Clinical benefits of precision medicine in treating solid cancers: European Society of Medical Oncology-Magnitude of Clinical Benefit Scale score-based analysis.

BACKGROUND: Precision and matched cancer medicine has the potential to complement the existing biomarker approaches in cancer treatment. However, despite their promising potential, certain negative results have highlighted their limitations in molecular biology-driven treatment strategies. This study aimed to evaluate the clinical benefits of precision therapies. MATERIALS AND METHODS: Three reviewers independently identified and assessed precision and matched cancer treatment studies published between January 2015 and December 2020. Clinical benefits of the treatments included in our cohort were assessed using two established frameworks; the European Society of Medical Oncology-Magnitude of Clinical Benefit Scale version 1.1 (ESMO-MCBS) and the American Society of Clinical Oncology Value Framework. RESULTS: Of the 290 eligible studies, 130 were for lung cancer, 51 for solid tumors, 24 for melanoma, and 24 for breast cancer. The common targets were: epidermal growth factor receptor (N = 66), serine/threonine-protein kinase B-Raf (N = 40), anaplastic lymphoma kinase (ALK) (N = 34), breast cancer protein (N = 26), phosphatidylinositol-3 kinase/protein kinase B/phosphatase and tensin homolog (PI3K/AKT/PTEN) pathway (N = 19), receptor tyrosine-protein kinase erbB-2 (HER2) (N = 19), mitogen-activated protein kinase (RAS/RAF/MAPK) pathway (N = 18), programmed death-ligand 1 (N = 12), fibroblast growth factor receptor (N = 8), and others (N = 43). The ESMO-MCBS scales ranged from 0 to 4. Based on the clinical benefit values, tumor mutational burden/mismatch repair-deficient/microsatellite instability-high for immunotherapy, anaplastic lymphoma kinase, and neurotrophic receptor tyrosine kinase therapeutic targets were considered high, whereas RAS/RAF/MAPK and PI3K/AKT/PTEN were considered low. Additionally, we found a significant difference between each average score (P < 0.001). CONCLUSIONS: This study showed that precision and matched cancer therapies require further improvement. This is consistent with the views of the tumor board and of clinicians that precision strategies need to be revised to improve their therapeutic effects.

Donor site selection and clinical outcomes of nipple-areola skin-sparing mastectomy with immediate autologous free flap reconstruction: A single-institution experience.

BACKGROUND: The objective of this study was to examine the clinical outcomes of immediate breast reconstruction using perforator flaps from different donor sites, and to characterize the trends among these flaps. METHODS: We retrospectively reviewed 136 consecutive patients who underwent immediate breast reconstruction using free flaps after skin-sparing mastectomy (SSM) or nipple-sparing mastectomy (NSM). The whole breast was pathologically analyzed in 5-mm sections. Breast reconstruction was performed using the deep inferior epigastric perforator (DIEP) flap, gluteal artery perforator (GAP) flap, and posterior medial thigh perforator (PMTP) flap. Patient characteristics were compared among donor sites. RESULTS: NSM was converted to SSM because of intraoperative subareolar tumor positivity in 7 of 107 patients. Eleven patients had positive margins in permanent sections. All but one patient had a positive horizontal margin in the peripheral direction. The 5-year recurrence-free survival rate was 91.9%. The locoregional recurrence rate was 5.1% with a mean follow-up observation period of 75 months. DEIP, GAP, and PMTP flaps were used in 64 (47.1%), 38 (27.9%), and 34 (25.0%) patients, retrospectively. DIEP flaps were used in older patients and those with a higher body mass index. GAP flaps were used in younger patients. DIEP and GAP flaps were used for larger breasts, and PMTP flaps for smaller breasts. CONCLUSION: NSM or SSM with immediate perforator flap breast reconstruction is an oncologically acceptable surgical option. We believe that age, desire to have children, body mass index, and excised breast volume are valuable factors for selecting the optimal donor site.

Outcomes of immediate perforator flap reconstruction after skin-sparing mastectomy following neoadjuvant chemotherapy.

BACKGROUND: The impact of neoadjuvant chemotherapy (NACT) on immediate free flap breast reconstruction remains controversial. Furthermore, the oncological outcomes of immediate free flap breast reconstruction after skin-sparing mastectomy (SSM) following NACT remain unclear. This study aimed to investigate the surgical complications and oncological outcomes of immediate perforator flap reconstruction after SSM following NACT. METHODS: A total of 201 consecutive patients with indications for immediate perforator flap reconstruction after SSM were included between 2004 and 2012. Surgical and oncological outcomes were compared between patients with and without NACT. RESULTS: There were 38 patients in the NACT group and 163 in the non-NACT control group. The median age of the NACT group was 39.5 years, which was significantly younger than the control group (43.0 years; P < 0.05). Patients in the NACT group also had more advanced and aggressive disease (P < 0.05). There was no significant difference in the frequency of surgical complications between the groups, no difference in the type of complications, and no significant difference in the frequencies of major and minor complications. No patients in the NACT group had delayed adjuvant therapy. Eight patients (4%) developed recurrences, with a median follow-up time of 3.0 years. Local recurrences occurred in three control patients but no patients in the NACT group. CONCLUSION: NACT does not affect short-term or interim outcomes after immediate perforator flap reconstruction and may thus represent a safe and practical treatment option for the multidisciplinary treatment of breast cancer.

Light and scanning electron microscopic study of the digestive tract in the catfish Pseudoplatystoma Corruscans Agassiz, 1829 (Pisces, Pimelodidae)

O trato digestivo do surubin Pseudoplatystoma corruscans foi estudado morfologicamente utilizando a microscopia de luz e eletrônica de varredura (MEV), além de técnicas histoquímicas. O epitélio estratificado do palato e faringe está constituído de uma camada basal com células indiferenciadas de núcleos elípticos de posiçäo central; uma camada média constituída de células intermediárias indiferenciadas, células gigantes acidófilas e células mucosas; e uma camada superficial de células achatadas. O esôfago apresenta estrutura semelhante, com células gigantes acidóficas menos numerosas e células poilimorfonucleares entre as células da camada basal, ao MEV, o palato evidenciou vários sulcos, sendo que a porçäo superficial está constituída de células hexagonais ou poligonais, em cuja área apical está presente as microcristas. A parte superficial da faringe apresenta células com microcristas dispostas concentricamente. O esôfago mostrou pregas longitudinais complexas, um epitélio estratificado cujas células apresentam microcristas irregulares. Os carbohidratos presentes nas células do tracto digestivo foram identificados como sendo mucosubstâncias neutras e ácidas

[Intracranial dural malignant lymphoma: case report].

A case of intracranial dural malignant lymphoma was presented. A 35-year-old woman was admitted with generalized seizure. The neurological findings and laboratory data were normal. Computed tomography (CT) showed a nodular lesion in the left frontal convexity with marked enhancement by contrast medium. Angiography showed a slight tumor stain and the feeding artery from the ethmoid artery. On surgery, a soft pinkish tumor was found to be located in the dura and subdural space. It was resected subtotally. The histological diagnosis was malignant lymphoma of B cell origin. Postoperative Ga scintigraphy and abdominal CT disclosed no abnormalities in other organs, but bone marrow examination revealed lymphoma cells, which suggested that the patient might have systemic lymphoma. The patient and her family refused additional treatment. The patient is alive and well now over six years after the craniotomy. Primary central nervous system (CNS) lymphomas usually arise in the cerebral parenchyma, while secondary CNS lymphomas commonly involve leptomeninges and perivascular spaces. Mass lesions arising in the dura are very rare.

[A case of essential thrombocythemia with clonal evolution in the terminal phase].

This 50-year-old male was admitted to the hospital on April 1983 with complaints of severe chest pain attacks 2 weeks previously. Laboratory data: On admission the blood findings were Hb 14.3 Gm/dl of blood, RBC 4.70 million/mm3, WBC 11,600/mm3 and a platelet count of 1.1 million/mm3. ECG showed elevation of ST-T in V1 to V4. Serum LDH and CPK levels were high. He was diagnosed as acute myocardial infarction with thrombocythemia. Three days after admission he abruptly fell into a semicomatose state and left hemiplesia. Head computed tomography showed a large, low-density lesion in the right mid-cerebral artery area, and we also diagnosed cerebral infarction. He was given nimustine (ACNU) 100 mg/week three times as remission induction therapy. For maintenance chemotherapy, at first we administered mitobronitol (DBM) 150 mg/day then changed to intermittent administration of ACNU 100 mg. On September 1991, the patient was admitted to the hospital with progressive anemia and uncontrollable thrombocythemia. Bone marrow chromosome analysis revealed aneuploidy. The patient received interferon alpha 3 million unit/day. The thrombocythemia could be controlled but his general condition deteriorated. On April 1992, he died of interstitial pneumonia.

[A case of ALL complicated with acute pancreatitis and pancreatic pseudocyst caused by L-asparaginase ].

We reported a case of ALL complicated with acute pancreatitis caused by L-asparaginase (L-Asp). The patient was a 42-year-old man, who showed eosinophilia in peripheral blood and an increase of lymphoblast in bone marrow. He was diagnosed as ALL (L2) and treated by JALSG '87 protocol. Remission induction chemotherapy including L-Asp was administered by 5,000 IU i.v. for 10 days. The day after giving all dose of L-Asp, slight epigastralgia developed and then became severe. After two days, s-amylase was markedly elevated, and the patient was diagnosed as acute pancreatitis caused by L-Asp. He was treated conservatively, but hyperglycemia occurred. The epigastrial tumor was palpable and gradually grew in size. CT-scan and abdominal ultrasonography revealed pancreatic pseudocyst, so he was treated by percutaneous cyst drainage. The patient died of a relapse of ALL. The prophylaxis and early diagnosis of the pancreatitis and hyperglycemia caused by L-Asp are very difficult. We have to examine more cases and pay greater attention to the chemotherapy, including L-Asp.

New technique using intraductal ultrasonography for the diagnosis of diseases of the pancreatobiliary system.

Intraductal ultrasonography (IDUS), a new technique for visualizing arterial structures, operates at an ultrasound frequency of 30 MHz to produce high resolution, cross-sectional images in real time. The purpose of this study was to provide a basis for interpreting IDUS images in vitro. We also attempted to determine the clinical usefulness of the IDUS system in diagnosing pancreatobiliary diseases in vivo. IDUS echograms of both the bile duct (BD) and main pancreatic duct (MPD) from autopsy specimens of 15 patients demonstrated three distinct layers with a fine reticular pattern in the pancreas in vitro. In clinical cases, the MPD and BD of four patients could be scanned by inserting the IDUS catheter via the major papilla without requiring endoscopic sphincterotomy. We hope that IDUS will become routine in scanning the BD and MPD to achieve early and accurate diagnoses of pancreatobiliary diseases.

Endocrine cells in a normal breast and non-cancerous breast lesion.

The authors confirmed the presence of endocrine cells for the first time in a normal breast as well as in a non-cancerous lesion of the breast. One hundred and eighty-eight blocks of normal breast tissues in 44 cases and 74 blocks of non-cancerous lesions in 35 cases were examined. Argyrophil cells were found in one block from a normal breast and in one block from a phyllodes tumor. Argyrophil cells in the normal breast showed positive reaction to anti-endocrine granule constituent (EGC) antibody with immunohistochemical method. Argyrophil cells found in the phyllodes tumor gave positive reaction to both anti-EGC and anti-serotonin antibodies. The present study is thought to be the first report in the literature of serotonin-positive cells in a non-cancerous breast lesion, a phyllodes tumor.

[Roentgenographical evaluation of physiological bow-leg and the infantile type of Blount's disease in children].

Roentgenographical examinations were carried out in 41 joints of 22 cases with physiological bowleg and 7 joints of 5 cases with the infantile type of Blount's disease. The observation periods were from 1 year and 4 months to 8 years and 1 month with an average of 4 years and 2 months. The femorotibial angle, the proximal tibial metaphyseal diaphyseal angle, the distal tibial metaphyseal diaphyseal angle and the tibial metaphyseal metaphyseal angle were measured, and evaluated statistically. The measurement of the proximal tibial metaphyseal diaphyseal angle and the tibial metaphyseal metaphyseal angle were more significant than that of the femorotibial angle for early differentiation of the infantile type of Blount's disease from physiological bowleg. The degree and it's change of the distal tibial metaphyseal diaphyseal angle show no difference between physiological bowleg and the infantile type of Blount's disease.

Age-dependent increase in deleted mitochondrial DNA in the human heart: possible contributory factor to presbycardia.

Cardiac function deteriorates with age, and endogenous damage to mitochondrial DNA (mt DNA) is believed to be a major contributory factor to aging. Mitochondria occupy a pivotal position in energy metabolism, and mitochondria have their own DNA, which encodes 13 subunits of the mitochondrial energy transducing system. Other subunits are encoded by nuclear DNA. DNA has been shown to have a high mutation rate, and genetic mutation might primarily be ascribed to mtDNA mutation in the energy transducing system. Recent advances in gene technology, especially in polymerase chain reactions (PCR), permit us to analyze mtDNA mutations in a small quantity of tissue. We devised rapid and accurate methods to detect mitochondrial mutations--the primer shift PCR method, PCR-Southern method, the modified primer shift PCR method, and the asymmetric PCR method. With these methods, we analyzed myocardia mtDNA in human cadavers of various ages (from 3 years old to 97 years old, mean 57 years old). The 7.4 kb deletion of mtDNA was commonly detected in elderly subjects, and the proportion of deleted mtDNA to normal mtDNA increased with age. Deleted mtDNA was observed in all subjects that were over 70 years old. The mutation was based on the directly repeated sequence: 5'-CATCAA-CAACCG-3', which exists in both the adenosine triphosphatase 6 gene and the displacement loop (D-loop) region. Replication impairment occurred at that directly repeated sequence, which caused the elimination of genomes between the adenosine triphosphatase 6 gene and the D-loop region and resulted in a 7.4 kb deletion.(ABSTRACT TRUNCATED AT 250 WORDS)

[Tumor necrosis factor in sputa of patients with bronchial asthma on exacerbation].

TNF is a cytokine recently implicated as an important inflammatory mediator. TNF concentrations in sputa from 13 patients with bronchial asthma on exacerbation and 12 patients with chronic obstructive pulmonary disease were measured. After sonication, the sputa were centrifuged. The supernatants were assayed for the presence of TNF by use of an enzyme-linked immunosorbent assay. TNF was detected in all patients with bronchial asthma (1783 +/- 420 pg/ml), while low values of TNF were detected in only 5 of the 12 COPD patients. It is suggested that TNF is involved in airway inflammation in bronchial asthma.

Inhibition of cyclic GMP phosphodiesterase by xanthine derivatives relaxes guinea-pig trachealis smooth muscle.

1. For the purpose of clarifying the mechanism of the airways smooth muscle relaxant action of xanthines, cyclic guanosine monophosphate (GMP) phosphodiesterase (PDE) from guinea-pig trachealis muscle was purified with diethylaminoethyl ether (DEAE) cellulose column chromatography. 2. Five 3-alkylxanthines (3-methylxanthine, 3-ethylxanthine, 3-n-propylxanthine (enprofylline), 3-n-butylxanthine, and 3-iso-butylxanthine), and five 1-methyl-3-alkylxanthines (1-methyl-3-methyl-xanthine (theophylline), 1-methyl-3-ethylxanthine, 1-methyl-3-n-propylxanthine, 1-methyl-3-n-butylxanthine, and 1-methyl-3-iso-butylxanthine (IBMX] were compared in terms of purified cyclic GMP PDE inhibition. The relationship between the structure and inhibition of cyclic GMP PDE was studied. 3. The -log EC50 values for relaxation of spontaneous tone of isolated guinea-pig trachealis preparations by the 3-alkylxanthines and 1-methyl-3-alkylxanthines were determined. 4. The five 1-methyl-3-alkylxanthines were each more potent in relaxing isolated trachealis smooth muscle than the corresponding 3-alkylxanthines. The 1-methyl-3-alkylxanthines were also more potent than the corresponding 3-alkylxanthines in their cyclic GMP PDE inhibitory effect. There was a strong positive correlation between the concentration of inhibitor which inhibited hydrolysis by 50% (IC50) values for cyclic GMP PDE inhibition by the xanthine derivatives and their EC50 values for trachealis muscle relaxation. 5. It is suggested that the mechanism by which xanthine derivatives relax trachealis smooth muscle involves inhibition of cyclic GMP PDE in addition to inhibition of cyclic adenosine monophosphate PDE.

Comparison of theophylline and enprofylline effects on human neutrophil superoxide production.

1. We investigated effects of theophylline (widely used for the treatment of asthma) and enprofylline (a new xanthine derivative with negligible adenosine antagonism) on O2- production by human neutrophils with n-formyl-methionyl-leucyl-phenylalanine (FMLP) stimulation. 2. Therapeutic concentrations of theophylline (1-100 mumol/L) enhanced O2- production, maximally by 43.1 +/- 24.4% at 30 mumol/L; the same concentrations of enprofylline inhibited O2- production. 3. When each agent was administered after pre-incubation with adenosine deaminase (ADA) (0.1 U/mL), O2- production was inhibited in a concentration-dependent manner in comparison with that under administration of ADA alone. 4. These results suggest that the difference of effects in the two xanthine derivatives at therapeutic concentrations might be due to the presence or absence of adenosine antagonism.

Mechanism of atrial natriuretic polypeptide and sodium nitroprusside-induced relaxation in guinea-pig tracheal smooth muscle.

Atrial natriuretic polypeptide (ANP) is composed of a family of peptides isolated from rat and human atria. In the present study, the relaxant effects of ANP, sodium nitroprusside and 8-bromo-cyclic guanosine monophosphate (GMP) were investigated in guinea-pig tracheal smooth muscle, and the tissue cyclic GMP and cyclic adenosine monophosphate (AMP) concentrations were measured. ANP, sodium nitroprusside and 8-bromo-cyclic GMP showed relaxant effects on the spontaneous tone in normal Krebs solution (5.9 mmol/l K(+)-2.4 mmol/l Ca++ solution). They diminished relaxant effects on 40 mmol/l K(+)-0.1 mmol/l Ca++ induced contraction, which was approximately the same tension as the spontaneous tone. Sodium nitroprusside and 8-bromo-cyclic GMP diminished less relaxant effects on 40 mmol/l K(+)-2.4 mmol/l Ca++ induced contraction, but ANP showed no relaxation. The tissue cyclic GMP levels following administration of ANP and sodium nitroprusside in normal Krebs solution, in 40 mmol/l K(+)-2.4 mmol/l Ca++ solution, and in 40 mmol/l K(+)-0.1 mmol/l Ca++ solution increased dose-dependently without regard to external Ca++ concentrations, while the tissue cyclic AMP levels did not change. These results suggest that ANP might be a novel potent relaxant in airway smooth muscle and the relaxant effect may be, at least in part, mediated by cyclic GMP. There was a difference in relaxant effects on tracheal smooth muscle between ANP and sodium nitroprusside.

Emphysematous change in chronic asthma in relation to cigarette smoking. Assessment by computed tomography.

To evaluate the occurrence and the degree of emphysema in chronic asthma in relation to the effect of cigarette smoking, we examined 35 subjects with irreversible airway obstruction (17 nonsmokers and 18 smokers). We performed pulmonary function testing and CT scans on all subjects. The ES was assessed by a visual scoring system on CT scans. Between nonsmokers and smokers, there was a significant difference in the ES (p less than 0.05), but not in the FEV1, TLC, and Dsb/VA (expressed as percent predicted values). The ES was 2.3 +/- 4.7 percent (mean +/- SD) in nonsmoking subjects and 13.7 +/- 16.7 percent in smoking subjects. In all subjects the ES showed significant correlations with Dsb/VA (p less than 0.001) and pack-years of cigarette consumption (p less than 0.001) but did not show correlations with FEV1 and with TLC. We concluded that emphysema can occur in smoking asthmatic subjects because of the effect of cigarette smoking, and CT scans are useful for detecting this emphysematous change.

[Effect of pulsed electromagnetic fields (PEMF) on osteoblast-like cells. Alterations of intracellular Ca2+].

Low-energy electromagnetic fields pulsed at frequencies of 60-90 Hz significantly increase healing of chronic fracture nonunions in man. These fields are effective at tissue current levels as low as several orders of magnitude lower than those required for transmembrane depolarization of normal cells. In this study, the effects of PEMF on culture of rat osteoblast-like cells have been examined. The PEMF promoted the growth of these cells, were also found to increase the basal level of [Ca2+]i, and to decrease the responses towards epidermal growth factor (EGF) and serum, when the degree of response was based on the intracellular Ca2+ transient. These effects of PEMF were mimicked by 12-O-tetradecanoyl phorbol 13-acetate (TPA), a potent activator of protein kinase C. Pretreatment of TPA enhanced the cell growth and suppressed the intracellular Ca2+ transient induced with EGF and then serum to about 170% of the control. Then, present study investigated how the PEMF and TPA modulate EGF receptors of these cells. Both PEMF and TPA decreased the level of EGF binding to these cells down to about 65% and 75%, respectively. Scatchard analysis revealed the decrease of EGF receptor without a significant change in the affinity for EGF by both. In conclusion, it was indicated that PEMF acts at cell membrane and modulates the receptors which is essential for cell growth and DNA synthesis.

[Effect of pulsed electromagnetic fields (PEMF) on human periodontal ligament in vitro. Alterations of intracellular Ca2+].

The concept of orthodontic tooth movement is based on the hypothesis that teeth move as a result of the biological response of periodontal tissues to the mechanical forces applied. There is a widely held hypothesis that mechanical stress generates an electrical signal which sets in motion the subsequent events, as in bone exposed to mechanical forces electrical currents are produced affect bone growth and remodeling. This implies a transduction mechanism which translates the electrical signal into a biochemical message, recognizable by the cellular machine. This study is aimed at the identification of the message and the investigation of its control. In fact, the effect of Pulsed Electromagnetic Fields (PEMF) on the intracellular second messenger, cytoplasmic Ca2+ in Human Periodontal Ligament Fibroblasts (HPLF) was investigated. The resting intracellular ionized calcium concentration ([Ca+2]i) of HPLF cells was 232.7 +/- 25.0 nM, and with PEMF [Ca2+]i increased from 12 hrs to 499.0 +/- 115.5 nM up to 12 hrs, then reached to a steady level through 24 hrs. The PEMF were also found to decrease the responses towards epidermal growth factor (EGF) and serum, when the degree of response was based on the intracellular Ca2+ transient. These effects of PEMF were mimicked by 12-0-tetradecanoyl phorbol 13-acetate (TPA), a potent activator of protein kinase C. Some reports have suggested that fibroblasts of the periodontal ligament contain high alkaline phosphatase (ALPase) activity as much as osteoblast. Since similar results concerning the [Ca2+]i were obtained in osteoblast (OB)-like cells, this experiment also supports the hypothesis that fibroblasts of periodontal ligament have osteoblastic features.