Neoliberal policy, rural livelihoods, and urban food security in West Africa: a comparative study of The Gambia, Cote d'Ivoire, and Mali.

This study examines the impact of two decades of neoliberal policy reform on food production and household livelihood security in three West African countries. The rice sectors in The Gambia, Côte d'Ivoire, and Mali are scrutinized as well as cotton and its relationship to sorghum production in Mali. Although market reforms were intended to improve food production, the net result was an increasing reliance on imported rice. The vulnerability of the urban populations in The Gambia and Côte d'Ivoire became especially clear during the 2007-2008 global food crisis when world prices for rice spiked. Urban Mali was spared the worst of this crisis because the country produces more of its own rice and the poorest consumers shifted from rice to sorghum, a grain whose production increased steeply as cotton production collapsed. The findings are based on household and market surveys as well as on an analysis of national level production data.

Expression of the ETV6-NTRK3 gene fusion as a primary event in human secretory breast carcinoma.

We report that human secretory breast carcinoma (SBC), a rare subtype of infiltrating ductal carcinoma, expresses the ETV6-NTRK3 gene fusion previously cloned in pediatric mesenchymal cancers. This gene fusion encodes a chimeric tyrosine kinase with potent transforming activity in fibroblasts. ETV6-NTRK3 expression was confirmed in 12 (92%) of 13 SBC cases, but not in other ductal carcinomas. Retroviral transfer of ETV6-NTRK3 (EN) into murine mammary epithelial cells resulted in transformed cells that readily formed tumors in nude mice. Phenotypically, tumors produced glands and expressed epithelial antigens, confirming that EN transformation is compatible with epithelial differentiation. This represents a recurrent chromosomal rearrangement and expression of a dominantly acting oncogene as a primary event in human breast carcinoma.

The influence of central review on outcome in malignant gliomas of the spinal cord: the CCG-945 experience.

OBJECT The impact of central pathology review on outcome has been described in pediatric patients with high-grade glioma (HGG). The objective of this report was to analyze the impact of the central pathology review on outcome in the subgroup of patients with institutional diagnosis of HGG of the spinal cord enrolled in the Children's Cancer Group 945 cooperative study. METHODS Five neuropathologists centrally reviewed the pathology of the 18 patients with HGG of the spinal cord who were enrolled in the study. These reviews were independent, and reviewers were blinded to clinical history and outcomes. A consensus diagnosis was established for each patient, based on the outcome of the review. RESULTS Of 18 patients, only 10 were confirmed to have HGG on central review. At a median follow-up of 12 years, event-free and overall survival for all 18 patients was 43.2% ± 13.3% and 50% ± 13.4%, respectively. After central review, 10-year event-free and overall survival for confirmed HGGs and discordant diagnoses was 30% ± 12.5% versus 58.3% ± 18.8% (p = 0.108) and 30% ± 12.5% versus 75% ± 14.2% (p = 0.0757), respectively. CONCLUSIONS The level of discordant diagnoses in children and adolescents with institutional diagnosis of HGG of the spinal cord was 44% in this experience. However, there was no significant difference in outcome between patients with confirmed and discordant diagnosis. This group of tumor deserves a specific attention in future trials.

Elevated expression of beta-site amyloid precursor protein cleaving enzyme 2 in brains of patients with Down syndrome.

The gene encoding the beta-site amyloid precursor protein cleaving enzyme 2 (BACE2) has been determined to be located on the long arm of chromosome 21 at 21q22.3. BACE2 cleaves the amyloid precursor protein at the beta-secretase site and is thought to contribute to amyloid beta protein production. In the present study, changes in the expression of BACE2 were investigated immunohistochemically in the frontal cortex of patients with Down syndrome (DS). The immunoreactivity for BACE2 was detected in neurofibrillary tangle-bearing neurons from the elderly DS brains with Alzheimer-type neuropathology, but were not detected in those of DS brains without Alzheimer-type neuropathology or of control brains of any age. This suggests the possibility that the elevated expression of BACE2 is involved in the Alzheimer-type neuropathology of DS.

Transcriptional profiling of medulloblastoma in children.

OBJECT: Although medulloblastoma is the most common malignant brain tumor found in children, little is known about its molecular pathogenesis. The authors have attempted to compare patterns of gene expression in medulloblastoma samples with those in the healthy cerebellum. METHODS: The authors used complementary (c)DNA microarray analysis to compare the expression of genes in samples of medulloblastoma and normal cerebellum. The expression levels of a subset of genes were then verified by immunohistochemical analysis. Six genes were identified that were expressed at a much higher level in at least five of six medulloblastomas: ezrin, cyclin D2, high mobility group protein 2, MAPRE1, histone deacetylase 2, and ornithine decarboxylase 1. A number of potentially important genes whose expression was much lower in medulloblastomas than in control cerebellum were also identified: tenascin R, TRK-B, FGF receptor, and death receptor 3. The expression levels of a subset of the identified genes were confirmed by immunohistochemical analysis, which was performed on fetal cerebellum and medulloblastoma samples. CONCLUSIONS: The authors demonstrate that cDNA microarray analysis is an effective method of increasing understanding of the molecular biology of medulloblastomas found in children. A comparison between gene expression patterns in medulloblastoma and those observed in healthy cerebellum may provide clues as to the origin of these tumors and may lead to the identification of new genes or pathways to be targeted for future therapies.

Pontocerebellar hypoplasia type 1: new leads for an earlier diagnosis.

Pontocerebellar hypoplasia type 1 is a rare disease characterized by pontocerebellar hypoplasia and anterior horn cell degeneration. The oldest reported child died at the age of 26 months. Two siblings were diagnosed with pontocerebellar hypoplasia type 1 after the death of the second sibling at 40 months of age from respiratory failure and the unexpected finding of anterior horn cell degeneration on her autopsy. The older sibling was a boy who was labeled as having cerebral palsy. He died at 14 months of age from pneumonia following a clinical course similar to his sister's, who was born 5 years after his death. Both siblings had significant global developmental delay with axial and peripheral hypotonia initially. Peripheral hypertonia with brisk reflexes developed later but were absent prior to death. Extensive investigations in the second sibling ruled out known metabolic (including congenital disorders of glycosylation) and mitochondrial diseases using skin fibroblast cultures and enzyme analysis. Genetic testing for Friedreich's ataxia; neuropathy, ataxia, and retinitis pigmentosa (NARP); spinal muscular atrophy; and spinocerebellar ataxia type 1, 2, 3, 6, 7, and 8 gene abnormalities was negative. The elecroretinogram showed a previously unreported finding of abnormal and progressive rod/cone response. Our cases provide clinical and previously unreported electroretinographic evidence for neurodegeneration in pontocerebellar hypoplasia type 1 and call for the expansion of the disease phenotype.

New insights into the neuropathogenesis of molybdenum cofactor deficiency.

BACKGROUND: Molybdenum cofactor deficiency (MOCOD) is a rare, progressive neurodegenerative disorder caused by sulphite oxidase enzyme deficiency. The neuropathological findings are consistent with a toxic insult to the brain that causes severe neuronal loss, reactive astrogliosis and spongiosis. The mechanisms responsible for these changes are unknown. METHODS: The case is a male infant with MOCOD who died at nine months of age from pneumonia. At autopsy, a complete neuropathological examination was performed including conventional immunohistochemical staining. In addition, brain sections were stained cytochemically with shikata and orcein which stain for disulphide bonds. The elemental composition of cortical cells was then analyzed in the scanning electron microscope using backscatter electron imaging and energy dispersive X-ray spectrometry. RESULTS: Neurons demonstrated cytoplasmic staining with shikata and orcein cytochemically when compared to control sections. Energy dispersive X-ray spectrometry analysis of these neurons confirmed the presence of excess sulphur and unexpectedly revealed excess magnesium accumulation. None of these findings was found in an age-matched control. CONCLUSIONS: In MOCOD we found abnormal accumulation of sulphur and magnesium in neurons. It is postulated that sulphur-containing compound(s) that are formed as a result of MOCOD cause excitotoxic neuronal injury in the presence of excess magnesium.

Excessive expression of synaptojanin in brains with Down syndrome.

We investigated the expression of synaptojanin, which has been mapped on 21q22.2 on human chromosome, in the cerebral cortex of patients with Down syndrome (DS), using immunohistochemistry and immunoblotting. Synaptojanin expression was observed in Cajal-Retzius cells, cortical plate neurons, subplate neurons, intermediate neurons, germinal matrix cells and the ventricular neuroepithelium of the fetal cerebrum in both controls and DS. After birth, synaptojanin immunoreactivity was mainly observed in cytoplasm of cortical neurons and neurophils. These expressions of synaptojanin suggest a broader role in not only synaptic vesicle recycling, but also the regulation of neuronal migration and synaptogenesis in the fetal period. In comparison with controls, DS brains clearly showed higher immunoreactivity of synaptojanin in every structure, and most of the large neurons showed immunoreactivity. Western blotting with synaptojanin confirmed the increased expression in DS brains. Although the reason for excessive expression of synaptojanin in DS brains is obscured, one possibility can be explained on the basis of a gene dosage effect. As another possibility, on the assumption that synaptojanin modulates synaptic transmission and plays roles in clathrin-mediated synaptic vesicle endocytosis and signaling, the excessive expression of synaptojanin may be involved in compensatory mechanisms occurring in developing DS brains, such as neuronal loss, atrophic basilar dendrites, decreased spines and abnormal synaptic density and length.

MYCC and MYCN oncogene amplification in medulloblastoma. A fluorescence in situ hybridization study on paraffin sections from the Children's Oncology Group.

CONTEXT: Brain tumors are the most common solid tumor in childhood, and medulloblastoma is the most common malignant brain tumor in this age group. Cytogenetic abnormalities that have been described in childhood medulloblastoma include loss of 17p, amplification of MYCC (c-myc), amplification of MYCN (N-myc), and isochromosome 17q. Data on these tumors indicate that the frequency of MYCC amplification is 5% to 10%. Fluorescence in situ hybridization is a powerful tool for investigating these features on archival material. OBJECTIVES: To determine if intratumoral heterogeneity exists for MYCC and MYCN in medulloblastomas and if tumors with amplified MYCC or MYCN exhibit consistent histologic patterns. DESIGN: In this fluorescence in situ hybridization study, we investigated the frequency and prognostic significance of MYCC and MYCN amplification in 77 medulloblastomas derived from the Children's Oncology Group. RESULTS: MYCC amplification occurred in only 4 (5.2%) of 77 tumors. The 4 patients died of clinically aggressive neoplasms within 7 months of diagnosis. Similarly, 4 of 77 patients' tumors were found to exhibit MYCN amplification, but survival data are incomplete at present, therefore prognostic significance cannot be characterized. CONCLUSIONS: These data establish the frequency of MYCC amplification in a large cohort of children with medulloblastoma and further suggest that MYCC amplification may be a marker of poor prognosis. Intratumoral heterogeneity was identified for these oncogenes in that 1 patient's tumor exhibited evidence of both MYCN and MYCC amplification, and this patient experienced a shortened survival time.

Pathologist interobserver variability of histologic features in childhood brain tumors: results from the CCG-945 study.

In the Children's Cancer Group-945 trial, study design allowed estimation of overall interpathologist observational agreement for 6 histologic features frequently used in brain tumor diagnoses. We evaluated agreement between pairs of 5 experienced neuropathologists, who had knowledge of the general diagnoses prior to slide readings. We performed this study in an attempt to further improve pathologist interinstitutional agreement. The features mitosis, necrosis, and giant cells had "fair" overall kappa estimates of reproducibility of around 0.5, while endothelial proliferation had only a "poor" overall kappa of 0.35. The Rogot reproducibility index averaged 0.5 for pleomorphism and hyperchromia. The upper bounds for the 10 pair summary agreement estimates were at best 0.65 ("good") for all 6 features. These relatively low-reproducibility estimates for the very small number of histologic features being assessed in tumors institutionally diagnosed as high-grade gliomas indicate that neuropathologists either used different operational definitions or interpreted them differently. We found that we could rank the histologic features from best to worst agreement among study pathologists as necrosis, giant cells, mitosis, endothelial proliferation, hyperchromic nuclei, and pleomorphic cells. We suggest that neuropathologists involved in multi-institutional studies of putative therapies not discard these traditional histologic features, but rather develop standardized operational definitions and measure their variability before beginning the studies. Only after such histologic feature variability studies are conducted will we have the data to identify specific histologic features of value to clinicians and researchers. Agreement and strict adherence to improved nonsubjective diagnostic criteria would improve histologic feature reliability and, consequently, their usefulness in studies.

Severe, fetal-onset form of olivopontocerebellar hypoplasia in three sibs: PCH type 5?

We present three siblings with a precise onset of fetal seizure-like activity who had severe olivopontocerebellar hypoplasia (OPCH) and degeneration. Autopsies at 20, 27, and 37 weeks gestation showed diffuse central nervous system volume loss that was most marked for the cerebellum and brain stem structures. Neuropathological abnormalities included dysplastic, C-shaped inferior olivary nuclei, absent or immature dentate nuclei, and cell paucity more marked for the cerebellar vermis than the hemispheres. Delayed development was seen in layer 2 of the cerebral cortex and in Purkinje cells of the cerebellum. Prenatal monitoring defined a developmental window of 16-18 weeks gestation when ultrasonic assessment of cerebellar width was used for prenatal diagnosis. We discuss our findings in the context of the differential diagnosis for infantile (O)PCH and propose a classification scheme for the pontocerebellar hypoplasias. These patients represent the earliest reported with OPCH and provide unique information regarding the developmental neuropathology of this condition.

Doublecortin immunoreactivity in giant cells of tuberous sclerosis and focal cortical dysplasia.

Cerebral cortical lesions of tuberous sclerosis (TSC) and focal cortical dysplasia (FCD) show disturbances in laminar architecture and cellular differentiation. We immunohistochemically studied the expression of doublecortin, a fetal neuronal protein that regulates neuronal migration, in the surgical specimens of five TSC and eight FCD patients. In both TSC and FCD, bizarre giant cells showed a variable degree of doublecortin immunoreactivity. Both cytomegalic neurons and balloon cells were positive. The staining tended to be more intense in TSC than in FCD, although there were exceptional cases in both groups. Doublecortin immunoreactivity of normal-sized neural cells was restricted to a small number of astrocytes, and comparable to that in control patients. The persistent expression of doublecortin by giant cells in the postnatal cerebrum is additional evidence of abnormal differentiation, which may be relevant to the pathogenesis of cortical disarray in TSC and FCD.

Differences in vasculature between pilocytic and anaplastic astrocytomas of childhood.

BACKGROUND: The clinical manifestations of childhood pilocytic astrocytoma (PA) and anaplastic astrocytoma (AA) markedly differ, especially in the time to progression and prognosis. Because of the aggressive course and poor survival rate of AA, one would expect it to be associated with a high angiogenic index. Counterintuitively, we often find higher microvessel density counts in PA than in AA. PROCEDURE: We examined the differences in type or density of microvasculature between the two neoplasms. To differentiate established, mature vessels from immature growing ones, we used antibodies to Factor VIII (FVIII) to stain endothelial cells (ECs) of blood vessels and alpha-smooth muscle actin (alpha-SMA) antibodies to stain vessels supported by adventitia. RESULTS: We found that large, mature, alpha-SMA-positive vessels predominated in PA, and small, immature, alpha-SMA-negative vessels in AA. The vessel maturation index was 54.5% for PA, and 6.1% for AA. Immunostaining with vascular endothelial growth factor (VEGF) and anti-flt-1/VEGF receptor-1 antibodies showed distinct tissue patterns. VEGF immunoreactivity occurred mainly in the processes of the tumor astrocytes in PA; the opposite was observed in AA. flt-1/VEGFR-1 was detected in the tumor cells of AA but not in those of PA. CONCLUSIONS: We propose that the predominance of small, alpha-SMA-negative vessels in AA represents immature, unstable vasculature with a potentially greater susceptibility to anti-angiogenic therapy. The expression of both flt-1 and VEGF by AA tumor cells also suggests a possible autocrine growth-promoting function for VEGF in addition to its role as paracrine pro-angiogenic growth factor for activated ECs, thus making anti-angiogenesis an attractive therapeutic target in the treatment of AA.

Marked disparity between age-related changes in dopamine and other presynaptic dopaminergic markers in human striatum.

Because age-related changes in brain dopaminergic innervation are assumed to influence human disorders involving dopamine (DA), we measured the levels of several presynpatic DAergic markers [DA, homovanillic acid, tyrosine hydroxylase (TH), aromatic L-amino acid decarboxylase (AADC), vesicular monoamine transporter 2 (VMAT2), and dopamine transporter (DAT)] in post-mortem human striatum (caudate and putamen) from 56 neurologically normal subjects aged 1 day to 103 years. Striatal DA levels exhibited pronounced (2- to 3-fold) post-natal increases through adolescence and then decreases during aging. Similarly, TH and AADC increased almost 100% during the first 2 post-natal years; however, the levels of TH and, to a lesser extent, AADC then declined to adult levels by approximately 30 years of age. Although VMAT2 and DAT levels closely paralleled those of TH, resulting in relatively constant TH to transporter ratios during development and aging, a modest but significant decline (13%) in DAT levels was observed in only caudate during aging. This biphasic post-natal pattern of the presynaptic markers suggests that striatal DAergic innervation/neuropil appears to continue to develop well past birth but appears to become overelaborated and undergo regressive remodeling during adolescence. However, during adulthood, a striking discrepancy was observed between the loss of DA and the relative preservation of proteins involved in its biosynthesis and compartmentation. This suggests that declines in DA-related function during adulthood and senescence may be explained by losses in DA per se as opposed to DAergic neuropil.

Outcome of children with centrally reviewed low-grade gliomas treated with chemotherapy with or without radiotherapy on Children's Cancer Group high-grade glioma study CCG-945.

BACKGROUND: The objectives of the current study were to determine the outcome of children who were treated with chemotherapy and radiotherapy on the Children's Cancer Group (CCG) high-grade glioma protocol (CCG-945) who were diagnosed with low-grade gliomas on post hoc central pathologic review and to identify clinical and biologic features associated with prognosis. METHODS: Between 1985 and 1991, 250 children with institutionally classified high-grade gliomas were enrolled on CCG-945. Patients older than 24 months with intracranial lesions were assigned randomly to receive either lomustine, vincristine, and prednisone (control regimen) or the 8-drugs-in-1-day regimen (experimental regimen); younger patients and those with primary spinal cord tumors were assigned nonrandomly to the experimental regimen. Central independent review by 5 neuropathologists led to a reclassification of low-grade glioma in 70 patients, who were the focus of the current study. RESULTS: The study involved 42 males and 28 females (median age, 7.7 years) with a median follow-up of 10.4 years. At 5 years, the progression-free survival (PFS) rate was 63% +/- 6%, and the overall survival (OS) rate was 79% +/- 5%, compared with a PFS rate of 19% +/- 3% (P < 0.0001) and an OS rate of 22% +/- 3% (P < 0.0001) in the remainder of the cohort. Significantly poorer 5-year PFS was seen in children younger than 24 months, those with fibrillary astrocytoma, and those with posterior fossa tumors. Patients demonstrated a modest improvement in PFS but no improvement in OS compared with children with low-grade gliomas who were treated with contemporary chemotherapy-alone approaches. CONCLUSIONS: The current report calls attention to the importance of central pathologic review in large multiinstitutional trials of children with gliomas and suggests that aggressive front-line combined chemoradiotherapy does not confer a survival advantage in this highly selected population of patients.