Do volar locking plates fit the volar cortex of the distal radius?

The purpose of this study was to measure the volar cortical angles of the commercially available volar locking plates and evaluate how well they fit the distal radius. We measured the volar cortical angles of the radial and intermediate columns of eight volar locking plates and compared them with the volar cortical angles of 90 cadaver distal radii. The mean radial and intermediate column volar cortical angles of the wider plates were significantly larger than those of narrower plates. The mean radial and intermediate column volar cortical angles were significantly larger in wider radii than narrower radii. The width of the distal radius did not correlate well with the mean volar cortical angles of the radial and intermediate columns.

LEVEL OF EVIDENCE

IV.

Abstract P1-02-11: Clinical utility of serial monitoring of circulating tumor DNA (ctDNA)in patients with neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC)

Introduction: Circulating tumor DNA (ctDNA) is a new biomarker which could guide further treatment. Characterization of tumor mutation profiles is required for informed choice of therapy, given that biological agents target specific pathways and effectiveness may be modulated by specific mutations. It would have clinical utility for neoadjuvant setting also. Thus, we assess the potency of ctDNA to predict tumor response to neoadjuvant chemotherapy(NAC) in locally advanced breast cancer(LABC).

Methods: We performed targeted deep sequencing of 30 plasma DNAs and 10 matched germline DNAs from 10 LABC patients. Serial plasma DNAs were collected at diagnosis, after 1st NAC and curative surgery. For the target enrichment, we designed RNA baits covering a total of ~202kb regions of human genome including a total of 83 cancer-related genes. We constructed the sequencing libraries according to the optimized protocol that we recently reported and sequenced on Illumina HiSeq2500 aiming a mean sequencing depth of ~10,000. After excluding unmapped reads, PCR duplicates and off-target reads, the coverage depths for plasma DNA and germline DNA samples were 2,627x and 4,833x on average, respectively. NAC response was measured by residual cancer burden(RCB) score, calculated as a continuous index combining pathologic measurements of primary tumor and nodal metastases for prediction of distant relapse-free survival.

Results: We analyzed ctDNA and primary tumor tissues from 10 patients with LABC scheduled NAC followed by operation in Samsung Medical Center. Of ten LABCs, one excluded from analysis because of angiosarcoma of breast. Five samples were triple-negative breast cancers (BCs), 2 were HER2 positive BCs and others were ER positive BCs. In tumor response, 1 patient had pathologic complete response (pCR), 1 had RCB class I, 4 and 3 patients did RCB class II and III.

Of 83 genes, in analysis of ctDNA at BC diagnosis, we found 2 to 6 mutations in each samples and 3 mutations were detected averagely. Most common mutation was TP53 (6 patients), followed by PIK3CA mutation. By measuring these mutations in serial ctDNA, we found that ctDNA had disappeared after first cycle of NAC in patient with pCR. In two patients with RCB class I, ctDNA had decreased by more than 10 percent (the level of ctDNA(pg/ml): 455.9 to 30.4, 5.8 to 0.0) of primary plasma sample after first NAC. Two patients increased level of ctDNA had tumor response with RCB class III and one patient had distant tumor recurrence within 3 months after curative surgery. However, correlation between the level of ctDNA and initial stage was not observed.

Patient No.Initial stageSurgical stageRCB scoreRCB classct DNA at diagnosis (pg/5ml)ctDNA after 1st NAG (pg/5ml)Tumor recurrence12A11.3331455.930.4No22B00pCR446.60.0No33B2A1.31515.80.0No42A12.132246.255.4No52B11.7972107.811.6No63B3A4.09033401.15075.5Yes73A2B3.92235088.68536.7No

Conclusions: This preliminary result suggests that serial monitoring of ctDNA would be a potiential surrogate marker to predict tumor response and recurrence during NAC in LABC patients. Further results with long-term outcomes are warranted.

Citation Format: Kim J-Y, Park D, Jung HH, Bae SY, Yu JH, Lee SK, Kim SW, Lee JE, Nam SJ, Ahn JS, Im Y-H, Park YH. Clinical utility of serial monitoring of circulating tumor DNA (ctDNA)in patients with neoadjuvant chemotherapy (NAC) for locally advanced breast cancer (LABC) [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 P1-02-11.

The impact of the acute respiratory distress syndrome on outcome after oesophagectomy

BACKGROUND

The Acute Respiratory Distress Syndrome (ARDS) is a serious complication of major surgery and consumes substantial healthcare resources. Oesophagectomy is associated with high rates of ARDS. The aim of this study was to characterize patients and identify risk factors for developing ARDS after oesophagectomy.

METHODS

A secondary analysis of data from 331 patients gathered during the Beta Agonists Lung Injury Prevention Trial was undertaken. Characteristics and outcomes of patients with early (first 72 h postoperatively) and late (after 72 h) ARDS were determined. Linear and multivariate regression analysis was used to study the differences between early and late ARDS and identify risk factors.

RESULTS

ARDS was associated with more non-respiratory organ failure (early 44.1%, late 75.0%, no ARDS 27.6% P<0.001), longer ICU stay (mean early 12.1, late 20.2, no ARDS 7.3 days P<0.001) and longer hospital stay (mean early 18.1, late 24.5, no ARDS 14.2 days P<0.001) but no difference in mortality or quality of life. Older patients (OR 1.06 (1.00 to 1.13), P=0.045) and those with mid-oesophageal tumours (OR 7.48 (1.62-34.5), P=0.010) had a higher risk for ARDS.

CONCLUSIONS

Early and late ARDS after oesophagectomy increases intensive care and hospital length of stay. Given the high incidence of ARDS, cohorts of patients undergoing oesophagectomy may be useful as models for studies investigating ARDS prevention and treatment. Further investigations aimed at reducing perioperative ARDS are warranted.

Validation of Hearts-Map, A Psychosocial Assessment Tool Applied to Children and Youth with Mental Health-Related Paediatric Emergency Visits

BACKGROUND: Mental health-related pediatric emergency department (PED) visits are increasing annually, and there is a need for a validated comprehensive standardized assessment tool to better manage these patients.

OBJECTIVES: The primary objective of this study was to evaluate HEARTSS-MAP, a psychosocial assessment tool, in terms of inter-rater agreement among clinicians as well as the tool’s performance in predicting needs for acute psychiatric consultation for hospitalization.

DESIGN/METHODS: The HEARTSS-MAP evaluation was done in two phases. We retrospectively reviewed 101 cases randomly sampled from a cohort of patients who sought care at the BC Children’s Hospital (BCCH) PED for mental health complaints. Narratives pertaining to each patient’s psychosocial assessment were recorded. Clinicians, including two emergency physicians, a bedside nurse, a nurse practitioner, and two psychiatrists, were blinded to the patients' outcomes, and individually applied the HEARTSS-MAP tool to the clinical narratives. The inter-rater agreement was calculated using Cohen’s kappa statistics. We then evaluated the tool’s sensitivity and specificity in predicting admission for the retrospective cohort, as well as a prospective cohort of 62 patients assessed and managed by a PED clinician using the HEARTSS-MAP.

RESULTS: There was substantial agreement between the two pediatric emergency reviewers (κ=0.7), and moderate agreement between the pedi-atric emergency physicians and the nurse practitioner (κ=0.6), and the bedside nurse (κ=0.5). Pediatric psychiatrists had fair agreement between themselves (κ=0.3), and between psychiatrists and emergency physicians (κ=0.4). Based on retrospective data, HEARTSS-MAP had a sensitivity of 91% (95%CI: 71 to 99%), and a specificity of 41% (95%CI: 30 to 53%). When applied to prospectively collected data, the sensitivity was 100% (95%CI: 75 to 100%), and specificity was 33% (95%CI: 20 to 48%).

CONCLUSION: HEARTSS-MAP, the first standardized psychosocial assessment tool to be implemented at BCCH PED, demonstrates strong inter-rater reliability between emergency clinicians, with a high sensitivity in identifying patients with mental health complaints requiring hospital admission.

Evaluation of anti-acne properties of phloretin in vitro and in vivo

OBJECTIVE

This study aimed to investigate the anti-acne properties of phloretin in vitro and in vivo.

METHODS

Anti-microbial activity against Propionibacterium acnes (P. acnes), Propionibacterium granulosum (P. granulosum) and Staphylococcus epidermidis (S. epidermidis) were observed by the minimum inhibitory concentration (MIC) and disc diffusion methods. The anti-inflammatory effects were studied in HaCaT cells based on P. acnes-induced inflammatory mediators, including PGE2 and COX-2, examined through enzyme-linked immunosorbent assay (ELISA) and luciferase reporter gene assay. Thirty healthy subjects with whiteheads participated in the clinical study. Comedo counting, and the amount of sebum and porphyrin were measured before treatment and following 4 consecutive weeks of treatment with phloretin.

RESULTS

Phloretin showed anti-microbial activities against P. acnes, P. granulosum, S. epidermidis with the MIC of 0.5, 0.5 and 0.25 mg mL(-1) , respectively. P. acnes-induced activation of the COX-2 promoter was markedly attenuated by phloretin treatment. Consistent with these results, inhibition of PGE2 production was also observed. In 1-month, placebo-controlled trials, phloretin showed clinically and statistically significant reduction of comedo counts and sebum output level. Compared to before treatment, whiteheads, blackheads, papules, sebum output level and amount of sebum and porphyrin were significantly decreased at 4 weeks in the test group.

CONCLUSIONS

This study revealed that phloretin inhibits the growth of P. acnes, P. granulosum, and S. epidermidis. In addition, we demonstrated that phloretin attenuates COX-2 and PGE2 expression during the P. acnes-induced upregulation of inflammatory signalling. Clinical studies further suggested that treatment with formulations containing phloretin confers anti-acne benefits. Based on these results, we suggest that phloretin may be introduced as a possible acne-mitigating agent.