Adjuvant chemotherapy in oestrogen-receptor-poor breast cancer: patient-level meta-analysis of randomised trials

Background: The long-term effects of adjuvant polychemotherapy regimens in oestrogen-receptor-poor (ER-poor) breast cancer, and the extent to which these effects are modified by age or tamoxifen use, can be assessed by an updated meta-analysis of individual patient data from randomised trials. Methods: Collaborative meta-analyses of individual patient data for about 6000 women with ER-poor breast cancer in 46 trials of polychemotherapy versus not (non-taxane-based polychemotherapy, typically about six cycles; trial start dates 1975-96, median 1984) and about 14 000 women with ER-poor breast cancer in 50 trials of tamoxifen versus not (some trials in the presence and some in the absence of polychemotherapy; trial start dates 1972-93, median 1982). Findings: In women with ER-poor breast cancer, polychemotherapy significantly reduced recurrence, breast cancer mortality, and death from any cause, in those younger than 50 years and those aged 50-69 years at entry into trials of polychemotherapy versus not. In those aged younger than 50 years (1907 women, 15% node-positive), the 10-year risks were: recurrence 33% versus 45% (ratio of 10-year risks 0·73, 2p<0·00001), breast cancer mortality 24% versus 32% (ratio 0·73, 2p=0·0002), and death from any cause 25% versus 33% (ratio 0·75, 2p=0·0003). In women aged 50-69 years (3965 women, 58% node-positive), the 10-year risks were: recurrence 42% versus 52% (ratio 0·82, 2p<0·00001), breast cancer mortality 36% versus 42% (ratio 0·86, 2p=0·0004), and death from any cause 39% versus 45% (ratio 0·87, 2p=0·0009). Few were aged 70 years or older. Tamoxifen had little effect on recurrence or death in women who were classified in these trials as having ER-poor disease, and did not significantly modify the effects of polychemotherapy. Interpretation: In women who had ER-poor breast cancer, and were either younger than 50 years or between 50 and 69 years, these older adjuvant polychemotherapy regimens were safe (ie, had little effect on mortality from causes other than breast cancer) and produced substantial and definite reductions in the 10-year risks of recurrence and death. Current and future chemotherapy regimens could well yield larger proportional reductions in breast cancer mortality.

Evolution in the deep sea: a combined analysis of the earliest diverging living chitons (Mollusca : Polyplacophora : Lepidopleurida)

Lepidopleurida is the earliest diverged group of living polyplacophoran molluscs. They are found predominantly in the deep sea, including sunken wood, cold seeps, other abyssal habitats, and a few species are found in shallow water. The group is morphologically identified by anatomical features of their gills, sensory aesthetes, and gametes. Their shell features closely resemble the oldest fossils that can be identified as modern polyplacophorans. We present the first molecular phylogenetic study of this group, and also the first combined phylogenetic analysis for any chiton, including three gene regions and 69 morphological characters. The results show that Lepidopleurida is unambiguously monophyletic, and the nine genera fall into five distinct clades, which partly support the current view of polyplacophoran taxonomy. The genus Hanleyella Sirenko, 1973 is included in the family Protochitonidae, and Ferreiraellidae constitutes another distinct clade. The large cosmopolitan genus Leptochiton Gray, 1847 is not monophyletic; Leptochiton and Leptochitonidae sensu stricto are restricted to North Atlantic and Mediterranean taxa. Leptochitonidae s. str. is sister to Protochitonidae. The results also suggest two separate clades independently inhabiting sunken wood substrates in the south-west Pacific. Antarctic and other chemosynthetic-dwelling species may be derived from wood-living species. Substantial taxonomic revision remains to be done to resolve lepidopleuran classification, but the phylogeny presented here is a dramatic step forward in clarifying the relationships within this interesting group.

A Search for Line Shape and Depth Variations in 51 Pegasi and tau Bootis

Spectroscopic observations of 51 Pegasi and tau Bootis show no periodic changes in the shapes of their line profiles; these results for 51 Peg are in significant conflict with those reported by Gray & Hatzes. Our detection limits are small enough to rule out nonradial pulsations as the cause of the variability in tau Boo, but not in 51 Peg. The absence of line shape changes is consistent with these stars' radial velocity variability arising from planetary mass companions.

Exoplanets or Dynamic Atmospheres? The Radial Velocity and Line Shape Variations of 51 Pegasi and tau Bootis

The stars 51 Pegasi and tau Bootis show radial velocity variations that have been interpreted as resulting from companions with roughly Jovian mass and orbital periods of a few days. Gray and Gray & Hatzes reported that the radial velocity signal of 51 Peg is synchronous with variations in the shape of the line lambda 6253 Fe I; thus, they argue that the velocity signal arises not from a companion of planetary mass but from dynamic processes in the atmosphere of the star, possibly nonradial pulsations. Here we seek confirming evidence for line shape or strength variations in both 51 Peg and tau Boo, using R = 50,000 observations taken with the Advanced Fiber Optic Echelle. Because of our relatively low spectral resolution, we compare our observations with Gray's line bisector data by fitting observed line profiles to an expansion in terms of orthogonal (Hermite) functions. To obtain an accurate comparison, we model the emergent line profiles from rotating and pulsating stars, taking the instrumental point-spread function into account. We describe this modeling process in detail. We find no evidence for line profile or strength variations at the radial velocity period in either 51 Peg or in tau Boo. For 51 Peg, our upper limit for line shape variations with 4.23 day periodicity is small enough to exclude with 10 sigma confidence the bisector curvature signal reported by Gray & Hatzes; the bisector span and relative line depth signals reported by Gray are also not seen, but in this case with marginal (2 sigma ) confidence. We cannot, however, exclude pulsations as the source of 51 Peg's radial velocity variation because our models imply that line shape variations associated with pulsations should be much smaller than those computed by Gray & Hatzes; these smaller signals are below the detection limits both for Gray & Hatzes's data and for our own. tau Boo's large radial velocity amplitude and v sin i make it easier to test for pulsations in this star. Again we find no evidence for periodic line shape changes, at a level that rules out pulsations as the source of the radial velocity variability. We conclude that the planet hypothesis remains the most likely explanation for the existing data.

Dynamic evolution of the genetic search region through fuzzy coding

A technique for automatic exploration of the genetic search region through fuzzy coding (Sharma and Irwin, 2003) has been proposed. Fuzzy coding (FC) provides the value of a variable on the basis of the optimum number of selected fuzzy sets and their effectiveness in terms of degree-of-membership. It is an indirect encoding method and has been shown to perform better than other conventional binary, Gray and floating-point encoding methods. However, the static range of the membership functions is a major problem in fuzzy coding, resulting in longer times to arrive at an optimum solution in large or complicated search spaces. This paper proposes a new algorithm, called fuzzy coding with a dynamic range (FCDR), which dynamically allocates the range of the variables to evolve an effective search region, thereby achieving faster convergence. Results are presented for two benchmark optimisation problems, and also for a case study involving neural identification of a highly non-linear pH neutralisation process from experimental data. It is shown that dynamic exploration of the genetic search region is effective for parameter optimisation in problems where the search space is complicated.

Apoptosis and chemotherapy in bladder cancer in bladder cancer

Purpose: To discuss the role of apoptosis, gene directed self-destruction of a cell, in the response of transitional cell carcinoma of the bladder cells to chemotherapy. Methods: A directed MEDLINE literature search of apoptosis, bladder cancer and chemotherapy was performed to extract the relevant information, which was reviewed. The characteristics of apoptotic cells were defined and the methods in common use to detect these traits were described. The role of the key mediators of the apoptotic process in bladder cancer is discussed in the context of chemosensitivity and stage of disease. The importance of induction of apoptosis post chemotherapy is highlighted. Results: On stimulus by appropriate external or internal signals, a cell may alter the expression of genes coding for proteins associated with the apoptotic process. The development of apoptosis depends on the balance between pro- and anti- apoptotic proteins. Key alterations in genes and proteins related to apoptosis within bladder cancer result in a shift away from an ability to undergo apoptosis towards a cell with increased survival properties that is chemoresistant. Conclusions: Much current research in bladder cancer is aimed at restoring chemosensitivity by shifting the balance in a cell towards a pro-apoptotic phenotype. Successful translation of this work into clinical practice may improve survival in patients in whom prognosis is currently poor.

A voxel based morphometry study investigating brain structural changes in first episode psychosis.

Schizophrenia (SCZ) and bipolar disorder (BP) are associated with neuropathological brain changes, which are believed to disrupt connectivity between brain processes and may have common properties. Patients at first psychotic episode are unique, as one can assess brain alterations at illness inception, when many confounders are reduced or absent. SCZ (N=25) and BP (N=24) patients were recruited in a regional first episode psychosis MRI study. VBM methods were used to study gray matter (GM) and white matter (WM) differences between patient groups and case by case matched controls. For both groups, deficits identified are more discrete than those typically reported in later stages of illness. SCZ patients showed some evidence of GM loss in cortical areas but most notable were in limbic structures such as hippocampus, thalamus and striatum and cerebellum. Consistent with disturbed neural connectivity WM alterations were also observed in limbic structures, the corpus callosum and many subgyral and sublobar regions in the parietal, temporal and frontal lobes. BP patients displayed less evidence of volume changes overall, compared to normal healthy participants, but those changes observed were primarily in WM areas which overlapped with regions identified in SCZ, including thalamus and cerebellum and subgyral and sublobar sites. At first episode of psychosis there is evidence of a neuroanatomical overlap between SCZ and BP with respect to brain structural changes, consistent with disturbed neural connectivity. There are also important differences however in that SCZ displays more extensive structural alteration.