COX-2 expression in lobular in situ neoplasia of the breast: correlation with histopathological grading system according to the Tavassoli classification.

AIMS: There is considerable evidence to link cyclooxygenase (COX)-2 to the development of cancer. The aim of this study was to assess COX-2 expression and its subcellular localization in lobular in situ neoplasia (LIN) of the breast and to verify differences in COX-2 expression between different grades of lesions according to the Tavassoli classification. METHODS AND RESULTS: We analysed the expression of COX-2 protein by immunohistochemistry in tissue samples of 51 LIN lesions classified into three grades according to the Tavassoli classification. COX-2 immunostaining was observed in 78.4% of LIN samples and showed a prevalent membranous rather than cytoplasmic pattern. COX-2 was expressed in 16/17 (94.1%) LIN1, 22/25 (88%) LIN2 and 2/9 (22.2%) LIN3. As regards COX-2 expression, a statistically significant difference was found between LIN1 and LIN3 (P = 0.001) and between LIN2 and LIN3 (P =0.001). No difference was found between LIN1 and LIN2. Moreover, a significant negative correlation was found between LIN grade and COX-2 expression (P < 0.0001). CONCLUSIONS: COX-2 is highly expressed in LIN, supporting a role for this protein in the early stage of breast carcinogenesis, representing the rationale for using COX-2 selective inhibitors in the earliest stages of breast cancer.

COX-2 expression in DCIS: correlation with VEGF, HER-2/neu, prognostic molecular markers and clinicopathological features.

AIMS: There is considerable evidence that links COX-2 to the development of cancer. The aim of our study was to assess, by immunohistochemistry, COX-2 expression in ductal carcinoma in situ (DCIS) and its possible correlation with HER-2/neu, vascular endothelial growth factor (VEGF) expression and other common immunohistochemical parameters (p53, ER, PGR, Ki67). METHODS AND RESULTS: Tissue samples of 49 archival cases of DCIS without any invasive component were analysed for COX-2, HER-2/neu, VEGF, oestrogen and progesterone receptors, Ki67 and p53 by immunohistochemistry using specific antibodies. COX-2 expression was detected in 43 (87.8%) tissue samples, of which 12 (24.5%) were graded as weak, 22 (44.9%) as moderate and nine (8.4%) as high expression. Only six (12.2%) lesions were negative for COX-2 expression. VEGF expression was detected in 93.8% of samples; 66.7% of lesions were found to be positive for HER-2/neu expression. Furthermore, COX-2 expression was significantly correlated with VEGF expression (P = 0.003). A significant positive correlation was also observed between COX-2 and HER-2/neu expression (P < 0.0001). CONCLUSIONS: Our results suggest that COX-2 is highly expressed in DCIS and takes part in the molecular pathway implicated in progression of breast cancer and may provide a rationale for targeting COX-2 in preinvasive breast cancer therapy.

Electrophysiological and iontophoretic aspects of the habenular influence on hippocampal neurones.

In previous experimental studies, carried out on cats, we demonstrated that electrical stimulation of lateral habenula (LH) at 0.5-3.0 Hz or 5-20 Hz had a double effect (low frequency-excitation; high frequency-inhibition) on the spontaneous firing rate of single hippocampal neurones. Our results, in agreement with similar case studies, allowed us to hypothesise that in the habenular modulation of the hippocampus the raphe nucleus is probably involved. In fact, all the effects of LH stimulation were antagonised by the iontophoretic intrahippocampal application of methysergide. In the present series of experiments, performed on rats, it was possible to demonstrate that LH stimulation at 1-10 Hz causes an excitation of a progressively major number of hippocampal neurones depending upon the increase of frequency stimulation. The absence of habenulo-induced effects after a iontophoretic application of methysergide on single hippocampal units suggests the involvement of the raphe nucleus. Furthermore, in consideration of recent anatomical evidences demonstrating an excitatory projection between LH and raphe nucleus, intraraphal N-methyl-D-aspartate (NMDA) application, performed through a Hamilton microsyringe, induces an inhibitory effect. All the results suggest that in the raphe context it is possible to hypothesise the presence of an intrinsic interneurone, directly activated by the excitatory projection arising from the LH; this interneurone is likely inhibitory on the serotonergic raphe-hippocampus efferent neurone. This functional organization is responsible for the effect of LH stimulation at different frequencies as well as for the effects of intraraphal NMDA application.

Lateral habenula and hippocampal units: electrophysiological and iontophoretic study.

In previous works we studied, on cats, the effects of lateral habenula (LH) stimulation on hippocampal units. In particular, the results showed an excitation or an inhibition in relation to the stimulation frequency (0.5-3.0 Hz or 5.0-20 Hz, respectively). All the LH stimulation effects were antagonised by iontophoretic intrahippocampal application of methysergide (MS). In this series of experiments it was possible to demonstrate, on rats, that LH stimulation causes an excitatory effect in a major number of hippocampal units in relation to the frequency increase. The inhibitory effect by iontophoretic serotonine application and the reversible blockade of habenular modulation after iontophoretic methysergide administration on hippocampal units suggest, on rats, the involvement of raphe. Such hypothesis, with anatomical evidences demonstrating an excitatory projection between LH and raphe, was confirmed by data concerning the effects of intraraphal NMDA iontophoretic application on hippocampal units (NMDA application for 30 s = excitation; NMDA administration for 10-15 min = inhibition). All the results suggest an habenular modulation of hippocampus through the involvement of the raphe in the context of which an interneurone is inhibitory on the efferent serotonergic raphe-hippocampus projection. This hypothesis finds further support from MS blockade effect during intraraphal NMDA iontophoretic administration.

QI team shares ownership and gets results.

The FOCUS-PDCA framework for process improvement developed by the Hospital Corporation of America helps the healthcare team look at work as a series of processes that can be improved rather than focus on the people involved in the processes. It is data driven, and it encourages teamwork and shared ownership in the process improvement opportunity. This article describes how, by using FOCUS-PDCA, the length of stay (LOS) quality improvement (QI) team at Hubbard Regional Hospital in Webster, MA, has decreased dramatically the time patients spend awaiting nursing home placement.

Electrophysiological and microiontophoretic analysis of the habenulo-hippocampal circuit.

In the cat, the effects of lateral habenula stimulation, at different ranges of frequency, on hippocampal units were studied. Habenular stimulation at low frequency excited, while at high frequency inhibited the greater part of hippocampal units. Moreover, in order to clarify the possible pathway involved in the habenulo-hippocampal circuit, the effects of iontophoretic acetylcholine and serotonin on hippocampal units were compared with those of habenular stimulation. Iontophoretic acetylcholine induced both excitatory and inhibitory responses while serotonin induced only inhibitory responses. Iontophoretic atropine blocked the effects of acetylcholine ejection but did not antagonize stimulation effects; ion-tophoretic methysergide induced an increase of basal firing of hippocampal units and antagonized both serotonin and habenular stimulation inhibition. The results suggest an influence of lateral habenula to the hippocampus which does not appear to be cholinergically-mediated. A possible involvement of the raphe as a relay station in the habenulo-hippocampal pathway is discussed.

Effect of acetylcholine and dopamine iontophoretically applied on the sensory responsive caudate unit.

A putative integrative function of the striatum was evaluated through the study of the electrical activity of sensory responsive caudate neurones. Both nervous (radial nerve) and auditory stimulations were delivered in order to characterize populations of neurones affected by peripheral stimuli; the units were previously activated by iontophoretic glutamate. On these units the iontophoretic ejection of ACh and DA was tested. Experimental results demonstrated a prevalent excitatory effect of ACh, while DA appeared to exert a drastic decrease on firing rate. A comparison between peripheral stimuli and chemical substances was made. The result of such study showed a most important action of the neurotransmitters employed. The activity of caudate units following single shock activation was also explored. This investigation underlined a certain degree of facilitatory influence of ACh; DA, on the contrary, had the tendency to exert a marked inhibitory action. The results are interpreted in view of the striatal peculiar position on cortico-striato-thalamo-cortical circuit. An integrative function of basal ganglia on sensori-motor activity of the cortex is postulated and the importance of ACh and DA is emphasized.

Unit study in cat claustrum of the effects of iontophoretic neurotransmitters and correlations with the effects of activation of some afferent pathways.

Glutamate (Glut), acetylcholine (ACh) and dopamine (DA) were iontophoretically applied on cat claustral neurons. Glut did not affect all the neurons; ACh had both excitatory and inhibitory effects, while DA was prevalently inhibitory. An analysis was made of the time-course of excitatory and inhibitory responses on the basis of the mean firing rate variations during and after ACh and DA release. Three types of responses are described for each drug: short lasting inhibition, long lasting inhibition and long lasting excitation. The experimental data were statistically elaborated. The effects of ACh and of DA were compared with those of activation obtained by sensorial peripheric and thalamic stimulations. ACh could be supposed to be the transmitter of most of the inhibitory terminals of these sensitive afferences to the claustrum.

Effects of iontophoretic 5-hydroxytryptamine on the unitary discharge frequency of caudate nucleus neurons in the rat.

Microiontophoretic application of 5-hydroxytryptamine (5-HT) on rat caudate nucleus neurons has both facilitatory and inhibitory effects on the discharge frequency of the neurons; in many cases 5-HT has a two-phase action. An analysis was made of the behaviour of facilitatory and inhibitory responses in time considering the mean firing rate variations during and after 5-HT iontophoretic release. The experimental results were statistically elaborated.