P3-14-26: The Effect of Biologic Subtype in Patients Treated with Neoadjuvant Chemotherapy: A UAB Experience

Purpose: Previous studies have suggested that the pre treatment clinical stage drives loco-regional recurrence (LRR), distant metastasis (DM) and survival in patients treated with neoadjuvant chemotherapy. This retrospective analysis was performed to look at the effect of biologic subtype on patient outcomes.

Methods: Between 1999 and 2005, 115 patients treated with neoadjuvant chemotherapy, surgery, and +/−radiation therapy at UAB were identified. Patient, tumor, and treatment characteristics were recorded. Pathologic complete response was defined as resolution of both invasive disease and DCIS in both the primary and nodal disease. Survival was measured using the Kaplan Meier statistics. Univariate and multivariate analyses of covariates associated with LRR, DM, progression-free (PFS) and overall survival (OS) were performed. Results: The mean age was 49 years, with a mean follow-up of 5.8 years. Subtype distribution was as follows: 52 luminal A, 17 luminal B, 36 triple negative, 9 Her2+ and one patient with an unknown biologic subtype. Distribution of clinical stage was as follows: 40 IIA, 34 IIB, 26 IIIA, 10 IIIB, and 5 IIIC. Tumors were down-staged following neoadjuvant therapy as follows: 18: pCR, 6: residual DCIS, 17: I, 38: IIA, 11: IIB, 13: IIIA, 5: IIIB, and 7: IIIC. Pre-treatment clinical stage did not significantly influence LRR, DM or progression free and overall survival; however, final pathologic T, N and group stage were associated with both progression free, p=0.003, 0.011, 0.005 and overall survival, p=0.02, 0.037, and 0.009. Complete resolution of tumor by mammographic or MR imaging to neoadjuvant chemotherapy, was associated with an increased overall survival, p=0.0025. Univariate analysis did not show a significant effect of biologic subtype, age, grade, use of radiation therapy or anti-hormonal therapy.

Discussion: In this retrospective series, response to chemotherapy and the final pathologic stage, representing the volume of residual disease, were important predictors of survival. Further study to determine factors predictive of chemotherapy response is needed.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-14-26.

P3-07-06: Prognostic Utility of Upfront Nodal Staging Prior to Neoadjuvant Chemotherapy: The UAB Experience

Purpose: Controversy exists regarding the prognostic utility of upfront lymph node staging in patients receiving neoadjuvant chemotherapy. This retrospective study explores whether upfront verses outback nodal staging influenced locoregional control and survival endpoints. Methods: Between 1999 and 2005 one hundred and fifteen patients treated with neoadjuvant chemotherapy at UAB were identified. Patient, tumor, and treatment variables were recorded. Timing of nodal assessment was based on either surgeon preference or stipulated upfront per several clinical protocols. Survival was measured using the Kaplan Meier statistics. Univariate and multivariate analyses of covariates associated with local-regional control (LRC), progressionfree (PFS) and overall survival (OS) were performed. Results: Mean age was 49 years and mean follow-up was 5.8 years. Stage distribution was as follows: 40 IIA, 34 IIB, 26 IIIA, 10 IIIB, and 5 IIIC. Definitive surgery included breast conservation in 49 patients, total mastectomy in 21 and modified radical mastectomy in 44. Seventy-two patients had upfront nodal sampling before neoadjuvant therapy, 36 by fine needle assessment and the remainder by sentinel node biopsy. Forty-three patients had their nodal assessment following neoadjuvant chemotherapy. Of those with upfront nodal staging: forty nine patients had a positive nodal result and 23 had negative findings. In those that were sampled at the time of definitive surgery: 21 had positive results, 21 had a negative result, and 1 patient did not have any nodes in the specimen. One hundred five patients had post-operative radiation therapy. Overall there was no difference in LRC, PFS or OS outcomes between patients that had an upfront nodal staging procedure and those that had their nodes sampled at the time of definitive surgery. Patients achieving pCR had a non-significant trend towards improved overall survival (p=0.12). Final pathologic T, N and group stage were statistically significant in determining the progression free, p=0.003, 0.011, 0.005 and overall survival, p=0.02, 0.037, and 0.009. Lymphovascular space invasion was associated with progression free survival on univariate analysis, p=0.0179, but not multivariate analysis. Other covariates including age, biologic subtype, grade, type of chemotherapy, use of radiation therapy, radiation volume, time to complete radiation therapy, and use of hormonal therapy did not affect outcomes. Discussion: Upfront as compared with outback lymph node staging did not influence locoregional control or survival endpoints. Final pathologic stage and not initial clinical stage remains the most important prognostic factor associated with survival.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-06.

Water's potential role: Insights from studies of the p53 core domain

Soluble proteins with amyloidogenic propensity such as the tumor suppressor protein p53 have high proportion of incompletely desolvated backbone H bonds (HB). Such bonds are vulnerable to water attack, thus potentially leading to the misfolding of these proteins. However, it is still not clear how the surrounding solvent influences the protein native states. To address this, systematic surveys by molecular dynamics simulations and entropy analysis were performed on the p53 core domain in this work. We examined seven wild/mutant X-ray structures and observed two types of water-network hydration in three "hot hydration centers" (DNA- or small molecule- binding surfaces of the p53 core domain). The "tight" water, resulting from the local collective hydrogen-bond interactions, is probably fundamental to the protein structural stability. The second type of water is highly "dynamical" and exchanges very fast within the bulk solution, which is unambiguously assisted by the local protein motions. An entropy mapping of the solvent around the protein and a temperature perturbation analysis further present the main features of the p53 hydration network. The particular environment created by different water molecules around the p53 core domain also partly explains the structural vulnerabilities of this protein.

Trends in sex hormone concentrations in US males: 1988-1991 to 1999-2004

Previous studies suggest that male testosterone concentrations have declined over time. To explore this in a large US population, we examined testosterone and free testosterone concentrations in National Health and Nutrition Examination Surveys (NHANES) from 1988-1991 and 1999-2004. We also examined sex hormone-binding globulin (SHBG), estradiol, and androstanediol glucuronide (3α-diol-G) over the same period. Non-Hispanic white, non-Hispanic black, and Mexican-American men from 1988-1991 and 1999-2004 NHANES surveys who were ≥20 years old and had serum from morning blood draws were included in this analysis (1988-1991: N = 1,413; 1999-2004: N = 902). Testosterone, estradiol and SHBG were measured by competitive electrochemiluminescence immunoassays and 3α-diol-G was measured by enzyme immunoassay. Free testosterone was calculated using testosterone and SHBG values. Adjusted mean hormone concentrations were estimated using linear regression, accounting for NHANES sampling weights and design, age, race/ethnicity, body mass index, waist circumference, alcohol use and smoking. Differences in adjusted mean concentrations (Δ) and two-sided p-values were calculated; p < 0.05 was statistically significant. Overall, 3α-diol-G and estradiol declined between 1988-1991 and 1999-2004, but there was little change in testosterone, free testosterone, or SHBG (Δ: 3α-diol-G = -1.83 ng/mL, p < 0.01; estradiol = -6.07 pg/mL, p < 0.01; testosterone = -0.03 ng/mL, p = 0.75; free testosterone = -0.001 ng/mL, p = 0.67; SHBG = -1.17 nmol/L, p = 0.19). Stratification by age and race revealed that SHBG and 3α-diol-G declined among whites 20-44 years old (Δ: SHBG = -5.14 nmol/L, p < 0.01; 3α-diol-G = -2.89 ng/mL, p < 0.01) and free testosterone increased among blacks 20-44 years old (Δ: 0.014 ng/mL, p = 0.03). Estradiol declined among all ages of whites and Mexican-Americans. In conclusion, there was no evidence for testosterone decline between 1988-1991 and 1999-2004 in the US general population. Subgroup analyses suggest that SHBG and 3α-diol-G declined in young white men, estradiol declined in white and Mexican-American men, and free testosterone increased in young black men. These changes may be related to the increasing prevalence of reproductive disorders in young men.

Unveiling and driving hidden resonances with high-fluence, high-intensity x-ray pulses

We show that high fluence, high-intensity x-ray pulses from the world's first hard x-ray free-electron laser produce nonlinear phenomena that differ dramatically from the linear x-ray-matter interaction processes that are encountered at synchrotron x-ray sources. We use intense x-ray pulses of sub-10-fs duration to first reveal and subsequently drive the 1s↔2p resonance in singly ionized neon. This photon-driven cycling of an inner-shell electron modifies the Auger decay process, as evidenced by line shape modification. Our work demonstrates the propensity of high-fluence, femtosecond x-ray pulses to alter the target within a single pulse, i.e., to unveil hidden resonances, by cracking open inner shells energetically inaccessible via single-photon absorption, and to consequently trigger damaging electron cascades at unexpectedly low photon energies.

Switching of ± 360° domain wall states in a nanoring by an azimuthal Oersted field

We demonstrate magnetic switching between two 360° domain wall vortex states in cobalt nanorings, which are candidate magnetic states for robust and low power magnetoresistive random access memory (MRAM) devices. These 360° domain wall (DW) or 'twisted onion' states can have clockwise or counterclockwise circulation, the two states for data storage. Reliable switching between the states is necessary for any realistic device. We accomplish this switching by applying a circular Oersted field created by passing current through a metal atomic force microscope tip placed at the center of the ring. After initializing in an onion state, we rotate the DWs to one side of the ring by passing a current through the center, and can switch between the two twisted states by reversing the current, causing the DWs to split and meet again on the opposite side of the ring. A larger current will annihilate the DWs and create a perfect vortex state in the rings.

Synthesis, characterization and biocompatibility of poly(2-ethyl-2-oxazoline)-poly(D,L-lactide)-poly(2-ethyl-2-oxazoline) hydrogels

A novel thermoreversible hydrogel based on poly(2-ethyl-2-oxazoline)-derived amphiphilic triblock copolymer, poly(2-ethyl-2-oxazoline)-poly(D,L-lactide)-poly(2-ethyl-2-oxazoline) (PEOz-PLA-PEOz), was developed. The synthesis of PEOz-PLA-PEOz was carried out by coupling monohydroxylated PEOz-PLA diblocks with adipoyl chloride as coupling agent and dimethylamino pyridine as catalyst. The tube inverting and rheological tests showed that triblock copolymers had sol-gel-sol transition behavior with increasing temperature, and the gelation was found to be thermoreversible. The critical gelation concentration, the sol-gel transition temperature at a given concentration depended on the EOz/LA ratio and the molecular weight of PEOz. Scanning electron microscopy observation revealed that the resultant bulky gel exhibited an interconnected porous three-dimensional (3D) microstructure after freeze-drying. In addition, the hydrogels showed good cytocompatibility in vitro. MTT assays revealed that the human skin fibroblast cells encapsulated within the hydrogels were viable and proliferated inside the 3D scaffold. This newly described thermoreversible hydrogel demonstrated attractive properties to serve as cell matrix for a variety of tissue engineering applications or pharmaceutical delivery vehicles.

Azilsartan treatment improves insulin sensitivity in obese spontaneously hypertensive Koletsky rats

AIM

Hypertension often coexists with insulin resistance. However, most metabolic effects of the antihypertensive agents have been investigated in nomotensive animals, in which different conclusions may arise. We investigated the metabolic effects of the new angiotensin II type 1 receptor blocker azilsartan using the obese Koletsky rats superimposed on the background of the spontaneously hypertensive rats.

METHODS

Male Koletsky rats were treated with azilsartan (2 mg/kg/day) over 3 weeks. Blood pressure was measured by tail-cuff. Blood biochemical and hormonal parameters were determined by enzymatic or ELISA methods. Gene expression was assessed by RT-PCR.

RESULTS

In Koletsky rats, azilsartan treatment lowered blood pressure, basal plasma insulin concentration and the homeostasis model assessment of insulin resistance index, and inhibited over-increase of plasma glucose and insulin concentrations during oral glucose tolerance test. These effects were accompanied by decreases in both food intake and body weight (BW) increase. Although two treatments showed the same effect on BW gain, insulin sensitivity was higher after azilsartan treatment than pair-feeding. Azilsartan neither affected plasma concentrations of triglyceride and free fatty acids, nor increased adipose mRNA levels of peroxisome proliferator-activated receptor (PPAR)γ and its target genes such as adiponectin, aP2. In addition, azilsartan downregulated 11β-hydroxysteroid dehydrogenase type 1 expression.

CONCLUSIONS

These results show the insulin-sensitizing effect of azilsartan in obese Koletsky rats. This effect is independent of decreases in food intake and BW increase or of the activation of adipose PPARγ. Our findings indicate the possible usefulness of azilsartan in the treatment of metabolic syndrome.

CFD and ventilation research

There has been a rapid growth of scientific literature on the application of computational fluid dynamics (CFD) in the research of ventilation and indoor air science. With a 1000-10,000 times increase in computer hardware capability in the past 20 years, CFD has become an integral part of scientific research and engineering development of complex air distribution and ventilation systems in buildings. This review discusses the major and specific challenges of CFD in terms of turbulence modelling, numerical approximation, and boundary conditions relevant to building ventilation. We emphasize the growing need for CFD verification and validation, suggest ongoing needs for analytical and experimental methods to support the numerical solutions, and discuss the growing capacity of CFD in opening up new research areas. We suggest that CFD has not become a replacement for experiment and theoretical analysis in ventilation research, rather it has become an increasingly important partner.

PRACTICAL IMPLICATIONS

We believe that an effective scientific approach for ventilation studies is still to combine experiments, theory, and CFD. We argue that CFD verification and validation are becoming more crucial than ever as more complex ventilation problems are solved. It is anticipated that ventilation problems at the city scale will be tackled by CFD in the next 10 years.

Observation of D+ → K(+)η(') and search for CP violation in D+ → π(+)η(') decays

We report the first observation of the doubly Cabibbo-suppressed decays D(+)→K(+)η((')) using a 791 fb(-1) data sample collected with the Belle detector at the KEKB asymmetric-energy e(+)e(-) collider. The ratio of the branching fractions of doubly Cabibbo-suppressed relative to singly Cabibbo-suppressed D(+)→π(+)η((')) decays are B(D(+)→K(+)η)/B(D(+)→π(+)η)=(3.06±0.43±0.14)% and B(D(+)→K(+)η')/B(D(+)→π(+)η')=(3.77±0.39±0.10)%. From these, we find that the relative final-state phase difference between the tree and annihilation amplitudes in D(+) decays, δ(TA), is (72±9)° or (288±9)°. We also report the most precise measurements of CP asymmetries to date: A(CP)(D(+)→π(+)η)=(+1.74±1.13±0.19)% and A(CP)(D(+)→π(+)η')=(-0.12±1.12±0.17)%.

Atomic scale fluctuations govern brittle fracture and cavitation behavior in metallic glasses

We perform atomistic simulations on the fracture behavior of two typical metallic glasses, one brittle (FeP) and the other ductile (CuZr), and show that brittle fracture in the FeP glass is governed by an intrinsic cavitation mechanism near crack tips in contrast to extensive shear banding in the ductile CuZr glass. We show that a high degree of atomic scale spatial fluctuations in the local properties is the main reason for the observed cavitation behavior in the brittle metallic glass. Our study corroborates with recent experimental observations of nanoscale cavity nucleation found on the brittle fracture surfaces of metallic glasses and provides important insights into the root cause of the ductile versus brittle behavior in such materials.

TWIST1 promotes the odontoblast-like differentiation of dental stem cells

Stem cells derived from the dental pulp of extracted human third molars (DPSCs) have the potential to differentiate into odontoblasts, osteoblasts, adipocytes, and neural cells when provided with the appropriate conditions. To advance the use of DPSCs for dentin regeneration, it is important to replicate the permissive signals that drive terminal events in odontoblast differentiation during tooth development. Such a strategy is likely to restore a dentin matrix that more resembles the tubular nature of primary dentin. Due to the limitations of culture conditions, the use of ex vivo gene therapy to drive the terminal differentiation of mineralizing cells holds considerable promise. In these studies, we asked whether the forced expression of TWIST1 in DPSCs could alter the potential of these cells to differentiate into odontoblast-like cells. Since the partnership between Runx2 and Twist1 proteins is known to control the onset of osteoblast terminal differentiation, we hypothesized that these genes act to control lineage determination of DPSCs. For the first time, our results showed that Twist1 overexpression in DPSCs enhanced the expression of DSPP, a gene that marks odontoblast terminal differentiation. Furthermore, co-transfection assays showed that Twist1 stimulates Dspp promoter activity by antagonizing Runx2 function in 293FT cells. Analysis of our in vitro data, taken together, suggests that lineage specification of DPSCs can be modulated through ex vivo gene modifications.

Body measurements of Chinese males in dynamic postures and application

It is generally accepted that there is a relationship between body dimensions, body movement and clothing wearing ease design, and yet previous research in this area has been neither sufficient nor systematic. This paper proposes a method to measure the human body in the static state and in 17 dynamic postures, so as to understand dimensional changes of different body parts during dynamic movements. Experimental work is carried out to collect 30 measurements of 10 male Chinese subjects in both static and dynamic states. Factor analysis is used to analyse body measurement data in a static state, and such key measurements describe the characteristics of different body figures. Moreover, one-way ANOVA is used to analyse how dynamic postures affect these key body measurements. Finally, an application of the research results is suggested: a dynamic block patternmaking method for high-performance clothing design.

Exploring serological classification tree model of active pulmonary tuberculosis by magnetic beads pretreatment and MALDI-TOF MS analysis

Pulmonary tuberculosis (TB) is an infectious disease disturbing status of public health, and accurate diagnosis of TB would effectively help control the disturbance. Our study tried to establish a classification tree model that distinguished active TB from non-TB individuals. We used matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) combined with weak cationic exchange (WCX) magnetic beads to analyse 178 serum samples containing 75 patients with active TB and 103 non-TB individuals (43 patients with common pulmonary diseases and 60 healthy controls). Samples were randomly divided into a training set and a test set. Statistical softwares were applied to construct this model. An amount of 48 differential expressed peaks (P < 0.05) were identified by the training set, and our model was set up by three of them, m/z 7626, 8561 and 8608. This model can discriminate patients with active TB from patients with non-TB with a sensitivity of 98.3% and a specificity of 84.4%. The test set was used to verify the performance, which demonstrated good sensitivity and specificity: 85.7% and 83.3%, respectively. Differential expressed peaks between smear-positive and smear-negative active TB also have been analysed. It came out that m/z 8561 and 8608 not only acted as vital factors in the pathogenesis of active TB but also played an important role in regulating different active TB status. In conclusion, MALDI-TOF MS combined with WCX magnetic beads was a powerful technology for constructing classification tree model, and the model we built could serve as a potential diagnostic tool for active TB.

Clinical efficacy of chemotherapy combined with verapamil in metastatic colorectal patients

In order to determine the clinical efficacy and adverse reactions of chemotherapy and verapamil infusion through a target artery to treat colorectal cancer patients with metastasis after failure with previous conventional treatments. Patients with metastatic colon cancer (n = 36) received an infusion of verapamil, interleukin-2, oxaliplatin (or hydroxy camptothecin or irinotecan hydrochloride), fluorouracil and calcium folinate through target artery using the Seldinger puncture technique. From the second day of infusion, the patients were treated with fluorouracil and calcium folinate via systematic intravenous injection for 2-3 days. Efficacy was evaluated after at least two treatment courses. The objective response including complete or partial response was 58.3% in the 36 patients; clinical benefit rate, evaluated by Karnofsky Performance Status score was 91.7%; by weight was 83.3%; by the amount of painkiller consumed was 80.6%. No patient experienced side effects associated with heart function. Post-treatment, the P-R period, Q-T period, QRS, and heart rate were not significantly different than before treatment. Liver function was significantly improved. Side effects of chemotherapy were minor in comparison to those observed with intravenous chemotherapy. Infusion of verapamil and chemotherapy directly into pelvic tumor tissue can increase treatment efficacy and has been shown to be a relatively safe technique.

Suppression of the 2010 Alexandrium fundyense bloom by changes in physical, biological, and chemical properties of the Gulf of Maine

For the period 2005-2009, the abundance of resting cysts in bottom sediments from the preceding fall was a first-order predictor of the overall severity of spring-summer blooms of Alexandrium fundyense in the western Gulf of Maine and southern New England. Cyst abundance off mid-coast Maine was significantly higher in fall 2009 than it was preceding a major regional bloom in 2005. A seasonal ensemble forecast was computed using a range of forcing conditions for the period 2004-2009, suggesting that a large bloom was likely in the western Gulf of Maine in 2010. This did not materialize, perhaps because environmental conditions in spring-summer 2010 were not favorable for growth of A.fundyense. Water mass anomalies indicate a regional-scale change in circulation with direct influence on A. fundyense's niche. Specifically, near-surface waters were warmer, fresher, more stratified, and had lower nutrients than during the period of observations used to construct the ensemble forecast. Moreover, a weaker-than-normal coastal current lessened A. fundyense transport into the western Gulf of Maine and Massachusetts Bay. Satellite ocean color observations indicate the 2010 spring phytoplankton bloom was more intense than usual. Early-season nutrient depletion may have caused a temporal mismatch with A. fundyense's endogenous clock that regulates the timing of cyst germination. These findings highlight the difficulties of ecological forecasting in a changing oceanographic environment, and underscore the need for a sustained observational network to drive such forecasts.

Endovascular treatment of ruptured and unruptured vertebral artery aneurysms

This paper analyzes the success of endovascular management of ruptured and unruptured vertebral artery aneurysms. Sixty-three patients with 65 vertebral (both acute dissection and chronic larger aneurysms are included) treated at our hospital form the basis of the analysis. Clinical outcome was evaluated using the modified Rankin Scale. Angiographic follow-up data was obtained for 44 patients (69.8%) for periods ranging from three to 16 months (mean, eight months). Based on the Hunt and Hess grading scale, the patient population included 34 patients (54.0%) with unruptured aneurysms, 28 (44.4%) with Grade 1 aneurysms, one (1.6%) with Grade 2 aneurysms. The locations of the aneurysms included 25 (38.5%) at the distal to posterior inferior cerebellar artery (PICA), 22 (33.8%) at the proximal to PICA and 18 (27.7%) at the vertebral artery-posterior inferior cerebellar artery (VA-PICA). Of the 63 patients, 12 (19%) were women and 51 (81%) were men. The mean age at treatment was 41.7 years (range, six-77 yrs). Follow-up angiograms were obtained in 44 (69.8%) out of 63 patients. Complete or virtually complete thrombosis was confirmed on early posttreatment angiography in 39 (88.6%) out of 44 patients. A slight reduction in the size of the lesion was noted in three patients and there was a significant residual lesion in two (4.5%) patients. Clinical follow-up revealed 90.5% patients in the mRS 0-2 category, 4.8% patients in the mRS>2 category, and 4.8% patients had died (mRS 6). Three patients died of rebleeding (n=1) or progressive mass effect/brainstem ischemia (n=2). Ruptured and unruptured aneurysms of the vertebral artery can be well treated using endovascular techniques, overall long-term results were good in 90.5% of patients.