Impact of sequence order of anthracyclines and taxanes in neoadjuvant chemotherapy on pathologic complete response rate in HER2-negative breast cancer patients.

PURPOSE: Data exploring optimal sequencing of anthracyclines and taxanes as neoadjuvant chemotherapy (NACT) for breast cancer are limited and inconsistent. The objective of this study was to assess the real-world impact of sequence order on pathologic complete response (pCR) and clinical outcomes from NACT. METHODS: Patients with HER2-negative breast cancer treated with NACT from May 2012 to April 2020 were identified from a prospectively collected institutional database. The primary endpoint was to compare rates of pCR (ypT0/isN0) between patients who received anthracyclines followed by taxanes (AC-T) to those who received taxanes followed by anthracyclines (T-AC). Additional endpoints of interest included clinical complete response, downstaging, Neo-Bioscore, conversion to breast-conserving surgery eligibility, relapse-free survival, and overall survival between groups. RESULTS: Of the 283 patients who met eligibility criteria, 187 (66%) received AC-T and 96 (34%) received T-AC. Sequence order did not influence the primary endpoint of pCR rate (19% for AC-T vs. 21% for T-AC, p = 0.752). There were also no significant differences in secondary NACT efficacy outcomes between groups. In the overall cohort, pCR rate was higher in patients with triple-negative breast cancer (TNBC) (32% vs. 13% in hormone-positive cancer, p < 0.001) and grade 3 tumors (31% vs. 12% for grade 1-2 tumors, p < 0.001). CONCLUSIONS: In this real-world analysis of HER2-negative breast cancer patients, there was no differential impact on pCR rate or clinical outcomes from NACT with sequence order of anthracyclines and taxanes. This supports the current variation in prescribing practice.

Screening for new primary cancers in patients with metastatic breast cancer: a provincial analysis of the Choosing Wisely Canada recommendations.

Introduction: Patients with metastatic cancer have a decreased life expectancy, and with screening and surveillance for new primary cancers, they run the risk of immediate harm with little chance of any benefit. Choosing Wisely Canada therefore recommends that such investigations be avoided in patients with metastatic disease. Methods: We examined cancer screening practices in a subset of patients with metastatic cancer in Newfoundland and Labrador. Patients with metastatic breast cancer seen at the provincial cancer clinic during 2014-2016 were identified from the Newfoundland and Labrador Cancer Registry. For each patient, we assessed whether any one or a combination of screening mammography, Pap (Papanicolaou) test, flexible sigmoidoscopy or colonoscopy, or fecal immunohistochemical test were performed at any point after the diagnosis of metastatic disease. Results: Of 305 patients with metastatic breast cancer, 114 (37.4%) underwent at least 1 screening investigation (mean: 2.92 investigations per screened patient). The most common screening investigations were mammography (n = 197) and Pap test (n = 107). Primary care providers ordered most of the screening investigations (70%); oncology specialists ordered 14%, and other specialists, 12%. Median overall survival for patients with breast cancer after a diagnosis of metastatic disease was 42 months, with a 5-year overall survival of 35.9%. Conclusions: A significant proportion of patients with metastatic breast cancer in Newfoundland and Labrador are still undergoing screening for new primary malignancies, which is discordant with oncology guidelines from Choosing Wisely Canada. Increased education strategies are needed if the Choosing Wisely Canada recommendations are to be implemented into routine clinical practice.

Cleavage of poly(cis-1,4-isoprene) rubber as solid substrate by cultures of Gordonia polyisoprenivorans.

Potential biotechnological recycling processes for rubber products include the bacterial degradation of poly(cis-1,4-isoprene) (IR) in order to achieve its total biodegradation or its biotransformation into useful products. The actinomycete Gordonia polyisoprenivorans strain VH2 catalyzes the degradation of IR and enables its use as a sole carbon source via ß-oxidation. The initial cleavage reaction is catalyzed by the extracellular latex clearing protein (Lcp). This dioxygenase is the key enzyme for the formation of oligo(cis-1,4-isoprene) molecules with different lengths, i.e., numbers of isoprene units. For the first time, IR was used as a solid substrate in 2-l fermenters. Two different particle size fractions (63-500 and 500-1000 µm) and three stirring rates (300, 400 and 500 rpm) were evaluated in the process. An increase of the cell concentration was achieved by using smaller particles and by using lower stirring rates, reaching a final biomass concentration of 0.52 g l-1 at 300 rpm after 12 days of cultivation. In order to enhance the formation of oligo(cis-1,4-isoprene) molecules, a transposon insertion mutant (TH5) of G. polyisoprenivorans strain VH2 that has lost the ability to transport the partial degradation products into the cells was used, thereby allowing the accumulation of the degradation products in the culture supernatants. Propionate, glucose and glycerol were evaluated as additional carbon sources besides IR, and the highest yields were observed on propionate. In 2-l bioreactors with pH control, different feeding regimes were performed during cultivation by the addition of propionate every 24 or 48 h for 16 days. After liquid-liquid extraction and a derivatization with Girard's T reagent, the oligo(cis-1,4-isoprene) molecules were detected by ESI-MS. The mass distribution of the degradation products was affected by the selection of the extraction solvent, but no influence of longer cultivation periods was detected.

X-ray magneto-optical polarization spectroscopy: an analysis from the visible region to the x-ray regime.

An ultra-high vacuum compatible multipurpose chamber for magneto-optical reflection and transmission experiments with polarization analysis on magnetic systems is introduced. It is applicable in a broad photon energy range from the visible to the soft x-ray regime and for a wide angular range from grazing to normal incidence. It exploits a novel magnetization device based on rotating permanent magnets, which generates tuneable magnetic fields up to 570 mT in longitudinal, transverse and polar geometry. The unique combination of these features enables the feasibility of all typical magneto-optical spectroscopy techniques as T-MOKE, L-MOKE, P-MOKE, x-ray magneto optical linear dichroism, x-ray magnetic circular dichroism in reflection and Kerr polarization-spectroscopy, which is demonstrated for Co with focus on the Co 3p edges.

[Therapeutic apheresis for autoimmune encephalitis: a nationwide data collection]. / Therapeutische Apherese bei autoimmuner Enzephalitis: Eine bundesweite Datenerhebung.

BACKGROUND: The correlation between detection of autoantibodies and the pattern and severity of symptoms in patients with encephalitis was the crucial factor for the initiation of immune therapy. The elimination of autoantibodies using therapeutic apheresis by plasma exchange (PE) and immunoadsorption (IA) is a pathophysiologically guided therapeutic approach. The aim was to evaluate the current use of PE and for the first time also of IA for patients with autoimmune encephalitis. METHODS: A nationwide data collection was performed and the modified Rankin score (mRS) was used to evaluate the severity of neurological symptoms. RESULTS: Data of 31 treatment courses (30 patients and 1 relapse) were documented and 22 patients were positive for autoantibodies (NMDA-R, GABA, VGKC, Hu). In 23 cases PA was performed, tryptophan IA in 7 cases and in 1 patient both methods were applied. In 67 % of the treatment courses the mRS improved and the mean mRS of all patients was 3.2 before apheresis and 2.2 after apheresis (p < 0.05). All patients who were treated with IA improved clinically from a mean mRS of 3.9 before IA to 1.9 after IA (p < 0.01). CONCLUSIONS: For immune-mediated forms of encephalitis rapid elimination of autoantibodies with PA and IA seems to be an effective therapeutic option as part of a multimodal immune therapy and is already established in many clinics in Germany.

TetraMag: a compact magnetizing device based on eight rotating permanent magnets.

In this paper we describe a novel magnetizing device based on eight rotatable permanent magnets arranged in a quadrupolar configuration, which is termed the TetraMag. TetraMag creates stable and homogeneous magnetic fields at the sample position with a resolution of 0.02 mT tunable between -570 mT and +570 mT. The field direction is continuously rotatable between 0° and 360° within the sample plane, while the field strength is maintained. A simplified mathematical description of TetraMag is developed leading to magnetic field calculations which are in good agreement with the experimental results. This versatile device avoids electrical energy dissipation, cooling mechanisms, and hysteresis effects known from classical electromagnets. It is ultrahigh vacuum compatible and it offers a completely free optical path over 180° for magneto-optical experiments. It is suitable for scattering experiments with synchrotron radiation and neutrons and may be employed in a large class of magnetization experiments.

In vivo fluxes in the ammonium-assimilatory pathways in corynebacterium glutamicum studied by 15N nuclear magnetic resonance

Glutamate dehydrogenase (GDH) and glutamine synthetase (GS)-glutamine 2-oxoglutarate-aminotransferase (GOGAT) represent the two main pathways of ammonium assimilation in Corynebacterium glutamicum. In this study, the ammonium assimilating fluxes in vivo in the wild-type ATCC 13032 strain and its GDH mutant were quantitated in continuous cultures. To do this, the incorporation of 15N label from [15N]ammonium in glutamate and glutamine was monitored with a time resolution of about 10 min with in vivo 15N nuclear magnetic resonance (NMR) used in combination with a recently developed high-cell-density membrane-cyclone NMR bioreactor system. The data were used to tune a standard differential equation model of ammonium assimilation that comprised ammonia transmembrane diffusion, GDH, GS, GOGAT, and glutamine amidotransferases, as well as the anabolic incorporation of glutamate and glutamine into biomass. The results provided a detailed picture of the fluxes involved in ammonium assimilation in the two different C. glutamicum strains in vivo. In both strains, transmembrane equilibration of 100 mM [15N]ammonium took less than 2 min. In the wild type, an unexpectedly high fraction of 28% of the NH4+ was assimilated via the GS reaction in glutamine, while 72% were assimilated by the reversible GDH reaction via glutamate. GOGAT was inactive. The analysis identified glutamine as an important nitrogen donor in amidotransferase reactions. The experimentally determined amount of 28% of nitrogen assimilated via glutamine is close to a theoretical 21% calculated from the high peptidoglycan content of C. glutamicum. In the GDH mutant, glutamate was exclusively synthesized over the GS/GOGAT pathway. Its level was threefold reduced compared to the wild type.

The lethal effects of Cyperus iria on Aedes aegypti.

The sedge Cyperus iria, a common weed in rice, contains large amounts of the insect hormone (10R) juvenile hormone III (JH III). Given its widespread distribution in Asia and Africa, we examined the possibility that C. iria could be used as a safe, inexpensive, and readily available mosquito larvicide. Plants of varying ages were harvested and leaves tested for lethal effects on larvae of the yellow fever mosquito, Aedes aegypti. The median lethal doses (LD50s) for frozen leaves from 1- and 2-month-old plants were 267 and 427 mg/100 ml of water, respectively. Leaves from 1-month-old C. iria contained 193 micrograms JH III/g fresh weight, whereas leaves from 2-month-old plants contained 143 micrograms JH III/g fresh weight. Larval sensitivity to the plant differed with age; 4-day-old larvae displayed the greatest mortality followed in decreasing sensitivity by larvae 5, 6, 3, and 2 days old. Six Cyperus species (C. albostriatus, C. alternifolius, C. esculentus, C. iria, C. miliifolius, and C. papyrus) of similar developmental stage were assayed for JH III content. Only C. iria was found to contain significant levels of JH III.

[Agoraphobia and "psychogenic"-attributed gait disorder as symptoms of "stiff-man" syndrome]. / Agoraphobie und "psychogen" anmutende Gangstörung als Symptome eines "stiff-man"-Syndroms (SMS).

We report on two patients with truncal rigidity and agoraphobia. The fear of crossing open places had been judged as psychogenic in both cases. The detection of positive GAD-antibodies led to our final diagnosis. Treatment with liquorphoresis and clonazepam or diazepam alone resulted in a prompt amelioration of the rigidity and, to a lesser extent, of the agoraphobia as well. The stiff-man syndrome has neurological and psychological aspects and shows one more facet of the syndrome of agoraphobia first described by Westphal.

Isolation of the Corynebacterium glutamicum glnA gene encoding glutamine synthetase I.

The Corynebacterium glutamicum glutamine synthetase I (GSI) structural gene glnA was cloned by a PCR approach using oligonucleotide primers derived from conserved amino acid sequences of the GSI proteins from various bacteria. Disruption or deletion of this gene in C. glutamicum led to a glutamine auxotrophic phenotype and complete loss of glutamine synthetase activity, indicating the key role of this enzyme in nitrogen metabolism. Additionally, indications for a second glutamine synthetase, GSII, were found.

Subcutaneous microvascular (capillary) calcification. Another basis for livedo-like skin changes?

A morbidly obese woman with acute renal failure, high serum phosphorus and slightly depressed serum calcium levels, developed areas of induration in the subcutis with associated livedo reticularis. Later, the subcutis became necrotic and the skin ulcerated. The arterioles, and notably widened occluded capillaries, were found to contain calcium and phosphorus as determined by energy dispersive spectrometry. X-ray diffraction of the subcutis in an early stage of this lesion showed that the mineral was most likely a poorly crystalline hydroxyapatite.

[Spinal claudication and malum perforans pedis. Late sequela of ankylosing spondylitis (Bechterew disease) with cystic lumbosacral arachnopathy]. / Claudicatio spinalis und Malum perforans pedis. Spätfolge einer Spondylitis ankylosans (Morbus Bechterew) mit zystischer lumbosakraler Arachnopathie.

Enlargement of the caudal sac with bony erosions of the spinal vertebrae may be a late sequel of ankylosing spondylitis. CT scans demonstrate typical changes. We report a case with spinal claudication and a neuropathic ulcer.

Affinity purification and binding analysis of the hemolymph juvenile hormone binding protein from Manduca sexta.

A high-affinity juvenile hormone binding protein was purified from the hemolymph of the tobacco hornworm, Manduca sexta, employing ammonium sulfate precipitation and affinity and size-separation chromatography. The naturally occurring enantiomer of juvenile hormone III (10R) was converted to juvenile hormone III acid and then covalently attached to aminohexyl-Sepharose 4B. Hemolymph from early fifth stadium (60 h postecdysis) larvae was used as the source of hJHBP. The yield of hJHBP was approximately 25% of the starting material, with 3.5 mg of highly purified, biologically active hJHBP recovered from 100 mL of hemolymph. Binding parameters were examined using equilibrium dialysis and highly purified, enantiomerically correct juvenile hormone I and II and racemic JH III. The equilibrium dissociation constants for juvenile hormone I and II were approximately 6 x 10(-10) M at 4 degrees C, while racemic juvenile hormone III displayed an equilibrium dissociation constant of 1.9 x 10(-9) M. At 25 degrees C the equilibrium dissociation constant for juvenile hormone I was 1.6 x 10(-9) M. Half-times of dissociation were also determined for the three homologs. The half-time of dissociation was 30 s for juvenile hormone I, 20 s for juvenile hormone II, and 13 s for juvenile hormone III at either 4 or 25 degrees C. Using the new equilibrium dissociation constants, we calculate that better than 99% of the circulating juvenile hormone titer may be bound to this hemolymph protein.

[Post-polio syndrome]. / Das Post-Polio-Syndrom.

The post-polio syndrome is a late sequel of former poliomyelitis. Patients develop slowly progressive weakness, fatigue and pain. We report 13 cases.

Immunohistochemical determination of estrogen and progesterone receptor status in breast cancer.

Immunohistochemical staining of fresh frozen tissue to identify estrogen and progesterone receptors was tested as a means to supplant the dextran-coated charcoal assay in a small community hospital. Forty-three tumors were compared, yielding an overall concordance of 88% between immunohistochemical staining and the dextran-coated charcoal assay for determination of combined estrogen/progesterone receptor status. In addition, there was greater than 70% concordance for semiquantitative grades. Staining also revealed many other advantages, such as a 65% reduction in costs. For these reasons, the authors have abandoned the dextran-coated charcoal assay in favor of staining for estrogen/progesterone receptor status.

[Inpatient crisis intervention in the general hospital: on the topic of the range of indications]. / Stationäre Krisenintervention im Allgemeinkrankenhaus: Zur Frage der Indikationsbreite.

In social psychiatry crisis and crisis intervention do not have a uniform nomenclature. However, the number of institutes which offer in-patient crisis intervention as a specific treatment is growing. Therefore, on the way from the pilot project to the standardized method, the question of indications becomes increasingly important. On the basis of indications we have evaluated our practical experience with 1086 patients in a Berlin crisis intervention center in a retrospective study. The results present our estimation of the range of indications of this specific treatment. In the following article it will be explained and brought to discussion.