Age-dependent changes in gross and histological morphology of the thyroid gland in South Australian koalas (Phascolarctos cinereus)

Studies characterising the thyroid gland structure of koalas are limited and have not previously been undertaken in South Australian populations. Hence, this study aimed to describe the thyroid gland morphology of koalas from the Mount Lofty region, South Australia. Results showed that thyroid gland morphology was highly variable between individual koalas (n = 36), ranging from that considered typical for healthy mammals, in which small colloid-filled follicles were lined by cuboidal epithelium, to that consistent with colloidal goitre, in which macrofollicles distended with colloid were lined by flattened epithelium. Juvenile koalas more frequently showed typical thyroid gland morphology than adults, with significantly higher thyroid follicle density (P < 0.05) and a higher proportion of follicles lined by cuboidal epithelium compared with flattened epithelium (P < 0.05). Thyroid glands of most adult koalas were characterised by colloidal macrofollicles (P < 0.01), and classified as colloidal goitre. There were no significant differences in thyroid gland morphology based on health status or sex of koalas. These findings suggest that an age-dependent colloidal goitre occurs in adult koalas, which is unlikely to have ill effects and may be associated with the low metabolic rate of this species, or exposure to a dietary goitrogen.

Intussusception secondary to a solitary peritoneal lung metastasis

We report a 77-year-old woman, newly diagnosed with a malignant lung neoplasm of indeterminate nature who presented with profuse bilious vomiting without abdominal distension, pain or constipation. CT confirmed proximal small bowel obstruction. Laparotomy found a large area of intussusception from an intraluminal mass in the small bowel, which was resected and a primary anastomosis performed. Histology reported the mass as metastatic non-small-cell carcinoma and brought clarity to the primary tumour diagnosis. The patient made a good recovery from the operation, but unfortunately died a few months later from complications of her metastatic disease.

Frozen blood products: clinically effective and potentially ideal for remote Australia

The development of effective cryopreservation techniques for both red blood cells and platelets, which maintain ex vivo biological activity, in combination with frozen plasma, provides for a unique blood banking strategy. This technology greatly enhances the storage life of these products. The rationale and potential advantages of using cryopreservation techniques for the provision of blood products to remote and military environments have been effectively demonstrated in several conflicts over the last decade. Current haemostatic resuscitation doctrine for the exsanguinating patient supports the use of red blood cells, platelets and frozen plasma early in the resuscitation. We believe an integrated fresh-frozen blood bank inventory could facilitate provision of blood products, not only in the military setting but also in regional Australia, by overcoming many logistic and geographical challenges. The processes involved in production and point of care thawing are sufficiently well developed and achievable to make this technology a viable option. The potential limitations of cryopreservation and subsequent product thawing need to be considered if such a strategy is to be developed. A substantial body of international experience using cryopreserved products in remote settings has already been accrued. This experience provides a template for the possible creation of an Australian integrated fresh-frozen blood bank inventory that could conceivably enhance the care of patients in both regional Australia and in the military setting.

A suite of computer-assisted techniques for assessing upper-extremity motor impairments

this paper presents the design and implementation of a suite of computer-assisted rehabilitation platform techniques that are intended especially for individuals with upper-extremity motor impairments. It utilizes force-reflecting and other devices to provide interactive upper limb assessment and therapy. It includes a rich menu of user-centered performance assessment capabilities, and includes support for telerehabilitation links, for protocol design, and for data analysis. Preliminary results of its use as a research tool for several projects are presented and discussed.

Serum cotinine and prognosis in breast cancer

Various studies have suggested that women who smoke have a worse prognosis if they develop breast cancer. Cotinine levels have been measured in sera from 511 patients with stage I and II breast cancer diagnosed between 1975 and 1980, all of whom had complete follow-up. Although the known prognostic factors, axillary nodal status, tumour size and grade were found to be significant, there was no relationship between serum cotinine and metastasis-free survival. A point estimate of serum cotinine was not found to be a determinant of survival in women with early breast cancer.

SU-E-I-53: Optimal KVp for Image Quality and Noise in Iodine Contrast in Head CTA

PURPOSE

For brain CT perfusion it is well established that 80 kVp is optimal. Although neuro-CT angiography is somewhat similar, emphasis is on the detection of aneurysms and related vascular pathologies throughout the brain. Thus it is necessary to visualize small and large blood vessels with contrast material, as well as form multi-planar views and 3D images, so image quality and noise in addition to contrast are important for thin slices. A study was initiated to determine the optimal kVp for neuro-CTA.

METHODS

A customized version of a commercial head phantom (CIRS 007TE-27 medium adult head CT dose phantom) was purchased to facilitate quantitative measurements with iodinated contrast material, contrast for white and gray matter, and to maintain the ability to perform dosimetry. The customization consisted of adding four 25 mm holes, 35 mm from the center arranged at 45 degree angles from the center, with solid rods equivalent with brain, white, and gray matter, as well as four fillable vials were included for study of contrast agents. Dosimetry measurements were carried out with standard pencil chamber and with 0.6 cc ionization chamber. For study of the optimal kVp for a head CTA, the vials were filled with four different concentrations of contrast, approximating low to medium concentrations that would be expected in such a study. The standard CTA protocol was followed, 64 × 0.625, pitch 0.53, rotation speed 0.5 second, and CTDIvol was kept constant for each kVp.

RESULTS

The best contrast was observed at 80 kVp; however, in order to achieve noise in CTA low enough to be clinically useful there may be issues with tube current capability for a clinical technique. Clinical investigation is underway.

CONCLUSIONS

The best balance of contrast and noise currently possible will be achieved at 100 kVp in a clinical scan.

P3-07-48: Axillary Imaging with Dynamic MRI Following Subcutaneous Injection of Superparamagnetic Iron Oxide Nanoparticles

Background: Surgical axillary staging with sentinel node biopsy in clinically node negative patients is standard of care in the management of breast cancer. However sentinel node biopsy is associated with morbidity including a 5% risk of lymphoedema. Superparamagnetic iron oxide (SPIO) enhanced axillary MRI is a promising novel imaging modality that could be used to characterize sentinel nodes non-invasively. We evaluated subcutaneous SPIO enhanced axillary MRI for pre-operative axillary imaging.

Material and methods: Patients scheduled for sentinel node biopsy as part of surgical management of early breast cancer were invited to undergo pre-operative axillary MRI. All images were acquired on a 1.5T scanner using a surface coil. The initial 7 scans were acquired on a Siemens Avanto and the later scans on a Achieva MRI scanner (Philips Best, Netherlands). Following a T2-weighted morphological scan, patients were injected with 2ml of SPIO (4ml in the final 3 patients) subcutaneously into the circumareolar margin in the upper outer quadrant of the affected breast. Post injection, a slightly T2*-weighted dynamic scan was performed (gradient echo, TE = 1.53ms, TR=2.9ms, flip angle 7 degrees, 3mm slice thickness). In addition to the dynamic scan, in 16 patients, a T2 mapping sequence was performed at 10minutes and 120 minutes post injection (turbo spin echo, 8 equi-spaced TEs from 10 to 80ms, TR=2136ms, 3mm slices with an in plane resolution of 1.4×1.4mm). Image analysis was undertaken using Osirix (v3.8, 64-bit). Two consultant radiologists experienced at reading breast and axillary MRI reported all scans. Results: A total of 23 patients underwent axillary MRI with subcutaneous SPIO. Of these in 18 patients (78%), uptake of SPIO was seen in sentinel nodes and lymphatic tracts. At least 1 sentinel node was identified in 17 patients (74%). A total of 106 nodes were identified (4.6 ± 1.7 nodes per patient) and of these 40 demonstrated a significant drop in signal intensity following SPIO injection (1.7 ± 1.3 nodes per patient). All 3 involved nodes were seen to contain a metastatic deposit on MRI.

Discussion: Axillary MRI with subcutaneous SPIO injection is a robust method for imaging sentinel nodes. The normal node count of the axillary basin is lower than expected on histology, suggesting that only the larger nodes and those that take up SPIO are visualized on MRI.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-48.

P2-08-07: Ex-Vivo High Resolution MRI of Sentinel Lymph Nodes Following Subcutaneous Injection of Superparamagnetic Iron Oxide Nanoparticles

Background: Superparamagnetic iron oxide (SPIO) enhanced axillary MRI is a promising novel imaging modality that could be used to characterize sentinel nodes non-invasively. In order to better characterize lymph nodes and evaluate their morphological features, we imaged nodes ex-vivo using high resolution MRI, following a pre-operative subcutaneous injection of SPIO.

Material and methods: Prior to surgery patients received a circumareolar injection of SPIO (Endorem, Guerbet, Paris) into the upper outer quadrant of the affected breast. Sentinel lymph nodes excised during surgery were transported to the imaging department fresh. Nodes were placed in glass tubes and scanned using a Bruker 9.4T MRI system (T2 mapping: turbo spin echo, 16 equi-spaced TEs from 7.1 to 113.6 ms, TR = 1616 ms. T2* mapping: gradient echo, 6 equi-spaced TEs from 3.5 to 21 ms, TR = 1000 ms, flip angle = 30 degrees. Diffusion-weighted: spin echo, b-values 0 and 1000 s/mm2, TE = 18 ms, TR = 6500 ms.). Slice thickness was 1 mm with an in plane spatial resolution of 100μm. Image analysis was undertaken using Osirix (v3.8, 64-bit).

Results: A total of 40 nodes were successfully imaged, excised from 14 patients. The internal architecture of nodes was clearly seen and in the 3 involved nodes, a macrometastasis was identified. Three patients received a 4ml injection of SPIO and 11 patients, a 2ml injection. More SPIO deposition was seen within nodal sinuses following 4ml of SPIO, but there was no significant decrease in mean T2 value. Four nodes were re-imaged following formalin fixation and nodal architecture was unchanged with a trend towards an increase in mean T2 values within nodes. SPIO was identified in all sentinel nodes.

Discussion: Ex-vivo MRI with subcutaneous SPIO contrast, is a useful method for imaging and characterization of sentinel nodes. A better understanding of ex-vivo features is a useful aide to understanding the morphological features seen following in-vivo SPIO enhanced axillary MRI.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-07.

Escherichia coli O115 forms fewer attaching and effacing lesions in the ovine colon in the presence of E. coli O157:H7

Escherichia coli O115 has been isolated from healthy sheep and was shown to be associated with attaching-effacing (AE) lesions in the large intestine. Following previous observations of interactions between E. coli O157 and O26, the aim of the present study was to assess what influence an O115 AE E. coli (AEEC) would have on E. coli O157 colonisation in vitro and in vivo. We report that E. coli O115- and O157-associated AE lesions were observed on HEp-2 cells and on the mucosa of ligated ovine spiral colon. In single strain inoculum, E. coli O115 associated intimately with HEp-2 cells and the spiral colon in greater numbers than E. coli O157:H7. However, in mixed inoculum studies, the number of E. coli O115 AE lesions was significantly reduced suggesting negative interference by E. coli O157. Use of the ligated colon model in the present work has allowed in vitro observations to be extended and confirmed whilst using a minimum of experimental animals. The findings support a hypothesis that some AEEC can inhibit adhesion of other AEEC in vivo. The mechanisms involved may prove to be of utility in the control of AE pathovars.

The cost-effectiveness of adjuvant chemotherapy for early breast cancer: A comparison of no chemotherapy and first, second, and third generation regimens for patients with differing prognoses

BACKGROUND

The risk of recurrence following surgery in women with early breast cancer varies, depending upon prognostic factors. Adjuvant chemotherapy reduces this risk; however, increasingly effective regimens are associated with higher costs and toxicity profiles, making it likely that different regimens may be cost-effective for women with differing prognoses. To investigate this we performed a cost-effectiveness analysis of four treatment strategies: (1) no chemotherapy, (2) chemotherapy using cyclophosphamide, methotrexate, and fluorouracil (CMF) (a first generation regimen), (3) chemotherapy using Epirubicin-CMF (E-CMF) or fluorouracil, epirubicin, and cyclophosphamide (FEC60) (a second generation regimens), and (4) chemotherapy with FEC60 followed by docetaxel (FEC-D) (a third generation regimen). These adjuvant chemotherapy regimens were used in three large UK-led randomised controlled trials (RCTs).

METHODS

A Markov model was used to simulate the natural progression of early breast cancer and the impact of chemotherapy on modifying this process. The probability of a first recurrent event within the model was estimated for women with different prognostic risk profiles using a parametric regression-based survival model incorporating established prognostic factors. Other probabilities, treatment effects, costs and quality of life weights were estimated primarily using data from the three UK-led RCTs, a meta-analysis of all relevant RCTs, and other published literature. The model predicted the lifetime costs, quality adjusted life years (QALYs) and cost-effectiveness of the four strategies for women with differing prognoses. Sensitivity analyses investigated the impact of uncertain parameters and model assumptions.

FINDINGS

For women with an average to high risk of recurrence (based upon prognostic factors and any other adjuvant therapies received), FEC-D appeared most cost-effective assuming a threshold of £20,000 per QALY for the National Health Service (NHS). For younger low risk women, E-CMF/FEC60 tended to be the optimal strategy and, for some older low risk women, the model suggested a policy of no chemotherapy was cost-effective. For no patient group was CMF chemotherapy the preferred option. Sensitivity analyses demonstrated cost-effectiveness results to be particularly sensitive to the treatment effect estimate for FEC-D and the future price of docetaxel.

INTERPRETATION

To our knowledge, this analysis is the first cost-effectiveness comparison of no chemotherapy, and first, second, and third generation adjuvant chemotherapy regimens for early breast cancer patients with differing prognoses. The results demonstrate the potential for different treatment strategies to be cost-effective for different types of patients. These findings may prove useful for policy makers attempting to formulate cost-effective treatment guidelines in the field of early breast cancer.

Multiple foci of invasive breast cancer: can breast MRI influence surgical management?

The use of MRI to assess the extent of breast disease is gaining increasing popularity with the subsequent detection of multiple invasive foci within the breast that had not been identified on previous standard mammography and ultrasonography. What impact this has on subsequent surgical management and ultimately disease-free survival remains a controversial topic. Should histologically confirmed multiple foci of invasive disease within a breast steer the surgical management towards mastectomy, or is there a role in select patients for breast conserving surgery, even if two or more incisions are required? This review considers the evidence for how MRI affects the mastectomy rate and compares this to surgical outcomes for breast conserving surgery in the presence of multiple invasive foci.

Development and psychometric testing of the Adaptive Capacity Index, an instrument to measure adaptive capacity in individuals with advanced cancer

BACKGROUND

We have proposed that declines in adaptive capacity, defined as the ability to adapt to multiple stressors, may serve as an indicator of risk for fatigue. A comprehensive measure of adaptive capacity does not exist.

OBJECTIVES

In this paper we describe construction of an instrument to measure adaptive capacity, the Adaptive Capacity Index (ACI).

DESIGN

Descriptive and psychometric.

SETTING

Six sites providing palliative care in Western Canada.

PARTICIPANTS

INCLUSION CRITERIA

≥18 years old, diagnosed with advanced cancer, able to read and write English, Mini-Mental Status Exam score ≥22. Pilot study n=48; Main study n=225 stratified using the Edmonton Symptom Assessment Scale (ESAS) tiredness score (≥0 to ≤2 n=60; ≥3 to ≤6 n=108; ≥7 and ≤10 n=57).

METHODS

Following ethics approval, 17 experts in symptom management assisted with content validation and consenting individuals completed the Functional Assessment of Cancer Therapy-Fatigue (FACT-F), the Profile of Mood States-Vigor short form (POMS-Vsf), and the ACI. A research assistant collected demographic information and assigned an Eastern Cooperative Oncology Group (ECOG) score. Data were analyzed using descriptive and inferential statistics (i.e., exploratory factor analyses, correlation, multivariate analyses of variance, and multiple regression).

RESULTS

Five 6-item ACI factors/subscales (Cognitive Function, Stamina/Muscle Endurance, Sleep Quality, Emotional Reactivity, and Social Interaction) were identified. The ACI-total scale and its subscales were internally consistent (Cronbach's alpha 0.76-0.89), and were significantly correlated with each other, and with each fatigue measure (Pearson's r ranging from -0.724 to 0.634). The ACI total score was sensitive to changes in the ESAS tiredness score. Stamina/Muscle Endurance, Cognitive Function, and Sleep Quality predicted 60.8% of the variance in FACT-F. Stamina/Muscle Endurance and Social Interaction predicted 36.8% of the variance in POMS-Vsf. Stamina/Muscle Endurance and Sleep Quality predicted 8% of the variance in ECOG.

CONCLUSIONS

The ACI is reliable and has beginning evidence of validity. In future studies we will examine relationships between ACI subscale scores and subsequent increases in fatigue and explore linkages to physiological processes. We will also establish ACI norms for early and late stage cancers and explore variations in ACI subscale scores base on age or gender.

Improving colon cancer screening rates in primary care: a pilot study emphasising the role of the medical assistant

BACKGROUND

Colorectal cancer (CRC) is the third-leading cause of cancer death for both men and women in the USA. Despite consensus recommendations for screening, just over half of eligible adults nationally have undergone screening. We therefore implemented a programme to improve the rate of CRC screening.

METHODS

This study was conducted in the Utah Health Research Network and the University of Utah Community Clinics, a 100 000 patient, seven-practice, university-owned system offering primary and secondary care and ancillary services including endoscopy. We focused on patients aged >or=50 who were seen between 1 January 2003 and 31 October 2006, and who were not current for CRC screening at the time of the visit. The study included a three-phase

INTERVENTION

electronic medical record (EMR) reminders, physician and medical assistant (MA) education about CRC screening guidelines, and redesign of patient visit workflow with an expanded role for MAs to review patients' CRC screening status and recommend testing when appropriate. With patient agreement, the MA entered a preliminary order in the EMR, and the physician confirmed or rejected the order. The primary outcome measure was the rate of screening colonoscopy ordered for eligible patients.

RESULTS

The baseline colonoscopy referral rate was 6.0%. Provider education and electronic reminders had minimal immediate impact on screening rates. Addition of the expanded MA role was associated with a sustained increase in colonoscopy referral order rate to 13.4%, a relative improvement of 123%.

CONCLUSIONS

The MA can play a key role in improving CRC screening rates as part of a redesigned system of primary care.

Lyme disease diagnosis and treatment: lessons from the AIDS epidemic

Lyme disease is a controversial tick-borne illness that is estimated to be four times more common than AIDS in the United States. This paper outlines the challenges overcome in the healthcare response to human immunodeficiency virus (HIV) infection, the development of sensitive laboratory tests for the AIDS virus, and the promotion of long-term combination antimicrobial regimens to effectively treat HIV disease. We suggest that similar challenges need to be overcome before the chronic form of Lyme disease can be successfully treated. Currently, diagnosis and treatment of Lyme disease is hindered by the lack of a uniform case definition that adequately reflects the clinical presentation of the disease, poor laboratory test sensitivity, and high treatment failure rates using short-term monotherapy. Consequently the optimal treatment for patients with persistent symptoms of Lyme disease remains undefined. Although antibiotic monotherapy has been successful in treating early Lyme disease, the use of combination antibiotic therapy modelled on HIV treatment appears to be more effective for patients with persistent symptoms of tick-borne infection. Resolution of the controversy surrounding Lyme disease should lead to improved diagnosis and treatment modelled on the approach to HIV disease.

Characterization of a pigment-dispersing hormone in eyestalks of the fiddler crab Uca pugilator

A pigment-dispersing hormone (PDH) from eyestalks of the fiddler crab Uca pugilator has been purified by gel filtration, ion-exchange chromatography, partition chromatography, and reversed-phase liquid chromatography. Based on automated gas-phase sequencing and subsequent identification of carboxyl-terminal amide, we have assigned the primary structure of this peptide as Asn-Ser-Glu-Leu-Ile-Asn-Ser-Ile-Leu-Gly-Leu-Pro-Lys-Val-Met-Asn-Asp-Ala-NH (2). We have confirmed the sequence by synthesizing this peptide and demonstrating that the synthetic PDH and the native PDH display identical chromatographic behavior and biological activity. This hormone is a member of a family of invertebrate neuropeptides that includes a light-adapting/pigment-dispersing octadecapeptide hormone from the prawn Pandalus borealis. In assays for melanophore pigment dispersion in destalked fiddler crabs, Uca PDH was 21-fold more potent than Pandalus PDH. These two hormones share a hexapeptide core sequence (residues 5-10: -Ile-Asn-Ser-Ile-Leu-Gly-) as well as the amino- and carboxyl-terminal residues but differ at positions 3, 4, 11, 13, 16, and 17. These results point to speciesrelated or group-specific structural differences among crustacean PDHs.

TEMPO EC for the enumeration of Escherichia coli in foods: collaborative study

The automated method for enumeration of Escherichia coli, TEMPO EC, in foods uses a dehydrated culture medium and enumeration card containing 48 wells across three different dilutions for the automatic determination of the most probable number (MPN). The alternative method was compared in a multilaboratory collaborative study to AOAC Official Method 966.24. Six food types were artificially contaminated with E. coli: raw ground beef, bagged lettuce, cooked chicken, pasteurized crabmeat, frozen green beans, and pasteurized whole milk. All foods were analyzed for E. coli counts by 11 collaborating laboratories throughout the United States. Test portions from the six food types each contaminated at four different contamination levels were evaluated. The study demonstrated that the TEMPO EC method is a reliable, automated assay for the enumeration of E. coli in foods.

Safety of intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease

AIM

Although intravenous antibiotic therapy is recommended for neurologic Lyme disease, safety concerns have been raised about treatment beyond 30 days in patients with persistent neurologic symptoms. The goal of our study was to evaluate the safety of extended intravenous antibiotic therapy in patients referred for treatment of neurologic Lyme disease.

METHODS

We enrolled 200 consecutive patients with significant neurologic symptoms and positive testing for Borrelia burgdorferi. Patients were treated with intravenous antibiotics using various intravascular devices (IVDs). Standard IVD care was administered to all patients, and monitoring for medication reactions and IVD complications was performed on a weekly basis.

RESULTS

The mean length of intravenous antibiotic treatment was 118 days (range, 7-750 days) representing 23,654 IVD-days. Seven patients (3.5%) experienced allergic reactions to the antibiotic medication, and two patients (1.0%) had gallbladder toxicity. IVD complications occurred in 15 patients (7.5%) representing an incidence of 0.63 per 1,000 IVD-days. The IVD problems occurred an average of 81 days after initiation of treatment (range, 7-240 days). There were six suspected line infections for an incidence of 0.25 per 1,000 IVD-days. Only one of the IVD infections was confirmed, and no resistant organisms were cultured from any patient. None of the IVD complications were fatal.

CONCLUSION

Prolonged intravenous antibiotic therapy is associated with low morbidity and no IVD-related mortality in patients referred for treatment of neurologic Lyme disease. With proper IVD care, the risk of extended antibiotic therapy in these patients appears to be low.

ER and HER2 Expression Are POSITIVELY Correlated in HER2 Non-Over Expressing Breast Cancer

Aim: To determine the relationship between ER and HER2 expression according to HER2 amplification status.Background: ER and HER2 are the most commonly measured biomarkers in breast cancer and are important targets for therapy. It is known that ER and HER2 positivity are inversely correlated and that among ER+ tumours ER expression is higher in HER2 non-overexpressing (−ve) than HER2 overexpressing (+ve) disease (Konecny et al, JNCI 2003, 95: 142-53). There are however, very few data on the quantitative relationship between ER and HER2 expression in HER2−ve tumours. We therefore measured the expression of ER and HER2 at both the mRNA and protein level in HER2 +ve and −ve breast carcinomas.Methods: ER and HER2 levels were assessed by IHC (6F11 antibody and HercepTest, respectively) on tissue microarrays and q-RT-PCR in formalin-fixed primary breast cancers from 429 patients in the tamoxifen arm of the ABC Trial (ABC Trialists, JNCI 2007, 99: 506-15). HER2 amplification status was assessed with the PathVysion 2-probe FISH test. ER IHC was H-scored. Transcript levels for ER and HER2 from 1139 HER2−ve TransATAC tumours were available from the Oncotype DX test (Dowsett et al, Cancer Res 2009, 69suppl: 75s).Results: Matched results were available from all analyses for 257 ABC patients except for 25 cases where HER2 was by IHC or FISH. HER2 was amplified in 14.4% and equivocal in 1.3% of cases. ER was +ve in 67% of cases. The expected negative correlation between levels of ER and HER2 expression was found in HER2 +ve tumours (r=-0.45, p=0.0028). In contrast in HER2-ve tumours (ER+ve and ER-ve combined) there was a significant POSITIVE correlation between ER and HER2 mRNA levels (r=0.43, p&lt;0.0001). As a result in HER2−ve tumours the quantitative level of HER2 was higher in ER+ve than ER−ve tumours (mean fold difference 1.74, p&lt;0.0001). There was a mean 5.8-fold higher HER2 transcript levels in HER2+ve vs HER2−ve tumours in ER+ve disease and 12.9-fold higher in ER−ve disease. The positive correlation though weaker was maintained in the ER+ve HER2−ve group (r=0.24, p=0.0023) and was present to a similar extent in that subgroup in TransATAC (r=0.25, p&lt;0.00001). The positive association was also significant in ER IHC analyses in ABC: mean±95%CI H-scores were 90±19 and 134±19 in the 0 and 1+ HER2 IHC categories, respectively (p=0.0013).Conclusions: ER and HER2 expression are positively correlated at both protein and transcript levels in HER2−ve breast cancer in contrast to their negative correlation in HER2+ve disease. The distinction between HER2+ve and HER2−ve is greater in ER−ve than ER+ve disease and this may lead to greater diagnostic uncertainties in ER+ve patients. These findings may also have importance for signaling pathways and application of targeted therapy in HER2−ve disease.*Acknowledgement: We are grateful to the ABC Trial Working and Biological Studies Groups, the ATAC Trialists and Cancer Research UK for funding.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 703.

The emerging need for adolescent-focused HIV care in South Africa

No Abstract

Reflections from a systematic review of dietary energy density and weight gain: is the inclusion of drinks valid?

The association between dietary energy density, increased energy intake and weight gain is supported by experimental evidence, but confirmation of an effect in free-living humans is limited. Experimental evidence supports a role of energy density in obesity through changes in food composition, not drinks consumption. The inclusion of drinks in the calculation creates a variable of questionable validity and has a substantive impact on the estimated energy density of the diet. We posit, based on the experimental evidence, that calculating the energy density of diets by excluding drinks and including calories from drinks as a covariate in the analysis is the most valid and reliable method of testing the relationship between energy density and weight gain in free-living humans. We demonstrate, by systematically reviewing existing observational studies of dietary energy density and weight gain in free-living humans, how current variation in the method for calculating energy density hampers the interpretation of these data. Reaching an a priori decision on the appropriate methodology will reduce the error caused by multiple comparisons and facilitate meaningful interpretation of epidemiological evidence to inform the development of effective obesity prevention strategies.