Conjunctival Melanoma in Finland 1967-2000: a population-based study

Eighty-five new cases of conjunctival melanoma (CM) were diagnosed in Finland between 1967 and 2000. The annual crude incidence of CM was 0.51 per million inhabitants. The average age-adjusted incidence of 0.54 doubled during the study period, analogous to the increase in the incidence of cutaneous malignant melanoma during this period, suggesting a possible role for ultraviolet radiation in its pathogenesis. Nonlimbal tumors were more likely than limbal ones to recur and they were associated with decreased survival. Increasing tumor thickness and recurrence of the primary tumor were other clinical factors related to death from CM. The histopathologic specimens of 85 patients with CM melanoma were studied for cell type, mitotic count, tumor-infiltrating lymphocytes and macrophages, mean vascular density, extravascular matrix loops and networks, and mean diameter of the ten largest nucleoli (MLN). The absence of epithelioid cells, increasing mitotic count and small MLN were associated with shorter time to recurrence according to the Cox univariate regression. None of the histopathologic variables was associated with mortality from CM. Four (5%) patients had a CM limited to the cornea without evidence of a tumor other than primary acquired melanosis of the conjunctiva. Because there are no melanocytes in the cornea, the origin of these melanomas most likely is the limbal conjunctiva. All four corneally displaced CM were limited to the epithelium, and none of the patients developed metastases. An anatomic sub-classification based on my patients and world literature was developed for corneally displaced CM. In 20 patients the metastatic pattern could be determined. Ten patients had initial systemic metastases detected, nine had initial regional metastases, and in one case the two types were detected simultaneously. The patients most likely to develop either type of initial metastases were those with nonlimbal conjunctival melanoma, those with a primary tumor more than 2 mm thick, and those with a recurrent conjunctival melanoma. Approximately two thirds of the patients had limbal CM, a location associated with good prognosis. One third, however, had a primary CM originating outside the limbus. In these patients the chance of developing local recurrences as well as systemic metastases was significantly higher than in patients with limbal CM. Each recurrence accompanies an increased risk of developing metastases, and recurrences contribute to death along with increasing tumor thickness and nonlimbal tumor location. In my data, an equal number of patients with initial locoregional and systemic metastasis existed. Patients with limbal primary tumors less than 2 mm in thickness rarely experienced metastases, unless the tumor recurred. Consequently, the patients most likely to benefit from sentinel lymph node biopsy are those who have nonlimbal tumors, CM that are over 2 mm thick, or recurrent CM. The histopathology of CM differs from that of uveal melanoma. Microvascular factors did not prove to be of prognostic importance, possibly due to the fact that CM at least as often disseminates first to the regional lymph nodes, unlike uveal melanoma that almost always disseminates hematogenously.

Functional regulation of the Neurofibromatosis 2 tumor suppressor merlin

Neurofibromatosis 2 (NF2) is an autosomal dominant disorder manifested by the formation of multiple benign tumors of the nervous system. Affected individuals typically develop bilateral vestibular schwannomas which lead to deafness and balance disorders. The syndrome is caused by inactivation of the NF2 tumor suppressor gene, and mutation or loss of the NF2 product, merlin, is sufficient for tumorigenesis in both hereditary and sporadic NF2-associated tumors. Merlin belongs to the band 4.1 superfamily of cytoskeletal proteins, which also contain the related ezrin, radixin, and moesin (ERM) proteins. The ERM members provide a link between the cell cytoskeleton and membrane by connecting membrane-associated proteins to actin filaments. By stabilizing complexes in the cell cortex, the ERMs modulate morphology, growth, and migration of cells. Despite their structural homology, overlapping subcellular distribution, direct molecular association, and partial overlap of molecular interactions, merlin and ezrin exert opposite effects on cell proliferation. Merlin suppresses cell proliferation, whereas ezrin expression is linked to oncogenic activity. We hypothesized that the regions which differ between the proteins might explain merlin s specificity as a tumor suppressor. We therefore analyzed the regions, which are most diverse between merlin and ezrin; the N-terminal tail and the C-terminus. To determine the properties of the C-terminal region, we studied the two most predominant merlin isoforms together with truncation variants similar to those found in patients. We also focused on the evolutionally conserved C-terminal residues, E545-E547, that harbor disease causing mutations in its corresponding DNA sequence. In addition to inhibiting cell proliferation, merlin regulates cytoskeletal organization. The morphogenic properties of merlin may play a role in tumor suppression, since patient-derived tumor cells demonstrate cytoskeletal abnormalities. We analyzed the mechanisms of merlin-induced extension formation and determined that the C-terminal region of amino acids 538-568 is particularly important for the morphogenic activity. We also characterized the role of C-terminal merlin residues in the regulation of proliferation, phosphorylation, and intramolecular associations. In contrast to previous reports, we demonstrated that both merlin isoforms are able to suppress cell proliferation, whereas C-terminally mutated merlin constructs showed reduced growth inhibition. Phosphorylation serves as a mechanism to regulate the tumor suppressive activity of merlin. The C-terminal serine 518 is phosphorylated in response to both p21-activated kinase (PAK) and protein kinase A (PKA), which inactivates the growth inhibitory function of merlin. However, at least three differentially phosphorylated forms of the protein exist. In this study we demonstrated that also the N-terminus of merlin is phosphorylated by AGC kinases, and that both PKA and Akt phosphorylate merlin at serine 10 (S10). We evaluated the impact of this N-terminal tail phosphorylation, and showed that the phosphorylation state of S10 is an important regulator of merlin s ability to modulate cytoskeletal organization but also regulates the stability of the protein. In summary, this study describes the functional effect of merlin specific regions. We demonstrate that both S10 in the N-terminal tail and residues E545-E547 in the C-terminus are essential for merlin activity and function.

Multi-dimensional Goodness-of-Fit Tests for Spectrum Sensing Based on Stochastic Distances

In this paper, we study two multi-dimensional Goodness-of-Fit tests for spectrum sensing in cognitive radios. The multi-dimensional scenario refers to multiple CR nodes, each with multiple antennas, that record multiple observations from multiple primary users for spectrum sensing. These tests, viz., the Interpoint Distance (ID) based test and the h, f distance based tests are constructed based on the properties of stochastic distances. The ID test is studied in detail for a single CR node case, and a possible extension to handle multiple nodes is discussed. On the other hand, the h, f test is applicable in a multi-node setup. A robustness feature of the KL distance based test is discussed, which has connections with Middleton's class A model. Through Monte-Carlo simulations, the proposed tests are shown to outperform the existing techniques such as the eigenvalue ratio based test, John's test, and the sphericity test, in several scenarios.

Mutational hotspot in Exon 20 of PIK3CA in breast cancer among Singapore Chinese

The recent identification of somatic mutations in the catalytic region of PIK3 (PIK3CA) in breast cancer and demonstration of their oncogenic function has implicated PIK3CA in mammary carcinogenesis. To investigate possible ethnic differences in patterns of PIK3CA mutations in Singaporean Chinese breast cancer and to characterize these in a panel of cell lines, we sequenced exons 9 and 20 in 80 primary tumors, 19 breast cancer cell lines and 7 normal human mammary epithelial cells (HMECs). Searching for novel hotspots of mutation, we sequenced additional exons ( 1, 2, 6, 7, 14 and 18) in 20 primary tumors and 6 breast cancer cell lines. We detected 33 point mutations in 31 of 80 (39%) breast cancers, and 11 mutations in 10 of 19 (53%) breast cancer cell lines. No mutations were detected in normal breast tissue adjacent to the tumor, or in the 6 normal HMECs. The exon 20 A3140G (H1047R) substitution was identified most frequently (22/31, 71%) and showed a significant association with patient age ( p = 0.043) and stage of the disease ( p = 0.025), but not with ER/PR status or histological grade of the tumor. The incidence of point mutations in PIK3CA, the A3140G substitution in particular, in Singapore breast cancers are among the most frequent reported to date for any gene in breast cancer. The results suggest that mutation of PIK3CA might contribute to development of early stage breast cancer and could provide a potent target for early diagnosis and therapy.

Clinical and molecular characteristics of hereditary non-polyposis colorectal cancer families in Southeast Asia

Hereditary non-polyposis colorectal cancer (HNPCC), predominantly due to germline MLH1/MSH2 mutations, is the commonest form of hereditary colorectal cancer (CRC), but data in Asians are sparse. We sequenced the MLH1/MSH2 coding and promoter core regions in CRC patients diagnosed below age 40, and/or with multiple primary cancers or familial cancer clustering suggestive of HNPCC, and correlated deleterious mutations with clinical and tumour features. Forty-six Chinese, Malay and Indian kindreds participated. Of the 153 cancers reported in the 46 kindreds, stomach (14%) and urogenital cancers (13%) were the most common extracolonic cancers, whereas endometrial cancer comprised only 7%. Eleven different MLH1 and 12 MSH2 mutations were identified, including nine novel and four recurring mutations in the Chinese. One Indian was a compound heterozygote for an MLH1 and MSH2 mutation. The MLH1/MSH2 mutation data in the Malays and the Indians represents the first in these ethnic groups. Factors strongly associated with deleterious mutations were the Amsterdam criteria, family history of stomach or multiple primary cancers, and MSI-high tumours, whereas family history of endometrial cancer and young cancer age alone correlated poorly. Distinct clinical and molecular characteristics were identified among Asian HNPCC kindreds and may have important clinical implications.

Proteomic analysis of colorectal cancer metastasis:stathmin-1 revealed as a player in cancer cell migration and prognostic marker

Metastasis accounts largely for the high mortality rate of colorectal cancer (CRC) patients. In this study, we performed comparative proteome analysis of primary CRC cell lines HCT-116 and its metastatic derivative E1 using 2-D DIGE. We identified 74 differentially expressed proteins, many of which function in transcription, translation, angiogenesis signal transduction, or cytoskeletal remodeling pathways, which are indispensable cellular processes involved in the metastatic cascade. Among these proteins, stathmin-1 (STMN1) was found to be highly up-regulated in E1 as compared to HCT-116 and was thus selected for further functional studies. Our results showed that perturbations in STMN1 levels resulted in significant changes in cell migration, invasion, adhesion, and colony formation. We further showed that the differential expression of STMN1 correlated with the cells' metastatic potential in other paradigms of CRC models. Using immunohistochemistry, we also showed that STMN1 was highly expressed in colorectal primary tumors and metastatic tissues as compared to the adjacent normal colorectal tissues. Furthermore, we also showed via tissue microarray analyses of 324 CRC tissues and Kaplan-Meier survival plot that CRC patients with higher expression of STMN1 have poorer prognosis.

Generalized Selection Combining in Cognitive MIMO Relay Networks

We propose transmit antenna selection with receive generalized selection combining (TAS/GSC) in dual-hop cognitive decode-and-forward (DF) relay networks for reliability enhancement and interference relaxation. In this paradigm, a single antenna which maximizes the receive signal-to-noise ratio (SNR) is selected at the secondary transmitter and a subset of receive antennas with the highest SNRs are combined at the secondary receiver. To demonstrate the impact of multiple primary users on the cognitive relay network, we derive new closed-form expressions for the exact and asymptotic outage probability with TAS/GSC in the secondary network. Several important design insights are reached. We corroborate that the full diversity gain is achieved, which is entirely determined by the total number of antennas in the secondary network. The negative impact of the primary network on the secondary network is reflected in the SNR gain.

Multiuser Cognitive Relay Networks in the Presence of Direct Links

In this paper, we investigate a multiuser cognitive relay network with direct source-destination links and multiple primary destinations. In this network, multiple secondary users compete to communicate with a secondary destination assisted by an amplify-and-forward (AF) relay. We take into account the availability of direct links from the secondary users to the primary and secondary destinations. For the considered system, we select one best secondary user to maximize the received signal-to-noise ratio (SNR) at the secondary destination. We first derive an accurate lower bound of the outage probability, and then provide an asymptotic expression of outage probability in high SNR region. From the lower bound and the asymptotic expressions, we obtain several insights into the system design. Numerical and simulation results are finally demonstrated to verify the proposed studies.

Transmit Antenna Selection for Interference Management in Cognitive Relay Networks

We propose transmit antenna selection (TAS) in decode-and-forward (DF) relaying as an effective approach to reduce the interference in underlay spectrum sharing networks with multiple primary users (PUs) and multiple antennas at the secondary users (SUs). We compare two distinct protocols: 1) TAS with receiver maximal-ratio combining (TAS/MRC) and 2) TAS with receiver selection combining (TAS/SC). For each protocol, we derive new closed-form expressions for the exact and asymptotic outage probability with independent Nakagami-m fading in the primary and secondary networks. Our results are valid for two scenarios related to the maximum SU transmit power, i.e., P, and the peak PU interference temperature, i.e., Q. When P is proportional to Q, our results confirm that TAS/MRC and TAS/SC relaying achieve the same full diversity gain. As such, the signal-to-noise ratio (SNR) advantage of TAS/MRC relaying relative to TAS/SC relaying is characterized as a simple ratio of their respective SNR gains. When P is independent of Q, we find that an outage floor is obtained in the large P regime where the SU transmit power is constrained by a fixed value of Q. This outage floor is accurately characterized by our exact and asymptotic results.

Multiuser Cognitive Relay Networks: Joint Impact of Direct and Relay Communications

In this paper, we propose a multiuser cognitive relay network, where multiple secondary sources communicate with a secondary destination through the assistance of a secondary relay in the presence of secondary direct links and multiple primary receivers. We consider the two relaying protocols of amplify-and-forward (AF) and decode-and-forward (DF), and take into account the availability of direct links from the secondary sources to the secondary destination. With this in mind, we propose an optimal solution for cognitive multiuser scheduling by selecting the optimal secondary source, which maximizes the received signal-to-noise ratio (SNR) at the secondary destination using maximal ratio combining. This is done by taking into account both the direct link and the relay link in the multiuser selection criterion. For both AF and DF relaying protocols, we first derive closed-form expressions for the outage probability and then provide the asymptotic outage probability, which determines the diversity behavior of the multiuser cognitive relay network. Finally, this paper is corroborated by representative numerical examples.

Secured Cooperative Cognitive Radio Networks with Relay Selection

In this paper, we propose physical layer security for cooperative cognitive radio networks (CCRNs) with relay selection in the presence of multiple primary users and multiple eavesdroppers. To be specific, we propose three relay selection schemes, namely, opportunistic relay selection (ORS), suboptimal relay selection (SoRS), and partial relay selection (PRS) for secured CCRNs, which are based on the availability of channel state information (CSI) at the receivers. For each approach, we derive exact and asymptotic expressions for the secrecy outage probability. Results show that under the assumption of perfect CSI, ORS outperforms both SoRS and PRS.

Four-dimensional CT analysis of vocal cords mobility for highly focused single vocal cord irradiation

Background and Purpose: To quantify respiratory motion of the vocal cords during normal respiration using 4D-CT. The final goal is to develop a technique for single vocal cord irradiation (SVCI) in early glottic carcinoma. Sparing the non-involved cord and surrounding structures has the potential to preserve voice quality and allow re-irradiation of recurrent and second primary tumors. Material and methods: Four-dimensional CTs of 1 mm slice thickness from 10 early glottic carcinoma patients were acquired. The lateral dimensions of the air gap separating the vocal cords were measured anteriorly, at mid-level and posteriorly at each phase of the 4D-CTs. The corresponding anterior-posterior gaps were similarly measured. Cranio-caudal vocal cords movements during breathing were derived from the shifts of the arythenoids. Results: The population-averaged mean gap size ± the corresponding standard deviation due to breathing (SD_B) for the lateral gaps was 5.8 ± 0.7 mm anteriorly, 8.7 ± 0.9 mm at mid-level, and 11.0 ± 1.3 mm posteriorly. Anterior-posterior gap values were 21.7 ± 0.7 mm, while cranio-caudal shift SD_B was 0.8 mm. Conclusion: Vocal cords breathing motions were found to be small relative to their separation. Hence, breathing motion does not seem to be a limiting factor for SVCI. © 2008 Elsevier Ireland Ltd. All rights reserved.

Exome sequencing of prostate cancer supports the hypothesis of independent tumour origins

BACKGROUND: Prostate cancer (PCa) is a clinically and pathologically heterogeneous disease. The rapid development of sequencing technology has the potential to deliver new biomarkers with emphasis on aggressive disease and to revolutionise personalised cancer treatment. However, a prostate harbouring cancer commonly contains multiple separate tumour foci, with the potential to aggravate tumour sampling. The level of intraprostatic tumour heterogeneity remains to be determined.

OBJECTIVE: To determine the level of intraprostatic tumour heterogeneity through genome-wide, high-resolution profiling of multiple tumour samples from the same individual.

DESIGN, SETTINGS, AND PARTICIPANTS: Multiple tumour samples were obtained from four individuals following radical prostatectomy. One individual (SWE-1) contained >70% cancer cells in all tumour samples, whereas the other three (SWE-2 to SWE-4) required the use of laser capture microdissection for tumour cell enrichment. Subsequently, DNA was extracted from all tissue samples, and exome sequencing was performed. All tumour foci of SWE-1 were also profiled using a high-resolution array for the identification of copy number alterations (CNA).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Shared somatic high-frequency single nucleotide variants (SNV) and CNAs were used to infer the level of intraprostatic tumour heterogeneity.

RESULTS AND LIMITATIONS: No high-frequency mutations, common for the three tumour samples of SWE-1, were identified. Ten randomly chosen positions were validated with Sanger sequencing in all foci, which verified the exome data. The high level of intraprostatic heterogeneity was consistent in all individuals. In total, three out of four individuals harboured tumours without an apparent common somatic denominator. Although we cannot exclude the presence of common structural rearrangements, a high-density array was used for the detection of deletions and amplifications in SWE-1, which agreed with the exome data.

CONCLUSIONS: We present evidence for the presence of somatically independent tumours within the same prostate. This finding will have implications for personalised cancer treatment and biomarker discovery.

Microphytobenthos vs Hydrobia: trophic coupling in estuarine environment

Os estuários são ambientes complexos, biologicamente diversos e muito importantes no que respeita à produtividade primária. As zonas intertidais destes ecossistemas são ocupadas por organismos que possuem uma elevada capacidade de sobrevivência e adaptação face às variadas e rápidas alterações nos factores ambientais (tais como temperatura, salinidade, conteúdo hídrico, etc.). As cadeias tróficas com origem no ecossistema estuarino bentónico são essencialmente herbívoras, regulando o fluxo de energia desde o fundo sedimentar e através do ecossistema. Nas áreas estuarinas intertidais a produção primária é essencialmente suportada pelo microfitobentos (MPB). Estas comunidades de microalgas bênticas constituem uma importante fonte de matéria orgânica e são por si só a principal fonte alimentar para as populações de Hydrobia. Neste contexto, a interacção MPB - Hydrobia é um modelo-chave na investigação da cadeia trófica estuarina de origem bentónica, actuando como um importante canal de transporte de energia para os níveis tróficos superiores, especialmente se considerarmos que Hydrobia é uma importante presa para peixes, aves e caranguejos. O presente estudo tem por objectivos gerais: i) a investigação do controlo ambiental (particularmente da luz e do teor em água do sedimento) e endógeno na migração vertical do MPB e ii) a identificação e potencial utilização de marcadores tróficos (pigmentos e ácidos gordos) úteis à investigação da interacção MPB – Hydrobia em laboratório e em condições naturais, considerando a existência de uma elevada plasticidade trófica por parte da Hydrobia e a elevada densidade populacional que estes organismos podem apresentar. A primeira fase de investigação resultou na comparação do papel dos estímulos ambientais e do controlo endógeno nos padrões de comportamento migratório vertical do microfitobentos, demonstrando a existência de um controlo essencialmente endógeno na formação e desintegração do biofilme superficial. A regulação e manutenção da biomassa à superfície do sedimento são claramente controladas pela variação dos factores ambientais, em especial da luz, cuja presença é essencial à formação total do biofilme microalgal à superfície do sedimento intertidal. Foi proposta uma nova abordagem metodológica com vista à estimativa nãodestrutiva do teor de água de sedimentos intertidais vasosos , possibilitando o estudo da influência da acção do vento no conteúdo hídrico dos sedimentos e o consequente impacto da dessecação na comunidade microfitobêntica. Observou-se que a dessecação provoca efeitos limitantes não só na biomassa superficial mas também na actividade fotossintética dos biofilmes microfitobênticos, conduzindo à diminuição da produtividade primária. No que respeita à dinâmica trófica da interacção MPB - Hydrobia foi estabelecido o uso do pigmento feoforbide a, quantificado nas partículas fecais da fauna, como marcador trófico que permite estimar a quantidade de biomassa de microalgas (clorofila a) incorporada pelos organismos animais.Para tal foi investigada e comprovada a existência de uma relação significativa entre a concentração de feopigmentos excretados e a concentração de clorofila a ingerida. Estes estudos foram desenvolvidos numa primeira fase à escala diária, considerando os efeitos dos ciclos sazonais, dia-noite e maré, e depois com a validação em condições naturais, numa escala mensal. A taxa de ingestão média de indivíduos de H. ulvae varia ao longo do dia, com o máximo em torno dos períodos diurnos de maré baixa, o que pode estar relacionado com a disponibilidade de MPB. As taxas de ingestão (TI) de H. ulvae variam ainda em função da estação do ano (TI verão > TI primavera) e em função da densidade de indivíduos (> densidade, < ingestão). Verificou-se um efeito negativo na concentração de clorofila disponível após herbívoria independentemente da densidade de indivíduos. Finalmente, a comparação dos perfis de ácidos gordos de H. ulvae provenientes de diferentes habitats com os perfis de potenciais fontes alimentares permitiu demonstrar que os ácidos gordos são ferramentas úteis na identificação do habitat ocupado por estes organismos. No entanto, apesar da ocupação de diferentes habitats e da integração de múltiplas fontes de produção primária na sua dieta foram sempre observados significativos níveis de ácidos gordos específicos de microalgas (em particular diatomáceas), reforçando o papel importante das comunidades de microalgas bênticas na dieta das populações de H. ulvae.

Functional sphere profiling reveals the complexity of neuroblastoma tumor-initiating cell model.

Neuroblastoma (NB) is a neural crest-derived childhood tumor characterized by a remarkable phenotypic diversity, ranging from spontaneous regression to fatal metastatic disease. Although the cancer stem cell (CSC) model provides a trail to characterize the cells responsible for tumor onset, the NB tumor-initiating cell (TIC) has not been identified. In this study, the relevance of the CSC model in NB was investigated by taking advantage of typical functional stem cell characteristics. A predictive association was established between self-renewal, as assessed by serial sphere formation, and clinical aggressiveness in primary tumors. Moreover, cell subsets gradually selected during serial sphere culture harbored increased in vivo tumorigenicity, only highlighted in an orthotopic microenvironment. A microarray time course analysis of serial spheres passages from metastatic cells allowed us to specifically "profile" the NB stem cell-like phenotype and to identify CD133, ABC transporter, and WNT and NOTCH genes as spheres markers. On the basis of combined sphere markers expression, at least two distinct tumorigenic cell subpopulations were identified, also shown to preexist in primary NB. However, sphere markers-mediated cell sorting of parental tumor failed to recapitulate the TIC phenotype in the orthotopic model, highlighting the complexity of the CSC model. Our data support the NB stem-like cells as a dynamic and heterogeneous cell population strongly dependent on microenvironmental signals and add novel candidate genes as potential therapeutic targets in the control of high-risk NB.