Temporal specificity and heterogeneity of Drosophila immune cells

Immune cells provide defense against non-self and have recently been shown to also play key roles in diverse processes such as development, metabolism, and tumor progression. The heterogeneity of Drosophila immune cells (hemocytes) remains an open question. Using bulk RNA sequencing, we find that the hemocytes display distinct features in the embryo, a closed and rapidly developing system, compared to the larva, which is exposed to environmental and metabolic challenges. Through single-cell RNA sequencing, we identify fourteen hemocyte clusters present in unchallenged larvae and associated with distinct processes, e.g., proliferation, phagocytosis, metabolic homeostasis, and humoral response. Finally, we characterize the changes occurring in the hemocyte clusters upon wasp infestation, which triggers the differentiation of a novel hemocyte type, the lamellocyte. This first molecular atlas of hemocytes provides insights and paves the way to study the biology of the Drosophila immune cells in physiological and pathological conditions.

The sentinel lymph node procedure for patients with preoperative diagnosis of ductal carcinoma in situ: risk factors for unsuspected invasive disease and for metastatic sentinel lymph nodes

BACKGROUND

Occult invasive disease could be found at definitive histology in patients initially diagnosed with large ductal carcinoma in situ (DCIS). Sentinel lymph node (SLN) biopsy is a reliable and minimally invasive procedure providing axillary information and avoiding a second operation in this particular group of patients. The aim of our study was to assess the value of SLN biopsy in patients with large DCIS who are at highest risk for being upstaged to invasive carcinoma.

PATIENTS AND METHODS

The study included 195 patients diagnosed with DCIS upon initial core biopsy and undergoing SLN biopsy. Many features were correlated with the presence of unsuspected invasive disease and positive SLN biopsy using univariate and multivariate analyses.

RESULTS

Of the 110 patients with pure DCIS, seven patients (6%) had a metastatic lymph node; 31 patients (16%) were found to have invasive disease upon final histology. Univariate analysis of predictors of unsuspected invasive carcinoma showed that patients having a preoperative biopsy that indicated DCIS with microinvasion (DCISM) or large DCIS were at a higher risk of invasive carcinoma after histological examination of the operative specimen. Of the 31 patients who were upstaged to invasive carcinoma at final histology, seven patients (22%) had a positive SLN biopsy. The analysis of predictors of positive SLN in our study shows that diffuse DCIS requiring mastectomy is the main risk factor for SLN metastasis.

CONCLUSION

There are no real predictive factors for invasive disease in patients with an initial diagnosis of DCIS or DCISM. Our study supports the value of SLN biopsy in patients with a preoperative DCISM biopsy or patients with a large pure DCIS biopsy requiring mastectomy.

Intrauterine brain teratoma: a case report of imaging (US, MRI) with neuropathologic correlations

Fetal brain tumors are rare and teratoma is considered as the most common. Fetal MR Imaging is currently used to evaluate cases of ventricular dilatation. We report a case of cerebral immature teratoma detected by ultrasonography because of ventricular dilatation at 24 gestational weeks. MRI was the more accurate imaging method in depicting the tumor and its consequences on brain development as well as in taking a decision with regard to the management of pregnancy.

Embryonic hematopoiesis modulates the inflammatory response and larval hematopoiesis in Drosophila

Recent lineage tracing analyses have significantly improved our understanding of immune system development and highlighted the importance of the different hematopoietic waves. The current challenge is to understand whether these waves interact and whether this affects the function of the immune system. Here we report a molecular pathway regulating the immune response and involving the communication between embryonic and larval hematopoietic waves in Drosophila. Down-regulating the transcription factor Gcm specific to embryonic hematopoiesis enhances the larval phenotypes induced by over-expressing the pro-inflammatory Jak/Stat pathway or by wasp infestation. Gcm works by modulating the transduction of the Upd cytokines to the site of larval hematopoiesis and hence the response to chronic (Jak/Stat over-expression) and acute (wasp infestation) immune challenges. Thus, homeostatic interactions control the function of the immune system in physiology and pathology. Our data also indicate that a transiently expressed developmental pathway has a long-lasting effect on the immune response.

The absorption of iron, with or without supplements of single amino acids and of ascorbic acid, in healthy and Fe-deficient children

1. Studies were done on the effect of ascorbic acid and five amino acids (histidine, cystine, cysteine, valine and glutamic acid) on intestinal iron absorption in a group of ninety Egyptian infants and young children, of which fifty-seven were healthy controls and thirty-three were suffering from Fe-deficiency anaemia. 2. Supplements tested promoted Fe absorption in healthy controls in the following order: valine larger than histidine larger than ascorbic acid. Cysteine, glutamic acid and cystine were found to have no significant effect. 3. Supplementation with valine, ascorbic acid and histidine also increased intestinal Fe absorption in anaemic subjects, but to a lesser extent than in controls. 4. Supplementation of haematinic therapy with these compounds is recommended. Their use is also suggested to improve the availability of the Fe content of everday diets.

Endocrine profiles in pediatric andrology. II. Insulin-dependent diabetic adolescents

Seventy-five diabetic male and female children and 75 matched controls were classified according to pubertal staging. Blood samples were assayed for gonadotropins and gonadal hormones. The ultimate adult height in diabetic patients was 5 cm less than that of controls. Almost all diabetic children had a retarded bone age. Levels of serum gonadotropins and gonadal hormones did not differ markedly between diabetic and healthy children. The delay in growth and maturation was not due to hormonal failure, but probably to chronic undernutrition of body cells and failure to utilize the amino acids for protein anabolism related to relative insulin deficiency.

[Effects of hormone replacement therapy for menopause on prognostic factors of breast cancer]

AIM

Hormone replacement therapy (HRT) is widely used by post-menopausal women. Although this treatment may slightly increase the incidence of breast cancer, more and more cases are diagnosed while women are taking HRT. The purpose of this study was to ascertain the influence of HRT on prognostic factors and outcome of breast cancer. Data on all breast cancer patients, including precise information on HRT, was prospectively and systematically recorded in a data base.

PATIENTS AND METHODS

From 1990 to 1998, 1223 post-menopausal women fulfilled the eligibility criteria for this study. The clinical features, laboratory findings and survival rates in 245 HRT users who developed breast cancer while being treated were compared with those of 245 matched breast cancer patients who had never received HRT.

RESULTS

Patients who developed breast cancer during HRT had fewer locally advanced cancers and smaller and better-differentiated cancers. Estradiol receptivity was quantitatively lower in users. Metastasis-free survival were better for the users.

CONCLUSION

We conclude that HRT does not affect the prognosis of breast cancer. Regular surveillance during HRT allows early detection of smaller lesions. The higher number of well-differentiated cancers and the distribution of hormone receptivity may reflect interaction between neoplastic tissue and exogenous hormones.

Diagnosis and management of adenocarcinoma of the ampulla of Vater during pregnancy

BACKGROUND

Cancer of the biliary tract has a poor prognosis and its association with pregnancy is uncommon. Early diagnosis allowing curative surgical resection offers the only hope of long-term survival.

CASE

This report describes the case of a young 26-week-pregnant woman admitted for cholestatis documented by clinical and laboratory examination. Ultrasonography (US) and magnetic resonance cholangiopancreatography (MRCP) were indicative of common bile tract obstruction. Caesarian section was performed at 32 weeks of pregnancy and the tumor was promptly biopsied. Histology demonstrated carcinoma of the ampulla of Vater. The patient underwent a Whipple procedure. Both mother and baby survived.

CONCLUSION

Pregnant patients with digestive cancer require careful management. Acute non-invasive assessment and radical surgery improve outcome for both the mother and fetus.

Protein-calorie malnutrition (PCM) in Egypt immunological changes of salivary protein in PCM

Whole saliva protein as well as the separated protein components were estimated in normal and malnourished Egyptian infants and young children. In normal, 8 protein components (Albumin, alpha1-antitrypsin, haptoglobin, beta2-lipoprotein, transferrin, IgA, IgM and IgG) were detected, while in PCM cases two more components (prealbumin and alpha2-macroglobulin) were found. The results also showed that the level of salivary protein components are markedly increased in edematous cases. In non-edeomatous ones, the level of these constituents are slightly increased in 3rd marasmus, but diminished in 2nd grade. It is concluded that the elevation of protein components in saliva of edematous cases could be a result of severe glandular tissue involvement as compared to controls and non-edematous cases. The value of IgA immunoglobulin as specific antibody originated from blood plasma and/or salivary glands may be used to reflect the extent of tissue affection in salivary glands of malnourished cases.

Salivary amino acids and proteins in normal and malnourished Egyptian infants and young children

Amino acids and proteins in whole saliva of normal and malnourished Egyptian infants and young children were investigated. 16 amino acids, 7 of them are essential, could be detected in saliva of normal infants. Electrophoretic analysis revealed the existence of 10 protein components in saliva of either normal or malnourished infants. In oedematous cases, salivary aminoacids, particularly the essential ones, were increased as well as most of the protein components. In non-oedematous cases, the pattern was more or less normal, but in 3rd grade marasmus, amino acid and protein components of saliva were somewhat increased. The conclusion was drawn that such increase is mainly due to tissue degeneration which is more marked in oedematous than non-oedematous form of the disease.

Clinical Management Factors Contribute to the Decision for Contralateral Prophylactic Mastectomy (CPM)

INTRODUCTION:Rates of CPM are reported to be increasing, yet factors driving this trend are unclear. We performed this analysis to determine if increasing rates of CPM are being driven by increased recognition of risk factors for contralateral breast cancer (CBC) or by treatment factors related to the index lesion.METHODS:From 1997-2005, 2967 patients with Stage 0-III primary unilateral breast cancer underwent mastectomy at MSKCC and were entered into a prospectively maintained database. Demographic, tumor and treatment factors were abstracted and comparisons made between patients who did and did not undergo CPM within one year of treatment for their index cancer. Generalized estimating equations were used to fit logistic regression models to identify independent predictors of CPM.RESULTS:The overall rate of CPM was 13.8%(n=408), increasing from 6.7% in 1997 to 24.4% in 2005 (p<0.0001). The median age of CPM pts was 44.9 vs 53.2 in the non-CPM group (p<.001) and only 7% of CPM pts were non-white compared to 25% of non-CPM pts (p<.001). Although 69% of CPM pts had a family history (FH) of breast cancer (vs 40% non-CPM; p<.001) only 8% had 2 or more first degree relatives affected. Genetic testing was performed in 29% of CPM pts; of those 37 (31%) were positive. The use of MRI increased from 1.3% to 36.3%of cases over the study period. MRI at diagnosis (43% vs 16%) and MRI generated biopsy in the contralateral or bilateral breasts (29% vs 4%) were strongly associated with CPM (p<.0001). Prior attempts at breast conservation (BCT) (28% vs 16%; p<.001) were more common in the CPM group, but number of attempts did not differ between groups. Patients undergoing CPM were more likely to have DCIS versus an invasive histology (p<0.0001), and of those with invasive disease, CPM patients had smaller tumors (1.2cm vs. 1.8cm, p<0.0001) and were more likely to be node negative (53% vs 43%, p<0.0001). ER, PR, and HER2 status were not associated with CPM. CPM rates among surgeons ranged from 9.8% to 26%. Multivariate analysis of predictors of CPM for 2387 patients with complete data is shown in the Table.VariableORp95%CIWhite race3.6<0.00012.4-5.4Age<502.3<0.00011.8-3.1FH breast cancer2.9<0.00012.3-3.7MRI at Dx2.2<0.00011.7-2.8BCT attempted1.60.000081.2-2.1Reconstruction3.2<0.00012.3-4.5DCIS histology1.40.021.1-1.9*adjusted for surgeonCONCLUSIONS: Factors associated with clinical management of the index cancer such as preoperative MRI with the potential for additional biopsy, failed attempt at BCT, and breast reconstruction were strongly associated with CPM. Age and FH were also independent predictors; however the FH profiles of CPM pts in this series do not support increased recognition of mutation carriers and truly high risk FH as a major cause of increasing rates of CPM. The lack of association with ER status, which results in treatment that decreases the risk of CBC, provides additional support that patients may be choosing CPM for reasons other than future risk. These data suggest that the need for additional procedures during management of the index cancer may be contributing to the increasing use of CPM among a relatively moderate risk patient population. Efforts to optimize BCT and minimize unnecessary tests may help to curb this trend.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 38.

Red blood cells amino-acid pattern in protein energy malnutrition and the effect of oral dosing with single amino acids

R.B.C.'s amino acid pattern was investigated in control and PEM subjects. The effect of oral dosing with cysteine, tryptophan and lysine on total amino acid nitrogen level of R.B.C.s was also studied. Results revealed that in moderate and severe kwashiorkor the total essential and non-essential R.B.C.'s amino acids were decreased. In 2nd grade marasmus the total R.B.C.'s amino acids in general showed lower values than normal. After oral administration of the tested amino acids, the transport index calculated as the level of maximum value of the total R.B.C.'s amino acids reached to the fasting level was lower in malnourished cases relative to controls except in 2nd grade marasmic cases given tryptophan or lysine. This criteria was considered to indicate lower rate of amino acid transport to R.B.C.s due to lower concentration in plasma or shift of transport mechanism from active transport to exchange diffusion.

Protein calorie malnutrition (PCM) in Egypt: comparative study of the electrolyte pattern in plasma and erythrocytes

The electrolytes sodium, potassium, calcium and magnesium were determined in both plasma and erythrocytes of 300 PCM subjects and 26 parallel healthy controls. The results obtained revealed that: The level of plasma sodium was lower than normal in all PCM cases except in marasmic kwashiorkor. The RBC's sodium content was more or less not affected. Plasma potassium level was markedly lower than normal in all groups of malnourished subjects. RBC's potassium was significantly lower than normal in severe K.W.O. and marasmic kwashiorkor, while it was high in 3rd grade marasmus. Magnesium level was lower than normal in both plasma and RBC's in all malnourished subjects. Calcium level dropped in plasma and was elevated in RBC's. Estimation of RBC's minerals may be useful in reflecting the concerned changes in tissues of PCM subjects.

Protein and amino acid pattern in juvinile diabetes

A number of 21 diabetic juveniles and 20 controls comprised the material of this study. Serum total proteins and their electrophoretic separated fractions were estimated. Serum free amino acids were also investigated. Results showed that serum proteins were within normal range. An average increase of 49.5% in total free amino acids was reported. In general, the data for all the detected amino acids showed an average increase when compared with normal values. The significance of these findings in relation to the normal values were discussed.

Dissociation of the E-Cadherin-Catenin-Complex (CCC) Is an Early and Progressive Event in Lobular Neoplasia

Recent data suggests that some lobular carcinoma in situ (LCIS) lesions may behave as precursors to invasive lobular carcinoma (ILC). Loss of E-cadherin (E-CD) mediated cell adhesion is characteristic of both LCIS and ILC and is reflected in the dis-cohesive appearance of the individual cells. Subsequent dissociation of the intracellular E-cadherin-catenin-complex (CCC) facilitates tumor progression, invasion and migration. Whether disruption of the CCC plays a role in the progression of select LCIS lesions to ILC remains unclear. The aim of this study was to evaluate the relation between loss of E-CD and dissociation of the CCC in pure LCIS and LCIS with concurrent ILC (LCIS w/ILC). Methods Thirty patients undergoing mastectomy for LCIS alone or LCIS w/ ILC were prospectively enrolled to an IRB-approved protocol. FFPE blocks were retrieved and sections prepared for IHC. 18 cases had LCIS w/ ILC, 12 cases had pure-LCIS. IHC was performed for ER, PR, E-CD, N-cadherin (N-CD), and α-, β- and phospho-β-catenin. ER/PR positivity was scored as any nuclear staining, and E-CD and N-CD by any membranous staining. a- and β-catenin expression was scored by site (membranous/cytoplasmic/nuclear) of staining compared to normal. Dissociation of the CCC was defined by loss of membranous α- and β-catenin expression.Results Median age at surgery was 51yrs (range 40-79); patients with pure LCIS were younger than those with LCIS w/ ILC (median 48yrs vs 57yrs, p=.0002). Among 18 cases of LCIS w/ ILC, the median tumor size was 2cm (range 1.4-5.7), 9 patients had N1 disease and 1 had M1 disease. All pure LCIS, LCIS w/ ILC and ILC lesions were ER/PR positive and E-CD negative. N-CD expression was also absent in all pure LCIS, LCIS w/ ILC and ILC lesions. Normal α-catenin membranous expression was confirmed in all normal epithelial cells but decreased with the transition from in-situ to invasive disease: pure-LCIS lesions 83%; LCIS w/ ILC 28%; ILC 0%. Loss of membranous α-catenin expression was accompanied by cytoplasmic α-catenin expression in all lesions. A similar trend of decreasing membranous staining from in-situ to invasive disease was observed for β-catenin, however in contrast to α-catenin, cytoplasmic β-catenin expression decreased from 67% in pure LCIS to 11% in LCIS w/ ILC and 6% in ILC. Active β-catenin (nuclear staining) was not seen in pure LCIS lesions and was only present in one case of LCIS w/ ILC. Inactive (phospho) β-catenin expression was present in all lesions.Conclusion Loss of E-CD expression is an early event in lobular neoplasia however subsequent dissociation of the intracellular CCC a a ppears to be a progressive process with complete dissociation occurring only in invasive lesions. This finding suggests that complete disruption of the CCC may be required to facilitate maintenance of the invasive phenotype; however, the absence of N-CD expression and predominance of inactive β-catenin in both in situ and invasive lesions suggests that alternate mechanisms are also required to mediate the pro-invasive effects of CCC dissociation. Further studies into the mechanisms of CCC dissociation and downstream events in lobular carcinoma are needed to define the role of this process in the transition from in-situ to invasive disease.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6149.

Unscarred uterine rupture--case report and literature review

BACKGROUND

Spontaneous uterine rupture is a life threatening event, and the diagnosis is difficult in an unscarred uterus. Many factors can help prevent the catastrophic consequences.

CASE

A 38-year-old multipara in labor was admitted at 39.5 weeks of gestation. Ultrasound suggested a macrosomic fetus but the cervix was well dilated. Labor was immediately monitored. Two hours later, the fetus developed progressive heart rate decelerations. While evaluating the unexplained anomaly, epigastric pain and vaginal bleeding prompted emergency cesarean delivery. The uterine tear was repaired with good evolution but the infant died a few days later.

CONCLUSION

The association of multiparity, uterine distension and active labor could be considered as risk factors of uterine rupture in cases of unexplained anomalies in an unscarred uterus, making a catastrophic event preventable.