Abstract P5-10-05: Time differences in breast cancer diagnosis among minorities in a large referal academic center

Background: Breast cancer (BC) is the most common malignancy and leading cause of cancer death in women. BC incidence is lower in Hispanic (H) (91.9/100,000) compared to non-Hispanic Whites (NHW -128.1/100.000) and Non-Hispanic Black (NHB - 124.3/100,000) population; however, mortality rate is higher in NHB (31/100,000) compared to NHW (21.9/100,000) and H (14.5/100,000). Diagnosis delay is a plausible factor that may explain differences in BC clinical outcomes among different race/ethnicity subgroups.

Objective: To compare time to diagnosis (TTD) by race/ethnicity in women with breast cancer diagnosed at Montefiore Medical Center from 2004 to 2012.

Methods: Patients with breast cancer and available race/ethnicity information diagnosed between 2004 and 2012 were categorized into 4 race/ethnicity groups: NHB, NHW, H or Asian. Dates of screening mammogram, diagnostic mammogram and biopsy were obtained. TTD was defined as the time difference between abnormal mammogram and biopsy dates.

Results: 919 patients had ethnicity information, 302 (32.8%) were H. TTD was longer in H compared to non-Hispanics (35 vs 31 days, z=2.2, p=0.02). Race and ethnicity information was available for 834 patients with a mean age of 62 years (SD:12.4). Of these, 252 (30.2%) were H and 387 (46.4%) were NHB. NHW had the shortest TTD (30 days), the highest frequency of Stage I (70%) and lowest frequency of high-nuclear grade (15.6%). NHB had a TTD of 31 days and higher frequency of triple negative disease (18.9%). TTD was significantly longer in H compared to NHW (35 vs 30 days, z=2.3, p=0.02), and there was a non-significant longer TTD when comparing H versus NHB (35 vs 31 days, z=1.9, p=0.0574). TTD between NHB and NHW was not different (31 vs 30 days, z=1.4, p=0.14).

Conclusions: The longer TTD in H vs Non-Hispanics was driven by the TTD in NHW. NHW had shorter TTD and more favorable pathological features which could lead to lower mortality rate. There was no difference in TTD between NHW and NHB but the latter had higher frequencies of triple negative disease. Correlation between TTD and mortality in our population will help to clarify the clinical effect of TTD differences among race/ethnicity subgroups.

 Total (n= 834)Not Hispanic Black (n=387)Not Hispanic White (n=180)Hispanic (n=302)Asian (n=15)Age (SD)62 (12.4)62.965.261.6 (11.9)53.2Stage*     I613 (65.7)239 (61.6)126 (70)202 (67.3)10 (66.7)II242 (25.9)121 (31.3)36 (20)71 (23.7)3 (20)III56 (6)19 (4.9)12 (6.7)20 (6.7)3 (15.3)IV21 (2.3)8 (2.1)6 (3.3)7 (2.3)1 (1)Histology*     IDC697 (75.1)292 (75.5)121 (67.2)224 (74.7)13 (86.7)ILC81 (8.7)34 (8.8)23 (12.8)21 (7)2 (13.3)Mixed140 (15.1)57 (14.7)33 (18.3)49 (16.3)0 (0)Grade*     High253 (28.4)138 (35.7)28 (15.6)73 (24.3)4 (26.7)Moderate426 (48)155 (40.1)86 (47.8)151 (50.3)9 (60)Low210 (23.6)83 (21.5)49 (27.2)62 (20.7)1 (6.7)Receptor status*     ER positive762 (81.8)286 (73.9)162 (90)258 (86)12 (80)PR positive632 (67.8)229 (59.2)137 (76.1)219 (73)11 (73.3)HER-2 positive143 (15.4)70 (18.1)14 (7.8)49 (16.3)5 (33.3)Triple negative115 (12.3)73 (18.9)14 (7.8)21 (7)1 (6.7)Times     Time to diagnosis33 (20-52)31 (19-52)30 (19-44.5)35 (21-58.5)42 (21-72)Screening to Diagnostic22 (14-36)22 (13-36)21 (13-32)23 (14-14)26 (17-37)Diagnostic to Biopsy7 (0-13)7 (0-13)6 (0-14)7 (1-13)5 (0-9)

Citation Format: Acuna A, Gligich O, Khan H, Xue X, Lin J, Sparano J, Anampa J. Time differences in breast cancer diagnosis among minorities in a large referal academic center [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 P5-10-05.

Assessment of Combined Ascorbyl Palmitate (AP) and Sodium Ascorbyl Phosphate (SAP) on Facial Skin Sebum Control in Female Healthy Volunteers

The skin is fortified with a setup of lipophilic and hydrophilic, enzymatic and non-enzymatic antioxidant systems. Ascorbyl palmitate (AP) and sodium ascorbyl phosphate (SAP) are reported as lipophilic and hydrophilic antioxidants, respectively used for skin care. Present study was aimed to assess the combined AP (in oil phase) and SAP (in aqueous phase) via multiple emulsion (ME₁) for controlling sebum secretions in healthy human females. FTIR analysis of AP and SAP was performed for identification. Multiple emulsions (ME₁ and control) were prepared and analyzed for physical stability. Antioxidant activities of AP, SAP as well as ME₁ (with combination of these compounds) were determined by DPPH method. 11 female volunteers were included in a single-blinded, placebo-controlled, split-face comparative study. Volunteers were instructed to apply ME₁ on left cheek while control (without AP and SAP) on right cheek, for a period of 90 days. A non-invasive photometric device (Sebumeter^®) was used for the measurement of sebum secretions on both sides of the face with subsequent time intervals. A good antioxidant activity of ME₁ was observed. ME₁ treatments reduced significant facial sebum secretions as compared with control/placebo treatments. It was concluded that combined AP and SAP supplementations to skin proved a promising choice for controlling facial sebum secretions and could be evaluated for undesired oily skin and acne reductions for beautifying the facial appearance.

The impact of age on nodal metastases and survival in gastric cancer

BACKGROUND

In gastric adenocarcinoma, the disparity in lymph node involvement between different age groups has not been thoroughly investigated. The objective of our study was to compare age-associated differences in adequate lymph node harvest and nodal involvement in gastric adenocarcinoma patients.

METHODS

We analyzed data extracted from the Surveillance, Epidemiology and End Results database on 13,165 patients diagnosed with stage I-III gastric adenocarcinoma between 2004 and 2011. All patients underwent surgical resection. Statistical comparisons between various age groups were done using the chi-square test and Cox regression.

RESULTS

Among 13,165 gastrectomy patients, proportion of patients that had >15 lymph nodes examined decreases significantly with increasing age (P < 0.0001). When adequately staged, older patients had a significantly lower proportion of node-positive tumors (P < 0.0001). Adequate nodal staging was also associated with improved 5-y disease-specific survival across all age groups.

CONCLUSIONS

In gastric adenocarcinoma, older patients are less likely to be adequately staged. However, when adequately staged, they are less likely to have node-positive tumors. Adherence to national guidelines, regardless of age, is associated with improved survival outcomes and may alter multimodality management of gastric cancer in the elderly.

An insidious case of hepatic artery pseudoaneurysm secondary to acalculus cholecystitis

A 68-year-old man with expressive dysphasia presented with upper gastrointestinal haemorrhage, jaundice and abdominal pain. He was unable to tolerate ultrasound tranducer pressure. His oesophagogastroduodenoscopy (OGD) showed large blood clots in the stomach with blood trickling from the ampulla. An urgent CT angiogram demonstrated a 32 mm pseudoaneurysm within the gallbladder fossa. The patient subsequently underwent an endovascular embolisation of the pseudoaneurysm performed by the interventional radiology team.

Stability of Field-Selected Resistance to Conventional and Newer Chemistry Insecticides in the House Fly, Musca domestica L. (Diptera: Muscidae)

The house fly, Musca domestica L. (Diptera: Muscidae), is a pest of livestock and has the ability to develop resistance to different insecticides. We assessed the fluctuations in seasonal stability of house fly resistance to insecticides from poultry facility populations in Pakistan. House fly populations were collected from poultry facilities located at Khanewal, Punjab, Pakistan in three seasons (July, November, and March) to investigate the fluctuations in their resistance to conventional (organophosphate, pyrethroid) and novel chemistry (spinosyn, oxadiazine, neonicotinoid) insecticides. Laboratory bioassays were performed using the feeding method of mixing insecticide concentrations with 20% sugar solutions, and cotton pads dipped in insecticide solutions were provided to tested adult flies. Bioassay results showed that all house fly populations had varying degrees of susceptibility to tested insecticides. Comparisons between populations at different seasons showed a significant fluctuation in susceptibility to organophosphate, pyrethroid, spinosyn, oxadiazine, and neonicotinoid insecticides. Highest resistant levels were found for organophosphate when compared with other tested insecticides. The resistance to conventional insecticides decreased significantly in March compared with July and November, while resistance to oxadiazine and avermectins decreased significantly in November. However, resistance to spinosad and imidacloprid remained stable throughout the seasons. All conventional and novel chemistry insecticides were significantly correlated with each other in all tested seasons except nitenpyram/lambda-cyhalothrin and nitenpyram/imidacloprid. Our data suggests that the variation in house fly resistance among seasons could be due to fitness costs or to the cessation of selection pressure in the off-season. These results have significant implications for the use of insecticides in house fly management.

Familial effects on structural changes relevant to knee osteoarthritis: a prospective cohort study

OBJECTIVE

Genetic factors play an important role in the pathogenesis of knee osteoarthritis (OA), but which knee structural changes mediate this is unclear. This study aimed to describe the differences in knee structural changes over 8-10 years between offspring having at least one parent with total knee replacement (TKR) for severe primary knee OA and controls with no family history of knee OA.

DESIGN

115 offspring (mean age 45 years) with a family history of TKR for severe knee OA were compared with 104 (mean age 46 years) controls. T1 or T2-weighted fat saturated magnetic resonance imaging (MRI) was performed respectively to evaluate knee cartilage defects, bone marrow lesions (BMLs), meniscal extrusion and tears at baseline and 10 years. Multivariate logistic regression model was used to adjust for potential confounders.

RESULTS

Offspring had a greater increase in cartilage defect score (1.03 vs 0.52, P = 0.007) and meniscal extrusion score (0.28 vs 0.10, P = 0.027) over 10 years, and a greater increase in meniscal tear score (0.40 vs 0.10, P = 0.012) over 8 years in the medial but not the lateral tibiofemoral compartment. Changes in BMLs over 8-years were not different between the two groups. These associations were independent of potential confounders, and strengthened after further adjustment for each other.

CONCLUSION

With the exception of BMLs, offspring with a family history of knee OA have a greater risk of increases in multiple knee structural abnormalities in the medial tibiofemoral compartment suggesting pleiotropic familial effects.

RanBP9 at the intersection between cofilin and Aβ pathologies: rescue of neurodegenerative changes by RanBP9 reduction

Molecular pathways underlying the neurotoxicity and production of amyloid β protein (Aβ) represent potentially promising therapeutic targets for Alzheimer's disease (AD). We recently found that overexpression of the scaffolding protein RanBP9 increases Aβ production in cell lines and in transgenic mice while promoting cofilin activation and mitochondrial dysfunction. Translocation of cofilin to mitochondria and induction of cofilin–actin pathology require the activation/dephosphorylation of cofilin by Slingshot homolog 1 (SSH1) and cysteine oxidation of cofilin. In this study, we found that endogenous RanBP9 positively regulates SSH1 levels and mediates Aβ-induced translocation of cofilin to mitochondria and induction of cofilin–actin pathology in cultured cells, primary neurons, and in vivo. Endogenous level of RanBP9 was also required for Aβ-induced collapse of growth cones in immature neurons (days in vitro 9 (DIV9)) and depletion of synaptic proteins in mature neurons (DIV21). In vivo, amyloid precursor protein (APP)/presenilin-1 (PS1) mice exhibited 3.5-fold increased RanBP9 levels, and RanBP9 reduction protected against cofilin–actin pathology, synaptic damage, gliosis, and Aβ accumulation associated with APP/PS1 mice. Brains slices derived from APP/PS1 mice showed significantly impaired long-term potentiation (LTP), and RanBP9 reduction significantly enhanced paired pulse facilitation and LTP, as well as partially rescued contextual memory deficits associated with APP/PS1 mice. Therefore, these results underscore the critical importance of endogenous RanBP9 not only in Aβ accumulation but also in mediating the neurotoxic actions of Aβ at the level of synaptic plasticity, mitochondria, and cofilin–actin pathology via control of the SSH1-cofilin pathway in vivo.

Smart microneedle coatings for controlled delivery and biomedical analysis

The work presented demonstrates an unconventional approach in the preparation of smart microneedle (MN) coatings utilising electrohydrodynamic atomisation (EHDA) principles. Stainless steel (600-900 µm in height) MNs were coupled to a ground electrode (in the EHDA coating set-up) with the deposition distance and collecting methodology varied for an ethanol:methanol (50:50) vehicle system. The preparation of nano- and micrometre-scaled pharmaceutical coatings was achieved. Fluorescein dye (serving as potential drug, sensory materials or disease state markers) and polyvinylpyrrolidone (PVP, polymer matrix system) formed the remaining components of the coating formulation. Based on these excipients and by varying the coating process, particles (100 nm to 3 µm) and fibres (400 nm to 1 µm) were deposited directly on MNs in controlled and selectable fashion (flow rates variable ∼ 5-50 µL/min, applied voltage variable 6-19 kV). These demonstrated options for multiple targeting and analysis applications. The underlying EHDA process permits room temperature fabrication, controlled output and scale-up potential for emerging MN devices as drug systems or lab-chip testing devices.

G-CSF and G-CSFR are highly expressed in human gastric and colon cancers and promote carcinoma cell proliferation and migration

Background:

Granulocyte colony-stimulating factor (G-CSF) is a pro-inflammatory cytokine that stimulates myeloid stem cell maturation, proliferation, and migration into circulation. Despite being a known growth factor, the impact of G-CSF on solid tumours has not been well examined. G-CSF receptor (G-CSFR) is expressed by some tumours, and thus the aim of this study was to examine the expression and impact of G-CSF and G-CSFR on gastrointestinal tumours.

Methods:

In this study, G-CSF expression was examined in human gastric and colon tumours and by tumour-derived stromal myofibroblasts and carcinoma cells. G-CSFR expression was examined on carcinoma cells isolated from human tissues. The effects of G-CSF on gastric and colon carcinoma cell proliferation, migration, and signalling were examined.

Results:

G-CSFR was highly expressed in 90% of human gastric and colon carcinomas. G-CSF was also found to be highly produced by stromal myofibroblasts and carcinoma cells. Exposure of carcinoma cells to G-CSF led to increased proliferation and migration, and expansion of a sub-population of carcinoma cells expressing stem-like markers. These processes were dependent on ERK1/2 and RSK1 phosphorylation.

Conclusions:

These data suggest that the G-CSF/R axis promotes gastric and colorectal cancer development and suggest they are potential tumour targets.

Clinical benefits of concurrent capecitabine and cisplatin versus concurrent cisplatin and 5-flurouracil in locally advanced squamous cell head and neck cancer

We aimed to assess the efficacy and safety of concurrent capecitabine and cisplatin over concurrent cisplatin and 5-flurouracil (5-FU) in locally advanced squamous cell carcinoma of the head and neck. One hundred and fifty-three patients (all of whom had stage III or IV unresectable disease with no distant metastases and who had received two cycles of taxol and cisplatin chemotherapy) were randomly assigned to receive either concurrent cisplatin (75 mg/m(2) in day 1 and 2) and 5-FU (750 mg/m(2) in day 1, 2, and 3) from the first day of radiotherapy at an interval of 3 weeks (Arm I) or cisplatin (75 mg/m(2) in day 1 and 2) and capecitabine (750 mg/m(2) in two divided doses from day 1-14) from the first day of radiotherapy at a 3-week interval (Arm II). Results showed that patients in Arm II had a significantly better rate of complete response, fewer nodes, and better overall response compared to those in Arm I. The two groups had a similar 3-year disease-free survival, progression free survival, and overall survival, i.e. they did not differ significantly. Variables indicating the quality of life of the two groups were compared. Patients in Arm II had a significantly higher quality of life compared to those in Arm I. The two groups had similar treatment-related acute and late toxicity, i.e. they did not differ significantly. These results have thoroughly substantiated the contention that concurrent chemoradiation with capecitabine and cisplatin may be regarded as an effective and well-tolerated regimen in the treatment of the patients with locally advanced head and neck cancer.

Design and construction of a single tube, quantitative endpoint, LATE-PCR multiplex assay for ventilator-associated pneumonia

AIMS

The goal of this study was to develop a molecular diagnostic multiplex assay for the quantitative detection of microbial pathogens commonly responsible for ventilator-associated pneumonia (VAP) and their antibiotic resistance using linear-after-the-exponential polymerase chain reaction (LATE-PCR).

METHOD AND RESULTS

This multiplex assay was designed for the quantitative detection and identification of pathogen genomic DNA of methicillin-resistant Staphylococcus aureus (MRSA), Acinetobacter baumannii, Pseudomonas aeruginosa, plus a control target from Lactococcus lactis. After amplification, the single-stranded amplicons were detected simultaneously in the same closed tube by hybridization to low-temperature molecular beacon probes labelled with four differently coloured fluorophores. The resulting hybrids were then analysed by determining the fluorescence intensity of each of the four fluorophores as a function of temperature.

CONCLUSIONS

This LATE-PCR single tube multiplex assay generated endpoint fluorescent contours that allowed identification of all microbial pathogens commonly responsible for VAP, including MRSA. The assay was quantitative, identifying the pathogens present in the sample, no matter whether there were as few as 10 or as many 100 000 target genomes.

SIGNIFICANCE AND IMPACT OF THE STUDY

This assay is rapid, reliable and sensitive and is ready for preclinical testing using samples recovered from patients suffering from ventilator-associated pneumonia.

Determination of the mode of action of enterolysin A, produced by Enterococcus faecalis B9510

AIM

The current study aimed to visualize the damage caused by enterolysin A to the cells of sensitive strains and to find out cleavage site within the peptidoglycan moiety of bacterial cell walls.

METHODS AND RESULTS

Enterolysin A produced by a local isolate, Enterococcus faecalis B9510 was found to rapidly kill cells of the sensitive strain Lactococcus lactis ssp. cremoris 2144 during 120 min of treatment as compared to the untreated control where no such effect was observed. Transmission electron microscopy of the enterolysin A-treated cells revealed leaking of the cytoplasmic contents ultimately resulting in complete lysis of cell walls. To find the cleavage site, purified cell walls of L. lactis ssp. cremoris 2144, Pediococcus pentosaceus 43201 and Lactobacillus delbrueckii ssp. bulgaricus ATCC 11842 were treated with enterolysin A, and liberated amino acids were derivatized for N and C terminals and analysed using thin layer chromatography on silica gel with isopropanol as solvent. The results showed that enterolysin A cleaves the peptide bonds at two locations within peptidoglycan subunits. The first location is between L-alanine and D-glutamic acid of the stem peptide and the other location is between L-lysine of the stem peptide and D-aspartic acid of the interpeptide bridge.

CONCLUSIONS

Enterolysin A cleaves the peptide bonds within the stem peptide as well as in the interpeptide bridge of Gram-positive bacterial cell walls. This gives a possible reason for the broad spectrum of enterolysin A activity.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first report identifying the cleavage site of enterolysin A within the cell walls of sensitive bacteria. This will help in identifying potential applications for enterolysin A.

Methylation profile of promoter region of p16 gene in colorectal cancer patients of Kashmir valley

Colorectal cancer (CRC) commonly known as bowel cancer is the third most common cause of cancer-related deaths in the western world and has been reported to show geographical variation in its incidence. Cancer development and progression is a complex process dictated by changes in expression and regulation of various genes which include tumor suppressor genes, DNA repair genes, translation regulatory genes and others. The aim of this case control study was to analyze the promoter hypermethylation at CpG islands of p16 gene in CRC patients among the Kashmiri population and co- relate it with expression pattern of p16. Genomic DNA was isolated from surgically resected tumor and adjacent normal samples and was modified using bisulphite modification kit. Methylation-specific polymerase chain reaction (PCR) was setup for the analysis of the promoter hypermethylation of p16 gene. The epigenetic analysis revealed that unlike other high risk regions, Kashmiri population has a different promoter hypermethylation profile of p16 gene as 66 percent of the cases showed p16 promoter hypermethylation in comparison to 20 percent of the normal cases which also showed promoter hypermethylation of p16 gene. The association of promoter hypermethylation with colorectal cancer was found to be significant (P=0.0006). Occurrence of p16 promoter hypermethylation was found to be unequally distributed in males and females with more frequency in males than in females but the difference was not statistically significant(P =0.7635). Similarly, frequency of p16 promoter hypermethylation was found to be certainly higher in Stage III/IV (83.33 percent) compared to Stage I/II (56.25 percent) but the difference was not statistically significant (P =0.0673). Also, the degree of p16 promoter hypermethylation increased with the increasing severity of the lesion but the difference was not again statistically significant (P =0.6145). Promoter hypermethylation correlated with the decrease in expression of the p16 gene in CRC patients leading to the diseased phenotype. These results suggest that p16 aberrant promoter hypermethylation in Kashmiri population contributes to the process of carcinogenesis in CRC and may be developed into a valuable tool for CRC diagnosis at early stages.

Infection control in United Kingdom neonatal units: variance in practice and the need for an evidence base

Infection prevention is a cornerstone of good neonatal care. There are, however, few research data to support infection control approaches in this population. Through a structured telephone interview we surveyed all neonatal units in the United Kingdom to identify infection control issues, practices and policies. Eighty seven percent of the 198 neonatal units participated. Twenty one units (12.2%) had closed with infection control issues in the last year; 14.1% had current infection control concerns; 81.5% of units decolonised MRSA positive infants, but over 15 regimens were used. Wide variations in hygiene measures were identified; 22.1% of units used theatre scrubs for all staff, 7.6% used aprons and 5.8% required gloves to be worn when entering clinical areas. Only 54% required hand washing and alcohol gel before entry to a patient care area; 11.6% required only the use of alcohol gel.

Although infection control issues are resulting in neonatal unit closures and risks to patients, there are considerable variations in hygiene and screening practices. There is little data to support the safety or efficacy of decolonisation in neonatal populations, but this is widely practised. Research needs to be carried out to evaluate the effectiveness of screening practices and decolonisation in order that a consistent evidence-based approach can be applied.

The Implementation of RSBY in Chhattisgarh, India: A study of the Durg district

The Rashtriya Swasthya Bima Yojana (RSBY) scheme is a health insurance model currently being implemented by the Indian government. It is a model, however, still in nascent state, subject to tensions and value testing. Very few studies have hitherto assessed the scheme’s implementation and whether the stated objectives of the government initiative are being fulfilled. This short study undertaken in the Durg district of Chhattisgarh reveals that RSBY fails to cover the population living Below the Poverty Line (BPL). Likewise there is discrepancy in the consistency of information and knowledge regarding the scheme among the beneficiaries who are themselves continuing to incur high out-of-pocket expenses. There are thus severe issues in transparency and accountability within the RSBY scheme. Unless the public health delivery system is strengthened and the private sector regulated and indeed monitored, the scheme will not yield the desired results, and the cost of healthcare will further escalate for the poor. In the absence of regulated health services there needs to be more debate, and indeed greater research, on the implementation and the design of RSBY.