Frequency of glycated hemoglobin monitoring was inversely associated with glycemic control of patients with Type 2 diabetes mellitus

BACKGROUND

The frequency of monitoring glycated hemoglobin (HbA(1c)) and its impact on glycemic control of Chinese Type 2 diabetes mellitus (T2DM) patients have not been well understood.

AIM

To explore the current status of the glycemic control, the frequency of HbA(1c) monitoring, and their relationship in T2DM outpatients in urban China.

SUBJECTS AND METHODS

A cross-sectional study was carried out in 15 hospitals purposely sampled from 4 cities of China. T2DM outpatients were consecutively recruited, and underwent a face-to-face interview in outpatient consulting rooms using a self-developed structured questionnaire to collect information. All consented patients were invited to have a free HbA(1c) test.

RESULTS

Among 1511 subjects, the average level of HbA(1c) was 8.1±1.6% with the ideal percents of 13.6% and 24.8% (HbA(1c)<6.5% and <7.0%, respectively). Less than 1/3 (339/1157) had received 2 or more HbA(1c) tests per yr, and they had a significantly lower average of HbA(1c) than those having only 1 or no test per yr (F=5.012, p=0.007). After adjustment for possible confounders including age, gender, and city, there was a significantly inverse association with adjusted odds ratios of 2.56 [95% confidence interval (CI): 1.71, 3.86] and 1.67 (95% CI: 1.11, 2.50), respectively, between the frequency of monitoring HbA(1c) (null, once vs ≥2 times per yr) and worse glycemic control (HbA(1c)≥7.0%).

CONCLUSIONS

Glycemic control of T2DM outpatients was poor in urban China. Frequency of HbA(1c) monitoring is seriously insufficient in majority of patients. Lower frequency of HbA(1c) monitoring is significantly associated with poor glycemic control.

Randomized phase II non-inferiority study (NO16853) of two different doses of capecitabine in combination with docetaxel for locally advanced/metastatic breast cancer

BACKGROUND

This phase II study investigated whether a lower-than-approved dose of capecitabine, plus docetaxel (XT), would improve tolerability versus standard-dose XT without compromising efficacy.

PATIENTS AND METHODS

Women aged ≥18 years with locally advanced/metastatic breast cancer resistant to anthracycline-based chemotherapy in the (neo)adjuvant, first- or second-line metastatic setting were eligible. Patients were randomly assigned to receive standard-dose XT (capecitabine 1250 mg/m(2) twice daily, days 1-14; docetaxel 75 mg/m(2), day 1 every 3 weeks) or low-dose XT (capecitabine 825 mg/m(2) twice daily, days 1-14; docetaxel as above). The primary objective was to demonstrate non-inferiority of low-dose to standard-dose XT in terms of progression-free survival (PFS).

RESULTS

470 patients were randomly allocated in a 1 : 1 ratio to standard-dose or low-dose XT. Median PFS was 7.9 versus 5.8 months [hazard ratio 1.16, 95% confidence interval (CI) 0.95-1.43] in the standard-dose and low-dose arms, respectively. The upper limit of the 95% CI was above the predefined non-inferiority margin (1.35, P = 0.078). Secondary efficacy end points were consistent with PFS. The frequency and severity of adverse events was similar in both treatment arms.

CONCLUSIONS

Non-inferiority of low-dose to standard-dose XT in terms of PFS was not demonstrated; this may be due to regional subgroup effects.

Epidemiological and clinical characteristics of the outbreak of 2009 pandemic influenza A (H1N1) at a middle school in Luoyang, China

OBJECTIVES

To describe the epidemiological and clinical characteristics of 2009 H1N1 influenza, particularly the incubation period and the duration of symptoms, and to assess the public health response to this outbreak.

STUDY DESIGN

A retrospective cohort study was conducted among all students and employees in a middle school by telephone survey and laboratory inspection.

METHODS

Nasopharyngeal specimens were collected and tested, and real-time reverse transcriptase polymerase chain reaction testing was performed to confirm the viral infection. The epidemiological and clinical characteristics were obtained through a telephone survey, and the incubation period and the duration of symptoms associated with 2009 H1N1 influenza were estimated by parametric distribution.

RESULTS

In total, 253 cases of influenza-like illness were found among students and employees, and 79 of these cases were confirmed as H1N1 infection through laboratory inspection. The response rate for the telephone survey was 93.48% for the students (2586/2768) and 85.87% for the employees (158/184). The average attack rate was 9.22% (253/2744). The main reported symptoms were fever (100%), cough (74.68%), sore throat (59.49%), headache (56.96%) and myalgia/arthralgia (51.90%). No complications were reported and no deaths occurred. The confirmed and suspected cases had no associated travel history or contact with a confirmed or probable case. The estimated median incubation period was 1.6 days [95% confidence interval (CI) 1.2-2.3]. The duration of symptoms was 3-11 days, and the median duration of symptoms was 7.5 days (95% CI 4.5-10.5).

CONCLUSIONS

The results suggest that the outbreak of 2009 H1N1 influenza in this middle school was widespread but not severe. The natural history of 2009 H1N1 influenza virus appears to be similar to that of previously circulating pandemic and interpandemic influenza viruses. The public health response indicates that school closure could have a substantial impact on the spread of 2009 H1N1 influenza.

Spatial-temporal model of haemorrhagic disease in white-tailed deer in south-east USA, 1983 to 2000

The present study constructed a spatial-temporal statistical model to identify the risk and protective factors for haemorrhagic disease (HD) in white-tailed deer in the five states of Alabama, Georgia, South Carolina, North Carolina and Tennessee. The response variable was binary, indicating the presence or absence of HD in an individual county, measured annually from 1983 to 2000. Predictor variables included climatic factors of temperature, rainfall, wind speed and dew point, remotely sensed data of normalised difference vegetation index (NDVI) and land surface temperature derived from archived remotely sensed advanced very-high-resolution radiometer (AVHRR) satellite data, elevation, a spatial autocorrelation (SA) term and a temporal autocorrelation term. This study first applied principal component factor analysis to reduce the volume of climatic data and remotely sensed data. Then, a generalised linear mixed model framework (GLMM) was used to develop a spatial-temporal statistical model. The results showed that the area under receiver operating characteristic curve (ROC) was 0.728, indicating a good overall fit of the model. The total prediction accuracy over the 18 year period with optimal cut-off probability was 67 per cent. The prediction accuracy for individual years ranged from 48 to 75 per cent.

P1-12-09: Safety and Efficacy of Neratinib in Combination with Capecitabine in Patients with ErbB2-Positive Breast Cancer

Background: Neratinib (HKI-272) is an irreversible pan-ErbB receptor tyrosine kinase inhibitor that has shown antitumor activity in patients with ErbB2+ breast cancer. Capecitabine has demonstrated efficacy and tolerability in combination with lapatinib, a reversible dual ErbB1/ErbB2 kinase inhibitor, in patients with ErbB2+ advanced breast cancer. The current study evaluated the safety and clinical activity of neratinib in combination with capecitabine.

Methods: In part 1 of this open-label, phase 1/2 study, the maximum tolerated dose (MTD) of neratinib in combination with capecitabine was determined in adults with advanced solid tumors. Part 2 of the study further evaluated the safety and clinical activity of neratinib plus capecitabine at the MTD in adults with confirmed ErbB2+ metastatic or locally advanced breast cancer (ECOG Performance Status of 0–2). Eligible patients had received prior taxane treatment and ≥1 prior trastuzumab-containing regimen for ≥6 weeks for metastatic or locally advanced disease. The primary endpoint of part 2 was objective response rate (ORR); tumor responses were assessed by investigators using modified RECIST version 1.0 guidelines every 6 weeks.

Results: In part 1 (n = 33), the MTD was determined to be neratinib 240 mg/day plus capecitabine 750 mg/m2 twice daily on Days 1 to 14 of each 21-day cycle. In part 2, as of April 2011, 72 female patients (median age of 52 years [range, 33–79 years]) with ErbB2+ breast cancer were enrolled and treated at the MTD; 7 patients had prior lapatinib exposure and all had prior trastuzumab and taxane exposure. As of the snapshot date, 56% of patients at the MTD were still participating in the study. The most common drug-related adverse events (AEs) in part 2 were diarrhea (89%), palmar-plantar erythrodysesthesia (57%), nausea (33%), vomiting (26%), and decreased appetite (22%). Grade 3/4 drug-related AEs in ≥5% of patients were diarrhea (25%) and palmar-plantar erythrodysesthesia (13%). Eight patients withdrew from part 2 due to AEs, including 4 who withdrew due to diarrhea. Dose interruptions of neratinib and capecitabine, respectively, due to AEs were required by 19 and 29 patients; dose reductions due to AEs were required by 8 and 22 patients. As of June 2010 (interim analysis), 22 patients were evaluable for efficacy in part 2 of the study. Of these 22 patients, 11 achieved a partial response for an ORR of 50%. An additional 2 patients maintained stable disease for ≥24 weeks, resulting in a clinical benefit rate of 59%, and 8 patients had stable disease for &lt;24 weeks. One patient had progressive disease without achieving a response or stable disease. Updated efficacy data will be presented.

Conclusions: The results of this study indicate that neratinib combined with capecitabine is tolerable and has promising antitumor activity in patients with ErbB2+ metastatic or locally advanced breast cancer pretreated with trastuzumab. This study supports further evaluation of this combination in ErbB2+ breast cancer.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-12-09.

P5-13-20: TOP2A Amplification Have Associated with Response to Anthracycline-Based Preoperative Chemotherapy in Primary Breast Cancer

Background: Recent studies have suggested that HER2 gene amplification or overexpression have association with sensitivity of anthracycline-based chemotherapy. Preclinical studies found that TOP2A amplification or deletion only could be detected in HER2 amplification or over-expressive cases. And TOP2A protein is the target of anthracycline. In fact, the value of HER2 for predicting response to anthracycline-based chemotherapy in breast cancer may be more likely related to the concomitant amplification of the TOP2A gene. In this study we studied the association between TOP2A gene amplification and response to anthracycline-based preoperative chemotherapy. Methods: 309 early and local advanced breast cancer cases were enrolled in our study. HER2 proteins were qualitatively analysed by IHC, and TOP2A gene alterations were quantified by real-time polymerase chain reaction (RT-PCR) in primary tumor core biopsies from all HER2 over expressive cases. The enrolled patients received an intense dose dense (IDD) (CE, Cyclophosphamide + Epirubicin) or conventionally (TE, Paclitaxel+Epirubicin) scheduled anthracycline- based preoperative chemotherapy. The tumor was evaluated every two cycles. Median time on study for 309 patients with follow-up was 38 months. Results: The pCR was 14.3%. HER2 overexpression was found in 80/309 (25.9%) breast cancer cases, of which 61/80 cases have been tested for TOP2A status. 19/80 cases have not been tested for TOP2A status because of lacking core biopsies tumor tissue after pathological diagnosis. HER2 overexpression was associated with a significantly higher pCR rate compared to HER2 lower expression (27.5% vs. 9.6%, P&lt;0.001). Further analysis was carried on and found the significantly higher pCR rate in TOP2A co-amplified cases compared to TOP2A deleted or normal cases (56.3% vs. 13.8%, P=0.001). HER2 overexpression was associated with a significantly higher pathologic complete response (pCR) rate only when TOP2A was co-amplified (56.3% vs. 9.6%, P&lt;0.001), but not when deleted or normal (13.8% vs. 9.6%, P=0.183), compared to HER2 lower expression tumors. The interaction between HER2 or TOP2A and anthracycline-based regiment was observed not only in IDD but conventionally scheduled preoperative chemotherapy. Discussion: Previous studies demonstrate that TOP2A gene amplification may define a subtype of HER2−positive breast cancer, This subtype of breast cancer may be highly sensitive to anthracycline-based chemotherapy, which may improve progression in HER2 and TOP2A co-amplification cases. Howerver, this viewpoint needs suppose from preoperative chemotherapy. Using RT-PCR to test TOP2A statue from 61 primary breast cancer tumor tissue, we demonstrate that TOP2A amplification breast cancer have highly sensitive to anthracycline-based preoperative chemotherapy. This finding suggests that TOP2A as a predictive marker in breast cancer should be included in future studies.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-13-20.

Preoperative three-dimensional reconstruction in vascularized fibular flap transfer

OBJECTIVE

The objective of this study was to investigate the added value of preoperative computerized tomographic angiography (CTA) and three-dimensional reconstruction of the lower limb in vascularized fibular flap transfer.

METHODS

Eighteen patients who underwent mandibular or maxillary reconstruction with a vascularized fibular flap were studied retrospectively by image analysis. The original DICOM data of preoperative CTA were analysed and applied to the reconstruction of the lower limb using SimPlant Pro software (version 11.04).

RESULTS

The course of the peroneal artery in 17 patients was the same except for one patient. The peroneal artery originates from the posterior tibial artery. The original external diameters of the peroneal artery were 2.99 ± 0.64 mm. The perpendicular lengths from fibular head to the origin of the peroneal artery and to the fibular perforator vessel were 42.88 ± 8.84 mm and 174.55 ± 25.62 mm, respectively.

CONCLUSION

The course of peroneal artery was relatively invariable, its original external diameter was thick. Preoperative CTA and three-dimensional reconstruction of the lower limb, which are noninvasive, accurate and direct-viewing methods, play an important, preoperative role in vascularized fibular flap transfer for lower limb vascular assessment.

Effects of pH Values of Hydrogen Peroxide Bleaching Agents on Enamel Surface Properties

This study investigated the influence of pH values of bleaching agents on the properties of the enamel surface. Sixty freshly extracted premolars were embedded in epoxy resin and mesiodistally sectioned through the buccal aspect into two parts. The sectioned slabs were distributed among six groups (n=10) and treated using different solutions. Group HCl was treated with HCl solution (pH=3.0) and served as a positive control. Group DW, stored in distilled water (pH=7.0), served as a negative control. Four treatment groups were treated using 30% hydrogen peroxide solutions with different pH values: group HP3 (pH=3.0), group HP5 (pH=5.0), group HP7 (pH=7.0), and group HP8 (pH=8.0). The buccal slabs were subjected to spectrophotometric evaluations. Scanning electron microscopy investigation and Micro-Raman spectroscopy were used to evaluate enamel surface morphological and chemical composition alterations. pH value has a significant influence on the color changes after bleaching (p&lt;0.001). Tukey's multiple comparisons revealed that the order of color changes was HP8, HP7&gt;HP5, HP3&gt;HCl&gt;DW. No obvious morphological alterations were detected on the enamel surface in groups DW, HP7, and HP8. The enamel surface of groups HCl and HP3 showed significant alterations with an erosion appearance. No obvious chemical composition changes were detected with respect to Micro-Raman analysis. Within the limitations of this study, it was concluded that no obvious morphological or chemical composition alterations of enamel surface were detected in the neutral or alkaline bleaching solutions. Bleaching solutions with lower pH values could result in more significant erosion of enamel, which represented a slight whitening effect.

Inconsistency and comprehensiveness of risk assessments for heavy metals in urban surface sediments

Numerous indices have been developed to assess environmental risk of heavy metals in surface sediments, including the total content based geoaccumulation index (I(geo)), exchangeable fraction based risk assessment code (RAC), and biological toxicity test based sediment quality guidelines (SQGs). In this study, the three indices were applied to freshwater surface sediments from 10 sections along an urbanization gradient of the Grand Canal, China to assess the environmental risks of heavy metals (Cu, Pb, Zn, Cd, and Cr) and to understand discrepancies of risk assessment indices and urbanization effects regarding heavy metal contamination. Results showed that Cd, Zn, and Pb were the most enriched metals in urban sections assessed by I(geo) and over 95% of the samples exceeded the Zn and Pb thresholds of the effect range low (ERL) of SQGs. According to RAC, Cu, Zn, Cd, and Cr had high risks of adversely affecting the water quality of the Grand Canal due to their remarkable portions of exchangeable fraction in surface sediment. However, Pb showed a relative low risk, and was largely bounded to Fe/Mn oxides in the urban surface sediments. Obviously, the three assessment indices were not consistent with each other in terms of predicting environmental risks attributed to heavy metals in the freshwater surface sediments of this study. It is recommended that risk assessment by SQGs should be revised according to availability and site specificity. However, the combination of the three indices gave us a comprehensive understanding of heavy metal risks in the urban surface sediments of the Grand Canal.

Secondary chondrosarcoma in the mandibular condyle

We report the case of a woman who had secondary chondrosarcoma in an osteochondroma in the left mandibular condyle, presenting as a large lobulated bone density mass in the left condyle process, to illustrate the clinical characteristics and imaging findings.

Climatic modifiers of the response to nitrogen deposition in peat-forming Sphagnum mosses: a meta-analysis

Peatlands in the northern hemisphere have accumulated more atmospheric carbon (C) during the Holocene than any other terrestrial ecosystem, making peatlands long-term C sinks of global importance. Projected increases in nitrogen (N) deposition and temperature make future accumulation rates uncertain. Here, we assessed the impact of N deposition on peatland C sequestration potential by investigating the effects of experimental N addition on Sphagnum moss. We employed meta-regressions to the results of 107 field experiments, accounting for sampling dependence in the data. We found that high N loading (comprising N application rate, experiment duration, background N deposition) depressed Sphagnum production relative to untreated controls. The interactive effects of presence of competitive vascular plants and high tissue N concentrations indicated intensified biotic interactions and altered nutrient stochiometry as mechanisms underlying the detrimental N effects. Importantly, a higher summer temperature (mean for July) and increased annual precipitation intensified the negative effects of N. The temperature effect was comparable to an experimental application of almost 4 g N m(-2)  yr(-1) for each 1°C increase. Our results indicate that current rates of N deposition in a warmer environment will strongly inhibit C sequestration by Sphagnum-dominated vegetation.