Abstract P3-14-06: A single-center report of 125 cases of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction

Objective

The aim of the current study is to determine the clinical value of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction using internal mammary as recipient vessels and to investigate the risk factors of internal mammary lymph nodes metastasis.

Methods

The clinical data of all free abdominal flap breast reconstructions using internal mammary as recipient vessels performed from November 2006 to April 2016 in Department of Breast Surgery, Fudan University Shanghai Cancer Center were included into the study. The incidence of internal mammary lymph node biopsy and the rate of metastasis were described. The differences between groups were compared using χ2 test. Univariate and multivariate Logistic regression analysis was conducted to evaluate risk factors of internal mammary lymph node metastasis.

Results

A total of 125 patients met the inclusion criteria, 89 (71.2%) of whom adopted unilateral immediate breast reconstructions. 64.8% of them were diagnosed with primary invasive breast cancer, while 27.2% were carcinoma in situ. According to AJCC TNM staging system, the percentages of patients with stage 0, I, II, III were 27.2%, 26.4%, 27.2% and 8.0%.

62 (49.6%) patients had internal mammary lymph nodes harvested. 6.4% (4/62) of those who adopted internal mammary lymph nodes biopsies were diagnosed with internal mammary lymph nodes metastasis, all in immediate breast reconstructions. 72 (57.6%) patients cut off costicartilage (the second or third costicartilage) during the exposure of internal mammary vessels. The excision of costicartilage is not associated with the harvest rate of internal mammary lymph node (P>0.05). All of the 4 patients upstaged their TMN stage of tumor after internal mammary lymph node metastasis and adopted adjuvant chemotherapy and radiotherapy. Up to May 2016, no recurrence or distant metastasis was reported.

In Logistic regression analysis, larger invasive tumor size and axillary lymph node metastasis were found to have correlations with internal mammary lymph node metastasis (larger invasive tumor size: P=0.029; axillary lymph node metastasis: P=0.004), while tumor location or immunohistochemical subtype had no correlations. In addition, axillary lymph node metastasis was proved to be a independent risk factor of internal mammary lymph node metastasis (P=0.036) while tumor size was not.

Conclusions

Internal mammary lymph nodes found incidentally during internal mammary recipient vessel exposure for free flap breast reconstruction could provide surgeons with important information for further treatment. This approach for internal mammary lymph node biopsy revealed an appreciable success rate and should be promoted in clinical practice. The size of invasive tumor and the axillary lymph node metastasis were associated with internal mammary lymph node metastasis.Objective

The aim of the current study is to determine the clinical value of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction using internal mammary as recipient vessels and to investigate the risk factors of internal mammary lymph nodes metastasis.

Methods

The clinical data of all free abdominal flap breast reconstructions using internal mammary as recipient vessels performed from November 2006 to April 2016 in Department of Breast Surgery, Fudan University Shanghai Cancer Center were included into the study. The incidence of internal mammary lymph node biopsy and the rate of metastasis were described. The differences between groups were compared using χ2 test. Univariate and multivariate Logistic regression analysis was conducted to evaluate risk factors of internal mammary lymph node metastasis.

Results

A total of 125 patients met the inclusion criteria, 89 (71.2%) of whom adopted unilateral immediate breast reconstructions. 64.8% of them were diagnosed with primary invasive breast cancer, while 27.2% were carcinoma in situ. According to AJCC TNM staging system, the percentages of patients with stage 0, I, II, III were 27.2%, 26.4%, 27.2% and 8.0%.

62 (49.6%) patients had internal mammary lymph nodes harvested. 6.4% (4/62) of those who adopted internal mammary lymph nodes biopsies were diagnosed with internal mammary lymph nodes metastasis, all in immediate breast reconstructions. 72 (57.6%) patients cut off costicartilage (the second or third costicartilage) during the exposure of internal mammary vessels. The excision of costicartilage is not associated with the harvest rate of internal mammary lymph node (P>0.05). All of the 4 patients upstaged their TMN stage of tumor after internal mammary lymph node metastasis and adopted adjuvant chemotherapy and radiotherapy. Up to May 2016, no recurrence or distant metastasis was reported.

In Logistic regression analysis, larger invasive tumor size and axillary lymph node metastasis were found to have correlations with internal mammary lymph node metastasis (larger invasive tumor size: P=0.029; axillary lymph node metastasis: P=0.004), while tumor location or immunohistochemical subtype had no correlations. In addition, axillary lymph node metastasis was proved to be a independent risk factor of internal mammary lymph node metastasis (P=0.036) while tumor size was not.

Conclusions

Internal mammary lymph nodes found incidentally during internal mammary recipient vessel exposure for free flap breast reconstruction could provide surgeons with important information for further treatment. This approach for internal mammary lymph node biopsy revealed an appreciable success rate and should be promoted in clinical practice. The size of invasive tumor and the axillary lymph node metastasis were associated with internal mammary lymph node metastasis.

Citation Format: Quan C, Huang N, Yang B, Zhang Y, Huang X, Chen J, Wu J. A single-center report of 125 cases of incidental internal mammary lymph node biopsy in free abdominal flap breast reconstruction [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 P3-14-06.

Maturation of human embryonic stem cell-derived cardiomyocytes (hESC-CMs) in 3D collagen matrix: Effects of niche cell supplementation and mechanical stimulation

Cardiomyocytes derived from human embryonic stem cells (hESC-CMs) are regarded as a promising source for regenerative medicine, drug testing and disease modeling. Nevertheless, cardiomyocytes are immature in terms of their contractile structure, metabolism and electrophysiological properties. Here, we fabricate cardiac muscle strips by encapsulating hESC-CMs in collagen-based biomaterials. Supplementation of niche cells at 3% to the number of hESC-CMs enhance the maturation of the hESC-CMs in 3D tissue matrix. The benefits of adding mesenchymal stem cells (MSCs) are comparable to that of adding fibroblasts. These two cell types demonstrate similar effects in promoting the compaction and cell spreading, as well as expression of maturation markers at both gene and protein levels. Mechanical loading, particularly cyclic stretch, produces engineered cardiac tissues with higher maturity in terms of twitch force, elastic modulus, sarcomere length and molecular signature, when comparing to static stretch or non-stretched controls. The current study demonstrates that the application of niche cells and mechanical stretch both stimulate the maturation of hESC-CMs in 3D architecture. Our results therefore suggest that this 3D model can be used for in vitro cardiac maturation study.

STATEMENT OF SIGNIFICANCE

Cardiomyocytes derived from human embryonic stem cells (hESC-CMs) are regarded as being a promising source of cells for regenerative medicine, drug testing and disease modeling. Nevertheless, cardiomyocytes are immature in terms of their contractile structure, metabolism and electrophysiological properties. In the current study, we have fabricated cardiac muscle strips by encapsulating hESC-CMs in collagen-based biomaterials and demonstrated that supplementation of mesenchymal niche cells as well as provision of mechanical loading particularly stretching have significantly promoted the maturation of the cardiomyocytes and hence improved the mechanical functional characteristics of the tissue strips. Specifically, with 3% niche cells including both fibroblasts and mesenchymal stem cells, a more mature hESC-CMs derived cardiac strip was resulted, in terms of compaction and spreading of cells, and upregulation of molecular signature in both gene and protein expression of maturation. Mechanical loading, particularly cyclic stretch, produces engineered cardiac tissues with higher maturity in terms of molecular signature markers and functional parameters including twitch force, elastic modulus and sarcomere length, when comparing with static stretch or non-stretched controls. The current study demonstrates that the application of niche cells and mechanical stretch both stimulate the maturation of hESC-CMs in 3D architecture, resulting in more mature cardiac strips. Our results contribute to bioengineering of functional heart tissue strips for drug screening and disease modeling.

Allergic Rhinitis Control Test questionnaire-driven stepwise strategy to improve allergic rhinitis control: a prospective study

BACKGROUND

Allergic Rhinitis Control Test (ARCT) has been validated for assessing allergic rhinitis (AR) control and identifying severe AR. The aim of the study was to assess the ARCT questionnaire as a tool for stepwise pharmacotherapy.

METHODS

A standard pharmacotherapy regimen from Step 1 (oral second-generation H1 antihistamine as needed) to Step 5 (oral corticosteroid) was carried out prospectively in a Chinese AR population. The AR patients were initiated with Allergic Rhinitis and its Impact on Asthma (ARIA) appropriate step treatment and assessed with ARCT every 15 days. If ARCT score was equal or above 20 (controlled AR) and maintained for 15 days, the patient would finish the study; if ARCT score was strictly <20 (uncontrolled AR), the patient would receive higher step treatment according to a predefined open design up to Step 5. The different AR control subgroups were compared.

RESULTS

A total of 255 patients were enrolled in the study; 5 patients dropped out and 2 (0.8%) were controlled at day 0, 85 (34.0%) at day 15, 177 (70.8%) at day 30, 222 (88.8%) at day 45, 241 (96.4%) at day 60 and 242 (96.8%) at day 75. Only 8 (3.2%) patients remained uncontrolled at the endpoint of the study. Patients with ARIA moderate/severe or persistent symptoms, moderate/severe impaired quality of life, asthma history, rhinorrhea and cough symptoms always needed up to Step 4 (nasal corticosteroid plus antihistamine) and prolonged treatments to achieve disease control.

CONCLUSIONS

The majority of AR can be controlled with standard stepwise treatment. ARCT offers an objective criterion for the stepwise pharmacotherapy of AR.

Immunologic environment influences macrophage response to Porphyromonas gingivalis

Macrophages adapt both phenotypically and functionally to the cytokine balance in host tissue microenvironments. Recent studies established that macrophages contribute an important yet poorly understood role in the development of infection-elicited oral bone loss. We hypothesized that macrophage adaptation to inflammatory signals encountered before pathogen interaction would significantly influence the subsequent immune response of these cells to the keystone oral pathobiont Porphyromonas gingivalis. Employing classically activated (M1) and alternatively activated (M2) murine bone-marrow-derived macrophage (BMDMø), we observed that immunologic activation of macrophages before P. gingivalis challenge dictated phenotype-specific changes in the expression of inflammation-associated molecules important to sensing and tuning host response to bacterial infection including Toll-like receptors 2 and 4, CD14, CD18 and CD11b (together comprising CR3), major histocompatibility complex class II, CD80, and CD86. M2 cells responded to P. gingivalis with higher expression of tumor necrosis factor-α, interleukin-6, monocyte chemoattractant protein-1, macrophage inflammatory protein-1α, regulated on activation normal T cell expressed and secreted, and KC than M1 cells. M1 BMDMø expressed higher levels of interleukin-10 to P. gingivalis than M2 BMDMø. Functionally, we observed that M2 BMDMø bound P. gingivalis more robustly than M1 BMDMø. These data describe an important contribution of macrophage skewing in the subsequent development of the cellular immune response to P. gingivalis.

Estimated GFR for Living Kidney Donor Evaluation

All living kidney donor candidates undergo evaluation of GFR. Guidelines recommend measured GFR (mGFR), using either an endogenous filtration marker or creatinine clearance, rather than estimated GFR (eGFR), but measurement methods are difficult, time consuming and costly. We investigated whether GFR estimated from serum creatinine (eGFRcr) with or without sequential cystatin C is sufficiently accurate to identify donor candidates with high probability that mGFR is above or below thresholds for clinical decision making. We combined the pretest probability for mGFR thresholds <60, <70, ≥80, and ≥90 mL/min per 1.73 m(2) based on demographic characteristics (from the National Health and Nutrition Examination Survey) with test performance of eGFR (categorical likelihood ratios from the Chronic Kidney Disease Epidemiology Collaboration) to compute posttest probabilities. Using data from the Scientific Registry of Transplant Recipients, 53% of recent living donors had predonation eGFRcr high enough to ensure ≥95% probability that predonation mGFR was ≥90 mL/min per 1.73 m(2) , suggesting that mGFR may not be necessary in a large proportion of donor candidates. We developed a Web-based application to compute the probability, based on eGFR, that mGFR for a donor candidate is above or below a range of thresholds useful in living donor evaluation and selection.

Improved detection of disease-associated variation by sex-specific characterization and prediction of genes required for fertility

Despite its great potential, high-throughput functional genomic data are rarely integrated and applied to characterizing the genomic basis of fertility. We obtained and reprocessed over 30 functional genomics datasets from human and mouse germ cells to perform genome-wide prediction of genes underlying various reproductive phenotypes in both species. Genes involved in male fertility are easier to predict than their female analogs. Of the multiple genomic data types examined, protein-protein interactions are by far the most informative for gene prediction, followed by gene expression, and then epigenetic marks. As an application of our predictions, we show that copy number variants (CNVs) disrupting predicted fertility genes are more strongly associated with gonadal dysfunction in male and female case-control cohorts when compared to all gene-disrupting CNVs (OR = 1.64, p < 1.64 × 10(-8) vs. OR = 1.25, p < 4 × 10(-6)). Using gender-specific fertility gene annotations further increased the observed associations (OR = 2.31, p < 2.2 × 10(-16)). We provide our gene predictions as a resource with this article.

High risk features of primary colorectal carcinomas which subsequently undergo peritonectomy

OBJECTIVE

Determine what portion of colorectal cancer (CRC) patients with peritoneal metastases (PM) undergoing peritonectomy would have been identified/treated if second-look surgery protocol existed for high-risk primary tumours.

BACKGROUND

The prognosis of CRC PM greatly improves following peritonectomy/HIPEC. Survival remains dependent upon stage of PM and there is some knowledge of high-risk factors for its development. Subsequently, there is interest in routine second-look laparotomy to follow-up high-risk CRC patients so to 'prevent' PM.

METHODS

Patients were retrospectively selected from the St George database, all of whom had had PM recurrence after primary CRC resection thus underwent peritonectomy/HIPEC. Each patient's primary tumour pathology was obtained with incidence of high-risk stage (T4), macroscopic (peritoneal involvement, ovarian metastases, perforated primary) and microscopic (mucinous, signet ring) features noted.

RESULTS

125 patients were included. At primary diagnosis, 34.4%, 46.4% and 19.2% were of T3, T4a and T4b stage. Primary tumour macroscopic features included 41.1%, 12.6% and 23.7% with synchronous peritoneal involvement, perforated primary and ovarian metastases. Primary tumour microscopic features included 8.1%, 44.0% and 5.6% with signet ring, mucinous and both pathologies. Individually T4 status, macroscopic and microscopic features would have identified 65.6%, 56.8% and 46.5% of patients. Any high-risk factor would have identified 85.6%.

CONCLUSION

Our study suggests that T4 stage, high-risk macroscopic and high-risk microscopic features at time of primary diagnosis identifies the majority of CRC patients who later develop PM. This provides support for a selective second-look protocol in such patients to enable early identification and, potentially, 'prevention' of CRC PM.

Molecular variation of Sporisorium scitamineum in Mainland China revealed by internal transcribed spacers

Sugarcane smut caused by the fungus Sporisorium scitamineum is a worldwide disease and also one of the most prevalent diseases in sugarcane production in mainland China. To study molecular variation in S. scitamineum, 23 S. scitamineum isolates from the 6 primary sugar-cane production areas in mainland, China (Guangxi, Yunnan, Guangdong, Hainan, Fujian, and Jiangxi Provinces), were assessed using internal transcribed spacer (ITS) methods. The results of ITS sequence analysis showed that the organisms can be defined at the genus level, including Ustilago and Sporisorium, and can also differentiate between closely related species. This method was not suitable for phylogenetic relationship analysis of different S. scitamineum isolates and could not provide support regarding their race ascription at the molecular level. The results of the present study will be useful for studies examining the molecular diversity of S. scitamineum and for establishing a genetic foundation for their pathogenicity differentiation and new race detection. In addition, our results can provide useful information for the pathogen selection principle in sugarcane smut resistance breeding and variety distribution.

Identification of smut-responsive genes in sugarcane using cDNA-SRAP

Sugarcane smut, caused by the fungus Sporisorium scitamineum, is one of the main diseases that affect sugarcane worldwide. In the present study, the cDNA-SRAP technique was used to identify genes that are likely to be involved in the response of sugarcane to S. scitamineum infection. In total, 21 bands with significant differential expression during cDNA-SRAP analysis were cloned and sequenced. Real-time qPCR confirmation demonstrated that expression of 19 of these 21 differential bands was consistent with the expression observed during cDNA-SRAP analysis, with a deduced false positive rate of 9.5%. Sequence alignment indicated that 18 of 19 differentially expressed genes showed homologies from 19% to 100% to certain genes in GenBank, including the following genes: topoisomerase (EU048780), ethylene insensitive (EU048778), and tetraspanin (EU048770). A real-time qPCR assay showed that during 0-72 h after pathogen infection, expression of the topoisomerase and the ethylene insensitive genes was upregulated, whereas expression of the tetraspanin gene was downregulated, identical to the expression patterns observed under salicylic acid treatment. Therefore, all three genes are thought to play a role during S. scitamineum challenge, but with different functions. To our knowledge, this is the first report on the application of cDNA-SRAP in differential gene expression analysis of sugarcane during a sugarcane-S. scitamineum interaction. The results obtained also contribute to a better understanding of the molecular mechanisms associated with sugarcane-S. scitamineum interactions.

Liver X receptors contribute to periodontal pathogen-elicited inflammation and oral bone loss

Periodontal diseases are chronic oral inflammatory diseases that are polymicrobial in nature. The presence of specific bacteria in subgingival plaque such as Porphyromonas gingivalis is associated with microbial dysbiosis and the modulation of host immune response. Bacterially elicited innate immune activation and inflammation are key elements implicated in the destruction of soft and hard tissues supporting the teeth. Liver X receptors (LXRs) are nuclear hormone receptors with important function in lipid homeostasis, inflammation, and host response to infection; however, their contribution to chronic inflammatory diseases such as periodontal disease is not understood. The aim of this study was to define the contribution of LXRs in the development of immune response to P. gingivalis and to assess the roles that LXRs play in infection-elicited oral bone loss. Employing macrophages, we observed that P. gingivalis challenge led to reduced LXRα and LXRβ gene expression compared with that observed with unchallenged wild-type cells. Myeloid differentiation primary response gene 88 (MyD88)-independent, Toll/interleukin-1 receptor-domain-containing adapter-inducing interferon-β (TRIF)-dependent signaling affected P. gingivalis-mediated reduction in LXRα expression, whereas neither pathway influenced the P. gingivalis effect on LXRβ expression. Employing LXR agonist and mice deficient in LXRs, we observed functional effects of LXRs in the development of a P. gingivalis-elicited cytokine response at the level of the macrophage, and participation of LXRs in P. gingivalis-elicited oral bone loss. These findings identify novel importance for LXRs in the pathogenesis of P. gingivalis infection-elicited inflammation and oral bone loss.

Personal inhalation exposure to polycyclic aromatic hydrocarbons in urban and rural residents in a typical northern city in China

Personal inhalation exposure samples were collected and analyzed for polycyclic aromatic hydrocarbons (PAHs) for 126 selected volunteers during heating and non-heating seasons in a typical northern Chinese city, Taiyuan. Measured personal PAH exposure levels for the urban residents in the heating and non-heating seasons were 690 (540-1051) and 404 (266-544) ng/m(3) , respectively, while, for the rural residents, they were 770 (504-1071) and 312 (201-412) ng/m(3) , respectively. Thus, rural residents are exposed to lower PAH contamination in comparison with the urban residents in the non-heating seasons. In the heating season, personal PAH inhalation exposure levels were comparable between the urban and rural residents, in part owing to the large rate of residential solid fuel consumption in the rural area for household cooking and heating. The estimated incremental lifetime cancer risks (ILCR) due to PAH exposure in Taiyuan were 3.36 × 10(-5) and 2.39 × 10(-5) for the rural and urban residents, respectively, significantly higher than the literature-reported national average level, suggesting an urgent need of PAH pollution control to protect human health.

Aging and contribution of MyD88 and TRIF to expression of TLR pathway-associated genes following stimulation with Porphyromonas gingivalis

BACKGROUND AND OBJECTIVE

Periodontal disease is a highly complex chronic inflammatory disease of the oral cavity. Multiple factors influence periodontal disease, including socio-economic status, genetics and age; however, inflammation elicited by the presence of specific bacteria in the subgingival space is thought to drive the majority of soft- and hard-tissue destruction. Porphyromonas gingivalis is closely associated with periodontal disease. Toll-like receptors (TLRs) and their intracellular signaling pathways play roles in the host response to P. gingivalis. The focus of the current study was to use microarray analysis to define the contributions of the TLR adaptor molecules myeloid differentiation factor 88 (MyD88) and Toll/interleukin-1 receptor domain-containing adaptor inducing interferon-beta (TRIF), and aging, on the expression of TLR pathway-associated mRNAs in response to P. gingivalis.

MATERIAL AND METHODS

Bone marrow-derived macrophages (BMØ) from wild-type (Wt), MyD88 knockout (MyD88-KO) and Trif(Lps2) [i.e. containing a point mutation in the lipopolysaccharide 2 (Lps2) gene rendering the Toll/interleukin (IL)-1 receptor domain-containing adaptor inducing interferon-beta (TRIF) protein nonfunctional] mice, at 2-and 12-mo of age, were cultured with P. gingivalis. Expression of genes in BMØ cultured with P. gingivalis was determined in comparison with expression of genes in BMØ cultured in medium only.

RESULTS

Using, as criteria, a twofold increase or decrease in mRNA expression, differential expression of 32 genes was observed when Wt BMØ from 2-mo-old mice were cultured with P. gingivalis compared with the medium-only control. When compared with 2-mo-old Wt mice, 21 and 12 genes were differentially expressed (p < 0.05) as a result of the mutations in MyD88 or TRIF, respectively. The expression of five genes was significantly (p < 0.05) reduced in Wt BMØ from 12-mo-old mice compared with those from 2-mo-old mice following culture with P. gingivalis. Age also influenced the expression of genes in MyD88-KO and Trif(Lps2) mice challenged with P. gingivalis.

CONCLUSIONS

Our results indicate that P. gingivalis induces differential expression of TLR pathway-associated genes, and both MyD88 and TRIF play roles in the expression of these genes. Age also played a role in the expression of TLR-associated genes following stimulation of BMØ with P. gingivalis.

Influence of polymer end-chemistry on the morphology of perfluorohexane polymeric microcapsules intended as ultrasound contrast agents

Ultrasound contrast agents (UCAs) composed of a liquid perfluorocarbon (PFC) core surrounded by a polymer shell have shown promising echogenicity as well as stability. In a strategy to optimize the ultrasound properties of these systems, encapsulating a liquid PFC with a low boiling point such as perfluorohexane (PFH) was suggested. The ultimate aim of these systems would be to induce phase-transition of the liquid PFH into gas by acoustic droplet vaporization (ADV) to further increase the UCA acoustic response. Microcapsules with a perfluorohexane core have been developed by an emulsion-evaporation process, using three biodegradable polymers: PLGA and PLA with acid (PLA-COOH) and ester (PLA-COOR) terminations. Despite their similar properties, these polymers were found to strongly influence the final microcapsule morphology. While PLGA was able to form nice core-shell microcapsules, the use of PLA-COOH led to decentered microcapsules and big "eye" morphologies, and PLA-COOR induced the formation of "acorn" morphologies. To shed light on morphologies disparities, polymer interfacial behavior was studied at the dichloromethane-water and the PFH-dichloromethane interfaces. One can conclude that the core-shell structure is the result of a significant adsorption of the polymer at the dichloromethane-water interface together with a good stability of the PFH droplet within the emulsion globule. Previous work has shown that the capsule's thickness-to-radius (T/R) ratio can be controlled easily by varying the polymer to perfluorocarbon proportions. This versatility was confirmed for PFH capsules with PLA-COOH and PLGA shells. Finally, the encapsulation efficiency of PFH was assessed by relating the T/R ratio to the volume fraction of PFH and by (19)F NMR spectroscopy.