First Efficacy Results of Capecitabine with Anthracycline- and Taxane-Based Adjuvant Therapy in High-Risk Early Breast Cancer: A Meta-Analysis

Background: Capecitabine is effective and indicated for the salvage treatment of metastatic breast cancer. Therefore, it is essential to evaluate the efficacy of capecitabine in the adjuvant setting. There have been two large randomized studies to determine whether patients with high-risk early breast cancer benefit from the addition of capecitabine to standard chemotherapy, but they have yielded inconsistent results. We first undertook a meta-analysis to evaluate the efficacy of the addition of capecitabine over standard treatment

Site-specific relapse pattern of the triple negative tumors in Chinese breast cancer patients

BACKGROUND: It has been reported that triple negative phenotype is characterized by aggressive clinical history in Western breast cancer patients, however its pattern of metastatic spread had never been reported in the Chinese population. Considering racial disparities, we sought to analyze the spread pattern for different sites of first recurrence in Chinese triple negative breast cancers. METHODS: A retrospective study of 1662 patients was carried out from a large database of breast cancer patients undergoing surgery between January 1, 2000 and March 31, 2004 at the Cancer Hospital, Fudan University, Shanghai, China. Survival curves were generated using the Kaplan-Meier method and annual relapse hazards were estimated by the hazard function. RESULTS: We found a statistically significant difference in relapse-free survival (RFS) for locoregional and visceral recurrence (P = 0.007 and P = 0.025, respectively) among the triple negative, ERBB2+ and HR+/ERBB2- subgroups in univariate analysis. In the multivariate Cox proportional hazards regression analysis, RFS for either locoregional or visceral relapse in the triple negative category was inferior to that in HR+/ERBB2- patients (P = 0.027 and P = 0.005, respectively), but comparable to that in ERBB2+ women (both P >0.05). Furthermore, the early relapse peak appeared later in the triple negative group than that in the ERBB2+ counterpart for both locoregional and visceral relapse. On the other hand, when compared with triple negative breast cancers, a significantly lower risk of developing bone relapse was discerned for ERBB2+ women (P = 0.048; HR = 0.384, 95% CI 0.148-0.991), with the borderline significance for HR+/ERBB2- breast cancers (P = 0.058; HR = 0.479, 95% CI 0.224-1.025). In terms of bone metastasis, the hazard rate remained higher for the triple negative category than that for the ERBB2+ subtype. CONCLUSION: Based on the site-specific spread pattern in different subgroups, the triple negative category of breast cancers in the Chinese population exhibits a different pattern of relapse, which indicates that different organotropism may be due to the different intrinsic subtypes. A better knowledge of the triple negative category is warranted for efficacious systemic regimens to decrease and/or delay the relapse hazard

Nodal and Nematic Superconducting Phases in NbSe2_2 Monolayers from Competing Superconducting Channels

Transition metal dichalcogenides like 2H-NbSe$_2$ in their two-dimensional (2D) form exhibit Ising superconductivity with the quasiparticle spins are firmly pinned in the direction perpendicular to the basal plane. This enables them to withstand exceptionally high magnetic fields beyond the Pauli limit for superconductivity. Using field-angle-resolved magnetoresistance experiments for fields rotated in the basal plane we investigate the field-angle dependence of the upper critical field (Hc$_2$), which directly reflects the symmetry of the superconducting order parameter. We observe a six-fold nodal symmetry superposed on a two-fold symmetry. This agrees with theoretical predictions of a nodal topological superconducting phase near Hc$_2$, together with a nematic superconducting state. We demonstrate that in NbSe$_2$ such unconventional superconducting states can arise from the presence of several competing superconducting channels

Nodal and Nematic Superconducting Phases in NbSe2_2 Monolayers from Competing Superconducting Channels

Transition metal dichalcogenides like 2H-NbSe$_2$ in their two-dimensional (2D) form exhibit Ising superconductivity with the quasiparticle spins are firmly pinned in the direction perpendicular to the basal plane. This enables them to withstand exceptionally high magnetic fields beyond the Pauli limit for superconductivity. Using field-angle-resolved magnetoresistance experiments for fields rotated in the basal plane we investigate the field-angle dependence of the upper critical field (Hc$_2$), which directly reflects the symmetry of the superconducting order parameter. We observe a six-fold nodal symmetry superposed on a two-fold symmetry. This agrees with theoretical predictions of a nodal topological superconducting phase near Hc$_2$, together with a nematic superconducting state. We demonstrate that in NbSe$_2$ such unconventional superconducting states can arise from the presence of several competing superconducting channels

Postoperative Fever: The Potential Relationship with Prognosis in Node Negative Breast Cancer Patients

Background: Postoperative fever may serve as an indirect sign to reflect the alterations of the host milieu caused by surgery. It still remains open to investigation whether postoperative fever has a bearing on prognosis in patients with lymph node negative breast cancers. Methods: We performed a retrospective study of 883 female unilateral patients with lymph node negative breast cancer. Fever was defined as an oral temperature $38 in one week postoperation. Survival curves were performed with Kaplan-Meier method, and annual relapse hazard was estimated by hazard function. Findings: The fever patients were older than those without fever (P,0.0001). Hypertensive patients had a propensity for fever after surgery (P = 0.011). A statistically significant difference was yielded in the incidence of fever among HR+/ERBB2-, ERBB2+, HR-/ERBB2- subgroups (P = 0.012). In the univariate survival analysis, we observed postoperative fever patients were more likely to recur than those without fever (P = 0.0027). The Cox proportional hazards regression analysis showed that postoperative fever (P = 0.044, RR = 1.89, 95%CI 1.02–3.52) as well as the HR/ERBB2 subgroups (P = 0.013, HR = 1.60, 95%CI 1.09–2.31) was an independent prognostic factor for relapse-free survival. Conclusion: Postoperative fever may contribute to relapse in node negative breast cancer patients, which suggests that changes in host milieu related to fever might accelerate the growth of micro-metastatic foci. It may be more precise t

Impacte des mutations du RyR2 (R420Q) liées à la tachycardie ventriculaire polymorphe sur la fonciton du cardiomyocyte

Catecholaminergic polymorphic ventricular tachycardia (CPVT) is a lethal genetic arrhythmia that manifests by syncope or sudden death in children and young adults under stress conditions without obvious cardiac structural abnormality. Several mechanisms have been proposed to explain the underlying Ca2+ release functional alterations due to mutations of RyR2 or of its accessory proteins. A novel CPVT mutation located on RyR2 N terminal portion has been identified in a Spanish family (RyR2R420Q). Here we used a KI mice model expressing the RyR2R420Q channel, and differentiated cardiomyocytes from induced pluripotent stem cells (hiPS-CM) generated from two brother patients (one with mutation, the other without mutation used as control). Confocal Ca2+ imaging analysis showed that human and mouse RyR2R420Q expressing ventricular cardiomyocytes have higher occurrence of Ca2+ sparks, enhanced fractional release, and significantly more proarrhythmogenic Ca2+ waves after isoproterenol stimulation. The action potential (AP) analysis, recorded using the micro-electrode technique in hiPSC-CMs and patch-clamp in KI mouse ventricular cells, showed Ca2+ -dependent delayed after depolarizations (DADs). The [Ca2+]i transient amplitudes of 1-Hz paced CPVT hiPSC-CMs was similar to control hiPSC-CMs. Whereas sarcoplasmic reticulum (SR) Ca2+ load, estimated by rapid caffeine (10 mM) application, was smaller in hiPS-CM from the RyR2R420Q carrier, both before and after 1 microM ISO application. However, the RyR2R420Q seems more prone to release Ca2+, as the [Ca2+]i transient normalized by the amount of Ca2+ stored in the SR, the fractional release, was higher in CPVT hiPSC-CMs. Even if SR Ca2+ load was smaller in CPVT hiPSC-CMs, they often presented proarrythmogenic behavior such as Ca2+ waves during diastolic periods. This behavior was further enhanced during β-adrenergic stimulation. Similar results were observed in KI mice, pointing to this model as a valuable tool to study the CPVT disease. We then studied the potential antiarrhythmic effect of venlafaxine and pregabalin in KI mouse cardiomyocytes and hiPS-CMs, two drugs among other medications that have been prescribed to one family carrier member and devoted of CPVT symptoms. We found that both of those drugs blunted ISO induced arrhythmogenic events in KI mouse cardiomyocytes. Venlafaxine showed antiarrhythmic effect in hiPS-CMs both by acute and chronic treatments.On overall, 1) the RyR2R420Q mutation shows enhanced diastolic Ca2+ release, which is further enhanced by isoproterenol inducing proarrhythmogenic events. 2) The effects were similar in hiPSC-CM and RyR2R420Q KI mice cardiomyocytes, pointing to hiPSC-CM as a valuable model to analyze pathological mechanisms; and 3) Venlafaxine may protect from arrhythmic CPVT patients, although more experiments are needed for in vivo test and to determine the mechanism of this antiarrhythmic effect.La tachycardie ventriculaire polymorphe catécholergique (CPVT) est une arythmie génétique létale qui se manifeste par une syncope ou une mort subite chez les enfants et les jeunes adultes dans des conditions de stress sans anomalie structurelle cardiaque évidente. Plusieurs mécanismes ont été proposés pour expliquer les altérations fonctionnelles sous-jacentes de la libération de Ca2+ dues aux mutations de RyR2 ou de ses protéines accessoires. Une nouvelle mutation CPVT située sur la partie N terminale de RyR2 a été identifiée dans une famille espagnole (RyR2R420Q). Ici, nous avons utilisé un modèle de souris KI exprimant le canal RyR2R420Q et des cardiomyocytes différenciés de cellules souches pluripotentes induites (hiPS-CM) générées à partir de deux patients frères (l'un avec mutation, l'autre sans mutation utilisé comme témoin). L’analyse des cardiomyocytes ventriculaires exprimant le RyR2R420Q humain et de souris étudiées par imagerie Ca2+confocale montre une augmentation des libérations de Ca2+spontanée durant la diastole (visualisé par les Sparks Ca2+), une libération fractionnelle plus élevée et une fréquence de vagues Ca2+ proarythmogènes augmentée après stimulation à l'isoprotérénol. L’analyse électrophysiologique, étudiée en enregistrant les potentiels d'action (AP) en utilisant les techniques de micro-électrodes sur les hiPSC-CM et de patch-clamp sur les cellules ventriculaires de souris KI, a montré des post-dépolarisations retardées dépendants du Ca2+ (DAD). L’amplitude des transitoires [Ca2+]i des cellules stimulées à 1 Hz étaient plus faible chez le groupe muté. La charge en Ca2+ du réticulum sarcoplasmique (SR), estimée par application rapide de caféine (10 mM), était aussi plus réduite dans les hiPS-CM exprimant RyR2R420Q, avant et après l'application ISO (1 μM). Cependant, le RyR2R420Q semble plus enclin à libérer du Ca2+, car le transitoire [Ca2+]i normalisé par la quantité de Ca2+ stockée dans le SR, la libération fractionnaire, était plus élevée dans les cellules mutées. Même si la charge Ca2+ du SR était plus petite dans les cellules RyR2R420Q, elles présentaient souvent un comportement pro-arythmogène tel que les vagues Ca2+ pendant les périodes diastoliques. Ce comportement est encore augmentée lors de la stimulation -adrénergique. Des résultats similaires ont été observés chez les souris KI, montrant ce modèle comme un outil précieux pour étudier la maladie CPVT. Nous avons ensuite étudié l'effet antiarythmique potentiel de la venlafaxine et de la prégabaline dans les cardiomyocytes de souris KI et le hiPS-CM, deux médicaments parmi d'autres prescrits à un membre porteur de la famille et qui a montré une réversion des symptômes du CPVT après le traitement. Nous avons constaté que ces deux médicaments atténuaient les événements arythmogènes de libération du Ca2+ induits par l'ISO dans les cardiomyocytes de souris KI. La venlafaxine a montré un effet antiarythmique dans hiPS-CM à la fois en traitements aigus et chroniques.Ainsi 1) le RyR2R420Q montre une augmentation de la libération diastolique du Ca2+ , encore plus augmentée par la stimulation à l ’isoproterénol, induisant des évènements proarythmogènes. 2) les effets sont retrouvés chez des cardiomyocytes ventriculaires des souris KI et chez des cellules hiPSC-CM, montrant que ces dernières sont un outil valable pour étudier les mécanismes pathologiques ; et 3) que la Venlafaxine peut protéger des arythmies chez les patients CPVT, bien que d’avantage d’expériences sont nécessaires afin de conclure quant à son utilité antiarythmique