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Breast cancer has become curable for the majority of women in Western Europe and North America. Advances have been made in imaging diagnostics as well as the implementation of nationwide screening programmes. Nowadays, we talk about prevention as well as treatment. Pathology has moved from pure morphology (tumour type, grade and stage) to biological characterisation of the tumour. Treatment has changed considerably through a better understanding of the disease; from a local disease predominated by extensive and mutilating surgical techniques to a point where breast cancer has come into its own as a systemic disease with equal “rights” to local as well as systemic treatment. This paradigm shift has led to a multidisciplinary approach of the understanding and treatment of breast cancer. Molecular classification has changed the understanding of breast cancer and will be the basis for an even more individualised treatment. New (biological) agents will help to further tailor treatment to response or resistance. While systemic treatment has been increased in number and duration surgical/local strategies have been reduced to minimum. Evidence-based medicine has helped to improve and standardise treatment of breast cancer. This review summarises the 10th Biedenkopf meeting that was held to review the advances in breast cancer understanding and treatment. [ABSTRACT FROM AUTHOR]

The major aim of neoadjuvant systemic therapy is to improve prognosis by individualizing treatment. The proven benefits of neoadjuvant systemic therapy include reducing tumor burden, higher breast-conserving surgery, and the possibility of in vivo monitoring of response to treatment. Other goals of neoadjuvant treatment are the detection of new prognostic and predictive biomarkers and the investigation of new drugs and imaging modalities. Although many prospective trials have answered important questions regarding neoadjuvant systemic therapy, several topics remain controversial. [ABSTRACT FROM AUTHOR]

Breast cancer is a heterogeneous disease of different subtypes on the molecular, histopathological, and clinical level. Genomic profiling techniques have led to several prognostic and predictive gene signatures of breast cancer that may further refine outcome prediction, especially in clinically equivocal situations. In particular, the predictive value of today's most important therapeutic targets, ER and HER2, are strongly influenced by the proliferative status of the tumor. Genomic assays are generally performed in a centralized manner, whereas routine pathological evaluation is mostly done on a decentralized basis, making the comparison of these methods difficult. Thus, there remains considerable uncertainty about the use of the new molecular markers in routine clinical decision making and their role in patient selection or stratification for future clinical trials. To address this concern, a group of representatives from breast cancer research groups in the areas of breast pathology, genomic profiling, and clinical trials critically reviewed all available data. Consensus recommendations are made on the practical use of molecular markers in breast cancer management and their incorporation into future clinical trials. Cancer 2011. © 2010 American Cancer Society. Considerable uncertainty remains on new molecular markers in breast cancer in routine clinical decision making. An expert panel reviewed all available data, making consensus recommendations on the use of molecular markers in breast cancer management and their incorporation into future clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Receptors for luteinizing hormone-releasing hormone (LHRH) can be utilized for targeted chemotherapy of cytotoxic LHRH analogs. The compound AEZS-108 (previously AN-152) consists of [D-Lys6]LHRH linked to doxorubicin. The objectives of this first study in humans with AESZ-108 were to determine the maximum tolerated dose and to characterize the dose-limiting toxicity, pharmacokinetics, preliminary efficacy, and hormonal effects. Methods: The study included 17 women with histologically confirmed epithelial cancer of the ovary, endometrium, or breast that was metastatic or unresectable and for which standard curative or palliative measures could not be used or were no longer effective or tolerated. In each patient, immunohistochemistry of primary tumor or metastatic lesion confirmed that the tumors expressed LHRH receptors. Results: One patient each received intravenous doses of 10, 20, 40, or 80mg/m2 of AEZS-108, six received 160mg/m2 and seven 267mg/m2 at 3week intervals. Dose-limiting leukopenia and neutropenia were observed at the highest dose. A total of 6 patients, 3 patients each in both upper dose groups, showed responses to AEZS-108. The half-life of AESZ-108 was estimated to be about 2h. Conclusions: The maximum tolerated dose of AESZ-108 in the absence of supportive medication is 267mg/m2 and this dose is recommended as starting dose for therapeutic Phase II studies. [Copyright &y& Elsevier]

The article presents the recommendations by an international panel of oncologists, radiologists, pathologists, surgeons and epidemiologists from Europe and the U.S. on the locoregional treatment of primary breast cancer. It highlights the importance of core needle biopsy as an accurate method of breast cancer diagnosis, as well as appropriate breast-conserving therapies for breast cancer. It also emphasizes on the need for strict monitoring of the quality standards of locoregional treatment.

Abstract: Due to landscaping, mining and construction activities on previously cultivated land, more and more soils are excavated, translocated, deposited and restored. In many cases restored soils show signs of structural degradation such as overcompaction and water logging. There is a lack of methods to evaluate and assess the physical quality of restored soil. In this study a fuzzy logic expert system was developed which allows us to evaluate the potential plant productivity of restored soils based on measured physical soil parameters. The system is based on the statements of a group of soil experts relating physical soil quality to packing density, penetration resistance, air capacity and saturated hydraulic conductivity according to their personal experience or expertise. From these statements we derived fuzzy membership functions and inference rules. The expert system was applied to evaluate 10 restored sites in comparison to nearby non-restored reference soils. The physical soil quality had remained unchanged or decreased after restoration at most investigated sites. Only two horizons showed clearly improved soil conditions after restoration. The validity of the fuzzy logic expert system is demonstrated by comparing the results with evaluations of the same soils using two other indicators of the physical soil quality for plant production: the least limiting water range (LLWR) and the S-parameter (i.e. the slope of the water retention curve at the inflection point). The physical soil quality assessment with the fuzzy logic expert system was highly correlated with both the LLWR (r 2 =0.80) and the S-parameter (r 2 =0.70). These results show that fuzzy logic expert systems may provide a suitable tool to assess physical soil quality, taking proper account of the vagueness and ambiguity necessarily involved in this task. [Copyright &y& Elsevier]

Abstract: Soil restoration is the process by which a soil that has been disturbed by excavation and displacement or by degradation is returned to its original state by means of active treatment. At the beginning of the process, restored soils are mechanically labile and susceptible to compaction. In this study, we monitored the regeneration of some physical soil quality indicators (bulk density, coarse porosity, penetration resistance) and the development of indicators of mechanical stability (precompression stress, compression index) of a refilled sandy loam originating from an Eutric Cambisol. In particular, we derived multiple linear regression equations to correlate precompression stress and compression index to soil texture, gravel content, organic carbon content and void ratio. During the 3-year observation period after restoration, bulk density and penetration resistance increased significantly, while coarse porosity decreased significantly. Nonetheless, these parameters remained in a range, which is considered to indicate suitable physical soil conditions for root growth over the entire period of observation. Precompression stress increased significantly in the topsoil as well as in the subsoil. The compression index was significantly higher in the topsoil than the subsoil and stayed fairly constant over the observation period. Precompression stress was negatively and the compression index was positively correlated with initial void ratio and to coarse porosity. Taking additional parameters into account, such as gravel content, clay content, silt content and organic matter content, improved the correlation with precompression stress. The equations derived with multiple linear regression analysis from our data set gave a satisfactory coefficient of determination for the compression index (r 2 =0.81), but rather poor estimates for precompression stress (r 2 =0.50). [Copyright &y& Elsevier]

Disturbance and productivity are often cited as the main factors determining temporal and spatial patterns in species distribution and the diversity of communities. A field experiment was conducted to test the role of these factors in the structuring of early successional fouling communities in a nutrient limited system at the south coast of Madeira Island. Macro-benthic sessile communities, established on artificial settlement substrata, were manipulated and surveyed over a 9-week period. We applied mechanical disturbances of four different frequencies crossed with three levels of inorganic nutrient enrichment. Fertilization enhanced community diversity by favouring the establishment and growth of macroalgae. Disturbance reduced diversity by eliminating species – but only at the highest nutrient level. This is explained by a multiple-stressor model; species most sensitive to nutrient deficiency (only present in the highest enrichment treatment) were simultaneously the most sensitive to disturbance. [ABSTRACT FROM AUTHOR]

Abstract: GABG-IV B-93 is a prospective, randomised study comparing goserelin (n =384) with no further treatment (n =392) in hormone receptor (HR)-negative breast cancer patients (n =465) after 3 cycles cyclophosphamide, methotrexate, 5-fluorouracil (CMF) for patients with 0–3 positive lymph nodes (LN) or 4 cycles epirubicin, cyclophosphamide (EC) followed by 3 cycles CMF for patients with 4–9 positive LN. After completion of the ZEBRA trial the study was amended to enrol also HR-positive patients with 1–9+LN (n =311). After a median follow-up of 4.7 years neither HR-negative nor HR-positive patients showed a benefit for goserelin. The adjusted estimated hazard ratio for event-free survival in HR-negative patients was 1.01 (goserelin versus control, 95% confidence interval [CI] 0.72–1.42, P =0.97) and 0.77 in HR-positive patients (95% CI 0.47–1.24, P =0.27). These results do not support the general use of goserelin after adjuvant chemotherapy in this group of premenopausal patients. [Copyright &y& Elsevier]

Abstract: Breast cancer remains a leading cause of cancer death in women worldwide, and the risk for disease recurrence continues despite improvements in screening and treatment and the use of prophylactic estrogen-inhibiting therapies such as tamoxifen. A number of long-term studies now indicate a significant risk for breast cancer recurrence among patients who have undergone the currently recommended five years of tamoxifen adjuvant therapy following successful treatment of their initial disease. This ongoing recurrence risk extends even to patients commonly considered at low risk for relapse, that is, those with low-grade, small tumors, and/or node-negative disease. Treatment with tamoxifen for more than five years appears detrimental rather than beneficial and, therefore, tamoxifen is not indicated for use beyond the initial five years. Endometrial cancer and thromboembolism are among the serious adverse events that have been observed with long-term tamoxifen treatment. The aromatase inhibitors are able to reduce overall estrogen levels and appear to be better tolerated over a long term. Letrozole is the most potent aromatase inhibitor and has been available in Europe since 1996 and in the United States since 1997. Letrozole has been approved for first-line treatment of postmenopausal women with hormone-receptor – positive or hormone-receptor – unknown, advanced or metastatic breast cancer in the United States and Europe, as well as for neoadjuvant treatment (primary systemic therapy) of early breast cancer prior to surgery in many countries. The results of the pivotal MA-17 trial demonstrate that letrozole is unique in its ability to improve disease-free survival in breast cancer patients who have undergone tamoxifen therapy for five years. The MA-17 results indicate that extended adjuvant therapy with letrozole reduces risk of recurrence in this setting by 42%, reduces risk of distant recurrence (metastasis), and may improve patient survival in the node-positive patient population. The results also show letrozole to be well tolerated and safe over the length of follow-up. The trial outcomes have led to the approval of letrozole for the extended adjuvant indication in more than 40 countries worldwide. Re-randomization of letrozole-treated patients from this pivotal trial is underway to investigate if ten years of extended adjuvant endocrine therapy leads to further improvement, and the results of this extension study should aid in resolving several open questions regarding extended adjuvant therapy, including who should be treated and for how long. [Copyright &y& Elsevier]

Background: All women with early breast cancer, even those with small tumors and negative nodes, remain at appreciable risk of recurrence after surgery over the subsequent 10–15 years. In women with tumors expressing estrogen receptors and/or progesterone receptors, standard systemic adjuvant therapy is 5 years of tamoxifen, which substantially reduces the risk of recurrence and breast cancer-related death. Tamoxifen efficacy benefits are limited to 5 years of treatment, presumably a consequence of acquired tamoxifen resistance. The third-generation aromatase inhibitors, which are highly selective and potent in suppressing whole-body estrogen synthesis in postmenopausal women, are being investigated as alternative or complementary treatments to tamoxifen. For treatment beyond adjuvant tamoxifen for 5 years, letrozole is the only aromatase inhibitor for which clinical trial data were reported. That trial, MA.17, evaluated letrozole as extended adjuvant treatment following standard adjuvant tamoxifen in postmenopausal women with predominantly estrogen receptor—and/or progesterone receptor—positive early breast cancer. Results: Compared with placebo, letrozole markedly reduced the residual risk of recurrence, by 42%, and the improvement in disease-free survival was irrespective of patient nodal status. A significant improvement in overall survival has already been seen in the patients at highest risk, those with positive nodes. Conclusion: On the basis of these results, extended adjuvant letrozole is recommended for all patients completing 5 years of adjuvant tamoxifen, including women generally considered at minimal risk. [ABSTRACT FROM AUTHOR]

Compares the value of tumor cell detection in bone marrow with axillary lymph node dissection in the prognosis of primary breast cancer after surgery. Profile of the patients; Prognostic indicators; Recommendations of the study.

Background: Expression of polo-like kinase-1 (PLK1), which has several functions in mitotic progression, is elevated in a broad range of human tumors. To investigate the role of PLK1 in neoplastic proliferation, we used the technique of RNA interference.Methods: Cells from several different cancer cell lines (MCF-7 breast cancer cells, HeLa S3 cervical cancer cells, SW-480 colon cancer cells, and A549 lung cancer cells) were transfected with small interfering (si) RNAs targeted against the human PLK1 or lamin genes. Northern and western blot analyses were used to examine PLK1 gene expression in transfected cancer cells and normal cells (human mammary epithelial cells [HMECs]). The phenotype, proliferation, and cell cycle distribution of cells transfected with siRNAs were also monitored by fluorescence microscopy and fluorescence-activated cell sorting analysis.Results: All cancer cell lines transfected with low doses of siRNAs targeted to PLK1 had greatly decreased levels of PLK1 mRNA and protein. siRNA4, which had the strongest inhibitory effect, reduced PLK1 mRNA in MCF-7 cells by 70% and PLK1 protein in MCF-7 cells by 95% 24 hours after transfection. Cell proliferation was reduced by between 66% and 99% 48 hours after transfection, and apoptosis was increased from 1%-5% to 13%-50% in transfected cells. Transfected SW-480 cells were mitotically arrested, and their centrosomes had lost the ability to nucleate microtubules. HMECs took up siRNAs less efficiently than cancer cells, and transfection with siRNAs targeted to PLK1 did not inhibit their proliferation.Conclusions: PLK1 function appears to be essential for centrosome-mediated microtubule events and, consequently, for spindle assembly. siRNAs targeted against human PLK1 may be valuable tools as antiproliferative agents that display activity against a broad spectrum of neoplastic cells at very low doses. [ABSTRACT FROM AUTHOR]

The anthracyclines doxorubicin and epirubicin, and the taxanes paclitaxel and docetaxel, are effective chemotherapeutic agents for the first-line and second-line treatment of metastatic breast cancer, and their clinical use is widespread. However, for women whose disease has progressed despite receiving these drugs, treatment options are limited. These women often have a good performance status, and may survive for many months or even years, so they should be given the opportunity to benefit from further chemotherapy. The goals of chemotherapy in these patients are to obtain maximum control of symptoms, prevent serious complications, and increase survival without diminishing quality of life. Several agents are used for this purpose, including fluorouracil, docetaxel (in patients who have already received paclitaxel), vinorelbine, and mitomycin c, but because data from controlled trials are limited, a standard regimen has not yet been established. Moreover, these agents may be inconvenient to administer and can be associated with adverse events requiring hospitalisation. Therefore, there is a clear need for additional therapeutic options for patients with metastatic breast cancer. Ideally, agents should have a convenient method of administration, eg, oral, and should be suitable for home-based rather than hospital-based therapy. Treatment should control disease in at least 20–30% of patients with an acceptable side-effect profile. Novel oral therapies have now been developed and are being used increasingly in patients whose disease has progressed following taxane therapy. [Copyright &y& Elsevier]

The brown alga Lobophora (Dictyotales, Phaeophyceae) is an important macroalga in the North‐eastern Atlantic archipelagos (i.e., Macaronesia). Notably in the Canaries it can dominate benthic assemblages. While the genus has been the subject of several ecological studies in the Canaries, no study has yet been conducted to assess species‐level diversity of Lobophora in Macaronesia. We reassessed the diversity of Lobophora in Macaronesia, reporting the presence of seven species (L. caboverdeana sp. nov., L. canariensis, L. dagamae sp. nov., L. delicata, L. dispersa, L. littlerorum, and L. schneideri). Lobophora spp. from Macaronesia are morphologically and ecologically distinguishable. In the Canaries, L. schneideri dominates the photophilic assemblages from the intertidal to 20‐30 m depth. Lobophora dagamae sp. nov. grows in less illuminated shallow habitats, and replaces L. schneideri from 30 to ~80 m. Lobophora canariensis also has a wide vertical distribution, from the intertidal to deep waters, while L. delicata, L. dispersa and L. littlerorum grow in shallow waters. The dominance of species with an upright habit versus prostrate or crustose species may be mediated by the pressure of herbivores. Four species have an amphi‐Atlantic distribution: L. littlerorum, L. canariensis, L. delicata, and L. schneideri. Lobophora schneideri and L. delicata are furthermore distributed in the Mediterranean Sea. By sampling a pivotal region in the Atlantic, this study significantly improves our knowledge of Lobophora biogeography in the Atlantic Ocean. Macaronesia constitutes a species–poor region for Lobophora where no diversification events occurred, and a region of overlap between the Greater Caribbean and the Indo‐Pacific. [ABSTRACT FROM AUTHOR]

The marine benthic dinoflagellate genus Gambierdiscus currently contains ~ 16 species that can be highly morphologically similar to one another, and therefore molecular genetic characterization is necessary to complement the morphological species determination. Gambierdiscus species can produce ciguatoxins, which can accumulate through the food chain and cause ciguatera fish poisoning. Recent studies have suggested that Gambierdiscus excentricus may be one of the main species responsible for ciguatoxin production in the temperate and tropical regions of the eastern Atlantic. The present study definitively identifies the species, G. excentricus, from Madeira Island, Northeast-Atlantic Ocean (32° 38′ N 16° 56′ W) by examining the morphology of a strain using light and scanning electron microscopy and sequencing regions of the ribosomal DNA (D8-D10 LSU, SSU rDNA). Variability in the shape of the apical pore and the microarchitecture of the apical pore plate were documented for the first time, as well as variability in the width of the second antapical plate. The first SSU rDNA sequence for the species is reported. Because G. excentricus is known to produce high levels of CTX-like compounds, its presence and toxicity should be regularly monitored to establish whether it is the primary cause of the ciguatera poisoning events on Madeira Island. [ABSTRACT FROM AUTHOR]

In order to characterize the coccolithophore community around the Madeira archipelago and to understand the effect of a transient frontal zone on its distribution, 149 seawater samples from the first 150 m were collected in 37 stations, during the research cruise POS466 of RV Poseidon. The present study revealed the occurrence of two biogeographic domains, NE and SW, during the late winter of 2014, with distinct physical-chemical and calcareous nannoplankton characteristics. The NE sector was characterized by higher coccolithophore cell densities (mean of 56 × 103 cell L−1) and a slightly lower diversity (Margalef diversity index of 1.80) when compared with the SW sector (mean of 47 × 103 cell L−1; Md index of 1.86). The more productive sector, NE, was associated with colder, less saline and higher nutrient content water masses, linked to the injection of a westerly flow with origin in the Azores frontal system. Total cell densities ranged between 12 × 103 and 112 × 103 cell L−1, being Emiliana huxleyi the dominant species followed by small Gephyrocapsa. The most common and subordinate taxa, in order of decreasing abundance, were: Gephyrocapsa oceanica , Michaelsarsia spp., Syracosphaera spp., Umbilicosphaera spp. and Algirosphaera robusta. Relationships between environmental conditions and spatial and vertical variability in coccosphere abundance, associated E. huxleyi and small Gephyrocapsa with the more productive water mass conditions, linked to the thermohaline transient front. G. oceanica distribution indicated its preference for warmer and less turbulent coastal waters, when compared to E. huxleyi and small Gephyrocapsa. Michaelsarsia spp. and A. robusta revealed preference for the northwest coast of Madeira, associated with mesotrophic conditions of the water column. Syracosphaera spp. and Umbilicosphaera spp. were well distributed throughout the archipelago and along the sampled depths, from the coast to open ocean conditions, as well as from lower to higher productive zones, displaying affinities for the meso to oligotrophic conditions, typical of these subtropical waters. The broad depth range of several taxa and the nonexistence of the coccolithophore vertical succession were the result of homogeneous and generalized well-mixed surface layer during the present survey. [ABSTRACT FROM AUTHOR]

The patterns of variability in the composition and structure of benthic communities along two depth strata (5 and 10 m) and the presence of sea urchins in structuring the subtidal rocky reefs were quantified in a long-established coastal marine protected area (Garajau MPA) and in two size equivalent and contiguous impacted areas (one highly urbanized and other with high fishing pressure) at Madeira Island (northeast Atlantic). Results suggest i) the MPA could be acting as a refuge for local biodiversity, ii) communities from the highly fished area could be suffering an impoverishment of local biodiversity, and iii) communities from the highly urbanized area would be enriched by the establishment of opportunistic species. These findings support that the level of human-pressure likely plays an important role in the composition of benthic communities in this insular ecosystem, although this was more relevant at the shallower stratum where the key grazer Diadema africanum explained 65% of the variance of benthic assemblages. It is suggested that this MPA small dimension and proximity to human impacted areas are limiting the survival of predators of the D. africanum. [ABSTRACT FROM AUTHOR]

Shallow subtidal macroalgal communities in the North-eastern Atlantic archipelagos (Azores, Madeira, Canaries and Cape Verde) were studied in order to identify their spatial organization patterns and the main drivers of change. Fifteen islands and 145 sites across 15º of latitude and 2850 km were sampled. We found high spatial variability across the scales considered (archipelago, island and site). The structure of macroalgal communities differed among archipelagos, except between Madeira and the Canaries, which were similar. Across a latitudinal gradient, macroalgal communities in the Azores were clearly separated from the other archipelagos; communities in Madeira and the Canaries occupied an intermediate position, while those in Cape Verde appeared at the opposite end of the gradient. In the Azores, species with warm-temperate affinities dominated communities. Cape Verde communities were, in contrast, dominated by tropical taxa, whereas in the subtropical Canaries and Madeira there was a mixture of species with colder and warmer affinities. Apart from crustose coralline algae, the Dictyotales were the group with greatest cover; larger and longer-lived species were progressively replaced by short-lived species along a latitudinal gradient from north to south. The perennial speciesZonaria tournefortiidominated the sea-bottom in the Azores, the semi-perennialLophophora variegatain the Canaries, the filamentous algae in Madeira and the ephemeralDictyota dichotomain Cape Verde. We hypothesized that the differences among archipelagos could be explained by synergies between temperature and herbivory, which increased in diversity southwards, especially in Cape Verde. This was supported by the predominance of non-crustose macroalgae in the Azores and of crustose macroalgae in Cape Verde, as would be predicted from the greater herbivore activity. At the scale of islands and sites, the same set of environmental variables drove differences in macroalgal community structure across all the Macaronesian archipelagos. [ABSTRACT FROM AUTHOR]

The population structure of the blue jack mackerel (Trachurus picturatus, Osteichthyes, Carangidae), in the northeast Atlantic is still unknown. To identify any distinct population units, three areas were selected: waters off Madeira, Peniche (mainland Portugal), and the Canary Islands. Knowledge of population structure is an aspect of the population dynamics of a species that is essential to effectively assess the existence of stocks and manage fisheries. In this study, geometric morphometrics and otolith shape analysis were successfully applied for population identification. Multivariate analysis of variance (MANOVA) revealed no body shape differences between males and females in each area studied, and therefore the sexes were combined for the analysis. The results of the discriminant analysis showed that a low misclassification occurred among areas; 78.0% of individuals were correctly classified. MANOVA performed on the otolith normalized elliptic Fourier descriptors revealed significant areal differences, but no difference between sexes. An overall classification success of 73.3% in the canonical discriminant analysis was achieved. These results indicate the usefulness of both otolith and body shape analysis for differentiation of blue jack mackerel stocks from the northeast Atlantic and indicate the existence of at least three distinguishable populations of this species. [ABSTRACT FROM AUTHOR]

Okadaic acid and its analogues are potent phosphatase inhibitors that cause Diarrheic Shellfish Poisoning (DSP) through the ingestion of contaminated shellfish by humans. This group of toxins is transmitted worldwide but the number of poisoning incidents has declined over the last 20 years due to legislation and monitoring programs that were implemented for bivalves. In the summer of 2012 and 2013, we collected a total of 101 samples of 22 different species that were made up of benthic and subtidal organisms such echinoderms, crustaceans, bivalves and gastropods from Madeira, São Miguel Island (Azores archipelago) and the northwestern coast of Morocco. The samples were analyzed by UPLC-MS/MS. Our main objective was to detect new vectors for these biotoxins. We can report nine new vectors for these toxins in the North Atlantic: Astropecten aranciacus, Arbacia lixula, Echinaster sepositus, Holothuria sanctori, Ophidiaster ophidianus, Onchidella celtica, Aplysia depilans, Patella spp., and Stramonita haemostoma. Differences in toxin contents among the species were found. Even though low concentrations were detected, the levels of toxins that were present, especially in edible species, indicate the importance of these types of studies. Routine monitoring should be extended to comprise a wider number of vectors other than for bivalves of okadaic acid and its analogues. [ABSTRACT FROM AUTHOR]

• Bacterial cellulose (BC) biopolymers are promising solutions to MPs pollution. • Fully hydrated BC biopolymers remove up to 99% of MPs from contaminated waters. • BC biopolymers maintain high efficiency and resistance through filtration cycles. • BC biopolymers show ability to substitute fossil-based filters in water filtration. Microplastics (MPs) pollution has become one of our time's most consequential issue. These micropolymeric particles are ubiquitously distributed across all natural and urban ecosystems. Current filtration systems in wastewater treatment plants (WWTPs) rely on non-biodegradable fossil-based polymeric filters whose maintenance procedures are environmentally damaging and unsustainable. Following the need to develop sustainable filtration frameworks for MPs water removal, years of R&D lead to the conception of bacterial cellulose (BC) biopolymers. These bacterial-based naturally secreted polymers display unique features for biotechnological applications, such as straightforward production, large surface areas, nanoporous structures, biodegradability, and utilitarian circularity. Diligently, techniques such as flow cytometry, scanning electron microscopy and fluorescence microscopy were used to evaluate the feasibility and characterise the removal dynamics of highly concentrated MPs-polluted water by BC biopolymers. Results show that BC biopolymers display removal efficiencies of MPs of up to 99%, maintaining high performance for several continuous cycles. The polymer's characterisation showed that MPs were both adsorbed and incorporated in the 3D nanofibrillar network. The use of more economically- and logistics-favourable dried BC biopolymers preserves their physicochemical properties while maintaining high efficiency (93–96%). These polymers exhibited exceptional structural preservation, conserving a high water uptake capacity which drives microparticle retention. In sum, this study provides clear evidence that BC biopolymers are high performing, multifaceted and genuinely sustainable/circular alternatives to synthetic water treatment MPs-removal technologies. [Display omitted] [ABSTRACT FROM AUTHOR]

Ciguatera fish poisoning (CFP) is a syndrome caused by the ingestion of fish contaminated with Ciguatoxins (CTXs). These phycotoxins are produced mainly by dinoflagellates that belong to the genus Gambierdiscus that are transformed in more toxic forms in predatory fish guts, and are more present in the Indo-Pacific and Caribbean areas. It is estimated that CFP causes per year more than 10,000 intoxications worldwide. With the rise of water temperature and anthropogenic intervention, it is important to study the prevalence of CFP in more temperate waters. Through inter- and subtidal sampling, 22 species of organisms were collected, in Madeira and Azores archipelagos and in the northwestern Moroccan coast, during September of 2012 and June and July of 2013. A total of 94 samples of 22 different species of bivalves, gastropods, echinoderms and crustaceans where analyzed by Ultra Performance Liquid Chromatography-Mass Spectometry-Ion Trap-Time of Flight (UPLC-MS-IT-TOF) and Ultra Performance Chromatography- Mass Spectrometry (UPLC-MS). Our main aim was to detect new vectors and ascertain if there were some geographical differences. We detected for the first time putative CTXs in echinoderms, in two starfish species—M. glacialis and O. ophidianus. We detected differences regarding uptake values by organisms and geographical location. Toxin amounts were significant, showing the importance and the need for continuity of these studies to gain more knowledge about the prevalence of these toxins, in order to better access human health risk. In addition, we suggest monitoring of these toxins should be extended to other vectors, starfish being a good alternative for protecting and accessing human health risk. [ABSTRACT FROM AUTHOR]

Background: In this study, we examined patients who had non-progressive disease for at least 2 years after diagnosis of inoperable locoregional recurrent or metastatic breast cancer under continuous trastuzumab treatment. Our primary goal was to assess the long-term outcome of patients with durable response to trastuzumab. Methods: 268 patients with HER2-positive inoperable locally recurrent or metastatic breast cancer and non-progressive disease for at least 2 years under trastuzumab treatment were documented retrospectively or prospectively in the HER-OS registry, an online documentation tool, between December 2006 and September 2010 by 71 German oncology centers. The study end point was time to tumor progression. Results: Overall, 47.1% of patients (95% confidence interval (CI): 39.9-54.1%) remained in remission for more than 5 years, while the median time to progression was 4.5 years (95% CI: 4.0-6.6 years). Lower age (<50 years) and good performance status (ECOG 0) at time of trastuzumab treatment initiation as well as complete remission after initial trastuzumab treatment were associated with longer time to progression. Interruption of trastuzumab therapy correlated with shorter time to progression. Conclusions: HER2-positive patients, who initially respond to palliative treatment with trastuzumab, can achieve a long-term tumor remission of several years. [ABSTRACT FROM AUTHOR]

Abstract: In recent years, the global distribution of phytoplankton functional types (PFT) and phytoplankton size classes (PSC) has been determined by remote sensing. Many of these methods rely on interpretation of phytoplankton size or type from pigment data, but independent validation has been difficult due to lack of appropriate in situ data on cell size. This work uses in situ data (photosynthetic pigments concentration and cell abundances) from the north-east Atlantic, along a trophic gradient, sampled from 2005 to 2010, as well as Atlantic Meridional Transect (AMT) data for the same region, to test a previously developed conceptual model, which calculates the fractional contributions of pico-, nano- and micro-plankton to total phytoplankton chlorophyll biomass (Brewin et al., 2010). The application of the model proved to be successful, as shown by low mean absolute error between data and model fit. However, regional values obtained for the model parameters had some effect on the relative distribution of size classes as a function of chlorophyll-a, compared with the results according to the original model. The regional parameterisation yielded a dominance of micro-plankton contribution for chlorophyll-a concentrations greater than 0.5mgm−3, rather than from 1.3mgm−3 in the original model. Intracellular chlorophyll-a (Chla) per cell, for each size class, was computed from the cell enumeration results (microscope counts and flow cytometry) and the chlorophyll-a concentration for that size class given by the model. The median intracellular chlorophyll-a values computed were 0.004, 0.224 and 26.78pg Chlacell−1 for pico-, nano-, and micro-plankton respectively. This is generally consistent with the literature, thereby providing an indirect validation of the method based on pigments to assign size classes. Using a satellite-derived composite image of chlorophyll-a for the study area, a map of cell abundance was generated based on the computed intracellular chlorophyll-a for each size-class, thus extending the remote-sensing method for mapping size classes of phytoplankton from chlorophyll-a concentration to mapping cell numbers in each class. The map reveals the ubiquitous presence of pico-plankton, and shows that all size classes are more abundant in more productive areas. [Copyright &y& Elsevier]

Summary: Background: Worldwide, many patients with HER2-positive early stage breast cancer do not receive trastuzumab—the standard adjuvant treatment. We investigated the efficacy and safety of adjuvant lapatinib for patients with trastuzumab-naive HER2-positive early-stage breast cancer, started at any time after diagnosis. Methods: This study was a placebo-controlled, multicentre, randomised phase 3 trial. Women outpatients from 33 centres with HER2-positive early-breast cancer who had previously received adjuvant chemotherapy but not trastuzumab were randomly assigned (1:1) to receive daily lapatinib (1500 mg) or daily placebo for 12 months. Randomisation was done with a computer-generated sequence, stratified by time since diagnosis, lymph node involvement at diagnosis, and tumour hormone-receptor status. Investigators, site staff, and patients were masked to treatment assignment. The primary endpoint was disease-free survival in the intention-to-treat population. This study is registered with ClinicalTrials.gov, number NCT00374322. Findings: Between August, 2006, and May, 2008, 3161 women were enrolled and 3147 were assigned to lapatinib (n=1571) or placebo (n=1576). After a median follow-up of 47·4 months (range 0·4–60·0) in the lapatinib group and 48·3 (0·7–61·3) in the placebo group, 210 (13%) disease-free survival events had occurred in the lapatinib group versus 264 (17%) in the placebo group (hazard ratio [HR] 0·83, 95% CI 0·70–1·00; p=0·053). Central review of HER2 status showed that only 2490 (79%) of the randomised women were HER2-positive. 157 (13%) of 1230 confirmed HER2-positive patients in the lapatinib group and in 208 (17%) of 1260 in the placebo group had a disease-free survival event (HR 0·82, 95% 0·67–1·00; p=0·04). Serious adverse events occurred in 99 (6%) of 1573 patients taking lapatinib and 77 (5%) of 1574 patients taking placebo, with higher incidences of grade 3–4 diarrhoea (97 [6%] vs nine [<1%]), rash (72 [5%] vs three [<1%]), and hepatobiliary disorders (36 [2%] vs one [<1%]). Interpretation: Our data show that there was no significant difference in disease-free survival between groups when analysed in the intention-to-treat population. However, exploratory analyses restricted to patients who had HER2-positive disease confirmed by central fluorescence in-situ hybridisation review suggested marginal benefit with lapatinib in terms of disease-free survival. Thus lapatinib might be an option for women with HER2-positive breast cancer who do not or cannot receive adjuvant trastuzumab. Funding: GlaxoSmithKline. [Copyright &y& Elsevier]

Summary: Background: Little is known about the treatment of breast cancer during pregnancy. We aimed to determine whether treatment for breast cancer during pregnancy is safe for both mother and child. Methods: We recruited patients from seven European countries with a primary diagnosis of breast cancer during pregnancy; data were collected retrospectively if the patient was diagnosed before April, 2003 (when the registry began), or prospectively thereafter, irrespective of the outcome of pregnancy and the type and timing of treatment. The primary endpoint was fetal health for up to 4 weeks after delivery. The registry is ongoing. The study is registered with ClinicalTrials.gov, number NCT00196833. Findings: From April, 2003, to December, 2011, 447 patients were registered, 413 of whom had early breast cancer. Median age was 33 years (range 22–51). At the time of diagnosis, median gestational age was 24 weeks (range 5–40). 197 (48%) of 413 women received chemotherapy during pregnancy with a median of four cycles (range one to eight). 178 received an anthracycline, 15 received cyclophosphamide, methotrexate, and fluorouracil, and 14 received a taxane. Birthweight was affected by chemotherapy exposure after adjustment for gestational age (p=0·018), but not by number of chemotherapy cycles (p=0·71). No statistical difference between the two groups was observed for premature deliveries before the 37th week of gestation. 40 (10%) of 386 infants had side-effects, malformations, or new-born complications; these events were more common in infants born before the 37th week of gestation than they were in infants born in the 37th week or later (31 [16%] of 191 infants vs nine [5%] of 195 infants; p=0·0002). In infants for whom maternal treatment was known, adverse events were more common in those who received chemotherapy in utero compared with those who were not exposed (31 [15%] of 203 vs seven [4%] of 170 infants; p=0·00045). Two infants died; both were exposed to chemotherapy and delivered prematurely, but both deaths were thought not to be related to treatment. Median disease-free survival for women with early breast cancer was 70·6 months (95% CI 62·1–105·5) in women starting chemotherapy during pregnancy and 94·4 months (lower 95% CI 64·4; upper 95% CI not yet reached) in women starting chemotherapy after delivery (unadjusted hazard ratio 1·13 [95% CI 0·76–1·69]; p=0·539). Interpretation: Although our data show that infants exposed to chemotherapy in utero had a lower birthweight at gestational age than did those who were unexposed, and had more complications, these differences were not clinically significant and, since none of the infants was exposed to chemotherapy in the first trimester, were most likely related to premature delivery. Delay of cancer treatment did not significantly affect disease-free survival for mothers with early breast cancer. Because preterm birth was strongly associated with adverse events, a full-term delivery seems to be of paramount importance. Funding: BANSS Foundation, Biedenkopf, Germany and the Belgian Cancer Plan, Ministry of Health, Belgium. [Copyright &y& Elsevier]

Summary: Background: We compared the efficacy and safety of the addition of lapatinib versus trastuzumab to anthracycline-taxane-based neoadjuvant chemotherapy. Methods: In the GeparQuinto randomised phase 3 trial, patients with untreated HER2-positive operable or locally advanced breast cancer were enrolled between Nov 7, 2007, and July 9, 2010. Patients were eligible if their tumours were classified as cT3/4a-d, or hormone receptor (HR)-negative, HR-positive with clinically node-positive and cT2 disease (cT2 cN+), or HR-positive and pathologically node-positive in the sentinel lymph node for those with cT1 disease (cT1 pNSLN+). Patients were randomly assigned in a 1:1 ratio to receive neoadjuvant treatment with four cycles of EC (epirubicin [90 mg/m2 intravenously] plus cyclophosphamide [600 mg/m2 intravenously], every 3 weeks), and four cycles of docetaxel (100 mg/m2 intravenously every 3 weeks) with either trastuzumab (6 mg/kg intravenously, with a starting loading dose of 8 mg/kg, for eight cycles, every 3 weeks) or lapatinib (1000–1250 mg per day orally) throughout all cycles before surgery. Randomisation was done by dynamic allocation with the minimisation method of Pocock and patients were stratified by participating site, HR status, and extent of disease (cT1–3 cN0–2 vs T4 or N3). The primary endpoint was pathological complete response (defined as ypT0 and ypN0) and was analysed in all patients who received at least one cycle of EC. Participants and investigators were not masked to treatment assignment. Pathologists in centres assessing surgery outcomes were masked to group assignment. This trial is registered with ClinicalTrials.gov, number NCT00567554. Findings: Of 620 eligible patients, 309 were randomly assigned to chemotherapy with trastuzumab (ECH-TH group) and 311 to chemotherapy with lapatinib (ECL-TL group). Two patients in the ECH-TH group and three patients in the ECL-TL group did not start treatment because of withdrawal of consent or immediate surgery. 93 (30·3%) of 307 patients in the ECH-TH group and 70 (22·7%) of 308 patients in the ECL-TL group had a pathological complete response (odds ratio [OR] 0·68 [95%CI 0·47–0·97]; p=0·04). Chemotherapy with trastuzumab was associated with more oedema (119 [39·1%] vs 88 [28·7%]) and dyspnoea (90 [29·6%] vs 66 [21·4%]), and ECL-TL with more diarrhoea (231 [75·0%] vs 144 [47·4%]) and skin rash (169 [54·9%] vs 97 [31·9%]). 43 (14·0%) patients discontinued in the ECH-TH group and 102 (33·1%) in the ECL-TL group. 70 serious adverse events were reported in the ECH-TH group and 87 in the ECL-TL group. Interpretation: This direct comparison of trastuzumab and lapatinib showed that pathological complete response rate with chemotherapy and lapatinib was significantly lower than that with chemotherapy and trastuzumab. Unless long-term outcome data show different results, lapatinib should not be used outside of clinical trials as single anti-HER2-treatment in combination with neoadjuvant chemotherapy. Funding: GlaxoSmithKline, Roche, and Sanofi-Aventis. [ABSTRACT FROM AUTHOR]

Abstract: Background: Molecular markers displaying bimodal expression distribution can reveal distinct disease subsets and may serve as prognostic or predictive markers or represent therapeutic targets. Oestrogen (ER) and human epidermal growth factor receptor 2 (HER2) receptors are strongly bimodally expressed genes in breast cancer. Material and methods: We applied a novel method to identify bimodally expressed genes in 394 triple negative breast cancers (TNBC). We identified 133 bimodally expressed probe sets (128 unique genes), 69 of these correlated to previously reported metagenes that define molecular subtypes within TNBC including basal-like, molecular-apocrine, claudin-low and immune cell rich subgroups but 64 probe sets showed no correlation with these features. Results: The single most prominent functional group among these uncorrelated genes was the X chromosome derived Cancer/Testis Antigens (CT-X) including melanoma antigen family A (MAGE-A) and Cancer/Testis Antigens (CTAG). High expression of CT-X genes correlated with worse survival in multivariate analysis (HR 2.02, 95% CI 1.27–3.20; P =0.003). The only other significant variable was lymph node status. The poor prognosis of patients with high MAGE-A expression was ameliorated by the concomitant high expression of immune cell metagenes (HR 1.87, 95% CI 0.96–3.64; P =0.060), whereas the same immune metagene had lesser prognostic value in TNBC with low MAGE-A expression. Conclusions: MAGE-A antigen defines a very aggressive subgroup of TNBC; particularly in the absence of immune infiltration in the tumour microenvironment. These observations suggest a therapeutic hypothesis; TNBC with MAGE-A expression may benefit the most from further augmentation of the immune response. Novel immune stimulatory drugs such as (anti-cytotoxic T-lymphocyte antigen-4 CTLA-4) directed therapies provide a realistic opportunity to directly test this hypothesis in the clinic. [Copyright &y& Elsevier]

Background: Current prognostic gene signatures for breast cancer mainly reflect proliferation status and have limited value in triple-negative (TNBC) cancers. The identification of prognostic signatures from TNBC cohorts was limited in the past due to small sample sizes. Methodology/Principal Findings: We assembled all currently publically available TNBC gene expression datasets generated on Affymetrix gene chips. Inter-laboratory variation was minimized by filtering methods for both samples and genes. Supervised analysis was performed to identify prognostic signatures from 394 cases which were subsequently tested on an independent validation cohort (n = 261 cases). Conclusions/Significance: Using two distinct false discovery rate thresholds, 25% and <3.5%, a larger (n = 264 probesets) and a smaller (n = 26 probesets) prognostic gene sets were identified and used as prognostic predictors. Most of these genes were positively associated with poor prognosis and correlated to metagenes for inflammation and angiogenesis. No correlation to other previously published prognostic signatures (recurrence score, genomic grade index, 70-gene signature, wound response signature, 7-gene immune response module, stroma derived prognostic predictor, and a medullary like signature) was observed. In multivariate analyses in the validation cohort the two signatures showed hazard ratios of 4.03 (95% confidence interval [CI] 1.71-9.48; P = 0.001) and 4.08 (95% CI 1.79-9.28; P = 0.001), respectively. The 10-year event-free survival was 70% for the good risk and 20% for the high risk group. The 26-gene signatures had modest predictive value (AUC = 0.588) to predict response to neoadjuvant chemotherapy, however, the combination of a B-cell metagene with the prognostic signatures increased its response predictive value. We identified a 264-gene prognostic signature for TNBC which is unrelated to previously known prognostic signatures. [ABSTRACT FROM AUTHOR]

Species richness is the most commonly used but controversial biodiversity metric in studies on aspects of community stability such as structural composition or productivity. The apparent ambiguity of theoretical and experimental findings may in part be due to experimental shortcomings and/or heterogeneity of scales and methods in earlier studies. This has led to an urgent call for improved and more realistic experiments. In a series of experiments replicated at a global scale we translocated several hundred marine hard bottom communities to new environments simulating a rapid but moderate environmental change. Subsequently, we measured their rate of compositional change (re-structuring) which in the great majority of cases represented a compositional convergence towards local communities. Re-structuring is driven by mortality of community components (original species) and establishment of new species in the changed environmental context. The rate of this re-structuring was then related to various system properties. We show that availability of free substratum relates negatively while taxon richness relates positively to structural persistence (i.e., no or slow re-structuring). Thus, when faced with environmental change, taxon-rich communities retain their original composition longer than taxon-poor communities. The effect of taxon richness, however, interacts with another aspect of diversity, functional richness. Indeed, taxon richness relates positively to persistence in functionally depauperate communities, but not in functionally diverse communities. The interaction between taxonomic and functional diversity with regard to the behaviour of communities exposed to environmental stress may help understand some of the seemingly contrasting findings of past research. [ABSTRACT FROM AUTHOR]

Guidelines for the locoregional treatment of primary breast cancer were last published by the US National Institutes of Health in 1991. Since then, new surgical and radiotherapeutic techniques have been developed, clinical trials have provided new evidence, and intriguing long-term effects have emerged from global metadatabases. A revision of these guidelines is therefore necessary and timely. To address this concern, in October 2008, a group of opinion leaders from Austria, Denmark, France, Germany, Italy, the Netherlands, the United Kingdom, and the United States who have worked and published in the field of locoregional treatment met and collectively prepared and approved the described set of recommendations for the use of surgery and radiotherapy in primary breast cancer outside of clinical trials. [ABSTRACT FROM AUTHOR]

Abstract: To compare dose-intensified epirubicin monotherapy with a standard sequential regimen, patients with primary breast cancer and ⩾10 involved axillary nodes were randomised to either four 21-day cycles of epirubicin 120mg/m2 (E120; n =202) or four 21-day cycles of epirubicin 90mg/m2 plus cyclophosphamide 600mg/m2 (EC) followed by three 28-day cycles of cyclophosphamide, methotrexate and 5-fluorouracil (CMF; n =209). Simultaneous hormonal treatment was applied in both arms. At 5years’ median follow-up, the 5-year event-free survival (EFS) rates were 47.7% (95% confidence interval [CI], 40.2–55.2%) for E120 and 45.9% (38.5–53.3%) for EC-CMF. E120 was as effective as EC-CMF with regard to EFS (hazard ratio [HR] for E120 versus EC-CMF 1.04; 95% CI, 0.79–1.36; p =0.79) and overall survival (HR 1.06; 95% CI 0.77–1.46; p =0.72). The data demonstrate that 4 cycles of dose-intensified epirubicin monotherapy can be as effective as 7 cycles of standard sequential polychemotherapy in high-risk breast cancer patients with ⩾10 positive lymph nodes, despite treatment with a single agent and a shorter treatment duration. [Copyright &y& Elsevier]

Sphingolipids are bioactive lipids implicated in apoptosis, cell survival and proliferation. We analyzed the prognostic value of enzymes from sphingolipid metabolism in breast cancer. Differences in expression of ceramide galactosyl transferase (UGT8), ceramide kinase (CERK), and Ganglioside GD3-Synthase (ST8SIA1) in breast cancer cells were investigated by using microarray data of 1,581 tumor samples. UGT8, CERK, and ST8SIA1 were associated with poor pathohistological grading ( P < 0.001). High CERK expression was correlated with ErbB2 status ( P = 0.006). Among ER positive breast cancers a significant worse prognosis for patients with tumors showing low ST8SIA1 and UGT8 expression was observed. In the ER negative subgroup those samples with high CERK expression displayed a worse prognosis. In a multivariate analysis only ST8SIA1 and tumor size remained significant. Our experiments reveal that expression of enzymes from the sphingolipid metabolism has prognostic implications in breast cancer. [ABSTRACT FROM AUTHOR]

Abstract: Key aspects of deep-ocean fluid dynamics such as basin-scale (residual) and tidal flow are believed to have changed over glacial/interglacial cycles, with potential relevance for climatic change. To constrain the mechanistic links, magnitudes and temporal succession of events analyses of sedimentary paleo-records are of great importance. Efforts have been underway for some time to reconstruct residual-flow patterns from sedimentary records. Attempts to reconstruct tidal flow characteristics from deep-sea sediment deposits, however, are at a very early stage and first require a better understanding of the reflection of modern tides in sediment dynamics. In this context internal (baroclinic) tides, which are formed by the surface (barotropic) tide interacting with seafloor obstacles, are believed to play a particularly important role. Here we compare two modern deep-sea environments with respect to the effect of tides on sediment dynamics. Both environments are influenced by kilometre-scale topographic features but with vastly different tidal forcing: (1) two sites in the Northeast Atlantic (NEA) being surrounded by, or located downstream of, fields of short seamounts (maximum barotropic tidal current velocities ∼5cms−1); and (2) a site next to the Anaximenes seamount in the Eastern Mediterranean (EMed) (maximum barotropic tidal current velocities ∼0.5cms−1). With respect to other key fluid-dynamical parameters both environments are very similar. Signals of sedimentary particle dynamics, as influenced by processes taking place in the bottom boundary layer, were traced by the vertical water-column distribution of radioactive disequilibria (daughter/parent activity ratios≠1) between the naturally occurring, short-lived (half-life: 24.1d) particulate-matter tracer 234Th relative to its very long-lived and non-particle-reactive parent nuclide 238U. Activity ratios of 234Th/238U<1 in water samples collected near the seafloor indicate fast 234Th scavenging onto particles followed by fast settling of these particles from the sampled parcel of water and, therefore, imply active sediment resuspension and dynamics on time scales of up to several weeks. In the Northeast Atlantic study region tides (in particular internal tides) are very likely to locally push total current velocities near the seafloor across the critical current velocity threshold for sediment erosion or resuspension whereas in the Eastern Mediterranean the tides are much too weak for this to happen. This difference in tidal forcing is reflected in a difference of the frequency of the occurrence of radioactive disequilibria <1 between total 234Th and 238U: In the near-bottom water column of the Northeast Atlantic region 59% of samples had detectable 234Th/238U disequilibria whereas at the Eastern Mediterranean site this fraction was only 7% (including a few disequilibria >1). The results of this study, therefore, add to the evidence suggesting that tides in the deep sea of the open oceans are more important for sediment dynamics than previously thought. It is hypothesised that (a) tide/seamount interactions in the deep open ocean control the local distribution of erosivity proxies (e.g., distributions of sediment grain sizes, heavy minerals and particle-reactive radionuclides) in sedimentary deposits and (b) the aforementioned topographically controlled sedimentary imprints of (internal) tides are useful in the reconstruction of past changes of tidal forcing in the deep sea. [Copyright &y& Elsevier]

Abstract: Plexins, cell-surface receptors for semaphorins, are involved in cell adhesion and migration. In the previous work, we demonstrated that the loss of Plexin B1 expression is associated with poor outcome in breast cancer patients. The goal of the present study was a validation of Plexin B1 expression in a large scale microarray dataset from n =1086 breast cancer patients. Plexin B1 correlates with ER status (p <0.001) and is of prognostic significance only in ER positive (p =0.024) but not in ER negative samples (p =0.85). Among ER positive tumours, the loss of Plexin B1 expression is associated with a positive ErbB2 status (p =0.05) and a high Ki67 expression (p =0.016) in univariate analysis. Multivariate Cox regression including all standard parameters among ER positive tumours revealed that Plexin B1 (HR 1.59, 95% confidence interval (CI) 1.03–2.47, p =0.036) remains a significant prognostic marker besides tumour size (HR 2.27, 95% CI 1.33–3.89, p =0.0028) and Ki67 (HR 1.78, 95% CI 1.12–2.84, p =0.0149). Interestingly, the prognostic value of Plexin B1 was pronounced in low proliferating ER positive tumours otherwise characterised by a low risk of recurrence. In conclusion, this study confirms our previous observations suggesting Plexin B1 as a new prognostic marker in ER positive breast cancers. [Copyright &y& Elsevier]

Multidrug resistance (MDR) has been linked to sphingolipid metabolism and preclinical data ascribe glucosylceramide synthase (GCS) a major role for MDR especially in breast cancer cells but no profound data are available on the expression of this potential therapeutic target in clinical breast cancer specimens. We analyzed microarray data of GCS expression in a large cohort of 1,681 breast tumors. Expression of GCS was associated with a positive estrogen receptor (ER) status, lower histological grading, low Ki67 levels and ErbB2 negativity ( P < 0.001 for all). In univariate analysis there was a benefit for disease free survival for patients with tumors displaying low levels of GCS expression but this significance was lost in multivariate Cox regression. Our results suggest ER positive tumors may be the most promising candidates for a potential therapeutic application of GCS inhibitors. [ABSTRACT FROM AUTHOR]

Membrane proteins of the claudin superfamily are important components of cellular tight and adherens junctions. Although their exact function remains unclear, these proteins may play a role in tissue remodeling, a process which is associated with several diseases including endometriosis. In the present work we analyzed the expression of 13 members of the claudin family in the endometrium and peritoneum by microarray analysis. Real-time polymerase chain reaction and immunohistochemistry in human endometrium and peritoneal endometriotic lesions were performed for validation of the expression of claudin-1, -3, -4, -5 and -7. Diminished expression of claudin-3, -4 and -7 in ectopic endometrium was frequently observed as indicated by all three methods. In contrast to a higher expression of claudin-5 mRNA detected in bulk biopsies of ectopic endometrium, immunohistochemistry revealed no alteration of claudin-5 protein expression in glandular cells of endometriosis samples. The downregulation of various members of the claudin family may contribute to endometrial cell detachment and increase the number of cells invading pelvic organs. [ABSTRACT FROM AUTHOR]

Among breast cancer patients, nonresponse to initial neoadjuvant chemotherapy is associated with unfavorable outcome. We compared the response of nonresponding patients who continued the same treat- ment with that of patients who switched to a well-tolerated non-cross-resistant regimen. Previously untreated breast cancer patients received two 3-week cycles of docetaxel at 75 mg/m2, doxorubicin at 50 mg/m2, and cyclophosphamide at 500 mg/m2 per day (TAC). Patients whose tumors did not decrease in size by at least 50% were randomly assigned to four additional cycles of TAC or to four cycles of vinorelbine at 25 mg/m2 and capecitabine at 2000 mg/rn2 (NX). The outcome was sonographic response, defined as a reduction in the product of the two largest perpendicular diameters by at least 50%. A differ- ence of 10% or less in the sonographic response qualified as noninferiority of the NX treatment. Pathological complete response was defined as no invasive or in situ residual tumor masses in the breast and lymph nodes. Toxic effects were assessed. All statistical tests were two-sided. Of 2090 patients enrolled in the GeparTrio study, 622 (29.8%) who did not respond to two initial cycles of TAC were randomly assigned to an additional four cycles of TAC (n = 321) or to four cycles of NX (n = 301). Sonographic response rate was 50.5% for the TAC arm and 51.2% for the NX arm. The difference of 0.7% (95% confidence interval = -7.1% to 8.5%) demonstrated noninferiority of NX (P = .008). Similar numbers of patients in both arms received breast-conserving surgery (184 [57.3%] in the TAC arm vs 180 [59.8%] in the NX arm) and had a pathological complete response (5.3% vs 6.0%). Fewer patients in the NX arm than in the TAC arm had hematologic toxic effects, mucositis, infections, and nail changes, but more had hand-foot syndrome and sensory neuropathy. Pathological complete responses to both regimens were marginal. Among patients who did not respond to the initial neoadjuvant TAC treatment, similar efficacy but better tolerability was observed by switching to NX than continuing with TAC. [ABSTRACT FROM AUTHOR]

Patients with an early response to neoadjuvant chemotherapy have chemosensitive tumors and a high probability for a pathological complete response at surgery. The relationship between extended chemo- therapy and pathological complete response at surgery was investigated in a clinical trial. Untreated breast cancer patients received two 3-week cycles of docetaxel at 75 mg/rn2, doxorubicin at 50 mg/rn2, and cyclophosphamide at 500 mg/rn2 (TAC). Those whose tumor size decreased by 50% or more by sonographic measurement (ie, reduction in the product of the two largest perpendicular diameters by at least 50%) were classified as responders and randomly assigned to receive four or six more cycles of TAC, for a total of six or eight TAC cycles. The primary aim was to increase the rate of a pathological complete response (defined as no invasive or in situ residual tumor masses in the breast and lymph nodes) from 20% to 26%. Sonographic response rates and rates of breast-conserving surgery and adverse effects were also assessed. All statistical tests were two-sided. Of the 2090 patients in the GeparTrio trial, 1390(66.5%) were randomly assigned as responders after two initial TAC cycles to receive an additional four (n = 704) or six (n = 686) TAC cycles. Rates of pathological complete response were not statistically significantly different between the arms (21.0% with six TAC cycles and 23.5% with eight TAC cycles; difference = 2.5%, 95% confidence interval [Cl] = -1.8% to 6.8%; P= .27). More clinical (48.2% vs 52.9%, difference = 4.7%; 95% Cl = -0.55% to 9.95%; P= .08) and sonographic (22.6% vs 27.6%, difference = 5%; 95% Cl = 0.45% to 9.55%; P= .033) complete responses at surgery were observed with eight TAC cycles than with six TAC cycles. The rate of breast-conserving surgery was similar in both arms (67.5% vs 68.5%, respectively, P= .68). Grade 3 or 4 leukopenia and edema and various grade 1 or 2 adverse events were more frequent in patients receiving eight TAC cycles than in those receiving six cycles. Patients receiving eight TAC cycles had statistically significantly higher sonographic response rates but not pathological complete response rates than those receiving six TAC cycles. However, they also had more toxic effects. So far, eight cycles of TAC cannot be recommended for the whole group of patients responding to two initial cycles of TAC. [ABSTRACT FROM AUTHOR]

Objective: To characterize the expression of WNT7A in human eutopic and ectopic endometrium. Design: Experimental study using real-time polymerase chain reaction, laser microdissection, in situ hybridization, and immunofluorescence. Setting: University-based laboratory. Patient(s): Patients with and without endometriosis undergoing surgery for benign indications. Intervention(s): None. Main Outcome Measure(s): Relative expression values compared with housekeeping genes using real-time polymerase chain reaction. Detection of positive cells by immunofluorescence and in situ hybridization. Result(s): In endometriosis, statistically significant higher WNT7A mRNA expression was observed compared with eutopic endometrium. Expression of WNT7A was found in the luminal and glandular epithelial cells as well as stroma cells in endometrium and endometriosis by immunofluorescence, in situ hybridization, and polymerase chain reaction of laser microdissected tissue. Conclusion(s): The results of the present study suggest that WNT7A plays a role in the pathophysiology of endometriosis. [Copyright &y& Elsevier]

Background. The metalloproteinases (MMPs) are a family of proteolytic enzymes involved in tissue remodeling and cell migration. Endometrial tissue remodeling proceeds during the menstrual cycle and requires a temporary and spatially balanced expression of several different MMPs. Various members of the MMPs also seem to play an important role in the invasion process of endometriosis; however, so far only a limited number of studies have focused on membrane-associated MMPs. Methods. The present study investigated the expression of membrane-type 5 metalloproteinase (MT5-MMP) in the human endometrium and endometriotic lesions by microarray hybridization, real-time polymerase chain reaction (PCR) and immunofluorescence. Results. Both the gene chip expression analyses as well as PCR indicated expression of MT5-MMP in normal human endometrium and strongly elevated transcript levels in most peritoneal endometriosis lesions analyzed. Moreover we detected enhanced MT5-MMP expression in the eutopic endometrium from patients suffering from endometriosis, further supporting a role of MT5-MMP in the formation of endometriosis. Immunohistochemical analysis was used to determine the intracellular localization and tissue distribution of MT5-MMP. While the MT5-MMP antigen expression could be clearly attributed to the membrane of epithelial cells, a highly complex differential immunohistochemical staining of MT5-MMP in the various compartments of endometrial tissue was observed. The strongest staining was seen in luminal epithelial cells, whereas endometrial glands frequently showed partial expression of MT5-MMP. Conclusion. Our microarray analysis and real-time PCR of MT5-MMP transcripts may point to an elevated tissue remodeling and cell migration in endometrium from endometriosis patients as implied by the function of related MMPs. [ABSTRACT FROM AUTHOR]

Abstract: Primary systemic therapy (PST) allows the observation of tumour response under treatment, but little is known regarding the typical course of clinical response during such therapy. The aim of this study is to support decision making in case of insufficient clinical response. Tumour response was assessed by palpation at different times in 436 patients with operable breast cancer from the dose-dense biweekly therapy arm of the GEPARDUO phase III trial. The predictive value of clinical response for pathologic complete response (pCR), prognostic models to assess the prognosis and individual courses of clinical response were investigated. Sensitivity and positive predictive value were low, but comparatively highest after the 3rd cycle. The predictive value of clinical response by palpation for pCR was subsequently limited. The majority of patients (68.1%) experienced a consistent decrease in tumour size during PST. The results indicate that decisions about further treatment should take place at the earliest after the 3rd cycle or 6 weeks of dose-dense PST. [Copyright &y& Elsevier]

The uterus is composed of different smooth muscle layers that serve various functions. First, menstrual debris is expulsed at the time of the menses. Second, sperm is transported in the preovulatory phase to maximize fertility, and third, the human embryo is placed in an adequate setting during implantation. Endometriosis is a gynecologic disorder leading to severe pain symptoms such as severe pain during menstruation (dysmenorrhea), chronic pelvic pain, pain during sexual intercourse (dyspareunia), and abnormal uterine bleeding. Besides, endometriosis is often associated with female infertility and exhibits a massive impairment in the physiology of uterine contractility that can be documented by the in vivo examination method of hysterosalpingoscintigraphy (HSSG). In addition, endometriosis is associated in 80–90% of subjects with adenomyosis and our data clearly indicate that sperm transport is disturbed by hyperperistalsis when at least one focus of adenomyosis can be detected via magnetic resonance imaging (MRI) and turns into dysperistalsis (a complete failure in sperm transport capacity) when diffuse adenomyosis affecting all myometrial uterine muscle layers is detected. Hence, dysperistalsis is significantly associated with reduced spontaneous pregnancy rates. We therefore recommend MRI and HSSG in every sterility workup. [ABSTRACT FROM AUTHOR]

Objective: To compare the expression of genes playing a decisive role during the embryonic development of the female genital tract (WNT4, WNT5A, WNT7A, PAX8) in the peritoneum of patients with endometriosis and control patients. Design: Experimental study using real-time polymerase chain reaction and in situ hybridization. Setting: University-based laboratory. Patient(s): Patients with and without endometriosis undergoing surgery for benign indications. Intervention(s): None. Main Outcome Measure(s): Percentage of samples positive for gene expression by using real-time polymerase chain reaction, as well as relative expression values compared with housekeeping genes. Confirmation of results by in situ hybridization. Result(s): Expression of WNT7A and PAX8 was found in the normal peritoneum in approximately half of the patients with endometriosis in contrast to the controls. In patients with endometriosis WNT7A and PAX8 in histologically normal peritoneum (with no evidence of endometriosis, endosalpingiosis, or other changes) were confirmed by in situ hybridization. Conclusion(s): The expression of these genes in the normal peritoneum suggests that endometriosis can arise through metaplasia and can in the process make use of the developmental steps involved in the embryonic development of the female genital tract. [ABSTRACT FROM AUTHOR]