Evidence of slow and variable choice-stepping reaction time in cancer survivors with chemotherapy-induced peripheral neuropathy.

BACKGROUND: Chemotherapy-induced peripheral neuropathy (CIPN) is reported to affect up to 70 % of cancer survivors. Despite evidence that CIPN-related impairments often translate into balance and mobility deficits, the effects on stepping and quality of gait, well-documented risk factors for falls, are unclear. AIMS: (i) Establish choice-stepping reaction time (CSRT) performance in survivors with CIPN compared to young and older healthy controls and people with Parkinson's disease; (ii) document walking stability; (iii) investigate relationships between stepping and gait data to objective and patient-reported outcomes. METHODS: 41 cancer survivors with CIPN (mean (SD) age: 60.8 (9.7) years) who were ≥3months post chemotherapy, performed tests of simple and inhibitory CSRT. Walking stability measures were derived from 3-D accelerometry data during the 6-minute walk test. CIPN was assessed using neurological grading and patient-reported outcome measures (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire in CIPN Questionnaire scale EORTC CIPN20). RESULTS: In both stepping tests, CIPN participants performed at the level of adults aged 10 years older and people with mild to moderate Parkinson's disease. Mean (SD) total stepping response times in both CSRT (1160 (190) milliseconds) and inhibitory CSRT (1191 (164) milliseconds) tests were not associated with objective neurological grading but were correlated with increased difficulty feeling the ground. Participants with lower-limb vibration sensation deficit had slower and more variable CSRT times. There were no associations between walking stability and objective measures of CIPN, and limited correlations with the EORTC-CIPN20. CONCLUSIONS: Cancer survivors with CIPN showed deficits in voluntary stepping responses and seemed to compensate for their sensory and motor deficits by walking slower to maintain stability. Objective and patient-reported outcomes of CIPN were correlated with slower and more variable stepping response times. Future studies should aim to identify the causes of the apparent premature decline in cognitive-motor function and develop remediating interventions.

An assessment of the acute dietary exposure to glyphosate using deterministic and probabilistic methods.

Use of glyphosate in crop production can lead to residues of the active substance and related metabolites in food. Glyphosate has never been considered acutely toxic; however, in 2015 the European Food Safety Authority (EFSA) proposed an acute reference dose (ARfD). This differs from the Joint FAO/WHO Meeting on Pesticide Residues (JMPR) who in 2016, in line with their existing position, concluded that an ARfD was not necessary for glyphosate. This paper makes a comprehensive assessment of short-term dietary exposure to glyphosate from potentially treated crops grown in the EU and imported third-country food sources. European Union and global deterministic models were used to make estimates of short-term dietary exposure (generally defined as up to 24 h). Estimates were refined using food-processing information, residues monitoring data, national dietary exposure models, and basic probabilistic approaches to estimating dietary exposure. Calculated exposures levels were compared to the ARfD, considered to be the amount of a substance that can be consumed in a single meal, or 24-h period, without appreciable health risk. Acute dietary intakes were <100% of the ARfD for all foodstuffs, except wild fungi, when calculated using the EFSA model. The model assumptions differ from those of the source model (German national model), resulting in the use of a higher variability factor. Intakes estimated with the German model represented only 18% of the ARfD. The impact of differing assumptions regarding variability and other input parameters is discussed. Probabilistic exposure estimates showed that the acute intake on no person-days exceeded 10% of the ARfD, even for the pessimistic scenario.

An assessment of dietary exposure to glyphosate using refined deterministic and probabilistic methods.

Glyphosate is a herbicide used to control broad-leaved weeds. Some uses of glyphosate in crop production can lead to residues of the active substance and related metabolites in food. This paper uses data on residue levels, processing information and consumption patterns, to assess theoretical lifetime dietary exposure to glyphosate. Initial estimates were made assuming exposure to the highest permitted residue levels in foods. These intakes were then refined using median residue levels from trials, processing information, and monitoring data to achieve a more realistic estimate of exposure. Estimates were made using deterministic and probabilistic methods. Exposures were compared to the acceptable daily intake (ADI)-the amount of a substance that can be consumed daily without an appreciable health risk. Refined deterministic intakes for all consumers were at or below 2.1% of the ADI. Variations were due to cultural differences in consumption patterns and the level of aggregation of the dietary information in calculation models, which allows refinements for processing. Probabilistic exposure estimates ranged from 0.03% to 0.90% of the ADI, depending on whether optimistic or pessimistic assumptions were made in the calculations. Additional refinements would be possible if further data on processing and from residues monitoring programmes were available.

The efficacy of HER2-targeted agents in metastatic breast cancer: a meta-analysis.

BACKGROUND: The addition of HER2-targeted agents to standard treatment has been shown to improve outcomes for HER2 positive metastatic breast cancer patients. We undertook a meta-analysis to evaluate the efficacy of HER2-targeted therapy in addition to standard treatment in metastatic breast cancer patients. PATIENTS AND METHODS: Eligible trials were randomised controlled trials (RCTs) comparing the addition of HER2 therapy to standard treatment (hormone or chemotherapy) reporting overall survival (OS), time to progression (TTP), progression-free survival (PFS) and/or response rates. RESULTS: Eight trials comprising 1848 patients were eligible for inclusion. HER2-targeted agents were trastuzumab and lapatinib and therapeutic partners were taxanes (4 RCTs), anthracyclines (1), capecitabine (2), anastrozole (1) and letrozole (1). The addition of HER2-targeted agents improved OS [hazard ratios (HR) 0.78; 95% confidence interval (CI) 0.67-0.91], TTP (HR 0.56; 95% CI 0.48-0.64), PFS (HR 0.63; 95% CI 0.53-0.74) and overall response rate (relative risk 1.67; 95% CI 1.46-1.90). CONCLUSIONS: Our meta-analysis confirms the benefit of adding HER2-targeted therapy to standard treatment in HER2 positive metastatic breast cancer. Compared with OS, TTP, PFS and ORR overestimate treatment benefit. Trials in our meta-analysis differed in terms of partner drug or HER2 agents, yet delivered comparable outcomes.

Evaluation of potassium iodide (KI) and ammonium perchlorate (NH4ClO4) to ameliorate 131I- exposure in the rat.

Nuclear reactor accidents and the threat of nuclear terrorism have heightened the concern for adverse health risks associated with radiation poisoning. Potassium iodide (KI) is the only pharmaceutical intervention that is currently approved by the Food and Drug Administration for treating (131)I(-) exposure, a common radioactive fission product. Though effective, KI administration needs to occur prior to or as soon as possible (within a few hours) after radioactive exposure to maximize the radioprotective benefits of KI. During the Chernobyl nuclear reactor accident, KI was not administered soon enough after radiation poisoning occurred to thousands of people. The delay in administration of KI resulted in an increased incidence of childhood thyroid cancer. Perchlorate (ClO(4)(-)) was suggested as another pharmaceutical radioprotectant for 131I- poisoning because of its ability to block thyroidal uptake of iodide and discharge free iodide from the thyroid gland. The objective of this study was to compare the ability of KI and ammonium perchlorate to reduce thyroid gland exposure to radioactive iodide (131I-). Rats were dosed with 131I- tracer and 0.5 and 3 h later dosed orally with 30 mg/kg of either ammonium perchlorate or KI. Compared to controls, both anion treatments reduced thyroid gland exposure to 131I- equally, with a reduction ranging from 65 to 77%. Ammonium perchlorate was more effective than stable iodide for whole-body radioprotectant effectiveness. KI-treated animals excreted only 30% of the (131)I(-) in urine after 15 h, compared to 47% in ammonium perchlorate-treated rats. Taken together, data suggest that KI and ammonium perchlorate are both able to reduce thyroid gland exposure to 131I- up to 3 h after exposure to 131I-. Ammonium perchlorate may offer an advantage over KI because of its ability to clear 131I- from the body.

Physical activity uptake in patients with HIV: who does how much?

Regular physical activity is recommended for patients with human immunodeficiency virus (HIV) to help manage their disease. However, to date, little is known about levels of uptake of this advice. This study describes daily physical activity in HIV antibody-positive patients attending a public hospital infectious diseases clinic, compares them with those of patients attending the clinic for general infectious diseases and investigates compliance with the recommendations of the Centres for Disease Control and Prevention and American College of Sports Medicine physical activity guidelines. During April 2006, 261 patients completed the International Physical Activity Questionnaire short form. One hundred and ninety-one reported being HIV antibody-positive. Results showed that 1:4 HIV antibody-positive and 1:3 HIV antibody-negative respondents failed to meet the recommended guidelines. These findings are of concern, given the evidence-based benefits of regular physical activity. Further work is needed to identify barriers to participation and interventions that can improve uptake.

Achilles tendon imaging.

The Achilles tendon is the largest and strongest tendon in the body, yet one of the most commonly injured. Tendon degeneration is a relatively common disorder, predisposing to tears and often associated with paratenonitis. Numerous other diseases involve the Achilles tendon, some with classic imaging appearances, others with non-specific appearances. The aim of this pictorial essay is to review the radiographic, computed tomographic, ultrasonographic and MR appearances of the normal and diseased Achilles tendon.

Effects of refining predicted chronic dietary intakes of pesticide residues: a case study using glyphosate.

A chronic consumer risk assessment based on a worst-case scenario, conducted as part of the European Union review leading to Annex I inclusion for glyphosate, was evaluated and refined. An extensive database of information on the effects of processing on the levels of glyphosate residues in food is available. This database together with refined consumption data from the UK's surveys of adults and toddlers and extensive monitoring data of glyphosate residues in mainly cereal products conducted in the UK were combined to examine the potential overestimates of dietary intakes that are predicted using the current regulatory methodology developed by the Food and Agricultural Organization/World Health Organization and applied as part of the European Union regulatory process. Analysis focussed on the chronic exposure from treated cereals, the crop group contributing significantly to the dietary intake of glyphosate residues. A steep reduction of predicted intake was seen when progressively realistic measures of residues were incorporated into the models, giving a strong indication of the conservative nature of current regulatory procedures. Calculations using even the most unrefined methodology gave rise to intakes of up to 11% of the acceptable daily intake, this was reduced to 0.6% of the acceptable daily intake when justifiable refinements based on extensive monitoring data collected in the UK were made. Consumption data for processed foods abstracted from the UK Food Standard Agency's database were used to refine further the predicted dietary intakes as a result of residue reductions or concentration from processing. The current regulatory model used in the UK generally only has the potential to use a single value for consumption of a particular food. The Pesticides Safety Directorate model consistently predicted the highest intakes with the exception of intakes by adults using the supervised trials median residue and median monitoring data. This suggests that conservatism in the regulatory model exists particularly where specific processing factors cannot be applied to individual fractions of the diet.

BH3-only Bcl-2 family members are coordinately regulated by the JNK pathway and require Bax to induce apoptosis in neurons.

The Bcl-2 family of proteins are key regulators of programmed cell death. A distinct subfamily of BH3-only molecules has been identified, but their exact mechanism of action remains unclear. Here we show that the BH3-only Bcl-2 family members, Dp5/Hrk and Bim, are induced upstream of the Bax checkpoint in neuronal apoptosis in a manner that shows significant dependence on JNK signaling. We also show that Dp5 and other BH3-only proteins kill cerebellar granule neurons in a Bax-dependent manner. These studies demonstrate that BH3-only members do not act independently in their proapoptotic activities but rather require the action of multidomain proapoptotic Bcl-2 family members to produce cell death.

Expression of GRK2 is increased in the left ventricles of cardiomyopathic hamsters.

Reduced beta-adrenergic responsiveness in the heart is a characteristic feature of heart failure. G protein-coupled receptor kinase 2 (GRK2) phosphorylates beta-adrenoceptors in an agonist-dependent manner, causing receptor uncoupling and desensitisation. Elevated levels of both GRK2 mRNA and activity have been shown to occur in the failing human heart (Ungerer et al. (1992) Circulation 87: 454-463). We have analysed levels of GRK2 protein in heart tissue from the cardiomyopathic Syrian hamster CHF 147 and compared these to GRK2 levels in age-matched, non-cardiomyopathic control hamsters (CHF 148). GRK2 protein levels were found to be significantly increased in the left ventricles of the cardiomyopathic hamsters compared to the controls. The relative amounts of GRK2 in the cardiomyopathic hamsters, as compared to normal controls, increased with age from 2-fold at 100 days to 5-fold at 350 days. These animals should provide a useful model for testing the effect of GRK2 inhibitors on the development of heart failure.

Nonylphenol affects gonadotropin levels in the pituitary gland and plasma of female rainbow trout.

Female rainbow trout (Oncorhynchus mykiss) were exposed to 4-nonylphenol (NP) at (mean measured) concentrations of 0.7, 8.3, and 85.6 micrograms/L for 18 weeks, during early ovarian development. Fish were sampled sublethally every six weeks, and terminal samples were taken at 18 weeks. NP induced an estrogenic effect (the synthesis of vitellogenin) at concentrations of 8.3 and 85.6 micrograms/L. An effect on gonadotropin synthesis and secretion was also observed. Plasma follicle stimulating hormone (FSH) levels and FSH gene expression in the pituitary were the most sensitive endpoints assessed, being reduced at the lowest dose employed (0.7 microgram NP/L). Pituitary gland luteinizing hormone (LH) content was significantly lower in fish exposed to 85.6 micrograms NP/L, and LH gene expression was suppressed in fish exposed to 8.3 and 85.6 micrograms NP/L. In contrast, plasma LH concentration increased in these fish, but by a very minor absolute amount, and returned to control levels by the final sampling time. Gonadal development ceased in the fish exposed to 85.6 micrograms NP/L, and steroidogenesis in these fish was also markedly inhibited. Although the mechanisms underlying these responses are unknown, this study demonstrates that NP has adverse effects on pituitary function that can result in inhibition of ovarian development.

Factors affecting the transfer of organochlorine pesticide residues to breastmilk.

Existing studies monitoring organochlorine pesticide residues in breastmilk were examined to identify whether common factors determine the extent of transfer of these residues. A structured review of the English language literature was conducted. Papers were reviewed and assessed using a structured protocol. A total of 77 papers were initially identified, 46 of which contained conclusions relating to the factors which may affect the transfer of residues into breastmilk. Owing to the diversity of findings, papers were screened further to include only those in which a minimum of background information relating to selection of mothers and to milk sampling procedures were reported. Only eight papers were deemed to contain adequate information. Age, parity/length of previous lactation, fat mobilisation and the time of sampling were identified as the most likely factors to be considered when assessing transfer of organochlorine pesticide residues into breastmilk. This review highlights the difficulties of assessing trends in breastmilk contaminants where comparable sampling procedures are not used.

Immunohistochemical localization of adenosine A1 receptors in human brain regions.

Adenosine exerts its physiological actions by binding to G-protein coupled receptors, four of which have been identified and cloned to date (A1, A2a, A2b and A3). Here we report the development of anti-human adenosine A1, receptor anti-peptide polyclonal antibodies and their use to define the distribution of A1, receptors in human brain regions, spinal cord and trigeminal ganglia by an immunohistochemical approach. Although the distribution of adenosine A1, receptor and its mRNA in the human brain has been investigated in the past by autoradiography and in situ hybridization, this is the first demonstration of localization of the A1, receptors by immunohistochemical means. Our localization data broadly agree with immunohistochemical data published for the human brain obtained using other experimental approaches. Furthermore, we have demonstrated the novel finding that abundant expression of the adenosine A1, receptor protein occurs in the trigeminal ganglia, which may be suggestive of a role of this receptor in analgesia.

Sex-change chemicals and their influence on the brain.

The potential for man-made chemicals to mimic or antagonise natural hormones is a controversial issue, but one for which increasing amounts of evidence are being gathered worldwide. The controversy surrounds not so much the matter of whether these chemicals can mimic hormones in vitro--this phenomenon has been widely accepted in the scientific world - but more whether, as a result, they can disrupt reproduction in a wildlife situation. It has, nevertheless, been acknowledged that many wildlife populations are exhibiting reproductive and/or developmental abnormalities such as intersex gonads in wild roach populations in the U.K. and various reproductive disorders in alligators in Lake Apopka, Florida. However, the causative agents for many of these effects are difficult to specify, due to the extensive mixtures of chemicals--each of which may act via different pathways--to which wild populations are exposed, together with the wide variability observed even in natural (uncontaminated) habitats. As a result, any information detailing fundamental mechanism of action of the so-called endocrine disrupting chemicals (EDCs) is of use in determining whether or not these chemicals, as they are present in the environment, may in fact be capable of causing some of the effects observed in wildlife over recent years.

Assessing the risks of pesticide residues to consumers: recent and future developments.

Assessing exposure of consumers to pesticide residues is an area of regulatory science that has rapidly developed over the last decade. From simplistic, deterministic models calculating lifetime exposure for adults only, assessment procedures have diversified so that more realistic estimates of long term exposures for adults, schoolchildren, toddlers and infants and short term exposures for adults and toddlers (who generally bound the more extreme consumer patterns) are now carried out. The final assessment of risk still remains a simplistic numeric comparison against hazard assessment based on a wide range of toxicity studies incorporating the appropriate safety or uncertainty factors. As development of risk assessments continues, the use of probabilistic models is becoming an invaluable information tool for quantitative risk management and aiding assessment of cumulative exposure. This paper examines the recent developments in risk assessment and consumer perception of the risks of pesticide residues, and speculates where the future developments in these areas may lie.

Architecture of the medial gastrocnemius in children with spastic diplegia.

Ultrasound images were obtained of the medial gastrocnemius at different ankle joint positions with the knee extended. Fascicle length and deep fascicle angle were measured in five normally developing adults (mean age 33 years, age range 24 to 36 years) and in five normally developing children (mean age 7.8 years, age range 7 to 11 years), and in seven children with spastic diplegia (mean age 10 years, age range 6 to 13 years). These architectural variables were similar in the groups of normally developing adults and children. Importantly, no statistical difference could be found between the normally developing children and those with diplegia for fascicle length. Deep fascicle angles were reduced significantly in the clinical group at a particular ankle joint angle but not at the resting angles. The difference in deep fascicle angles is explained as a function of resting muscle length and is not attributed any clinical importance. Our results do not explain the structural origin of muscle contracture explicitly. However, they do indicate that most of the fixed shortness in the medial gastrocnemii of ambulant children with spastic diplegia is not due to reduced muscle fascicle length. We suggest that muscle contracture may be better explained in terms of shortness of the aponeuroses of pennate muscles, such as the medial gastrocnemius, through reduced muscle fascicle diameter.

Myogenin is a specific marker for rhabdomyosarcoma: an immunohistochemical study in paraffin-embedded tissues.

Myogenin belongs to a group of myogenic regulatory proteins whose expression determines commitment and differentiation of primitive mesenchymal cells into skeletal muscle. The expression of myogenin has been demonstrated to be extremely specific for rhabdomyoblastic differentiation, which makes it a useful marker in the differential diagnosis of rhabdomyosarcomas (RMS) from other malignant small round cell tumors of childhood. Commercially available antibodies capable of detecting myogenin in routinely processed formalin-fixed paraffin-embedded (FFPE) tissue are now available. In this study, we evaluated myogenin expression using the monoclonal myf-4 antibody (Novocastra Labs) on FFPE in a large number of pediatric tumors in order to define the clinical utility of this marker. A total of 119 tumors were studied. These included 48 alveolar RMS (ARMS), 20 embryonal RMS (ERMS), one spindle cell RMS, 16 Ewing's sarcomas (ES), six nephroblastomas, two ectomesenchymomas, seven precursor hematopoietic neoplasms, five olfactory neuroblastomas, three neuroblastomas, six desmoplastic small round cell tumors, and five rhabdoid tumors. Distinct nuclear staining for myogenin was noted in all 69 RMS. Notably, the number of positive tumor cells differed between the ARMS and ERMS. In ARMS, the majority of tumor cells (75 to 100%) were positive, in contrast to ERMS, in which the positivity ranged from rare + to 25% in all but three tumors. Additionally, myogenin positivity was seen in two of two ectomesenchymomas and in two nephroblastomas with myogenous differentiation. All other tumors were clearly negative. Our results indicate that staining for myogenin is an extremely reliable and specific marker for rhabdomyoblastic differentiation. It gives consistent and easily interpretable results in routinely fixed tissues.