Inverted Duplication and Deletion of 10q25q26 in a Patient without Any Obvious Skeletal Anomalies

We report on a girl with inverted duplication and deletion of 10q25q26 revealed by array-CGH and FISH analysis. Array-CGH analysis demonstrated a ∼13.1-Mb duplication encompassing 10q25.3q26.2 and a ∼5-Mb deletion at 10q26.2q26.3. No single-copy region was detected between the deleted and duplicated segments. FISH analysis found the arrangement duplicated in an inverted position. FISH analysis using the same probes did not show any abnormality in both parents, which indicates a de novo occurrence. The frequently reported features of distal 10q duplication include developmental delay, blepharophimosis, hypotonia, skeletal anomalies and some facial dysmorphisms. The girl presented with many features of distal 10q duplication with the exception of skeletal anomalies. To our knowledge, this is the fourth patient reported in the literature with inv dup del 10q. 10q duplication seems to account for most of the phenotypes for our patient. Although no obvious skeletal feature was found in our patient at present, follow-up assessment of skeletal development should be planned with the increase of age.

Prevalence and extent of right-to-left shunt in migraine: a survey of 217 Chinese patients

BACKGROUND

Recently, contrast-enhanced transcranial Doppler (cTCD) studies have shown that right-to-left shunt (RLS) may be a risk factor for migraine in Westerners; however, limited data in the literature describes the prevalence of RLS in Chinese patients with migraine.

OBJECTIVE

To assess the prevalence of RLS in patients with migraine in China and to evaluate the relationship between the extent of RLS and migraine.

METHODS

A total of 217 consecutive patients with a diagnosis of migraine and 100 volunteers were recruited. cTCD was used to assess the prevalence and the extent of RLS in all subjects.

RESULTS

In the migraine group, the rate of positive RLS was 44.2% (96/217), with 23.5% (51/217) of these being large. In the healthy group, 28.0% (28/100) were positive for RLS overall, and 5.0% (5/100) were large (P = 0.006; P < 0.001). In patients having migraines with aura (MwA), 66.1% (39/59) were positive for RLS overall, and 37.3% (22/59) were large, which was significantly higher when compared with the healthy group (P < 0.001; P < 0.001); in patients having migraines without aura (MwoA), 36.1% (57/158) were positive for RLS overall, and 18.4% (29/158) were large, which was against significantly higher (P < 0.001; P = 0.003). In the MwoA group, the large RLS rate was also higher than in the healthy group (P = 0.002).

CONCLUSIONS

A close correlation has been documented between RLS and migraine, especially MwA, but these relationships exist only when the shunts were large.

Effects of ginsenoside Rg1 or 17β-estradiol on a cognitively impaired, ovariectomized rat model of Alzheimer's disease

Ginsenoside Rg1, which could improve spatial learning and memory, might be a useful agent for preventing and treating cognitive impairment in Alzheimer's disease (AD). The present study was designed to test the neuroprotective effects of ginsenoside Rg1 on an ovariectomized (OVX) and d-galactose (d-gal)-injected rat model of AD, which is characterized with progressive learning and memory deficits, AD-related molecules alteration and differentiation/apoptosis imbalance in hippocampal neurons. OVX Wistar rats received daily injections of d-gal (100mg/kg) combined with different concentrations of ginsenoside Rg1 (5, 10, 20mg/kg) or 17-β-estradiol (E2, 100 μg/kg), or normal saline (NS, 1.0 ml/kg) for 6 weeks. Ovarian steroid deprivation plus d-gal injection led to spatial learning and memory capacity impairments, as well as increased Aβ(1-42) production. Ginsenoside Rg1 and E2-treatment significantly ameliorated these deteriorations in AD rats. Seven weeks after surgery, α-secretase a disintegrin and metallopeptidase domain 10 (ADAM 10) in hippocampus of AD rats was dramatically decreased, while β-secretase β-site APP-cleaving enzyme 1 (BACE 1) increased compared with those in sham-operated ones (P<0.05). Levels of cleaved caspase 3 were increased in the hippocampus of AD rats. Ginsenoside Rg1 and E2-treatment increased ADAM 10 level while reduced BACE 1 level and apoptosis. Moreover, moderate i.e. 10mg/kg/d and high i.e. 20mg/kg/d ginsenoside Rg1 displayed more effective function than low i.e. 5mg/kg/d ginsenoside Rg1. Our findings demonstrate the neuroprotective effects of ginsenoside Rg1 and E2 on AD rats and support the potential application of ginsenoside Rg1 in the treatment of learning and memory impairments in postmenopausal women.

Meta-analysis of the efficacy and safety of bronchial thermoplasty in patients with moderate-to-severe persistent asthma

This meta-analysis assessed the efficacy and safety of a novel intervention for asthma, bronchial thermoplasty (BT), in patients with moderate-to-severe persistent asthma. An electronic literature search identified three randomized controlled trials (RCT) of BT that recruited 421 patients in total. Outcomes of interest were the Asthma Quality of Life Questionnaire (AQLQ) score, morning peak expiratory flow (PEF), tolerability and safety. Compared with standard medications and sham BT treatment, BT significantly improved AQLQ scores and PEF from baseline to the end of the trials. There were more respiratory adverse events and hospitalizations for adverse respiratory events with BT than with medications or sham treatment during the treatment period, but most events resolved, on average, within a week. This effect of BT treatment was not seen during the posttreatment period. Additional long-term RCT are required to confirm whether BT provides benefit to patients with moderate-to-severe persistent asthma.

Preclinical pharmacology of TP1, a novel potent triple reuptake inhibitor with antidepressant properties

Triple reuptake inhibitors (TRIs) that block the dopamine transporter (DAT), norepinephrine transporter (NET), and serotonin transporter (SERT) are being developed as a new class of antidepressant that may have better efficacy and fewer side effects compared with traditional antidepressants. The purpose of this study was to characterize a new chemical entity, 4-[2-(dimethylamino)-1-(1-hydroxycyclohexyl)ethyl] phenyl 4-methoxybenzoate hydrochloride (TP1). TP1 was designed as a prodrug of desvenlafaxine. Competitive radioligand binding assays were performed using cells expressing the human dopamine (DA) transporter (hDAT), the human serotonin (5-HT) transporter (hSERT), and the human norepinephrine (NE) transporter (hNET) with K(i) values for TP1 of 190 nM, 2076 nM, and 1023 nM, respectively. Uptake assays were performed with IC(50) values for TP1 of 712 nM, 521 nM, and 628 nM, respectively. TP1 (0.06 mmol/kg, orally) rapidly penetrated rat brain and hypothalamus, translated into desvenlafaxine within 1 h, and demonstrated higher bioavailability and better pharmacokinetic properties than desvenlafaxine succinate (DVS). TP1 (0.06 mmol/kg, orally) significantly increased extracellular levels of DA, NE, and 5-HT compared with baseline in the rat hypothalamus by microdialysis assay. In dose-response assays, oral administration of TP1 reduced the time of immobility in a dose-dependent manner during tail suspension test and forced swimming test (FST). This antidepressant-like effect manifests in the absence of significant increases in motor activity even at doses of up to 32 mg/kg. The ability of TP1 to inhibit the reuptake of three biogenic amines closely linked to the etiology of depression may result in a therapeutic profile different from antidepressants that inhibit the reuptake of serotonin and/or NE.

Predictors of survival in patients with recurrent ovarian cancer undergoing secondary cytoreductive surgery based on the pooled analysis of an international collaborative cohort

BACKGROUND

This study aims to identify prognostic factors and to develop a risk model predicting survival in patients undergoing secondary cytoreductive surgery (SCR) for recurrent epithelial ovarian cancer.

METHODS

Individual data of 1100 patients with recurrent ovarian cancer of a progression-free interval at least 6 months who underwent SCR were pooled analysed. A simplified scoring system for each independent prognostic factor was developed according to its coefficient. Internal validation was performed to assess the discrimination of the model.

RESULTS

Complete SCR was strongly associated with the improvement of survival, with a median survival of 57.7 months, when compared with 27.0 months in those with residual disease of 0.1-1 cm and 15.6 months in those with residual disease of >1 cm, respectively (P<0.0001). Progression-free interval (≤23.1 months vs >23.1 months, hazard ratio (HR): 1.72; score: 2), ascites at recurrence (present vs absent, HR: 1.27; score: 1), extent of recurrence (multiple vs localised disease, HR: 1.38; score: 1) as well as residual disease after SCR (R1 vs R0, HR: 1.90, score: 2; R2 vs R0, HR: 3.0, score: 4) entered into the risk model.

CONCLUSION

This prognostic model may provide evidence to predict survival benefit from secondary cytoreduction in patients with recurrent ovarian cancer.

Surface Melting of Particles: Predicting Spherule Size in Vapor-Phase Nanometer Particle Formation

There is still no reliable method to predict the all-important size of the ‘primary’ spherules found in combustion-synthesized particulate products. Toward this end, we introduce surface melting concepts in developing a coagulation-coalescence model for nanoparticles in the low temperature regions of diffusion flames. The associated surface self-diffusivity, which controls the rate of spherule sintering at temperatures well below the equilibrium melting point, is therefore modified to include an important size effect. This formulation is used to calculate the sintering rate of two adjacent particles in a flame coagulation environment corresponding to a condensed phase volume fraction of Ca. 10−1 ppm. Predicted spherule sizes show encouraging agreement with our experimental data for ca. 10 nm diameter Al2O3 particles synthesized on the fuel side of a laminar CH4/O2 diffusion flame seeded with Al(CH3)3 (TMA)[1].

Population-based analysis of multimodality treatment of gastric cancer

124

Background: Limited data is available for the role of multimodality management for gastric adenocarcinoma and its outcome in the community.

Methods: We retrospectively reviewed the outcomes for 341 patients (pts) who were diagnosed with gastric cancer in a community-based health-care system, including 9 hospitals, from 2000 to 2009.

Results: 148/341 pts had undergone surgery and were included in the analysis. Median age at diagnosis was 68 year (range: 32-96), 56% were male, 55% were Caucasian and 25% were black. The stage distribution was as follows: 27% (40 pts) localized, 61% (90 pts) locally advanced and 12% (18 pts) with distant metastasis. 98 pts (66%) received surgery alone, 22 pts (15%) received perioperative chemotherapy, and 28 pts (19%) received perioperative chemo-radiation. After a median follow-up time of 5.2 yrs, the median OS for the entire group was 1.9 years, and 88 deaths had occurred at the last follow up. By stage, the median OS was 7 yrs, 2.3 yrs, and 0.3 yrs for localized stage, regional stage, and metastatic disease, respectively. The 5-yr survival was significantly better in pts who received perioperative chemo-radiation (68%), compared to those who received with surgery alone (33%) or perioperative chemotherapy (0%) (p=0.002). The 5-yr survivals by stage and treatment are shown in the table.

Conclusions: Perioperative chemo-radiation was associated with a significantly better OS compared to surgery alone. Trimodality therapy for gastric cancer appears to be underutilized in the community setting described here. The survival advantage of surgery plus chemoradiation compared to surgery plus chemotherapy remains controversial and should be investigated in clinical trials.

[Table: see text]

No significant financial relationships to disclose.

Advanced-stage colon cancer prior to the screening age: Association with age, race, and insurance status

377

Background: Stage-at-diagnosis is a major determinant of outcome in colon cancer. Population-based screening is currently only recommended after age 50, but the number of colon cancers diagnosed before 50 is increasing. We aimed to identify risk factors associated with advanced-stage disease (stage III or IV) among colon cancers diagnosed before 50.

Methods: Between 2003 and 2007, 248,716 colon adenocarcinomas (25,383 diagnosed before age 50) were reported to the National Cancer Database. Patients with familial adenomatous polyposis were excluded. Among the cases diagnosed before 50, independent predictors for presenting at advanced stages (stage III or IV) were identified using multivariate logistic regression.

Results: 10.2% of all colon cancers occur prior to age 50. Stage III or IV disease accounted for 62.2% of the cases before age 50, and 46.9% of those diagnosed at or after age 50 (p<0.001). Among colon cancers diagnosed before 50, independent risk factors for advanced-stage disease included: very young age groups (age 18-30 and age 30-40 vs. age 40-50), African American race (vs. Caucasian), and having Medicaid, non-Medicare government insurance or no insurance (vs. private insurance), after adjusting for gender, tumor location, geographic region, and treatment facility type (Table).

Conclusions: In the unscreened population of patients before age 50, disparities in age, race, and insurance are associated with the stage at presentation. The risk factors identified help alert the treating clinicians toward patients most vulnerable to delays in their cancer diagnosis.

[Table: see text]

No significant financial relationships to disclose.

Cisplatin (C) based chemoradiation (CXRT) for locally advanced squamous cell carcinoma (SCCA) of the anal canal (AC): A 20-year perspective

482

Background: The standard of care for locally advanced SCCA of the AC is 5-fluorouracil (5-FU)/mitomycin C (MMC) with concurrent XRT. C was evaluated with 5-FU in 2 large phase III studies (RTOG 98-11 and ACT II) to establish superiority over 5-FU/MMC. Neither study showed significant differences for disease-free survival (DFS) or overall survival (OS). RTOG 98-11 reported reduced colostomy-free survival (CFS) in the C-induction arm; no differences were noted in the ACT II study. We present our 20-year experience with C for locally advanced SCCA of the AC which has been adopted as the standard unless contraindicated.

Methods: A retrospective, single institution analysis for locally advanced SCCA of the AC was completed in patients (pts) that received concurrent 5-FU/C/XRT from 1989-2009. Medical records were reviewed for history of STDs, chronic immunosuppression, stage, dose of XRT, toxicity, clinical response (CR), recurrence, and OS. Multidisciplinary management included surgical, radiation, and medical oncologists. OS, DFS, and CFS were calculated using the K-M method. The log-rank test was used to compare OS among these subgroups.

Results: 185 pts were identified (51 M:134 F). The median age was 56 (35-83 y.o.). AJCC stage was I (n = 25); II (n = 76); IIIA (n = 36); and IIIB (n = 48). The median XRT dose was 55 Gy in 30 fractions. 181 pts were evaluable for response; 4 were lost to follow up. Complete CR (cCR) was noted in 169 pts (93%); partial response (n = 12); 6 pts received an APR. After a median follow up of 8.6 years, 14 pts (8%) developed local recurrence; 11 received salvage surgery. 16 pts (9%) developed distant metastases (DM). The 5-yr DFS = 81%, 5-yr OS = 85% and 5-yr CFS was 88%. By univariate analysis, N-stage was a poor prognostic indicator for 5-yr DFS (p = 0.02) and DM (p = 0.046) but not OS or CFS. Increased T-stage correlated with salvage surgery (p = 0.005).

Conclusions: Cisplatin-based chemoradiation for locally advanced SCCA of the anal canal resulted in favorable DFS, OS, and CFS compared to historical data and phase III studies. Platinum-based therapy for anal cancer appears to be an acceptable alternative to MMC and should be considered as a standard option for locally advanced disease.

No significant financial relationships to disclose.

Wnt/beta-catenin is involved in the proliferation of hippocampal neural stem cells induced by hypoxia

BACKGROUND AND AIM

Beta-catenin, as a major effector molecule in the canonical Wnt signaling pathway, could regulate adult neurogenesis. Here, the role of Wnt/β-catenin signaling pathway in the proliferation of hippocampal neural stem cells (NSCs) induced by hypoxia was investigated.

METHODS

The hippocampal NSCs of neonatal green fluorescent protein transgenic mice on day 0 were cultured in hypoxia (5% O(2)) and traditional O(2) (20% O(2)). The expression of β-catenin, p-GSK-3β, and cyclinD1 in NSCs was measured under hypoxia or traditional O(2) by western blotting. NSCs were electroporated with pTOPFLASH reporter in different conditions and the LEF/TCF-dependent luciferase activity was assayed.

RESULTS

Hypoxia increased the proliferation and reduced the apoptosis of hippocampal NSCs. NSCs proliferation was inhibited by transfecting with pAxin, whereas promoted by transfecting with pβ-catenin.

CONCLUSION

Hypoxia could enhance the proliferation of hippocampal NSCs and β-catenin contributed to this action.

Evaluations of boar gonad development, spermatogenesis with regard to semen characteristics, libido and serum testosterone levels based on large White Duroc x Chinese Erhualian crossbred boars

Chinese Erhualian pigs are known for prolificacy with distinct reproductive traits compared with Western commercial breeds. In this study, a four-generation intercross resource population was constructed using White Duroc boars and Chinese Erhualian sows as founder animals, and a total of 14 male reproductive traits were recorded in 411 F2/F3 boars including the testis and epididymis weights, the seminiferous tubular diameter and spermatogenesis at 60, 90 and 300 days of age, semen characteristics, serum testosterone concentration and libido level at 300 days of age. The White Duroc-Erhualian boars showed remarkable segregations in the traits measured except for the seminiferous tubular diameter and had high ratio (13.9%) of the abnormality of spermatogenesis, providing a good experimental population for detecting quantitative trait loci affecting these male reproductive traits. Furthermore, the correlations among nine male reproductive traits at 300 days of age indicated that the testis weight and the body weight were strongly correlated with the sperm production, supporting the two traits as important parameters for boar selection to increase sperm production and ultimately improve boar fertility. The libido level in the White Duroc-Erhualian boars that was evaluated by a new and easily recorded scoring system showed a significant correlation with serum testosterone concentration. Yet, both libido and serum testosterone concentration were not correlated with the sperm production. Results of this study provided new information on the male reproductive physiology and genetics in Chinese Erhualian and White Duroc boars.

Minimal limb volume change has a significant impact on breast cancer survivors

We sought to define the incidence, risk factors, symptoms, and quality of life (QOL) outcomes associated with various degrees of postoperative limb volume change (LVC). A prospective cohort study was performed obtaining serial limb volume measurements using a perometer on 269 women undergoing surgery for breast cancer. Four groups were created based on maximum LVC: none < 5.0%, mild 5.0-9.9%, moderate 10.0-14.9%, and severe 15.0%. Symptoms and QOL were assessed. 81 (30.1%), 70 (26.0%), and 14 (5.2%) women developed mild, moderate, and severe LVC, respectively. Increases in body mass index (p < 0.001) and post-operative complications (p = 0.002) were associated with increasing LVC. Lower QOL scores were associated with a moderate LVC (OR = 3.72, 95% CI, 1.29-10.73, p = 0.015) and postoperative infections (OR = 5.04, 95% CI, 1.73-14.70, p = 0.003). LVC at 5.0% occurs in up to 61.3% of breast cancer survivors and is associated with a significant increase in symptoms and a change in reported quality of life.

The detecting and clinical value of anti-cyclic citrullinated peptide antibodies in patients with systemic lupus erythematosus

The aim of this article is to compare the prevalence of anti-cyclic citrullinated peptide (anti-CCP) antibodies in systemic lupus erythematosus (SLE) patients with and without arthritis and in patients with rheumatoid arthritis (RA). Anti-CCP antibodies were measured using ELISA in 159 SLE patients with arthritis (12 patients with erosive arthritis), 108 SLE patients without arthritis, 76 RA patients, and 87 healthy subjects (controls). The following had anti-CCP antibodies above the cut-off level (5 U/ml): 27.3% of SLE patients, 42.1% SLE patients with arthritis, 5.6% SLE patients without arthritis, 85.5% RA patients and 1.1% controls. The mean titre of anti-CCP antibodies in the SLE group was much lower than that in the RA group (33 +/- 72 vs. 160 +/- 125 U/ml), but higher in SLE patients with erosive arthritis than those with non-erosive arthritis (221 +/- 88 vs. 32 +/- 42 U/ml). Hand poly-arthritis occurred more frequently in anti-CCP-positive SLE patients with erosive arthritis than those with non-erosive arthritis. Anti-CCP antibodies were prevalent in some SLE patients, more prevalent in SLE patients with arthritis than those without arthritis. Anti-CCP-positive SLE patients were more likely associated with hand poly-arthritis, and high titre of anti-CCP antibodies might be used as a predictor for the complication of erosive arthritis.

Molecular detection of three shrimp viruses and genetic variation of white spot syndrome virus in Hainan Province, China, in 2007

Abstract White spot syndrome virus (WSSV), Taura syndrome virus (TSV) and infectious hypodermal and haematopoietic necrosis virus (IHHNV) have been responsible for major pandemics affecting the shrimp farming industry. Shrimp samples were collected from eight farms in Hainan Province, China, during 2007 and analysed by polymerase chain reaction (PCR) or reverse transcriptase PCR methods to determine the prevalence of these viruses. From the eight sampling locations, only samples from one farm did not show any indication of infection with WSSV, TSV or IHHNV, while samples from one additional farm exhibited evidence of infection with TSV only. Surprisingly, evidence of co-infection with TSV and IHHNV was found among samples at two farms while evidence of co-infection with all three viruses (WSSV, TSV and IHHNV) was detected among shrimp samples at four farms. To further elucidate the molecular characteristics of WSSV in China, we further analysed genomic features of WSSV isolates based on the ORF23/24 variable region. From these data, we identified two novel WSSV strains which contain nucleotide deletions of 5657 and 11093 bp, respectively, when compared with the largest WSSV-TW isolate.

The validity of cause of death coding within the Surveillance, Epidemiology, and End Results (SEER) Registry

6544

Background: Disease-specific survival (DSS) analysis within large cancer registries is more informative than other methods of survival analysis but requires accurate information regarding the cause of death (COD). The purpose of this study was to evaluate the validity of the COD code for patients diagnosed with colon cancer and the extent to which it varies with regard to age, sex, and race within SEER. Methods: Patients with colon adenocarcinoma were identified from SEER (ver. 2008) from 1988 to 1998 to have at least 7 years of follow-up. Relative survival (RS) was calculated matching for age, sex, and the year of diagnosis using U.S. life-tables. Colon cancer cause of death was then assigned using SEER COD recode for colon and rectal death (21040–50). The number of observed and expected deaths by year was calculated to estimate deaths attributable to colon cancer. The ratio of this number to the recorded cause of death was defined as the validity of the COD code in SEER. Results: 86,641 patients were identified. Relative survival declined during the first 7 years of observation but then leveled indicating a minimum number of deaths subsequently attributable to colon cancer. At year 7 the observed number of deaths for the SEER cohort was 49,104; the expected number of deaths using life tables was 17,173. The difference (31,931) is theoretically attributable to colon cancer. Within the SEER cohort, 30,227 deaths were coded colorectal cancer deaths, an estimated validity of 94.6%. Stratified results demonstrated validity was sensitive to race but not age or gender (table). Conclusions: Cause of death coding for colon cancer in SEER is highly valid, suggesting that the use of DSS for colon cancer is appropriate.

[Table: see text]

No significant financial relationships to disclose.

[The application of flexible neural microelectrode on retinal prosthesis]

The latest development and the merit of using flexible neural microelectrodes are mainly reported in the paper, in which the properties of based-material, the micro-structure of neural microelectrodes and the method about how to test the microelectrodes are also included.

Statistical optimization of process parameters on biohydrogen production from glucose by Clostridium sp. Fanp2

Statistically based experimental designs were applied to optimizing process parameters for hydrogen production from glucose by Clostridium sp. Fanp2 which was isolated from effluent sludge of anaerobic hydrogen-producing bioreactor. The important factors influencing hydrogen production, which identified by initial screening method of Plackett-Burman, were glucose, phosphate buffer and vitamin solution. The path of steepest ascent was undertaken to approach the optimal region of the three significant factors. Box-Behnken design and response surface analysis were adopted to further investigate the mutual interaction between the variables and identify optimal values that bring maximum hydrogen production. Experimental results showed that glucose, vitamin solution and phosphate buffer concentration all had an individual significant influence on the specific hydrogen production potential (Ps). Simultaneously, glucose and vitamin solution, glucose and phosphate buffer were interdependent. The optimal conditions for the maximal Ps were: glucose 23.75 g/l, phosphate buffer 0.159 M and vitamin solution 13.3 ml/l. Using this statistical optimization method, the hydrogen production from glucose was increased from 2248.5 to 4165.9 ml H2/l.

Outcome analysis for melanoma patients undergoing deep pelvic lymph node dissection

8514

Background: The benefits of deep pelvic lymph node dissection (DLND) for node-positive melanoma patients continue to be debated. The objective of our analysis was to assess factors associated with metastatic disease to deep pelvic nodes and examine survival outcomes following DLND. Methods: We retrospectively reviewed the records of 804 patients undergoing lymph node dissection (1990-2001). 97 patients underwent a superficial inguinofemoral lymph node dissection along with a DLND for indications which included: suspicious radiologic imaging (n= 31), documented superficial disease and concern for deep involvement (n = 57), and in-transit disease undergoing limb perfusion (n=9). Logistic regression was performed to identify factors associated with the metastatic tumor spread to deep nodes. Associations between clinicopathologic factors and disease-specific survival (DSS) were estimated using the Cox proportional hazards model. Results: Fifty-four patients (56%) had metastatic disease (median 2 positive lymph nodes, range 1–12) within their deep pelvis. With a median follow-up of 7.5 years, the 5-year DSS was 42% for patients with positive deep pelvic nodes and 52% for those with negative deep pelvic nodes (p = 0.07). When the number of metastatic deep nodes was stratified, the 5-year DSS for patients with 1 positive node, 2–3 positive nodes, and >3 positive nodes was 49%, 48%, and 27%, respectively (p = 0.04). Age ≥ 50 years (odds ratio [OR] = 3.5, p = 0.03), increasing number of positive superficial nodes (OR = 2.1, p < 0.001), and suspicious findings on pelvic CT images (OR = 11.9, p < 0.001) were associated with metastatic deep nodes. In the multivariate analysis, the number of positive deep nodes (hazard ratio [HR] = 1.1, p = 0.03), male gender (HR = 1.9, p = 0.03), and extra-capsular nodal extension of tumor (HR = 2.7, p < 0.001) were identified as adverse prognostic factors for DSS. Conclusions: Survival outcomes in patients with melanoma metastatic to ≤ 3 deep pelvic lymph nodes are comparable to those in patients without deep nodal involvement. These favorable outcomes support an aggressive surgical approach (i.e., DLND) in patients ≥ 50 years, with multiple positive superficial nodes, and suspicious CT findings.

No significant financial relationships to disclose.

The relationship among nephrin, podocin, CD2AP, and alpha-actinin might not be a true 'interaction' in podocyte

The abnormality of a single podocyte molecule, caused by a single gene mutation, such as NPHS1, NPHS2, CD2AP, and ACTN4, can lead to the hereditary/congenital nephrotic syndromes (NS). Further studies suggested that more than one podocyte molecule were together involved in acquired or experimental NS. However, we do not know much on the relationship among these podocyte molecules, and the molecular response induced by the change of each podocyte protein to the remaining ones. We respectively knockdown the nephrin, podocin, CD2AP, or alpha-actinin-4 mRNA by using reconstructed RNA interference vector--psiRNA-hH1GFPzeo in mouse podocyte clone. The molecular behavior or response was revealed by the quantitative expression both at mRNA and protein levels with RT-PCR and Western blot, and by the molecular distribution detected with confocal microscopy. With nephrin knockdown, only CD2AP increased, whereas podocin showed no change. Contrarily, with podocin or CD2AP knockdown, nephrin decreased, while CD2AP or podocin increased. Nephrin, podocin, or CD2AP knockdown did not change the expression of alpha-actinin-4, whereas alpha-actinin-4 knockdown begetted the reduction of nephrin, and the increment of podocin and CD2AP. The redistributions of nephrin, podocin, and CD2AP were revealed around a predominant nuclear staining compared with the membrane surface staining in the control podocytes. Our data imply that the response between the four podocyte molecules is very complicated and evidently different. There is not always an interaction between podocyte molecules. The normal localization of podocyte molecules would depend on their normal expression quantity and the molecular reactions between them.

Initial biopsy procedure for breast cancer diagnosis influences number of surgical procedures and cost of care

598

Background: Excisional biopsy (ExB) and percutaneous needle biopsy (PB) are both accurate methods for diagnosing breast cancer. However, comprehensive breast cancer staging requires surgical assessment of the primary tumor and regional nodes. This study was designed to examine surgical and financial implications for breast cancer patients undergoing either ExB or PB. Methods: We evaluated 2,459 women with invasive breast cancer enrolled in a comprehensive database from 2000 to 2005. Clinical and treatment factors were compared for patients who had ExB versus PB. Total costs, facility fees (operating rooms, radiology suites, and pathology processing), and professional fees were estimated. A multivariate logistic regression was performed to determine factors associated with biopsy type. Results: PB was utilized in 1817 (74%) patients and ExB in 642 (26%). Of ExB patients, 86% were performed prior to referral. Patients undergoing ExB required a greater number of surgical procedures for margin control and lymph node assessment compared to PB (median 2.0 vs. 1.0, respectively). ExB exacted a cost increase 1.7 times that of PB, with a difference of >$3400 at our institution. After adjusting for age, tumor size and year of diagnosis, ExB was significantly associated with an increased number of surgical procedures required for definitive treatment compared to PB (OR = 166.7, p < 0.001). Conclusions: Excisional biopsy for breast cancer diagnosis results in an increased need for return trips to the operating room and higher cost of care. Percutaneous biopsy should be considered as the preferred approach in the diagnosis of breast cancer.

No significant financial relationships to disclose.

Lymphedema is common among post-operative cancer survivors

18524

Background: Lymphedema (LE) is associated with the surgical treatment of a number of tumors and is a serious long-term condition with significant medical, economic, and quality of life consequences. Early detection and management are critical to preventing LE progression and complications. We examined the literature to ascertain the incidence and identify factors associated with an increased postoperative risk for LE. Methods: We systematically reviewed the oncology literature (1972–2005) to identify studies that examined postoperative LE. Data pertaining to the type of malignancy, the surgical procedure performed, the criteria used to define LE, and the median follow-up time were extracted. The incidence of LE was summarized using weighted averages. Results: We identified a total of 122 reports of postoperative LE (N = 24,095 patients), which were broken down by cancer type as follows: breast cancer (n = 45), melanoma (n = 31), gynecologic (GYN) malignancies (n = 30), genitourinary (GU) malignancies (prostate n = 6, penile n = 6, bladder n = 2), and sarcoma (n = 2). When only prospective studies (n = 74, 61%) were considered, the incidence of LE following axillary node dissection (AND) in patients with breast cancer was 19% compared with 8% following AND for melanoma. The incidence of lower extremity LE following inguinofemoral and/or pelvic lymph node dissection for melanoma was 30% compared with 24%, 14%, and 20% for GYN malignancies, GU malignancies and sarcomas. The relative risk of postoperative lower extremity LE increased two-fold in patients who received radiation therapy. Methods of measuring LE included extremity circumference (n = 17 studies) with various defined thresholds (>1 cm [n = 8], >2 cm [n = 7], and >3 cm [n = 2]). Fourteen studies used volume measurements, while the remainder used an ad hoc clinical grading method. The lowest incidence of LE was seen in studies with the shortest follow-up. Conclusions: LE is a common condition resulting from the surgical treatment of a number of different malignancies. To enhance the quality of postoperative care in cancer survivors, objective LE measurement and symptom assessment should be part of standard practice during both early and long-term follow-up.

No significant financial relationships to disclose.

Routine use of sentinel lymph node surgery in patients undergoing prophylactic mastectomy: A decision analysis model

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Background: Patients with invasive carcinoma identified following prophylactic mastectomy (PM) require axillary lymph node dissection (ALND) for nodal staging as standard surgical treatment. Since most patients will be node negative, sentinel lymph node (SLN) surgery has been advocated to avoid the sequelae of unnecessary axillary surgery. However, since SLN surgery is not without complications and the incidence of invasive cancer in PM is extremely low, we sought to compare surgical strategies using a decision analysis model in order to define the true risks and benefits of routine SLN surgery versus standard surgical treatment (ALND). Methods: Model estimates were derived by systematic review of the literature. The outcomes examined were: (1) the number of SLN procedures that would need to be performed to avoid one ALND in a pathologically node negative patient; and (2) the probability of long-term axillary complications with each strategy. Occult breast cancer was defined as invasive cancer in the PM specimen and/or SLN metastases. Results: The following weighted averages were used to inform the model: i) incidence of invasive cancer in PM of 1%, ii) incidence of nodal disease of 25% in the presence of invasive breast cancer and 1% in the absence of invasive cancer in the breast, and iii) incidence of complications after ALND of 30% and after SLN surgery of 6%. Routine use of SLN surgery doubled the sensitivity for detection of carcinoma compared to ALND. However, 133 SLN procedures were required to avoid one ALND in a node negative PM patient. Additionally, the probability of complications per breast cancer detected was 10-fold greater with the SLN strategy. When the risk of breast cancer was projected at 10%, 13 SLN procedures were required to avoid one negative ALND and the complication rate per cancer detected was 2-fold greater in the SLN arm. Conclusions: The benefit of adding SLN surgery in patients undergoing PM depends on the probability of detecting invasive cancer. Routine SLN surgery in PM is not warranted given the large number of procedures required to benefit one patient and the complications associated with performing SLN surgery in all patients. However, the SLN strategy may be appropriate for subgroups of patients at higher risk of occult carcinoma.

No significant financial relationships to disclose.

Meta-analysis of sentinel lymph node biopsy after preoperative chemotherapy in patients with breast cancer

BACKGROUND

Women with breast cancer are more frequently being treated with preoperative neoadjuvant chemotherapy. The reliability of sentinel lymph node biopsy (SLNB) following chemotherapy has not been determined. This was a meta-analysis of studies that examined the results of SLNB after preoperative chemotherapy.

METHODS

Included articles had to meet two criteria. First, patients had to have had operable breast cancer and to have undergone SLNB after preoperative chemotherapy and, second, patients had to have undergone subsequent axillary lymph node dissection. Meta-analyses were performed in which Bayesian hierarchical models were created to estimate the identification rate (IR) and sensitivity of SLNB in this setting.

RESULTS

Twenty-one studies were identified that included a total of 1273 patients. The IRs reported ranged from 72 to 100 per cent, with a pooled estimate of 90 per cent. The sensitivity of SLNB ranged from 67 to 100 per cent, with a pooled estimate of 88 (95 per cent confidence interval 85 to 90) per cent. Meta-analyses performed using Bayesian modelling resulted in (posterior) estimates for IR and sensitivity of 91 (95 per cent credible interval 88 to 94) and 88 (95 per cent credible interval 84 to 91) per cent respectively.

CONCLUSION

SLNB is a reliable tool for planning treatment after preoperative chemotherapy.

Family-based association studies of the TCP1 gene and schizophrenia in the Chinese Han population

A previous case-control study by Yang et al. indicated that the TCP1 gene in 6q25 was associated with schizophrenia in the Han population. To replicate this result, we selected eight SNPs (rs2273828, rs3818298, rs1547094, rs1547093, rs2295898, rs2295899, rs4832, rs15982) spanning the whole gene and performed a family-based study using 325 trios samples. Our transmission disequilibrium test showed neither allele nor haplotype association with schizophrenia, and suggests that the TCP1 locus is not associated with schizophrenia in the Chinese population. Since 6q25 has consistently been found to be a susceptible region for schizophrenia, we suggest that other genes within this region should be the focus of attention.