Promising results with exemestane in the first-line treatment of metastatic breast cancer: a randomized phase II EORTC trial with a tamoxifen control.

Because tamoxifen (TAM), a nonsteroidal antiestrogen, is routinely used in the adjuvant setting, other hormone therapies are needed as alternatives for first-line treatment of metastatic breast cancer (MBC). Currently, exemestane (EXE) and other antiaromatase agents are indicated for use in patients who experience failure of TAM. In this multicenter, randomized, open-label, TAM-controlled (20 mg/day), phase II trial, we examined the activity and tolerability of EXE 25 mg/day for the first-line treatment of MBC in postmenopausal women. Exemestane was well tolerated and demonstrated substantial first-line antitumor activity based on intent-to-treat analysis of peer-reviewed responses. In the EXE arm, values for complete, partial, and objective response, clinical benefit, and time to tumor progression (TTP) exceeded those reported for TAM although no statistical comparison was made. Based on these encouraging results, a phase III trial will compare EXE and TAM.

Evaluation of tumor response, disease control, progression-free survival, and time to progression as potential surrogate end points in metastatic breast cancer.

PURPOSE: Overall survival (OS) can be observed only after prolonged follow-up, and any potential effect of first-line therapies on OS may be confounded by the effects of subsequent therapy. We investigated whether tumor response, disease control, progression-free survival (PFS), or time to progression (TTP) could be considered a valid surrogate for OS to assess the benefits of first-line therapies for patients with metastatic breast cancer. PATIENTS AND METHODS: Individual patient data were collected on 3,953 patients in 11 randomized trials that compared an anthracycline (alone or in combination) with a taxane (alone or in combination with an anthracycline). Surrogacy was assessed through the correlation between the end points as well as through the correlation between the treatment effects on the end points. RESULTS: Tumor response (survival odds ratio [OR], 6.2; 95% CI, 5.3 to 7.0) and disease control (survival OR, 5.5; 95% CI, 4.8 to 6.3) were strongly associated with OS. PFS (rank correlation coefficient, 0.688; 95% CI, 0.686 to 0.690) and TTP (rank correlation coefficient, 0.682; 95% CI, 0.680 to 0.684) were moderately associated with OS. Response log ORs were strongly correlated with PFS log hazard ratios (linear coefficient [rho], 0.96; 95% CI, 0.73 to 1.19). Response and disease control log ORs and PFS and TTP log hazard ratios were poorly correlated with log hazard ratios for OS, but the confidence limits of rho were too wide to be informative. CONCLUSION: No end point could be demonstrated as a good surrogate for OS in these trials. Tumor response may be an acceptable surrogate for PFS.

Enhanced inflammatory responses in alpha-tocopherol transfer protein null mice

The liver preferentially secretes alpha-tocopherol into plasma under the control of the hepatic alpha-tocopherol transfer protein (alpha-TTP). alpha-TTP-null mice (Ttpa(-/-) mice) are vitamin E deficient, therefore were used for investigations of in vivo responses to sub-normal tissue alpha-tocopherol concentrations during inflammation. Increased basal oxidative stress in Ttpa(-/-) mice was documented by increased plasma lipid peroxidation, and superoxide production by bone marrow-derived neutrophils stimulated in vitro with phorbol 12-myristate 13-acetate. Lipopolysaccharide (LPS) injected intraperitoneally induced increases in lung and liver HO-1 and iNOS, as well as plasma NO(x) in Ttpa(+/+) mice. LPS induced more modest increases in these markers in Ttpa(-/-) mice, while more marked increases in plasma IL-10 and lung lavage TNF alpha were observed. Taken together, these results demonstrate that alpha-tocopherol is important for proper modulation of inflammatory responses and that sub-optimal alpha-tocopherol concentrations may derange inflammatory-immune responses.

Unraveling EU Policies: the ““Common Basic Principles”” and the ““European Integration Fund”” as a technology of government

this paper is about EU “soft policies” on immigrant integration. It analyzes the “Common Basic Principles” (CBPs) and the “European Integration Fund” (EIF), two devices that have been recently established within this framework. It adopts the theoretical perspective of the “anthropology of policy” and “governmentality studies”. It shows the context of birth of the aforementioned devices, as well as their functioning and the assessment done by the actors implied in the elaboration/implementation/evaluation of the related policies. It is based both on documentary research as well as direct observation and interviews done to the actors implied. It concludes that the PBC and the EIF should be considered as a “technology of government”, that strives to align the conduct of the actors with the governmental aims, as well as it produces specific practices and knowledge. It also underlines an intrinsic feature of many policies: their “congenital failure”, since they are (often) disputed and resignified by situated actors, who are embedded in asymmetrical power relations.

Reading of audiovisual productions of contemporary art in art education

This article focuses on the reading of audiovisual productions of contemporary art as a creative process, seeking to analyse which effects of meaning the articulations between the visual and sound systems produce, and the meaning that children give to then. It describes a video art, identifying the languages that compose it and the relationships that link them. Such reading exercise had as corpus of analysis the Chair video art, by Masaru Ozaki, and counted with the theoretical and methodological support of the discourse semiotics, especially with studies on assembly procedures that articulate visual and auditory languages. Also, it presents a focal study with the meanings that a group of children gave to the video art. The findings indicate the importance of including the reading of audiovisual productions of contemporary art at school through the problematization of effects of meaning produced by the interrelation between different languages. And they suggest some subsidies that allow teachers from different areas of knowledge to reflect about the visuality in their pedagogical practice; the choice of the audiovisual materials taken to the classroom and other ways of seeing these texts edited.

Severe Vitamin E deficiency modulates airway allergic inflammatory responses in the murine asthma model

Allergic asthma is a complex immunologically mediated disease associated with increased oxidative stress and altered antioxidant defenses. It was hypothesized that a-tocopherol (a-T) decreases oxidative stress and therefore its absence may influence allergic inflammatory process, a pathobiology known to be accompanied by oxidative stress. Therefore, selected parameters of allergic asthma sensitization and inflammation were evaluated following ovalbumin sensitization and re-challenge of a-T transfer protein (TTP) knock-out mice (TTP-/-) that have greatly reduced lung a-T levels (e.g.

Mice lacking alpha-tocopherol transfer protein gene have severe alpha-tocopherol deficiency in multiple regions of the central nervous system

Ataxia with vitamin E deficiency is caused by mutations in a-tocopherol transfer protein (a-TTP) gene and it can be experimentally generated in mice by a-TTP gene inactivation (a-TTP-KO). This study compared a-tocopherol (a-T) concentrations of five brain regions and of four peripheral organs from 5 months old, male and female, wild-type (WT) and a-TTP-KO mice. All brain regions of female WT mice contained significantly higher a-T than those from WT males. a-T concentration in the cerebellum was significantly lower than that in other brain regions of WT mice. These sex and regional differences in brain a-T concentrations do not appear to be determined by a-TTP expression which was undetectable in all brain regions. All the brain regions of a-TTP-KO mice were severely depleted in a-T. The concentration of another endogenous antioxidant, total glutathione, was unaffected by gender but was decreased slightly but significantly in most brain regions of a-TTP-KO mice. The results show that both gender and the hepatic a-TTP, but not brain a-TTP gene expression are important in determining a-T concentrations within the brain. Interestingly, functional abnormality (ataxia) develops only very late in a-TTP-KO mice in spite of the severe a-tocopherol deficiency in the brain starting at an early age.

The Cyclin D1 (CCND1) A870G polymorphism predicts clinical outcome to lapatinib and capecitabine in HER2-positive metastatic breast cancer

BACKGROUND: Lapatinib plus capecitabine emerged as an efficacious therapy in metastatic breast cancer (mBC). We aimed to identify germline single-nucleotide polymorphisms (SNPs) in genes involved in capecitabine catabolism and human epidermal receptor signaling that were associated with clinical outcome to assist in selecting patients likely to benefit from this combination.

PATIENTS AND METHODS: DNA was extracted from 240 of 399 patients enrolled in EGF100151 clinical trial (NCT00078572; clinicaltrials.gov) and SNPs were successfully evaluated in 234 patients. The associations between SNPs and clinical outcome were analyzed using Fisher's exact test, Kaplan-Meier curves, log-rank tests, likelihood ratio test within logistic or Cox regression model, as appropriate.

RESULTS: There were significant interactions between CCND1 A870G and clinical outcome. Patients carrying the A-allele were more likely to benefit from lapatinib plus capecitabine versus capecitabine when compared with patients harboring G/G (P = 0.022, 0.024 and 0.04, respectively). In patients with the A-allele, the response rate (RR) was significantly higher with lapatinib plus capecitabine (35%) compared with capecitabine (11%; P = 0.001) but not between treatments in patients with G/G (RR = 24% and 32%, respectively; P = 0.85). Time to tumor progression (TTP) was longer in patients with the A-allele treated with lapatinib plus capecitabine compared with capecitabine (median TTP = 7.9 and 3.4 months; P < 0.001), but not in patients with G/G (median TTP = 6.1 and 6.6 months; P = 0.92).

CONCLUSION: Our findings suggest that CCND1A870G may be useful in predicting clinical outcome in HER2-positive mBC patients treated with lapatinib plus capecitabine.

Clinical benefit of fulvestrant in postmenopausal women with advanced breast cancer and primary or acquired resistance to aromatase inhibitors: final results of phase II Swiss Group for Clinical Cancer Research Trial (SAKK 21/00).

BACKGROUND: The aim of this study was to evaluate the efficacy and tolerability of fulvestrant, an estrogen receptor antagonist, in postmenopausal women with hormone-responsive tumors progressing after aromatase inhibitor (AI) treatment. PATIENTS AND METHODS: This is a phase II, open, multicenter, noncomparative study. Two patient groups were prospectively considered: group A (n=70) with AI-responsive disease and group B (n=20) with AI-resistant disease. Fulvestrant 250 mg was administered as intramuscular injection every 28 (+/-3) days. RESULTS: All patients were pretreated with AI and 84% also with tamoxifen or toremifene; 67% had bone metastases and 45% liver metastases. Fulvestrant administration was well tolerated and yielded a clinical benefit (CB; defined as objective response or stable disease [SD] for >or=24 weeks) in 28% (90% confidence interval [CI] 19% to 39%) of patients in group A and 37% (90% CI 19% to 58%) of patients in group B. Median time to progression (TTP) was 3.6 (95% CI 3.0 to 4.8) months in group A and 3.4 (95% CI 2.5 to 6.7) months in group B. CONCLUSIONS: Overall, 30% of patients who had progressed following prior AI treatment gained CB with fulvestrant, thereby delaying indication to start chemotherapy. Prior response to an AI did not appear to be predictive for benefit with fulvestrant.

Mechanism of tocopherol transfer by human α-tocopherol transfer protein (α-hTTP)

Vitamin E is a well known fat soluble chain breaking antioxidant. It is a general tenn used to describe a family of eight stereoisomers of tocopherols. Selective retention of a-tocopherol in the human circulation system is regulated by the a -Tocopherol Transfer Protein (a-TIP). Using a fluorescently labelled a-tocopherol (NBD-a-Toc) synthesized in our laboratory, a fluorescence resonance energy transfer (FRET) assay was developed to monitor the kinetics of ligand transfer by a-hTTP in lipid vesicles. Preliminary results implied that NBD-a-Toe simply diffused from 6-His-a-hTTP to acceptor membranes since the kinetics of transfer were not responsive to a variety of conditions tested. After a series of trouble shooting experiments, we identified a minor contaminant, E coli. outer membrane porin F (OmpF) that co-purified with 6-His-a-hTTP from the metal affinity column as the source of the problem. In order to completely avoid OmpF contamination, a GST -a-hTTP fusion protein was purified from a glutathione agarose column followed by an on-column thrombin digestion to remove the GST tag. We then demonstrated that a-hTTP utilizes a collisional mechanism to deliver its ligand. Furthennore, a higher rate of a-tocopherol transfer to small unilamellar vesicles (SUV s) versus large unilamellar vesicles (LUV s) indicated that transfer is sensitive to membrane curvature. These findings suggest that ahTTP mediated a-Toc transfer is dominated by the hydrophobic nature of a-hTTP and the packing density of phospholipid head groups within acceptor membranes. Based on the calculated free energy change (dG) when a protein is transferred from water to the lipid bilayer, a model was generated to predict the orientation of a-hTTP when it interacts with lipid membranes. Guided by this model, several hydrophobic residues expected to penetrate deeply into the bilayer hydrophobic core, were mutated to either aspartate or alanine. Utilizing dual polarization interferometry and size exclusion vesicle binding assays, we identified the key residues for membrane binding to be F 165, F 169 and 1202. In addition, the rates of ligand transfer of the u-TTP mutants were directly correlated to their membrane binding capabilities, indicating that membrane binding was likely the rate limiting step in u-TTP mediated transfer of u-Toc. The propensity of u-TTP for highly curved membrane provides a connection to its colocalization with u-Toc in late endosomes.

“Can’t you at least die with a little dignity?” The Right to Die Debates and Normative Dignity

Article

The influence of environmental contaminants on time to pregnancy

Cette thèse porte sur l’évaluation de l’impact de certains composés environnementaux sur la fécondité féminine, tel que mesuré par le délai de conception (« time to pregnancy » en anglais, ou TTP). Cette recherche a été réalisée dans le cadre de l’Étude mère-enfant sur les composés chimiques de l’environnement (MIREC), une cohorte de grossesse de 2001 femmes recrutées durant le premier trimestre dans dix villes canadiennes de 2008 à 2011. Les données des questionnaires et les échantillons biologiques ont servi à évaluer l’effet de deux groupes de composés : les persistants [composés perfluorés – perfluorooctanesulfonate (PFOS), perfluorooctanoate (PFOA) et perfluorohexane sulfonate (PFHxS)] et les non persistants (bisphénol A, triclosan et phtalates). Cette thèse comprend également une analyse du potentiel du ratio index-annulaire (2D:4D) comme mesure de sensibilité endocrinienne. À ce jour, des mesures anthropométriques ont été collectées sur environ 800 mères-enfants dans le cadre de l’Étude mère-enfant sur les composés chimiques de l’environnement : biomonitoring et neurodéveloppement à la petite enfance (MIREC CD Plus), un suivi de la cohorte MIREC portant sur la croissance et le développement des enfants jusqu’à 5 ans. Sur l’ensemble, les résultats de cette thèse permettent d’étoffer les preuves concernant les effets adverses potentiels de plusieurs contaminants environnementaux sur la fécondité féminine, telle que mesurée par le TTP. Dans le premier article, nous avons montré une association entre les PFOA et les PFHxS et une baisse de fécondité, ce que d’autres recherches avaient déjà révélé. Dans le deuxième article, nous avons évalué l’effet du triclosan sur le TTP, ce qui n’avait jamais été examiné, pour montrer un délai plus élevé chez les femmes du quartile supérieur d’exposition. De plus, nos résultats sont en accord avec ceux de la seule étude ayant évalué l’effet du Bisphénol A sur la fécondité féminine, qui n’avait pas détecté d’effet. Finalement, nos données semblent indiquer une association entre l’exposition des femmes aux phtalates et un TTP plus court, mais ces résultats ne sont pas statistiquement significatifs. En ce qui a trait au potentiel du ratio index-annuaire (2D:4D) pour mesurer la sensibilité endocrinienne chez les femmes, nos données ne permettent pas d’établir une association entre ce ratio et le TTP. Pour ce qui est des enfants, nous n’avons pas trouvé d’effet adverse entre le tabagisme de la mère durant la grossesse et leur ratio 2D:4D. Par conséquent, nos données ne semblent pas justifier l’utilisation du ratio 2D:4D pour mesurer la sensibilité endocrinienne en lien avec le potentiel reproducteur (basé sur le TTP) ou l’exposition des enfants au tabac durant le premier trimestre de grossesse.

Diazafluoren-9-yliden als Bindungsmotiv für Metallfragmente in kreuzkonjugierten π-Systemen

In der vorliegenden Dissertation wurden kreuzkonjugierte organische Verbindungen basierend auf Diazafluorenmethyliden- sowie Dipyridylmethyliden-Bausteinen synthetisiert, die zum einen photoredoxaktive Metallfragmente komplexieren können und zum anderen erweiterte π-konjugierte Pfade auf der Grundlage von Alkineinheiten ermöglichen. Das kreuzkonjugierte Motiv wurde über die Kupplung von Alkineinheiten an halogenierte Methyliden-Einheiten, den so genannten Dibromolefinen, zugänglich gemacht. Zur Synthese von Dibromolefinen wurden verschiedene Methoden untersucht. Literaturbekannte Methoden wie die Wittig-Reaktion und ihre Modifikationen sowie die Corey-Fuchs-Reaktion konnten für die Diazafluoreneinheit nicht erfolgreich angewendet werden. Bei einer mikrowellenunterstützten Reaktion konnte sowohl ausgehend von Diazafluoren-9-on als auch von Di-2-pyridylketon eine Dibromolefinierung (55 % und 65 %) erreicht werden. Die Eignung der Mikrowellenstrahlung für Dibromolefinierungsreaktionen nach Corey und Fuchs wurde weiterhin an verschiedenen Aldehyden und Ketonen untersucht. In den meisten Fällen konnten gute bis sehr gute Ergebnisse erzielt werden. Durch die erfolgreiche Synthese von Dibromolefinen über Mikrowellensynthese wurde die Realisierung von diversen π-konjugierten Systemen möglich. Dies erfolgte exemplarisch durch die Kupplung der Alkine 5-Ethinyl-2,2’-bipyridin, 1-(Ferrocenylethinyl)-4-(ethinyl)benzol, Tri(tolyl)propin sowie der TIPS- und TMS-Acetylene. Neben der Vielfalt an Möglichkeiten zur Funktionalisierung von Dipyridyl- und Diazafluorenbausteinen zeigte sich zudem, dass sogar räumlich anspruchsvolle Verbindungen wie die geminale angeordneten voluminösen Tri(tolyl)propinyl-Substituenten an der Doppelbindung erfolgreich synthetisiert werden können. Die Koordinationseigenschaften der neu synthetisierten Verbindungen konnten durch Umsetzungen der Diazafluoren- und Dipyridylverbindungen mit PdCl2 und [RuCl2(bpy)2] erfolgreich gezeigt werden. Im Hinblick auf die Herstellung von Funktionsmaterialien eignen sich die Endiin-Strukturmotive aufgrund von diversen Variationsmöglichkeiten wie Koordination von Übergangsmetallen sowie Funktionalisierung der Peripherie gut. Dadurch können die elektronischen Eigenschaften wie die Absorption oder elektrochemische Potentiale der Verbindungen modifiziert werden. Die UV/Vis-Spektren der neu synthetisierten Verbindungen zeigen, dass Absorptionen in längerwelligen Bereichen durch Verlängerung des Konjugationspfades gesteuert werden können. Zudem lassen sich weitere photophysikalische Eigenschaften wie MC-, LC-, LMCT- oder MLCT-Übergänge durch Koordination von Metallen generieren. Die elektrochemischen Potentiale der Dipyridyl- und Diazafluorenbausteine konnten durch Anbindung von verschiedenen Substituenten beeinflusst werden. Es zeigte sich, dass sich die Reduktionswellen im Vergleich zu denen der Ketone zu niedrigeren Potentialen verschieben, wenn Alkine an die Dipyridylmethyliden- und Diazafluorenmethyliden-Bausteine geknüpft wurden. Zudem konnte beobachtet werden, dass die Signale nicht immer reversibel sind. Insbesondere die Dipyridylverbindungen zeichneten sich durch irreversible Reduktionswellen aus. Die Realisierung von π-konjugierten Systemen gelang auch mit cyclischen kohlenstoffbasierten Verbindungen. Über das separat synthetisierte 2,2’-Diethinyltolan konnte eine cyclische Verbindung, ein dehydroannulen-radialenisches System, erfolgreich hergestellt werden. Die Koordination von redoxaktiven Metallzentren wie [Ru(bpy)2] konnte für diese Verbindung ebenfalls erfolgreich gezeigt werden. Die elektronische Wechselwirkung zwischen dem Metallzentrum und dem dehydroannulenischen System könnte sowohl über theoretische Methoden (zeitabhängige Dichtefunktionaltheorie) als auch experimentell wie z. B. über transiente Absorptionsspektroskopie untersucht werden. Diese zukünftig durchzuführenden Untersuchungen können Aufschluss über die Ladungstransferraten und -dauer geben. Im Hinblick auf die Realisierung von Modellverbindungen für molekulare Drähte wurden lineare Systeme basierend auf der Diazafluoreneinheit synthetisiert. Zur Synthese von derartigen Systemen war es zunächst notwendig, die Dibromolefine unsymmetrisch zu alkinylieren. Die unsymmetrische Substitution gestaltete sich als Herausforderung, da eine Einfachkupplung mit einem Acetylen nicht möglich war. In den meisten Fällen wurden zweifach substituierte Spezies mit den identischen Alkinen erhalten. Die besten Ausbeuten konnten durch die konsekutive Zugabe von TIPS-Acetylen und darauffolgend TMS-Acetylen in die Reaktionsmischung erhalten werden. Offenbar spielt der räumliche Anspruch des Erstsubstituenten in diesem Zusammenhang eine Rolle. Die selektive Entschützung der unterschiedlich silylierten Verbindungen erfolgte mit K2CO3 in MeOH/THF (1:1). Die oxidative Homokupplungsreaktion erfolgte ohne Isolierung der entschützten Spezies, da diese instabil ist und zur Polymerisation neigt. Aufgrund der Instabilität der entschützten Spezies sowie möglichen Nebenreaktionen waren die Ausbeuten sowohl bei der TIPS-geschützten Verbindung als auch bei der TTP-geschützten Verbindung gering. Versuche, lineare Systeme von dipyridylbasierten Verbindungen zu erhalten, schlugen fehl. Die π-konjugierten Systeme lassen aufgrund der effektiven Überlappung der beteiligten π-Orbitale hohe Ladungsträgermobilitäten vermuten. Die im Rahmen dieser Arbeit synthetisierten Verbindungen könnten mit Schwefelverbindungen die Anbindung an Elektroden zulassen, worüber die Leitfähigkeiten der Verbindungen gemessen werden könnten.

De la morbilidad a la perdurabildad : caso empresarial multiproyectos

El presente trabajo de grado es el resultado del proyecto de investigación realizado con el Centro de estudios empresariales para la perdurabilidad (CEEP) y el grupo de investigación empresarial de la facultad de Administración de la Universidad del Rosario, donde se muestra el trabajo de una de las tres líneas que ha venido realizando el grupo de investigación: perdurabilidad empresarial, aprendizaje de resurgimiento y condiciones de incidencia que permitan que las pequeñas y medianas empresas perduren en la línea de tiempo en el contexto Colombiano. En el presente escrito se encuentran los resultados de los análisis y la información recolectada para el caso de la empresa Multiproyectos, empresa que obtuvo el premio ave fénix en el año 2007, el cual destaca el resurgimiento de las empresas que se vieron envueltas en la crisis y que por fruto de su esfuerzo, sinergia y ardua disciplina lograron superarla.