Association between use of benzodiazepines and risk of fractures: a meta-analysis

Benzodiazepines (BZDs) are some of the most commonly prescribed drugs in the world. It has been shown that BZD use could be associated with increased fracture risk. However, studies on the use of BZDs and fracture risk have yielded inconsistent results. Results from the present meta-analysis show that BZD use is associated with a moderate and clinically significant increase in the risk of fractures.

INTRODUCTION

The relationship between the use of BZDs and fracture risk has been neither well identified nor summarized. This meta-analysis reports on the use of BZDs, especially short-acting BZDs, and their correlation with a moderate and clinically significant increase in fracture risk. This analysis will provide evidence for clinicians to consider fracture risk when prescribing BZDs among the elderly population. This study was conducted to determine whether people who take BZDs are at an increased fracture risk.

METHODS

A systematic search of studies published through January 2013 was conducted using MEDLINE, EMBASE, OVID, and ScienceDirect. Case-control and cohort studies that assessed the relationship between BZD use and the risk of fractures were identified. Literature searches, study selections, methodological assessments, and data mining were independently conducted by two reviewers. Disagreements were resolved by consensus. STATA 12.0 software was used for the meta-analysis. Random effects models were used for pooled analysis due to heterogeneity among the studies.

RESULTS

There were 25 studies, including 19 case-control studies and 6 cohort studies, that met the inclusion criteria. Overall, the results of the meta-analysis indicated that BZD use was associated with a significantly increased fracture risk (relative risk (RR) = 1.25; 95% confidence intervals (CI), 1.17-1.34; p < 0.001). Increased fracture risk associated with BZD use was observed in participants aged ≥65 years old (RR = 1.26; 95% CI, 1.15-1.38; p < 0.001). When only hip fractures were included as the outcome measure, the RR increased to 1.35. However, subgroup meta-analyses showed that there was no significant association between BZD use and fracture risk in Eastern countries (RR = 1.27; 95% CI, 0.76-2.14; p = 0.362) as well as between long-acting BZD use and risk of fractures (RR = 1.21; 95% CI, 0.95-1.54; p = 0.12). After accounting for publication bias, we observed that the overall association between BZD use and fracture risk to be slightly weaker (RR = 1.21; 95% CI, 1.13-1.30) but still significant.

CONCLUSION

The results of this meta-analysis demonstrate that the use of BZD, especially short-acting BZD, is associated with a moderate and clinically significant increase in fracture risk. However, large prospective studies that minimize selection bias are necessary to determine a more accurate fracture risk associated with BZD use.

Prevalence of carbapenem-hydrolyzing class D β-lactamase genes in Acinetobacter spp. isolates in China

In order to assess the prevalence of carbapenem-hydrolyzing class D β-lactamase genes in Acinetobacter spp. isolates in China, we conducted a polymerase chain reaction (PCR)-based surveillance of OXA-type β-lactamase gene clusters for a total of 2,880 Acinetobacter spp. isolates collected from 23 Chinese provinces. All isolates were tested for susceptibility to 12 antimicrobial agents and showed high rates of resistance to all these agents except minocycline. We also found that the vast majority of carbapenem-resistant Acinetobacter spp. were OXA-23-like-producing isolates, predominantly Acinetobacter baumannii isolates. Besides, bla OXA-58-like and bla OXA-24-like genes were detected in 32 and 11 isolates, respectively, involving many provinces throughout China. Furthermore, these two carbapenem-resistance determinants were located on transferable plasmids in most cases, indicating an emerging threat for both OXA-58-like- and OXA-24-like-producing Acinetobacter spp. isolates in China. Interestingly, a novel homologue of the bla OXA-143 gene was identified in a susceptible Acinetobacter pittii isolate. Overall, these observations suggest that the bla OXA-23-harboring A. baumannii isolates are the most frequent carbapenem-resistant Acinetobacter spp. in China, and the bla OXA-24-like and bla OXA-58-like genes have emerged as potential threats of hospital outbreaks of multidrug-resistant Acinetobacter spp.

Extraction of (9,8) single-walled carbon nanotubes by fluorene-based polymers

Selective polymer wrapping is a promising approach to obtain high-chiral-purity single-walled carbon nanotubes (SWCNTs) needed in technical applications and scientific studies. We showed that among three fluorene-based polymers with different side-chain lengths and backbones, poly[(9,9-dihexylfluorenyl-2,7-diyl)-co-(9,10-anthracene)] (PFH-A) can selectively extract SWCNTs synthesized from the CoSO4 /SiO2 catalyst, which results in enrichment of 78.3 % (9,8) and 12.2 % (9,7) nanotubes among all semiconducting species. These high-chiral-purity SWCNTs may find potential applications in electronics, optoelectronics, and photovoltaics. Furthermore, molecular dynamics simulations suggest that the extraction selectivity of PFH-A relates to the bending and alignment of its alkyl chains and the twisting of its two aromatic backbone units (biphenyl and anthracene) relative to SWCNTs. The strong π-π interaction between polymers and SWCNTs would increase the extraction yield, but it is not beneficial for chiral selectivity. Our findings suggest that the matching between the curvature of SWCNTs and the flexibility of the polymer side chains and the aromatic backbone units is essential in designing novel polymers for selective extraction of (n,m) species.

[Evaluation for the clinical application of all embryos cryopreservation: a multi-centre study in northern area of China]

OBJECTIVE

To investigate the clinical outcome of patients who underwent cryopreservation of all embryos.

METHODS

A retrospective analysis was made in the clinical data of patients with cryopreservation of all embryos between April 2011 and September 2011 in four hospitals of North China. The patients were divided into five groups according to the reasons of cryopreservation of all embryos: ovarian hyperstimulation syndrome (OHSS) group, serum progesterone elevation group, endometrial group, hydrosalpinx group and others. The clinical pregnancy rate per transfer, implantation rate and cumulative clinical pregnancy rate were analyzed.

RESULTS

The clinical pregnancy rate, implantation rate and cumulative clinical pregnancy rate of the OHSS group were 55.4%, 34.8% and 73.7%, respectively. The rates of the serum progesterone elevation group were 25.5%, 11.2% and 43.1%, respectively. The rates of the endometrial group were 54.8%, 34.4% and 61.5%, respectively. The rates of the hydrosalpinx group were 60%, 30% and 60%, respectively. The rates of the other factors group were 36.0%, 24.5% and 44.0%, respectively.

CONCLUSION

The strategy of cryopreservation of all embryos could improve the clinical outcomes of patients with severe OHSS. It still needs a large multi-centre, randomized trial to evaluate its effectiveness and side effects, although it has the positive clinical application for other reasons of cryopreservation of all embryos.

Deep sequencing-based transcriptional analysis of bovine mammary epithelial cells gene expression in response to in vitro infection with Staphylococcus aureus stains

Staphylococcus aureus (S. aureus) is an important etiological organism in chronic and subclinical mastitis in lactating cows. Given the fundamental role the primary bovine mammary epithelial cells (pBMECs) play as a major first line of defense against invading pathogens, their interactions with S. aureus was hypothesized to be crucial to the establishment of the latter’s infection process. This hypothesis was tested by investigating the global transcriptional responses of pBMECs to three S. aureus strains (S56,S178 and S36) with different virulent factors, using a tag-based high-throughput transcriptome sequencing technique. Approximately 4.9 million total sequence tags were obtained from each of the three S. aureus-infected libraries and the control library. Referenced to the control, 1720, 219, and 427 differentially expressed unique genes were identified in the pBMECs infected with S56, S178 and S36 S. aureus strains respectively. Gene ontology (GO) and pathway analysis of the S56-infected pBMECs referenced to those of the control revealed that the differentially expressed genes in S56-infected pBMECs were significantly involved in inflammatory response, cell signalling pathways and apoptosis. In the same vein, the clustered GO terms of the differentially expressed genes of the S178-infected pBMECs were found to comprise immune responses, metabolism transformation, and apoptosis, while those of the S36-infected pBMECs were primarily involved in cell cycle progression and immune responses. Furthermore, fundamental differences were observed in the levels of expression of immune-related genes in response to treatments with the three S. aureus strains. These differences were especially noted for the expression of important pro-inflammatory molecules, including IL-1α, TNF, EFNB1, IL-8, and EGR1. The transcriptional changes associated with cellular signaling and the inflammatory response in this study may reflect different immunomodulatory mechanisms that underlie the interaction between pBMECs and S. aureus strains during infection by the latter.

Abstract P1-01-13: Intraoperative evaluation of sentinel lymph nodes using touch imprint cytology in patients with early-stage breast cancer: A series of 4367 procedures

Background: As the screening for breast cancer becomes common in China, an increasing number of early-stage breast cancer has been detected. For those patients, especially the ones with cliniaclly negetive lymph nodes, sentinel lymph node biopsy (SLNB) plays an important role in the assessment of the axillary status, while minimizing the mobidity of axillary lymph node dissection(ALND). Accurate intraoperative assessment of SLN metastases enables the selection of patients for ALND during the same operation. Touch imprint cytology (TIC) serves as a main intraoperative evaluation of SLNs in our institute since Feb-2005. The purpose of this study is to evaluate its clinical value.

Methods: Early-stage breast cancer patients treated in our institute between Feb-2005 and Apr-2013 enrolled in this study. To avoid breast tissue contamination, all patients had an intraoperative SLNB performed before undergoing lumpectomy or mastectomy. The fresh SLNs were sectioned into 1.5-3.0mm pieces along the short axis, TIC was performed on both surfaces of each piece, its result was correlated with the histological assessments with Hematoxylin-Eosin (H&E) staining, which considered as the gold standard.

Results: A total of 4,367 early-stage breast cancer patients enrolled in the study, and 14,112 SLNs were successfully harvested. Among those, 917 (21.0%) patients were confirmed to have at least one SLN positive for metastases, and 1343 (9.5%) positive SLNs were removed. Based on the final H&E report, the sensitivity, specificity and overall accuracy of TIC was 71.4%, 99.2% and 93.6%, respectively on a per patient basis, and 69.6%, 99.5% and 96.6%, respectively on a per node basis. The sensitivity for macrometastasis and micrometastasis was 74.8% and 26.5%, respectively on a per patient basis, and 78.9% and 25.2%, respectively on a per node basis. To discuss the influence of error results on the surgery procedure, we further reviewed the detail medical records of the patients enrolled in the recent 3 years. Of all the 3290 patiens treated between Jun-2010 and Apr-2013, 207(6.5%) patients needed a second opereation to have the ALN dissected. Meanwhile, 20(0.6%) patients had undergone extra ALND because of the false positive results of TIC.

Conclusion: The sensitivity of TIC seems a little lower then the ones reported previously, but the overall accuracy still remains acceptable. In addition, only 7.1% patients were influenced by the error results of TIC, along with the advantages, such as the shorter preparation time and the less cost of cytological specimens, we consider TIC a feasible method, and believe it can serve well in the intraoperative evaluation of SLNs for early-stage breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-01-13.

Abstract P4-06-03: Assays on core biopsies and surgically resected tumors may result in different subtyping of the invasive breast cancer from the same patient

Background Core biopsies (CBs) are often used for biomarker expression assays to determine the treatment regimen. However, a number of other clinically important analyses (e.g. OncoType Dx), are performed on surgically resected tumors (SRTs). A previous study has shown that biomarkers ER, PR, and Ki67 expressed higher in CBs than in SRTs. Here we analyze how this difference impacts the subtyping of ER+ breast tumors.

Methods Female patients enrolled in the Clinical Breast Care Project (CBCP) from a civilian site were selected for this study, where expression of ER, PR, HER2, and Ki67 were assayed by IHC in a reference lab on CBs; the same 4 assays were performed on SRTs by a CBCP central lab. Both labs are CLIA-certified. Patients treated with neoadjuvant chemotherapy and those with multiple tumors were excluded. 167 cases were identified for this study to compare assays performed on CBs and SRTs from the same patients. ER and PR were positive if &gt;1% nuclear staining, HER2 was negative if IHC = 0 or 1+, positive if IHC = 3+, and for IHC = 2+ FISH was used for the final call. Ki67 was positive if &gt; = 15% nuclear staining. LA was ER+/HER2-/Ki67-, LB1 was ER+/HER2-/Ki67+, and LB2 was ER+/HER2+. For histologic grades, only readings from the central lab on SRTs were used. Statistical analyses were performed using SAS.

Results This analysis confirmed that Ki67, ER, and PR showed higher percent nuclear staining in CBs than in SRTs from the same patients. The difference for Ki67 was more striking and unidirectional. ER and PR cases clustered at the upper percent levels. Histograms with a bin-width of 15% show a peak at 15% for Ki67 difference between CBs and SRTs, whereas the peaks for ER and PR differences were at 0%. McNemar's (or Exact McNemar’s) test showed significant differences between the binary status calls for Ki67 (p = 3.2E-15) and ER (p = 0.012), but not for PR (p = 0.65). Assays on CBs and SRTs resulted in different subtype calls for the cases (Table 1). Grade distributions were different between LA and LB (p&lt;0.001 for both CB- and SRT-based subtypes, Chi-Square or Fisher's Exact test), but not so between LB1 and LB2 (p = 0.23 for CB, 0.31 for SRT). However, SRT-based LB1 cases concentrate more on higher grades compared to CB-based cases (p = 0.048).

Table 1. ER+ subtypes based on IHC assays (from CBs and SRTs) and corresponding grades (from SRTs) CBSRTSubtypeG1G2G3G1G2G3LA2126034518LB11435342820LB2036032

Discussion On IHC assays, Ki67 expression is strikingly higher in CBs than in SRTs, and ER expression is also higher in CBs than in SRTs. This directly resulted in more LB than LA subtypes based on CBs. SRT-based LB1 cases concentrate more on higher grades compared to CB-based cases, which is more consistent with the observation that LB subtypes have worse outcomes. A limitation of this study is that technical differences between the labs may contribute to the observed differences between CBs and SRTs. Further studies need to be performed to determine whether SRT should also be assayed in addition to CB for treatment regimen decision-making.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense, or US Government.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-06-03.

Abstract P4-04-16: Highly variably expressed exons (HVEE) of cancer genes and survival disparity in human breast cancer

Background: RNA-Seq is a powerful technology for accurately quantifying the transcriptome of human cancers. The human breast cancer section of the TCGA has generated RNA-Seq data for over 950 samples from primary tumors and adjacent normal tissues. Analysis of these data has provided insights into transcript isoforms and gene fusions related to the etiology of breast cancer. These rich data no doubt contain other insights into the expression of cancer genes and how it relates to cancer clinical outcomes.

Methods: TCGA RNA-Seq data were downloaded from TCGA data portal. A total of 712 samples were available when this project started, including data from 607 primary breast tumors of which 108 were Basal-like, 316 Luminal A, 139 Luminal B, and 54 HER2-enriched. Data from 65 adjacent normal tissues were also included to be used as controls. We examined the exon-level expression for a group of 137 strongly cancer related genes that can be grouped into 12 pathways (Vogelstein et al. 2013). We focused on exons that display a significant (p &lt;0.05) difference in their expression variation, compared to the other exons of the same gene (&gt; 2 fold changes in terms of standard deviation based on bootstrap resampling). We refer to these exons as HVEEs (Highly variably expressed exons). Using both unsupervised and supervised algorithms (e.g. non-negative matrix factorization), we classified the samples from various subtypes based on the expression patterns of the HVEEs and looked for patterns that associate with clinical outcomes.

Results: For many cancer genes, such as BRCA2 and PTEN, the distribution of within-gene exon expression is similar across all tumor samples and the control group. Subtype-specific amplification of oncogenes (e.g. ERBB2 in the HER2 subtype) and lower expression of cancer genes (e.g. AR in the basal subtype) have also been observed. We observed that exon expression across genes and across samples has in general small variations. Out of the 2,153 exons from the 137 cancer genes, we identified only 41 genes with HVEEs. Most of these genes have only one HVEE but a small number of them have multiple HVEEs (48 in total). Interestingly, HVEEs in 31 of these genes are consistent across the four breast cancer subtypes, as well as the normal group. However, the medians of such HVEE expression across the normal samples are in general significantly lower than those across the tumor samples in any tumor subtypes. Further, using the exon expression data of only the HVEEs, we identified distinct clusters for the basal-like subtype. The 108 basal-like subtype samples can be classified into two clusters with 41 and 67 samples, respectively, based on the expression level of the HVEEs from the above mentioned 31 genes. Overall survival for patients in these two clusters trends toward significance (log-rank test p = 0.058).

Discussion: The consistency of HVEEs across breast cancer and the normal samples and the ability of the HVEE expression level to stratify basal-like breast cancer in a clinically meaningful way is intriguing. We are extending the study to a larger dataset for validation.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense, or US Government.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-16.

Abstract P2-19-07: Current trends of breast reconstruction after mastectomy for breast cancer patients in China

Background: To ascertain the current trends of breast reconstruction (BR) for breast cancer patients in China, we conducted a retrospective study in Committee of Breast Cancer Society, Chinese Anti-Cancer Association.

Methods: We designed a questionnaire for this study, and it included questions on surgeon demographics, number of mastectomy and BR, type and timing of BR, reconstructive choices in the setting of preoperative or postoperative radiotherapy (RT) or chemotherapy, complication, oncoplastic surgery, fat grafting, physician and patient satisfaction, etc. All data were collected until 2012. Questionnaires were sent to 52 members of Committee of Breast Cancer Society by e-mail. By Jun-2013, 30 questionnaires (response rate 57.7%) had been returned. Among all, 3 were excluded for not performing BR. Finally, 27 respondents were included.

Results: All but one of these 27 hospitals were Class Three Grade A hospitals in China. A total of 402 surgeons worked in the general surgery or oncological surgery department, among them, only 84 (20.9%) were able to perform BR. Surgeons from 10 hospitals would also choose to cooperate with the plastic department to finish the complicated reconstructive procedure. In 2012, 21026 mastectomies were performed; among them, 679 (3.2%) received immediate BR, 102 (0.5%) received delayed BR while 192 (0.9%) received delayed-immediate one. At the same time, 414 (2.0%) had their breast reconstructed by implant while 393 (1.9%) chose the autologous ones, the choices of reconstructive type were not recorded for other 166 (0.8%) cases. According to these 27 respondents, 88.9% predominantly performed prosthetic (1265 cases in all) or latissimus dorsi myocutaneous flap (LDMF) with or without an implant (1571 cases in all) BR from the time of their first BR operation to the end of 2012. During the same period, 327 pedicled transverse rectus abdominis myocutaneous (TRAM) BR were performed in 20 hospitals, while 169 free TRAM BR, which requiring technique of microsurgery, were carried out in 9 hospitals (68.6% were performed by a single surgeon from Nov-2006). The overall complication rate of BR was 12.4%. As RT had low to medium effect on increasing the operational difficulties and influencing the esthetic outcomes of BR, about 75% surgeons would choose delayed autologous BR in patients who had previous RT. Autologous flaps were also recommended for patients who need postoperative RT, but the timing still remained controversial. The overall cosmetic outcomes of the reconstructed breasts satisfied the majority of physicians and patients.

Conclusion: With the growing number of breast cancer patients who need to undergo mastectomy, more and more BR are needed to improve the quality of life for them, but the ratio is still low in China, partially because of the lack of qualified plastic surgeons. As free flap BR requiring microsurgical techniques seems still complicated for most surgeons, implant and LDMF BR are the most common choices for patients nowadays in China. In addition, the effect of radiotherapy will be an important consideration when deciding the type and timing of BR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-19-07.

Abstract P5-13-09: Evaluation on the risk factors and prognosis for patients with synchronous bilateral breast cancer in a Chinese cohort

Background: There has been an increasing rate of synchronous bilateral breast cancers, mainly because of the increased morbidity, improved detection abilities, better prognosis and higher life expectancy of breast cancer patients. However, evidences in the literature regarding the risk factors of bilateral breast cancers are scare, and the survival of synchronous bilateral breast cancers still remain controversies. The purpose of the present study is to investigate the risk factors and prognosis of bilateral breast cancers in a Chinese cohort.

Methods: The present study included 181 patients with synchronous bilateral breast cancer and 10,831 patients with unilateral breast cancer treated in Fudan University Shanghai Cancer Center between Jan 2007 and Dec 2012. Patients with metastases or inflammatory diseases, or metachronous bilateral breast cancer (after 6 months of first cancer) were excluded. Age of the cases, family history, menopausal status, histology types, pathological stages, types of accompanied benign lesions, and patterns of surgeries and adjuvant therapies were examined to investigate the risk factors of bilateral breast cancers.

Results: Patients with synchronous bilateral breast cancer were significantly elder than those with unilateral breast cancer (mean age 53 yrs vs. 51yrs, p&lt;0.001). Presence of sclerosing adenoma and lobular carcinoma component were the two independent risk factors of early-stage synchronous bilateral breast cancer, with the relative risk rate at 5.52 (95% CI: 3.04-10.01) and 5.00 (95% CI: 2.64-9,47), respectively. The rate of in situ carcinoma with or without microinvasion was significantly higher in patients with sclerosing adenoma associated synchronous bilateral breast cancers at 64.3%. With a median follow-up of 35 months, the disease free survival for synchronous bilateral breast cancer was 95.0%, similar to that of unilateral breast cancer. However, for synchronous bilateral breast cancer patients with N3 disease or previously received neoadjuvant therapy (20 cases), the 1.5 year-disease free survival was merely 50%, significantly worse than that of unilateral breast cancer with N3 disease or previous neoadjuvant therapy.

Conclusion: The rate of synchronous bilateral breast cancer was higher in patients with sclerosing adenosis or lobular carcinoma component. The prognosis for early-stage synchronous bilateral breast cancer was similar to those with early-stage unilateral breast cancer. However, among patients with N3 disease or previously received neoadjuvant therapy, synchronous bilateral cohort was associated to worse survival compared with unilateral cohort.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-13-09.

Abstract P4-07-05: Cyclin D1 induction of dicer governs microRNA processing and expression in breast cancer

MicroRNAs (miRNAs), a class of non-coding small RNA, regulate gene expression through base-pairing binding to the complementary sequence in the 3’ untranslated region (3’ UTR) of mRNA. miRNAs contribute to the timing of development, apoptosis, cell cycle progression, cellular proliferation, stem cell self-renewal, cancer initiation and metastasis. The expression of miRNA is regulated during cell-cycle transition and cellular contact in part via active degradation. Aberrant expression of miRNAs or mutations of miRNA genes have been described in many types of tumors, including mammary tumors. The RNase III endoribonuclease Dicer cleaves long double-stranded RNA (dsRNA) or stem-loop-stem structured pre-miRNA to form mature miRNAs. RNAi-mediated knock-down of Dicer in human cells led to defects in both miRNA production and shRNA-mediated RNAi.

Initially cloned as a breakpoint rearrangement in parathyroid adenoma, the cyclin D1 gene encodes the regulatory subunit of the holoenzyme that phosphorylates and inactivates both the pRb tumor suppressor and the key inducer of mitochondrial biogenesis NRF-1. In addition, a DNA bound form of cyclin D1 regulates gene expression. Cyclin D1 expression is induced during mammary gland and retinal differentiation, and deletion of the murine cyclin D1 gene resulted in failed terminal alveolar breast bud development and retinal degeneration. Diverse biological functions regulated by cyclin D1 include the induction of cellular proliferation, angiogenesis, cellular migration, DNA damage repair, mitochondrial biogenesis, stem cell maintenance, and miRNA expression. Cyclin D1 was shown to regulate the miR-17/20 locus and found to bind the miR-17/20 regulatory region.

In order to determine further the mechanism by which cyclin D1 regulates non-coding RNA, we conducted studies of miRNA processing. We established cyclin D1-/- mouse embryonic fibroblasts cells (MEFs) and cyclin D1 knockdown (KD) MCF-7 human breast cancer cells. miRNA analysis indicated an induction of mature miRNA expression in cyclin D1 overexpressing cells. Analysis of the miRNA processing regulators demonstrated the selective induction of Dicer expression by cyclin D1. In cyclin D1-/- cells the reduction of Dicer abundance was accompanied by impairment of pre-miRNA to mature miRNA processing, which was restored with cyclin D1 rescue. Transient transgenic expression of cyclin D1 in the mouse mammary gland, or sustained transgenic expression of cyclin D1 induced mouse mammary gland tumors, recapitulated the induction of Dicer expression. Cyclin D1 and Dicer expression were correlated in luminal A and basal-like human breast cancer. Cyclin D1 regulation of cellular proliferation and migration was dependent upon Dicer. By demonstrating cyclin D1 induced Dicer abundance and function in tissue culture and in vivo, we provide evidence for novel crosstalk between the cell-cycle and non-coding miRNA biogenesis.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-05.

Abstract P4-07-13: High microRNA-621 level predicts a better response to neoadjuvant chemotherapy in breast cancer patients

Purpose: Weekly paclitaxel plus carboplatin (PCb) regimen is an effective neoadjuvant chemotherapy for breast cancer. However, some patients respond to this regimen poorly and suffer from side effects. In this study, we aimed to define the microRNA (miRNA) biomarker for predicting sensitivity to PCb chemotherapy in breast cancer patients, and to explore the potential molecular mechanisms.

Experimental Design: 81 patients with stages II and III breast cancer, who received four cycles of weekly PCb regimen preoperative chemotherapy, were included. Gene expression profiles from 31 patients was used as training set to determine differentially expressed genes (DEGs) and to predict miRNAs that may be associated with chemotherapeutic sensitivity. The other 50 patients were analyzed as validation set to test the accuracy of DEG identification and miRNAs prediction by quantitative real-time PCR. In parallel, in vitro and in vivo analyses were carried out to determine the potential mechanisms of miRNA-dependent drug sensitivity.

Results: Gene profiling analyses in the training set revealed significant correlation between high expression level of miR-345 and miR-621 and pathologic complete response (pCR) in breast cancer patients. We further validated that the expression level of miR-621 was significantly higher in tumor tissues of pCR patients than that in non-pCR patients (P = 0.01). In breast cancer cell lines, ectopic overexpression of miR-621 promoted apoptosis and increased chemosensitivity to paclitaxel and carboplatin both in vitro and in vivo. The potential miR-621-target genes were determined by TargetScan and miRNA CLIP-seq database, which were further confirmed as DEGs reversely-correlated to miR-621 in breast cancer patient samples. Among those, FBXO11 was verified as one of the direct targets of miR-621 in breast cancer cells, whose expression level negatively associated with chemosensitivity in breast cancer patients. The molecular mechanisms by which miR-621/FBXO11 axis regulates chemosensitivity may involve regulation of p53 transcriptional activity and epithelial-mesenchymal transition (EMT) in breast cancer cells.

Conclusions: Our study revealed a strong correlation between miR-621 expression and chemosensitivity in breast cancers. High level of miR-621 predicts sensitivity to PCb regimen neoadjuvant chemotherapy in breast cancer patients who tend to achieve pCR. The increased chemosensitivity may be mediated by down-regulation of FBXO11 gene, which leads to enhanced p53 transactivity and reduced EMT in breast cancer cells. Therefore, miR-621 may be used as predictive biomarker and the potential therapeutic target in breast cancer treatment.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-07-13.

Abstract P4-06-09: HER2+ and HER2- luminal B subtypes have similar overall survival and histologic grade distributions

Background There are multiple subtypes in invasive breast cancers (IBCs). Immunohistochemistry (IHC)-based assays using ER, PR, HER2, and Ki67 for subtyping has been developed. However, association between such subtypes and treatment outcomes and histology is not completely known, and are impacted by dataset-to-dataset and pathologist-to-pathologist variations. We report an analysis on these problems, as a pilot study of a project involving 5,000 patients and 250 protein biomarkers.

Methods Patients were enrolled for the Clinical Breast Care Project from a military site with data collected per IRB-approved protocols, from 2000 to 2010. Total of 215 female IBC cases were included in this study, with surgically resected tumors (SRT) assayed for ER, PR, HER2, and Ki67 by IHC in a central CLIA-certified lab following clinical guidelines where applicable. All slides were reviewed by a single experienced breast pathologist. ER and PR was positive if nuclear staining was &gt;5%. HER2 was negative if IHC = 0 or 1+ and positive if IHC = 3+; For IHC = 2+, the FISH result determined the final call. Ki67 was positive if nuclear staining was &gt; = 15%. For IBC subtypes, LA was ER+/HER2-/Ki67-; Two LB subtypes were defined, with LB1 being ER+/HER2-/Ki67+ and LB2 being ER+/HER2+; Her2+ was ER-/PR-/HER2+; TN was ER-/PR-/HER2-. Statistical analyses were performed using SAS, Kaplan-Meier estimate and log-rank test were used for survival analysis and the follow-up period was 10 years with a median of 4.6 years. Chi-Square test was used for categorical data analysis supplemented by Fisher's Exact test as appropriate.

Results 204 of the 215 cases were classified into subtypes of LA (n = 74, 7 deceased), LB1 (n = 53, 4 deceased), LB2 (n = 14, 1 deceased), Her2+ (n = 14, 1 deceased), and TN (n = 49, 16 deceased). Despite the low number of events in some subtypes, there was a significant difference in overall survival between the 5 subtypes of IBCs defined here (p = 0.0023), with TN cases showing the least favorable outcome. No difference was observed in outcome between LB1 and LB2 (p = 0.86). Overall, Ki67+ cases trended toward worse outcomes (p = 0.08), which was also observed in TN (p = 0.17) but not other subtypes. Histologic grades were significantly different among the 5 subtypes (p = 6.25E-20); 96% of LA cases were G1 or G2, over 80% of LB1 and LB2 cases were G2 or G3, and all Her2+ and 93% of TN cases were G2 or G3. Within the luminal subtypes, grade distribution for LA cases was significantly different from that for LB cases (p&lt;0.0001) but there was no difference between LB1 and LB2 cases (p = 0.95).

Discussion In this cohort where all IHC and pathology slides were reviewed by a single pathologist, we used cell proliferation marker Ki67 to help classify luminal IBCs into LA, LB1 (HER2-), and LB2 (HER2+). Overall survival analysis result for all cases was consistent with the literature, Ki67+ cases trended toward worse outcomes, and no outcome difference was identified between LB1 and LB2. Histologic grade distributions in different subtypes were consistent with the literature; we further found no difference between LB1 and LB2 subtypes.

The views expressed in this abstract are those of the authors and do not reflect the official policy of the Department of Defense, or US Government.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-06-09.

Comparison of line-scanned and point-scanned dual-axis confocal microscope performance

The point-scanned dual-axis confocal (PS-DAC) microscope has been shown to exhibit superior capability to reject out-of-focus and multiply scattered light in comparison to its conventional single-axis counterpart. However, the slow frame rate (typically <5 Hz) resulting from point-by-point data collection makes these systems vulnerable to motion artifacts. While video-rate point-scanned confocal microscopy is possible, a line-scanned dual-axis confocal (LS-DAC) microscope provides a simpler means of achieving high-speed imaging through line-by-line data collection, but sacrifices contrast due to loss of confocality along one dimension. Here we evaluate the performance trade-offs between an LS-DAC and PS-DAC microscope with identical spatial resolutions. Characterization experiments of the LS-DAC and PS-DAC microscopes with tissue phantoms, in reflectance mode, are shown to match results from Monte Carlo scattering simulations of the systems. Fluorescence images of mouse brain vasculature, obtained using resolution-matched LS-DAC and PS-DAC microscopes, demonstrate the comparable performance of LS-DAC and PS-DAC microscopy at shallow depths.

Abstract S4-04: Overcoming resistance to PI3K inhibitors in PIK3CA mutant breast cancer using CDK4/6 inhibition: Results from a combinatorial drug screen

Various components of the phosphatidylinositol 3-kinase (PI3K) pathway are deregulated across a spectrum of human cancers. Notably, cancers with PIK3CA mutations, seen in roughly 30% of breast cancers, are amongst the most sensitive to PI3K inhibitors (PI3Ki) as single agents. Therefore, there have been great efforts to develop PI3K inhibitors specifically for these types of cancers, and many agents have already entered the clinic.

Although initial responses and prolonged stable disease have been observed, resistance frequently emerges. Moreover, there is a subset of PIK3CA mutated cancers that unexpectedly do not exhibit an initial response or disease stabilization upon exposure to PI3K inhibitors, despite presence of the mutation. These cancers are said to have de novo resistance to PI3K inhibition. To determine methods of overcoming resistance to PI3K inhibitors, we generated two models with acquired resistance to the p110a isoform specific inhibitor BYL-719 (BYL) using MDA-MB-453 (453) and T47D. We also established one model of resistance to the pan-PI3K inhibitor GDC-0941 using MCF7 cells. These lines were chosen because of their PIK3CA mutated status and sensitivity to PI3K inhibition. Each cell line was grown in increasing concentrations of PI3K inhibitor until the cells proliferated readily at a dose of drug that effectively reduced cell viability and inhibited pAKT in the sensitive parental cell lines. Interestingly, both BYL resistant cells (453R and T47DR) were cross resistant GDC and the MCF7R line was refractory to BYL.

To elucidate mechanisms to overcome resistance to PI3K inhibitors, we undertook a combinatorial drug screen, in which PI3K inhibitor resistant cells were treated with escalating doses of a panel of 45 targeted agents, both in the presence and absence of a fixed dose of PI3Ki, to determine which agents synergized effectively with PI3K inhibition in these resistant cells. We observed in each of the three PI3Ki resistant models a synergy between the CDK4/6 inhibitor LEE-011 and PI3K inhibition. We furthermore tested this combination of agents in a PIK3CA mutated breast cancer model with de novo resistance to PI3K inhibitors, CAL51, and again noted efficacy with the combination of GDC and LEE-011 while either agent on its own displayed minimal activity.

To determine whether addition of CDK 4/6 inhibition might be an effective addition to PI3Ki in the upfront setting in vivo, we injected each of the PIK3CA mutated lines MCF7, 453, and T47D into female nude mice and treated with vehicle, BYL, LEE-011, or the combination. We noted in each of the three models that the combination of agents, led to tumor regression that was more substantial than single agent treatment, and furthermore delayed the acquisition of resistance relative to single agent therapy. We furthermore tested GDC with LEE-011 singly and in combination in both MCF7 and CAL51 xenografts and again noted that the combination of agents led to tumor regression, whereas in these instances, single agent treatment did not.

We conclude that the combination of PI3K and CDK 4/6 inhibition may be an effective strategy for treating PIK3CA mutated breast cancer and deserves further study in the clinical setting.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S4-04.

Jet and underlying event properties as a function of charged-particle multiplicity in proton-proton collisions at [Formula: see text]

Characteristics of multi-particle production in proton-proton collisions at [Formula: see text] are studied as a function of the charged-particle multiplicity, Nch. The produced particles are separated into two classes: those belonging to jets and those belonging to the underlying event. Charged particles are measured with pseudorapidity |η|<2.4 and transverse momentum pT>0.25 GeV/c. Jets are reconstructed from charged-particles only and required to have pT>5 GeV/c. The distributions of jet pT, average pT of charged particles belonging to the underlying event or to jets, jet rates, and jet shapes are presented as functions of Nch and compared to the predictions of the pythia and herwig event generators. Predictions without multi-parton interactions fail completely to describe the Nch-dependence observed in the data. For increasing Nch, pythia systematically predicts higher jet rates and harder pT spectra than seen in the data, whereas herwig shows the opposite trends. At the highest multiplicity, the data-model agreement is worse for most observables, indicating the need for further tuning and/or new model ingredients.

Denis RD, Stahlman J, Stamen R, Stanecka E, Stanek RW, Stanescu C, Stanescu-Bellu M, Stanitzki MM, Stapnes S, Starchenko EA, Stark J, Staroba P, Starovoitov P, Staszewski R, Staude A, Stavina P, Steele G, Steinbach P, Steinberg P, Stekl I, Stelzer B, Stelzer HJ, Stelzer-Chilton O, Stenzel H, Stern S, Stewart GA, Stillings JA, Stockton MC, Stoebe M, Stoerig K, Stoicea G, Stonjek S, Stradling AR, Straessner A, Strandberg J, Strandberg S, Strandlie A, Strang M, Strauss E, Strauss M, Strizenec P, Ströhmer R, Strom DM, Strong JA, Stroynowski R, Stugu B, Stumer I, Stupak J, Sturm P, Styles NA, Su D, Subramania HS, Subramaniam R, Succurro A, Sugaya Y, Suhr C, Suk M, Sulin VV, Sultansoy S, Sumida T, Sun X, Sundermann JE, Suruliz K, Susinno G, Sutton MR, Suzuki Y, Suzuki Y, Svatos M, Swedish S, Swiatlowski M, Sykora I, Sykora T, Ta D, Tackmann K, Taffard A, Tafirout R, Taiblum N, Takahashi Y, Takai H, Takashima R, Takeda H, Takeshita T, Takubo Y, Talby M, Talyshev AA, Tam JYC, Tamsett MC, Tan KG, Tanaka J, Tanaka R, Tanaka S, Tanaka S, Tanasijczuk AJ, Tani K, Tannoury N, Tapprogge S, Tarem S, Tarrade F, Tartarelli GF, Tas P, Tasevsky M, Tashiro T, Tassi E, Tayalati Y, Taylor C, Taylor FE, Taylor GN, Taylor W, Teinturier M, Teischinger FA, Teixeira Dias Castanheira M, Teixeira-Dias P, Temming KK, Ten Kate H, Teng PK, Terada S, Terashi K, Terron J, Testa M, Teuscher RJ, Therhaag J, Theveneaux-Pelzer T, Thoma S, Thomas JP, Thompson EN, Thompson PD, Thompson PD, Thompson AS, Thomsen LA, Thomson E, Thomson M, Thong WM, Thun RP, Tian F, Tibbetts MJ, Tic T, Tikhomirov VO, Tikhonov YA, Timoshenko S, Tiouchichine E, Tipton P, Tisserant S, Todorov T, Todorova-Nova S, Toggerson B, Tojo J, Tokár S, Tokushuku K, Tollefson K, Tomlinson L, Tomoto M, Tompkins L, Toms K, Tonoyan A, Topfel C, Topilin ND, Torrence E, Torres H, Torró Pastor E, Toth J, Touchard F, Tovey DR, Tran HL, Trefzger T, Tremblet L, Tricoli A, Trigger IM, Trincaz-Duvoid S, Tripiana MF, Triplett N, Trischuk W, Trocmé B, Troncon C, Trottier-McDonald M, Trovatelli M, True P, Trzebinski M, Trzupek A, Tsarouchas C, Tseng JCL, Tsiakiris M, Tsiareshka PV, Tsionou D, Tsipolitis G, Tsiskaridze S, Tsiskaridze V, Tskhadadze EG, Tsukerman II, Tsulaia V, Tsung JW, Tsuno S, Tsybychev D, Tua A, Tudorache A, Tudorache V, Tuggle JM, Tuna AN, Turala M, Turecek D, Turk Cakir I, Turra R, Tuts PM, Tykhonov A, Tylmad M, Tyndel M, Uchida K, Ueda I, Ueno R, Ughetto M, Ugland M, Uhlenbrock M, Ukegawa F, Unal G, Undrus A, Unel G, Ungaro FC, Unno Y, Urbaniec D, Urquijo P, Usai G, Vacavant L, Vacek V, Vachon B, Vahsen S, Valencic N, Valentinetti S, Valero A, Valery L, Valkar S, Valladolid Gallego E, Vallecorsa S, Valls Ferrer JA, Van Berg R, Van Der Deijl PC, van der Geer R, van der Graaf H, Van Der Leeuw R, van der Ster D, van Eldik N, van Gemmeren P, Van Nieuwkoop J, van Vulpen I, Vanadia M, Vandelli W, Vaniachine A, Vankov P, Vannucci F, Vari R, Varnes EW, Varol T, Varouchas D, Vartapetian A, Varvell KE, Vassilakopoulos VI, Vazeille F, Vazquez Schroeder T, Veloso F, Veneziano S, Ventura A, Ventura D, Venturi M, Venturi N, Vercesi V, Verducci M, Verkerke W, Vermeulen JC, Vest A, Vetterli MC, Vichou I, Vickey T, Vickey Boeriu OE, Viehhauser GHA, Viel S, Villa M, Villaplana Perez M, Vilucchi E, Vincter MG, Vinogradov VB, Virzi J, Vitells O, Viti M, Vivarelli I, Vives Vaque F, Vlachos S, Vladoiu D, Vlasak M, Vogel A, Vokac P, Volpi G, Volpi M, Volpini G, von der Schmitt H, von Radziewski H, von Toerne E, Vorobel V, Vos M, Voss R, Vossebeld JH, Vranjes N, Vranjes Milosavljevic M, Vrba V, Vreeswijk M, Vu Anh T, Vuillermet R, Vukotic I, Vykydal Z, Wagner W, Wagner P, Wahrmund S, Wakabayashi J, Walch S, Walder J, Walker R, Walkowiak W, Wall R, Waller P, Walsh B, Wang C, Wang H, Wang H, Wang J, Wang J, Wang K, Wang R, Wang SM, Wang T, Wang X, Warburton A, Ward CP, Wardrope DR, Warsinsky M, Washbrook A, Wasicki C, Watanabe I, Watkins PM, Watson AT, Watson IJ, Watson MF, Watts G, Watts S, Waugh AT, Waugh BM, Weber MS, Webster JS, Weidberg AR, Weigell P, Weingarten J, Weiser C, Wells PS, Wenaus T, Wendland D, Weng Z, Wengler T, Wenig S, Wermes N, Werner M, Werner P, Werth M, Wessels M, Wetter J, Whalen K, White A, White MJ, White R, White S, Whitehead SR, Whiteson D, Whittington D, Wicke D, Wickens FJ, Wiedenmann W, Wielers M, Wienemann P, Wiglesworth C, Wiik-Fuchs LAM, Wijeratne PA, Wildauer A, Wildt MA, Wilhelm I, Wilkens HG, Will JZ, Williams E, Williams HH, Williams S, Willis W, Willocq S, Wilson JA, Wilson A, Wingerter-Seez I, Winkelmann S, Winklmeier F, Wittgen M, Wittig T, Wittkowski J, Wollstadt SJ, Wolter MW, Wolters H, Wong WC, Wooden G, Wosiek BK, Wotschack J, Woudstra MJ, Wozniak KW, Wraight K, Wright M, Wrona B, Wu SL, Wu X, Wu Y, Wulf E, Wynne BM, Xella S, Xiao M, Xie S, Xu C, Xu D, Xu L, Yabsley B, Yacoob S, Yamada M, Yamaguchi H, Yamaguchi Y, Yamamoto A, Yamamoto K, Yamamoto S, Yamamura T, Yamanaka T, Yamauchi K, Yamazaki T, Yamazaki Y, Yan Z, Yang H, Yang H, Yang UK, Yang Y, Yang Z, Yanush S, Yao L, Yasu Y, Yatsenko E, Yau Wong KH, Ye J, Ye S, Yen AL, Yildirim E, Yilmaz M, Yoosoofmiya R, Yorita K, Yoshida R, Yoshihara K, Young C, Young CJS, Youssef S, Yu D, Yu DR, Yu J, Yu J, Yuan L, Yurkewicz A, Zabinski B, Zaidan R, Zaitsev AM, Zambito S, Zanello L, Zanzi D, Zaytsev A, Zeitnitz C, Zeman M, Zemla A, Zenin O, Ženiš T, Zerwas D, Zevi della Porta G, Zhang D, Zhang H, Zhang J, Zhang L, Zhang X, Zhang Z, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou N, Zhou Y, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zibell A, Zieminska D, Zimin NI, Zimmermann C, Zimmermann R, Zimmermann S, Zimmermann S, Zinonos Z, Ziolkowski M, Zitoun R, Živković L, Zmouchko VV, Zobernig G, Zoccoli A, zur Nedden M, Zutshi V, Zwalinski L. Measurement of jet shapes in top-quark pair events at [Formula: see text] using the ATLAS detector

A measurement of jet shapes in top-quark pair events using 1.8 fb-1 of [Formula: see text]pp collision data recorded by the ATLAS detector at the LHC is presented. Samples of top-quark pair events are selected in both the single-lepton and dilepton final states. The differential and integrated shapes of the jets initiated by bottom-quarks from the top-quark decays are compared with those of the jets originated by light-quarks from the hadronic W-boson decays [Formula: see text] in the single-lepton channel. The light-quark jets are found to have a narrower distribution of the momentum flow inside the jet area than b-quark jets.

Quantitative detection of the rice false smut pathogen Ustilaginoidea virens by real-time PCR

Rice false smut (RFS) is an important rice disease that is caused by the pathogen Ustilaginoidea virens. In this study, we developed a real-time polymerase chain reaction (PCR) assay to detect U. virens and to estimate the level of disease. The genomic DNAs of U. virens and rice were extracted together from the rice samples. Real-time PCR assays were performed and compared to conventional nested-PCR assays. The real-time PCR assay presented a consistent linearity of the standard curve (R(2) = 0.9999). The detection limit could be as low as 40 fg U. virens DNA with a rice genomic DNA background on using the real-time PCR assay, which showed significantly higher sensitivity than the conventional nested-PCR assay. We conclude that the real-time PCR quantitative assay is a useful tool for detecting U. virens and for early defense and control of RFS.

Measurement of top quark polarization in top-antitop events from proton-proton collisions at √s=7 TeV using the ATLAS detector

This Letter presents measurements of the polarization of the top quark in top-antitop quark pair events, using 4.7  fb(-1) of proton-proton collision data recorded with the ATLAS detector at the Large Hadron Collider at √s=7  TeV. Final states containing one or two isolated leptons (electrons or muons) and jets are considered. Two measurements of α(ℓ)P, the product of the leptonic spin-analyzing power and the top quark polarization, are performed assuming that the polarization is introduced by either a CP conserving or a maximally CP violating production process. The measurements obtained, α(ℓ)P(CPC)=-0.035±0.014(stat)±0.037(syst) and α(ℓ)P(CPV)=0.020±0.016(stat)(-0.017)(+0.013)(syst), are in good agreement with the standard model prediction of negligible top quark polarization.

Measurement of the 13C/12C of atmospheric CH4 using near-infrared (NIR) cavity ring-down spectroscopy

A near-infrared (NIR) continuous-wave-cavity ring-down spectrometry (CW-CRDS) device was developed with the goal of measuring seasonal changes in the isotopic composition of atmospheric CH4 on Earth and eventually on Mars. The system consisted of three distributed feedback laser diodes (DFB-LDs), two of which were tuned to the absorption line peaks of (12)CH4 and (13)CH4 at 6046.954 cm(-1) and 6049.121 cm(-1), respectively, and a third that measured the baseline at 6050.766 cm(-1). The multiple laser design improved the long-term stability of the system and increased the data acquisition rate. The acquisition frequency was further increased by utilizing a semiconductor optical amplifier (SOA) to initiate cavity ring-down events. The high repetition rate combined with the superhigh reflectivity mirrors yielded precise isotopic measurements in this NIR region, even though the line strengths of CH4 in this region are 200 times weaker than those of the strongest mid-IR absorption bands. The current system has a detection limit of 1.9 × 10(-12) cm(-1), corresponding to 10 pptv of CH4 at 100 Torr. For ambient air samples that contained 1.9 ppmv CH4, the δ(13)C of the CH4 was determined to be -48.7 ± 1.7‰ (1σ).

Glomerular mannose-binding lectin deposition is a useful prognostic predictor in immunoglobulin A nephropathy

There is accumulating evidence to support a hypothesis of the activation of the lectin complement pathway in immunoglobulin A nephropathy (IgAN). The glomerular deposition of mannose-binding lectin (MBL), an initiator of the lectin pathway, has been identified, but its clinical significance has not been defined consistently. The aim of the present study was to investigate the value of glomerular MBL deposition as a useful histological biomarker in evaluating the severity and predicting the prognosis of IgAN. We included all consecutive patients with biopsy-proven primary IgAN from December 2008 to July 2010. Renal deposition of MBL was detected by immunofluorescence. The biopsy material from 131 patients (72 men) was thus used for MBL staining. The deposition of MBL was observed in a predominantly mesangial pattern in 45 patients (34·35%), which presented as global or segmental deposition. Compared with the patients without glomerular MBL deposition, those with glomerular MBL deposition had more severe proteinuria, decreased renal function, lower levels of serum albumin and a greater possibility of hypertension at the time of renal biopsy; they had more severe histological changes according to the Oxford classification (i.e. mesangial hypercellularity, segmental glomerulosclerosis, endocapillary hypercellularity and tubular atrophy/interstitial fibrosis), and their ratio presented an increase as the histopathological phenotypes segregated according to Lee's classification; furthermore, the follow-up data demonstrated that they had a lower renal remission rate. In conclusion, glomerular MBL deposition may predict a poor prognosis, and thus can be a new prognostic factor in IgA nephropathy.