Childhood brainstem gliomas

Childhood brainstem gliomas (BSGs) are rare but can be very difficult to treat successfully and they tend to have poor survival rates. However, a team of Spanish researchers have found that a chemotherapy regimen of irinotecan and cisplatin (I/C) produced rapid clinical responses and shrank the tumours by more than 20% in all six children enrolled in a clinical trial.

Dr Jaume Mora told the European Cancer Conference (ECCO 14) in September in Barcelona that this was the first time that such a response had been achieved in children with high grade gliomas, while in low grade gliomas the response was comparable with the best achieved by other chemotherapies.

All six children were still alive at one year, although the disease had progressed in three children with the most life-threatening tumours. The usual average survival rate for BSGs is between 4-15 months.

Dr Mora, who is head of the department of paediatric oncology at Hospital Sant Joan de Deu, Barcelona, Spain, explained: “The main treatment for BSGs is radiotherapy. Surgery is not really an option because of the way the tumour is situated in life-threatening anatomical structures situated in the brain stem.

However, for children the long-term adverse consequences of radiotherapy have meant that doctors have looked to clinical trials to see if chemotherapy could be substituted for radiotherapy.

However, most of these trials have failed; at present, many centres use radiation therapy for high-grade gliomas and diffuse intrinsic pontine tumours, the deadliest of all BSGs. For lowgrade gliomas in children few combination regimens have shown significant changes in the long-term natural history of this disease: vincristine and carboplatin is the current protocol and was pioneered by the Duke’s University group in the USA.

The Italians have tested cisplatin and VP-16 with very good results for low-grade gliomas.”



New method for PAP smear

A new way to examine cell changes in the cervix may mean that fewer women will develop cervical cancer. This is shown in a study from the Sahlgrenska Academy, published in Cancer Cytopathology.

Women between the ages of 23 and 60 are regularly called in to submit cell samples. Participating in these check-ups has been shown to provide good protection against cervical cancer. But the test method is not entirely reliable and some women who do have regular check-ups nevertheless still get cancer.

Researchers at the Sahlgrenska Academy at Göteborg University in Sweden have carried out a large-scale study comprising 13,484 women in the Göteborg area. Samples were taken at five different maternity clinics.

The women were randomly selected to submit cell specimens using either the traditional method or a partially new method. With the new method – liquid-based cytology – the sampler mixes the cells in a fluid solution instead of smearing them on a glass slide.

In the laboratory the solution is processed in a machine that produces a glass slide with a purer background that is easier to assess.

In the study, all cell changes found were examined in the same way, regardless of sample type. After the women had been examined using tissue biopsies taken by a gynaecologist, between 40% and 60% more women with major changes were found in the group that had been sampled using liquid-based cytology.

All changes of this degree of severity were then treated with a simple surgical procedure. “If cell changes in a woman are missed, there are usually further chances of finding them, since these changes develop slowly.

But the results of the study indicate that more cases of cancer can be prevented if we start using this more sensitive method,” says Björn Strander, a doctoral student at the Sahgrenska Academy. The study also showed that fewer samples had to be thrown out as unassessable. “Now that we have acquired experience with the method, we see many advantages for the laboratory.

The samples are easier to assess, and work goes faster. The remaining fluid can be used for other lab analyses, such as virus testing, which can be a valuable complement in the diagnosis. What’s more, part of the diagnosis can be done automatically, a factor that will be important in the future,” says Walter Ryd, head of the Cytology Laboratory at the Sahlgrenska University Hospital and leader of the study.

Article:
Liquid-based cytology versus conventional Papanicolaou smear in an organized screening program: a prospective randomized study. Björn Strander, Agneta Andersson- Ellström, Ian Milsom, Thomas Rådberg, Walter Ryd. Cancer Cytopathology.



Non-invasive prenatal test

Researchers have developed a new Non-Invasive Prenatal Diagnostic (NIPD) test based on minute traces of foetal DNA in the mother’s blood.

The new type of test can be used to identify foetal blood group in pregnancies where the woman is rhesus negative.

This is especially important if the foetus itself is rhesus positive, in which case the woman may become sensitised and develop antibodies against her own child.

However, at this time the tests are expensive according to a statement by European-based Special Advances in Fetal and Neonatal Evaluation (SAFE) Network of Excellence which was due to hold a meeting to debate the technical performance, costs and benefits of this new form of testing and its potential for widespread implementation in different countries.

NIPD tests are being developed in laboratories throughout the world following the observation that circulatory cell-free foetal DNA is present in maternal plasma and serum.

Techniques for extracting and amplifying this DNA have already begun to impact on clinical practice as a reliable and efficient alternative to invasive testing to identify foetal blood group and, when clinically necessary, to determine the sex of a foetus.

The SAFE Network (funded by the European Commission) is dedicated to developing non-invasive tests for use in the diagnosis of other genetic conditions such as cystic fibrosis, beta thalassaemia and Down’s syndrome.

Visit: www.safenoe.org



Fatty hearts revealed

A simple imaging technique developed by US-based University of Texas Southwestern Medical Center researchers has revealed fat buildup in the hearts of prediabetic people long before symptoms of heart disease or diabetes appear.

The technique detects fat accumulation in cells of the beating heart in a way no other clinical method can, the researchers said, and may provide a way to screen patients for early signs of heart disease in diabetes.

“Hearts beat; people breathe; and magnetic resonance imaging is very sensitive to motion, so we had to find a way to electronically ‘freeze’ the image of the heart,” said Dr Lidia Szczepaniak, assistant professor of internal medicine at UT Southwestern and senior author of a study appearing in the 4 September issue of Circulation.

Dr Szczepaniak and her colleagues developed a technique that captures the signal from a beating heart as a person lies in an ordinary magnet used for MRI scanning.

The researchers knew that fat built up in the hearts of people with heart failure or non-insulin-dependent diabetes (type 2) from earlier studies involving patients undergoing heart transplants, but they didn’t know if this fatty buildup occurred before or after the diabetic conditions developed.

“There is currently no way to clinically evaluate the fatty heart,” Dr Szczepaniak said. “Using this technique, which analyses magnetic signals, we might be able to determine if people are prone to heart disease very early before the disease progresses.

This method might also allow us to measure the effectiveness of medical treatments targeted toward lowering fat in the heart.” In the new study, the UT Southwestern researchers used an ordinary MRI system, but added the newly developed computer software to convert the signals from a moving heart into a single image.

They looked at lean and obese people with normal blood sugar, obese people beginning to show abnormal sugar metabolism, and obese people with fullblown type 2 diabetes. Their most important finding, Dr Szczepaniak said, was that fat buildup in the heart develops before the onset of diabetes.

They also found that the amount of fat in the heart of people with abnormal sugar metabolism was significantly higher than in those with normal blood sugar, whether obese or lean. The amount of fat in the heart was unrelated to the amount of fat in the bloodstream or liver, indicating that measuring any of those factors could not predict accumulation of fat in the heart.

Fat in the heart did correspond to the amount of fat in the stomach region, however. But Dr Unger also cautioned that no sophisticated test can replace common sense in fighting obesity: “You don’t need a fancy test to tell a patient not to eat too much.”



Hyperactive kids

A study by researchers at the University of Southampton, United Kingdom, has shown evidence of increased levels of hyperactivity in young children consuming mixtures of some artificial food colours and the preservative sodium benzoate.

The possibility of food colours and preservatives affecting children's behaviour has long been an unresolved question for parents. This significant new research by a team from the University of Southampton's Schools of Psychology and Medicine provides a clear demonstration that changes in behaviour can be detected in three-year-old and eight-year-old children.

The research, published in The Lancet online (6 September), involved studying levels of hyperactivity in 153 three-year-olds and 144 eight-year-olds living in the city of Southampton.

The children were selected from the general population to represent the full range of behaviour, from normal through to hyperactive, and not for any previous behavioural problems or known sensitivities to particular foods.

The children's families were asked to put them on a diet free from the additives used in the study. Over a sixweek period the children were then given a drink each day which either contained one of two mixtures of food colours and benzoate preservative, or just fruit juice – with all the drinks looking and tasting identical.

Hyperactivity is a behaviour indicated by increased movement, impulsivity and inattention. The results of the Southampton study show that when the children were given the drinks containing the test mixtures, in some cases their behaviour was significantly more hyperactive.

Professor of Psychology, Jim Stevenson, who led the research, comments: “We now have clear evidence that mixtures of certain food colours and benzoate preservative can adversely influence the behaviour of children.

There is some previous evidence that some children with behavioural disorders could benefit from the removal of certain food colours from their diet. We have now shown that for a large group of children in the general population, consumption of certain mixtures of artificial food colours and benzoate preservative can influence their hyperactive behaviour.

“However parents should not think that simply taking these additives out of food will prevent all hyperactive disorders. We know that many other influences are at work but this at least is one a child can avoid.”



PET for breast tumours

Researchers in Australia have shown that positron emission tomography (PET) that uses a radioactive sugar molecule is more useful than mammography and ultrasound in predicting a breast tumour’s response to chemotherapy and, therefore, the patient’s ultimate likelihood of survival.

In research presented at the European Cancer Conference (ECCO 14) in September in Barcelona, Dr Vinod Ganju reported that when the scanning procedure was used to measure the accumulation of radioactive glucose fluorodeoxyglucose (FDG) in tumour tissue from patients with locally-advanced breast cancer before and after preoperative chemotherapy, women who had the highest accumulation at the beginning and who then had the highest percentage drop in accumulation after four cycles of chemotherapy were more likely to have a complete response to their treatment i.e. no tumour cells remaining in the final tumour resection specimen.

However, measurements taken using mammography or ultrasound were not able to predict a pathological response accurately. FDG-PET works by injecting a sugar molecule (FDG), tagged with a radioactive tracer, into the patient. The molecule is metabolically active and concentrates in tumour tissues where it emits energy that PET scanning can detect.

PET measures the “standard uptake values” (SUVs), in other words, how much FDG has accumulated in the tumour. If the SUVs drop after chemotherapy, this shows that there are fewer, or no, cancer cells available where the FDG can accumulate.

This study suggests that tumours with high initial SUVs seem to be more sensitive to chemotherapy, thereby giving a better chance of achieving a reduction or complete removal of the cancer. Dr Ganju, a medical oncologist for Monash Oncology Research Institute (MORI) and Monash Breast Cancer Research Consortium, Monash Medical Centre, Melbourne, Australia, said: “In our study, we were able to show that patients who had higher baseline SUVs and a greater reduction in SUV at the second PET scan, were more likely to respond to the chemotherapy and achieve a complete pathological response.

Patients who achieve a complete pathological response are more likely to survive and have a better prognosis.” He added: “This study shows that women with high baseline SUVs and a higher percentage reduction of SUVs after four cycles of chemotherapy are more likely to achieve a pathological complete response to neoadjuvant chemotherapy.

FDG-PET appears to be an important addition to conventional imaging of women with breast cancer and may contribute significantly to a more individualised management of their disease. Currently, all patients receive the same chemotherapy regardless of their tumour characteristics.

It would be very valuable to target therapies according to baseline tumour characteristics. This could spare the patient unnecessary ongoing chemotherapy, or enable them to switch to a different therapy if the first was found to be ineffective.”



Woman need sleep

New research led by researchers at Warwick Medical School at the University of Warwick, United Kingdom, reveals that women’s health is much more at risk from sleep deprivation than men’s.

The researchers looked at men and women sleeping less than or equal to five hours a night to see if their risk of having hypertension was any higher than men and women getting the recommended seven hours or more of sleep a night.

Among other problems, increased hypertension increases the risk of cardiovascular problems. The research team looked at data from “The Whitehall II Cohort” which studied volunteers from 20 Londonbased civil service departments.

There were a total of 6,592 participants (4,199 men and 1,567 women). The Warwick team defined hypertension as blood pressure equal to or higher than 140/90 mm Hg or if the subject made regular use of antihypertensive medications.

The researchers found that the those women in the study group who slept less than or equal to five hours a night were twice as likely to suffer from hypertension than women who slept for the more recommended seven hours or more a night.

The researchers found no difference between men sleeping less than five hours and those sleeping seven hours or more.

Professor Francesco Cappuccio from the University of Warwick’s Warwick Medical School who led the research, said that women sleeping less than five hours a night should try to get more sleep as: “Sustained sleep curtailment, ensuing excessive daytime sleepiness, and the higher cardiovascular risk are causes for concern.

Emerging evidence also suggests a potential role for sleep deprivation as a predictor or risk factor for conditions like obesity and diabetes.”

The research paper entitled: “Gender-Specific Associations of Short Sleep Duration wth Prevalent and Incident Hypertension: The Whitehall II Study” is published in the October issue of Hypertension.

                                  
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