Anti-androgen vinclozolin impairs sperm quality and steroidogenesis in goldfish

In mammals, vinclozolin (VZ) is known as anti-androgen, which causes male infertility via androgen receptor (AR) antagonism. In aquatic animals, the VZ effects on reproductive functions are largely unknown and results are somewhat contradictory. To understand VZ adverse effects on male reproduction, mature goldfish (Carassius auratus) were exposed to three nominal VZ concentrations (100, 400, and 800 μg/L) and alternations in gonadosomatic (GSI) and hepatosomatic indices (HSI), 17β-estradiol (E(2)), 11-ketotestosterone (11-KT) and sperm quality were investigated compared to the solvent control. One group was exposed to E(2) (nominal concentration of 5 μg/L), an estrogenic compound, as a negative control. Following one month exposure, GSI and HSI were unchanged in all VZ treated groups compared to solvent control. Sperm volume, motility and velocity were reduced in fish exposed to 800 μg/L VZ. This was associated with the decrease in 11-KT level, suggesting direct VZ effects on testicular androgenesis and sperm functions. In goldfish exposed to 100 μg/L VZ, 11-KT was increased but E(2) remained unchanged. This is, probably, the main reason for unchanged sperm quality at 100 μg/L VZ. In goldfish exposed to E(2), GSI and 11-KT were decreased, E(2) was increased and no sperm was produced. The present study shows different dose-dependent VZ effects, which lead to impairment in sperm quality via disruption in steroidogenesis. In addition to VZ effects through competitive binding to AR, our data suggests potential effects of VZ by direct inhibition of 11-KT biosynthesis in fish as well as abnormalities in sperm morphology.

P2-08-02: Magnetic Resonance Imaging as a Predictor of Pathologic Response in Patients Treated with Neoadjuvant Systemic Treatment for Operable Breast Cancer (TBCRC 017)

Background: Increased pathologic complete response (pCR) rates observed with neoadjuvant chemotherapy for invasive breast cancer has prompted interest in whether patients with pCR can be identified preoperatively and potentially spared the morbidity of surgery. This multicenter retrospective study was performed to determine the accuracy of preoperative MRI in predicting pCR in the breast and whether MRI performance differs by molecular subtype, histology, and treatment regimen.

Methods: 770 women from 8 institutions were retrospectively identified as having received neoadjuvant systemic therapy with MRI obtained at baseline and after completion of systemic treatment. Tumor phenotypes were defined on the basis of estrogen and progesterone receptor (ER/PR or HR) and HER2 receptor status. Univariate and multivariate analyses of factors influencing radiographic complete response (rCR) and pCR were recorded, with rCR defined as resolution of any abnormal enhancement, mass, or distortion on MRI, and pCR defined as resolution of both invasive disease and DCIS.

Results: rCR and pCR for the total group were 182/746 (24%) and 179/746 (24%), respectively, with the highest rate of pCR seen among the triple-negative (TN; 57/155; 37%) and HR-/HER2+ (38/101; 38%) subtypes. Covariates significantly associated with rCR included T stage (p=0.0002), tumor grade (p=0.005), IHC phenotype (p=0.005), and chemotherapy regimen (p<0.0001). On multivariate analysis, only tumor phenotype was independently associated with likelihood of rCR, with both TN (OR = 2.00, 95% CI 1.20−3.33) and HR-HER2+ (OR=2.30, 95% CI 1.09–4.83) more likely to achieve rCR than HR+HER- (reference group). Overall accuracy of MRI for prediction of pCR was 74%. Sensitivity, NPV, PPV, and accuracy differed significantly among tumor subtypes, with the greatest NPV in the HR-/HER2+ and TN subtypes (table1). Among patients with rCR, ER- status (OR=6.4, 95% CI 1.1 to 35.6), PR- status (OR=3.8, 95% CI 1.2 to 11.4), and tumor grade of 3 vs 1 or 2 (OR=2.49, 95% CI 1.22−5.07) were independently associated with likelihood of pCR. Discussion: MRI performance for predicting pCR in patients with invasive breast cancer receiving neoadjuvant systemic therapy differed significantly among breast cancer subtypes; however this difference is likely due to subtype differences in frequency of pCR and not to intrinsically better or worse MRI detection. The relatively low NPV of MRI following neoadjuvant systemic therapy does not support using MRI rCR alone to accurately identify those patients that can safely avoid surgery.

Use of intraoperative digital specimen mammography to improve operative efficiency

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Background: The traditional method of confirming excision of a targeted lesion during wire localized breast biopsy has been with standard specimen mammograms (SSM). More recently, intraoperative digital specimen mammograms (IDSM) have been used to provide immediate specimen evaluation for the surgeon in the operating room. We sought to evaluate operative time with the use of IDSM versus SSM.

Methods: A retrospective chart and electronic operating room record review of consecutive patients of a single breast surgical oncologist at a quaternary care academic center. Three hundred and forty-four (344) consecutive patients from 2003 to 2010 who underwent wire localized excisional biopsy or wire localized lumpectomy without lymph node evaluation, with specimen evaluation by IDSM or SSM. Operative time, defined as documented time of incision to documented time of closure, was recorded for SSM versus IDSM.

Results: We compared demographics of the two groups transitioning from SSM to IDSM (Table). During the study period, median operative time decreased from 50 minutes in the SSM group to 37 minutes in the IDSM group (p<0.001).

Conclusions: Operative times with the use of IDSM are significantly shorter than with SSM. Downstream effects include decreases in anesthetic time, anesthetic use, operating room charges, and increasing surgeon productivity.

[Table: see text]

Surgical margins and the risk of local-regional recurrence (LRR) following mastectomy for early-stage breast cancer

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Background: We sought to clarify the influence of a positive or close superficial or deep mastectomy margin on the risk of LRR.

Methods: We reviewed the charts of 561 consecutive women who underwent mastectomy without radiation for newly diagnosed in situ or invasive breast cancer between 1998 and 2005. The study cohort consists of 167 of these women who had a positive or close (≤2 mm) superficial or deep surgical margin. LRR as the site of first recurrence (+/− simultaneous distant disease) and distant metastasis (DM) rates were calculated using the Kaplan-Meier method. The median age was 50 years. Forty-five (27%) had ductal carcinoma in situ (DCIS) only. Of the 122 women with invasive disease, 79% had T1, 18% T2, and 3% T3 tumors, and 25% had positive axillary nodes (range, 1-4; 68% 1 positive node). Twenty-nine (24%) of those with invasive disease had lymphovascular invasion. The superficial margin was positive in 61 (37%) and close in 69 (41%). The deep margin was positive in 28 (17%) and close in 51 (31%).

Results: The median follow-up was 6.3 years (range, 1-12.4). The 5-year LRR rate was 5% (95% CI 2-10%) and the DM rate was 3% (95% CI 1-8%). Twelve patients had a LRR; this included the chest wall in 9 and the axilla in 4. Five of the 12 had positive nodes. Four of 92 (4%) with close margins had a LRR vs. 8/75 (11%) with positive margins (log-rank p=0.15). Of the 45 with pure DCIS, 1 (2%) had a LRR. Of those with invasive disease, LRR occurred in 1/28 (4%) who had invasive disease at (positive) or near (close) the superficial margin, 3/38 (8%) with DCIS at or near the superficial margin, 0/12 with invasive disease at or near the deep margin, and 1/12 (8%) with DCIS at or near the deep margin. Both margins were positive or close in 32/122 patients with invasive disease; 6 of these (19%) had a LRR.

Conclusions: The risk of LRR in patients with a positive or close surgical margin after mastectomy is generally low. The benefit of post-mastectomy radiation in this population with otherwise favorable features is likely to be small. While there may be a higher risk of LRR in patients with disease at or close to both margins (likely representing extent of disease), numbers in these categories are small and these results should be interpreted with caution.

Can axillary lymph node dissection be omitted in patients with breast cancer and positive sentinel nodes?

Sentinel lymph node biopsy has evolved as the surgical procedure of choice for women with clinically negative axillae, as part of an effort to move toward the less invasive surgical management of breast cancer. Axillary lymph node dissection remains the standard of care for patients with a positive axillary node and was previously performed on all patients with breast cancer prior to the implementation of the sentinel lymph node biopsy. There is, however, controversy regarding whether or not all patients with a positive sentinel lymph node need to undergo completion axillary dissection for either prognostic or therapeutic purposes. This article reviews the literature related to this controversial and evolving topic.

Neoadjuvant cisplatin and bevacizumab in triple negative breast cancer (TNBC): Safety and efficacy

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Background: We have previously shown that neoadjuvant cisplatin has activity in TNBC, a subtype of breast cancer for which there is no effective targeted therapy. Bevacizumab adds to the efficacy of chemotherapy in metastatic breast cancer; however, there is limited data on the safety or efficacy of bevacizumab in combination with chemotherapy in the neoadjuvant or adjuvant setting. Thus, we sought to explore the safety and efficacy of the addition of bevacizumab to cisplatin in the treatment of TNBC. Methods: 51 patients (pts) with confirmed TNBC provided informed consent and were enrolled in a single arm phase II trial of neoadjuvant cisplatin 75 mg/m2 q 3 weeks x 4 cycles and bevacizumab 15 mg/kg q 3 weeks x 3 cycles prior to definitive surgery. Only 3 cycles of bevacizumab were delivered to allow 6 weeks between the last dose of bevacizumab and surgery. Research biopsies were obtained and breast MRI performed before treatment and at surgery. Postoperatively, pts received doxorubicin and cytoxan (AC) plus bevacizumab or AC/Taxol plus bevacizumab. Median age was 50 yrs (range 30 to 66 yrs); tumors were clinical T1 (2%), T2 (80%), T3 (18%). Results: Forty-six pts are evaluable for response and 5 pts are still receiving neoadjuvant therapy. Clinical responses to date: 12/46 (26%) clinical complete response (cCR), 24/46 (52%) clinical partial response (cPR), 5/46 (11%) stable disease (SD), and 1/46 (2%) progressive disease (PD). Non-responders included 4/46 (9%) pts who discontinued protocol therapy for toxicity. To date, 7/46 (15%) pts achieved a complete pathological response (Miller-Payne 5) and an additional 10/46 (22%) were Miller-Payne 4. Five pts did not complete neoadjuvant therapy, 2 with tinnitus/hearing loss and 3 with grade 4 toxicities consisting of refractory hypertension in 1 pt and pulmonary embolism (PE) in 2 pts. Tissue-based assays to predict platinum/bevacizumab responses, including BRCA1/2 status, are underway. Conclusions: Cisplatin and bevacizumab has some activity in TNBC as demonstrated by 37% of evaluable pts with a Miller-Payne 4 or 5 pathological response. However, toxicity, including tinnitus/hearing loss, hypertension and PE, limited completion of neoadjuvant therapy in 11% of pts.

No significant financial relationships to disclose.

Energy calibration and full-pattern refinement for strain analysis using energy-dispersive and monochromatic X-ray diffraction

Precise channel-to-energy conversion is very important in full-pattern refinement in energy-dispersive X-ray diffraction. Careful examination shows that the channel-to-energy conversion is not entirely linear, which presents an obstacle to obtaining accurate quantitative data for lattice strains by pattern refinement. In order to establish an accurate quadratic channel-to-energy conversion function, aMatlabprogram was written to find the best quadratic coefficient and hence the whole energy conversion function. Then this energy conversion function was used to perform a whole-pattern fitting of the energy-dispersive X-ray diffraction pattern of a Ti64 sample. The strain across the Ti64 bar calculated from the fitting results has been compared with values obtained by single-wavelength X-ray diffraction utilizing a Laue monochromator.

Prediction of breast cancer size by ultrasound, mammography and core biopsy

Neoadjuvant chemotherapy and non-surgical tumor ablation rely upon imaging studies to determine tumor size. In this study the accuracy of ultrasound (US) mammography and core biopsy in determining tumor size was examined in 202 patients with Stages I and II breast cancer. The most accurate single modality for determining tumor size was mammography with a correlation coefficient of 0.66, followed by US (r = 0.48) and core biopsy (r = 0.28). Size measurements were less accurate in lobular than ductal cancers. The combination of the three modalities understaged 25% of the tumors > 1cm in size, and overstaged 10% of those < 1cm. The inability to accurately determine tumor size has important implications for the use of non-surgical ablation.

Observation of divergent-beam X-ray diffraction from a crystal of diamond using synchrotron radiation

In 1947 Kathleen Lonsdale conducted a series of experiments on X-ray diffraction using a divergent beam external to a crystal sample. Unlike the Kossel technique, where divergent X-rays are excited by the presence of fluorescing atoms within the crystal, the use of an external divergent source made it possible to study non-fluorescing crystals. The resulting photographs not only illustrated the complexity of X-ray diffraction from crystals in a truly beautiful way, but also demonstrated unprecedented experimental precision. This long-forgotten work is repeated here using a synchrotron radiation source and, once again, considerable merit is found in Lonsdale's technique. The results of this experiment suggest that, through the use of modern 'third-generation' synchrotron sources, divergent-beam diffraction could soon enjoy a renaissance for high-precision lattice-parameter determination and the study of crystal perfection.

Spirometric reference values in a large Middle Eastern population

Ethnic differences in pulmonary function have been frequently reported. The purposes of this study were to derive equations for the prediction of normative spirometry values for a large population of Persians in Isfahan and compare them to reference values from a White Euro-USA population. Spirometry measurements were obtained from 4,341 randomly selected healthy nonsmoker subjects in Isfahan, Iran, utilising American Thoracic Society guidelines and a vigorous quality assurance program. Measured data from 3,213 subjects were analysed using multiple regression techniques to derive prediction equations for spirometric variables; the remaining 1,128 subjects were used as a control group to test the validity of the derived equations. In addition, predicted values were compared with values derived from recently published equations for the USA. Derived prediction equations showed good performance for most spirometric parameters. Compared with USA Whites, adult Persians have minimally lower forced vital capacities, while the values for children are close to USA Whites. In comparison with reference equations based on European or USA populations, local reference values are more biologically and technically suitable for the interpretation of spirometric data from Iranian populations.

Is arm span an accurate measure of height to predict pulmonary function parameters?

Interpretation of pulmonary function tests basically depends on prediction of normal values derived from equations using non-deformed body height. In many patients body height can not be accurately measured. The arm-span method has been used for estimating body height, but the normal relationship between body height and arm span is not exact and differs in various ethnic groups and even between two genders of the same race. In order to minimise the error of estimation of non-deformed body height, the normal relationship between body height and arm span was determined for 754 Persian males and 708 females aged 7 to 82 years, all having normal body stature. In accordance with earlier reports, two sets of spirometric parameters derived once from height, sex, age; and again from arm-span, sex, age were statistically different, and overestimated when the measured arm-span was used. The body-height/arm-span relationship is described using linear regression equations; in subgroups aging 20 years or less and those older than 20 in different genders. The results indicate significant sex and age differences in the arm-span/height ratio. Two sets of spirometric parameters predicted by real height, sex, age/and predicted height, sex, age were not statistically different for most of the parameters especially vital capacity.

IN CONCLUSION

height estimated from arm span, performs much better than arm span to predict pulmonary function parameters.