education as primary prevention in health care

The purpose of this survey research was to identify practicing nurses' knowledge about the biophysiological and psychosocial components of alcohol and its pharmacological effects. Additionally, data were gathered with the intent of assisting nurses in the early identification of and intervention with individuals at risk for the disease of alcoholism. The study consisted of a convenience sample of 298 practicing nurses employed by community hospitals that had been identified as having no specific treatment program for chemical dependency. The investigation obtained self-reported information by means of a questionnaire. The instrument elicited both demographics and the answers to 25 fixed alternative questions designed to obtain information in nine topic areas. Findings indicated that 66% of the nurses incorrectly answered questions aimed at correlating population statistics to the disease of alcoholism and its physiological effects. Questions about knowledge of the pharmacological properties of alcohol were answered incorrectly by 93% of the participants. One-way analysis of variance was computed to compare the total score for each of the variables listed. Conclusions document a critical need for increased alcohol education in basic nursing programs. Content related to the pharmacological properties, the disease concept and the biophysiological and psychosocial effects of alcohol should be included in curriculum design.

[Effects of methylflavonolamine hydrochloride on contractility of isolated rabbit ileum]

Methylflavonolamine hydrochloride (MFA), verapamil (Ver), and trifluoperazine (Tri) inhibited the contractions induced by submaximal concentrations of acetylcholine (ACh) and serotonin (5-HT). IC50 values (mumol.L-1) were 33.2 +/- 0.7, 0.276 +/- 0.018, 3.83 +/- 0.23, and 15.31 +/- 0.10, 0.233 +/- 0.017, 2.33 +/- 0.20, respectively. MFA, Ver, and Tri inhibited the contractions induced by CaCl2 and pD'2 values were 4.3 +/- 0.3, 6.23 +/- 0.22, 4.99 +/- 0.24, respectively. MFA 3 mumol.L-1, Ver 0.03 mumol.L-1, and Tri 3 mumol.L-1 inhibited the contractions induced by ACh in Ca(2+)-free medium, while MFA 60 mumol.L-1, Tri 30 mumol.L-1, but not Ver 0.6 mumol.L-1, had pronounced inhibitions on extracellular calcium-dependent contractions induced by ACh. These results suggest that MFA has a calcium antagonistic effect and that MFA is similar to Tri, but not Ver, in mechanism.