Abstract

Malignant Melanoma - Update on Biochemical Follow-up

Peter Arenberger

Standard screening in melanoma patients is a useful tool for detection of clinical progression, however, an instant methodology for exact detection of subclinical disease, progression or a time-dependent therapy response observation is still lacking.
Detection of circulating melanoma cells is, therefore, a possible novel promising staging method. Inconsistent data, however, on method sensitivity and patient predicting outcome has been shown repeatedly.
Recently, a multimarker real-time RT-PCR methodology for quantification of five melanoma markers Melan-A, gp 100, MAGE-3, MIA and tyrosinase was described by our group. In the present prospective trial blood specimens of 65 patients with AJCC stage IIB-III cutaneous melanoma after surgery were periodically examined. In the above group 27 % of subjects relapsed during the study. Prior to the disease progression we could observe a statistically significant tumor marker elevation 0 to 9 months in all patients with clinical relapse. In our hands, MAGE-3 became the most sensitive progression marker. During progression 3 concordant positive markers were seen in 39 % of patients, followed by 2 concordant positive markers in 28 % and 1 marker in 33 %.
This study supports the use of a multimarker real-time RT-PCR as a disease progression predictor. The dynamic assessment of serially obtained blood specimens represents a useful method for early metastasis detection and treatment response of melanoma patients.

Can the Premature Birth Rate be Reduced? The Situation in the USA

Akihiko Noguchi

Premature birth rate and low birth weight rate are in an increasing trend in industrialized countries including USA and Japan. Infant mortality rate (IMR) is 50-75 times and three times higher for infants born <32 weeks and 32-36 weeks respectively than term-born counterparts. In US, IMR is higher than in Japan particularly among black infants and simply the "lower socioeconomic class" is not the answer. Premature birth is heterogeneous in origin, and idiopathic in 70% of the cases. Increased utilization of reproductive technology only accounts for a part. Evidence suggests environmental factors play a significant role and genetic-environmental interaction is plausible. Recently, chronic psychosocial stress of women has been postulated to be contributory by modifying the endocrine milieu. In a preliminary analysis in St. Louis, homeless pregnant women with high behavioral and social risks were accommodated in a home designed for these women and produced a significantly less number of premature and low birth weight infants as compared with the general population. Furthermore, in a randomized controlled study in Washington DC, psychobehavioral intervention specifically targeting smoking (primary and secondary), intimate partner violence (IPV), and depression among black pregnant women significantly decreased the rate of miscarriage and low birthweight. These studies may have significant implication to the Japanese situation. Significant number of Japanese women of reproductive age seem exposed to smoking, may have underling psychosocial stress, may suffer from subclinical depression and/or from IPV. Identification and targeting this population may impact on the increasing trend of premature birth in Japan.