The RET mutation E768D confers a late-onset Familial medullary thyroid carcinoma - only phenotype with incomplete penetrance: Implications for screening and management of carrier status

Objective: We describe a 4-generation family with familial medullary thyroid carcinoma (FMTC) - a variant of multiple endocrine neoplasia type 2 (MEN 2) without extra-thyroid features. RET mutation analysis confirmed an E768D mutation in exon 13 in 8 family members, 3 affected with medullary thyroid cancer alone while the other 5 were detected to be mutation carriers. This mutation has been described in very few families worldwide and the spectrum of disease and natural history is unclear. Results: Three affected members had medullary thyroid cancer (MTC) confirmed histologically at ages 25, 50 and 56 years, respectively. The E768D mutation appears to have a less aggressive clinical course compared to other high risk RET mutations with no evidence of clinical recurrence up to I I years after initial therapy. Of five gene carriers identified, two are asymptomatic at the age of 70 and 61, and three had raised calcitonin levels at 46, 39, and 45 years. Following total thyroidectomy, one gene carrier had a histologically normal thyroid at age 46, following a mildly elevated calcitonin, one had C-cell hyperplasia at the age of 39, and one had a frank focus of carcinoma in the left thyroid lobe at the age of 45. No members had evidence of phaeochromocytoma or parathyroid disease on screening. Conclusion: The RET E768D mutation is associated with MTC with a later age at presentation, incomplete penetrance and less aggressive course compared with other high risk RET mutations. To date in this family the E768D mutation has not been associated with either phaeochromocytoma or hyperparathyroidism. The appropriate screening strategy for and management of E768D carriers is difficult reflecting the phenotypic heterogeneity.

A study of the use of the trimesium salt of glyphosate to desiccate and ret flax and linseed (Linum usitatissimum) and of its effects on the yield of straw, seed and fibre

A replicated field plot experiment was carried out in Northern Ireland in 1996 with flax, cv Ariane, and linseed, cv Flanders, each grown at seed rates of 500, 1000 and 1500 seeds/m(2), in which a comparison was made between netting of the standing crop, following desiccation by the trimesium salt of glyphosate (Touchdown, Zeneca Ltd.), and water or dew retting of the pulled crop. Application at 4 litres/ha on 9 August, 33 days after the mid-point of flowering (MPF), achieved both desiccation and partial retting of the crop within 14 days. Over 16 % clean long fibre was extracted by scutching the stand-netted flax straw, yielding 800 kg/ha fibre, while water retting achieved 20 extraction and 980 kg/ha yield and dew netting 8.5 % and 420 kg/ha respectively. The dew retting was uneven, resulting in high losses during fibre extraction, while water retting for 7 days at 25 degreesC did not achieve complete retting resulting in a high content of woody fragments in the fibre. Fibre yields increased by almost 50 % with the high v. low seed rate. Linseed was less well retted than flax and contained higher levels of impurity in the extracted long fibre which, after retting, yielded 120 to 310 kg/ha at extraction rates of 2.9 % to 7.5 %.

In a second experiment in 1998 flax cvs. Viola and Evelyn were treated with the timesium salt of glyphosate at rates of 2, 4 or 6 litres/ha 10, 20, 30 or 40 days after MPF on 5 July. Viola desiccated satisfactorily at all spray dates with 4 and 6 litres/ha glyphosate. The 20-day treatment desiccated more slowly than the 30-day and the 2 litres/ha rate did not achieve complete desiccation, but the trimesium salt of glyphosate achieved better desiccation at this timing than that found in earlier studies with the original form of glyphosate. Evelyn desiccated more slowly and less evenly than Viola particularly at the 20-day and 40-day timings. Spraying at MPF + 10 days interrupted early development of the seed and fibre significantly reducing yields. Due to slower desiccation the 20-day timing was no better than the 30-day, which was well retted by harvest 44 days after spraying, and gave the highest yield of clean long fibre. The spraying 40 days after MPF was considered too late in the season to be of practical use. It was concluded that retting of standing flax following desiccation with the trimesium salt of glyphosate was more effective than with the earlier formulation and that resting of the standing crop could achieve equivalent or better retting with similar fibre yields to traditional retting methods. The optimum spray timing was found to be about 30 days after MPF with 4 or 6 litres/ha, the lower rate being adequate for glyphosate responsive varieties such as Viola.

Comprehensive molecular pathology analysis of small bowel adenocarcinoma reveals novel targets with potential for clinical utility

Small bowel accounts for only 0.5% of cancer cases in the US but incidence rates have been rising at 2.4% per year over the past decade. One-third of these are adenocarcinomas but little is known about their molecular pathology and no molecular markers are available for clinical use. Using a retrospective 28 patient matched normal-tumor cohort, next-generation sequencing, gene expression arrays and CpG methylation arrays were used for molecular profiling. Next-generation sequencing identified novel mutations in IDH1, CDH1, KIT, FGFR2, FLT3, NPM1, PTEN, MET, AKT1, RET, NOTCH1 and ERBB4. Array data revealed 17% of CpGs and 5% of RNA transcripts assayed to be differentially methylated and expressed respectively (p < 0.01). Merging gene expression and DNA methylation data revealed CHN2 as consistently hypermethylated and downregulated in this disease (Spearman -0.71, p < 0.001). Mutations in TP53 which were found in more than half of the cohort (15/28) and Kazald1 hypomethylation were both were indicative of poor survival (p = 0.03, HR = 3.2 and p = 0.01, HR = 4.9 respectively). By integrating high-throughput mutational, gene expression and DNA methylation data, this study reveals for the first time the distinct molecular profile of small bowel adenocarcinoma and highlights potential clinically exploitable markers.