Estimation of 85Kr dispersion from the spent nuclear fuel reprocessing plant in Rokkasho, Japan, using an atmospheric dispersion model

The spent nuclear fuel reprocessing plant of Japan Nuclear Fuel Limited (JNFL) located in Rokkasho, Japan, discharged small amounts of (85)Kr into the atmosphere during final tests of the plant with actual spent fuel from 31 March 2006 to October 2008. During this period, the gamma-ray dose rates due to discharged (85)Kr were higher than the background rates measured at the Institute for Environmental Sciences and at seven monitoring stations of the Aomori prefectural government and JNFL. The dispersion of (85)Kr was simulated by means of the fifth-generation Penn State/NCAR Mesoscale Model and the CG-MATHEW/ADPIC models (ver. 5.0) with a vertical terrain-following height coordinate. Although the simulated gamma-ray dose rates due to discharged (85)Kr agreed fairly well with measured rates, the agreement between the estimated monthly mean (85)Kr concentrations and the observed concentrations was poor. Improvement of the vertical flow of air may lead to better estimation of (85)Kr dispersion.

The prognostic value of concurrent phrenic nerve palsy in newborn babies with neonatal brachial plexus palsy

PURPOSE

To investigate the prognostic value of concurrent phrenic nerve palsy for predicting spontaneous motor recovery in neonatal brachial plexus palsy.

METHODS

We reviewed the records of 366 neonates with brachial plexus palsy. The clinical and follow-up data of patients with and without phrenic nerve palsy were compared.

RESULTS

Of 366 newborn babies with neonatal brachial plexus palsy, 21 (6%) had concurrent phrenic nerve palsy. Sixteen of these neonates had upper-type palsy and 5 had total-type palsy. Poor spontaneous motor recovery was observed in 13 neonates with concurrent phrenic nerve palsy (62%) and in 129 without concurrent phrenic nerve palsy (39%). Among neonates born via vertex delivery, poor motor recovery was observed in 7 of 9 (78%) neonates with concurrent phrenic nerve palsy and 115 of 296 (39%) without concurrent phrenic nerve palsy.

CONCLUSIONS

Concurrent phrenic nerve palsy in neonates with brachial plexus palsy has prognostic value in predicting poor spontaneous motor recovery of the brachial plexus, particularly after vertex delivery.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Suppressive effects of neutrophil by Salp16-like salivary gland proteins from Ixodes persulcatus Schulze tick

Salp16, a 16-kDa tick salivary gland protein, is known to be the molecule involved in the transmission of Anaplasma phagocytophilum, an obligate intracellular pathogen causing zoonotic anaplasmosis, from its mammalian hosts to Ixodes scapularis. Recently, the presence of A. phagocytophilum was documented in Japan and Ixodes persulcatus was identified as one of its vectors. The purpose of this study was to identify Salp16 genes in I. persulcatus and characterize their function. Two cDNA clones encoding the Salp16-like sequences were obtained from the salivary glands of fed female I. persulcatus ticks and designated Salp16 Iper1 and Iper2. Gene expression analyses showed that the Salp16 Iper genes were expressed specifically in the salivary glands and were up-regulated by blood feeding. These proteins attenuated the oxidative burst of activated bovine neutrophils and inhibited their migration induced by the chemoattractant interleukin-8 (IL-8). These results demonstrate that Salp16 Iper proteins contribute to the establishment of blood feeding as an immunosuppressant of neutrophil, an essential factor in innate host immunity. Further examination of the role of Salp16 Iper in the transmission of pathogens, including A. phagocytophilum, will increase our understanding of the tick-host-pathogen interface.

Survival of HER2-positive primary breast cancer patients treated by neoadjuvant chemotherapy plus trastuzumab: a multicenter retrospective observational study (JBCRG-C03 study)

We investigated the disease-free survival (DFS) of HER2-positive primary breast cancer patients treated with neoadjuvant chemotherapy plus trastuzumab, as well as predictive factors for DFS and pathologic response. Data from 829 female patients treated between 2001 and 2010 were collected from 38 institutions in Japan. Predictive factors were evaluated using multivariate analyses. The 3-year DFS rate was 87 % [95 % confidence interval (CI) 85-90]. The pathologic complete response (pCR: ypT0/is + ypN0) rate was 51 %. The pCR rate was higher in the ER/PgR-negative patients than in the ER/PgR-positive patients (64 vs. 36 %, P < 0.001). Patients with pCR showed a higher DFS rate than patients without pCR (93 vs. 82 %, P < 0.001). Multivariate analysis revealed three independent predictors for poorer DFS: advanced nodal stage [hazard ratio (HR) 2.63, 95 % CI 1.36-5.21, P = 0.004 for cN2-3 vs. cN0], histological/nuclear grade 3 (HR 1.81, 95 % CI 1.15-2.91, P = 0.011), and non-pCR (HR 1.98, 95 % CI 1.22-3.24, P = 0.005). In the ER/PgR-negative dataset, non-pCR (HR 2.63, 95 % CI 1.43-4.90, P = 0.002) and clinical tumor stage (HR 2.20, 95 % CI 1.16-4.20, P = 0.017 for cT3-4 vs. cT1-2) were independent predictors for DFS, and in the ER/PgR-positive dataset, histological grade of 3 (HR 3.09, 95 % CI 1.48-6.62, P = 0.003), clinical nodal stage (HR 4.26, 95 % CI 1.53-13.14, P = 0.005 for cN2-3 vs. cN0), and young age (HR 2.40, 95 % CI 1.12-4.94, P = 0.026 for ≤40 vs. >40) were negative predictors for DFS. Strict pCR (ypT0 + ypN0) was an independent predictor for DFS in both the ER/PgR-negative and -positive datasets (HR 2.66, 95 % CI 1.31-5.97, P = 0.006 and HR 3.86, 95 % CI 1.13-24.21, P = 0.029, respectively). These results may help assure a more accurate prognosis and personalized treatment for HER2-positive breast cancer patients.

Abstract P6-06-20: Predictive factors for pathologic complete response and disease-free survival after neoadjuvant chemotherapy with trastuzumab: A multicenter retrospective observational study in patients with HER2-positive primary breast cancer (JBCRG-C03 study)

BACKGROUND:

Addition of trastuzumab to neoadjuvant chemotherapy (NAC) improved pathologic complete response (pCR) rate in HER2-positive breast cancer. Although recent trials have shown favorable prognosis with NAC plus trastuzumab, clinicopathological factors to predict the outcome have not been fully understood. The aim of this study was to investigate the survival after NAC with trastuzumab and to explore the predictive factors.

PATIENTS AND METHODS:

This is a multicenter retrospective observational study. Patients with HER2-positive primary breast cancer treated with NAC plus trastuzumab from 2001 to 2010 were identified from the institutional database. Primary end point was disease-free survival (DFS). pCR was defined as ypT0/is+ypN0. Kaplan-Meier method was used to estimate DFS. Logistic regression and proportional hazard analysis were used to identify clinicopathological factors to predict pCR and DFS, respectively.

RESULTS:

733 patients were included in the analysis (whole dataset). 425 were ER/PgR-negative (HR- dataset) and 306 were ER/PgR-positive (HR+ dataset). Radiation therapy was performed in 90% of lumpectomy and 31% of mastectomy. Hormonal therapy was performed in 84% of HR+ dataset. pCR rate was 45% in whole dataset, 60% in HR- dataset, and 34% in HR+ dataset. Table 1 showed the result of multivariate analysis for pCR in whole dataset. When HR+ and HR- dataset were analyzed separately, no definitive predictors for pCR were identified in multivariate analysis. Although the patients with pCR showed a significantly favorable prognosis than those without pCR at 3 years DFS, in whole dataset (93% vs 83%, p&lt;0.0001) and HR- dataset (94% vs 80%, p&lt;0.0001), there was no significant difference in HR+ dataset (89% vs 86%, p = 0.10). Different predictors were selected for DFS when multivariate analysis was conducted separately between HR- and HR+ dataset (Table 2).

CONCLUSIONS:

In this observational study, we clarified predictors for pCR and DFS in HER2-positive patients treated with neoadjuvant trastuzumab containing therapy based on tumor subtype. Our results may help us to predict the prognosis more precisely and to simulate the disease course.

Table 1) Multivariate logistic regression analysis for pCR in whole datasetFactorsOR95%CIp-valuePost- vs Pre-menopause1.50(1.05-2.15)0.026*cT1-2 vs cT3-41.72(1.16-2.59)0.008*ER/PgR-negative vs ER/PgR-positive3.32(2.30-4.82)&lt;0.0001*Grade 3 vs 1-21.28(0.89-1.84)0.183

Table 2) Multivariate proportional hazard analysis for DFSFactors†HR95%CIp-valueWhole dataset   Pre- vs Post-menopause1.61(1.04-2.52)0.033*cN2-3 vs cN03.06(1.58-6.24)0.001*cN1 vs cN02.26(1.23-4.41)0.007*Grade 3 vs 1-21.87(1.20-2.97)0.006*non-pCR vs pCR1.90(1.18-3.13)0.008*HR- dataset   Pre- vs Post-menopause1.70(1.01-2.85)0.046*cT3-4 vs cT1-21.86(1.09-3.17)0.024*non-pCR vs pCR3.28(1.90-5.87)&lt;0.0001*HR+ dataset   cN2-3 vs cN05.01(1.79-16.19)0.002*cN1 vs cN03.50(1.40-10.61)0.006*Grade 3 vs 1-22.95(1.52-5.87)0.001*†Only factors with statistical significance

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-20.

Abstract P1-14-08: A prospective multicenter randomized phase II neo-adjuvant study of 5-fluorouracil, epirubicin and cyclophosphamide (FEC) followed by docetaxel, cyclophosphamide and trastuzumab (TCH) versus TCH followed by FEC versus TCH alone, in patients (pts) with operable HER2 positive breast cancer: JBCRG-10 study

Background: The current standard treatment of primary systemic therapy (PST) in HER2 positive breast cancer is anthracyclines (A) and/or taxanes combined with trastuzumab (H) which demonstrates high pathological complete response (pCR). The pCR is considered as a predictive marker of prognosis although results are slightly different depending on the hormone receptor status. We conducted a randomized phase II study to examine sequence of treatments and necessity of A in the treatments using TCH to improve outcome and reduce cardiac toxicity in Japanese HER2 positive pts.

Methods: Pts were treated with FEC (5FU 500 mg/m2, epirubicin 100 mg/m2, cyclophosphamide 500 mg/m2) and/or TCH (docetaxel 75 mg/m2, cyclophosphamide 600 mg/m2, H 6 mg/kg, loading by 8 mg) in 3 groups: 4 cycles of FEC followed by 4 cycles of TCH (A-TCH); 4 cycles of TCH followed by 4 cycles of FEC (TCH-A) or 6 cycles of TCH. An unplanned interim analysis was conducted due to one death by interstitial lung disease (ILD) in the A-TCH after completion of 8 cycles. The pCR results suggested A containing regimens did not exceed benefit from the current standard regimen. The study was continued by limiting allocation only to the TCH group considering efficacy and safety. The primary endpoint was pCR and secondary endpoints were overall response rate (ORR) and safety.

Results: A total of 103 pts were enrolled between Sep. 2009 and Sep. 2011; 21 pts in the A-TCH, 22 pts in the TCH-A and 60 pts in the TCH including pts enrolled after termination of random allocation. Characteristics of the 103 pts were; median age of 54 (range, 33–70), median tumor size of 35 mm (range, 12–80), 42 pts with N(+) (40.8%) and 62 ER positive pts (60.2%). Characteristics of pts in the TCH were; median age of 54.5 (range, 33–67), median tumor size of 35.5 mm (range, 12–80), 25 pts with N(+) (41.7%) and 34 ER positive pts (56.7%). No major difference was reported between groups treated with or without A. Per protocol population was 59 pts in the TCH and its pCR rate was 45.8% (95% CI, 32.2–59.3: ER negative, 61.5%; ER positive, 33.3%). ORR was 86.4% assessed by MRI or CT. Although it is an exploratory analysis, the pCR rate of A containing regimens was 39.0% (ER negative, 57.1%; ER positive, 29.6%). Adverse events ≥grade 3 were reported in 50 pts (48.5%). Reported ILD was in 5 pts (A-TCH, 1; TCH-A, 1; TCH, 3). The mean left ventricular ejection fraction (LVEF) decreased from 70.0% to 69.0% after treatment (A-TCH, 65.9%; TCH-A, 70.4%; TCH, 69.0%). Decrease of LVEF in the A-TCH was significant (p &lt; 0.01).

Conclusion: The pCR rate of the TCH group was similar to previous reports on A including regimens. Although ILD had been occurred during the treatment containing the TCH, no other new safety issues were reported. We were not able to conclude preferable sequence of A and T since statistical power was not sufficient. However, the result of LVEF suggested TCH followed by A or TCH were preferable. Six cycles of TCH could be one of treatment options as a PST in HER2 positive breast cancer to exclude A. (UMIN000002365)

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-14-08.

Growth Disturbance of the Paralytic Limb in Newborn Brachial Plexus Palsy

Growth disturbance of the paralytic limb was analyzed in 50 patients with newborn brachial plexus palsy. The ratio of the bone length on the paralyzed side to that on the normal side as depicted on the roentogenogram was calculated at the average age of 7.2 years. While in upper type palsy the ratio was 95% in the humerus, 97% in the radius, and 96% in the ulna, that in total type palsy was 93%, 89%, and 88%, respectively. In mild paralysis, it was 95%, 98%, and 97%, respectively, while in severe paralysis, it was 93%, 88%, and 88%, respectively. In those who underwent neurosurgical reconstruction, it was 94%, 93%, and 92%, respectively, while in those who did not, it was 92%, 84%, and 85%, respectively.

The degree of shortening was well correlated with the extent and severity of paralysis, and early neurosurgical reconstruction was found to reduce it.

The diagnostic accuracy of high-resolution endoscopy, autofluorescence imaging and narrow-band imaging for differentially diagnosing colon adenoma

BACKGROUND AND STUDY AIMS

Conventional colonoscopy can result in unnecessary biopsy or endoscopic resection due to its inability to distinguish adenomas from hyperplastic polyps. This study therefore evaluated the efficacy of high-resolution endoscopy (HRE), autofluorescence imaging (AFI), and narrow-band imaging (NBI) in discriminating colon adenoma from hyperplastic polyps.

PATIENTS AND METHODS

This was a prospective multicenter study in patients undergoing AFI and NBI examinations. HRE, AFI, and NBI images were classified into two groups based on morphological characteristics, the predominant color intensities, and the visibility of meshed capillary vessels, respectively. Each of the endoscopic photographs were independently evaluated by a single endoscopist. The images were then assessed by three specialists and three residents, the latter having performed < 500 colonoscopies and < 30 NBI and AFI examinations. Diagnostic test statistics were calculated to compare the accuracy in differentiating colon adenoma from hyperplastic polyps for each method.

RESULTS

A total of 183 patients were enrolled in the study and 339 adenomas and 85 hyperplastic polyps were identified. AFI and NBI could distinguish adenoma from hyperplastic polyps with an accuracy of 84.9 % and 88.4 %, respectively, whereas HRE exhibited an accuracy of 75.9 %. In the 358 lesions in which the AFI diagnosis was consistent with that of NBI, the accuracy, sensitivity, and specificity were high, at 91.9 %, 92.7 %, and 92.9 %, respectively. During the study comparing specialists and residents, AFI and NBI dramatically improved the diagnostic accuracy of residents from 69.1 % to 86.1 % and 84.7 %, respectively.

CONCLUSIONS

Both AFI and NBI are considered to be feasible tools that can discriminate colon adenoma from hyperplastic polyps, and their use may be particularly beneficial for less-experienced endoscopists.