Comparison of hemodynamic response to tracheal intubation and postoperative pain in patients undergoing closed reduction of nasal bone fracture under general anesthesia: a randomized controlled trial comparing fentanyl and oxycodone

Background

The present study aimed to compare the intravenous bolus effect of oxycodone and fentanyl on hemodynamic response after endotracheal intubation and postoperative pain in patients undergoing closed reduction of nasal bone fracture.

Methods

In this prospective randomized double-blinded study, 64 patients undergoing closed reduction of nasal bone fracture were randomized into one of two groups: the fentanyl group (Group F) or the oxycodone group (Group O). Each drug (fentanyl 2 mcg/kg in Group F and oxycodone 0.2 mg/kg in Group O) was administered prior to the induction of general anesthesia. Hemodynamic changes after endotracheal intubation and postoperative pain were then measured in both groups.

Results

There was no significant difference in the change in mean arterial pressure and heart rate between pre-induction and post-intubation in both Groups F and O (P > 0.05). Postoperative pain in Group O was milder than that in Group F (P < 0.001); however, time to awakening from the end of operation was shorter in Group F (P = 0.012).

Conclusion

In patients undergoing closed reduction of nasal bone fracture, oxycodone attenuates hemodynamic response to endotracheal intubation similar to fentanyl. However, oxycodone is more effective than fentanyl in improving postoperative pain.

Trial registration

Clinical Research Information Service (Trial registry number: KCT0001153) on 3 July, 2014

Electronic supplementary material

The online version of this article (doi:10.1186/s12871-016-0279-x) contains supplementary material, which is available to authorized users.

A randomized, multi-center, open-label, phase III study of once-per-cycle DA-3031, a pegylated G-CSF, in comparison with daily filgrastim in patients receiving TAC chemotherapy for breast cancer

PURPOSE

This multi-center, randomized, phase III study was conducted to demonstrate the non-inferiority of DA-3031 compared with daily filgrastim in patients during the first cycle of chemotherapy for breast cancer in terms of the duration of severe neutropenia (DSN).

METHODS

Seventy-four patients with breast cancer who were receiving combination chemotherapy with docetaxel, doxorubicin, and cyclophosphamide (TAC) were enrolled. All participants were randomized to receive either daily subcutaneous injections of filgrastim 100 μg/m²/day for up to 10 days or a single subcutaneous injection of DA-3031 at fixed doses of 6 mg on day 2 of each chemotherapy cycle.

RESULTS

The mean duration of grade 4 (G4) neutropenia in cycle 1 was 2.08 ± 0.85 days for the filgrastim group and 2.28 ± 1.14 days for the DA-3031 group. The difference between groups was 0.2 ± 1.10 days (95 % confidence interval (CI) = -0.26, 0.66), which supported non-inferiority. No statistically significant differences were observed in nadir absolute neutrophil count (ANC) (154.34/mm³ and 161.75/mm³ for the filgrastim and DA-3031 groups, respectively; P = 0.8414) or in time to ANC recovery (10.03 ± 0.75 and 9.83 ± 1.56 days in the filgrastim and DA-3031 groups, respectively; P = 0.0611) during cycle 1. Serious AEs occurred in six (15.8 %) patients receiving filgrastim and in ten (27.8 %) patients receiving DA-3031; however, none was determined to be related to the study drug.

CONCLUSIONS

DA-3031 and daily filgrastim are similar in regard to DSN and safety in breast cancer patients receiving TAC chemotherapy.

Randomized controlled trial on preemptive analgesia for acute postoperative pain management in children

BACKGROUND

Preemptive analgesia is an anti-nociceptive treatment that starts before surgery and prevents the establishment of central sensitization. Whether preemptive analgesia is more effective than conventional regimens for managing postoperative pain remains controversial. This study evaluated the efficacy of intravenous preemptive analgesia for acute postoperative pain control in pediatric patients.

METHODS

In this prospective randomized controlled trial, 51 children aged 3-7 years, scheduled for corrective osteotomy were randomized into control (group C) or preemptive (group P) group. Both groups received standardized general anesthesia, including intravenous patient-controlled analgesia (IV-PCA) with fentanyl, which was started before skin incision in group P or 5 min thereafter in group C. IV-PCA data, pain scores using verbal rating scale (VRS) and Wong-Baker FACES(®) pain rating scale (WBFS), emergence agitation score (EAS) using the Pediatric Anesthesia Emergence Delirium (PAED) scale, analgesic requirements, and complications were recorded.

RESULTS

The primary outcome, pain score at postoperative 1 h, showed no difference between the groups. Both groups did not demonstrate emergence agitation (PAED cutoff value ≥ 12), although the EAS at admission to the postanesthetic care unit (PACU) was lower in group P than in group C (P = 0.002; mean difference 4.85, 95% CI 1.97-7.73). There were no differences in the delivered volume of IV-PCA, frequency of pushing the IV-PCA button, effective push attempts, VRS, WBFS, EAS at discharge from the PACU, additional analgesic requirements, and complications.

CONCLUSION

Preemptive analgesia using IV-PCA with fentanyl showed no significant advantages for postoperative analgesia after corrective osteotomy in pediatric patients.

Analgesic efficacy of two interscalene blocks and one cervical epidural block in arthroscopic rotator cuff repair

PURPOSE

Despite its effectiveness in other surgeries, studies on continuous epidural block in upper-extremity surgery are rare because of technical difficulties and potential complications. This study compared postoperative analgesic efficacy and safety of ultrasound-guided continuous interscalene brachial plexus block (UCISB) and fluoroscopy-guided targeted continuous cervical epidural block (FCCEB) in arthroscopic rotator cuff repair (ARCR).

METHODS

Seventy-five patients were randomly and equally assigned to groups FCCEB (0.2%), UCISB75 (0.75%), and UCISB20 (0.2%) according to the initial ropivacaine dose (8 ml). The background infusion (0.2% ropivacaine at 5 ml/h), bolus (3 ml of 0.2% ropivacaine), and lockout time (20 min) were consistent. Respiratory effects [respiratory discomfort (modified Borg scale), ventilatory function, and hemidiaphragmatic excursion (ultrasound)], analgesic quality [pain severity at rest and motion attempt (VAS-R and -M), number of boluses, analgesic supplements, and sleep disturbance], neurologic effects, procedural discomfort, satisfaction, and adverse effects were evaluated preprocedurally and up to 72 h postoperatively.

RESULTS

FCCEB caused less respiratory depression and sensorimotor block, but had less analgesic efficacy than UCISBs (P < 0.05). FCCEB caused nausea, vomiting, and dizziness more frequently (P < 0.05) and had lower patient satisfaction than UCISBs (P < 0.05). UCISB75 can cause severe respiratory distress in patients with lung disorders. Other variables were not significantly different between the groups.

CONCLUSIONS

UCISB20 may provide superior postoperative analgesia and is the most recommendable postoperative analgesic method in ARCR.

LEVEL OF EVIDENCE

Randomized controlled trials, Therapeutic study, Level I.

Abstract P1-09-09: Role of endocrine therapy in premenopausal patients with hormone receptor-positive metastatic breast cancer, compared with postmenopausal patients: Diachronic analyses from nationwide cohort in Korea (KCSG BR 14-07)

Background

Endocrine therapy (E) has a major role in treatment of hormone receptor (HR)-positive metastatic breast cancer (MBC). However, in contrast to western countries, premenopausal patients (PRE) more prevalent (50% of all breast cancer patients) and have less options of E than postmenopausal patients (POST) in Korea where the use of LHRH agonist in combination aromatase inhibitors (AIs) in PRE is restricted. Recently we have been successfully established nationwide cohort for the patients MBC (575 patients from 26 institutes). This study was designed to evaluate the role of E especially in PRE.

Methods

The patients with MBC were prospectively or retrospectively enrolled between September 2014 and May 2015. Only menopausal status-confirmed patients (296) were analyzed. Postmenopause was defined, based on NCCN guideline. Total duration of treatment was defined as the time from start day of any first treatment to end of any last treatment. Total duration of E was defined as the sum of time duration of each E. Overall survival was calculated from the start day of any treatment for MBC to any causes of death. This work is supported by National Strategic Coordinating Center for Clinical Research (H110C2020).

Results

A total of 296 patients with HR-positive MBC were analyzed [PRE, 169 (57.1%) and POST, 127 (42.9%)]. Except age (mean 44 and 60 years), baseline characteristics including in pathology, HER2 status, initial pathologic stage, de novo metastasis versus recurrence, surgery and adjuvant treatment (chemotherapy, endocrine therapy and radiotherapy) were well balanced. 92 (54.4%) of PRE and 77 (60.6%) of POST received at least one or more E through all treatment course. 41 (24.2%) of PRE and 44 (34.6%) received E as 1st-line treatment (p=0.034). Among PRE who received 1st-line of E, 30 (71.4%) and 9 (21.4%) of PRE received 2nd- and 3rd-line E. 20 (45.4%) and 10 (22.7%) of POST received 2nd- and 3rd- or more line of E. Most of PRE (54%) received tamoxifen+/-goserelin and 32% of PRE received AIs along with ovarian suppression. 71% of POST received AIs. As initial treatment, E was more frequently used in POST than in PRE (34.6% and 24.3%, p=0.053). Overall survival (OS) of all patients was 18.2 months (95% CI, 14.8-21.5). There was no difference in OS between PRE (17.8 months, 10.9-24.8) and POST (18.5 months, 95% CI, 13.2-23.9) (P=0.337). No difference of OS was observed (E, 18.1 moths, 95% CI, 13.0-23.3; chemotherapy 21.2 moths, 95% CI, 16.8-25.5), regardless of initial treatment. Total duration of treatment of PRE and POST were 15.2 and 13.6 months, respectively with no significant difference (p=0.389). PRE (8.3 moths, 95% CI,5.7-10.8) showed the trend toward longer duration of E in comparison with POST (5.5 moths, 95% CI,4.4-6.7), however the difference did not reach statistical significance (p=0.051).

Conclusion

E was more commonly used as 1st-line therapy in POST than in PRE. Although PRE had limited options of E, E was used in long duration of treatment especially in PRE. These findings suggested that E had a role in treatment for PRE with HR-positive MBC and could be used in treatment for PRE with good efficacy.

Citation Format: Kim T-Y, Ahn J-H, Yoon JH, Sohn JH, Kim GM, Lee KH, Park YH, Koh S-J, Lee SE, Chae Y, Lee KS, Lee KE, Won HS, Kim JH, Jeong J, Park KH, Cho EK, Im Y-H, Im S-A, Jung KH. Role of endocrine therapy in premenopausal patients with hormone receptor-positive metastatic breast cancer, compared with postmenopausal patients: Diachronic analyses from nationwide cohort in Korea (KCSG BR 14-07). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-09-09.

Abstract P1-10-31: Impact of increased physical activities after diagnosis on fatigue and overall pain during cancer treatment: A prospective cohort study

Background

Existing evidence strongly suggests that exercise is not only safe but also feasible during cancer treatment. Physical activity is recommended for improving multiple post-treatment adverse effects on bone health, muscle strength, and other quality-of-life measures. Yet, limited evidence exists regarding effect of increased physical activity after diagnosis on symptoms management of breast cancer patients.

Methods

A total of 422 patients were recruited from July 2010 to July 2011 at two cancer hospitals in Seoul, Korea. Physical activity in sports (PAS) was assessed using Minnesota Leisure Time Physical Activity Questionnaire before and 2 weeks, 3-, 6-, 12-, 24- and 36-months after diagnosis. Physical symptoms including fatigue, pain, arm symptom, and insomnia were measured using EORTC-C30 and BR23. Growth mixture models were used to identify trajectory classes of physical activity patterns. Multivariate analysis was used to find impact of PAS on symptom management using SAS.

Results

Three distinct PAS groups were identified according to 3-year change patterns: moderate to moderate (MM): 40.8%, none to moderate (NM): 31.1% and moderate to high (MH): 28.1%. The LM and MH group increased PAS from diagnosis but it began to decrease from 1 year after diagnosis. Compared to the MM, the NM and MH reported significantly lower level of fatigue (MM:40.7, NM:32.2, MH:33.7), pain(MM:28.0, NM:25.6, MH:20.6), systemic therapy side effects (MM:26.9, NM:22.6, MH:21.8), and breast symptoms (MM:25.4, NM:21.7, MH:20.2) during active treatment (6 months after diagnosis).

Change patterns of quality of life according to trajectory groups At diagnosis2 weeks3 months6 months12 months24 months36 monthsFatigueMM31.3±1.930.2±1.935.3±2.0140.7±2.1137.8±2.1138.5±2.1141.0±2.21NM30.2±1.928.2±1.931.9±2.132.2±2.2233.6±2.135.6±2.2137.8±2.31MH28.8±2.327.4±2.233.0±2.433.7±2.51233.9±2.4136.2±2.5137.1±2.51PainMM15.1±1.531.3±1.9123.2±2.0128.0±2.0123.5±2.0122.0±2.0121.2±1.91NM15.4±1.532.4±2.023.3±2.0125.6±2.122.7±2.021.1±2.123.8±2.01MH17.2±1.828.4±2.3121.2±2.320.6±2.4219.7±2.321.1±2.318.6±2.2Systemic therapy side effectsMM16.8±1.114.3±1.2133.2±1.7126.9±1.5125.4±1.5126.2±1.6128.6±1.71NM15.0±1.114.5±1.235.2±1.7122.6±1.61222.0±1.6124.5±1.7127.7±1.81MH15.6±1.412.9±1.4134.4±2.0121.8±1.81221.8±1.7122.1±1.9124.7±2.01Breast symptomsMM13.8±1.226.4±1.6120.8±1.5125.4±1.6123.6±1.6119.2±1.7119.6±1.71NM13.0±1.224.7±1.6119.6±1.5121.7±1.61222.3±1.7119.9±1.8119.1±1.81MH16.0±1.424.1±1.8119.4±1.820.2±1.81217.8±1.8217.4±2.014.0±1.92*adjusted with age, stage, and radiotherapy 1 p&lt;0.05 (differences from baseline within group), 2 p&lt;0.05 (differences from MM group within time)

Conclusion

The results of the study confirmed that increased physical activity after diagnosis, even with patients who did not exercise at all before diagnosis, helps to control fatigue, pain, systemic side effects, and breast symptoms during treatment. It is necessary to find ways to promote physical activity after diagnosis and help patients to stay active during treatment.

Citation Format: Lee JK, Kang D, Choi E-K, Kong S, Lee S-K, Lee JE, Han W, Park YH, Ahn JS, Im YH, Noh D-Y, Nam S-J, Cho J. Impact of increased physical activities after diagnosis on fatigue and overall pain during cancer treatment: A prospective cohort study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-31.

Abstract P4-13-27: A phase Ib dose de-escalation study of combined tamoxifen and goserelin acetate with alpelisib (BYL719) or buparlisib (BKM120) in premenopausal patients with HR+/HER2– locally advanced or metastatic breast cancer

Background: Growing evidence suggests that concomitant inhibition of the phosphatidylinositol 3-kinase (PI3K)/AKT/mammalian target of rapamycin pathway could enhance and extend the clinical benefit of endocrine therapies in hormone receptor-positive (HR+) metastatic breast cancer (mBC). In this Phase Ib study (NCT02058381), alpelisib (a p110α-selective inhibitor) or buparlisib (a pan-PI3K inhibitor) was combined with tamoxifen and goserelin acetate in premenopausal women with mBC, a more prevalent patient population in Asian vs Western countries.

Methods: Premenopausal women with HR+/human epidermal growth factor receptor 2-negative (HER2–) locally advanced or mBC and no prior endocrine therapy for metastatic disease were recruited in Taiwan, Republic of Korea, and Thailand. Patients (pts) received tamoxifen (20 mg once daily [QD]) and goserelin (3.6 mg Q28D) with either alpelisib (350 mg QD; Group 1) or buparlisib (100 mg QD; Group 2) on a continuous dosing schedule in 28-day cycles. The primary objective was to define the recommended Phase II dose (RP2D) for each combination, based on dose-limiting toxicities (DLTs) observed during Cycle 1, using a dose de-escalation design. Secondary objectives included pharmacokinetics, safety and tolerability (per Common Terminology Criteria for Adverse Events v4.03), efficacy (per Response Evaluation Criteria In Solid Tumors v1.1), and impact on quality of life.

Results: As of February 2, 2015, 12 pts, all Asian, have been treated in the first cohort. In Group 1, 6 pts with a median age of 43 were treated with alpelisib (350 mg starting dose), and no DLTs were observed in Cycle 1. In Group 2, 6 pts with a median age of 47 were treated with buparlisib (100 mg starting dose), and 1 DLT of Grade (G) 3 alanine aminotransferase/aspartate aminotransferase elevation was observed. In Group 1, significant toxicities included hypokalemia (G3: 1 pt), rash (G3: 1 pt; G1/2: 2 pts), anemia (G3: 1 pt), leukopenia (G3: 1 pt), and infections (G3: 1 pt; G1/2: 1 pt); no G4 toxicities were reported. In Group 2, significant toxicities included liver toxicity (G4: 1 pt; G3: 1 pt; G1/2: 2 pts), psychiatric disorders (G4: 1 pt; G3: 1 pt; G1/2: 1 pt), rash (G3: 1 pt; G1/2: 2 pts), hypertension (G3: 1 pt; G1/2: 1 pt), and hyperglycemia (G3: 1 pt). No pts in Group 1, and 5/6 pts in Group 2, have discontinued treatment due to adverse events (AEs). Median treatment duration was 110 days in Group 1 and 71 days in Group 2.

Conclusions: The combination of alpelisib (350 mg) with tamoxifen and goserelin resulted in a manageable toxicity profile. Meanwhile, the same combination with full-dose buparlisib (100 mg) was less well tolerated; despite the appearance of only one DLT during Cycle 1, the majority of pts subsequently stopped treatment due to AEs. An expansion phase is ongoing, and results will be integrated with safety, tolerability, and efficacy results for the first 15 pts enrolled in each group. PIK3CA status at baseline will also be assessed.

Citation Format: Lu Y-S, Ro J, Tseng L-M, Chao T-Y, Chitapanarux I, Valenti R, Canatar A, Salomon H, Park YH. A phase Ib dose de-escalation study of combined tamoxifen and goserelin acetate with alpelisib (BYL719) or buparlisib (BKM120) in premenopausal patients with HR+/HER2– locally advanced or metastatic breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-27.

Abstract P2-08-19: Prognostication of HER family gene expression collaborate with ESR1 expression in patients with triple negative breast cancer

Background: Triple-negative breast cancer (TNBC) consists of heterogeneous sub-population. Although many investigators made an effort to categorize and classify TNBCs using genetic expressions, it is still needed to be defined for prognostication Traditionally, HER family genes have been known to contribute mammalian glands formation and breast cancer generation as well as ESR gene. Moreover, target agents for HER family genes have been already developed. Accordingly, we investigated the expression profiles of HER family genes with ESR in patients with TNBC to categorize into sub-types and determine the prognostic value of HER family genes in search of clinical implications.

Methods : We investigated the results of the nCounter expression assay (NanoString®) for ERBB1, ERBB2, ERBB3, ERBB4 and ESR1 using mRNA extract from paraffin-embedded tumor tissues in 203 patients diagnosed as TNBC. We used the results of nCounter expression assay using 84 TNBC tissues for validation and 52 breast cancer tissues diagnosed as other subtypes to control the expression assay results of these five genes.

Results: Two-hundred and three patients were diagnosed as TNBC from 2000 to 2004 and received adjuvant chemotherapy after curative surgery. Eighty-four TNBC patients for validation set and 52 patients diagnosed as other subtypes for control set were selected from the patients diagnosed as breast cancer from 2005 to 2010 and received curative surgery. Through analyzing 5 genes using the nCounter expression profiles from 203 TNBC tissues, we found that increased expression of ERBB4 was associated with poor prognosis by survival analysis (5 year disease recurrence free survival (DRFS), low vs. high expression [cut-off: median]: 90.1% vs. 80.2%; p =.002). This trend was still remained in validation set composed of TNBC (5 year DRFS, low vs. high expression [cut-off : median]: 61.1% vs. 44.0%), whereas was not observed in other subtypes of breast cancer (44.4% vs. 80.8%). The Kaplan-Meier estimates of the rates of 5 year DRFS in the subgroups classified according to the level of 5 genes expression showed that the group of higher expression of all HER family genes and lower expression of ESR1 gene had dismal prognosis rather than other groups in patients with TNBC (5 year DRFS, this group vs. others: 50.0% vs. 88.2%; p &lt;.001). In a multivariate Cox regression model, ERBB4 expression identified as a useful marker for predicting long-term prognosis in patients with TNBC although other HER family genes and ESR1 expressions did not predict prognosis of TNBC with statistical significance (Table 1).

Impact of the m RNA expression levels of ERBB family and ESR1 on DRFS Hazard Ratio95% CIP-valueStage  &lt;.001I1.0NA IIA1.200.40-3.57 IIB3.751.20-11.74 IIIA5.461.55-9.24 IIIC59.9214.30-251.12 EGFR  .167Low1.0NA High1.690.80-3.55 ERBB2  .057Low1.0NA High0.430.18-1.03 ERBB3  .061Low1.0NA High2.200.96-5.04 ERBB4  .016Low1.0NA High2.681.20-5.95 ESR1  .113Low1.0NA High0.570.28-1.15 

Conclusions: The expression profile of HER family genes could be used as a prognostic marker in patients with TNBC. Further study is needed to identify the expression profiles of HER family gene as predictive marker of HER targeting treatment in patients with TNBC.

Citation Format: Kim J-Y, Ahn T, Jung HH, Park K, Do I-G, Kil WH, Kim SW, Lee JE, Nam SJ, Ahn JS, Park YH, Im Y-H. Prognostication of HER family gene expression collaborate with ESR1 expression in patients with triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-19.

Abstract P6-10-03: Does participation in clinical trials influence on survival in patients with metastatic breast cancer?

Background

Recently, many clinical trials (TRIAL) especially incorporated with molecular-targeted agents are being conducted in treatment for breast cancer worldwide. However, the relation of participating clinical trials with survival has not been actively studied. This study was designed to evaluate whether participation in clinical trials could improve overall survival (OS) or not in patients with metastatic breast cancer (MBC), compared with conventional treatment.

Method

Korean Cancer Study Group (KCSG) has successfully established Nationwide Cohort in KOREA to conduct diachronic analysis (KCSG BR 14-07). Clinical data for patients with MBC were collected from this Cohort. OS was defined as the time duration from first diagnosis of metastasis to any cause of death. This work is supported by National Strategic Coordinating Center for Clinical Research (H110C2020).

Results

A total of 575 patients with metastatic breast from 26 institutes in KOREA cancer MBC were consequently enrolled between September 2014 and May 2015. 156 (27.1%) of patients were enrolled to at least one or more clinical trials and 419 patients received only conventional treatment (CONV). Age, hormone status, HER2 status, initial pathologic stage, metastasis versus recurrence, adjuvant treatment, ECOG performance status (PS) (0, 1 vs 2 or more) were similar between TRIAL and CONV. 30% of trials were associated with HER2-targeted agents. As initial treatment, chemotherapy was more frequently used in TRIAL (85.9%) than in CONV (79.0%) (P=0.038). Number of regimens of chemotherapy was greater in TRIAL (2.9+/-1.8) than CONV (2.1+/-1.6) (P&lt;0.001). Number of regimens of endocrine therapy (E) was similar between TRIAL (1.4+/-0.6) and CONV (1.5+/-0.7) (P=0.474). Overall survival of all patients was 16.2 months (95% CI, 14.1-18.1). TRIAL showed significant prolongation of survival, compared with CONV [21.1 (95% CI, 17.7-24.6) vs 15.1 months (95% CI, 13.1-17.2); P=0.005]. The differences in OS was constantly observed in HER2-positive [23.8 (16.7-30.9) vs 17.2 months (95% CI, 12.4-21.9); P=0.018] and Triple-negative [15.4 (10.5-20.3) vs 12.0 months (95% CI, 10.2-13.8); P=0.025]. In multivariate analysis, initial metastasis, hormone status, ECOG PS did not influence on OS between TRIAL and CONV (P=0.849)

Conclusion

Participating in clinical trials could be associated with prolongation of survival. This results constantly maintained in HER2-positive and triple-negative MBC. These findings suggested that clinical trials are useful for the patients with MBC, even if the patients do not complete the standard treatment.

Citation Format: Kim T-Y, Sohn JH, Kim S-B, Yoon JH, Kim GM, Lee KH, Koh S-J, Park YH, Lee SE, Chae Y, Lee KS, Lee KE, Won HS, Kim JH, Jeong J, Park KH, Cho EK, Im Y-H, Im S-A, Jung KH. Does participation in clinical trials influence on survival in patients with metastatic breast cancer?. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P6-10-03.

Abstract P1-10-30: Effect of mind and beauty education on body image among young breast cancer patients: A randomized controlled trial

Background

The proportion of young age-onset breast cancer in Korea is relatively higher than Western countries. Young breast cancer patients are more likely to suffer from altered appearance due to cancer treatment such as breast disfiguration, hair loss, skin change and experience poor body image. This randomized controlled trial (RCT) is designed to evaluate the effect of mind and beauty education program on body image among breast cancer patients under 40-years old.

Methods

A total of 109 eligible breast cancer patients aged 18-40 years old, who had surgery and/or chemotherapy within 18 months and who reported poor body image (&lt;66 EORTC QLQ-BR23 body image score) were recruited and randomly assigned to intervention and control group from July 2014 and April 2015 at an university-based hospital in Seoul, Korea. Intervention group received a structured 8 hours education (2 hours for 4 weeks, 1 hour for mind control and 1 hour for altered appearance management) and control group had education after outcome evaluation. Body image as primary outcome was assessed using both EORTC QLQ-BR23 and body image scale (BIS). In addition, socio-demographic characteristic, self-esteem, quality of life, anxiety, and depression were assessed. Outcomes were evaluated before the intervention, right after the intervention (visit 2), and 3 (visit 3) and 6 months (visit 4) after the intervention. T-test and intention-to-treat analysis performed to compare the outcomes of the two groups.

Results

A total of 54 and 55 patients were assigned to intervention and control group respectively with block randomization. Among the intervention group, 43 participants (79.6%) attended for more than 6 hours of education. Total 46 participants (85.2%) in intervention group and 53 participants (96.4%) in control group completed the questionnaire at visit 2.

Mean age of the study population was 35.5 years old and there were 53 (48.6%), 32 (29.3%), 23 (21.1%) stage I, II, and III breast cancer patients respectively. At baseline, none of the socio-demographic, clinical, psycho-social characteristics were different between two groups. While there was no difference with the body image at baseline between intervention (57.69±20.57) and control group (53.09±26.98) (P=0.327), intervention group reported significantly improved body image than control group (EORTC QLQ-BR23 - Intervention; 71.69±20.27 and Control; 55.97±23.07, P&lt;0.001). The results were similar with BIS measured body image (BIS - Intervention; 17.77±6.29 and Control; 21.29±6.94, P=0.012).

Conclusion

This study provided evidence supporting that mind and body education program would be beneficial to young women with breast cancer who would suffer from low body image. Active education program and psychosocial support related to altered appearance would help young breast cancer patients to make a smooth transit when they return to usual life.

Trial registration: This study is registered in Korean Clinical Research Information Service (CRIS) with registration number KCT0001191.

Funding: This study was supported by grants from Amorepacific.

Citation Format: Lee JK, Cho J, Park SK, Kim I-R, Yoon J-H, Choi E-K, Cho S-Y, Lee S-K, Lee JE, Kim S, Nam S-J, Park YH, Ahn JS, Im YH. Effect of mind and beauty education on body image among young breast cancer patients: A randomized controlled trial. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-30.

The changes of non-invasive hemoglobin and perfusion index of Pulse CO-Oximetry during induction of general anesthesia

BACKGROUND

We hypothesized that induction of general anesthesia using sevoflurane improves the accuracy of non-invasive hemoglobin (SpHb) measurement of Masimo Radical-7® Pulse CO-Oximetry by inducing peripheral vasodilation and increasing the perfusion index (PI). The aim of this study is to investigate the change in the SpHb and the PI measured by Rad7 during induction of general anesthesia using sevoflurane.

METHODS

The laboratory hemoglobin (Hblab) was measured before surgery by venous blood sampling. The SpHb and the PI was measured twice; before and after the induction of general anesthesia using sevoflurane. The changes of SpHb, Hbbias (Hbbias = SpHb - Hblab), and PI before and after the induction of general anesthesia were analyzed using a paired t-test. Also, a Pearson correlation coefficient analysis was used to analyze the correlation between the Hbbias and the PI.

RESULTS

The SpHb and the PI were increased after the induction of general anesthesia using sevoflurane. There was a statistically significant change in the Hbbias from -2.8 to -0.7 after the induction of general anesthesia. However, the limit of agreement (2 SD) of the Hbbias did not change after the induction of general anesthesia. The Pearson correlation coefficient between the Hbbias and the PI was not statistically significant.

CONCLUSIONS

During induction of general anesthesia using sevoflurane, the accuracy of SpHb measurement was improved and precision was not changed. The correlation between Hbbias and PI was not significant.

Determination of the 95% effective dose of remifentanil for the prevention of coughing during extubation in children undergoing tonsillectomy (with or without adenoidectomy)

BACKGROUND

Limited data are available regarding the 95% effective dose (ED95 ) of remifentanil to prevent the cough response during emergence from general anesthesia in children.

METHODS

This study included 40 patients aged 3-12 years who underwent elective tonsillectomy with or without adenoidectomy. A predetermined remifentanil dose was infused continuously with desflurane during surgery and was continued until extubation. In the emergence period, the cough response during awake extubation was assessed to determine the remifentanil dose for the next patient. The first patient received remifentanil at the rate of 0.01 μg·kg(-1) ·min(-1) , and subsequent patients received a 0.01 μg·kg(-1) ·min(-1) higher dose than the previous patient if there was more than moderate coughing detected, and the patient after those with less than mild coughing received either the same dose (95% probability) or a 0.01 μg·kg(-1) ·min(-1) lower dose (5% probability) using the biased coin design. Times to extubation and adverse events were recorded. The ED95 was calculated using the maximum-likelihood estimation.

RESULTS

The ED95 of remifentanil for preventing coughing during extubation was 0.060 μg·kg(-1) ·min(-1) (95% confidence interval, 0.037-0.068). There was moderate coughing in all groups receiving 0.01-0.06 μg·kg(-1) ·min(-1) of remifentanil, but no cough response occurred in the group receiving remifentanil 0.07 μg·kg(-1) ·min(-1) . Time to extubation was weakly correlated with remifentanil infusion rate (r = 0.331). One patient who received remifentanil 0.07 μg·kg(-1) ·min(-1) showed desaturation over 5 s immediately after extubation, but recovered after receiving 100% oxygen.

CONCLUSION

The ED95 of the continuous remifentanil infusion rate was 0.060 μg·kg(-1) ·min(-1) to prevent the cough response during extubation in children after tonsillectomy.

RAS status in Korean patients with stage III and IV colorectal cancer

BACKGROUND

KRAS mutations are common and clearly contribute to malignant progression. The frequency of NRAS mutations and their relationship to clinical, pathologic, and molecular features remains unclear.

METHODS

We evaluated 130 colorectal tumors for mutations in KRAS and NRAS gene. We tested for mutations in codons 61 and 146 of KRAS and codons 12, 13, 59, 61 and 146 of NRAS. Mutation status was determined by targeted dideoxy sequencing.

RESULTS

Among the analyzed primary tumors, 36.2% had KRAS mutation. Of the 83 KRAS codon 12 and 13 wild-type patients, 7.2% had KRAS codon 61, 146 or NRAS. 40.7% harbored any RAS mutation.

CONCLUSION

The frequency of other RAS (NRAS and KRAS exon 3, 4) activating mutations in colorectal cancers is relatively low in Korean colorectal cancer patients.

The effect of lidocaine on apoptotic neurodegeneration in the developing mouse brain

Background

General anesthetics induce neuronal apoptosis in the immature brain. Regional anesthesia using local anesthetics can be an alternative to general anesthesia. Therefore, this study investigated the possible effect of lidocaine on neuronal apoptosis.

Methods

Fifty-one 7-day-old C57BL6 mice were allocated into control (group C), lidocaine (group L), lidocaine plus midazolam (group LM) and isoflurane (group I) groups. Group C received normal saline administration. Groups L and LM were injected with lidocaine (4 mg/kg, subcutaneously) only and the same dose of lidocaine plus midazolam (9 mg/kg, subcutaneously). Group I was exposed to 0.75 vol% isoflurane for 6 h. After 6 h, apoptotic neurodegeneration was assessed using caspase-3 immunostaining and terminal deoxynucleotidyl transferase dUTP nick-end labelling (TUNEL) staining.

Results

For the entire brain section, neuronal cells exhibiting caspase-3 activation were observed more frequently in group I than in group C (P < 0.001). In the thalamus, apoptosis of group L was more frequent than that of group C (P < 0.001), but less freqent than that of groups LM and I (P = 0.0075 and P < 0.001, respectively). In the cortex, group I experienced more apoptosis than group L and C (all Ps < 0.001). On TUNEL staining, the difference in apoptosis between the lidocaine and control groups was marginal (P = 0.05).

Conclusions

Lidocaine induced minimal apoptosis in the developing brain compared with isoflurane and lidocaine plus midazolam. However, we cannot fully exclude the possible adverse effect of subcutaneously administered lidocaine on the developing brain.

Transthoracic echocardiographic guidance for obtaining an optimal insertion length of internal jugular venous catheters in infants

BACKGROUND

There are multiple methods of determining the optimal position of central venous catheter (CVC) tips. The purpose of this study was to assess the feasibility of transthoracic echocardiography (TTE), and compare TTE and height-based method for correct positioning of CVCs in infants undergoing cardiac surgery.

METHODS

Ultrasonography-guided central venous catheterization was performed via the right internal jugular vein. Longitudinal images of the right atrium and superior vena cava were obtained using TTE. The catheter tip was located 10 mm above the crista terminalis. If the catheter tip was not clearly visualized, the probe was rotated to obtain transverse images and the CVC tip was positioned at the level of the pulmonary artery bifurcation. The mean distance from the catheter tip to the level of the carina was compared with that calculated using a height-based formula.

RESULTS

Among 106 cases, positioning of the CVC tip under TTE guidance failed in four patients; thus, the success rate was 96.2%. The mean distance from the CVC tip to the level of the carina was different for positioning using the TTE method (-3.8 ± 8.2 mm; 95% confidence interval, -5.5 to -2.2 mm) and that using the height-based formula (6.1 ± 9.6 mm; 95% CI, 4.2 to 8.0 mm; P = 0.001). The distance was consistent regardless of the height when the insertion length was determined using TTE (r = -0.048, P > 0.05).

CONCLUSIONS

Transthoracic echocardiography is a practical method for the correct placement of the CVC tip with less variability compared to the height-based method.

Overexpression of the Brassica rapa transcription factor WRKY12 results in reduced soft rot symptoms caused by Pectobacterium carotovorum in Arabidopsis and Chinese cabbage

Chinese cabbage (Brassica rapa L. ssp. pekinensis), an important vegetable crop, can succumb to diseases such as bacterial soft rot, resulting in significant loss of crop productivity and quality. Pectobacterium carotovorum ssp. carotovorum (Pcc) causes soft rot disease in various plants, including Chinese cabbage. To overcome crop loss caused by bacterial soft rot, a gene from Chinese cabbage was isolated and characterised in this study. We isolated the BrWRKY12 gene from Chinese cabbage, which is a group II member of the WRKY transcription factor superfamily. The 645-bp coding sequence of BrWRKY12 translates to a protein with a molecular mass of approximately 24.4 kDa, and BrWRKY12 was exclusively localised in the nucleus. Transcripts of BrWRKY12 were induced by Pcc infection in Brassica. Heterologous expression of BrWRKY12 resulted in reduced susceptibility to Pcc but not to Pseudomonas syringae pv. tomato in Arabidopsis. Defence-associated genes, such as AtPDF1.2 and AtPGIP2, were constitutively expressed in transgenic lines overexpressing BrWRKY12. The expression of AtWKRY12, which is the closest orthologue of BrWRKY12, was down-regulated by Pcc in Arabidopsis. However, the Atwrky12-2 mutants did not show any difference in response to Pcc, pointing to a difference in function of WRKY12 in Brassica and Arabidopsis. Furthermore, BrWRKY12 in Chinese cabbage also exhibited enhanced resistance to bacterial soft rot and increased the expression of defence-associated genes. In summary, BrWRKY12 confers enhanced resistance to Pcc through transcriptional activation of defence-related genes.

Sevoflurane post-conditioning increases nuclear factor erythroid 2-related factor and haemoxygenase-1 expression via protein kinase C pathway in a rat model of transient global cerebral ischaemia

BACKGROUND

The antioxidant mechanism of sevoflurane post-conditioning-induced neuroprotection remains unclear. We determined whether sevoflurane post-conditioning induces nuclear factor erythroid 2-related factor (Nrf2, a master transcription factor regulating antioxidant defence genes) and haemoxygenase-1 (HO-1, an antioxidant enzyme) expression, and whether protein kinase C (PKC) is involved in Nrf2 activation, in a rat model of transient global cerebral ischaemia/reperfusion (I/R) injury.

METHODS

Eighty-six rats were assigned to five groups: sham (n=6), control (n=20), sevoflurane post-conditioning (two cycles with 2 vol% sevoflurane inhalation for 10 min, n=20), chelerythrine (a PKC inhibitor; 5 mg kg(-1) i.v. administration, n=20), and sevoflurane post-conditioning plus chelerythrine (n=20). The levels of nuclear Nrf2 and cytoplasmic HO-1 were assessed 1 or 7 days after ischaemia (n=10 each, apart from the sham group, n=3).

RESULTS

On day 1 but not day 7 post-ischaemia, Nrf2 and HO-1 expression were significantly higher in the sevoflurane post-conditioning group than in the control group. Chelerythrine administration reduced the elevated Nrf2 and HO-1 expression induced by sevoflurane post-conditioning.

CONCLUSIONS

Sevoflurane post-conditioning increased Nrf2/HO-1 expression via PKC signalling in the early phase after transient global cerebral I/R injury, suggesting that activation of antioxidant enzymes may be responsible for sevoflurane post-conditioning-induced neuroprotection in the early phase after cerebral I/R injury.

First Report of White Blister Rust Caused by Albugo candida on Wasabi in Korea

Wasabi (Wasabia japonica (Miq.) Matsum.), a member of the Brassicaceae family, is a commercially important crop in East Asian countries such as China, Japan, Korea, and Taiwan. In Korea, wasabi is under commercial development since it has become popular as a condiment due to its strong pungent constituents. In May 2013, wasabi plants showing typical symptoms of white blister rust disease were first observed in plastic greenhouses in Taebaek City, Korea. Leaves of infected plants had whitish sori on the lower surfaces and chlorotic blotches on the corresponding upper leaf surfaces. Later, sori changed to creamy to light tan with necrosis of leaf lesion. New infections might occur anytime during the growing season. A representative sample was deposited in the Korea University Herbarium (KUS-F27596). Microscopic examination of fresh materials was performed under a light microscope. The grouped sporangiophores were hyaline, clavate or cylindric, and measured 20 to 35 × 10 to 14 μm. The sporangia were arranged in basipetal chains, hyaline, globose to subglobose, with uniform wall thickness and measured 16 to 21 × 13 to 18 μm. The primary sporangia were morphologically similar to the secondary sporangia, although the former exhibited a slightly thicker wall than the latter. No resting organs were observed. Previously, the white blister rust pathogen on wasabi has been considered either Albugo candida or A. wasabiae, although the latter name is often considered a synonym of A. candida. Based on the morphological characteristics and the specific host plant, the causal agent of this disease was identified as A. candida (2). To confirm this morphological identification, genomic DNA was extracted from infected plant tissue, and the amplification and sequencing of the internal transcribed spacer (ITS) region of rDNA of the Korean specimen were performed using procedures outlined by Choi et al. (1), with oomycete-specific primer set, DC6 and LR0. The resulting 835-bp sequence of the region was deposited in GenBank (Accession No. KF887494). Since this was the first ITS sequence submitted for A. candida on wasabi, comparable data were not available. A comparison with the ITS sequences available in the GenBank database revealed that it is identical to A. candida found on Capsella bursa-pastoris (AF271231), and shows a high similarity of 99% with many A. candida sequences originating from other brassicaceous plants. Therefore, the pathogen found in Korea was confirmed to be A. candida. In Korea, it has been reported that A. candida attacks Brassica juncea, B. campestris subsp. penikensis, and B. napus (3), but to our knowledge this is the first record of A. candida on wasabi (4). The white blister rust caused by A. candida is one of the most devastating diseases of wasabi in Japan and Taiwan where the crop is widely cultivated. On the other hand, in the United States, Canada, and New Zealand, where wasabi is a new crop on a commercial scale, there is no record of this disease. These facts taken together suggest that wasabi white blister rust be not only currently spreading in East Asia, but it also poses a new and serious threat to production of this crop in countries in which it is currently absent. References: (1) Y. J. Choi et al. Mol. Phylogenet. Evol. 40:400, 2006. (2) Y. J. Choi et al. Fungal Divers. 27:11, 2007. (3) Y. J. Choi et al. Plant Pathol. J. 27: 192, 2011. (4) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved November 15, 2013.

A pilot study on the safety and efficacy of generic mycophenolate agent as conversion maintenance therapy in stable liver transplant recipients

PURPOSE

The patent covering mycophenolate mofetil (MMF) in Korea has expired and, thus, several generic MMF agents are now commercially available. The supply of Cellcept (Roche Korea) was interrupted at the end of 2011, so it was inevitable that a generic MMF would be used instead. During this period, we performed a prospective pilot study to examine the safety and efficacy of a generic mycophenolate agent (Myconol: Hanmi Pharmaceutical, Seoul Korea) for use as conversion maintenance therapy in stable liver transplantation (OLT) recipients.

METHODS

OLT recipients, who were treated with MMF on an outpatient basis from January 2012 to March 2012, attended follow-up interviews conducted. The patients had undergone OLT ≥ 2 years before the study, had tolerated Cellcept, and showed stable liver function. Fifty-three patients were followed up for more than 3 months after conversion to the same dose of Myconol.

RESULTS

After conversion to Myconol, 6 patients (11.3%) experienced new side effects, which disappeared when they reverted to Cellcept (n = 5) or stopped taking Myconol medication (n = 1). The side effects associated with Myconol included gastrointestinal symptoms (indigestion and diarrhea; n = 3), skin eruptions (n = 1), pruritus (n = 1), and insomnia (n = 1). The mean mycophenolic acid levels were 1.71 ± 0.88 μg/mL for Cellcept and 1.83 ± 0.91 μg/mL for Myconol, which showed a strong correlation (r(2) = 0.92, P < .001).

CONCLUSIONS

Myconol showed similar pharmacokinetics to those of Celcept, but a small proportion of patients experienced agent-specific side effects; therefore, patients should be closely monitored when taking Myconol. Also, further studies, with a greater number of patients, are required to identify the full spectrum of drug-associated side effects.

Ultrasound-guided Prolotherapy with Polydeoxyribonucleotide Sodium in Ischiofemoral Impingement Syndrome

Ischiofemoral impingement syndrome is an uncommon disorder defined by hip pain caused by the narrowing of the space between the ischial tuberosity and lesser trochanter with associated entrapment of the quadratus femoris muscle. We effectively treated two male patients using ultrasound-guided prolotherapy with polydeoxyribonucleotide sodium mixed with local anesthetics. A 24-year-old male patient with no history of trauma or surgery complained of bilateral hip and groin pain; magnetic resonance imaging demonstrated slight narrowing of the bilateral ischiofemoral spaces with mild enhancement of the left quadratus femoris muscle. A 23-year-old male patient with a history of iliotibial band release and iliopsoas tendon release complained of left hip and groin pain; magnetic resonance imaging revealed swelling of the left quadratus femoris muscle. After the fifth treatment session of prolotherapy, the pain severity score using the visual analog scale was found to be minimal (0-1/10), and follow-up magnetic resonance imaging revealed a slightly decreased enhancement of the quadratus femoris muscle compared with that on previous images. Prolotherapy with polydeoxyribonucleotide sodium was an efficacious treatment for two patients with ischiofemoral impingement syndrome who were not candidates for surgery.