Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report

Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.

Characteristics and local structure of hafnia-silicate-zirconate ceramic nanomixtures

Zirconate systems having the composition 3HfO₂·15SiO₂·xY₂O₃·(82 - x)ZrO₂, where x = 2, 7 and 12 mol% Y₂O₃, were synthesized by a sol-gel method. The analysis of X-ray diffraction data showed the presence of the t-ZrO₂, m-ZrO₂, m-HfO₂, Y₂SiO₅ and Y₂Si₂O₇ crystalline phases in a ceramic nanomixture. Spectroscopic data show that the increase of the Y₂O₃ content of samples determines the increase of the t-ZrO₂, m-HfO₂ and silicate crystalline phases. Gap energy values decrease almost linearly with increasing Y₂O₃ content of samples. A detailed study of XANES data does not show a significant difference with increasing Y₂O₃ content of the samples suggesting an appreciable stability of the hafnium ions +4 oxidation state and their microvicinity. EXAFS results show that the local structure around the Hf cation is similar to that from the monoclinic crystalline HfO₂ where the Hf-O coordination number tends to 7. The bond lengths of Hf-O shells show small deviations from ∼2.12 Å and the Hf-metal paths become more structured by increasing the Y₂O₃ content of the samples.

The Dual Blockade in the Neoadjuvant Setting of HER-2 Positive Early-Stage Breast Cancer

Patients with positive Her-2/neu breast cancer and a high risk of recurrence are known to benefit from the addition of the dual blockade of Her-2/neu with Trastuzumab and Pertuzumab to the neoadjuvant chemotherapy, a combination which has been demonstrated to give a higher rate of a complete pathologic response in the breast and in the axilla. The purpose of this review is to outline the efficacy of the dual blockade with Trastuzumab and Pertuzumab in the neoadjuvant treatment of high-risk Her-2 positive breast cancer. Electronic databases (Pubmed, Medline, and Cochrane Database of Systematic Reviews) were searched for English- and German-language studies, which were published in the last ten years. The search has been focused on neoadjuvant clinical trials as well as on the data presented in the abstracts published at the San Antonio Breast Cancer Symposium as well as at the annual meeting of the American Society of Clinical Oncology. The results reported in the published clinical trials demonstrated a higher pathologic complete response rate in breast and lymph nodes after using targeted therapy with two anti-Her-2/neu agents - Trastuzumab and Pertuzumab in combination with neoadjuvant chemotherapy for early-stage Her-2/neu positive breast cancers. The pathologic complete response rate is the most important prognostic marker in Her-2/neu positive tumors, a higher pathologic complete response rate being demonstrated to be associated with a better survival outcome in terms of higher overall survival and disease-free survival rates.

Non-Invasive Prenatal Testing beyond Trisomies

The last decade has seen incredible advances in the genetic era, in next-generation sequencing of cell-free DNA in the maternal plasma, detecting abnormal fetal chromosomes. Non-invasive prenatal testing (NIPT) has showed increased sensitivity and specificity for Down syndrome superior to any other screening test. Technical advances have made possible the detection of other conditions which does not necessarily mean clinical benefit for the patient. Private laboratories have added multiple conditions in the panel of NIPT, but some of these abnormalities are so rare, that their prevalence is not even clear. Data regarding clinical performance of extended NIPT is lacking. Implementation of such a test has to be carefully weighed, and not only the benefits but also the harm should be taken into account.

First-trimester screening-biomarkers and cell-free DNA

Background: The introduction of cell-free DNA into clinical practice has changed the screening approach. Healthcare professionals and future parents tend to overestimate NIPT (noninvasive prenatal testing) capabilities despite its relatively high cost and limited information.Objective: In this review, our aim was to survey how various countries have introduced contingent screening models and to discuss the advantages and disadvantages of the combined screening test and the use of NIPT.Data source: The Web of Science, PubMed database and institutional websites were searched for information regarding screening approaches and the implementation in different countries.Results: There are nine countries and regions that have already approved contingent screening test, while others (e.g. Australia) are discussing the implementation of contingent screening versus universal use of NIPT. There are several recent meta-analyses debating whether to use NIPT for universal screening for trisomies and other fetal conditions.Conclusions: NIPT is a reasonable option as an advanced screening test for trisomy 21, 18 and 13 only. Introducing screening by NIPT instead of a first-trimester screening will cause the loss of other valuable information including accurate dating of pregnancy, diagnosing major structural fetal abnormalities and multiple pregnancies at an early gestational age. Additionally, the opportunity to screen for early preeclampsia will be lost. Currently, the price for NIPT is still high adding extra strain on publicly funded health systems.

The Characteristics of Microbiome in Newborns and Children and the Effects of Antibiotic Use

The acquisition of the infant�s microbiota is a vastly researched subject and of high interest. As more information is gathered, scientists prove the link between an unbalanced microbiome and certain afflictions. Antibiotics are widely used drugs and one of the factors that can shape the composition of the infant�s gut bacterial colonization. In this paper we aim to present the natural history of the child�s microbiome and the way it can be influenced by the use of antibiotics.

Abstract P5-09-14: Prevalence and type of BRCA mutations in young breast cancer patients undergoing genetic cancer risk assessment in two developing countries: Analysis of two cohorts from Romania and Mexico

Background: a previous study found significant clinicopathological differences between young Breast Cancer BrCA patients (pts) from Romania (Ro) and from Mexico (Mx). Here, we provide a molecular and clinical description of pts carrying BRCA mutations of both cohorts.

Methods: in this retrospective study, we analyzed 2 cohorts of BRCA1/2 mutations carriers tested in COEI from Mx between 2014-2017 and IOCN from Ro between 2015 to 2016. Ro pts were selected according to NCCN criteria, while Mx pts were selected based on risk evaluation models. NGS analysis and MLPA for BRCA1&2 were performed in all pts. We compared demographic, clinicopathological and molecular data.

Results: 65 pts, 21 (32.7%) from Mx and 44(67.7%) from Ro carried a BRCA mutation. 66.7% of Mx pts and 65.9% of Ro pts carried a BRCA1 mutation. We found clinical similarities: Mean age was 44.5y for Mx and 40.59y for Ro pts. IDC was the most frequent type of BrCa in both series (90.5 vs 90.9%). TNBC was seen in 13 Mx vs 27 Ro pts (61.9% vs 61.4%), HR positive was seen in 7 (33.3%) and 12 (27.3%) cases. Grading 3 was more frequently seen in Ro, while grading 2 was mainly noted in MX pts(p=<0.020). BRCA1/2 pathogenic mutations were different between the 2 cohorts and no BRCA 1/2 identical mutation was identified. 15 different mutations in 21 Mx pts, and 16 different mutations in 44 Ro pts were found. Mutations were different between 2 cohorts. Notably for the Ro cohort, 4 founder mutations (c.181T>G, c.3607C>T, c.5266dupC in BRCA1,and c.9928A>G[GPC1] in BRCA2) were found in 31/44 pts, while the Mx cohort, c.5123C>A and del 9-12del ex in BRCA1 were found in 6/21 mutations. Three Large rearrangements (LR) were exclusively seen in the Mx pts (5/21).

Conclusions Both cohorts didn't share any mutation, but the clinical features are similar. BRCA1 del 9-12del is a Mexican founder mutation, we found it in 14% of Mx pts, LR have been described more frequently in Latin American Populations, we found it in 30% of the MX cohort, while for Ro cohort four recurrent mutations qualify as founder mutations.

Citation Format: Campos-Gomez S, Antone N, Pacheco-Cuéllar G, Pop L, Campos Gomez K, Stoian A, Eniu R, Valdes-Andrade J, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu AE. Prevalence and type of BRCA mutations in young breast cancer patients undergoing genetic cancer risk assessment in two developing countries: Analysis of two cohorts from Romania and Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-09-14.

Abstract P4-06-11: Is myriad a reliable genetic risk model for prediction BRCA1/2 mutations in Romanian high-risk breast cancer patients?

Aim: To assess the predictive efficacies of genetic risk model Myriad for BRCA1/2 mutations in high-risk Romanian breast cancer patients (pts).

Methods: This prospective study evaluated the validity of Myriad risk assessment model for 250 high-risk breast cancer pts tested for BRCA1/2 mutations between 02.2015-12.2016 at IOCN. Inclusion criteria selected pts diagnosed with triple negative breast cancer under the age of 50, or having conventional family history criteria. All pts signed an informed consent. Myriad calculator software was utilized in order to assess the score for all 250 patients. BRCA testing was performed using an AmpliSeq-based sequencing analysis, on the Ion Torrent Personal Genome Machine at RCFG. Pathogenic mutations were validated using Sanger technology. MLPA was performed for all pts.

Results:The mean Myriad scores for all patients was 8.09% (2.2-26.6%) and the mean Myriad score for BRCA1/2 mutated pts was 11.56% (2.2-26.6%). The majority of pts, 166 (66,4%) presented a Myriad score between 2.2-4.8%, out of which 18 pts (40.9%) were BRCA1/2 mutated. Considering a higher score and the presence of deleterious BRCA1/2 mutations, 12 (27.27%) pts presented a score of 10.3-10.4%, 9 (20.45%) pts a score of 21.2-21.9%, and respectively 5 (11.36%)pts had a score of 26.6%. The subgroup analyzes revealed that the prediction of Myriad genetic risk model in high-risk breast cancer pts was statistical significant when the groups present scores between 10.3 and 26.2%. Other subgroup analysis failed to demonstrate statistical significance.

Table 1: Frequency analysis according to Myriad genetic risk model scores and BRCA1/2 mutational status.Myriad genetic risk model scores* (n=250)BRCA 1/2 mutated (n=44)No BRCA1/2 mutation (n= 191)Variants of unknown significance # (n=18)2.2-4.8% (n=166)18(40.9%)136(71.20%)12(66.66%)6.9%-8% (n=8)08(4.18%)010.3-10.4% (n=45)12(27.27%)29(15.18%)4(22.22%)15.9%(n=1)01(0.52%)021.2%-21.9% (n=14)9(20.45%)4(2.09%)1(5.55%)26.6% (n=16)5(11.36%)10(5.23%)1(5.55%)* The risk was calculated using BRCA risk calculator available at http://www.myriadpro.com/brca-risk-calculator/calc.html # Number of VUS results includes 3 pts that presented BRCA mutations positive results.

Table 2: Myriad genetic risk model stratified by 10.3 and 21.2% scores and BRCA test results.Data analyzedBRCA 1/2 mutatedNo BRCA1/2 mutationTotalP valueMyriad score 10.3%1229410.0100Myriad score 21.2%9413 Total213354 

Conclusions: The Myriad genetic risk model can be an acceptable risk assessment tool for determining the risk of carrying BRCA mutations in Romanian population if the score is between 10-20%. The inaccuracy in carrier prediction using Myriad model represents a challenge worthy of additional investigation and comparison with other genetic models. Genetic counselors should recognize this limitation when using Myriad model and recommending genetic testing for Romanian high-risk breast cancer pts.ClinicalTrials.gov Identifier: NCT02317120.

Citation Format: Eniu A, Pop L, Stoian A, Dronca E, Matei R, Ligtenberg M, Ouchene H, Onisim A, Rotaru O, Eniu R, Antone N. Is myriad a reliable genetic risk model for prediction BRCA1/2 mutations in Romanian high-risk breast cancer patients? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-11.

Patency of uterine wall in pregnancies following assisted and spontaneous conception with antecedent laparoscopic and abdominal myomectomies - a difficult case and systematic review

A case of uterine rupture at 24 weeks in a pregnancy succeeding myomectomy and triple embryo transfer is described and literature is reviewed systematically to evaluate the importance of uterine rupture in pregnancies after myomectomy in general and some important sub-populations. Systematic search identified 179 papers and following a strategical selection process 45 studies were analyzed in detail, including 6 cohort and 19 observational studies, 3 case series and 17 case reports. Comparison of risk of uterine rupture after abdominal and laparoscopic myomectomy is made. In pregnancies after IVF number of embryos transferred are determined. Optimal contraceptive intervals and surgical techniques are discussed. The consequences of these observations are analyzed and conclusions are made which can assist individualizing treatment options and improve patient selection.

Surgery – a challenge in haemophiliacs with inhibitors

Treatment of haemophiliacs with inhibitors is of great concern in low-income countries confronting shortage in substitutive treatment. Invasive interventions on these patients represent a major challenge due to the fact that costs are significantly higher in comparison to similar procedures conducted on patients without inhibitors. Objective: In the context of insufficient availability of clotting factor, we aimed at highlighting the experience of surgical treatment in inhibitor patients. We analyzed the indications, types of performed interventions and outcomes. Patients, methods: This single center, retrospective analysis has been conducted on 7 inhibitor patients registered and treated in Haemophilia Center of Timisoara over ten years (1997–2007): six patients with severe hemophilia A (3 – high titer, 3 – low titer), one patient with von Willebrand disease (low titer).Three patients developed inhibitors only after 2–5 days post surgery. Results: A total of 15 invasive procedures were carried out: 2 orthopedic interventions (1 arthrodesis, 1 arthroscopic synovectomy), 2 urogenital interventions (1 surgical testicular detorsion, 1 orchiectomy), 4 limb amputations (2 bilateral upper and 2 lower limb amputation), 2 pseudotumour (PT) surgery interventions, 5 drainages (2 massive pyohaemothorax, 1 drainage of shank haematoma, 1 drainage of compressive forearm haematoma, 1 drainage of thigh haematoma). Haemostasis was achieved in patients with low level inhibitors (< 5 BU/ml) with high doses of FVIII concentrates; in those with high inhibitor

Risks and challenges of orthopaedic invasive interventions in haemo -philia in a low-resource country

Haemophilic arthropathy is a defining feature and a debilitating condition of persons with haemophilia (PwH) in low resource countries. Orthopaedic surgery is unavoidable for patients with high occurrence of joint damage. Aims: We aimed to evaluate the spectrum and outcome of invasive orthopaedic therapies in PwH and von Willebrand diseases (VWD). Patients and methods: Our descriptive observational retrospective study included 131 invasive surgical procedures, performed on 76 consecutive patients, most of them (93.4%) with severe disease, treated in Timisoara’s Haemophilia Center over a period of 12 years; 17.1% had pre-operation anti-FVIII inhibitors. Invasive elective procedures were predominant (90.8%) as compared to emergency measures (9.2%); according to their invasiveness, 20.6% of interventions were major, 44.3% intermediate and 35.1% minor. Results: were good in the majority of cases; significantly reduced joint bleed rate and pain score were the most consistent achievements. The greatest proportion of complications occurred after major (66.7%), compared to moderate (25.6%) and minor (7.7%) interventions. The main threatening complication was the development (3.8%) or increase (4.6%) of inhibitor titer. Local bacterial infections and wound dehiscence complicated the evolution in 4.6% and 0.8 % of cases, respectively; we noticed no blood-borne infections or thrombotic accidents. Low dosage (10.7%) and short duration of substitution (21.4%) led to increased post-surgical bleeding and post-haemorrhagic anaemia. Conclusions: Surgery is a highly demanding intervention in haemophilia, which cannot be ignored in a low resource country. It represents a life or limb-saving and quality of life-improving measure.

An adamantane-based COF: stability, adsorption capability, and behaviour as a catalyst and support for Pd and Au for the hydrogenation of nitrostyrene

A bimodal (micro/mesoporous) COF was synthesized by coupling tetrakis-1,3,5,7-(4′-iodophenyl)adamantane with 4,4′-diethynylbiphenyl following a Sonogashira protocol.

Correction: An adamantane-based COF: stability, adsorption capability, and behaviour as a catalyst and support for Pd and Au for the hydrogenation of nitrostyrene

Correction for ‘An adamantane-based COF: stability, adsorption capability, and behaviour as a catalyst and support for Pd and Au for the hydrogenation of nitrostyrene’ by M. M. Trandafir et al., Catal. Sci. Technol., 2016, 6, 8344–8354.

Development of inhibitors in haemophilia. Ongoing epidemiological study

A number of 513 consecutive patients (494-haemophilia A and 19-haemophilia B) from eight haemophilia treatment centers have been investigated with Bethesda assay for the presence of factor VIII or IX inhibitors. The overall prevalence of inhibitors was 15.20%, 18.48% in severe, 5.60% in moderate and 12.24% in mild forms. The prevalence was higher than reported in most of the western countries. The age at start of substitution (p = 0.9775), the frequent switching of factor concentrates (p = 0.8931) were not relevant factors for the development of inhibitors. It is worth to be mentioned the unexpectedly occurrence of inhibitors in prior inhibitor negative (6/72) patients (during surgical interventions) probably due to their previous scarce substitution, occurrence which seems not being connected with the continuous infusion modality of factor VIII administration (p = 0.8341). In controversial situations, in the field of low titer (≤ 1 BU/ml) inhibitors for a reliable interpretation of the results the performance of recovery index and half-life time assessment of FVIII/IX was undertaken.