Glioblastoma recurrence after cediranib therapy in patients: lack of "rebound" revascularization as mode of escape

Recurrent glioblastomas (rGBM) invariably relapse after initial response to anti-VEGF therapy. There are 2 prevailing hypotheses on how these tumors escape antiangiogenic therapy: switch to VEGF-independent angiogenic pathways and vessel co-option. However, direct evidence in rGBM patients is lacking. Thus, we compared molecular, cellular, and vascular parameters in autopsy tissues from 5 rGBM patients who had been treated with the pan-VEGF receptor tyrosine kinase inhibitor cediranib versus 7 patients who received no therapy or chemoradiation but no antiangiogenic agents. After cediranib treatment, endothelial proliferation and glomeruloid vessels were decreased, and vessel diameters and perimeters were reduced to levels comparable to the unaffected contralateral brain hemisphere. In addition, tumor endothelial cells expressed molecular markers specific to the blood-brain barrier, indicative of a lack of revascularization despite the discontinuation of therapy. Surprisingly, in cediranib-treated GBM, cellular density in the central area of the tumor was lower than in control cases and gradually decreased toward the infiltrating edge, indicative of a change in growth pattern of rGBMs after cediranib treatment, unlike that after chemoradiation. Finally, cediranib-treated GBMs showed high levels of PDGF-C (platelet-derived growth factor C) and c-Met expression and infiltration by myeloid cells, which may potentially contribute to resistance to anti-VEGF therapy. In summary, we show that rGBMs switch their growth pattern after anti-VEGF therapy--characterized by lower tumor cellularity in the central area, decreased pseudopalisading necrosis, and blood vessels with normal molecular expression and morphology--without a second wave of angiogenesis.     

First identification of Neospora caninum by PCR in aborted bovine foetuses in Romania

The first identification of Neospora caninum infection in aborted bovine foetuses in Romania is reported. Nine aborted foetuses were collected from a dairy farm. The foetal age of foetuses was between 3 and 7 months. A 7-month-old foetus was mummified. N. caninum DNA Nc-5 region was amplified from samples extracted from brain tissues of three (33.3%) aborted foetuses. The foetal ages of PCR positive foetuses were 3, 4 and 7 months (mummified). No specific lesions or tissue cysts were found to the histological examination, because of advanced autolysis of brains.     

An in vitro study of magnetic particle targeting in small blood vessels

The magnetic guidance and capture of particles inside the human body, via the circulatory system, is a novel method for the targeted delivery of drugs. This experimental study confirms in vitro that a dipolar capturing device, based on high-energy magnets with an active space of 8.7 cm x 10 cm x 10 cm, retains colloidal magnetic particles (MPs) (<30 nm) injected in the capillary tubes, where flow velocities are comparable to that encountered in the capillary beds of tumours (<0.5 cm s(-1)). The build-up of the deposition of the MPs was investigated using video imaging techniques that enabled continuous monitoring of the blocking of the vessel whilst simultaneously recording the colloid's flow rate. The parameters of practical importance (length of MP deposit, time of capillary blocking) were estimated and were found to be dependent on the initial fluid velocity, the MP concentration and the distance between the capillary tube and the polar magnetic pieces. Although the tube used in this experiment is larger (diameter = 0.75 mm, length = 100 mm) than that of real capillaries (diameter = 0.01 mm, length approximately 1.5 mm), the flow velocities chosen were similar to those encountered in the capillary beds of tumours and the length/diameter ratio was approximately equal (133 for the present set-up, 100-150 for real capillaries). In these circumstances and using the same magnetic field conditions (intensity, gradient) and MPs, there is close similarity with magnetic capture in a microscopic capillary system. Moreover, the macroscopic system permits analysis of the distribution of MPs in the active magnetic space, and consequently the maximum targetable volume. This study revealed that the capture of particles within the active space was strongly influenced by the gradient of the magnetic field and the flow velocity. Thus, when the magnetic field gradient had medium values (0.1-0.3 T cm(-1)) and the fluid velocity was small (0.15 cm s(-1)), the particles were captured in small, compact and stable deposits (L < 4 cm) and the time necessary for blocking of the capillary was <150 s. Doubling the value for the flow velocity did not influence significantly either the length of MP deposits nor the blocking time. However, lower gradients (<0.1 T cm(-1)) and larger velocities (0.3-0.9 cm s(-1)) result in the formation of larger deposits (4 cm < L < 10 cm) that are unstable at the beginning of the capture process. These large deposits do become stable given sufficient time for the deposition process to take place in conjunction with a decrease in the flow rate. As a consequence, the time necessary for blocking of the capillary increased up to 450 s. Decreasing the MP concentration from 0.02 g cm(-3) to 0.005 g cm(-3) decreased the deposit lengths by approximately 20% and doubled the values of the blocking time. The maximum targetable volume obtained by the present method is approximately 350 cm(3), which corresponds to medium-sized tumours. The capillary vessels were blocked only for the situation that occurs for microcirculation within a tumour. This reduces the concentration of MPs trapped within the normal tissues, which occurs when using particles of micrometre size. This work showed the potential of using colloidal MPs and dipolar magnetic devices for treatment of human patients, when the affected sites are positioned at medium distances from the surface of the body (e.g. head, neck, breast, hands and legs).     

Successful surgical repair of a triple cardiac rupture using modified cohesive double patch technique

Introduction The association between both left and right ventricular free wall ruptures (FWR) and post-infarction anterior ventricular septal defect (VSD) is an exceptional situation.

Case report We present the case of a patient who developed a VSD and two FWRs (of the left and right ventricle, respectively) shortly after the onset of an anterior AMI. We surgically closed this complex rupture using the cohesive double patch technique with two Teflon patches combined with an infarct exclusion technique. The left and right ventricular patches were attached cohesively to the septal wall and the infarcted area was excluded without reducing the left ventricular cavity.

Conclusion Association between post-infarction ventricular septal rupture and both left and right free wall ruptures are a very rare and dangerous situation. The modified cohesive double patch technique associated the modified Cooley technique seems to be the correct surgical solution.     

The effects of ulipristal on Bax/Bcl-2, cytochrome C,Ki-67 and cyclooxygenase-2 expression in a rat model with surgically induced endometriosis

Objective

To evaluate the effect of ulipristal on Bax/Bcl-2, cytochrome C, Ki-67 and cyclooxygenase-2 expression in surgically induced endometriosis in a rat model.

Study design

We conducted a prospective, randomized, controlled, experimental study at the Experimental Research Center of the Iuliu Hatieganu University of Medicine and Pharmacy in Cluj-Napoca, Romania. Endometriosis was induced in 40 female Wistar albino rats by transplanting two autologous fragments of uterine horn onto bowel mesentery. After a 4-week induction period, we formed two groups: the first group was treated with ulipristal (UPA+) for 8 weeks, while the second group was treated only with the vehicle used for ulipristal (UPA−). We measured the volumes and masses of the implants both before and after treatment. A pathologist examined the sections microscopically for histological hallmarks of endometriosis. Immunostaining for Bax/Bcl-2, cytochrome C, Ki-67 and cyclooxygenase-2 (COX-2) was assessed in both groups.

Results

Ulipristal reduced the average implant volume and mass, indicating that the drug is effective (P = 0.01). The treatment induced a greater than 50% reduction in the volume and mass of endometrial implants, and the histological findings correspond to this result. The overall Bax positivity rate was higher in the group treated with ulipristal (42.37% vs. 21.05% for UPA+ and UPA−, respectively) (P = 0.0062). The overall Bcl-2 positivity rate was smaller in the group treated with ulipristal (15% vs. 40% for UPA+ and UPA−, respectively) (P = 0.0593). The cytochrome C global positivity rate was 5% in the UPA− group and increased to 50% in the UPA+ treatment group (P < 0.0001). The COX-2 positivity rate decreased from 75% in the UPA− treatment group to 10% in the UPA+ treatment group (P < 0.0001) and the Ki67 positivity rate also decreased from 55% in the UPA− group to 10% in the UPA+ treatment group (P < 0.0002).

Conclusions

Treatment with ulipristal contributed to the regression and atrophy of endometriotic lesions in rats. The immunohistochemical expression profiles of Bax/Bcl-2 and cytochrome C revealed a pro-apoptotic effect of ulipristal. We also observed a reduced cellular proliferation, indicated by a decrease in Ki-67 expression and an anti-inflammatory effect, shown by a decrease in COX-2 expression after treatment with ulipristal.     

The multifaceted nature of the relationship between performance and brain activity in motor sequence learning

The ‘learning and performance’ conundrum has for a long time puzzled the field of cognitive neuroscience. Deciphering the genuine functional neuroanatomy of motor sequence learning, among that of other skills, has thereby been hampered. The main caveat is that changes in neural activity that inherently accompany task practice may not only reflect the learning process per se, but also the basic motor implementation of improved performance. Previous research has attempted to control for a performance confound in brain activity by adopting methodologies that prevent changes in performance. However, blocking the expression of performance is likely to distort the very nature of the motor sequence learning process, and may thus represent a major confound in itself. In the present study, we postulated that both learning-dependent plasticity mechanisms and learning-independent implementation processes are nested within the relationship that exists between performance and brain activity. Functional magnetic resonance imaging (fMRI) was used to map brain responses in healthy volunteers while they either (a) learned a novel sequence, (b) produced a highly automatized sequence or (c) executed non-sequential movements matched for speed frequency. In order to dissociate between qualitatively distinct, but intertwined, relationships between performance and neural activity, our analyses focused on correlations between variations in performance and brain activity, and how this relationship differs or shares commonalities between conditions. Results revealed that activity in the putamen and contralateral lobule VI of the cerebellum most strongly correlated with performance during learning per se, suggesting their key role in this process. By contrast, activity in a parallel cerebellar network, as well as in motor and premotor cortical areas, was modulated by performance during learning and during one or both control condition(s), suggesting the primary contribution of these areas in motor implementation, either as a function or not of the sequential content of movements. Our findings thus highlight the multifaceted nature of the link between performance and brain activity, and suggest that different components of the striato-cortical and cerebello-cortical motor loops play distinct, but complementary, roles during early motor sequence learning.