Bone marrow micrometastases in 109 breast cancer patients: Correlations with clinical and pathological features and prognosis

Background: The presence in bone marrow of cells which react with monoclonal antibodies against tumor-associated antigens has been proposed over the last few years as a new prognostic factor in breast cancer patients. Patients and methods: Bone marrow aspirates were obtained from 109 stage I and II breast cancer patients during or 2–4 weeks after primary surgery. The samples were processed for leukocyte separation on a Ficoll-Hypaque gradient and then used to prepare cytospin slides for immunocytochemical analysis. The slides were stained with a pool of monoclonal antibodies (MoAbs) which recognize tumor associated antigens, using the alkaline phosphatase anti-alkaline phosphatase method. The median follow-up was 36 months (range 15–62); 22 patients relapsed and 7 died. Results: Thirty-four of the 109 patients (31.1%) had MoAb positive bone marrow cells. The bone marrow was positive in 28/74 (37.9%) patients who had the aspirate taken during surgery and in 6/35 (17.1%) who had it taken after surgery (p = 0.055). No association was found between bone marrow positivity and tumour size, nodal status, menopausal status, estrogen receptor positivity or the proliferative index. No association was found between bone marrow and prognosis: the log-rank test was 0.291 (p > 0.5) for OS and 0.023 for DFS; the hazard ratio (positive vs negative) was 1.51 for OS (95% CI: 0.33–6.86) and 0.93 for DFS (95% CI: 0.35–2.45). Conclusions: In our series, bone marrow positivity did not correlate with prognostic parameters or prognosis. Of interest is the relative excess of positivity when the bone marrow was obtained during surgery.     

Myofiberbreak-up: a marker of ventricular fibrillation in sudden cardiac death

BACKGROUND: Electrophysiologically, ventricular fibrillation is defined as a "chaotic, random, asynchronous electrical activity of the ventricles due to repetitive re-entrant excitation and/or rapid focal discharge". To this point its morphological equivalent has not been defined. MATERIAL AND METHOD: Several groups of different diseases and types of accidental death in normal subjects were studied. A complete autopsy was performed and the hearts were examined in 432 cases. A total of 16 myocardial samples per heart were processed for histological examination and sections were stained by haematoxylin and eosin or by specific stains. The frequency, location and extent of myocellular segmentation (stretching and/or rupture) of intercalated discs and associated changes of myocardial bundles and single myocells were investigated. A quantitative analysis was performed and the data were processed for statistical evaluation. RESULTS: The frequency of MFB was maximal in coronary (88%) and Chagas (76%) groups followed by the intracranial brain haemorrhage group (52%). The extent of myofiberbreak-up was maximal in coronary/Chagas groups followed by intracranial haemorrhage and transplant groups. CONCLUSIONS: No correlation was seen between gender, age, heart weight, degree of coronary atherosclerosis, myocardial fibrosis, survival and MFB. If our postulate is correct, finding MFB in the myocardium might allow the diagnosis of a malignant arrhythmia followed by cardiac arrest due to ventricular fibrillation even in the absence of clinical information (sudden death out-of-hospital).     

Allergic rhinitis phenotypes based on mono-allergy or poly-allergy

Inflammation Research - Allergic rhinitis (AR) is characterized by typical symptoms that are dependent on inflammation. Poly-allergy is a frequent phenomenon. Phenotyping AR represents an...     

The endocannabinoid 2-AG controls skeletal muscle cell differentiation via CB1 receptor-dependent inhibition of Kv7 channels

Little is known of the involvement of endocannabinoids and cannabinoid receptors in skeletal muscle cell differentiation. We report that, due to changes in the expression of genes involved in its metabolism, the levels of the endocannabinoid 2-arachidonoylglycerol (2-AG) are decreased both during myotube formation in vitro from murine C₂C₁₂ myoblasts and during mouse muscle growth in vivo. The endocannabinoid, as well as the CB1 agonist arachidonoyl-2-chloroethylamide, prevent myotube formation in a manner antagonized by CB1 knockdown and by CB1 antagonists, which, per se, instead stimulate differentiation. Importantly, 2-AG also inhibits differentiation of primary human satellite cells. Muscle fascicles from CB1 knockout embryos contain more muscle fibers, and postnatal mice show muscle fibers of an increased diameter relative to wild-type littermates. Inhibition of K_v7.4 channel activity, which plays a permissive role in myogenesis and depends on phosphatidylinositol 4,5-bisphosphate (PIP2), underlies the effects of 2-AG. We find that CB1 stimulation reduces both total and K_v7.4-bound PIP2 levels in C₂C₁₂ cells and inhibits K_v7.4 currents in transfected CHO cells. We suggest that 2-AG is an endogenous repressor of myoblast differentiation via CB1-mediated inhibition of K_v7.4 channels.The endocannabinoid system (ECS) refers to a large group of endogenous molecules including the two major arachidonate-derived neuromodulatory mediators, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), known as endocannabinoids (EC); several enzymes involved in the metabolism of AEA (NAPE-PLD, ABDH4, GDE1, PTPN22 for biosynthesis and FAAH for degradation) and 2-AG (DAGLα and DAGLβ for biosynthesis and MAGL, ABDH6, ABDH12, and FAAH for degradation); and two G protein-coupled receptors known as cannabinoid receptor of type-1 (CB1) and type-2 (CB2). AEA also activates the cation permeant transient receptor potential vanilloid type-1 (TRPV1) channels (1). In mammals, the ECS regulates a large number of physiological processes; alterations in its activity are in fact responsible for the onset or progression of many types of disorders affecting both the central and the peripheral nervous system as well as other organs (2–5). So far, a few studies have reported that CB1 receptor activity controls key skeletal muscle metabolic processes such as insulin signaling, glucose uptake, and fatty acid oxidation (6, 7). However, little, if anything at all, is known about the expression profile and the functional role played by the ECS during skeletal muscle development.Skeletal myogenesis is a tightly regulated process that requires coordinated changes in a large number of genes allowing proliferating myoblasts to withdraw from the cell cycle and fuse to form large multinucleated myotubes (8). Several classes of ion channels play a pivotal role in the initiation of the differentiation process. For example, the sequential activation of two distinct classes of K⁺ channels, the ether-a-go-go K_v10.1 and the inward-rectifier KIR2.1 (9, 10), is known to be one of the first molecular events that causes myoblast hyperpolarization. This event, in turn, leads to the activation of voltage-dependent T-type Ca²⁺ channels, which increase the [Ca²⁺]_i necessary to initiate myoblast commitment to differentiation into myotubes (11). More recently, members of the K_v7 (KCNQ) subfamily of voltage-activated K⁺ channels have been found to be expressed in both myoblasts and myotubes (12, 13), and, in particular, it has been shown that K_v7.4 channel expression plays a permissive role in skeletal myogenesis (14).The K_v7 subfamily comprises five subunits (K_v7.1–K_v7.5), each showing distinct tissue distribution and physiological properties. K_v7 channel function is regulated by several classes of G_q/11-coupled receptors including muscarinic (15), bradikynin (16), serotonin (17), and somatostatin receptors (18). Stimulation of these receptors leads to phospholipase C (PLC) activation and subsequent hydrolysis of phosphatidylinositol 4,5-bisphosphate (PIP2) into inositol 1,4,5-trisphosphate (IP3) and diacylglycerol (DAG). Thus, considering that PIP2 is strictly required for K_v7 channels activity, G_q/11-coupled receptor stimulation represents one of the most important cellular mechanisms through which this subclass of K⁺ channels is kept under negative control (19). Interestingly, the M current, which is underlied by K_v7 channels, can be also inhibited following CB1 receptor stimulation by AEA at the postsynaptic level in hippocampal neurons (20) or by stimulation of the G_q/11-coupled orphan receptor GPR55 (21).In this study, we have endeavored to understand the role played by the ECS in muscle development and its impact on K_v7 activity during myogenesis by using molecular biology, biochemical, pharmacological, morphological, and electrophysiological techniques. Our results indicate that the endocannabinoid 2-AG tonically inhibits differentiation of mouse and human myoblasts via sequential activation of CB1 receptors, reduction of PIP2 levels, and inhibition of K_v7 channel activity.     

Robot-assisted Gastrectomy for Gastric Cancer: Current Status and Technical Considerations

Background

Robot-assisted gastrectomy has been reported as a safe alternative to the conventional laparoscopy or open approach for treating early gastric carcinoma. To date, however, there are a limited number of published reports available in the literature.

Methods

We assess the current status of robotic surgery in the treatment of gastric cancer, focusing on the technical details and oncological considerations.

Results

In gastric surgery, the biggest advantage of robotic surgery is the ease and reproducibility of D2-lymphadenectomy. Reports show that even the intracorporeal digestive restoration is facilitated by use of the robotic approach, particularly following total gastrectomy. Additionally, the accuracy of robotic dissection is confirmed by decreased blood loss, as reported in series comparing robot-assisted with laparoscopic gastrectomy. The learning curve and technical reproducibility also appear to be shorter with robotic surgery and, consequently, robotics can help to standardize and diffuse minimally invasive surgery in the treatment of gastric cancer, even in the later stages. This is important because the application of minimally invasive surgery is limited by the complexity of performing a D2-lymphadenectomy. The potential to reproduce D2-lymphadenectomy, enlarged resections, and complex reconstructions provides robotic surgery with an important role in the therapeutic strategy of advanced gastric cancer.

Conclusions

While published reports have shown no significant differences in surgical morbidity, mortality, or oncological adequacy between robot-assisted and conventional laparoscopic gastrectomy, more studies are needed to assess the indications and oncological effectiveness of robotic use in the treatment of gastric carcinoma. Herein, the authors assess the current status of robotic surgery in the treatment of gastric cancer, focusing on the technical details and oncological considerations.     

Defining the Epsilon‐Sarcoglycan (SGCE) Gene Phenotypic Signature in Myoclonus‐Dystonia: A Reappraisal of Genetic Testing Criteria

Mutations or exon deletions of the epsilon‐sarcoglycan (SGCE) gene cause myoclonus‐dystonia (M‐D), but a subset of M‐D patients are mutation‐negative and the sensitivity and specificity of current genetic testing criteria are unknown. We screened 46 newly enrolled M‐D patients for SGCE mutations and deletions; moreover, 24 subjects previously testing negative for SGCE mutations underwent gene dosage analysis. In our combined cohorts, we calculated sensitivity, specificity, positive and negative predictive values, and area under the curve of 2 published sets of M‐D diagnostic criteria. A stepwise logistic regression was used to assess which patients' characteristics best discriminated mutation carriers and to calculate a new mutation predictive score (“new score”), which we validated in previously published cohorts. Nine of 46 (19.5%) patients of the new cohort carried SCGE mutations, including 5 novel point mutations and 1 whole‐gene deletion; in the old cohort, 1 patient with a complex phenotype carried a 5.9‐Mb deletion encompassing SGCE. Current diagnostic criteria had a poor ability to discriminate SGCE‐positive from SGCE‐negative patients in our cohort; conversely, age of onset, especially if associated with psychiatric features (as included in the new score), showed the best discriminatory power to individuate SGCE mutation carriers, both in our cohort and in the validation cohort. Our results suggest that young age at onset of motor symptoms, especially in association with psychiatric disturbance, are strongly predictive for SGCE positivity. We suggest performing gene dosage analysis by multiple ligation‐dependent probe amplification (MLPA) to individuate large SGCE deletions that can be responsible for complex phenotypes. © 2013 Movement Disorder Society