110 DEVELOPMENT AND DELIVERY OF A MULTI-DISCIPLINARY HYBRID EDUCATION PROGRAM IN SYNCOPE AND RELATED DISORDERS DURING THE COVID-19 PANDEMIC

Background

Syncope and related disorders is an important area for training of all health professionals. During the COVID-19 pandemic, we adapted the delivery of our annual face-to-face certified program to a 9-month hybrid program. Here, we describe the development, delivery, and evaluation of such new program.

Methods

A pre-existing curriculum was modified to incorporate online content, online lecture delivery and interactive group learning, in addition to individual practical placements in a syncope management unit, in line with government and hospital infection control guidance at the time. Monthly content included video consultant case presentations, ECG analysis and interpretation, and instructional videos of diagnostic testing and relevant technologies. A comprehensive online week-long lecture program was developed.

Results

The lecture week included 30 clinical lectures, 10 clinical case presentations and 10 ‘how to’ practical videos for testing/monitoring procedures. Further learning over zoom incorporated learner case presentations in a small group format. At the completion of the course the leaners attended a final online half day of lectures and completed the multi choice question examination.

Conclusion

“Thank you so much for putting together such a fantastic week of training.” “The quality and expertise of the speakers was outstanding.” “I have taken a huge amount away to incorporate into my practice and local unit.”

The above learner feedback is consistent with our aim to deliver a high-quality specialist program for those interested in advancing the management of syncope and related disorders. Over time, this specialist training will aid the development of regional syncope management units across Ireland. The benefits of a hybrid learning model include multiple options to cater for all categories of learners, thus suggesting it is the cornerstone of future learning modalities.

Developing a new Governance Approval Process to support federated discovery and meta-analysis of data across the UK through the CO-CONNECT project

Objectives To develop a new approval process for federated data custodians to install and support a new platform which enables researchers to run from one website, instantaneous, aggregate-level queries to determine the number of patients in each dataset which meet their research criteria. To agree security controls across data custodians which protect patient confidentiality whilst also providing this new automated capability for researchers and reducing the burden on each data custodian to manually provide the information. ApproachThe COVID - Curated and Open aNalysis aNd rEsearCh plaTform (CO-CONNECT) has integrated a Cohort Discovery Tool into the Health Data Research (HDR) UK Innovation Gateway website and is connecting >50 different federated datasets. The underpinning architecture is novel, without precedent at such a scale in the UK. We found that although each data custodian recognised the benefits of the platform, many were unclear of the process to formally approve this new model. We have worked across data custodians to co-develop the required new processes and document the security controls. ResultsWe found vast differences in technical knowledge and infrastructures across different data custodians, especially across small research groups hosting data on consented research cohorts verses larger organisations who host and manage routinely collected data. A model for approvals evolved for these 2 separate groups: Consented research cohorts: a 2-stage process of a pre-assessment for the need for a DPIA and/or completed DPIA. All returned a positive outcome which deemed no personal identifiable information was being used. Unconsented population level data: 4 different documents were required each being approved by different committees within each data custodian: DPIA, Data Access Application, Security Risk Assessment, Disclosure Control Assessment. As the model was novel to many data custodians, we developed many different explainer videos and detailed step by step instructions. ConclusionWe recommend a new approvals process for new technologies/models is developed to support initiatives which are not covered by the traditional data access request process. Increased investment in teams which approve data governance and IT security applications which have been overwhelmed by the increased demand for their services to review COVID-19 related projects would be welcomed.

Abstract P4-15-01: Integrin avb6 is a therapeutic target for high-risk breast cancer and enhances trastuzumab efficacy

The integrin avβ6 promotes migration, invasion and survival of cancer cells, but the biological relevance has yet to be ascertained in breast cancer. Our immunhistochemical analysis of over 2000 breast cancers has revealed that high expression of the protein for the integrin subunit beta6 (β6) is associated with very poor survival (HR = 1.99, P = 2.9×10-6) and increased metastases to distant sites (P = 0·02). This correlation was confirmed at the mRNA level via bioinformatic analysis of the 2000 women in the METABRIC cohort. Furthermore, co-expression of HER2 gave a significantly worse prognosis (HR = 3.43, P = 4×10-12), which we investigated further.

We report from in vitro studies that HER2-driven invasion is mediated by αvβ6 in an Akt2-dependent manner. Using the well-tolerated αvβ6-blocking antibody 264RAD in vivo we show that antibody-blockade of this integrin suppressed growth of BT-474 and MCF-7/HER2-18 human breast cancer xenografts similarly to trastuzumab alone (P<0.001), the antibody used for treating HER2-positive cancers (both 10mg/kg, bi-weekly). Moreover, when 264RAD was co-administered it significantly enhanced the ability of trastuzumab to suppress BT-474 tumor growth with a reduction in mean tumor volume of 94.8%+/-1.18% compared to 70.8%+/-5.98% observed with trastuzumab alone (P<0.0001) after 2 weeks treatment. This trend was reproduced even in the MCF-7/HER2-18 trastuzumab-resistant breast cancer tumors where a 76.24%+/-10.15% reduction was observed with combination therapy (P<0.0001) compared with only 44.62%+/-10.43% (P = 0.0006) and 46.6%+/-14.71% (P = 0.0004) reductions in final volume with 264RAD and trastuzumab respectively. The combination therapy was so effective it almost eradicated 100mm3 BT-474 tumors and completely eliminated small (10-20mm3) MCF-7/HER2-18 tumors.

264RAD or trastuzumab prolonged survival to a similar degree (14.3% and 33.33% treated mice alive after 100d, respectively, no significant difference) but again, when both drugs were combined 85.7% of mice were alive after 100d, a highly significant response compared with PBS (P<0.0001) or monotherapies (264RAD: P<0.0001, trastuzumab: P<0.0001). Post-therapy biochemistry revealed residual tumors expressed significantly reduced αvβ6, HER2, HER3 and downstream signaling molecules including Akt2 and Smad2, essentially a much lower ‘grade’ tumour.

Since 70% of women treated with trastuzumab either have, or develop resistance, we suggest combined targeting of αvβ6 and HER2 could provide an important novel therapy for thousands of women with breast cancer. In fact, over 39,000 American women annually (NIH statistics) will develop HER2+ breast cancers for which no specific therapies exist. Our data shows that in excess of 40% of these women with trastuzumab-resistant disease are also likely to express high levels of αvβ6.

Our data also suggest that routine determination of the level of expression of αvβ6 on breast cancers would be a valuable clinical tool as it identifies novel high-risk groups of women that require enhanced therapeutic intervention.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-15-01.

Abstract P4-19-02: Early experience of patient donation and researcher use of tissues donated to a national breast cancer tissue bank

The need for a specialist breast cancer biobank was recognised through a Gap Analysis conducted by the UK charity, Breast Cancer Campaign (Thompson AM et al., Breast Cancer Res 2008: 10(2); R26). As a result The Breast Cancer Campaign Tissue Bank (www.breastcancertissuebank.org) was launched in 2010 as a coalition of 4 centres of excellence for breast cancer research in the UK. Breast cancer patients presenting to these centres are offered the opportunity to donate surplus tissue and bloods to The Breast Cancer Campaign Tissue Bank. Researchers can apply for these samples by completing a simple on line application form. Here we describe our early experience of patient donation to The Breast Cancer Campaign Tissue Bank and outline the sample requests received from researchers to date. Most of the first year of operation (2010) was spent developing SOPs and ensuring collection protocols were robust, with some limited prospective collection. The collection was pump-primed from existing resources. By 2011 all sites were operational and working to the same standards. Over a 2 year period (Jan 2011 - Dec 2012), over 90% of suitable patients (1803) consented to tissue donation. From these we derived 3951 frozen tissue aliquots, 1517 formalin-fixed paraffin-embedded cases and 2012 blood derivatives (serum, plasma and whole blood). Asian patients were less likely to consent while younger patients tended not to donate blood, but were happy to donate tissue. All male patients consented to tissue and blood donation. At Dec 2012, the total numbers of sample aliquots derived from these donated tissue and blood samples was 22, 127. This includes frozen and formalin-fixed paraffin-embedded tissues, serum, plasma and whole blood. At present, application for tissue samples is restricted to the UK and Ireland but we aim to open to international applications in the near future. All applications are reviewed by an international Tissue Access Committee which includes appropriate clinical and scientific expertise plus representation by patient advocates. At 1st June 2013, seventeen applications had been received, of which 14 were approved. Three applications were rejected, made on the basis that the applicants were not making the best use of the donated material. Thus far, tissues have been dispatched to 9 researchers with 5 in preparation. These include 465 formalin-fixed paraffin-embedded cases and 158 frozen samples, all provided with a basic minimum dataset. Early experience of patient consent was encouraging with patients overall very enthusiastic and willing to donate to our biobanking programme. More research is needed to help understand the barriers in preventing ethnic minorities to donate and the reluctance in some young people to donate blood samples. Interest by the breast cancer research community in accessing samples is steadily rising as the resource becomes more widely known and increased website traffic is translating into applications for tissues. This has been an ambitious multidisciplinary endeavour but we are building a valuable resource to service the needs of the breast cancer research community with the goal of helping translate laboratory results into clinical benefit.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-02.

Pilot task-based assessment of noise levels among firefighters

PURPOSE

Over one million American firefighters are routinely exposed to various occupational hazards agents. While efforts have been made to identify and reduce some causes of injuries and illnesses among firefighters, relatively little has been done to evaluate and understand occupational noise exposures in this group. The purpose of this pilot study was to apply a task-based noise exposure assessment methodology to firefighting operations to evaluate potential noise exposure sources, and to use collected task-based noise levels to create noise exposure estimates for evaluation of risk of noise-induced hearing loss by comparison to the 8-hr and 24-hr recommended exposure limits (RELs) for noise of 85 and 80.3 dBA, respectively.

METHODS

Task-based noise exposures (n=100 measurements) were measured in three different fire departments (a rural department in Southeast Michigan and suburban and urban departments in Northern California). These levels were then combined with time-at-task information collected from firefighters to estimate 8-hr noise exposures for the rural and suburban fire departments (n=6 estimates for each department). Data from 24-hr dosimetry measurements and crude self-reported activity categories from the urban fire department (n=4 measurements) were used to create 24-hr exposure estimates to evaluate the bias associated with the task-based estimates.

RESULTS

Task-based noise levels were found to range from 82-109 dBA, with the highest levels resulting from use of saws and pneumatic chisels. Some short (e.g., 30 min) sequences of common tasks were found to result in nearly an entire allowable daily exposure. The majority of estimated 8-hr and 24-hr exposures exceeded the relevant recommended exposure limit. Predicted 24-hr exposures showed substantial imprecision in some cases, suggesting the need for increased task specificity.

CONCLUSIONS

The results indicate potential for overexposure to noise from a variety of firefighting tasks and equipment, and suggest a need for further exposure characterization and additional hearing loss prevention efforts.

RELEVANCE TO INDUSTRY

Firefighters may be at risk of noise-induced hearing loss, which can affect their fitness for duty and ability to respond effectively to emergencies. The results of this study suggest that additional efforts at hearing loss prevention among firefighters are warranted.

ERbeta1 represses basal breast cancer epithelial to mesenchymal transition by destabilizing EGFR

Introduction

Epithelial to mesenchymal transition (EMT) is associated with the basal-like breast cancer phenotypes. Sixty percent of basal-like cancers have been shown to express wild-type estrogen receptor beta (ERβ1). However, it is still unclear whether the ERβ expression is related to EMT, invasion and metastasis in breast cancer. In the present study, we examined whether ERβ1 through regulating EMT can influence invasion and metastasis in basal-like cancers.

Methods

Basal-like breast cancer cells (MDA-MB-231 and Hs578T), in which ERβ1 was either overexpressed or down-regulated were analyzed for their ability to migrate and invade (wound-healing assay, matrigel-coated Transwell assay) as well as for the expression of EMT markers and components of the EGFR pathway (immunoblotting, RT-PCR). Co-immunoprecipitation and ubiquitylation assays were employed to examine whether ERβ1 alters epidermal growth factor receptor (EGFR) protein degradation and the interaction between EGFR and the ubiquitin ligase c-Cbl. The metastatic potential of the ERβ1-expressing MDA-MB-231 cells was evaluated in vivo in a zebrafish xenotransplantation model and the correlation between ERβ1 and E-cadherin expression was examined in 208 clinical breast cancer specimens by immunohistochemistry.

Results

Here we show that ERβ1 inhibits EMT and invasion in basal-like breast cancer cells when they grow either in vitro or in vivo in zebrafish. The inhibition of EMT correlates with an ERβ1-mediated up-regulation of miR-200a/b/429 and the subsequent repression of ZEB1 and SIP1, which results in increased expression of E-cadherin. The positive correlation of ERβ1 and E-cadherin expression was additionally observed in breast tumor samples. Down-regulation of the basal marker EGFR through stabilization of the ubiquitin ligase c-Cbl complexes and subsequent ubiquitylation and degradation of the activated receptor is involved in the ERβ1-mediated repression of EMT and induction of EGFR signaling abolished the ability of ERβ1 to sustain the epithelial phenotype.

Conclusions

Taken together, the results of our study strengthen the association of ERβ1 with the regulation of EMT and propose the receptor as a potential crucial marker in predicting metastasis in breast cancer.

NT5E CpG island methylation is a favourable breast cancer biomarker

BACKGROUND

Relapse risk assessment and individual treatment recommendations remain suboptimal for breast cancer patients. In the light of existing preclinical and clinical data, we studied NT5E (5'-nucleotidase, ecto) expression and NT5E CpG island methylation in breast cancer.

METHODS

We used RT-PCR, qPCR, methylation-specific PCR and pyrosequencing to analyse NT5E in breast carcinoma cell lines and primary and breast carcinomas.

RESULTS

NT5E CpG island methylation was inversely associated with NT5E expression in breast carcinoma cell lines. In clinical series, patients whose primary tumours had NT5E CpG island methylation were less likely to develop metastasis (P=0.003, OR=0.34, 95% CI: 0.17-0.69). In 3/4 paired samples, NT5E was methylated in primary tumours and demethylated in CNS metastases. Patients progressing to non-visceral as compared with visceral metastases were more likely to have NT5E CpG island methylation in primary tumours (P=0.01, OR=11.8). Patients with tumours lacking detectable methylation had shorter disease-free survival (DFS) (P=0.001, HR=2.7) and overall survival (OS) (P=0.001, HR=3). The favourable prognostic value of NT5E methylation was confirmed in oestrogen receptor negative (P=0.011, HR=3.27, 95% CI: 1.31-8.12) and in triple negative cases (P=0.004; HR=6.2, 95% CI: 1.9-20). Moreover, we observed a more favourable outcome to adjuvant chemotherapy in patients whose tumours were positive for NT5E CpG island methylation: DFS (P=0.0016, HR=5.1, 95% CI: 1.8-14.37) and OS (P=0.0005, HR=7.4, 95% CI: 2.416-23.08).

CONCLUSION

NT5E CpG island methylation is a promising breast cancer biomarker.

P5-21-03: The Breast Cancer Campaign Tissue Bank

The breast cancer research community has recognised that access to a source of carefully collected well-annotated human breast tissue is essential for translational research. Research institutions often face barriers in gaining access to this resource as collections typically have restrictive access policies or an over burdensome application process. This was formally recognised by around 50 prominent breast cancer researchers through a Gap Analysis conducted in London, UK in 20061. As a direct result of this report, 4 leading UK centres (Barts Cancer Institute, the Universities of Dundee, Leeds and Nottingham) with multi disciplinary expertise in pathology, basic science, bioinformatics and computer science have collaborated with a leading breast cancer charity to form the Breast Cancer Campaign Tissue Bank (BCCTB; http://www.breastcancercampaigntissuebank.org). BCCTB is a unique resource of biological materials and supportive clinical data, efficiently and ethically collected from patients with breast cancer, to provide researchers with high quality, relevant materials, helping to raise the standard of breast cancer research and facilitating the co-ordinated translation of scientific findings into the clinical setting. A wide range of biological materials are banked, including fresh frozen tumour and surrounding tissue, isolated purified cell populations (which can be provided for culture or DNA/RNA/protein extraction), whole blood and serum samples, as well as formalin-fixed paraffin-embedded material. Specialised collections are also available through the Bank on a collaborative basis. BCCTB has a centralised IT system allowing efficient tracking of samples and recording of raw data from studies, and providing a user-friendly web-based search portal to view material available. A purpose-built Bioinformatics platform allows mining breast cancer literature data from multiple sources and integrating different types of -omics and clinical data alongside publically relevant annotations from a growing number of biological resources such as NCBI, Ensembl, UniProt and Reactome. This platform is also fully interoperable with the International Cancer Genome Consortium (ICGC) and can be automatically cross-queried from the ICGC data portal which allows direct cross-comparison of experimental findings generated from the ICGC breast cancer projects with literature-derived information stored in our portal. Together this results in the highly efficient and co-ordinated use of samples, reducing duplication of effort and facilitating data mining and analysis. As science is constantly evolving we have an inbuilt R&D program, including cell immortalisation, investigating improved sample storage and collection methods and on-going IT development, all of which will ensure the bank remains cutting-edge. Tissue is released following review by a Tissue Access Committee comprising clinical and non-clinical breast cancer researchers and patient advocates. Direct interaction with end users ensures the materials and data supplied meets the researcher needs. Currently BCCTB is accepting applications from UK based researchers with projects funded by Breast Cancer Campaign. It will launch to the wider breast cancer community in the next 18 months.

1Thompson A et al., Breast Cancer Research 2008, 10:R26.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-21-03.

P4-02-06: Progesterone Receptor Expression Predicts Poor Outcome in Estrogen Receptor Positive, Lymph Node Negative Breast Cancer – A Population Based Study

Background: Estrogen receptor (ER) positive, lymph node (LN) negative breast cancer usually carries a good prognosis; endocrine therapy is often the only adjuvant treatment. However, a small proportion of such patients do badly (possibly representing those with luminal B cancers identified by gene expression profiling). A clinically applicable method for identifying this subgroup of poor prognosis ER+, LN- patients is required to offer them more intensive adjuvant therapy.

Material and methods: A consecutive, unselected series of 1072 new, operable breast cancer patients diagnosed between 2000 and 2004 was studied for ER and progesterone receptor (PR) expression, HER2 status and standard pathological and demographic parameters. ER and PR expression were scored on immunohistochemistry (IHC) on preoperative, diagnostic core biopsies using the “Quickscore” method. This ensured optimal fixation and tissue processing avoiding the variable fixation of resection specimens and the well-described sampling error of tissue micro-array (TMA) methodologies. PR expression is frequently heterogeneous resulting in false negative scores in at least 12% of cases by TMA analysis. HER2 status was assessed using IHC with dual color FISH for cases scoring 2+. Adjuvant therapy was prescribed using standard protocols; all patients with ER+ disease received adjuvant endocrine therapy. Follow up data were obtained from the oncology database, and the registrar of deaths for the date and cause of death. All deaths not attributable to breast cancer were censored at the date of death. Accordingly, the primary end-point was breast cancer-specific overall survival. Survival analysis was carried out by Kaplan-Meier survival curves analysed by the Log-Rank test. Multivariate analysis was carried out using Cox's regression.

Results: Overall, PR- cancers had a worse prognosis than PR+ (p<10−12, Hazard Ratio 3.40), even in the ER+ (p=0.006, HR 1.86), LN- (p=10−8, HR=5.33) and LN+ (p=10−11, HR=3.26) sub-groups. In the ER+ LN- group, the absence of PR expression predicted worse prognosis (88% vs 96% 8 year survival, p=0.0003) with a hazard ratio of 3.75. This is considerably more significant than Ki67 IHC scoring reported for a similar group of patients in other studies (HR 2.22). Multivariate analysis demonstrated that PR expression was an independent prognostic variable second only to LN status and more powerful than ER.

Discussion: Patients with ER+, LN-, PR- breast cancers have a significantly worse prognosis than those with ER+, LN-, PR+ cancers. Unlike Ki67, PR IHC uses a simple, cost effective, standard methodology (as for ER) and should identify patients who may require chemotherapy in addition to endocrine therapy in this group of otherwise good prognosis patients.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-02-06.

Identifying women at increased risk of breast cancer: Can we use genotyping at low penetrance loci?

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Background: Most inherited predisposition to breast cancer is attributable to low penetrance susceptibility loci, a number of which have been identified through genome-wide association studies. Although individually each locus has a small effect, combining data from multiple loci would be expected to provide more risk information. We investigated the size of risk determination that can be achieved using genotyping at 18 loci. We then calculated its effect when combined with risk estimated from family history alone in terms of management under UK guidelines, where a woman who has a 10 year risk of 3% or greater requires additional breast screening from a younger age.

Methods: Genotyping for 18 loci was carried out in 253 women at increased risk of breast cancer due to a positive family history and 118 matched controls. The relative risks conferred by genotype at the 18 loci were combined under a log-additive model and transformed into a log-polygenic risk. The BOADICEA risk estimation tool was used to calculate breast cancer risk due to family history.

Results: Both the increased risk and control groups demonstrated a normal distribution of log-polygenic risk with similar variance. There was a significantly higher mean in the increased risk compared to the control group (mean = 0.1313 and 0.0874 respectively, p = 0.007). No significant correlation was found between polygenic risk calculated from genotype data and the family history risk estimated using BOADICEA. When polygenic risk was combined with family history risk there was significant reclassification of risk for those with a family history. 36.76% moved into a higher risk category while 3.68% moved into a lower risk category.

Conclusions: Our data suggests that genotyping will be clinically relevant for estimating breast cancer risk. Individuals with a family history overall have a higher genotype risk than the population. The lack of correlation of genotype risk with BOADICEA risk suggests that the two risk estimates can be considered independently. By combining genotype with family history data, we demonstrated a significant reclassification of risk for individuals with a family history, with better identification of women in this group requiring intervention.

A Pin1/mutant p53 axis promotes aggressiveness in breast cancer

TP53 missense mutations dramatically influence tumor progression, however, their mechanism of action is still poorly understood. Here we demonstrate the fundamental role of the prolyl isomerase Pin1 in mutant p53 oncogenic functions. Pin1 enhances tumorigenesis in a Li-Fraumeni mouse model and cooperates with mutant p53 in Ras-dependent transformation. In breast cancer cells, Pin1 promotes mutant p53 dependent inhibition of the antimetastatic factor p63 and induction of a mutant p53 transcriptional program to increase aggressiveness. Furthermore, we identified a transcriptional signature associated with poor prognosis in breast cancer and, in a cohort of patients, Pin1 overexpression influenced the prognostic value of p53 mutation. These results define a Pin1/mutant p53 axis that conveys oncogenic signals to promote aggressiveness in human cancers.

Medication errors: a baseline survey of dispensing errors reported in community pharmacies

Focal points

Medication errors: a baseline survey of interventions recorded during the dispensing process in community pharmacies

Focal points

Increased mortality in HER2 positive, oestrogen receptor positive invasive breast cancer: a population-based study

BACKGROUND

This study assessed the impact of human epidermal growth factor receptor 2 (HER2) status on the outcomes in an unselected population of breast cancer patients who did not receive HER2-targeted therapy.

METHODS

HER2 status by immunohistochemistry and fluorescence in situ hybridisation was compared with clinicopathological data, overall survival (OS) and disease-free survival (DFS) for all patients presenting with breast cancer over 3 years.

RESULTS

In 865 patients (median follow up 6.02 years), HER2 positivity was identified in 13.3% of all cancers and was associated with higher tumour grade (P<10(-8)), lymphovascular invasion (P<0.001) and axillary nodal metastasis (P=0.003). There was a negative association with oestrogen-receptor (ER) and progesterone-receptor expression (P<10(-8)), but the majority (57%) of HER2+tumours were ER+HER2 positivity was associated with poorer OS (P=0.0046) and DFS (P=0.0001) confined to the lymph node-positive (LN+) and ER+ subgroups.

CONCLUSION

HER2-positive cancers were less common in this population-based cohort than most selected series. The association of HER2 positivity with poor prognosis was confined to the ER+ and LN+ subgroups. The survival deficit for the 7.5% of patients with ER+/HER2+ cancer compared with ER+/HER2- patients points to a significant subgroup of women who may not (currently) be considered for HER2-directed therapy.

High CCND1 amplification identifies a group of poor prognosis women with estrogen receptor positive breast cancer

CCND1 encodes for the cyclin D1 protein involved in G1/S cell cycle transition. In breast cancer the mechanism of CCND1 amplification, relationship between cyclin D1 protein expression and the key clinical markers estrogen receptor (ER) and HER2 requires elucidation. Tissue microarrays of primary invasive breast cancer from 93 women were evaluated for CCND1 amplification by fluorescent in-situ hybridization and cyclin D1 protein overexpression by immunohistochemistry. CCND1 amplification was identified in 27/93 (30%) cancers and 59/93 (63%) cancers had overexpression of cyclin D1. CCND1 amplification was significantly associated with cyclin D1 protein overexpression (p < 0.001; Fisher's exact test) and both CCND1 amplification and cyclin D1 protein expression with oestrogen receptor (ER) expression (p = 0.003 and p < 0.001; Fishers exact test). Neither CCND1 amplification nor cyclinD1 expression was associated with tumor size, pathological node status or HER2 amplification, but high CCND1 amplification (Copy Number Gain (CNG) > or = 8) was associated with high tumor grade (p = 0.005; chi square 7.915, 2 df) and worse prognosis by Nottingham Prognostic Index (p = 0.001; 2 sample t-test). High CCND1 amplification (CNG > or = 8) may identify a subset of patients with poor prognosis ER-positive breast cancers who should be considered for additional therapy.

NF-kB Complex Activation and Association of αB-Crystallin and Vimentin with Poor Prognosis in Primary Breast Cancer

Background: Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) is a protein complex found in almost all animal cell types and is involved in cellular responses to stimuli such as stress, free radicals, cytokines et.c. NF-kB plays a key role in regulating the immune response and incorrect regulation of NF-kB has been linked to the development of cancer, several inflammatory and autoimmune diseases. The role of NF-kB, its subunits and pathways in breast cancer and in the surrounding stromal tissues remains uncertain. αB-crystallin is a heat shock protein, which function as stress-induced molecular chaperones to inhibit the aggregation of denatured proteins. Previous studies have identified αB-crystallin as a marker of poor prognosis for breast cancer and have suggested that it is an excellent marker for tumours of basal origin. The aim of this study is to examine, for the first time, NF-kB and αB-crystallin, vimentin and HSPs in the same set of breast cancers and stroma and relate this to clinical parameters including outcome.Methods: Tissue Micro Arrays of 0.6mm cores of 246 breast cancers were stained with antibodies to αB-crystallin, vimentin, HSP27 (antibody ERD5) and HSP27 82P and 12 subsequent antibodies for NF-kB (IKKa, Ser276, Ser32/36, 180/181, P52, 1kkygmma, P65, RELB, P100/P52, IkBa, cREL, and P50) and scored using the Quick Score Method.Results: Positive associations have been found between αB-crystallin and IKBA (P=0.001 Fishers exact test (FET)), RELB (P&lt;0.001 (FET)) and SER32/36 (P=0.03 (FET)) whereas Vimentin was positively associated IKBA (P=0.003 (FET)), IKKA (P=0.001 (FET)), P50 (P=0.002 (FET)), RELB (P&lt;0.001 (FET)) and SER32/36 (P=0.01 (FET)). Positive associations have also been found between HSP27 and P50 (P=0.002 (FET)), SER32/36 (P&lt;0.001 (FET)). Antibodies such as 180/181 (P=0.04 Kaplan Meier Log Rank (KM), cREL (P=0.03 (KM)), IKBA (P=0.03 (KM)) and IKKA (P=0.01 (KM)) was associated with good survival and P50 (P=0.002 (KM)) and P65 (P=0.01 (KM)) to poor survival. Expression of αB-crystallin was associated with vimentin (P&lt;0.001 (FET)). Its expression was linked to a low expression of the estrogen receptor. Vimentin expression was associated with estrogen receptor (ER) negative cancers and poor survival (P &lt;0.001 (FET)), P=0.002 (KM Log Rank) respectively). In contrast to αB-crystallin, low expression of HSP27 was associated with low ER and progesterone receptor (PGR).Conclusions: Associations were found between various antibodies within the NF-kB pathway as well as the heat shock proteins αB-crystallin, vimentin and HSP27 with varying implications for overall survival. We aim to clarify the mechanisms to prevent the aggregation of stress-accumulated misfolded proteins and apoptosis resulting better survival.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2143.

The clinical relevance of p53 isoforms modifying the effects of p53 mutation on survival from breast cancer

10505

Background: p53 is a key gene in the development of breast cancer and response to therapy. Nine splice variants of p53 in breast cancer have been identified, with full length p53, p53beta and p53gamma (both 46kD, C terminal truncated proteins) commonly expressed. This study examined the clinical relevance of splice variants in breast cancer. Methods: Tumors from 248 patients with primary breast cancer were examined for mutation with the Roche p53 mutation chip and p53 isoform expression detected by RT-PCR followed by nested PCR; full clinical and pathological data included median follow up of 6.4 years. Results: p53 mutation, identified in 65/248 (26%) cancers, was significantly associated by Chi square test with shorter survival (p=0.001), histological grade 3 (p<0.001) and estrogen receptor (ER) negative cancers (p<0.001), as expected. Expression of p53 beta or p53 gamma mRNA was associated with p53 mutation (p=0.002, Fisher's exact test). Intriguingly, the patient groups with a mutant p53 cancer but expressing p53 gamma or p53 beta or both isoforms had survival curves comparable to patients with cancer containing wild type p53. Similarly, p53 gamma or p53 beta was associated with ER negative cancers (Chi square; p<0.001), but the group of ER negative tumors expressing p53 gamma or p53 beta had improved survival similar to ER positive cancers. Patients with p53 mutant, p53 beta negative and ER negative cancers comprised half of those who died within 3 years of diagnosis. Conclusions: p53 beta or p53 gamma isoform expression in breast cancer is associated with better prognosis and may moderate disease behaviour even in mutant p53 and ER negative cancers. Manipulation of p53 isoforms in breast cancer may thus offer therapeutic potential.

No significant financial relationships to disclose.

Catatonia in autism: a distinct subtype?

Catatonia is a life-threatening disorder characterized by motor abnormalities, mutism, and disturbances of behaviour, which is increasingly being diagnosed in persons with autism. In this report, we describe the presentation and course of catatonia in an adolescent with autism who responded to electroconvulsive therapy (ECT). The illness started with depressive symptoms, but the predominant feature was one of extreme obsessive slowing and immobility. We propose that catatonia should be ruled out as a cause of regression sometimes seen in adolescents with autism, and that catatonia of autism may index a distinct subtype with a particularly poor outcome.

A naturalistic investigation of the effects of day-long consumption of tea, coffee and water on alertness, sleep onset and sleep quality

RATIONALE

The effects of caffeine, especially caffeinated coffee, on human performance have been extensively studied. However, few studies have been naturalistic representations of how tea/coffee is normally consumed in terms of dose and time of consumption.

OBJECTIVES

This study investigated the effects of day-long consumption of tea, coffee and water on cognitive and psychomotor performance, and sleep quality at night.

METHODS

Thirty healthy volunteers received equal volume drinks equivalent to either 1 or 2 cups of tea (containing 37.5 mg or 75 mg caffeine), or coffee (75 mg or 150 mg caffeine), or water, in a randomised five-way crossover design. Drinks were administered on four occasions during the day (0900, 1300, 1700 and 2300 hours). A psychometric battery consisting of critical flicker fusion (CFF), choice reaction time (CRT) and subjective sedation (LARS) tests, was administered pre-dose and at frequent time points post-dose. The Leeds Sleep Evaluation Questionnaire (LSEQ) was completed each morning and a wrist actigraph was worn for the duration of the study.

RESULTS

Caffeinated beverages maintained CFF threshold over the whole day (P<0.05), independent of caffeine dose or beverage type. During the acute phase of beverage ingestion, caffeine significantly sustained performance compared to water after the first beverage for CFF and subjective sedation (P<0.05), and after the second beverage for the Recognition component of the CRT task (P<0.05). Additionally, there were significant differences between tea and coffee at 75 mg caffeine after the first drink. Compared to coffee, tea produced a significant increase in CFF threshold between 30 and 90 min post-consumption (P<0.01). However, following the second beverage caffeinated coffee at 75 mg significantly improved reaction time (P<0.05), compared to tea at the same dose, for the Recognition component of the CRT task. Caffeinated beverages had a dose dependent negative effect on sleep onset (P<0.001), sleep time (P<0.001) and sleep quality (P<0.001).

CONCLUSIONS

These results indicate that ingestion of caffeinated beverages may maintain aspects of cognitive and psychomotor performance throughout the day and evening when caffeinated beverages are administered repeatedly. This study also demonstrates that day-long tea consumption produces similar alerting effects to coffee, despite lower caffeine levels, but is less likely to disrupt sleep. Other differences between tea and coffee were more subtle, and require further investigation.

Inferring sublexical correspondences from sight vocabulary: evidence from 6- and 7-year-olds

We report an experiment designed to investigate 6-to-7-year-old children's ability to acquire knowledge of sublexical correspondences between print and sound from their reading experience. A computer database containing the printed word vocabulary of children taking part in the experiment was compiled and used to devise stimuli controlled for grapheme-phoneme correspondence (GPC) frequency and rime neighbourhood consistency according to the children's reading experience. Knowledge of GPC rules and rime units was compared by asking children to read aloud three types of nonword varying in regularity of GPC and consistency of rime pronunciation. Results supported the view that children can acquire knowledge of both GPC rules and rime units from their reading experience. GPC rule strength affects the likelihood of a GPC response; rime consistency affects the likelihood of a rime response.

The use of an information system architecture modeling tool in the development of disease management systems

A Disease Management System (DMS) refers to an integrated healthcare delivery system that provides patient centered care throughout the course of the disease independent of delivery site. A fundamental barrier for the development, implementation and monitoring of a DMS is lack of an appreciation by care providers of the complexity of these systems, and what is required for their maintenance. Foremost in the development of these systems is the presence of information systems that attempt to deal with the temporal, spatial and information needs of the DMS.

PURPOSE

The Zachman Framework for Information Systems Architecture is used in many industries in the development of information systems. Its choice is based on the recognition of a need for a methodology in the conceptualization and modeling of complex information systems. This paper provides a brief overview of the Zachman Framework and its potential application in DMS development. In particular it will be the focus on the need for "perspective" clarification as the first step in the development of such complex systems.

RESULTS

This paper reviews DMS and their potential information needs. The clarification of "perspectives" provides a method toward team building and unification of purpose by decreasing conflict and recognizing the unique contributions that each perspective holder makes.

A multipurpose template for implant placement

A case report is presented describing the laboratory fabrication and clinical use of an innovative template. This template was designed to function as a radiographic implant positioning guide, accurate bone sounding guide, and surgical guide. This appliance is intended to serve additional roles as an aid in flap reflection and as a pick-up impression tray.

Human pulmonary responses to experimental inhalation of high concentration fine and ultrafine magnesium oxide particles

Exposure to air polluted with particles less than 2.5 micron in size is associated epidemiologically with adverse cardiopulmonary health consequences in humans. The goal of this study was to characterize human pulmonary responses to controlled experimental high-dose exposure to fine and ultrafine magnesium oxide particles. We quantified bronchoalveolar lavage (BAL) cell and cytokine concentrations, pulmonary function, and peripheral blood neutrophil concentrations in six healthy volunteers 18 to 20 hr after inhalation of fine and ultrafine magnesium oxide particles produced from a furnace system model. We compared postexposure studies with control studies from the same six subjects. Mean +/- standard deviation (SD) cumulative magnesium dose was 4,138 +/- 2,163 min x mg/m3. By weight, 28% of fume particles were ultrafine (<0.1 micron in diameter) and over 98% of fume particles were fine (<2.5 micron in diameter). There were no significant differences in BAL inflammatory cell concentrations, BAL interleukin (IL)-1, IL-6, IL-8, tumor necrosis factor, pulmonary function, or peripheral blood neutrophil concentrations postexposure compared with control. Our findings suggest that high-dose fine and ultrafine magnesium oxide particle exposure does not produce a measurable pulmonary inflammatory response. These findings are in marked contrast with the well-described pulmonary inflammatory response following zinc oxide particle inhalation. We conclude that fine and ultrafine particle inhalation does not result in toxicity in a generic manner independent of particle composition. Our findings support the concept that particle chemical composition, in addition to particle size, is an important determinant of respiratory effects.

Effects of hot tea, coffee and water ingestion on physiological responses and mood: the role of caffeine, water and beverage type

Psychopharmacological studies using caffeinated beverages or caffeine have rarely considered temporal effects on psychological and physiological function or the specific contribution of caffeine, hot water, or beverage type to the observed effects. The effect of 400 ml hot tea, coffee, and water consumption on systolic and diastolic blood pressure (SBP and DBP), heart rate, skin conductance (a measure of sympathetic nervous system activation), skin temperature, salivary cortisol, and mood were monitored in 16 healthy caffeine-withdrawn (14 h) subjects in a complete crossover design. Beverages were ingested with/without 100 mg caffeine and milk (tea/coffee only). Hot beverage ingestion rapidly increased skin conductance and temperature (+1.7 degrees C) with peak effects observed only 10-30 min post-consumption. Caffeine in the beverage rapidly augmented skin conductance responses but, in contrast to the effect of hot water, reduced the skin temperature response and increased SBP (+2.8 mmHg) and DBP (+2.1 mmHg) 30-60 min post-consumption. Both caffeine and milk addition to beverages independently improved mood and reduced anxiety 30 and 60 min post-consumption. Milk addition had no other effects apart from attenuating the transient increase in physiological responses associated with the drinking phase. There were no effects of beverage consumption on salivary cortisol or of beverage vehicle on salivary caffeine levels, the latter indicating that caffeine pharmacokinetics was similar in both tea and coffee, and not different from caffeinated water. In keeping with this, the responses to tea and coffee ingestion were similar and largely accounted for by the effects of hot water and caffeine. However, tea potentiated the increase in skin temperature compared to coffee and water indicative of a greater vasodilatory response plausibly related to the presence of flavonoids in tea. We conclude that ingestion of hot caffeinated beverages stimulates physiological processes faster than hitherto described, primarily via the effects of hot water and caffeine, but with beverage type and milk playing important modulatory roles.

Randomised controlled trial of a synthetic triglyceride milk formula for preterm infants

AIMS

To test whether use of infant formula containing synthetic structured triglycerides results in: (i) increased palmitate absorption; (ii) increased total fat absorption; (iii) reduction in calcium soap formation in the gut; and hence (iv) increased calcium absorption.

METHODS

A randomised study was made of 24 infants comparing three formulas, one containing the synthetic fat Betapol with 74% of palmitate in the 2-position, which was substantially higher than in the two comparison diets (8.4% and 28%). The hypothesised outcomes were tested using balance studies, detailed chemical analysis of stool specimens and dual calcium isotope tracers (44calcium orally and 46calcium intravenously).

RESULTS

Three of the four hypotheses were confirmed: use of a formula rich in 2-position palmitate (i) improved palmitate (16:0) and also (18:0) absorption; (ii) reduced the formation of insoluble calcium soaps in the stool; and (iii) improved calcium absorption, determined by the dual tracer technique from 42 (SE 3)% to 57 (7)%.

CONCLUSION

Synthetic triglycerides that mimic the stereoisometric structure of those in breast milk may have a valuable role in the design of formulas used for preterm infants in neonatal intensive care units.

The effect of triglyceride positional distribution on fatty acid absorption in rats

BACKGROUND

Human milk contains palmitic acid predominantly in the triglyceride sn-2 position, and differs from the palmitic acid positional distribution found in most infant formulas (predominantly positions sn-1 and sn-3). Following lipolysis by pancreatic lipase, 2-monoglycerides and free fatty acids are produced. All 2-monoglycerides are well absorbed, including 2-monopalmitin, thus providing one reason for the efficient absorption of palmitic acid in breast-fed infants. If infants are fed fat blends with palmitic acid located in the sn-1 and sn-3 positions, the resulting free fatty acids may form poorly absorbed calcium soaps. Therefore, many infant formulas contain only modest levels of palmitic acid.

METHODS

Fat absorption studies were conducted in rats with preparations containing various amounts of palmitic acid in the triglyceride sn-2 position. Determining total fat absorption, specific fatty acid absorption, and the presence of calcium-fatty acid soaps.

RESULTS

Betapol, a new triacylglycerol, similar to human milk in its palmitic acid content and positional distribution, demonstrated excellent absorption characteristics compared to fat blends derived from either palm olein or oleo (similar in fatty acid profile to Betapol, but with most palmitic acid in the sn-1 and sn-3 positions). A five-point dose response was used to further evaluate the relationship of positional distribution and fat loss. Palmitic acid excretion and fecal fatty acid soaps were negatively correlated to the presence of palmitic acid in the sn-2 position.

CONCLUSION

These studies provide evidence that palmitic acid can be efficiently absorbed, avoiding fatty soap formation of it is present in the sn-2 position.

Neurobehavioral effects of low-level methanol vapor exposure in healthy human volunteers

Methanol-powered vehicles are being introduced in the United States as a solution to air pollution. This study assessed whether acute exposure to methanol vapor at the current industrial threshold limit value of 200 ppm for 4 hr has adverse effects on human neurobehavioral performance. Twenty-six healthy subjects (15 men, 11 women; ages 26-51 years) were exposed to methanol or water vapor for 4 hr while seated in a chamber. The subjects served as their own controls in a randomized, double-blind study design. The variables assessed were serum and urine methanol and formate levels; visual performance (color discrimination and contrast sensitivity); and neurophysiological (auditory evoked potentials) and neurobehavioral performances. Exposure to methanol increased serum concentrations and urinary excretions of methanol, but did not affect formate levels. Overall visual, neurophysiological, and neurobehavioral test outcomes were not significantly affected, unless certain between-subject variables are considered. Slight effects on P-300 amplitude and Symbol Digit testing were noted. We conclude that acute exposure of healthy people to low concentrations of methanol had little effect on these measures of neurobehavioral performance.

Welding helmet airborne fume concentrations compared to personal breathing zone sampling

Metal fume concentrations inside the welding helmet and in the personal breathing zone in 23 experimental welding exposures were studied to explore whether welding helmet use substantially attenuates exposure to airborne metal fume. Observations produced a mean ratio of inside to outside metal fume concentrations of 0.9 +/- S.D. 0.2 with a highly variable effect. Iron fume concentration was inversely correlated with this ratio, representing greater helmet-associated attenuation with heavier exposure (r = -0.70, p < 0.001). In contrast to previous reports, these data suggest that welding helmet use provides marginal and highly variable reductions in fume exposure and cannot substitute for standard respiratory protection.

Respiratory effects of occupational exposure to aerosolized pentamidine

To determine the respiratory effects on health care workers of occupational exposure to aerosolized pentamidine (AP) used for the prophylaxis of Pneumocystis carinii pneumonia, we designed a clinical prospective study using subjects as their own controls. Sixteen health care workers whose job duties included administration of AP at one or more of nine San Francisco Bay Area medical centers participated in the study. Pentamidine concentrations ranged in breathing zone samples from < 0.03 to 62.2 micrograms/m3. Pentamidine was not detected in the urine of any of the subjects. There were no significant increases in symptoms on days when AP was administered. Cross-workshift spirometry on days when AP was administered showed a statistically significant mean decrease (0.14 liter) in forced expiratory volume in 1 second. There was no statistically significant difference in mean diurnal variation of peak expiratory flow rate on days when AP was administered. Methacholine inhalation challenge testing did not show a statistically significant mean change in airway responsiveness across the workweek. The ambient concentrations of pentamidine that we measured document that detectable occupational exposure to AP can occur in poorly ventilated treatment rooms. The cross-workshift decrement in forced expiratory volume in 1 second that we observed in association with AP administration supports the respiratory tract irritant potential of inhaled pentamidine. We recommend that steps be taken to minimize health care worker exposure to AP.

Palmitic acid is absorbed as sn-2 monopalmitin from milk and formula with rearranged triacylglycerols and results in increased plasma triglyceride sn-2 and cholesteryl ester palmitate in piglets

Milk fatty acids contain 20-30% palmitic acid (16:0), with approximately 70% of the 16:0 esterified to the sn-2 position of the milk triacylglycerol. Formulae containing vegetable and oleo oils contain different amounts of 16:0, but all have unsaturated fatty acids esterified to the triacylglycerol sn-2 position. Intraluminal triacylglycerol hydrolysis by endogenous lipases produces sn-2 monoacylglycerols and free fatty acids, which are absorbed and re-esterified in the enterocyte for secretion to plasma. The extent of absorption and re-esterification of sn-2 monoacylglycerols from milk or formula fats in infants is unknown. This was studied by feeding piglets sow milk or formulae containing similar total saturated fat, 18:1, 18:2(n-6) and 18:3(n-3) with unsaturated fatty acids at the sn-2 position or with rearranged triacylglycerols containing approximately 30% 16:0, with 70% 16:0 in fatty acids at the sn-2 position. Feeding milk or 16:0 on the sn-2 position of formula with rearranged triacylglycerols resulted in higher 16:0 esterified to the plasma triacylglycerol sn-2 position and in cholesteryl esters than feeding formulae with 0.4 to 4.4% 16:0 in the sn-2 position fatty acids. The absorption of 16:0 as monopalmitin from milk and any metabolic importance in human infants has yet to be determined.

Dietary saturated, monounsaturated, n-6 and n-3 fatty acids, and cholesterol influence platelet fatty acids in the exclusively formula-fed piglet

Platelet lipid composition is important to normal platelet morphology and function, and is influenced by dietary fatty acids and cholesterol. The fatty acid composition and cholesterol content of infant formulas differs from those of human milk, but the possible effects on platelet lipids in young infants is not known. This was studied in piglets fed from birth to 18 d of age with one of eight formulas differing in saturated fatty acid chain length, or content of 18:1, 20:5n-3 plus 22:6n-3, or cholesterol. A reference group of piglets fed sow milk was also studied. Sow milk has a fatty acid composition and cholesterol content similar to that of human milk. Piglets fed formulas high in 18:1 (34.9-40.8% wt fatty acids) and low in 16.0 (< or = 6.5% wt fatty acids) had lower platelet counts and greater platelet size than piglets fed sow milk (40.4% 18:1, 30.7% 16:0). Piglets fed formulas high in 16:0 (27-29.6%) and 18:1 (40-40.6%), or low in both 16:0 (5.9-6.1%) and 18:1 (10.8-11.2%), had similar platelet counts and size to piglets fed sow milk. Platelet phospholipid % 20:4n-6 was lower in all the groups of piglets fed formula than in the group fed sow milk. Addition of fish oil with 20:5n-3 plus 22:6n-3 to the formula further decreased platelet phospholipid 20:4n-6. Addition of cholesterol to the formula increased the platelet phospholipid % 20:4n-6 and platelet volume.

Saturated fatty acid chain length and positional distribution in infant formula: effects on growth and plasma lipids and ketones in piglets

Human milk contains a large proportion of palmitic acid (16:0) with > 70% esterified to the center sn-2 position of the milk triglyceride. Infant formulas often use 8:0 + 10:0 [medium-chain triglyceride (MCT)] or 12:0 + 14:0 (coconut oil) as the saturated fat. The effect of formula saturated fatty acid composition; 8:0 + 10:0, 12:0 + 14:0, or 16:0 from palm oil or synthesized triglyceride containing predominantly sn-2 16:0 on plasma lipids and fatty acids was studied in piglets. Although the formulas contained similar 18:1 and 18:2n-6, plasma lipid percentages of 18:1 and 18:2n-6 were higher in piglets fed the formula with MCT or coconut oil rather than the formulas with 16:0, or sow milk. The sn-2 16:0 of the synthesized triglyceride had unique properties. Specifically, piglets fed synthesized triglyceride had significantly higher cholesteryl ester 16:0 identical to that in piglets fed sow milk and higher plasma total and high-density-lipoprotein cholesterol than piglets fed the other formulas.

The effect of age and initial visual acuity on the systemic and visual prognosis of central retinal vein occlusion

Papillophlebitis is the term that is often used to describe a central retinal vein occlusion with preserved visual acuity in a young, healthy patient. Among 194 patients with a diagnosis of central retinal vein occlusion (CRVO), 19 patients were identified who were under 50 years of age and who had visual acuity of 6/12 or better in the affected eye. These patients retained good vision in the affected eye during the course of the disorder with 17 eyes returning to 6/6. All of these patients remained healthy over a mean follow-up period of about four years. This group of patients was compared to a second group of 28 patients who also were under 50 years of age, but who had initial visual acuity in the affected eye less than 6/12. These patients had a variable visual outcome. In addition, they had a higher prevalence of systemic hypertension over the follow-up period than did a group of age-matched control subjects. An additional comparison was made to a group of 26 patients with visual acuity of 6/12 or better in the affected eye but who were over 50 years of age. Forty-six per cent of these patients had final visual acuity less than 6/12, and they had a higher prevalence of systemic vascular disease than did a group of age-matched control subjects.

Methylene chloride intoxication in a furniture refinisher. A comparison of exposure estimates utilizing workplace air sampling and blood carboxyhemoglobin measurements

A 35-year-old furniture refinisher came to the occupational medicine clinic with complaints of upper respiratory irritation, fatigue, and lightheadedness occurring on a daily basis after using a methylene chloride-containing paint stripper. Determinations of blood carboxyhemoglobin (COHb) on three occasions showed an apparently linear elevation of COHb as a function of hours worked on the day of sampling. COHb levels predicted from spot industrial hygiene measurements were in close concordance with those observed in the patient, indicating the potential usefulness of COHb monitoring in estimating airborne exposure levels. Methylene chloride (or dichloromethane) is an organic solvent that has found wide use as a degreaser, paint remover, aerosol propellant, and a blowing agent for polyurethane foams, and as a solvent in food processing, photographic film production, and plastics manufacturing. Discovery of its unusual metabolic fate--conversion to carbon monoxide in vivo--has earned the compound a special place in the solvent toxicology literature. Demonstration of oncogenicity in experimental animals has occasioned a reconsideration of exposure limits, with emphasis upon stricter controls. In some workplaces, conditions prevail in which controls are inadequate to prevent even acute toxicity, much less long-term exposure risks.

Choroidal neovascularization after laser photocoagulation for diabetic macular edema

Choroidal neovascular membranes (CNVMs) developed in eight patients after photocoagulation for clinically significant diabetic macular edema (DME). The CNVMs developed in areas where Bruch's membrane was ruptured and were diagnosed 2 weeks to 5 months after treatment. Only six patients had symptoms. The CNVMs were treated in four patients; final visual acuity was poor in all eight patients. This serious complication that follows laser treatment for DME may be related to the use of repeated small-size, short-duration laser or intense laser burns, or both.

Protocol for the comprehensive evaluation of building-associated illness

A protocol is outlined that represents a multidisciplinary approach to investigations of problem buildings and building-associated illness. The protocol includes methods to obtain background information on a problem and to conduct the initial site visit. The initial visit often leads to a more extensive medical investigation and environmental evaluation, as covered in this paper. The protocol also describes how the results of medical and environmental evaluations might best be analyzed to make ways to correct problems.

MSG effects on beta-endorphin and alpha-MSH in the hypothalamus and caudal medulla

Monosodium glutamate (MSG) was given to neonatal male rats to determine its effects on neurons containing beta-endorphin (beta-END) and alpha-melanocyte stimulating hormone (alpha-MSH) within the basal hypothalamus (arcuate nucleus) and caudal medulla [nucleus tractus solitarius (NTS)] and on the levels of beta-END and alpha-MSH within these areas. Immunocytochemical studies demonstrated a reduction in the number of cells within the medial hypothalamic area (arcuate nucleus) among MSG-treated animals versus saline controls. MSG did not reduce the number of cell bodies within the caudal medulla (NTS). MSG significantly reduced beta-END and alpha-MSH immunoreactive levels in the basal hypothalamus as determined by radioimmunoassay. Whereas a significant reduction in the level of beta-END occurred in the ventral caudal medulla (VCM), none occurred in the dorsal caudal medulla (DCM). In contrast, levels of alpha-MSH increased significantly in the DCM among animals receiving MSG compared to control animals. This study documents the contribution of beta-endorphin containing neurons of the basal hypothalamus to areas of the caudal medulla. The effect of MSG on beta-endorphin and alpha-MSH neurons in these areas and their differential effects on levels in the caudal medulla areas raises questions about the sites of origin of these peptides.

The mouse eye lens obsolescence (Elo) mutant: studies on crystallin gene expression and linkage analysis between the mutant locus and the gamma-crystallin genes

Previous studies showed that the mouse Elo (eye lens obsolescence) mutation is located on chromosome 1, at a site near the Len-1 locus, which is defined by a set of polymorphic gamma-crystallin proteins. To investigate further the relationship between Elo and the gamma-crystallins, we have examined the steady-state levels of gamma-crystallin transcripts in normal and mutant eyes and analyzed the linkage relationship between the Elo locus and the gamma-crystallin genes. Our data showed that, while gamma-crystallin mRNA levels are preferentially reduced in the mutant eyes, the mutation does not seem to map within the gamma-crystallin gene cluster. The distance between Elo and the gamma 6 gene (the most proximal gamma-crystallin gene member) is estimated to be 1.4 +/- 0.9 cM, whereas that between gamma 6 and the distantly linked gamma 2 gene is 2.7 +/- 1.3 cM. Our data also suggest the possibility of recombination hot spots with the gamma-crystallin gene cluster.

Postnatal development of ACTH and alpha-MSH in the medulla oblongata of rat: alpha-MSH is the predominant peptide

ACTH and alpha-MSH levels were measured by radioimmunoassays in extracts of the caudal medulla oblongata of developing rats on postnatal (P) days 1-42 at 7 day intervals, and in adult rats. From P1 to adulthood, ACTH increased greater than 11-fold from 7.2 +/- 1.9 fmol to 82.4 +/- 12.6 fmol per medulla section (mean +/- S.E.M.). In comparison, alpha-MSH increased greater than 7-fold from 68.75 +/- 11.0 fmol to 491 +/- 97.8 fmol during this time period. ACTH/microgram of soluble protein decreased during postnatal development from 0.006 +/- 0.01 to 0.005 +/- 0.001 fmol/microgram of protein and alpha-MSH increased from 0.06 +/- 0.01 fmol/microgram of protein to 0.11 +/- 0.009 fmol/microgram of protein between P1 and P7, decreased to 0.015 +/- 0.003 fmol/microgram of protein by P42 and increased to 0.03 +/- 0.006 fmol/protein per unit protein by adulthood. These data indicate a significant shift in the levels of alpha-MSH detected during development with a decrease in the concentration of material occurring from early postnatal development (P1-P7) to adulthood, which does not appear to be solely related to a regional increase in protein. These studies, as well as radioimmunoassays for ACTH and alpha-MSH in combination with sizing chromatography of pooled extracts at P1, P7 and the adult, demonstrated the predominance of alpha-MSH at all ages.