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2.
Radiography (Lond) ; 26(1): 71-75, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31902458

RESUMO

INTRODUCTION: Soft tissue sarcomas of the extremities (STSE) are rare malignancies. We report current UK practice for immobilisation of soft tissue sarcoma of STSE, as part of the initial study set-up within the IMRiS trial, a phase II study of intensity modulated radiotherapy (IMRT) in primary bone and soft tissue sarcoma. METHODS: A facility questionnaire (FQ) was circulated to 29 IMRiS centres investigating the variation in immobilisation devices, planning techniques, and imaging protocols. A workshop was held to address concerns raised by centres. It focused on STSE immobilisation and patient set-up. Robustness of patient set-up at each centre was evaluated based on the following criteria: evidence of local set-up audit, calculation of margins based on set-up audit results, imaging frequency, and number of patients treated per centre per annum. RESULTS: Twenty-seven (93%) questionnaires were returned. 30% (8/27) of responders routinely treated STSE with IMRT. The remaining 70% (19/27) had little or no experience with IMRT for STSE. Vacuum bags were the most frequent immobilisation device (9/27), followed by thermoplastic shells (7/27). Nine centres had audited their local set-up; however, only 4 had calculated margins in response to the results. Ten centres were classified as having high level of robustness. CONCLUSIONS: Immobilisation devices and planning techniques for STSE are inconsistent across centres. Robustness of set-up is an important tool to ensure quality of results in a multicentre trial setting with such different levels of experience. The IMRiS trial Quality Assurance programme encourages centres to assess robustness of set-up through local audit and subsequent calculation of treatment margins. IMPLICATIONS FOR PRACTICE: This is the first study that used robustness criteria to tailor QA support to individual centres.


Assuntos
Extremidades/diagnóstico por imagem , Radioterapia de Intensidade Modulada , Sarcoma/diagnóstico por imagem , Sarcoma/radioterapia , Feminino , Humanos , Imobilização , Masculino , Garantia da Qualidade dos Cuidados de Saúde , Planejamento da Radioterapia Assistida por Computador , Inquéritos e Questionários , Reino Unido
3.
Sci Rep ; 9(1): 14551, 2019 10 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601938

RESUMO

Tenosynovial giant cell tumors (TGCT), are rare colony stimulating factor-1(CSF-1)-driven proliferative disorders affecting joints. Diffuse-type TGCT often causes significant morbidity due to local recurrences necessitating multiple surgeries. Imatinib mesylate (IM) blocks the CSF-1 receptor. This study investigated the long term effects of IM in TGCT. We conducted an international multi-institutional retrospective study to assess the activity of IM: data was collected anonymously from individual patients with locally advanced, recurrent or metastatic TGCT. Sixty-two patients from 12 institutions across Europe, Australia and the United States were identified. Four patients with metastatic TGCT progressed rapidly on IM and were excluded for further analyses. Seventeen of 58 evaluable patients achieved complete response (CR) or partial response (PR). One- and five-year progression-free survival rates were 71% and 48%, respectively. Thirty-eight (66%) patients discontinued IM after a median of 7 (range 1-80) months. Reported adverse events in 45 (78%) patients were among other edema (48%) and fatigue (50%), mostly grade 1-2 (89%). Five patients experienced grade 3-4 toxicities. This study confirms, with additional follow-up, the efficacy of IM in TGCT. In responding cases we confirmed prolonged IM activity on TGCT symptoms even after discontinuation, but with high rates of treatment interruption and additional treatments.


Assuntos
Antineoplásicos/uso terapêutico , Tumor de Células Gigantes de Bainha Tendinosa/tratamento farmacológico , Mesilato de Imatinib/uso terapêutico , Adulto , Austrália , Progressão da Doença , Intervalo Livre de Doença , Europa (Continente) , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Receptores de Fator Estimulador de Colônias/antagonistas & inibidores , Estudos Retrospectivos , Resultado do Tratamento , Estados Unidos
4.
Cancer Chemother Pharmacol ; 82(5): 887-898, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30206658

RESUMO

PURPOSE: For many cancers, adolescents and young adults (AYA) have worse outcomes than for children and adults. Many factors may contribute to the AYA survival gap, including differences in biology, therapeutic intent, and adherence to therapy. It has been observed that male AYAs have poorer outcomes than females. The purpose of this work was to test the proposition that gender-related pharmacologic factors may account for a component of the AYA survival gap. PATIENTS AND METHODS: A prospective, multi-institutional pharmacologic study of 79 patients in total with chemosensitive cancers (Ewing sarcoma, osteosarcoma and Hodgkin lymphoma) was conducted, with conventional doxorubicin treatment. Pharmacokinetic data of 13 children, 40 AYAs and 13 adults were valid for analysis. Population pharmacokinetics models were developed for doxorubicin and its metabolite doxorubicinol based on the data created in this study. Consequently, model-based analysis was conducted to investigate the relevant topics. RESULTS: The clearance of doxorubicinol (normalized to body surface area), the main active metabolite of doxorubicin, appears faster in male AYAs than female (p = 0.04, 95% CI 0.1-3.9 L/h). The exposure of doxorubicinol (normalized to dose) is lower in male AYA than female (p = 0.03, 95% CI - 0.005 to - 0.0002 h/L). These might be correlated to the observed difference on nadir neutrophil count between male AYA and female (p = 0.027, 95% CI 0.09-1.4). CONCLUSION: Gender-related differences in doxorubicin pharmacology may account for worse outcomes for male AYAs with chemosensitive cancers compared to females. These findings may reduce the AYA survival gap compared to other age groups.


Assuntos
Antibióticos Antineoplásicos/farmacocinética , Doxorrubicina/análogos & derivados , Modelos Biológicos , Neoplasias/tratamento farmacológico , Caracteres Sexuais , Adolescente , Adulto , Fatores Etários , Antibióticos Antineoplásicos/administração & dosagem , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/metabolismo , Doxorrubicina/administração & dosagem , Doxorrubicina/farmacocinética , Doxorrubicina/uso terapêutico , Feminino , Doença de Hodgkin/tratamento farmacológico , Doença de Hodgkin/metabolismo , Humanos , Neoplasias/metabolismo , Gravidez , Estudos Prospectivos , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/metabolismo , Adulto Jovem
5.
Mucosal Immunol ; 9(6): 1407-1417, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-26883724

RESUMO

Immunity to many human and murine gastrointestinal helminth parasites requires interleukin-4 (IL-4)-directed type 2 helper (TH2) differentiation of CD4+ T cells to elicit type-2 immunity. Despite a good understanding of the inflammatory cascade elicited following helminth infection, the initial source of IL-4 is unclear. Previous studies using the rat helminth parasite Nippostronglyus brasiliensis, identified an important role for basophil-derived IL-4 for TH2 differentiation. However, basophils are redundant for TH2 differentiation following infection with the natural helminth parasite of mice Heligmosomoides polygyrus, indicating that other sources of IL-4 are required. In this study using H. polygyrus, which is controlled by IL-4-dependent immunity, we identified that group-2 innate lymphoid cells (ILC2s) produced significant amounts of IL-4 and IL-2 following H. polygyrus infection. Leukotriene D4 was sufficient to stimulate IL-4 secretion by ILC2s, and the supernatant from activated ILC2s could potently drive TH2 differentiation in vitro in an IL-4-dependent manner. Furthermore, specific deletion of IL-4 from ILC2s compromised TH2 differentiation in vivo. Overall, this study highlights a previously unrecognized and important role for ILC2-derived IL-4 for TH2 differentiation in a natural TH2-dependent model of human helminthiasis.


Assuntos
Diferenciação Celular/imunologia , Imunidade Inata , Interleucina-4/biossíntese , Subpopulações de Linfócitos/imunologia , Subpopulações de Linfócitos/metabolismo , Nematospiroides dubius/imunologia , Células Th2/citologia , Animais , Citocinas/metabolismo , Modelos Animais de Doenças , Interações Hospedeiro-Parasita/imunologia , Linfonodos/imunologia , Camundongos , Camundongos Knockout , Camundongos Transgênicos , Infecções por Strongylida/imunologia , Infecções por Strongylida/metabolismo , Células Th2/imunologia , Células Th2/metabolismo
6.
Br J Cancer ; 110(10): 2420-6, 2014 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-24736584

RESUMO

BACKGROUND: There are neither prospective data nor agreement on the optimal routine follow-up procedures in patients treated for soft tissue sarcoma of the limb. METHODS: Data on 174 consecutive patients with a soft tissue sarcoma of the limb undergoing follow-up by oncologists at a single centre from 2003 to 2009 were included in this analysis. The rate and site of recurrence and mode of detection were analysed. Outcome of the patients was assessed. RESULTS: Eighty-two patients (47%) experienced relapse of any type. Isolated local recurrence occurred in 26 patients and local relapse with synchronous pulmonary metastases in five patients. Local recurrences were detected clinically in 30 of these 31 patients; magnetic resonance imaging identified only one local recurrence. Twenty-eight patients developed isolated lung metastases; in nine patients these were amenable to resections, seven of whom are currently free of disease after treatment. Lung metastases were detected by chest x-ray (CXR) in 19 patients, computed tomography scanning in 3 patients, and clinically in 11 patients. Twenty-three patients developed non-pulmonary metastases. More than 80% of relapses occurred in the first 2 years of follow-up; however, later recurrences were also observed. CONCLUSIONS: Routine follow-up CXR can detect lung metastases suitable for surgical resection, although the optimal interval of imaging has yet to be defined. Local relapse is almost always detected by patients or physicians, and routine scanning of the primary site is of doubtful benefit. Patient and physician education to detect local relapse may be helpful. Prospective evaluation of follow-up is recommended.


Assuntos
Extremidades/patologia , Sarcoma/epidemiologia , Neoplasias de Tecidos Moles/epidemiologia , Adolescente , Adulto , Idoso , Quimioterapia Adjuvante , Terapia Combinada , Intervalo Livre de Doença , Extremidades/cirurgia , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/diagnóstico , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/secundário , Sarcoma/terapia , Neoplasias de Tecidos Moles/terapia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
7.
Math Biosci ; 251: 63-71, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24631178

RESUMO

The number of T Lymphocytes (T cells) in the body is under homeostatic control. At equilibrium, the majority of naive T cells are non-dividing and express low levels of the surface protein CD44. In conditions of T cell deficiency (lymphopenia), naive T cells enter into a proliferative phase, undergoing cell division accompanied by a subtle change in their surface expression of CD44. In this study, we use a mathematical modelling approach to analyse the proliferative response of transgenic T cells in lymphopenic conditions. Our nonlinear model is composed of ordinary differential equations and partial differential equations structured by age (maturity of cell) and CD44 expression. To better understand the evolution of CD44 expression on the surface of T cells during cell division, we present a numerical analysis to solve a parameter identification problem. Finally, we show the parameters and the simulations that we obtain from the model and compare them to experimental data.


Assuntos
Linfopenia/imunologia , Linfopenia/patologia , Modelos Imunológicos , Linfócitos T/imunologia , Linfócitos T/patologia , Algoritmos , Animais , Ciclo Celular , Proliferação de Células , Genes RAG-1 , Receptores de Hialuronatos/metabolismo , Conceitos Matemáticos , Camundongos , Camundongos Knockout , Dinâmica não Linear , Processos Estocásticos
8.
Eur J Surg Oncol ; 40(4): 394-401, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24534361

RESUMO

AIMS: To evaluate tumour volume changes after preoperative radiotherapy (PRT) for borderline operable soft tissue sarcomas (STS). MATERIALS AND METHODS: A retrospective review was performed of 68 patients who received PRT between December 2004 and July 2011. Endpoints were radiological response, surgical margins, local control and survival. RESULTS: Median tumour size was 12.5 cm. Tumour location was extremity (87%), trunk (12%), and neck (1%). Commonest histological subtypes were myxoid liposarcoma (32%) and myxofibrosarcoma (16%). The majority of patients (88%) received 50 Gy in 25 fractions. Post-radiotherapy imaging was available in 55 cases. By RECIST there was stable disease in 89%, partial response in 7% and progressive disease in 4%. Tumour volumes reduced in 80%. Median change in maximal tumour dimension was -13.6%; median change in volume was greater, at -33.3%. Tumour volumes increased in 11 cases (20%). However, surgical margins were clear in all 11 cases, with no local recurrences in this group. For the entire group, surgical margins were clear in 93%, and microscopically positive in 7%. Eight patients (12%) had local relapse at 2-24.8 months after surgery. Two year local relapse free survival was 87.5%; 2 year overall survival was 74.7%. CONCLUSION: The majority of tumours showed reduction in volume. A small number of tumours increased in volume, but there was no definite relationship between volume increase and poor surgical outcomes or lower local control rates. Local control was equivalent to published series' of PRT. PRT is a reasonable approach in patients with borderline resectable tumours.


Assuntos
Terapia Neoadjuvante/métodos , Sarcoma/patologia , Sarcoma/radioterapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Fracionamento da Dose de Radiação , Extremidades , Feminino , Humanos , Lipossarcoma Mixoide/patologia , Lipossarcoma Mixoide/radioterapia , Masculino , Pessoa de Meia-Idade , Neoplasia Residual/radioterapia , Neoplasia Residual/cirurgia , Radioterapia Adjuvante , Estudos Retrospectivos , Sarcoma/cirurgia , Tronco , Resultado do Tratamento
9.
Eur J Cancer ; 50(2): 388-96, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24215845

RESUMO

AIM: Brostallicin is a DNA minor groove binder that has shown activity in patients with soft tissue sarcoma (STS) failing first-line therapy. The present study assessed the safety and efficacy of first-line brostallicin in patients with advanced or metastatic STS >60 years or not fit enough to receive combination chemotherapy. A prospective explorative pharmacogenetic analysis was undertaken in parallel. METHODS: Patients were randomised in a 2:1 ratio between IV brostallicin 10mg/m(2) and doxorubicin 75 mg/m(2) once every 3 weeks for a maximum of six cycles. Disease stabilisation at 26 weeks (primary end-point) was considered a 'success'. Further testing of brostallicin was warranted if ≥ 35 'successes' were observed in the first 72 eligible patients treated with brostallicin. In addition, patients were genotyped for glutathione S transferase (GST) polymorphisms. RESULTS: One hundred and eighteen patients were included (79 brostallicin and 39 doxorubicin). Brostallicin was well tolerated in comparison to doxorubicin with less grade 3-4 neutropenia (67% versus 95%), grade 2-3 systolic dysfunction (0% versus 11%), alopecia (17% versus 61%) and grade 2-3 mucositis (0% versus 18%). For brostallicin versus doxorubicin, 'successes' were observed in 5/77 versus 10/36, progression free survival at 1 year was 6.5% versus 15.6%, objective response rate was 3.9% versus 22.2% and overall survival at 1 year was 50.5% versus 57.9%, respectively. Only GSTA1 genotype was significantly associated with success rate of doxorubicin treatment. CONCLUSION: Brostallicin cannot be recommended at this dose and schedule in this patient population as first-line therapy. GSTA1 genotype may be predictive for doxorubicin efficacy but warrants further study.


Assuntos
Neoplasias Ósseas/tratamento farmacológico , Doxorrubicina/uso terapêutico , Guanidinas/uso terapêutico , Pirróis/uso terapêutico , Sarcoma/tratamento farmacológico , Adulto , Antibióticos Antineoplásicos/uso terapêutico , Neoplasias Ósseas/genética , Neoplasias Ósseas/patologia , Intervalo Livre de Doença , Esquema de Medicação , Europa (Continente) , Frequência do Gene , Genótipo , Glutationa Transferase/genética , Humanos , Isoenzimas/genética , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Metástase Neoplásica , Farmacogenética , Polimorfismo Genético , Sarcoma/genética , Sarcoma/patologia , Resultado do Tratamento
10.
Br J Cancer ; 101(11): 1860-8, 2009 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-19935799

RESUMO

BACKGROUND: SR4554 is a fluorine-containing 2-nitroimidazole, designed as a hypoxia marker detectable with 19F magnetic resonance spectroscopy (MRS). In an initial phase I study of SR4554, nausea/vomiting was found to be dose-limiting, and 1400 mg m(-2) was established as MTD. Preliminary MRS studies demonstrated some evidence of 19F retention in tumour. In this study we investigated higher doses of SR4554 and intratumoral localisation of the 19F MRS signal. METHODS: Patients had tumours > or = 3 cm in diameter and < or = 4 cm deep. Measurements were performed using 1H/19F surface coils and localised 19F MRS acquisition. SR4554 was administered at 1400 mg m(-2), with subsequent increase to 2600 mg m(-2) using prophylactic metoclopramide. Spectra were obtained immediately post infusion (MRS no. 1), at 16 h (MRS no. 2) and 20 h (MRS no. 3), based on the SR4554 half-life of 3.5 h determined from a previous study. 19Fluorine retention index (%) was defined as (MRS no. 2/MRS no. 1)*100. RESULTS: A total of 26 patients enrolled at: 1400 (n=16), 1800 (n=1), 2200 (n=1) and 2600 mg m(-2) (n=8). SR4554 was well tolerated and toxicities were all < or = grade 1; mean plasma elimination half-life was 3.7+/-0.9 h. SR4554 signal was seen on both unlocalised and localised MRS no. 1 in all patients. Localised 19F signals were detected at MRS no. 2 in 5 out of 9 patients and 4 out of 5 patients at MRS no. 3. The mean retention index in tumour was 13.6 (range 0.6-43.7) compared with 4.1 (range 0.6-7.3) for plasma samples taken at the same times (P=0.001) suggesting (19)F retention in tumour and, therefore, the presence of hypoxia. CONCLUSION: We have demonstrated the feasibility of using 19F MRS with SR4554 as a potential method of detecting hypoxia. Certain patients showed evidence of 19F retention in tumour, supporting further development of this technique for detection of tumour hypoxia.


Assuntos
Espectroscopia de Ressonância Magnética/métodos , Neoplasias/metabolismo , Nitroimidazóis/farmacocinética , Adulto , Idoso , Idoso de 80 Anos ou mais , Hipóxia Celular/fisiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nitroimidazóis/efeitos adversos , Oxigênio/metabolismo , Pressão Parcial , Adulto Jovem
11.
Eur J Cancer ; 45(13): 2293-7, 2009 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-19467857

RESUMO

Patients diagnosed with advanced gastrointestinal stromal tumours (GISTs) who are resistant or intolerant to both imatinib and second-line sunitinib have a poor prognosis and few therapeutic options. We evaluated the efficacy of nilotinib, a novel tyrosine kinase inhibitor (TKI) in patients pretreated with imatinib and sunitinib. Fifty-two consecutive patients treated with oral nilotinib, 400mg twice daily, within the nilotinib compassionate use programme in 12 European cancer centres, were included in this retrospective analysis. Median age was 59 years (range 24-80), and all patients had WHO performance score better than 3. All patients had failed both imatinib and sunitinib pretreatment, either due to progressing GIST (96%) or intolerance (4%). Five patients (10%; 95% confidence interval (CI) 2-18) responded to nilotinib and 19 patients (37%; 95% CI 24-50) achieved a disease stabilisation. Nilotinib was generally well tolerated, but six patients (12%) discontinued treatment due to intolerance. Median progression-free survival of nilotinib treatment was 12 weeks (95% CI 9-15; range 0-104) and median overall survival was 34 weeks (95% CI 3-65; range 2-135). Nilotinib is active in GIST resistant to both imatinib and sunitinib. These results warrant further investigation of nilotinib in GIST.


Assuntos
Antineoplásicos/administração & dosagem , Resistencia a Medicamentos Antineoplásicos , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Pirimidinas/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/efeitos adversos , Benzamidas , Intervalo Livre de Doença , Feminino , Tumores do Estroma Gastrointestinal/mortalidade , Humanos , Mesilato de Imatinib , Indóis/efeitos adversos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Piperazinas/efeitos adversos , Pirimidinas/efeitos adversos , Pirróis/efeitos adversos , Estudos Retrospectivos , Sunitinibe , Resultado do Tratamento , Adulto Jovem
12.
Clin Oncol (R Coll Radiol) ; 19(8): 572-6, 2007 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-17624747

RESUMO

AIMS: Trabectedin (ET-743, Yondelis) is a marine-derived alkaloid that has two actions. It binds in the minor groove of DNA resulting in a conformational change; thus potentially altering interactions with transcription factors and other DNA binding proteins and it also interacts with the transcription-coupled nucleotide excision repair machinery to induce lethal double-stranded DNA breaks. In recent phase II trials it has shown considerable activity in the treatment of sarcomas. Here the use of trabectedin in patients with advanced refractory sarcoma from a single institution is presented. MATERIALS AND METHODS: Twenty-one patients with advanced refractory sarcoma from a single UK centre were treated with trabectedin on a named patient compassionate basis programme. All patients had received prior treatment with an anthracycline, and 95% had received ifosfamide. RESULTS: The patients received a median of four cycles of treatment. Objective partial responses were seen in three patients (14%) and a further eight patients (38%) achieved durable stable disease for a median duration of 4.5 months. The estimated 3- and 6-month progression-free survival was 58.8 and 17.6%, respectively. Six patients experienced early disease progression, and four patients died while on treatment. One death was due to treatment-related toxicity. Overall the drug was relatively well tolerated, with hepatic and haematological toxicities most commonly encountered. Both necessitated delays and/or dose reductions in a proportion of patients. Other significant toxicities were nausea, vomiting and asthenia. CONCLUSION: The disease responses and durable nature of disease stabilisation seen in a proportion of our patients support the continued investigational use of this drug in the treatment of advanced soft tissue sarcomas.


Assuntos
Antraciclinas/uso terapêutico , Antineoplásicos Alquilantes/uso terapêutico , Dioxóis/uso terapêutico , Ifosfamida/uso terapêutico , Sarcoma/tratamento farmacológico , Tetra-Hidroisoquinolinas/uso terapêutico , Resultado do Tratamento , Adolescente , Adulto , Antineoplásicos Alquilantes/efeitos adversos , Antineoplásicos Alquilantes/farmacologia , Dioxóis/efeitos adversos , Dioxóis/farmacologia , Progressão da Doença , Intervalo Livre de Doença , Feminino , Humanos , Ifosfamida/efeitos adversos , Ifosfamida/farmacologia , Masculino , Pessoa de Meia-Idade , Sarcoma/mortalidade , Sarcoma/fisiopatologia , Tetra-Hidroisoquinolinas/efeitos adversos , Tetra-Hidroisoquinolinas/farmacologia , Fatores de Tempo , Trabectedina , Reino Unido
13.
Clin Oncol (R Coll Radiol) ; 19(4): 265-8, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17433971

RESUMO

Tumour-related hypoglycaemia is a rare paraneoplastic phenomenon most frequently occurring with insulinomas, but also associated with non-islet cell tumours. It has been observed in a range of tumour types, but recently a small number of cases have been described in association with gastrointestinal stromal tumours. We describe a further case of a patient with gastrointestinal stromal tumour that was complicated by non-islet cell tumour hypoglycaemia, and discuss the mechanisms and management of non-islet cell tumour hypoglycaemia in the context of gastrointestinal stromal tumour.


Assuntos
Neoplasias Abdominais/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Hipoglicemia/diagnóstico , Neoplasias do Jejuno/diagnóstico , Recidiva Local de Neoplasia/diagnóstico , Neoplasias Abdominais/complicações , Neoplasias Abdominais/secundário , Adulto , Diagnóstico Diferencial , Evolução Fatal , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/secundário , Humanos , Hipoglicemia/complicações , Hipoglicemia/patologia , Fator de Crescimento Insulin-Like II/metabolismo , Neoplasias do Jejuno/complicações , Neoplasias do Jejuno/patologia , Masculino , Metástase Neoplásica , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia
14.
Clin Oncol (R Coll Radiol) ; 17(5): 385-90, 2005 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-16097572

RESUMO

Radiation myelopathy is a rare, devastating, late effect of radiotherapy to the spinal cord. Spinal cord tolerance is currently accepted as about 50 Gy in 1.8-2 Gy fractions. However, the effect of chemotherapy on cord tolerance is unclear. This issue is important, given the increasing use of chemotherapy in combination with radiotherapy. We describe the case of a 17-year-old boy with a right apical paraspinal Ewing's tumour in the neck treated with induction chemotherapy, high-dose chemotherapy (busulfan and melphalan) with peripheral stem-cell rescue and, 4 months later, radiotherapy to the primary tumour site (cervical cord received 50 Gy in 30 fractions). After a latent period of 4 months, he developed a progressive, severe and ultimately fatal radiation myelopathy, which we suggest was due to a synergistic interaction between the high-dose chemotherapy and the radiotherapy. The use of such chemotherapy regimens in Ewing's tumours should be carefully considered, particularly when radiotherapy encompassing the spinal cord is an essential component of management.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bussulfano/efeitos adversos , Melfalan/administração & dosagem , Melfalan/efeitos adversos , Radioterapia/efeitos adversos , Sarcoma de Ewing/tratamento farmacológico , Sarcoma de Ewing/radioterapia , Doenças da Medula Espinal/etiologia , Adolescente , Neoplasias Ósseas/tratamento farmacológico , Neoplasias Ósseas/radioterapia , Bussulfano/administração & dosagem , Terapia Combinada , Evolução Fatal , Humanos , Masculino , Medula Espinal/efeitos da radiação
15.
J Appl Microbiol ; 95(2): 218-24, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12859751

RESUMO

AIM: To detect L-form bacteria in developing Chinese cabbage seedlings. METHODS AND RESULTS: Stable Bacillus subtilis L-forms were genetically modified to express the gus gene (encoding beta-glucuronidase). Germinated seeds of Chinese cabbage were soaked in mannitol based suspensions of the L-form bacteria or with mannitol alone and after washing were grown in aseptic conditions on plant growth medium. Histochemical staining of beta-glucuronidase activity (X-gluc) and Polymerase Chain Reaction (PCR) detection of the gus gene were achieved in the L-form associated seedlings. beta-Glucuronidase was localized in discrete spots, mainly in the roots with staining, and was also observed in the cotyledons and base of stems. Correlation was observed between PCR detection of the gus gene and histochemical staining with detection in similar tissues. Stable L-form bacteria were non-culturable after their association with plant material. CONCLUSIONS: The gus reporter gene system with its associated histological staining for enzyme activity was used successfully for detecting B. subtilis L-form bacteria in plant material. SIGNIFICANCE AND IMPACT OF THE STUDY: These molecular marked L-forms should provide a specific and sensitive technique for detecting L-form bacteria in planta and offer a method for further understanding the L-form/plant association.


Assuntos
Bacillus subtilis/isolamento & purificação , Brassica/microbiologia , Glucuronidase/metabolismo , Formas L/isolamento & purificação , Bacillus subtilis/enzimologia , DNA Bacteriano/análise , Glucuronidase/genética , Formas L/enzimologia , Plantas Geneticamente Modificadas , Reação em Cadeia da Polimerase/métodos , Plântula/microbiologia , Simbiose
16.
Br J Radiol ; 76 Spec No 2: S128-38, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-15572335

RESUMO

Studies of pharmacokinetics (which is what the body does to the drug) and pharmacodynamics (which is what the drug does to the body) are essential components of the modern process of cancer drug discovery and development. Defining the precise relationship between pharmacokinetics and pharmacodynamics is critical. It is especially important to establish a well understood pharmacological "audit trail" that links together all of the essential parameters of drug action, from the molecular target to the clinical effects. The pharmacological audit trail allows us to answer two absolutely crucial questions: (1) how much gets there; and (2) what does it do? During the pre-clinical drug discovery phase, it is essential that pharmacokinetic/pharmacodynamic (PK/PD) properties are optimized, so that the best candidate can be selected for clinical development. As part of contemporary mechanistic, hypothesis-testing clinical trials, construction of the pharmacological PK/PD audit trail facilitates rational decision-making. However, PK/PD endpoints frequently require invasive sampling of body fluids and tissues. Non-invasive molecular measurements, e.g. using MRI or spectroscopy, or positron emission tomography, are therefore very attractive. This review highlights the need for PK/PD endpoints in modern drug design and development, illustrates the value of PK/PD endpoints, and emphasises the importance of non-invasive molecular imaging in drug development. Examples cited include the use of PK/PD endpoints in the development of molecular therapeutic drugs such as the Hsp90 molecular chaperone inhibitor 17AAG, as well as the development of SR-4554 as a non-invasive probe for the detection of tumour hypoxia.


Assuntos
Antineoplásicos , Diagnóstico por Imagem/métodos , Neoplasias/metabolismo , Rifabutina/análogos & derivados , Antineoplásicos/farmacocinética , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , Benzoquinonas , Proteínas de Choque Térmico HSP90/antagonistas & inibidores , Humanos , Hipóxia/fisiopatologia , Lactamas Macrocíclicas , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética/métodos , Neoplasias/tratamento farmacológico , Neoplasias/fisiopatologia , Nitroimidazóis , Tomografia por Emissão de Pósitrons/métodos , Rifabutina/uso terapêutico , Tecnologia Farmacêutica/métodos , Ultrassonografia/métodos
17.
J Exp Med ; 194(9): 1253-61, 2001 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-11696591

RESUMO

T cell receptor interactions with peptide/major histocompatibility complex (pMHC) ligands control the selection of T cells in the thymus as well as their homeostasis in peripheral lymphoid organs. Here we show that pMHC contact modulates the expression of CD5 by naive CD4 T cells in a process that requires the continued expression of p56(lck). Reduced CD5 levels in T cells deprived of pMHC contact are predictive of elevated Ca(2)+ responses to subsequent TCR engagement by anti-CD3 or nominal antigen. Adaptation to peripheral pMHC contact may be important for regulating naive CD4 T cell responsiveness.


Assuntos
Adaptação Fisiológica/imunologia , Linfócitos T CD4-Positivos/imunologia , Animais , Antígenos CD5/biossíntese , Antígenos CD5/imunologia , Antígenos H-2/biossíntese , Antígenos H-2/imunologia , Haplótipos , Proteína Tirosina Quinase p56(lck) Linfócito-Específica/biossíntese , Proteína Tirosina Quinase p56(lck) Linfócito-Específica/imunologia , Complexo Principal de Histocompatibilidade/imunologia , Camundongos
18.
J Appl Microbiol ; 91(4): 652-9, 2001 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11576302

RESUMO

AIMS: To assess the activity of Brevibacillus brevis (formerly Bacillus brevis) Nagano and the antibiotic it produces, gramicidin S, against the plant pathogen Botrytis cinerea. METHODS AND RESULTS: Germination and growth of Bot. cinerea were assessed in the presence of B. brevis or gramicidin S in liquid media, on solid media and on leaf sections of Chinese cabbage. Germination was 10-fold more sensitive to gramicidin S than growth. Inhibition of Bot. cinerea was greater in liquid media compared with on solid media. Activity of gramicidin S against Bot. cinerea on leaf sections was much lower than in vitro. In vitro inhibition of Bot. cinerea by B. brevis Nagano was similar to equivalent levels of gramicidin. CONCLUSIONS: Antibiosis, via gramicidin S, is the mode of antagonism exhibited by B. brevis Nagano against Bot. cinerea in vitro. SIGNIFICANCE AND IMPACT OF THE STUDY: The mode of antagonism of B. brevis against Bot. cinerea was elucidated. The differing activity of gramicidin S against Bot. Cinerea in vitro and on leaf sections indicates one mechanism by which biocontrol activity may differ between laboratory and field conditions.


Assuntos
Antibiose , Bacillus/crescimento & desenvolvimento , Botrytis/crescimento & desenvolvimento , Controle Biológico de Vetores , Bacillus/metabolismo , Botrytis/efeitos dos fármacos , Brassica/microbiologia , Meios de Cultura , Gramicidina/biossíntese , Gramicidina/farmacologia , Doenças das Plantas/microbiologia , Folhas de Planta/microbiologia
19.
Radiat Res ; 155(6): 837-46, 2001 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-11352767

RESUMO

Hypoxia is important in tumor biology and therapy. This study compared the novel luminescence fiber-optic OxyLite sensor with the Eppendorf polarographic electrode in measuring tumor oxygenation. Using the relatively well-oxygenated P22 tumor, oxygen measurements were made with both instruments in the same individual tumors. In 24 air-breathing animals, pooled electrode pO(2) readings lay in a range over twice that of sensor pO(2(5min)) values (-3.2 to 80 mm Hg and -0.1 to 34.8 mm Hg, respectively). However, there was no significant difference between the means +/- 2 SE of the median pO(2) values recorded by each instrument (11.0 +/- 3.3 and 8.1 +/- 1.9 mm Hg, for the electrode and sensor respectively, P = 0.07). In a group of 12 animals treated with carbon monoxide inhalation to induce tumor hypoxia, there was a small but significant difference between the means +/- 2 SE of the median pO(2) values reported by the electrode and sensor (1.7 +/- 0.9 and 2.9 +/- 0.7 mm Hg, respectively, P = 0.009). A variable degree of disparity was seen on comparison of pairs of median pO(2) values from individual tumors in both air-breathing and carbon monoxide-breathing animals. Despite the differences between the sets of readings made with each instrument from individual tumors, we have shown that the two instruments provide comparable assessments of tumor oxygenation in groups of tumors, over the range of median pO(2) values of 0.6 to 28.1 mm Hg.


Assuntos
Carcinossarcoma/metabolismo , Neoplasias Experimentais/metabolismo , Oxigênio/metabolismo , Animais , Técnicas Biossensoriais , Monóxido de Carbono/metabolismo , Eletrodos , Tecnologia de Fibra Óptica , Medições Luminescentes , Fibras Ópticas , Polarografia
20.
Lett Appl Microbiol ; 32(2): 63-6, 2001 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11169044

RESUMO

AIMS: To develop selective media for the enumeration of Botrytis cinerea. METHODS AND RESULTS: Two new media, Botrytis Selective Medium (BSM) and Botrytis Spore Trap Medium (BSTM), were developed and compared with currently available media for the enumeration of B. cinerea conidia from the environment. The new Botrytis media proved advantageous over previous media because they were easier to prepare, had greater selectivity and allowed enumeration when a greater number of colony-forming units were present on individual plates. CONCLUSION: BSM and BSTM were shown to be suitable selective media for the enumeration of B. cinerea conidia from the environment. SIGNIFICANCE AND IMPACT OF THE STUDY: The media developed can be used to monitor the population of the pathogen B. cinerea and will allow detailed studies within the crop environments.


Assuntos
Ascomicetos/crescimento & desenvolvimento , Meios de Cultura , Folhas de Planta/microbiologia , Microbiologia do Solo , Brassica/microbiologia , Contagem de Colônia Microbiana , Esporos Fúngicos/crescimento & desenvolvimento
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