Abstract P5-19-03: Factors that influence posttraumatic growth in patients with breast cancer: A longitudinal trial

Objectives:

The main focus of previous research into coping with breast cancer, have been mostly with regards to the negative impacts such as emotional stress, anxiety, depression or cognitive dysfunction. However, patients also report positive changes that have come about as a result of their struggle with cancer. This is referred to as posttraumatic growth (PTG). The aim of this study was to assess the presence of PTG in breast cancer patients at two measurements and to explore the association between personality traits (resilience, optimism, self-efficacy) and positive emotions on PTG.

Patients and Methods:

The study group comprised of 80 women (with a mean age of 53.6 years, SD=10.2) recently diagnosed with stage I to III breast cancer. They completed self-report measures of PTG, resilience, optimism, self-efficacy and positive emotions up to three weeks after diagnose (t1) and then following by an update six months later (t2). Sociodemographic characteristics, emotional distress, anxiety and depression were also recorded.

Results:

Planned comparison: Breast cancer patients showed an increase of PTG from t1 to t2 (p=.00035). Resilience, optimism, self-efficacy and positive emotions did not change in the total sample from t1 to t2. Emotional distress, anxiety and depression have significantly declined from t1 to t2 (anxiety p=.015, depression p=.029, emotional distress p=.000065). Moreover, we found a significant positive correlation between positive emotions to PTG (r=-.386, p=.0004) and optimism to PTG (r=.334, p=.002) at t2, respectively. Depression t2 correlated negatively to PTG at t2 (r=-.264 p=.018).

Explorative results: We also calculated the difference between PTG t2 and t1. We found 67.5% (n=54) of the patients with an increase of PTG and 32.5% (n=26) without or with negative change. In a subgroup analysis we noticed that patients without benefit of PTG showed a decline of resilience (p=.015), self-efficacy (p=.028) and positive emotions (p=.045) between t1 and t2. Furthermore, anxiety and depression did not improve from t1 to t2 in this group.

Conclusions: Positive emotions and optimism represent indicators of PTG in breast cancer patients. A decline of anxiety and depression is associated with a higher rate of PTG. Psycho-oncological strategies related to these factors may support PTG in breast cancer patients. Future studies are needed to search for effective interventions to support patients in PTG.

Citation Format: Berndt U, Gottschlik Y, Leplow B, Thomssen C. Factors that influence posttraumatic growth in patients with breast cancer: A longitudinal trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-19-03.

[Aspiration in a specialised weaning unit--an underestimated problem]

This retrospective case series shows that 45 % of patients aspirated straight after removal of the tracheal cannula. The present case series includes 82 patients with long-term mechanical ventilation (LTMV) admitted to a specialised weaning unit. Aspiration was proven after patients sipped water coloured with patent blue V. Colour was detected with a bronchoscope after passing through the tracheostoma and directed toward the VC. The aspiration rate in this study is in good agreement with other reports in the literature.We could find no significant statistical differences concerning age (p = 0.97), gender (47 % vs. 49), number of bronchoscopies (p = 0.91) and comorbidities (p = 0.326) between patients with and without aspiration. The duration of the stay at the ward and the duration of ventilation as well as the parameter Hb at the time of admission (p = 0.566), CO2(p = 0.288/p = 0.716), HCO3 (p = 0.915/p = 0.612) and CRP (p = 0.402/p = 0.523) at the time of admission and discharge also showed no significant differences.The Kaplan Meier curves show a considerable divergence between patients with and without aspiration. However, the Log Rank Test (p = 0.348) and the univariate Cox Regression (HR 1.4, 95 % CI 0.689 - 2.849) were not significant. We believe that this can be attributed to the event rate, which was too low in our collective. This trend to a higher mortality of patients with aspiration might be due to weakness of the respiratory muscles when there is reduced coughing. Proof of aspiration in these patients is only one aspect of a multidimensional problem. Larger, prospective cohort studies are needed to show whether aspiration can serve as a prognostic marker.

TNFα inhibitors restrict T cell activation and cycling via Notch-1 signalling in inflammatory bowel disease

BACKGROUND

Tumour necrosis factor α (TNFα) inhibitors such as adalimumab and infliximab are frequently prescribed for inflammatory bowel disease (IBD). Despite the clinical success of TNFα inhibitors, their physiological mode of action is not fully understood. The aim of this study was to investigate the mode of action of anti-TNFα agents in IBD.

METHODS

It was hypothesised that Notch mediates anti-TNFα action in T cells. A study was carried out to identify Notch-1 as a link by which anti-TNFα antibodies mediate their inhibitory functions.

RESULTS

TNFα inhibitors induced T cell apoptosis, inhibited activation, reduced cytokine secretion and restricted cell cycling. TNFα blockade at several levels showed that TNFα is responsible for inducing apoptosis by anti-TNFα but not for cell cycle restriction. By linking Notch and TNFα it was shown that (1) Notch-1 mucosal expression differs in inflamed and non-inflamed mucosa and increases in response to anti-TNFα treatment; (2) Notch-1 function is regulated by TNFα inhibitors; (3) Notch-1 binds to TNFα; and (4) Notch-1 inhibition prevents anti-TNFα-induced T cell cycle arrest but not apoptosis.

CONCLUSIONS

TNFα inhibitors potently inhibit T cell function. By demonstrating for the first time that Notch-1 mediates the inhibitory effects of adalimumab and infliximab on T cell cycling, this study reveals a new mode of action and also an underlying signalling pathway by which biological agents act in IBD.

NAC functions as a modulator of SRP during the early steps of protein targeting to the endoplasmic reticulum

NAC acts as a modulator of SRP function. It can bind to signal sequences directly. SRP initially displaces NAC from RNCs; however, when the signal sequence emerges, trimeric NAC·RNC·SRP complexes form. Upon docking NAC·RNC·SRP complexes to the ER, NAC remains bound, allowing NAC to shield cytosolically exposed nascent chain domains.

Nascent polypeptide-associated complex (NAC) was initially found to bind to any segment of the nascent chain except signal sequences. In this way, NAC is believed to prevent mistargeting due to binding of signal recognition particle (SRP) to signalless ribosome nascent chain complexes (RNCs). Here we revisit the interplay between NAC and SRP. NAC does not affect SRP function with respect to signalless RNCs; however, NAC does affect SRP function with respect to RNCs targeted to the endoplasmic reticulum (ER). First, early recruitment of SRP to RNCs containing a signal sequence within the ribosomal tunnel is NAC dependent. Second, NAC is able to directly and tightly bind to nascent signal sequences. Third, SRP initially displaces NAC from RNCs; however, when the signal sequence emerges further, trimeric NAC·RNC·SRP complexes form. Fourth, upon docking to the ER membrane NAC remains bound to RNCs, allowing NAC to shield cytosolically exposed nascent chain domains not only before but also during cotranslational translocation. The combined data indicate a functional interplay between NAC and SRP on ER-targeted RNCs, which is based on the ability of the two complexes to bind simultaneously to distinct segments of a single nascent chain.

Abstract P5-11-16: Cognitive Effects of Endocrine Therapy in Patients with Breast Cancer

Background: Adjuvant endocrine therapy is the mainstay in the therapy of primary breast cancer. However, the impact of endocrine therapy on cognitive function in patients with breast cancer is still unclear. Numerous studies suggest a protective effect of estrogens on neurons. From these findings it has been derived that the almost complete estrogen deprivation by aromatase suppression would modify cognitive performances. The primary aim of our study was to ascertain, whether neurocognitive functioning is altered in breast cancer patients receiving various endocrine therapies.

Patients and Methods: In a cross sectional study we investigated 80 post-menopausal women with breast cancer. Memory, spatial cognition, processing speed and attention were evaluated. Patients who ever received chemotherapy were not included. To compare cognitive task performance we constituted four treatment groups (see tab. 1).

Tab. 1 Groups and Medication

Patient characteristics were equally distributed, however, “switch” patients had received significantly more hormone replacement therapy before the onset of breast cancer than all other groups. We also evaluated mood, depression, anxiety, pre-morbid intelligence and self-perception of memory in order to receive homogenous groups. All participants were interviewed about their compliance to their medication. In this study, we used univariate statistical analyses of variance (ANOVA) and we calculated the effect-sizes of significant values. In case of lacking normal distribution we applied non-parametric statistics.

Results: Women who solely received aromatase inhibitor treatment showed a significant impairment of general memory (p=0.01, d=1.15) and verbal memory (p=0.026, d=0.97) in comparison to the control group. In more than 50% of the aromatase inhibitor patients we found below-average performance concerning verbal memory compared to normative data. The aromatase inhibitor group performed significantly worse than the tamoxifen-(p=0.035, d=0.64) and the “switch-group” (p=0.03, d=0.91) with regard to attention. With respect to their spatial abilities, no significant differences in navigation and in mental rotation were noted. With regard to path integration we solely ascertained significant lower results of the aromatase inhibitor patients compared with the tamoxifen group (p=0.04). Overall, no differences were observed between the “switch”- and the tamoxifen patients. Surprisingly, most patients perceived their own memory performance as averaged. Self-perception of memory correlated with anxiety and depression but not with test scores.

Conclusion: Treatment with tamoxifen alone seems to be less harmful for cognitive abilities than treatment with aromatase inhibitors alone. Patient may benefit from prior tamoxifen therapy when sequentially treated with aromatase inhibitors however this observation must be confirmed in further studies as well as the potential role of prior hormone replacement therapy and the objective adherence to therapy assessed by serum drug levels measurements.

Comparative Multi-Epitope-Ligand-Cartography reveals essential immunological alterations in Barrett's metaplasia and esophageal adenocarcinoma

Background

Barrett's esophagus (BE) is caused by gastroesophageal reflux with consecutive mucosal inflammation, predisposing patients to the development of esophageal adenocarcinoma (EAC). We investigated changes in T cell-related mucosal combinatorial molecular protein patterns in both diseases using the novel Multi-Epitope-Ligand-Cartography, a unique robotic whole-cell imaging technology that simultaneously visualizes dozens of proteins in structurally intact tissues and correlates cellular localization of proteins with function.

Results

Biopsies were taken during endoscopy from BE, EAC, and normal control tissue, and proteomic microscopy was performed on 32 different epitopes. When the significance level was set to p < 0.0005 and the search depth to five antibody combinations, controls and BE can be differentiated by 63, controls and EAC by 3222, and BE from EAC by 1521 distinct protein combinations.

For example, the number of activated apoptotic naïve and memory T cells was significantly increased only in BE, whereas the number of activated apoptotic helper and regulatory T cells was significantly elevated in BE and EAC. In contrast, the number of activated apoptotic cytotoxic T cells was significantly elevated only in EAC. Confirming different pathways in BE and EAC, the number of T lymphocytes with p53 expression and downregulation of bcl2 expression (CD3⁺p53⁺Bcl2^-NfkB^-) was significantly increased in EAC compared to BE and controls. Interestingly, the number of precursor T cells (CD7⁺) was significantly elevated only in EAC. These cells lack Bax and caspase-8, suggesting impaired apoptosis in the early stages of T cell differentiation.

Conclusion

Proteomic analysis showed for the first time that proteins, which are critically involved in the mucosal immune system of the esophagus, are distinctly expressed in BE and EAC, whereas others are comparably altered in both diseases, suggesting that many pathogenic events might be shared by both diseases. Topological proteomic analysis, therefore, helps us to understand the different pathogenic events in the underlying disease pathways.

The Hsp70 homolog Ssb is essential for glucose sensing via the SNF1 kinase network

Yeast senses the availability of external energy sources via multiple interconnected signaling networks. One of the central components is SNF1, the homolog of mammalian AMP-activated protein kinase, which in yeast is essential for the expression of glucose-repressed genes. When glucose is available hyperphosphorylated SNF1 is rendered inactive by the type 1 protein phosphatase Glc7. Dephosphorylation requires Reg1, which physically targets Glc7 to SNF1. Here we show that the chaperone Ssb is required to keep SNF1 in the nonphosphorylated state in the presence of glucose. Using a proteome approach we found that the Deltassb1Deltassb2 strain displays alterations in protein expression and suffers from phenotypic characteristics reminiscent of glucose repression mutants. Microarray analysis revealed a correlation between deregulation on the protein and on the transcript level. Supporting studies uncovered that SSB1 was an effective multicopy suppressor of severe growth defects caused by the Deltareg1 mutation. Suppression of Deltareg1 by high levels of Ssb was coupled to a reduction of Snf1 hyperphosphorylation back to the wild-type phosphorylation level. The data are consistent with a model in which Ssb is crucial for efficient regulation within the SNF1 signaling network, thereby allowing an appropriate response to changing glucose levels.

Prognostic factors of long-term outcome in gastroenteropancreatic neuroendocrine tumours

Neuroendocrine tumours (NET) of the gastroenteropancreatic system comprise a malignant entity with a low incidence. Only limited information is available on long-term clinical outcome and clinically applicable prognostic factors. We performed a retrospective analysis of a large, well-characterized centre-based patient cohort of 399 patients with histologically proven NET. Data were analysed according to epidemiological, clinical and histopathological characteristics. Detailed survival analyses using the Kaplan-Meier method were performed. Prognostic factors were tested by log-rank testing and independent risk factors were analysed using a Cox regression model. In the studied cohort, primary tumours originated in the fore-, mid- and hindgut in 46.1, 37.1 and 4.5% respectively. Extra-intestinal or unknown primary tumours were present in 8.4 and 10.5% respectively. Distant metastasis was present at initial diagnosis in 69.4%. Most frequent metastatic sites were liver (85%), peritoneal cavity (18%), bones (8%), other intra-abdominal sites (6%) and lungs (4%). Overall, 5- and 10-year survival rates were 78 and 63% respectively. Time to progression after initial diagnosis was significantly shorter in pancreatic as compared with ileal NET. Survival analysis revealed significantly better clinical outcome for primary tumours smaller than 25 mm, absence of metastasis, absence of any clinical symptoms, positive immunohistochemical staining for chromogranin A and a lower Ki67 index. These results were confirmed as independent by multivariate analysis. Therefore, this large retrospective analysis of a well-documented cohort of patients with NET demonstrates several prognostic factors of clinical relevance and wide availability, which should be considered for risk stratification in the management of NET.

Galectin-4 controls intestinal inflammation by selective regulation of peripheral and mucosal T cell apoptosis and cell cycle

Galectin-4 is a carbohydrate-binding protein belonging to the galectin family. Here we provide novel evidence that galectin-4 is selectively expressed and secreted by intestinal epithelial cells and binds potently to activated peripheral and mucosal lamina propria T-cells at the CD3 epitope. The carbohydrate-dependent binding of galectin-4 at the CD3 epitope is fully functional and inhibited T cell activation, cycling and expansion. Galectin-4 induced apoptosis of activated peripheral and mucosal lamina propria T cells via calpain-, but not caspase-dependent, pathways. Providing further evidence for its important role in regulating T cell function, galectin-4 blockade by antisense oligonucleotides reduced TNF-alpha inhibitor induced T cell death. Furthermore, in T cells, galectin-4 reduced pro-inflammatory cytokine secretion including IL-17. In a model of experimental colitis, galectin-4 ameliorated mucosal inflammation, induced apoptosis of mucosal T-cells and decreased the secretion of pro-inflammatory cytokines. Our results show that galectin-4 plays a unique role in the intestine and assign a novel role of this protein in controlling intestinal inflammation by a selective induction of T cell apoptosis and cell cycle restriction. Conclusively, after defining its biological role, we propose Galectin-4 is a novel anti-inflammatory agent that could be therapeutically effective in diseases with a disturbed T cell expansion and apoptosis such as inflammatory bowel disease.

Somatostatin-producing neuroendocrine tumors of the duodenum and pancreas: incidence, types, biological behavior, association with inherited syndromes, and functional activity

Somatostatin-producing neuroendocrine tumors (SOM-NETs) of the duodenum and pancreas appear to be heterogeneous. To determine their clinicopathological profiles, respective data were analyzed on a series of 82 duodenal and 541 pancreatic NETs. In addition, the clinical records of 821 patients with duodenal or pancreatic NETs were reviewed for evidence of a somatostatinoma syndrome. Predominant or exclusive expression of somatostatin was found in 21 (26%) duodenal and 21 (4%) pancreatic NETs. They were classified as sporadic (n=31) or neurofibromatosis type 1 (NF1)-associated duodenal NETs (n=3), gangliocytic paragangliomas (GCPGs; n=6), or poorly differentiated neuroendocrine carcinomas (pdNECs; n=2). In addition, five duodenal and four pancreatic SOM-NETs were found in five patients with multiple endocrine neoplasia type 1 (MEN1). Metastases occurred in 13 (43%) patients with sporadic or NF1-associated SOM-NETs, but in none of the duodenal or pancreatic MEN1-associated SOM-NETs or GCPGs. Sporadic advanced (stage IV) SOM-NETs were more commonly detected in the pancreas than in the duodenum. None of the patients (including the 821 patients for whom only the clinical records were reviewed) fulfilled the criteria of a somatostatinoma syndrome. Our data show that somatostatin expression is not only seen in sporadic NETs but may also occur in GCPGs, pdNECs, and hereditary NETs. Surgical treatment is effective in most duodenal and many pancreatic SOM-NETs. MEN1-associated SOM-NETs and GCPGs follow a benign course, while somatostatin-producing pdNECs are aggressive neoplasms. The occurrence of the so-called somatostatinoma syndrome appears to be extremely uncommon.

Systematic high-content proteomic analysis reveals substantial immunologic changes in colorectal cancer

The immune system is a significant determinant of epithelial tumorigenesis, but its role in colorectal cancer pathogenesis is not well understood. The function of the immune system depends upon the integrity of the protein network environment, and thus, we performed MELC immunofluorescence microscopy focusing on the lamina propria. By analyzing structurally intact tissues from colorectal cancer, ulcerative colitis, and healthy colonic mucosa, we used this unique and novel highly multiplexed robotic-imaging technology, which allows visualizing dozens of proteins simultaneously, and explored the toponome in colorectal cancer mucosa for the first time. We identified 1,930 motifs that distinguish control from colorectal cancer tissue. In colorectal cancer, the number of activated T cells is increased, explained by a lack of bax, caspase-3, and caspase-8. Whereas CD4(+)CD25(+) T cells are decreased and are, other than in ulcerative colitis, not activated, cytotoxic T cells are significantly increased in colorectal cancer. Furthermore, the number of activated human lymphocyte antigen (HLA)-DR(+) T-cells is increased in colorectal cancer, pointing to an altered antigen presentation. In colorectal cancer, CD3(+)CD29(+) expression and assembly of the LFA-1 and LFA-3 receptor are differentially changed, indicating a distinct regulation of T-cell adhesion in colorectal cancer. We also identified increased numbers of natural killer and CD44(+) cells in the colorectal cancer mucosa and nuclear factor-kappaB as regulator of apoptosis in these cell populations. High-content proteomic analysis showed that colorectal cancer induces a tremendous modification of protein expression profiles in the lamina propria. Thus, topological proteomic analysis may help to unravel the role of the adaptive immune system in colorectal cancer and aid the development of new antitumor immunotherapy approaches.

Galectin-2 induces apoptosis of lamina propria T lymphocytes and ameliorates acute and chronic experimental colitis in mice

Galectins have recently emerged as central regulators of the immune system. We have previously demonstrated that carbohydrate-dependent binding of galectin-2 induces apoptosis in activated T cells. Here, we investigate the potential therapeutic effect of galectin-2 in experimental colitis. Galectin-2 expression and its binding profile were determined by immunohistochemistry. Acute and chronic colitis was induced by dextran sodium sulfate administration and in a T-cell transfer colitis model. Apoptosis was assessed by TdT-mediated dUTP-biotin nick-end labeling, and cytokine secretion was determined by cytometric bead array. We show that galectin-2 was constitutively expressed mainly in the epithelial compartment of the mouse intestine and bind to lamina propria mononuclear cells. During colitis, galectin-2 expression was reduced, but could be restored to normal levels by immunosuppressive treatment. Galectin-2 treatment induced apoptosis of mucosal T cells and thus ameliorated acute and chronic dextran-sodium-sulfate-induced colitis and in a T-helper-cell 1-driven model of antigen-specific transfer colitis. Furthermore, the pro-inflammatory cytokine release was inhibited by galectin-2 treatment. In preliminary toxicity studies, galectin-2 was well tolerated. Our study provides evidence that galectin-2 induces apoptosis in vivo and ameliorates acute and chronic murine colitis. Furthermore, galectin-2 has no significant toxicity over a broad dose range, suggesting that it may serve as a new therapeutic agent in the treatment of inflammatory bowel disease.

Proteomic analysis of the inflamed intestinal mucosa reveals distinctive immune response profiles in Crohn's disease and ulcerative colitis

Although Crohn's disease (CrD) and ulcerative colitis (UC) share several clinical features, the mechanisms of tissue injury differ. Because the global cellular function depends upon the protein network environment as a whole, we explored changes in the distribution and association of mucosal proteins to define key events involved in disease pathogenesis. Endoscopic biopsies were taken from CrD, UC, and control colonic mucosa, and Multi-Epitope-Ligand-Cartographie immunofluorescence microscopy with 32 different Abs was performed. Multi-Epitope-Ligand-Cartographie is a novel, highly multiplexed robotic imaging technology which allows integrating cell biology and biomathematical tools to visualize dozens of proteins simultaneously in a structurally intact cell or tissue. In CrD, the number of CD3+CD45RA+ naive T cells was markedly increased, but only activated memory, but not naive, T cells expressed decreased levels of Bax, active caspase-3 or -8. In UC, only CD4+ T cells coexpressing NF-kappaB were caspase-8 and poly(ADP-ribose)-polymerase positive. Furthermore, the number of CD4+CD25+ T cells was elevated only in UC, whereas in CrD and controls, the number of these cells was similar. By using hub analysis, we also identified that the colocalization pattern with NF-kappaB+ and poly(ADP-ribose)-polymerase+ as base motifs distinguished CrD from UC. High-content proteomic analysis of the intestinal mucosa demonstrated for the first time that different T cell populations within the intestinal mucosa express proteins translating distinct biological functions in each form of inflammatory bowel disease. Thus, topological proteomic analysis may help to unravel the pathogenesis of inflammatory bowel disease by defining distinct immunopathogenic profiles in CrD and UC.

Prognostic relevance of the novel TNM-classification system for neuroendocrine tumors of foregut origin

15147

Background: Until recently no TNM-classification existed for neuroendocrine tumors (NET) of the gastroenteropancreatic system. In 2006 Rindi et al. proposed a new TNM-classification system for foregut-NET of gastric, duodenal and pancreatic origin. The present study validates prognostic significance of the new TNM-classification in a cohort from a German referral center. Methods: The case files of 193 patients with histologically proven foregut NET were analyzed retrospectively. Patients were classified according to Capella (1995) and the WHO (2000) and to the new TNM-classification. Uni- and multivariate analysis was performed using log-rank and Cox regression methods. Results: Primary tumors localization was gastric (n=48), duodenal (23) and pancreatic (122); 35 patients (18%) died during the observation period. Overall 5- and 10-year survival rates (YSR) were 76% and 65% resp., while 5- and 10-YSR according to NET-related deaths (74% of all deaths, 26/35) were 83% and 74% resp.. The classifications by Capella and the WHO significantly discriminated between low and high grade malignant NET (p<0,001 and 0,002 resp.), but did not allow further prognostic differentiation. In contrast, the newly proposed TNM-classification system was able to significantly differentiate stage IV NET from all other stages (I vs. IV p=0,001; II vs. IV p=0,001; III vs. IV p=0,008) as well as stage III from stage I NET (p=0,038). Furthermore, the new classification system which includes a grading system according to the mitotic index (Ki67-index; G1 <3%, G2 3–20%, G3 >20%) was also able to significantly distinguish all three groups from each other (G1 vs. G3 p<0,001; G2 vs. G3 p<0,001). On multivariate analysis stage I and II as well as stage III-NET had a decreased hazard ratio (HR) when compared to stage IV-NET (I/II: HR 0,094, p=0,003; III: HR 0,38, p=0,096). In the same model G1 and G2-NET were associated with an decreased HR as compared to G3-NET (G1: HR 0,05, p=0,01; G2: HR 0,20, p=0,002). Conclusions: Here we demonstrate prognostic relevance of the newly proposed TNM-classification system for foregut-NET with statistical significance which therefore provides a new and powerful tool for future classification of NET.

No significant financial relationships to disclose.

Survival and clinical outcome of patients with neuroendocrine tumors of the gastroenteropancreatic tract in a german referral center

Neuroendocrine tumors (NETs) are rare neoplasms. Approximately 75% of all cases manifest in the gastroenteropancreatic (GEP) system. Because of the low incidence of NETs, limited data about the clinical outcome and prognostic variables are available. In an attempt to identify prognostic parameters, we investigated the distribution of primary tumors, pattern of metastasis formation, clinical presentation, histological classification, and outcome of therapeutic interventions in a large patient cohort cared for in a German referral center. In 254 patients with GEP-NETs, the primary tumor was of foregut, midgut, or hindgut origin in 44.1% (28.7% pancreas), 43.7% (34.7% jejunoileum), and 4.3%, respectively. No primary tumor was found in 7.9%. Metastases occurred preferentially in lymph nodes and the liver. The overall 5-year survival rate was 57.1%. In the absence or presence of metastases at initial diagnosis the 5-year survival rate was 80.0% and 51.7%, respectively. The 5-year survival rate was related to the localization of the primary and was 75.0% and 42.9% for jejunoileal and pancreatic tumors, respectively. The size of the primary tumor (<2 cm) and histological grading as low-grade malignant were both associated with a significantly longer survival. Surgery with curative intent was attempted in 141 patients. However, an R(0) resection was achieved in only 66.0% of these patients. Five-year survival rate in the latter group was significantly higher (77.3%) as compared with all surgical patients (55.4%). Long-term tumor-free survival was obtained in only 53.7% of successfully resected patients. Palliative medical treatment, either with chemotherapy (i.e., especially for foregut NETs) or biotherapy (especially for midgut NETs), was only moderately effective for both therapeutic regimens.

The Cologne Carbon Cluster experiment: ro-vibrational spectroscopy on C8 and other small carbon clusters

We report on our ongoing efforts in obtaining the IR-spectra of the linear carbon cluster molecules Cn with n=8-13. So far C8, C9, C10, and C13 have been recorded at Cologne. With the exception of C8 all assignments have been secured. For C8 a tentative assignment could be derived with the bandcenter of the sigmau antisymmetric stretching mode located at nu0=2067.9779 cm(-1) and a preliminary rotational constant in the vibrational ground state of B"=0.02068 cm(-1). The measured signal to noise ratio of the ro-vibrational band is fairly weak and thus the lower J ro-vibrational transitions can not be assigned with certainty. As a consequence the band center remains uncertain by 4 J or 0.17 cm(-1). For a more reliable assignment the sensitivity of the system has to be increased by at least one order of magnitude. The envisaged sensitivity increase of our experiment will be discussed along with the intention to perform terahertz observations of the low energetic bending ro-vibrational spectra. These sub-mm wave measurements will be carried out simultaneously with the IR measurements.

Hand eczema in metalworker trainees--an analysis of risk factors

The present study, as part of PROMETES (Swiss Prospective Metal Worker Eczema Study), was performed to examine risk factors for the development of occupational hand dermatitis in metal-worker trainees. Since this disease is very common, a high standard of preventive measures is necessary, especially for persons with an endogenous disposition for the development of eczema, e.g., atopics. Within the cohort of 201 healthy young men, 47 (23%) showed at least mild signs of hand eczema at 1 point of the 2.5 year observation period. Various occupational and domestic exposures, skin protection behaviour, regeneration time, and smoking habits, as well as atopic disposition, were studied with regard to their influence on the skin condition of the metalworker trainees. By multivariate analysis, we determined 3 important risk factors for the development of hand eczema in the cohort. (i) We showed once more the important influence of an atopic disposition as a major risk factor for occupational contact dermatitis. (ii) Furthermore, the results suggest that, apart from chemical irritants, mechanical factors should not be underestimated in their role as irritants to the epidermal barrier. (iii) Additionally, an insufficient amount of skin recovery time seems to support a cumulative sub-irritant effect on the skin, which may lead to irritant contact dermatitis.

Efficacy of a barrier cream and its vehicle as protective measures against occupational irritant contact dermatitis

The actual advantage of barrier creams over bland emollients for skin protection is still hotly debated. In a randomized, double-blinded study, a newly-introduced barrier cream and its moisturizing vehicle were compared regarding their skin compatibility, efficacy and resulting acceptance. Thus, 2 panels of 25 hospital nurses with mild signs of skin irritation were asked to use 1 of the test products provided (verum or vehicle) over a period of 4 weeks. Effects of both types of preparations were studied weekly by clinical examination and the instrumental assessment of bioengineering parameters. Results showed no significant differences between barrier cream and vehicle. In both groups, clinical skin status improved and stratum corneum hydration increased significantly during the study period. Both preparations were tolerated and accepted well, thus showing both skin protection and skin care. These results contribute to the debate as to whether a strict distinction between "skin care" and "skin protection" products is justified. The vehicle alone is capable of positively influencing skin status. Emphasis must be laid on regular, frequent, and correct application of a product for it to be effective.

Is occupational irritant contact dermatitis predictable by cutaneous bioengineering methods? Results of the Swiss Metalworkers' Eczema Study (PROMETES)

BACKGROUND

Since identification of subjects with high eczema risk by screening tests is desirable, different skin bioengineering methods were studied for their validity as predictive measures for the development of hand eczema.

METHODS

205 metalworker trainees were followed up over 2.5 years from the beginning of their apprenticeship to observe the occurrence of hand eczema. Within the first weeks of their training they underwent a number of noninvasive biophysical tests. Transepidermal water loss, skin moisture and skin roughness were measured, and irritation tests with dimethyl sulfoxide (DMSO), sodium hydroxide (NaOH) and sodium lauryl sulfate were conducted. Sensitivity, specificity and predictive values of the performed tests and test combinations were calculated.

RESULTS

None of the observed single biophysical methods can be considered a valid screening test.

CONCLUSION

A combination of short irritation tests (DMSO and NaOH tests) and the measurement of skin moisture, however, allows to identify individuals at high risk for hand dermatitis with a high sensitivity, though low specificity.

Role of the atopy score and of single atopic features as risk factors for the development of hand eczema in trainee metal workers

This study was performed as part of PROMETES (Swiss Prospective Metal Worker Eczema Study) to examine the role of atopy as a possible risk factor for the development of hand eczema in trainee metal workers. In a cohort of 201 young men without any skin problems at the start of their apprenticeship, 9.5% developed signs of dermatitis on their hands within a period of 6 months. The 2. 5-year incidence was 23%. We did not find a significantly increased risk for hand eczema in those participants with an atopic skin diathesis according to the atopy score of Diepgen et al. (Dermatosen 1991; 39: 79-83) Analysis of individual atopic signs and symptoms showed reported metal reactivity to have a significant influence on the onset of early skin damage within 6 months, whereas a history of flexural eczema appeared to be significantly related to the overall incidence over 2.5 years.

Cephalometric investigations concerning the geometry of the viscerocranium of human anencephalic fetuses

Cephalometric investigations were carried out on 16 macerated skulls of anencephalic fetuses aged around 6 months and compared with the values obtained from a group of 18 normally developed specimens. The skull geometry of the anencephalic fetuses was different from normal proportions: anencephalic fetuses showed a clear mandibular prognathism, and a maxilla tilted in anterior direction. The values describing length of maxilla and length of the anterior cranial base, and NS-Ba angle were found to be within the normal range. From the results it can be concluded that the defective development of the forebrain seems to have no effects on the length development of the anterior cranial base although it does influence the form of the surrounding bony structures. The formation of the mandibular prognathism cannot be brought into direct connection with the defective brain development.

[Metatarsal osteotomies for the correction of hallux valgus and metatarsus primus varus congenitus]

It is reported about the combined use of different methods for metatarsal osteotomy and in conclusion we recommend a differentiation of these corrective techniques and their indications. The differentiation is based on the consideration of the valgus angle, the grade of secondary arthrosis and the functional load of the joints.