Anatomical variation of the ulnar artery: clinical and developmental significance

Introduction: Variation of the ulnar artery in the upper limb is uncommon. The existence of such a variant is of particular clinical significance, as these arteries are more susceptible to trauma, and can be easily confused with superficial veins during medical and surgical procedures, potentially leading to iatrogenic distal limb ischemia. Case report: During routine dissection we observed a unilateral case of superficial ulnar artery in a 60-year-old male cadaver. It originated from the left brachial artery in the middle of the arm, near to insertion of coracobrachialis muscle. From its origin, it passed downwards in the medial part of arm behind the median nerve and forearm in a supericial plane compared to normal ulnar artery. In the hand, the supericial ulnar artery anastomosed with the palmar branch of the radial artery, creating the supericial palmar arch. Brachial artery divided into the radial and common interosseous arteries in the cubital fossa. The normal ulnar artery was absent. The existence of superficial ulnar artery is undeniably of interest to the clinicians as well as to the anatomists.

Benzo(a)pyrene, an Active Product of Cigarette Smoke, Role in PLA2 Isoforms Activation in Colon Cancer

Background and aim: One of the active combustion product of cigarette smoke, Benzo[a]pyrenes, role in pulmonary cancer is clearly understood. However, its role in gastrointestinal cancer including colon cancer is not clearly understood. Methods: In this study, benzo(a)pyrenes was treated to colon cells to evaluate its role in cell viability, cellular ROS, and gene expression of various PLA2 isoforms was evaluated by FACS and PCR. The identified PLA2 was silenced at the gene level to evaluate its role in cell viability and ROS generation. Results: B(a)P treatment at 1 µg/mL for 48 h to HCT-15 male colon cells significantly reduced the cell viability without affecting HT-29 female colon cells. Higher doses and longer treatment duration with B(a)P showed that female colon cells were highly sensitive than male colon cells. Annexin-V/PI staining for preapoptotic detection showed that B(a)P treatment increased the apoptosis in both the cell types in a concentration and time-dependent manner. The cytosolic ROS (cROS) and superoxide radical (SOR) formation in the female colon cells was significantly higher than male colon cells unlike the mitochondrial ROS (mtROS) production which was significantly higher in male colon cells. Treatment with B(a)P significantly upregulated the IID and IVA PLA2 isoform groups in HCT-15 male colon cells, whereas IB was upregulated in HT-29 female colon cells among the various PLA2 isozyme gene studied (IB, IID, III, IVA, IVB, IVC, VI, X, aiPLA2 and iPLA2). Gene silencing experiments targeting PLA2 IID and IVA in the HCT-15 male colon cells and IB in HT-29 female colon cells showed no effect with B(a)P treatment on the cell proliferation, apoptosis, membrane integrity and free radicals (ROS, mtROS, and SOR) generation. Conclusion: Targeting specific PLA2 isozymes in a cell-specific manner abolished the B(a)P-induced PLA2-mediated oxidative damage–related signaling pathways.

Longitudinal Trial of a Smart Phone Application for Tele–Follow-Up of Thyroid Cancer Patients in Context of a Developing Country: Compliance, Satisfaction and Cost-Benefit Analysis

Background and context: Over the next decades, cancer burden is expected to reach 20 million new cases annually in low- and middle-income countries (LMICs) by 2025. The rate of incidence of thyroid cancer has increased more than any other cancer worldwide. In the United States has seen >300% increase within the past 30 years and few estimates suggest that thyroid cancer could become the third most common cancer diagnosed in women by 2019. Health care services therefore need to gear up to provide close clinical follow-up care for people both in primary and specialist care. Information and communication technologies may enable more integrated treatment and care pathways across geographical boundaries. Though, hospital-based telemedicine system has been proved to be effective in carrying out continuity of care after primary treatment is over, current usage of social media in such situations are not studied well. The social media–based remote monitoring can be done at leisure, convenient to both patients and treating surgeons and does not require costly hospital infrastructure. Aim: We conducted this study to assess the effect of remote monitoring using tele–follow-up on compliance, satisfaction and economic benefit. Strategy/Tactics: Use of social media tools to empower patients on regular follow-up. Program/Policy process: Remote monitoring using social media. Outcomes: A total of 67 postoperative patients were followed up using social media tools. A total of 248 tele-sessions were held. The average number of tele-consultation per patient was 3.7 (range 2-6). The reasons for tele–follow-up were: confirmation of histology report (n = 62), medication dosage adjustments (n = 58), wound evaluation (n = 42), reporting of S. TSH and S. calcium levels (n = 128) and medical fitness certificate (n = 3). Wound evaluation through tele–follow-up was on par with OPD follow-up as no patient had to report to OPD for wound infection. Satisfaction level was excellent in 55% of patients and very good in 25%. 20% of the patients said that satisfaction level was average. If all of these 67 patients would have come to our OPD follow-up, they would have traveled 830 km per patient on an average, apart from losing work hours. Average cost and work days saving per visit was $78 and 5.4 days respectively. Compliance was good as all patients reported on the date and time of appointment. The technique ensures satisfactory follow-up. What was learned: Low- and middle-income countries need an eHealth revolution using this type of technology to achieve the goal of health for all as availability of health care facilities is a problem in such geographical locations in addition to lack of human resources as compared with patients needing healthcare.

Adrenocortical Suppression in Children with Nephrotic Syndrome Treated with Low-Dose Alternate Day Corticosteroids

Corticosteroids form the mainstay of therapy for all forms of nephrotic syndrome. The long-term use of this medication is associated with serious side effects including adrenocortical suppression. The primary objective of this study was to identify adrenocortical suppression (assessed by single morning serum cortisol levels) in children with nephrotic syndrome on treatment with low-dose alternate day steroids. This cross-sectional study was conducted in the Department of Pediatrics in a tertiary care hospital from January 2014 to January 2015. Seventy children (1–18 years) with nephrotic syndrome (steroid sensitive and resistant) who were in remission and on low-dose alternate day steroids for at least 8 weeks or had received steroids of 2 mg/kg/d for at least 2 weeks in the last 1 year (infrequent relapsers) were enrolled. Relevant history was taken, clinical examination was done and blood samples were drawn for serum cortisol, lipid profile, kidney function tests, fasting blood sugar, glycated hemoglobin (HbA_1c), and serum albumin. Forty percent (28/70) children had adrenocortical suppression as assessed by low morning serum cortisol levels. The mean serum cortisol levels were 188 nmol/L and were significantly lower in frequently relapsing individuals (85.9 nmol/L) as compared to other types of nephrotic syndrome (P = 0.05). The prevalence of adrenocortical suppression was higher in steroid-resistant patients (57%) as compared to 28% in frequently relapsing and 11% in steroid-dependent patients. Fifty-seven percent of patients with adrenocortical suppression had short stature while 50% had obesity. All individuals had normal serum HbA_1c levels. The cumulative steroid doses and total duration of corticosteroid therapy were significantly higher in patients with adrenocortical suppression. Children with nephrotic syndrome treated with low-dose alternate day steroids have a high prevalence of adrenocortical suppression on screening with single morning cortisol sample. Those with frequently relapsing or steroid-resistant diseases are at a higher risk of suppression.

PTH [1-34]-induced alterations predispose the mandibular condylar cartilage to mineralization

OBJECTIVE

To study the effects of intermittent parathyroid hormone (PTH [1-34]) on the mandibular condylar cartilage (MCC) and subchondral bone in adult female mice.

MATERIALS AND METHODS

Twenty-two, 20-week-old female mice were used for in vivo experiments. The experimental mice (n=11) received daily intraperitoneal injections of PTH [1-34] for 3 weeks, while control mice (n=11) received intraperitoneal injections of 0.9% saline solution. Mice were euthanized and then micro-computed tomography (micro-CT); histology and immunostaining were carried out to assess the response.

RESULTS

Intermittent PTH [1-34] led to early MCC breakdown and surface irregularities. Micro-CT analyses indicated that PTH [1-34] treatment led to increased bone volume fraction, tissue density and trabecular thickness, while decreasing the trabecular spacing. Histological analyses showed decreased proteoglycan secretion, increased bone turnover (TRAP staining) and increased mineralization. Furthermore, PTH [1-34] treatment showed increased apoptosis of the cells. Our immunohistochemistry showed increased expression of pSMAD158 in the MCC and subchondral bone with PTH administration, whereas sclerostin (SOST) expression was decreased.

CONCLUSIONS

Intermittent PTH [1-34] results in early mineralization of the MCC, which may result in cartilage degeneration. Our results identified a novel mechanism by which PTH [1-34] induces alteration in the microarchitecture of the MCC and the subchondral bone.

Abstract P4-06-03: Characteristics of CHEK2 mutation carriers in a large academic health center in Michigan

Background: Germline mutations in CHEK2, a cell-cycle checkpoint kinase, are associated with increased susceptibility to breast, colon, and other cancers. The clinical characteristics and cancer risks of patients with CHEK2 mutations is under investigation.

Methods: Patients identified with a pathogenic germline CHEK2 mutation between September 2013 and April 2017 were evaluated. Clinical multigene panel testing using next generation sequencing technologies was utilized. All patients received comprehensive pre- and post-test genetic counseling. Genetic testing results, demographics, tumor characteristics and outcomes were analyzed.

Results: A total of 107 CHEK2 mutation carriers were identified, of whom 88 (82%) were females. The vast majority were Caucasian (99%), and of those, 17 (16%) had Ashkenazi Jewish ancestry. The median age at time of genetic testing was 52 (range: 22-89). The most common mutations identified were: I157T (28%), c.1100delC (27%), p.S428F (15%) and c.1427C>T (9%). Seven of these patients (7%) were found to carry a second pathogenic cancer risk mutation: BRCA, ATM, NBN, NF1, and MUTYH. One patient was found to carry 3 pathogenic mutations (1100delC, ATM, and BRCA). Sixty-three (59%) patients had a prior diagnosis of malignancy, with a mean age of diagnosis of 53. Of the 88 females, the most common type of malignancy was breast cancer (55%), with a mean age of diagnosis of 52 (range: 35-79). Of the 19 males, breast cancer was seen in 4 patients. The most common known histopathology was invasive ductal carcinoma (72%), followed by DCIS (15%), invasive lobular carcinoma (9%), and papillary carcinoma (4%). Majority of the patients had breast tumors with low or moderate grade (62%), less than two centimeters (61%), node negative (70%), and estrogen/progesterone receptor positive/HER2neu negative (96%). Two patients had triple negative breast cancers. Of the 48 female mutation carriers with breast cancer, 38% underwent bilateral mastectomy. The 1- and 5-year survival was 100% with a median follow up of 57 months. Five of the 48 females developed a contralateral breast cancer, with a median time to contralateral recurrence of 6 years (range: 3-17). Two patients developed in-breast tumor recurrence at 9 and 19 years, respectively. Other cancers observed were papillary thyroid cancer (3 patients), melanoma (2 patients), and prostate (2 patients). One patient developed angiosarcoma of the chest wall two years after radiation therapy.

Conclusion: Our study describes the unique clinical characteristics of CHEK2 mutation carriers in a US-based clinic at Beaumont Health. Majority of breast cancers were early stage, hormone receptor positive and demonstrated excellent outcomes. Despite the early stage, a significant proportion of patients underwent bilateral mastectomy. Additional pathogenic mutations were identified in 10% of patients; validating the importance of panel testing in assessing cancer risk. Future studies are needed to better define the clinical presentation, cancer risks, mutational spectrum, and outcomes of CHEK2 mutation carriers in order to provide tailored screening and management guidelines for this emerging population.

Citation Format: Blankenship LM, Yadav S, Yumpo Cardenas P, Zakalik D. Characteristics of CHEK2 mutation carriers in a large academic health center in Michigan [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 P4-06-03.

Final overall survival analysis for the phase II RECORD-3 study of first-line everolimus followed by sunitinib versus first-line sunitinib followed by everolimus in metastatic RCC

Background

RECORD-3 compared everolimus and sunitinib as first-line therapy, and the sequence of everolimus followed by sunitinib at progression compared with the opposite (standard) sequence in patients with metastatic renal cell carcinoma (mRCC). This final overall survival (OS) analysis evaluated mature data for secondary end points.

Patients and methods

Patients received either first-line everolimus followed by second-line sunitinib at progression (n = 238) or first-line sunitinib followed by second-line everolimus (n = 233). Secondary end points were combined first- and second-line progression-free survival (PFS), OS, and safety. The impacts of neutrophil lymphocyte ratio (NLR) and baseline levels of soluble biomarkers on OS were explored.

Results

At final analysis, median duration of exposure was 5.6 months for everolimus and 8.3 months for sunitinib. Median combined PFS was 21.7 months [95% confidence interval (CI) 15.1–26.7] with everolimus-sunitinib and 22.2 months (95% CI 16.0–29.8) with sunitinib-everolimus [hazard ratio (HR)_{EVE-SUN/SUN-EVE}, 1.2; 95% CI 0.9–1.6]. Median OS was 22.4 months (95% CI 18.6–33.3) for everolimus-sunitinib and 29.5 months (95% CI 22.8–33.1) for sunitinib-everolimus (HR_{EVE-SUN/SUN-EVE}, 1.1; 95% CI 0.9–1.4). The rates of grade 3 and 4 adverse events suspected to be related to second-line therapy were 47% with everolimus and 57% with sunitinib. Higher NLR and 12 soluble biomarker levels were identified as prognostic markers for poor OS with the association being largely independent of treatment sequences.

Conclusions

Results of this final OS analysis support the sequence of sunitinib followed by everolimus at progression in patients with mRCC. The safety profiles of everolimus and sunitinib were consistent with those previously reported, and there were no unexpected safety signals.

Clinical Trials number

ClinicalTrials.gov identifier, NCT00903175

Neutrophil Gelatinase-associated Lipocalin: As a Predictor of Early Diabetic Nephropathy in Type 2 Diabetes Mellitus

This study was carried out to look for diagnostic and prognostic role of neutrophil gelatinase-associated lipocalin (NGAL) in early diabetic nephropathy (DN) in type 2 diabetes individuals. NGAL was measured in both urinary and serum sample of 144 type 2 diabetes individuals stratified into three categories based on urinary albumin-creatinine ratio and 54 control populations with estimated glomerular filtration rate >60 mL/min/1.73 m² and serum creatinine <1.2 mg/dl. The serum NGAL (sNGAL), urine NGAL (uNGAL), and uNGAL/urine creatinine were significantly higher in diabetic individuals than in the control populations with significant difference in between the groups (P < 0.05). Difference of above values between control value and normoalbuminuria was also statistically significant (P < 0.05). Again, sNGAL and uNGAL correlate positively with albuminuria (P < 0.05). Tubular injury may precede glomerular injury in diabetic individuals, and NGAL can be used as a biomarker to diagnose DN even earlier to incipient nephropathy. Both sNGAL and uNGAL can predict albuminuria and be used as a noninvasive tool for diagnosis, staging, and progression of DN.

Reply to Comment on "Solid-Liquid Work of Adhesion"

Extrand's interpretation in his "Comment on "Solid-Liquid Work of Adhesion" by Tadmor and Coworkers" may lead to an important discussion and physical understanding of the problem. Below, we compare the two approaches and elucidate the differences to put them in the right perspective.

Lung cancer: analysis of biomarkers and methods of diagnostic and prognostic value

This paper summarizes the overwhelming evidence that targeted therapy is better than chemotherapy for the treatment of lung cancer. The focus is on lung cancer because of the sheer magnitude of this disease especially in males. In India, lung cancer constitutes 6.9 per cent of all new cancer cases and 9.3 per cent of all cancer related deaths in both sexes (1). Currently the world we reside has a norm of developing cure to an abnormal state of living body (so called disease) based on evidences, recognized during the diagnosis of the disease. It is done to ensure optimized therapy of treatment and maximize the outcome. Personalized medicine is also an uprising norm. In this kind, all the variables such as host, environment, patient, etc. are considered for an individual case and the course of treatment is followed based on the standard options available. Its main objective is the best interest of the patient. Through a survey conducted in the northern belt of the country we tried to determine the biomarkers currently being used and the scope of targeted therapy. Thus, in its most basic form medicine is not only a science but is also an art.

Dissolution of steel slags in aqueous media

Steel slag is a major industrial waste in steel industries, and its dissolution behavior in water needs to be characterized in the larger context of its potential use as an agent for sequestering CO₂. For this purpose, a small closed system batch reactor was used to conduct the dissolution of steel slags in an aqueous medium under various dissolution conditions. In this study, two different types of steel slags were procured from steel plants in India, having diverse structural features, mineralogical compositions, and particle sizes. The experiment was performed at different temperatures for 240 h of dissolution at atmospheric pressure. The dissolution rates of major and minor slag elements were quantified through liquid-phase elemental analysis using an inductively coupled plasma atomic emission spectroscopy at different time intervals. Advanced analytical techniques such as field emission gun-scanning electron microscope, energy-dispersive X-ray, BET, and XRD were also used to analyze mineralogical and structural changes in the slag particles. High dissolution of slags was observed irrespective of the particle size distribution, which suggests high carbonation potential. Concentrations of toxic heavy metals in the leachate were far below maximum acceptable limits. Thus, the present study investigates the dissolution behavior of different mineral ions of steel slag in aqueous media in light of its potential application in CO₂ sequestration.

Experimental study of dissolution of minerals and CO2 sequestration in steel slag

This study strives to achieve a substantial amount of steel slag carbonation without using any harmful chemicals. For this purpose, experiments were performed in an aqueous medium, in a semi-batch reactor, to investigate the effect of varying reaction conditions during the steel slag CO₂ sequestration process. Further, studying the effect of dissolution on carbonation reactions and the mineralogical changes that subsequently occur within the slag helps provide insight into the parameters that ultimately have an impact on the carbonation rate as well the magnitude of the impact.

Purification, characterization and retting of Crotolaria juncea fibres by an alkaline pectin lyase from Fusarium oxysporum MTCC 1755

Using solid-state fermentation, production of an industrially important pectin lyase from a fungal strain Fusarium oxysporum MTCC 1755 was attempted, which was further subjected to purification and characterization. The enzyme was purified by three steps, namely ammonium sulfate fractionation, cation-exchange chromatography on CM cellulose followed by gel filtration chromatography using Sephadex G-100 column. A 16-fold purification with 31.2% yield and 3.2 U/mg specific activity was achieved. The optimum pH of the purified enzyme was 9.0 and stability ranged from pH 5.0-7.0 for 24 h. Optimum temperature of purified enzyme was found to be 40 °C while temperature stability ranged from 10 to 50 °C for 30 min. The K _m and k _cat of the enzyme was 1.75 mg/ml and 83.3 s^-1, respectively. The purified enzyme was found to be highly stimulated by Ca²⁺ ions while sugars like mannitol and sorbitol, and salts like NaCl and CaCl₂ enhanced the thermostability. The purified pectin lyase was found suitable for retting of Crotolaria juncea fiber.

Abstract P5-08-14: Synchronous bilateral breast cancer compared to unilateral breast cancer: A population based study

Introduction: The clinical presentation and outcome of synchronous bilateral invasive breast cancer compared to unilateral breast cancer is not well studied. In this study, we present a population based comparison of tumor characteristics and survival between invasive unilateral and bilateral breast cancer.

Methods: Data from National Cancer Institute- Surveillance, Epidemiology and End Results (SEER) was analyzed to identify women who had a diagnosis of invasive ductal carcinoma (ICD-O-3: 8500/3) between the years 2000 and 2013. Women who were diagnosed with an invasive contralateral breast cancer within two months of initial diagnosis were classified under synchronous bilateral breast cancer group. Women who developed a contralateral breast cancer between three to twelve months of diagnosis were excluded. All women who did not develop a second breast cancer, or developed it after twelve months of initial diagnosis were classified under unilateral breast cancer group. Patients with an in-situ breast cancer diagnosis in the contralateral breast within twelve months of diagnosis of invasive ductal carcinoma were excluded. Patients with metastatic disease and unknown stage at presentation were excluded. Tumor characteristics and survival were compared between the two groups using the index case only. Mann-Whitney U test was used for continuous variables while Chi-square test was used for categorical variables. Kaplan-Meier curves and Cox proportional hazard regression models were used to compare survival. All data analysis was performed using SPSS 21.

Results: A total of 414,766 patients met our inclusion criteria. Of these, 3,590 patients were in the synchronous bilateral breast cancer group, while 411,176 were in the unilateral breast cancer group. Compared to unilateral breast cancer patients, bilateral breast cancer patients were slightly older (62 Vs 59, p&lt;0.05) and were more likely to have higher T, N or overall stage at presentation. Their tumors were also more likely to be estrogen or progesterone receptor positive (p&lt;0.05). Patients with bilateral breast cancer also had higher rates of mastectomy (63.3% Vs 39.1%, p&lt;0.05).

Patients with bilateral breast cancers had a significantly worse survival compared to patients with unilateral breast cancer (Table 1). In a multivariate Cox proportional hazard regression, adjusting for age at diagnosis, T-Stage, N-Stage, overall stage, hormone receptor status, type of surgical treatment and radiation therapy, bilateral breast cancers had a mortality hazard ratio of 1.48 (95% CI: 1.35 – 1.62, p&lt;0.001) compared to unilateral breast cancers.

Conclusions: Our study demonstrates that bilateral breast cancer has a worse prognosis compared to invasive unilateral breast cancer. These findings have important implications for patients, and contribute to our understanding of the unique outcomes of bilateral breast cancer which will guide treatment and follow up.

Table 1: Survival of unilateral vs bilateral breast cancer Unilateral breast cancerBilateral breast cancer5-year cause specific survival91.7%86.5%10-year cause specific survival86.1%77.7%

Citation Format: Yadav S, Zakalik D. Synchronous bilateral breast cancer compared to unilateral breast cancer: A population based study [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 P5-08-14.