Specific computed tomography imaging characteristics of congenital mesoblastic nephroma and correlation with ultrasound and pathology

INTRODUCTION

Congenital mesoblastic nephroma (CMN) is a common solid renal tumor in the neonate. Congenital mesoblastic nephroma can be divided into classic, cellular, and mixed types. The prognosis of CMN is very optimistic. But CMN can easily be misdiagnosed as the other malignant renal tumors by radiology. However, no studies have described the computed tomography (CT) imaging appearance of CNM in detail. The objective of this study is retrospective analyses of the multislice CT characteristics of CMN and their corresponding ultrasound findings and pathology.

METHODS

This retrospective study reviewed the enhanced CT images of the CMNs and other renal tumors in children younger than 1 year in the past 10 years from the First Affiliated Hospital of Sun Yat-sen University. Two radiologists had noted the CT imaging characteristics of these images. t-test and Fisher's exact test were used in the comparison of imaging characteristics between the CMNs and other renal tumors.

RESULTS AND DISCUSSION

Compared with other malignant renal tumors, the CMNs tend to appear as smaller round masses without clear coverage or clear boundary with the kidney in CT images (P < 0.01). The intratumor pelvis and the double-layer sign are the specific characteristics of CMNs (P < 0.01). The gender, quality of tumor (solid or solid-cystic), character of enhancement (homogeneous or heterogeneous enhancement), peri-renal hemorrhage, or peripheral lymph node enlargement showed no statistical significance (P > 0.05) between CMNs and other renal tumors. The appearances of CMN with classic components in the CT images are relevant to the pathological findings. The intratumor pelvis is caused by the classic components of CMN growing to encapsulate the pelvis. The double-layer sign in CT image correlates with the specific hypoechoic ring in ultrasound, which is caused by the slow blood flow and delay contrast agent filling in the blood sinus located in the peripheral part of the tumor. The differential diagnosis of CMN should include the other solitary renal tumors such as Wilms' tumor, clear-cell sarcoma of the kidney, and rhabdoid tumor of the kidney.

CONCLUSION

The unclear coverage and unclear boundary with the kidney, the intratumor pelvis, and double-layer sign after contrast were specific CT imaging characteristics of CMN.

Thermal and chemical inactivation of Lactobacillus virulent bacteriophage

The effect of thermal treatments and several biocides on the viability of Lactobacillus virulent phage P1 was evaluated. Times to achieve 99% inactivation (T₉₉) of phage at different treatment conditions were calculated. The thermal treatments applied were 63, 72, and 90°C in 3 suspension media (de Man, Rogosa, Sharpe broth, reconstituted skim milk, and Tris magnesium gelatin buffer). Phage P1 was completely inactivated in 5 and 10 min at 90 and 72°C, respectively; however, reconstituted skim milk provided better thermal protection at 63°C. When phage P1 was treated with various biocides, 800 mg/L of sodium hypochlorite was required for total inactivation (∼7.3 log reduction) within 60 min, whereas treatment with 100% ethanol resulted in only a ∼4.7 log reduction, and 100% isopropanol resulted in a 5.2-log reduction. Peracetic acid (peroxyacetic acid) at the highest concentration used (0.45%) resulted in only a ∼4.-log reduction of phage within 60 min. The results of this study provide additional information on effective treatments for the eradication of potential phage infections in dairy plants.

Riemerella anatipestifer extracellular protease S blocks complement activation via the classical and lectin pathways

Riemerella anatipestifer (RA) is the causative agent of infectious serositis in ducklings and other avian species. It is difficult to control the disease due to its 21 serotypes, poor cross-protection, and bacterial resistance to antimicrobial agents. The complement system is an important component of the innate immune system. However, bacterial pathogens exploit several strategies to evade detection by the complement system. Here, we purified and identified a 59-kDa RA extracellular protease S (EcpS) consisting of a gelatinase. In this study, we aimed to determine how EcpS interferes with complement activation and whether it could block complement-dependent neutrophil function. We found that EcpS potently blocked RA phagocytosis and killing by duck neutrophils. Furthermore, EcpS inhibited the opsonization of bacteria by complement 3b. EcpS specifically blocked complement 3b and complement 4b deposition via the classical and lectin pathways, whereas the alternative pathway was not affected. In summary, we show that RA can survive the bactericidal activity of the duck complement system. These results indicate that RA has evolved mechanisms to evade the duck complement system that may increase the efficiency by which this pathogen can gain access and colonize the inner tissues where it may cause severe infections.

Abstract P6-12-06: Nonsteroidal, tissue selective androgen receptor modulator (SARM), enobosarm, reduces growth of androgen receptor-positive breast cancer in patient-derived preclinical models

Introduction: In breast cancer the androgen receptor (AR) is the most abundantly expressed steroid receptor with 75-95% of estrogen receptor (ER)-positive and 40-70% of ER-negative breast cancers expressing the AR. Historically, advanced breast cancer has been treated with androgens, resulting in significant clinical response. However, the use of steroidal androgens fell from favor as a result of their virilizing side effects. Nonsteroidal, tissue selective androgen receptor modulators (SARMs) will provide a novel targeted approach to exploit the therapeutic benefits of androgens in breast cancer.

Aims: To test the effects of enobosarm (a first-in-class SARM) and enzalutamide (AR antagonist) on the growth of patient-derived breast cancer xenografts (PDX) and to discern the mechanism of action of AR-targeted therapies in AR-positive breast cancer.

Materials and Methods: AR-positive PDXs with varying receptor expression (ER, progesterone receptor (PR), and HER2) were implanted in immunecompromised mice. Mice carrying PDXs were treated with vehicle, 10 mg/kg/day (mpk) enobosarm (GTx, Inc., Memphis, TN), or 20 mpk enzalutamide (Medivation Inc.), orally. Tumor volume was measured twice or thrice weekly. Tumors that received enobosarm were further analyzed to determine the mechanism of action.

Results: Enobosarm significantly (p&lt;0.01) inhibited the growth of ER-, PR-, and HER2- positive HCI-7 and ER- and PR- negative and HER2-positive HCI-12 PDX. While enobosarm inhibited the growth of HCI-12 by ~80% and HCI-7 by ~60%, enzalutamide failed to inhibit the growth of the HCI-7 PDX. In contrast, neither enobosarm nor enzalutamide inhibited the growth of ER- and PR-negative and HER2-positive HCI-9 PDX, consistent with the heterogeneity of AR-positive breast cancers. Growth of two triple-negative breast cancer (TNBC) PDXs were inhibited by 30-40% by enobosarm, but not by enzalutamide. These results were reproduced in xenografts developed with breast cancer cell lines, MCF-7 and MDA-MB-231 expressing the AR. Gene expression studies conducted with the HCI-12 tumors indicated that enobosarm inhibited the expression of various proliferative genes (MUC2, IL10RA, IGSF1, SLC6A4, and others) and increased the expression of growth inhibitory genes (CYP4F8, MYBPC1, and others). Ingenuity pathway analysis demonstrated that enobosarm inhibited genes that are downstream of HER2 signaling. Interestingly, miR-21-3p, which has been implicated in chemo-resistance, was consistently expressed at approximately 10-50-fold higher than miR-21-5p in PDXs. This imbalance was partially reversed by enobosarm.

Conclusion: These results indicate that AR-positive breast cancers are highly heterogeneous and that enobosarm has promise as novel targeted therapy to treat AR-positive breast cancer. Enobosarm is currently in phase II clinical trial in both ER-positive breast cancer and in TNBC patients.

Citation Format: Narayanan R, Ponnusamy S, Fan M, Yang CH, Grimes BL, Fleming MD, Pritchard EF, Berry MP, Oswaks RM, Fine RE, Loiseau J-C, Schwartzberg LS, Pfeffer LM. Nonsteroidal, tissue selective androgen receptor modulator (SARM), enobosarm, reduces growth of androgen receptor-positive breast cancer in patient-derived preclinical models [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-12-06.

Cortical Thickness of Native Tibetans in the Qinghai-Tibetan Plateau

BACKGROUND AND PURPOSE

High-altitude environmental factors and genetic variants together could have exerted their effects on the human brain. The present study was designed to investigate the cerebral morphology in high-altitude native Tibetans.

MATERIALS AND METHODS

T1-weighted brain images were obtained from 77 Tibetan adolescents on the Qinghai-Tibetan Plateau (altitude, 2300-5300 m) and 80 matched Han controls living at sea level. Cortical thickness, curvature, and sulcus were analyzed by using FreeSurfer.

RESULTS

Cortical thickness was significantly decreased in the left posterior cingulate cortex, lingual gyrus, superior parietal cortex, precuneus, and rostral middle frontal cortex and the right medial orbitofrontal cortex, lateral occipital cortex, precuneus, and paracentral lobule. Curvature was significantly decreased in the left superior parietal cortex and right superior marginal gyrus; the depth of the sulcus was significantly increased in the left inferior temporal gyrus and significantly decreased in the right superior marginal gyrus, superior temporal gyrus, and insular cortex. Moreover, cortical thickness was negatively correlated with altitude in the left superior and middle temporal gyri, rostral middle frontal cortex, insular cortex, posterior cingulate cortex, precuneus, lingual gyrus, and the right superior temporal gyrus. Curvature was positively correlated with altitude in the left rostral middle frontal cortex, insular cortex, and middle temporal gyrus. The depth of the sulcus was negatively correlated with altitude in the left lingual gyrus and right medial orbitofrontal cortex.

CONCLUSIONS

Differences in cortical morphometry in native Tibetans may reflect adaptations related to high altitude.

White matter predicts functional connectivity in premanifest Huntington's disease

Objectives

The distribution of pathology in neurodegenerative disease can be predicted by the organizational characteristics of white matter in healthy brains. However, we have very little evidence for the impact these pathological changes have on brain function. Understanding any such link between structure and function is critical for understanding how underlying brain pathology influences the progressive behavioral changes associated with neurodegeneration. Here, we demonstrate such a link between structure and function in individuals with premanifest Huntington's.

Methods

Using diffusion tractography and resting state functional magnetic resonance imaging to characterize white matter organization and functional connectivity, we investigate whether characteristic patterns of white matter organization in the healthy human brain shape the changes in functional coupling between brain regions in premanifest Huntington's disease.

Results

We find changes in functional connectivity in premanifest Huntington's disease that link directly to underlying patterns of white matter organization in healthy brains. Specifically, brain areas with strong structural connectivity show decreases in functional connectivity in premanifest Huntington's disease relative to controls, while regions with weak structural connectivity show increases in functional connectivity. Furthermore, we identify a pattern of dissociation in the strongest functional connections between anterior and posterior brain regions such that anterior functional connectivity increases in strength in premanifest Huntington's disease, while posterior functional connectivity decreases.

Interpretation

Our findings demonstrate that organizational principles of white matter underlie changes in functional connectivity in premanifest Huntington's disease. Furthermore, we demonstrate functional antero–posterior dissociation that is in keeping with the caudo–rostral gradient of striatal pathology in HD.

A decision support tool for evaluating the air quality and wind comfort induced by different opening configurations for buildings in canyons

This study formulated a new index for evaluating both the air quality and wind comfort induced by building openings at the pedestrian level of street canyons. The air pollutant concentrations and wind velocities induced by building openings were predicted by a series of CFD simulations using ANSYS Fluent software based on standard k-ɛ model. The types of opening configurations investigated inside isolated and non-isolated canyons included separations, voids and permeable elements. It was found that openings with permeability values of 10% were adequate for improving the air quality and wind comfort conditions for pedestrians after considering the reduction in development floor areas. Openings were effective in improving the air quality in isolated canyons and different types of opening configurations were suggested for different street aspect ratios. On the contrary, openings were not always found effective for non-isolated canyons if there were pollutant sources in adjacent street canyons. As such, it would also be recommended introducing openings to adjacent canyons along with openings to the target canyons. The formulated index can help city planners and building designers to strike an optimal balance between air quality and wind comfort for pedestrians when designing and planning buildings inside urban streets and thus promoting urban environmental sustainability.

Characterization and adsorption of Lactobacillus virulent phage P1

Bacteriophage infection of lactic acid bacteria is considered an important problem worldwide in the food fermentation industry, as it may produce low quality or unsafe foods, cause fermentation failure, and result in economic losses. To increase current knowledge on the properties of Lactobacillus virulent phages, we evaluated the effect of divalent cations, temperature, pH, and chloramphenicol on the adsorption ability of Lactobacillus virulent phage P1. Phage P1 was isolated from the abnormal fermentation liquid of Lactobacillus plantarum IMAU10120. The results showed that this phage belonged to the Siphoviridae family. The latent period of this phage was 45min, and the burst time was 90min. Burst size was 132.88±2.37 phage counts expressed per milliliter per infective center. This phage showed good tolerance at different temperatures, but incubation at 50°C only affected its adsorption. Adsorption rate reached a maximum value between 30 and 42°C. A high adsorption value of phage infectivity was obtained from pH 6 to 8. Moreover, calcium ions promoted and increased the adsorption capacity of phage P1, but magnesium ions had negative effects. Chloramphenicol had no effect on phage adsorption. This study increased current knowledge on the characterization and biological aspects of Lactobacillus virulent phages, and may provide some basic information that can be used to design successful antiphage strategies in the food industry.

[Correlation between susceptibility weighted imaging manifestation and serum cystatin C for delayed graft function]

OBJECTIVE

To explore the correlation between susceptibility weighted imaging (SWI) manifestation and serum cystatin C level for delayed graft function (DGF).

METHODS

The conventional MRI, SWI and serum cystatin C of 27 cases with DGF in nephrotransplantation center in Third Affiliated Hospital of Suzhou University from September 2014 and August 2015 were retrospectively analyzed.By contrasting conventional MRI images of transplanted kidney in DGF, the imaging manifestations of benign tumors such as cysts and angiomyolipomas were excluded on SWI images, and then making the renal cortex as the reference, if the abnormal signal lesions were found in the transplanted kidney, the location and signal intensity would be analyzed. The differences in serum cystatin C level between DGF groups without and with abnormal signal lesions were compared by using independent-sample t-test.The correlation between SWI manifestation and serum cystatin C level for DGF was assessed with Spearman rank correlation analysis.

RESULTS

A total of 15 cases were found without abnormal signal lesions and the average value of their serum cystatin C level was (2.92±0.44) mg/L.A total of 12 cases were found with abnormal low signal lesions located at junctional zone between cortex and medulla, and the average value of their serum cystatin C level was (6.91±0.96) mg/L. The differences in serum cystatin C level between the two DGF groups were statistically significant (t=-4.040, P=0.000). There was a positive correlation between the abnormal low signal lesions on SWI and serum cystatin C level (r=0.660, P=0.000).

CONCLUSION

The status of renal function impairment could be reflected by being with or without abnormal signal lesions on SWI. A relatively big renal function impairment may be predicted by the appearance of abnormal low signal lesions at junctional zone between cortex and medulla on SWI.

Central composite design approach towards optimization of super activated carbons from bamboo for hydrogen storage

Super activated carbons were developed from moso bamboo and central composite design was used to determine optimum responses by investigating the influence of activation parameters, weight ratio of KOH/precursor (W) and activation temperature (T).

Effects of silencing MTA1 gene by RNA interference on invasion and metastasis of endometrial carcinoma

OBJECTIVE

The study aimed at the silence effect of MAT1 gene and proteins in Ishikawa cell of human endometrial carcinoma cell line through RNAi mediated by siRNA and also discussed the effect of MTA1 gene silence on the invasion and metastasis of endometrial carcinoma.

MATERIALS AND METHODS

According to the principle of designing siRNA sequence, siRNA aiming at MTA1 gene (MTA1-siRNA) and siRNA used for negative control (Control-siRNA) were designed and synthesized and Ishikawa cell was transfected by transfection reagents. RT-PCR method as well as western blot was used, respectively, to detect the MTA1 mRNA and protein expression of stably transfected cells. Transwell method and scarification experiment were adopted to detect the invasion and metastasis of Ishikawa cells.

RESULTS

The expression results of MTA1 on the levels of mRNA and protein showed that the expression level in transfected MTA1-siRNA group was obviously lower than that in non-transfected group and transfected control-siRNA group (p <0.05), while there was no significant difference between non-transfected group and transfected control-siRNA group (p > 0.05). Effective interference on the expression of MTA1 gene remarkably lowered the invasion and metastasis of endometrial carcinoma Ishikawa cells.

CONCLUSION

RNAi aiming at MTA1 can effectively inhibit the expression of MTA1 in endometrial carcinoma Ishikawa cells and the effective silence of MTA1 can weaken the invasion and metastasis of Ishikawa cells, which provides a new strategy for gene therapy of endometrial carcinoma and an experimental basis for inhibiting the invasion and metastasis of endometrial carcinoma.

Can tumor regression grade influence survival outcome in ypT3 rectal cancer?

PURPOSE

Locally advanced rectal cancer (LARC) patients achieving ypT3 status following neoadjuvant chemoradiation are considered to have poor response with minimal downstaging. However, residual cancer cell amounts vary in the subserosa/perirectal fat. Tumor regression grading (TRG) is an evaluation method based on the proportion of fibrosis and residual cancer cells. The aim of this study is to assess the influence of TRG in ypT3 rectal cancer patients who received neoadjuvant chemoradiation.

METHODS

We retrospectively reviewed 325 LARC patients who received neoadjuvant chemoradiation and surgery. TRG scores were recorded by two independent pathologists. Among these patients, 143 were staged as ypT3. We analyzed TRG and other clinicopathological factors and their relationship with survival outcome including overall survival (OS) and disease-free survival (DFS).

RESULTS

Among 143 ypT3 patients, 44 (30.8 %) were TRG1, 84 (58.7 %) were TRG2 and 15 (10.5 %) were TRG3. Seventy-nine (55.3 %) of these patients had metastatic lymph nodes. In univariate analysis, TRG was not associated with DFS (TRG2 vs TRG1, P = 0.852; TRG3 vs TRG1, P = 0.593) or OS (TRG2 vs TRG1, P = 0.977; TRG3 vs TRG1, P = 0.665). Palliative surgery (HR 3.845; 95 % CI 1.670-8.857; P = 0.002) and metastatic lymph nodes after surgery (HR 5.894; 95 % CI 1.142-3.48; P = 0.015) were significantly associated with decreased DFS, while palliative surgery was the only factor associated with worse OS (HR 6.011; 95 % CI 2.150-16.810; P = 0.001). Palliative surgery (HR 3.923; 95 % CI 1.696-9.073; P = 0.001) and metastatic lymph nodes (HR 2.011; 95 % CI 1.152-3.512; P = 0.014) also showed prognostic significance for DFS in multivariate analysis.

CONCLUSIONS

Residual cancer cells evaluated by TRG score after neoadjuvant chemoradiation do not influence survival outcome in ypT3 rectal cancer patients. However, lymph node status is a significant prognostic factor in ypT3 patients.

A new small molecule inhibits Streptococcus mutans biofilms in vitro and in vivo

AIMS

The aim of this study was to identify new small molecules that can inhibit Streptococcus mutans biofilms by in vitro and in vivo model.

METHODS AND RESULTS

We evaluated the effect of a small molecule 2-amino-imidazole/triazole conjugate (2-AI/T) on the formation of Strep. mutans biofilms by culturing in 96-well plates. Toxicity was assessed through cell culture and intragastrically administering to mice. The anti-biofilm and anti-caries effects were investigated in vivo. The inhibitive mechanism was detected by isobaric tag for relative and absolute quantification (itraq) and RT-QPCR. In vitro and in vivo study revealed that 2-AI/T significantly inhibited biofilm formation of Strep. mutans and is more so than inhibiting planktonic cells without toxicity. The ribosome and histidine metabolism pathways of Strep. mutans were significantly regulated by this compound.

CONCLUSIONS

These results suggest that the 2-AI/T conjugate is a potent inhibitor that can be potentially developed into a new drug to treat and prevent dental caries.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study to use small molecule from marine natural products, to protect from dental caries in vivo. It has potential broad range application in clinical caries prevention, or as a bioactive ingredient for food applications.

Chemoradiation for gastric cancer: controversies, updates and novel techniques

The INT0116 trial established the role of adjuvant chemoradiation (CRT) in the multidisciplinary approach to the management of locally advanced gastric cancer. However, whether adjuvant CRT is indispensable for patients undergoing D2 dissection remains undefined. The adjuvant chemoradiation therapy in stomach cancer (ARTIST) trial, which was designed to compare adjuvant chemotherapy to CRT, failed to demonstrate differences in disease-free and overall survival in the whole study group; however, subgroup analysis indicated that patients with lymph node metastasis may benefit from additional radiation. A follow-up ARTIST II trial is currently under way. The efficacy of adjuvant CRT remains controversial because of variation among studies in the inclusion criteria and treatment delivery methods; however, the identification of patients who would benefit from CRT is critical. Advanced radiotherapy techniques such as intensity-modulated radiotherapy protect normal tissues via motion management and decreased radiation-induced toxicity and contribute to plan optimization. Further studies integrating clinical and molecular factors as well as neoadjuvant CRT are warranted.

AT1R A1166C polymorphism and risk of pregnancy-induced hypertension: a meta-analysis of case control studies

PURPOSE

The purpose of this study was to perform a quantitative review of previous case control studies examining the association between AT1R A1166C polymorphism and pregnancy-induced hypertension (PIH).

MATERIALS AND METHODS

Odds ratio (OR) and 95% confidence intervals (CI) were used as measures of effect sizes. Overall effect sizes were derived using a random-effects model or fixed-effects model when appreciated, and stratified by ethnicity. Funnel plots and Egger's regression asymmetry tests were utilized for publication bias detection.

RESULTS

A total of ten articles (including 920 PIH cases and 1408 controls) were included in this meta-analysis. The overall effect sizes (OR = 2.14, 95% CI: 1.54-2.98, p < 0.00001) of additive model indicated PIH patients had a significant higher frequency of allele C. Meanwhile, the OR of the dominant model was 2.22 (95% CI: 1.51-3.26,p < 0.00001) which signified that PIH patients also had a significant higher frequency of AC+CC genotypes. The subgroup analyses were in line with the overall outcomes except the Caucasians PIH patients had a non-significant CA+CC genotypes (OR = 1.37, 95% CI: 0.95-1.98, p > 0.05). The Egger's test of additive model (p = 0.451) and dominant model (p = 0.623) revealed no statistical significance for publication bias.

CONCLUSION

The meta-analysis suggested that the AT1R Al166C polymorphism was significantly associated with the PIH, especially in Asian subjects.

Synthesis of novel monolithic activated carbons from phenol–urea–formaldehyde resin

Phenol–urea–formaldehyde (PUF) organic foams have been firstly synthesized from phenol–urea–formaldehyde resin under alkaline conditions, which can be used as precursor to produce cellular activated carbon foams.

TRAIL-expressing gingival-derived mesenchymal stem cells inhibit tumorigenesis of tongue squamous cell carcinoma

Recent research has verified that mesenchymal stromal/stem cells (MSCs) derived from bone marrow or adipose tissues can migrate toward a variety of tumors. In this study, we explored whether human gingival-derived MSCs (G-MSCs) can migrate toward tongue squamous cell carcinoma (TSCC) and evaluated the antitumor effect of engineered G-MSCs in expressing and delivering the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL). An in vitro cell migration assay with Transwell plates showed that human G-MSCs can migrate toward TSCC cell lines (Tca8113 and Cal27). Then, human G-MSCs, as a type of cell-based vehicle, were transduced with full-length TRAIL and enhanced green fluorescent protein reporter genes by the lentivirus (LV) system (G-MSCs with full-length TRAIL; G-MSCFLT). Tca8113 and Cal27 were co-cultured with G-MSCFLT, respectively, to evaluate the function of G-MSCFLT on tumor cells in vitro. This resulted in G-MSCFLT's inducing a great number of tumor cell necrosis and apoptosis. Meanwhile, in vivo antitumor assays were performed by administering G-MSCFLT to nude mice locally and systematically (mixed injection with tumor cells and tail vein injection). This showed that G-MSCFLT can reduce or even inhibit TSCC growth regardless of the method of administration, especially when the mixed injection of tumor cells and G-MSCFLT was at a ratio of 1:1, which showed no tumor formation. Furthermore, this verified that G-MSCFLT migrated toward TSCC in quantity. These data emphasize the effectiveness of G-MSCs as a vehicle for cell-based gene therapy and the antitumor activity of TRAIL-expressing G-MSCs.

Giant delayed pseudo-aneurysm following screw placement in C1 lateral mass

We report the case of a patient who suffered iatrogenic vertebral artery injury (VAI) during a cervical spine posterior fixation procedure. The patient suffered massive bleeding and hemorrhagic shock at the time of screws placement in C1 lateral mass and C2 pedicle. The postoperative MRI and CT angiography showed a pseudoaneurysm 7.0 cm in diameter in the cervical spine. The iatrogenic VAI during posterior screw fixation is extremely rare. But, it can cause catastrophic consequences. We discuss the causes for the iatrogenic VAI and review the preventative measures and suitable management to avoid iatrogenic complications.

Module function and two-way clustering analysis of Epstein-Barr virus-related nasopharyngeal cancer

This study sought to identify and characterize the function of genes as diagnostic markers for Epstein-Barr virus (EBV)-related nasopharyngeal cancer (NPC). The gene expression profile of GSE13597 was downloaded from the Gene Expression Omnibus database, which included 28 EBV-related NPC gene expression profile data sets, 25 disease samples, and 3 control samples. Data were pre-processed, and differentially expressed genes were screened using the R language. The co-expression coefficient was calculated to construct a co-expression network using Cytoscape. ClusterONE was used to perform module analysis to find enriched gene families. The BiCAT software was used to perform a two-way clustering analysis of differentially expressed gene expression profiles based on the co-expression networks and to verify the enriched gene families, followed by functional enrichment analysis of these gene families. The MCM gene family was found to be enriched in EBV-related NPC. This gene family is essential for eukaryotic DNA replication. Functional analysis of differentially expressed genes in the co-expression network revealed that the enriched biological processes and pathways were mainly involved in the cell cycle. EBV-related NPC is likely associated mainly with the process of cell reproduction, providing a strong basis for the prevention, diagnosis, and treatment of EBV-related NPC and a direction for targeted chemotherapy.

Abstract P1-08-26: Hypertension and phosphorylated vascular endothelial growth factor receptor 2 are potential independent predictive factors for progession-free survival in apatinib-treated advanced breast cancer

Background: Apatinib, one specific tyrosine kinase inhibitor that targets the VEGF receptor 2 was assessed in patients with advanced breast cancer. This substudy was to explore potential predictive and prognostic factors for apatinib-treated breast cancer.

Method: 80 patients were enrolled and received a starting dose of apatinib 750 or 500 mg/d in 4-week cycles. Efficacy was assessed according to RECIST 1.1 criteria, toxicity was graded based on the CTC adverse events version 4.0. The analyzed factors included patient-related factors, such as age; tumor-related factors, such as circulating biomarkers determined by multiplex cytokine assay and phosphorylated VEGFR2 by immunostaining; and treatment-related factors, such as adverse events. Cox Proportional Hazard model and Logistic test were performed as multivariate analysis to define the independent prognostic factors.

Result: Median PFS was 3.84 months, OS 10.64 months, with 17.5% of objective response rate.

Table 1. Efficacy summary No.PFS(months) 95% CIOS(months) 95% CIORR(%)CBR(%)Total803.84 (2.66, 5.03)10.64 (8.55, 12.73)17.537.5TNBC604.30 (2.83, 5.77)9.23 (5.69, 12.77)2041.67non-TNBC203.34 (2.05, 4.63)10.66 (10.38, 10.95)1025P value 0.2110.6700.4990.286

The most frequent adverse events were hypertension (66.3% for all grades, 17.5% for grade 3/4), hand-foot skin reaction (HFSR, 62.5% for all grades, 20% for grade 3/4), and proteinuria (61.3% for all grades, 7.5% for grade 3/4). According to univariate analysis, longer PFS was correlated with hypertension (p = 0.011), HFSR (p = 0.018), post-menopause (p = 0.021), less previous chemotherapy (p = 0.021), higher drug trough concentration (p = 0.025), and higher baseline serum sVEGFR2 (p = 0.031). Median PFS was 6.60 and 2.00 m in patients with higher and lower p-VEGFR2 expressions (p = 0.001). According to multivariate regression analysis, hypertension (p = 0.038; HR, 0.583, 95% CI 0.351 - 0.969) and p-VEGFR2 expression level (p = 0.013; HR, 0.404, 95% CI 0.198 - 0.826) were independent predictive factors of PFS.

Table 2. Summary of univariate analysisFactorsHR (95% CI)Hypertension, with / without0.4856(0.2794 - 0.8442)Hand-foot skin reaction, with / without0.5337(0.3178-0.8963)Proteinuria, with / without0.7887(0.4896-1.270)Fatigue, with / without0.6540 (0.4113-1.040)Age ≥ 60y / &lt; 60y0.5591(0.3101-1.008)Menstruation status, pre / post0.5321(0.3111- 0.9102)ECOG = 0 / ECOG = 10.8989(0.5688-1.421)TNBC / non-TNBC0.6904(0.3863-1.234)DFI ≥ 12m / &lt; 12m0.7114(0.4436-1.141)Visceral metastasis, yes / no0.7999(0.4800-1.333)No. of metastasis site, ≥ 3 / &lt; 31.276(0.7773-2.096)Lines of prior chemothyrapy, ≥ 2 / &lt; 21.792(1.094-2.935)Tumor markers, elevated / normal1.437(0.8507-2.426)sVEGFR2, high / low0.4111(0.1829-0.9239)VEGFR2, high / low0.5112(0.2243-1.165)p-VEGFR2, high / low0.2544(0.1117-0.5796)Hazard ratios for each factor

Conclusion: Apatinib showed substantial antitumor activity in patients with heavy-pretreated advanced breast cancer with manageable toxicity. Hypertension and p-VEGFR2 were independent predictive factors for PFS in apatinib-treated advanced breast cancer, and significantly correlated to higher CBR.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-08-26.

Long term ketamine and ketamine plus alcohol toxicity - what can we learn from animal models?

This review addressed the adverse effects of the frequently-used recreational drug, ketamine through using mice and monkey models. Our laboratory has documented initially that ketamine can induce the formation of hyperphosphorlated tau (hypertau), which is a hallmark of Alzheimer's disease (AD), in the cerebral cortex of both mice and monkeys as well as apoptosis in neurons in these species. Besides the cerebral cortex, other centers in the central nervous system (CNS) and peripheral nervous system (PNS) are also influenced by ketamine. Cerebellum was found to be down-regulated in both mice and humans after long-term of ketamine administration and it was caused by the apoptosis of Purkinje cells. Deleterious effects in other organs reported in long-term ketamine users include of kidney dysfunction leading to proteinuria, fibrosis of the urinary bladder and reduction in size of the urinary bladder leading to frequent urination, increase of liver fibrosis and cardiac problems such as premature ventricular beats. Moreover, ketamine is usually co-administrated with other chemicals such as caffeine or alcohol. It has been reported increased harmful effects when ketamine was used in combination with the above substances. Mechanisms of damages of ketamine might be due to 1) up-regulation of NMDA receptors leading to overestimation of glutamatergic system or 2) the metabolite of ketamine which was a hydroquinone exerted toxicity.