Severe ovarian hyperstimulation syndrome in a naturally conceived singleton pregnancy after ovulation induction: a case report

OBJECTIVE

To present a case of severe ovarian hyperstimulation syndrome (OHSS) in a naturally conceived singleton pregnancy after ovulation induction.

CASE

A 31-year-old woman with polycystic ovarian syndrome (PCOS) underwent ovulation induction therapy. Six days later, she was admitted to the present hospital with the symptoms of OHSS. Ultrasonography confirmed the single live intrauterine pregnancy, as well as enlarged multicystic ovaries and marked ascites that required abdominal paracentesis. The woman was treated with intravenous infusion, exogenous colloid supplementation, essentiale liver treatment, rocephin anti-infective therapy for skin lymphangitis of left lower limb, and drainage of the ascites. She recovered by day 45 of admission.

CONCLUSION

Severe OHSS may develop in women with PCOS who undergo ovulation induction therapy. Serious complications may develop rapidly and therefore OHSS must be treated urgently and with multidisciplinary management.

Implication of Differential Peroxiredoxin 4 Expression with Age in Ovaries of Mouse and Human for Ovarian Aging

Ovarian aging has been associated with increased levels of reactive oxygen species and the deficiencies of antioxidant defense. The antioxidant peroxiredoxin 4 (Prdx4), as a member of Prdx protein family, controls cellular oxidative stress by reducing H2O2 levels. In previous studies, we provided evidence that Prdx4 was abundantly expressed in mouse and human ovaries and expression of Prdx4 in matured follicles was higher than that in immatured follicles. Accordingly, we speculated that Prdx4 expression could be associated with follicle development and it may be as a part of the antioxidative mechanism in follicular development. In this study, we demonstrated that Prdx4 was mainly expressed in the granulosa cells of mouse ovaries and the expression levels significantly increased along development of follicles. However, the expression levels of Prdx4 decreased when mice reached the aged stage (18 months old). Likewise a similar pattern that was observed in the mice study was also found in human ovaries where Prdx4 was expressed lower in premenopausal women than young women. Subsequent in vitro experiments indicated that Prdx4 mRNA and protein levels both increased with H2O2 in a concentrationdependent manner, but decreased rapidly with high concentration of H2O2, and the changes were closely related to cell proliferation. Taken together, these findings argue our understanding on the role of oxidative stress and antioxidant in follicular development and ovarian aging.

Ras-association domain family 10 acts as a novel tumor suppressor through modulating MMP2 in hepatocarcinoma

Ras-Association Domain Family 10 (RASSF10) is the last identified member of the RASSF family. The functional characteristics of this new gene in human cancers remain largely unclear. Here, we examined RASSF10 for the biological functions and related molecular mechanisms in hepatocellular carcinoma (HCC). We found that RASSF10 is expressed in normal human liver tissue, but is silenced or down-regulated in 62.5% (5/8) of HCC cell lines. The mean expression level of RASSF10 was significantly lower in primary HCCs compared with their adjacent normal tissues (P<0.005, n=52). The promoter methylation contributes to the inactivation of RASSF10 as demonstrated by bisulfite genomic sequencing and demethylation treatment analyses. Transgenic expression of RASSF10 in silenced HCC cell lines suppressed cell viability, colony formation and inhibited tumor growth in nude mice (QGY7703, P<0.01; HepG2, P<0.05). Furthermore, RASSF10 was shown to induce the cell accumulation in G1 phase with the increase of p27, as well as the decrease of cyclinD1 and CDK2/CDK4. Over-expression of RASSF10 also inhibited HCC cells migration (P<0.01) or invasion (P<0.05). Adhesion genes array revealed that Matrix Metalloproteinase 2 (MMP2) was a downstream effector of RASSF10. RASSF10 acting as a tumor suppressor to inhibit HCC invasion partially mediated by Focal Adhesion Kinase or p38 MAPK to decrease the accumulation of MMP2. Our study suggests that RASSF10 acts as a tumor suppressor for HCC.

[Gas chromatography for measurement of chlorpyrifos in serum]

OBJECTIVE

To investigate the method for the measurement of chlorpyrifos in serum by gas chromatography, and to provide a basis for emergency treatment of poisoning in clinical practice.

METHODS

Venous blood (3.0 ml) was collected from patients. After coagulation, the blood samples were centrifuged at 4 000 r/min for 5 minutes, and 0.5 ml of serum was placed in a glass test tube with a cork; 4.0 ml of ethyl acetate was then added and mixed rapidly, and this solution was subjected to extraction for 5 minutes and centrifuged at 4 000 r/min for 10 minutes. The ethyl acetate layer was placed in a conical tube and extracted twice with the same method. The extract was mixed and blow-dried with nitrogen, and the residue was dissolved with 50.0 μl ethanol. Gas chromatography was used for measurement, with a sample size of 1 μl and a retention time of 9.609 minutes.

RESULTS

The linear range of this method was 0.2~20.0 μg/ml, and the regression equation was y=2 372.6x+357.2(r=0.999 6). The detection limit of chlorpyrifos in serum was 0.05 μg/ml, and the recovery rate was 84.6%~102.4%. The relative standard deviation was 3.6%~4.8%, and the intra-day and inter-day relative standard deviations were 3.62%~5.10% and 3.77%~4.98%, respectively.

CONCLUSION

This detection method is accurate, simple, and convenient, and can be used for the clinical diagnosis of chlorpyrifos poisoning.

Abstract P6-11-01: Cost-effectiveness of pertuzumab in HER2+ metastatic breast cancer

Purpose

The Clinical Evaluation of Pertuzumab and Trastuzumab (CLEOPATRA) study showed a 15.7-month survival benefit with the addition of pertuzumab (P) to docetaxel and trastuzumab (TH) as first-line treatment for patients with HER2 overexpressing metastatic breast cancer. We performed a cost-effectiveness analysis to assess the value of the addition of pertuzumab to docetaxel and trastuzumab.

Patient and Methods

We developed a decision-analytic Markov model to evaluate the cost-effectiveness of TH with or without P in U.S. patients with metastatic breast cancer. The model followed patients weekly over their remaining lifetimes. Health states included: stable disease, progressing disease, hospice, and death. Transition probabilities were based on the CLEOPATRA study. Costs reflected the 2014 Medicare rates. Health state utilities were the same as those used in other recent cost-effectiveness studies of trastuzumab and pertuzumab. Outcomes included health benefits expressed as discounted quality-adjusted life-years (QALYs), costs in U.S. dollars, and cost-effectiveness expressed as an incremental cost-effectiveness ratio. One-way and multi-way deterministic and probabilistic sensitivity analyses explored the effects of specific assumptions.

Results

Modeled median survival was 39.4 months (TH) and 56.9 months (THP). The addition of pertuzumab resulted in an additional 1.81 life years gained (0.62 QALYs) at a cost of $472,668 per QALY gained. Deterministic sensitivity analysis showed that THP is unlikely to be cost-effective even under the most favorable assumptions, and probabilistic sensitivity analysis predicted 0% chance of cost-effectiveness at a willingness-to-pay of $100,000 per QALY gained.

Conclusion

The addition of pertuzumab to docetaxel and trastuzumab in patients with metastatic HER2+ breast cancer is unlikely to be cost-effective in the United States.

Citation Format: Qian Y, Durkee BY, Pollom EL, King M, Dudley SA, Shaffer JB, Chang DT, Gibbs IC, Goldhaber-Fiebert JD, Horst KC. Cost-effectiveness of pertuzumab in HER2+ 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 P6-11-01.

Physician preferences for bone metastasis drug therapy in Canada

BACKGROUND

Currently in Canada, several bone-targeted agents (btas) with varying characteristics are available for the prevention of skeletal-related events (sres) in patients with bone metastasis secondary to solid tumours. In the present study, we evaluated the preferences of physicians in Canada for the various attributes of the available btas.

METHODS

Physicians treating patients with bone metastasis from solid tumours were invited to complete an online discrete-choice experiment. Respondents were asked to choose between pairs of hypothetical medications for virtual patients. Each hypothetical medication was described based on predefined key attributes: time until first sre, time until worsening of pain, medication-related annual risk of osteonecrosis of the jaw (onj), medication-related annual risk of renal impairment, and mode of administration. A random-parameters logit model was used to analyze the choices between hypothetical medications and thus infer physician preferences for medication attributes.

RESULTS

Responses from the 200 physicians who completed the discrete-choice experiment suggested that months until first sre, risk of renal impairment, and months until worsening of pain were considered the most important attributes affecting choice of bta. The annual risk of onj was considered the least important attribute.

CONCLUSIONS

When making treatment decisions about the choice of bta for patients with bone metastasis from solid tumours, delaying sres and worsening of pain, and reducing the risk of renal impairment are primary considerations for physicians in Canada.

Infusion of dendritic cells carrying donor lymphocytes treated with 8-methoxypsoralen and ultraviolet A light induces CD19+ IL-10+ regulatory B cells and promotes skin allograft survival

PUVA-SP DCs are immature dendritic cells (imDCs) that have taken up donor splenic lymphocytes treated with 8-methoxypsoralen and ultraviolet A light (PUVA-SPs). Phagocytosis of donor PUVA-SPs does not stimulate phenotype maturation of recipient imDCs, and infusion of PUVA-SP DCs can induce CD4(+)CD25(high)Foxp3(+) regulatory T cells (Treg). However, the regulatory effect of PUVA-SP DCs on B cells is poorly understood. In this study, we compared PUVA-SP DCs with imDCs in terms of lipopolysaccharide (LPS) responsiveness and flow cytometric analysis of interleukin (IL) 10 expression in splenic CD19(+)B cells. Our results demonstrate that PUVA-SP DCs can suppress subsequent LPS-induced DC maturation and that infusion of PUVA-SP DCs, in the absence of an immunosuppressant, significantly promotes skin allograft survival. This effect was associated with up-regulation of circulating regulatory B cells exhibiting preferential IL-10 secretion. Our results suggest that effective treatments involving infusion of PUVA-SP DCs is likely related to the modulation not only of T-cell and Treg functions but also of B-cell and regulatory B-cell (Breg) functions.

Glucose- and Triglyceride-lowering Dietary Penta-O-galloyl-α-D-Glucose Reduces Expression of PPARγ and C/EBPα, Induces p21-Mediated G1 Phase Cell Cycle Arrest, and Inhibits Adipogenesis in 3T3-L1 Preadipocytes

Plant polyphenols, such as hydrolysable tannins, are present in the human diet and known to exhibit anti-diabetic and anti-obesity activity. We previously reported that the representative hydrolysable tannin compound α-penta-galloyl-glucose (α-PGG) is a small molecule insulin mimetic that, like insulin, binds to insulin receptor (IR) and activates the IR-Akt-GLUT4 signaling pathway to trigger glucose transport and reduce blood glucose levels in db/db and ob/ob diabetic mice. However, its effects on adipogenesis and lipid metabolism were not known. In this study, high fat diet (HFD)-induced diabetic and obese mice were treated with α-PGG to determine its effects on blood glucose and triglycerides. 3T3-L1 preadipocytes were used as a cell model for identifying the anti-adipogenic activity of α-PGG at molecular and cellular levels as a first step in elucidating the mechanism of action of the compound. In vivo, oral administration of α-PGG significantly reduced levels of blood glucose, triglyceride, and insulin in HFD-induced diabetic/obese mice (P<0.05). In vitro, α-PGG inhibited the differentiation of 3T3-L1 preadipocytes into mature adipocytes. α-PGG suppressed the expression of positive adipogenic factors PPARγ C/EBPα and mTOR and augmented the negative adipogenic factor Pref-1. Furthermore, α-PGG induced upregulation of p21 and G1 phase cell cycle arrest. In contrast, adipogenic signaling pathways mediated by insulin, the cAMP response element binding protein (CREB) and glucocorticoid receptor (GR), were not inhibited. RNAi knockdown of p21 led to a 4-fold increase in triglyceride level in 3T3-L1 preadipocytes treated with MDI and α-PGG compared to regular preadipocytes. These results indicate, for the first time, that α-PGG is blood triglyceride- and glucose-lowering in HFD-induced obese and diabetic mice. It selectively inhibited some but not all major adipogenic pathways as well as the mTOR-p21-mediated cell cycle regulatory pathway. It is very likely that these apparently diverse but coordinated activities together inhibited adipogenesis. These results expand our knowledge on how PGG works in adipocytes and further confirm that α-PGG functions as an orally-deliverable natural insulin mimetic with adipogenetic modulatory functions.

DNA methylation profiles in placenta and its association with gestational diabetes mellitus

Emerging evidences indicate that placenta plays a critical role in gestational diabetes mellitus (GDM). DNA methylation could be associated with altered placental development and functions. This study is to uncover the genome-wide DNA methylation patterns in this disorder. DNA methylation was measured at >385,000 CpG sites using methylated DNA immunoprecipitation (MeDIP) and a huamn CpG island plus promoter microarray. We totally identified 6,641 differentially methylated regions (DMRs) targeting 3,320 genes, of which 2,729 DMRs targeting 1,399 genes, showed significant hypermethylation in GDM relative to the controls, whereas 3,912 DMRs targeting 1,970 genes showed significant hypomethylation. Functional analysis divided these genes into different functional networks, which mainly involved in the pathways of cell growth and death regulation, immune and inflammatory response and nervous system development. In addition, the methylation profiles and expressions of 4 loci (RBP4, GLUT3, Resistin and PPARα) were validated by BSP for their higher log2 ratio and potential functions with energy metabolism. This study demonstrates aberrant patterns of DNA methylation in GDM which may be involved in the pathophysiology of GDM and reflect the fetal development. Future work will assess the potential prognostic and therapeutic value for these findings in GDM.

MLK3 promotes melanoma proliferation and invasion and is a target of microRNA-125b

BACKGROUND

Metastatic melanoma is a disease with high mortality and limited therapeutic options. MicroRNAs (miRNAs) can be used to classify melanoma stage.

METHODS

Expression of the miRNA miR-125b and serine/threonine kinase mixed lineage kinase (MLK)3 was assessed in primary malignant melanoma tissues and several melanoma cell lines by quantitative reverse transcription PCR. The effect of MLK3 and miR-125b on cell proliferation was evaluated by MTS assay, and cell invasion was evaluated by Transwell invasion assays. Targeting of MLK3 by miR-125b was evaluated using luciferase reporter assay and western blotting.

RESULTS

We found significantly increased levels of MLK3 in metastatic primary malignant melanomas and melanoma cell lines, with levels being especially high in metastatic lines. To investigate the functional significance of MLK3, we used knockdown MLK3, which was found to suppress cell growth and invasion. Using bioinformatics, we identified MLK3 as one potential target of miR-125b. miRNA transfection and luciferase assay confirmed that MLK3 was regulated by miR-125b at both the transcriptional and translational levels. Cell proliferation and cell invasion was inhibited by overexpression of miR-125b.

CONCLUSIONS

MLK3 is upregulated in metastatic melanoma, and regulates cell proliferation and invasion in melanoma cells. MLK3 is a direct target of miR-125b.

Long Noncoding RNA: its partners and their roles in cancer

RNA transcripts, which do not encode proteins, have received considerable attention in recent years. These non-coding RNAs are classified into two groups: small non-coding RNAs and long non-coding RNAs (lncRNAs). Increasing evidence suggests that lncRNAs are emerging as key regulators in many biological processes. However, knowledge of the underlying mechanisms whereby they act is still limited. Here, we try to elucidate the way that lncRNAs function in the context of DNA, RNA and protein interaction networks. It is noteworthy that lncRNA and another type of non-coding RNA microRNA (miRNA) may 'talk' to each other more frequently than ever expected. Additionally, lncRNAs display aberrant expression profiles in different kinds of cancers, with their potential roles in carcinogenesis and cancer metastasis. We summarize the effect of some cancer related lncRNAs upon tumor biological events, including cell proliferation, apoptosis, invasion and metastasis. Finally, we focus on the clinical value of lncRNAs, considering their potential application in cancer diagnosis, prognosis and therapeutic intervention.

Small-volume vitrification for human spermatozoa in the absence of cryoprotectants by using Cryotop

Cryotop is a carrier that has been used successfully in the cryopreservation of human spermatozoa. Here, we explored a novel method to vitrify human spermatozoa without cryoprotective agents (CPAs) using Cryotop. Spermatozoa from 21 Normozoospermic patients were collected and vitrified without CPAs or with sucrose in small volume using Cryotop. The sperm recovery rate, motility, viability, chromatin damage and DNA fragmentation were assessed. No significant difference was observed in the sperm recovery rate and motility rate between the spermatozoa cryopreserved without CPAs and with sucrose. The post-thawed spermatozoa cryopreserved without CPAs had a higher viability and lower damage to sperm chromatin and DNA than those cryopreserved with sucrose. These results suggest that small numbers of human spermatozoa can be successfully vitrified without CPAs using Cryotop.

The p53-estrogen receptor loop in cancer

Tumor suppressor p53 maintains genome stability by regulating diverse cellular functions including cell cycle arrest, apoptosis, senescence and metabolic homeostasis. Mutations in the p53 gene occur in almost all human cancers with a frequency of up to 80%. However, it is only 20% in breast cancers, 18% in endometrial cancers and 1.5% in cervical cancers. Estrogen receptor alpha (ERα) plays a pivotal role in hormone-dependent cancer development and the status of ERα is used for designing treatment strategy and for prognosis. A closer look at the cross-talk between p53 and ERα has revealed that their activities are mutually regulated. This review will summarize the current body of knowledge on p53, ERα and ERβ in cancer. Clinical correlations between estrogen receptors and p53 status have also been reported. Thus, this review will discuss the relationship between p53 and ERs at both the molecular and clinical levels.

Modelling of a novel high-impedance matching layer for high frequency (>30 MHz) ultrasonic transducers

This work describes a new approach to impedance matching for ultrasonic transducers. A single matching layer with high acoustic impedance of 16 MRayls is demonstrated to show a bandwidth of around 70%, compared with conventional single matching layer designs of around 50%. Although as a consequence of this improvement in bandwidth, there is a loss in sensitivity, this is found to be similar to an equivalent double matching layer design. Designs are calculated by using the KLM model and are then verified by FEA simulation, with very good agreement Considering the fabrication difficulties encountered in creating a high-frequency double matched design due to the requirement for materials with specific acoustic impedances, the need to accurately control the thickness of layers, and the relatively narrow bandwidths available for conventional single matched designs, the new approach shows advantages in that alternative (and perhaps more practical) materials become available, and offers a bandwidth close to that of a double layer design with the simplicity of a single layer design. The disadvantage is a trade-off in sensitivity. A typical example of a piezoceramic transducer matched to water can give a 70% fractional bandwidth (comparable to an ideal double matched design of 72%) with a 3dB penalty in insertion loss.

Abstract P6-11-04: Profound prevention of experimental brain metastases of breast cancer by temozolomide in a MGMT-dependent manner

Purpose: Brain metastases of breast cancer cause neurocognitive damage and are incurable. We evaluated in experimental brain metastasis model a role of temozolomide, an oral brain permeable alkylating agent characterized by significant uptake in the central nervous system, in the prevention of brain metastases of breast cancer.

Material and methods: To assess preventive role of temozolomide, mice were inoculated with 175,000 triple-negative 231-BR-EGFP cells in 0.1 mL PBS in the left ventricle of the heart. Three days after tumor cell inoculation, mice were randomized to temozolomide at the dose of 50 mg/kg delivered by oral gavage in saline, 5 days a week for 4 weeks, or vehicle. Subsequent experiments used temozolomide doses of 25, 10, 5, 1 and 0.5 mg/kg. To evaluate the efficacy of temozolomide in treating established BM, mice received temozolomide (50 mg/kg) beginning on either day 18 or day 24 post-injection of 231-BR-EGFR cells, 5 days a week for two and one week, respectively. To investigate the impact of temozolomide on survival, mice injected with 231-BR-EGFP cells were randomized to vehicle, temozolomide on days 3-14, or temozolomide on days 17-28 post-injection, per the schedule described above. To determine the functional contribution of MGMT expression in the BM preventive model, similar experiments were performed using 231-BR-EGFP cells with induced MGMT expression, and MGMT-positive Jimt-1 cells. Metastases were counted in step sections of one hemisphere of each brain. Additionally, the percentage of MGMT-positive tumor cells in 62 patient-matched sets of breast cancer primary tumors and resected brain metastases was determined immunohistochemically.

Results: Temozolomide, when dosed at 50, 25, 10 or 5 mg/kg, 5 days/week, beginning 3 days after inoculation, completely prevented the formation of experimental brain metastases from MGMT-negative 231-BR-EGFP cell line. At a 1 mg/kg dose, temozolomide prevented 68% of large brain metastases, and was ineffective at a dose of 0.5 mg/kg. When the 50 mg/kg dose was administered beginning on days 18 or 24, temozolomide efficacy was reduced or absent. Both schedules of temozolomide (days 3-14 and days 17-28) significantly increased survival (P = .0003 by long-rank test). Earlier administration of temozolomide resulted in long term survival of 6 and 2 out of 10 mice, respectively; a significant difference compared to vehicle (P &lt; .0001 and .0003, respectively).Temozolomide was ineffective at preventing brain metastases in the MGMT-positive 231-BR-EGFP and Jimt-BR3 sublines. In 62 patient-matched sets of primary breast tumors and resected brain metastases 43.5% of the specimens had concordant low MGMT expression, while in another 14.5% sets high MGMT staining in the primary tumor corresponded with low staining in the brain metastasis.

Conclusions: Temozolomide profoundly prevents the outgrowth of experimental brain metastases of breast cancer in a MGMT-dependent manner. The majority of patients had low MGMT expressing brain metastases. These data provide a compelling rationale for investigating preventive efficacy of temozolomide in high-risk advanced breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-11-04.

Abstract P3-10-01: Burden of symptoms associated with development of metastatic bone disease in patients with breast cancer

Background: Bone is the most common site of distant metastasis in advanced breast cancer patients (pts). Development of bone metastases (mets) is associated with substantial morbidity including skeletal complications, decreased quality of life, increased pain, and shortened lifespan. Pt burden of symptoms associated with bone mets has been assessed in tumor types other than breast or in metastatic disease not specific to bone. This study characterizes patterns of pt-reported symptoms over time among breast cancer pts with bone mets.

Methods: The Oncology Services Comprehensive Electronic Records (OSCER) database was used to retrospectively identify women with breast cancer who developed bone mets during their care and had ≥1 ACORN Patient Care Monitor (PCM) assessment. The PCM summarizes symptoms on an 11-point scale (0 = not a problem to 10 = as bad as possible). Moderate/severe symptoms were defined by a PCM score ≥4. PCM items relevant to metastatic disease (fatigue, physical pain, trouble sleeping, numbness/tingling, anxious, loss of interest in others) were assessed. A generalized linear mixed model was used to evaluate symptom progression before and after bone mets diagnosis (dx). Kaplan-Meier methods were used to estimate time to development of and proportion of pts with moderate/severe symptoms after bone mets dx.

Results: 1105 pts with breast cancer and bone mets were included. In general, the proportion of pts with moderate/severe symptom burden increased in the months (mos) before bone mets dx (Table 1). The odds (risk) of pts experiencing moderate/severe symptom burden increased in the mos leading up to bone mets dx, with a 9% increase per mo for both fatigue and physical pain, and a 19% increase per mo for numbness/tingling (P&lt;0.001 for all). Non-significant changes were observed in the risk of pts experiencing trouble sleeping (3%), anxiousness (0%), or loss of interest in others (16%). After bone mets dx, the cumulative proportion of pts with moderate/severe symptom burden increased with time (Table 2). Median time to moderate/severe symptoms after bone mets dx was 1.4 mos for fatigue, 1.9 mos for physical pain, 3.9 mos for trouble sleeping, 9.3 mos for numbness/tingling, 20.6 mos for anxious, and was not reached for loss of interest in others.

Table 1. Unadjusted proportion of pts with moderate/severe symptom burden before or at time of bone mets dxSymptom12 mos before dx6 mos before dxAt bone mets dxFatigue35%37%52%Physical pain29%34%47%Trouble sleeping22%25%28%Numbness/tingling16%18%19%Anxious14%16%23%Loss of interest in others4%6%6%

Conclusions: These data from a large number of breast cancer pts treated at community oncology practices show that pts experience increasing symptom burden for a substantial period of time before bone mets dx. Most pts continue to experience burdensome symptoms after bone mets dx. These findings reinforce the need for multiple symptoms to be proactively monitored and managed in these pts.

Table 2. KM estimate: cumulative proportion of pts with moderate/severe symptom burden after bone mets dxSymptom2 mos after dx12 mos after dxFatigue58%82%Physical pain51%74%Trouble sleeping39%64%Numbness/tingling26%53%Anxious27%46%Loss of interest in others9%22%

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-10-01.

Computational hemodynamics analysis of intracranial aneurysms treated with flow diverters: correlation with clinical outcomes

BACKGROUND AND PURPOSE

Recent studies have shown promising results regarding intracranial aneurysms treated with flow diverters. However, these have had adverse effects, including delayed aneurysm occlusion, posttreatment symptoms, and rupture. The hemodynamic profiles of aneurysms treated with flow diverters were analyzed to determine the ones associated with successful and failed treatments.

MATERIALS AND METHODS

Patient-specific computational fluid dynamics were used to simulate hemodynamic profiles, including the presence of jet flow, energy loss, volume flow, and wall shear stress in 4 successful occlusions of aneurysms and 4 failed cases after flow-diverter deployment. In these 4 failed cases, hemodynamic profiles were examined again after a hypothetic second intervention. This involved replacing the failed flow diverter with a hypothetic optimally deployed flow diverter or simulated placement of a second flow diverter within the first (double hypothetic optimally deployed).

RESULTS

Where successful occlusions were achieved, a marked obliteration of jet flow was observed. Flow entering the aneurysm sac was diverted via the center of the flow diverter and joined smoothly with the continuation of flow leaving the aneurysm sac into the parent arteries. These observations were supplemented by a reduction in the other hemodynamic profiles. Aneurysm neck geometry might influence the efficacy of the flow diverter.

CONCLUSIONS

Hemodynamic indices, as calculated by using computational fluid dynamics techniques, have close correlation with flow-diverter treatment outcome. Computational fluid dynamics could be potentially useful as a planning tool for neurointerventionists by simulating an optimized flow-diverter deployment strategy before the procedure and evaluating posttreatment outcome.

A fluid-structure interaction study using patient-specific ruptured and unruptured aneurysm: the effect of aneurysm morphology, hypertension and elasticity

Fluid-structure interaction (FSI) simulations using five patient-specific aneurysm geometries are carried out to investigate the difference between ruptured and unruptured aneurysms. Two different blood pressure conditions (normal and hypertension, for all cases), and two different values of elastic modulus (1 and 2MPa, for two cases) are tested. Ruptured aneurysms (RA) generally displayed larger displacement at the dome, lower area-average WSS and higher von Mises stress than unruptured aneurysms (URA) regardless of elasticity or blood pressure condition. RAs had a longitudinal expansion whereas URAs had a radial expansion, which was the key difference between the two types. The difference in expansion pattern may be one of the keys to explaining aneurysm rupture, and further analysis is required in the future to confirm this theory.

Genetic variation in dopamine-related gene expression influences motor skill learning in mice

Several neurodevelopmental disorders with a strong genetic basis, including attention-deficit/hyperactivity disorder, autism spectrum disorders and developmental coordination disorder, involve deficits in fine motor skills. This phenotype may depend on heritable variation in components of the dopamine (DA) system, which is known to play a critical role in motor skill learning. In this study, we took advantage of two inbred strains of mice (BALB/c and C57BL/6) that differ markedly in the number of midbrain DA neurons in order to investigate the influence of such naturally occurring genetic variation on the acquisition and performance of fine motor skills. Gene expression analysis of midbrain, frontal cortex and striatum showed significant differences in the expression of presynaptic and postsynaptic dopaminergic (DAergic) markers (e.g. tyrosine hydroxylase, DA transporter, DA D4 receptor, DA D5 receptor and DARPP-32) between these two strains. BALB/c mice had lower learning rate and performance scores in a complex skilled reaching task when compared with C57BL/6 mice. A negative correlation was found between the motor learning rate and level of DARPP-32 mRNA expression in the frontal cortex contralateral to the trained forelimb. The rate of motor learning was also negatively correlated with the levels of DARPP-32 and DA D1 receptor mRNAs in the striatum. Our results suggest that genetically driven variation in frontostriatal DAergic neurotransmission is a major contributor to individual differences in motor skill learning. Moreover, these findings implicate the D1R/cAMP/DARPP-32 signaling pathway in those neurodevelopmental disorders that are associated with fine motor skill deficits.

Analysis of morphologic and hemodynamic parameters for unruptured posterior communicating artery aneurysms with oculomotor nerve palsy

BACKGROUND AND PURPOSE

Posterior communicating artery aneurysms with oculomotor nerve palsy may imply sudden enlargement of the aneurysm sac and have a high risk of rupture. Our aim was to identify the morphologic and hemodynamic parameters in this special period of aneurysm progression and to assess related rupture risk indices.

MATERIALS AND METHODS

We analyzed the morphologic and hemodynamic parameters of 9 unruptured posterior communicating artery aneurysms with oculomotor nerve palsy and 9 ruptured ones. The morphologic parameters were measured and calculated from patient-specific 3D rotational angiographic images, and pulsatile computational fluid dynamic simulation was then performed for hemodynamic parameters.

RESULTS

There was no significant statistical difference between the 2 groups in size, aspect ratio, size ratio, aneurysm angle, or vessel angle; analysis only demonstrated a significantly lower wall shear stress of the aneurysm wall in the symptomatic unruptured group in hemodynamics (P = .024), whereas there were no differences in wall shear stress of the parent artery, low wall shear stress area, and oscillatory shear index.

CONCLUSIONS

From morphologic and hemodynamic perspectives, we demonstrated that posterior communicating artery aneurysms with oculomotor nerve palsy had characteristics similar to those of ruptured ones, except for lower wall shear stress on the aneurysm wall, which might indicate an important role in aneurysm rupture.

The influence of elastic upstream artery length on fluid-structure interaction modeling: a comparative study using patient-specific cerebral aneurysm

Fluid-structure interaction (FSI) simulations using a patient-specific geometry are carried out to investigate the influence the length of elastic parent artery and the position of constraints in the solid domain on the accuracy of patient-specific FSI simulations. Three models are tested: Long, Moderate, and Short, based on the length of the elastic parent artery. All three models use same wall thickness (0.5 mm) and the elastic modulus (5 MPa). The maximum mesh displacement is the largest for the Long model (0.491 mm) compared to other models (0.3 mm for Moderate, and 0.132 mm for Short). The differences of hemodynamic and mechanical variables, aneurysm volume and cross-sectional area between three models are all found to be minor. In addition, the Short model takes the least amount of computing time of the three models (11h compared to 21 h for Long and 19 h for Moderate). The present results indicate that the use of short elastic upstream artery can shorten the time required for pati ent-specific FSI simulations without impacting the overall accuracy of the results.