Citations

Migraine clusters in families and is considered to be a strongly heritable disorder. Hemiplegic migraine is a rare subtype of migraine with aura that may occur as a familial or a sporadic condition. Three genes have been identified studying families with familial hemiplegic migraine ( FHM ). The first FHM gene that was identified is CACNA1A . A second gene, FHM2 , has been mapped to chromosome 1 q 21‐23. The defect is a new mutation in the α 2 subunit of the N a/ K pump ( ATP1A2 ). A third gene ( FHM3 ) has been linked to chromosome 2q24. It is due to a missense mutation in gene SCN1A ( Gln1489Lys ), which encodes an α1 subunit of a neuronal voltage‐gated N a+ channel. Genome‐wide association studies have identified many non‐coding variants associated with common diseases and traits, like migraine. These variants are concentrated in regulatory DNA marked by deoxyribonuclease I hypersensitive sites. A role has been suggested for the two‐pore domain potassium channel, TWIK ‐related spinal cord potassium channel. TWIK ‐related spinal cord potassium channel is involved in migraine by screening the KCNK18 gene in subjects diagnosed with migraine.

Summary Background Duchenne muscular dystrophy ( DMD ) and Becker muscular dystrophy ( BMD ) are associated with life‐threatening perioperative complications, including rhabdomyolysis, hyperkalemia, and hyperthermia. Current recommendations contraindicate use of succinylcholine and volatile anesthetics; however, the latter recommendation remains controversial. Objective To review the perioperative outcomes of patients with DMD and BMD . Methods We reviewed records of patients with DMD or BMD who underwent anesthetic management at our institution from January 1990 through December 2011. Results We identified 47 patients ( DMD , 37; BMD , 10) who underwent 117 anesthetic exposures ( DMD , 101; BMD , 16). Volatile anesthetic agents were used 66 times ( DMD , 59; BMD , 7). One patient with undiagnosed BMD received succinylcholine and developed acute rhabdomyolysis and hyperkalemic cardiac arrest. All other major complications were attributed to the procedure (i.e., large bleeding), to preexisting comorbidities (i.e., respiratory failure, cardiac disease), or to both. Conclusions Use of succinylcholine in children with dystrophinopathy is contraindicated. These patients have significant comorbidities and are frequently undergoing extensive operations; complications related to these factors can develop, as evidenced by our series. These complications may occur with use of volatile and nonvolatile anesthetics. However, because most of our patients were older than 8 years at the time of surgery, our observation cannot be generalized to younger dystrophin‐deficient children.

BACKGROUNDAlthough rituximab‐based chemoimmunotherapy (CIT) has substantially improved clinical outcomes in chronic lymphocytic leukemia (CLL), only 40% to 50% of patients achieve a complete remission (CR). There remains interest in identifying new approaches to improve the effectiveness of CIT. Ofatumumab is a fully human anti‐CD20 monoclonal antibody with greater apparent single‐agent activity than rituximab in CLL patients.METHODSPreviously untreated CLL patients in need of therapy received 6 cycles of CIT induction with pentostatin, cyclophosphamide, and ofatumumab (PCO) followed by response assessment.RESULTSOf the 48 patients enrolled, 77% completed PCO induction. Adverse events during induction included grade 3+ hematologic toxicity (27%) and grade 3+ nonhematologic toxicity (23%). Median CD4 count after induction and 6 months later were 186 × 106/L and 272 × 106/L. The overall response rate was 96% (46 of 48 patients), and the CR rate was 46% (22 of 48 patients). Among the 38 patients who underwent minimal residual disease evaluation, 7 (18%) were negative for minimal residual disease. After median follow‐up of 24 months, 10 (21%) patients have progressed and 8 (17%) have required retreatment. The efficacy and toxicity of ofatumumab‐based CIT compare favorably to our historical trials of rituximab‐based CIT using an identical chemotherapy backbone (n = 64). Time to retreatment also appeared longer for ofatumumab‐based CIT (free of retreatment at 24 months: 86% [95% confidence interval = 75‐99] versus 68% [95% confidence interval = 56‐81] for rituximab‐based CIT).CONCLUSIONSOfatumumab‐based CIT is well tolerated in patients with previously untreated CLL. The efficacy of ofatumumab‐based CIT compares favorably to historical trials of rituximab‐based CIT, suggesting randomized trials comparing ofatumumab‐based CIT and rituximab‐based CIT should be considered. Cancer 2013;119:3788–3796. © 2013 American Cancer Society.

Abstract Initial genome wide association studies (GWAS) of common cancers focused on combining all available cases in order to maximize the statistical power of the studies. While many genome wide significant associations (p < 5 × 10−8) were observed, this approach overlooked the possibility that certain genetic risk factors might have greater effects in specific populations. With this in mind more recent studies have focused on associations between common genetic variants and disease in populations other than those of northern European ancestry. In addition, GWAS of predisposed individuals, such as carriers of BRCA1 and BRCA2 mutations, have been conducted based on the hypothesis that unique modifiers of breast and ovarian cancer risk might influence disease in these populations. More recently, associations with histological subtypes of tumors have been observed for a number of different cancer types. In the setting of breast cancer, specific associations with estrogen receptor status of tumors and even triple negative tumors (estrogen receptor, progesterone receptor, and HER2 negative) have been reported. Ongoing studies further suggest that specific associations with histochemical markers and tumor grade may also exist in the general population. Here we will discuss recent associations between genetic variants and subpopulations of disease using breast cancer as a model, and consider the importance of these findings for an improved understanding of the etiology of breast cancer and enhanced cancer risk assessment. Citation Format: Fergus J. Couch. Tumor heterogeneity: Making the most of diversity. [abstract]. In: Proceedings of the AACR Special Conference on Post-GWAS Horizons in Molecular Epidemiology: Digging Deeper into the Environment; 2012 Nov 11-14; Hollywood, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(11 Suppl):Abstract nr IA11A.

Abstract Background: Terminal duct lobular units (TDLUs) are the anatomical source of most breast cancers. TDLU involution, manifested as atrophy and loss of TDLUs, is associated with reduced breast cancer risk. We hypothesize that breast cancer susceptibility loci are associated with TDLU involution. Accordingly, we evaluated relationships between 25 established breast cancer susceptibility markers and their association with TDLU involution in the Susan G. Komen for the Cure® Tissue Bank (KTB). Methods: Subjects were women ages 18-84 (N=680), who had no personal history of any cancer, were not currently taking menopausal hormones, completed a risk factor questionnaire, provided an Oragene® saliva sample, and donated a 10-guage needle tissue core from the upper outer breast quadrant for research. We genotyped 25 known single nucleotide polymorphisms (SNPs) associated with breast cancer risk using TaqMan® assays. Pathologists masked to risk data classified three features inversely related to TDLU involution using one histological section of breast tissue/subject: number of TDLUs per section (TDLU density), TDLU diameters and number of acini per TDLU. SNPS were compared to metrics of TDLU involution categorized in tertiles: TDLU density (0-1, 2-8, 9+), mean TDLU diameter (53-291, 292-415, 416-1143 microns), and mean number of acini per TDLU (2-10, 11-20, 21+). We estimated age-adjusted per-allele odds ratios (ORs) and 95% confidence intervals (CIs) using ordinal logistic regression models with TDLU measures as the outcome and SNPs as the explanatory variables. Associations with TDLU density were based on up to 680 women with genotype data, while associations with diameter and acini measures were based on up to 469 women with observed TDLUs. Results: The rs3803662 (TOX3/TNRC9) SNP risk allele showed an association with increased TDLU density, larger TDLUs, and more acini in TDLUs (TDLU density per-allele OR=1.29 95%CI=1.04-1.60; TDLU diameter OR=1.32 95%CI=1.00-1.74; and TDLU acini OR=1.34 95%CI=1.02-1.77), consistent with previous observations of significant associations seen for this SNP with mammographic density (a well-established risk factor for breast cancer), breast cancer risk, and survival of breast cancer. In addition, we observed associations for four other SNPs with TDLU density (rs311499, rs10483813, rs2981582, rs3817198), for one other SNP with mean TDLU diameter (rs11249433), and for three other SNPs with mean TDLU acini number (rs704010, rs10941679, rs11249433). Conclusion: These data suggest that breast cancer susceptibility SNPs may be associated with TDLU involution levels, and could represent a mechanism by which they influence breast cancer risk. These findings warrant replication in other studies and provide support for the concept that levels of TDLU involution represent an intermediate marker of breast cancer risk. Citation Format: Jonine D. Figueroa, Gretchen L. Gierach, Ruth Pfeiffer, Stephen Chanock, Louise Brinton, Deesha A. Patel, Daniel Visscher, Carolyn Mies, Stephen Hewitt, Susan Clare, Anna Maria Storniolo, Mark Sherman. Associations between breast cancer susceptibility markers and terminal duct lobular unit involution in normal breast tissues among women from the Susan G. Komen for the Cure® Tissue Bank. [abstract]. In: Proceedings of the AACR Special Conference on Post-GWAS Horizons in Molecular Epidemiology: Digging Deeper into the Environment; 2012 Nov 11-14; Hollywood, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(11 Suppl):Abstract nr 58.

Abstract Background: The Colorectal Cancer Family Registry (Colon CFR) has served as an international resource for studies of the genetics and epidemiology of colorectal cancer (CRC) since 1997. It is the largest family-based resource in the world for the study of CRC and other cancers, such as endometrial cancer, that occur in CRC families. The Colon CFR has recruited participants via six institutions: Cancer Care Ontario, Fred Hutchinson Cancer Research Center, Mayo Clinic, University of Hawaii, University of Southern California Consortium, and University of Melbourne. Methods: CRC cases were recruited from both population-based cancer registries and family cancer clinics. Controls were recruited from population-based sources. Relatives were recruited via cases and controls. Participants were asked to: donate a blood sample; give permission to access any tumor tissue; complete a detailed personal and family history of cancer including degree of relationship, site of cancer and age of diagnosis; and complete a detailed baseline lifestyle questionnaire that was administered across all recruitment sites, which included items on established and suspected risk factors for colorectal cancer: personal characteristics including age, sex, height and weight, country of birth, ethnicity, race and religion; history of exercise, alcohol consumption and smoking; medication use including NSAIDs, cholesterol-lowering agents, diabetes medication and post- menopausal hormone use; history of colorectal cancer screening including fecal occult blood test, sigmoidoscopy, colonoscopy; personal history of surgery including polypectomy, other bowel surgery and hysterectomy; frequency of meat consumption and method of cooking; reproductive history (for women). Participants were also asked for detail information on the frequency of food consumption and portion size using a food frequency questionnaire. Follow-up of participants has been conducted every five years, by questionnaire, to update vital status, surgery, cancer screening, polypectomy, and personal and family history of cancer history. Participants have been characterized for major known predisposing CRC gene mutations and have undergone a genome-wide SNP testing and tested for known CRC SNPs. Results: The Colon CFR has enrolled 35,297 participants (11,635 affected with CRC, 3,629 affected with other cancers, and 20,033 unaffected) who have completed baseline questionnaires. We have 5-year follow-up data on 24,692 participants (6,329 affected with CRC, 2,261 affected with other cancers, and 16,102 unaffected) and 10-year follow-up data on 10,467 (3,654 affected with CRC, 1,182 affected with other cancers, and 5,631 unaffected). We have GWAS data on 3,830 participants, candidate SNP data on 18,000 participants, and mismatch repair gene mutation data on 2,697 participants (and observed 1,697 carriers with a deleterious mutation). Conclusion: This largest and best characterized CRC cohort in the world will facilitate post-GWAS research to provide insight into the role of environmental factors, and how they interact with genetic factors on CRC risk. Researchers are encouraged by the National Cancer Institute (USA) and the Colon CFR investigators to apply for access to this unique resource of data and biospecimens for collaborative research. Citation Format: Aung Ko Win, Daniel D. Buchanan, Noralane M. Lindor, Robert W. Haile, Polly A. Newcomb, Loic Le Marchand, Steven Gallinger, Hopper L. John, Casey Graham, Mark A. Jenkins. The Colon Cancer Family Registry: A major resource for post-GWAS gene-environment studies. [abstract]. In: Proceedings of the AACR Special Conference on Post-GWAS Horizons in Molecular Epidemiology: Digging Deeper into the Environment; 2012 Nov 11-14; Hollywood, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(11 Suppl):Abstract nr 43.

Objectives/Hypothesis Pediatric obstructive sleep apnea syndrome ( OSAS ) is a common disorder with serious clinical implications if left untreated. The recommended initial treatment for pediatric patients with obstructive sleep apnea syndrome ( OSAS ) is adenotonsillectomy. However, recent reports have shown variable surgical results with adenotonsillectomy in the treatment of pediatric OSAS . Study Design Prospective, controlled study. Methods From April 2007 to August 2010, 24 participants were assigned alternatively to either adenotonsillectomy with pillar suturing (intervention group) or adenotonsillectomy alone (control group). Result The average improvement in apnea hypopnea index ( AHI ) was 42.6% in the control group and 79.9% in the intervention group ( P =0.037). The success rate was 50% in the control group and 91.6% in the intervention group ( P =0.034). Six patients (50%) in the intervention group achieved complete resolution of pediatric OSAS , as defined by an AHI <1/hour, compared to 2 patients (16.7%) in the control group ( P =0.097). Conclusion Adenotonsillectomy with pillar suturing showed significant improvement in treating pediatric patients with OSAS compared to adenotonsillectomy alone. The procedure is simple and safe. Level of Evidence 4. Laryngoscope , 123:2574–2578, 2013