Comparison of open and pneumovesical approaches for Politano-Leadbetter ureteric reimplantation: a single-center long-term follow-up study

PURPOSE

To report our experience with the laparoscopic pneumovesical approach for Politano-Leadbetter ureteric reimplantation and to compare the results to those obtained using a traditional open approach.

METHODS

We retrospectively reviewed the medical records of 52 patients who underwent Politano-Leadbetter ureteral reimplantation between 2012 and 2017. The peri-operative parameters, postoperative outcomes, and complication rates of patients who underwent the open approach for the Politano-Leadbetter procedure and those who underwent the laparoscopic pneumovesical approach were compared.

RESULTS

During the study period, 52 ureteric reimplantation procedures were analyzed. Among these, 28 and 24 patients underwent surgery using the open and pneumovesical approaches, respectively. The mean operative time did not differ between the groups (143.64 min vs. 128.12 min, P = 0.092). However, the pneumovesical group had a shorter duration of hospital stay (5.08 days vs 7.43 days, P = 0.001) and required less morphine analgesic for pain than did the open group (7.7% vs 32.1%, P = 0.027). No significant differences in the success rates (94.9% vs 92.5%, P = 0.512) or procedure-related complications were noted between the pneumovesical and open techniques.

CONCLUSIONS

The transvesicoscopic Politano-Leadbetter technique with pneumovesicum is safe and effective for ureteric reimplantation and is comparable to the open approach.

Chronic exposure to non-eruptive volcanic activity as cause of bronchiolar histomorphological alteration and inflammation in mice

It is estimated that 10% of the worldwide population lives in the vicinity of an active volcano. However, volcanogenic air pollution studies are still outnumbered when compared with anthropogenic air pollution studies, representing an unknown risk to human populations inhabiting volcanic areas worldwide. This study was carried out in the Azorean archipelago of Portugal, in areas with active non-eruptive volcanism. The hydrothermal emissions within the volcanic complex of Furnas (São Miguel Island) are responsible for the emission of nearly 1000 tons of CO₂ per day, along with H₂S, the radioactive gas - radon, among others. Besides the gaseous emissions, metals (e.g., Hg, Cd, Al, Ni) and particulate matter are also released into the environment. We test the hypothesis that chronic exposure to volcanogenic air pollution alters the histomorphology of the bronchioles and terminal bronchioles, using the house mouse, Mus musculus, as bioindicator species. Mus musculus were live-captured at three different locations: two villages with active volcanism and a village without any type of volcanic activity (reference site). The histomorphology of the bronchioles (diameter, epithelium thickness, smooth muscle layer thickness, submucosa thickness and the histological evaluation of the peribronchiolar inflammation) and of the terminal bronchioles (epithelium thickness and classification) were evaluated. Mice chronically exposed to volcanogenic air pollution presented bronchioles with increased epithelial thickness, increased smooth muscle layer, increased submucosa thickness and increased peribronchiolar inflammation. Similarly, terminal bronchioles presented structural alterations consistent with bronchodysplasia. For the first time we demonstrate that chronic exposure to non-eruptive volcanically active environments causes inflammation and histomorphological alterations in mice lower airways consistent with asthma and chronic bronchitis. These results reveal that chronic exposure to non-eruptive volcanic activity represents a risk factor that can affect the health of the respiratory system of humans inhabiting hydrothermal areas.

RNA Granules Hitchhike on Lysosomes for Long-Distance Transport, Using Annexin A11 as a Molecular Tether

Long-distance RNA transport enables local protein synthesis at metabolically-active sites distant from the nucleus. This process ensures an appropriate spatial organization of proteins, vital to polarized cells such as neurons. Here, we present a mechanism for RNA transport in which RNA granules "hitchhike" on moving lysosomes. In vitro biophysical modeling, live-cell microscopy, and unbiased proximity labeling proteomics reveal that annexin A11 (ANXA11), an RNA granule-associated phosphoinositide-binding protein, acts as a molecular tether between RNA granules and lysosomes. ANXA11 possesses an N-terminal low complexity domain, facilitating its phase separation into membraneless RNA granules, and a C-terminal membrane binding domain, enabling interactions with lysosomes. RNA granule transport requires ANXA11, and amyotrophic lateral sclerosis (ALS)-associated mutations in ANXA11 impair RNA granule transport by disrupting their interactions with lysosomes. Thus, ANXA11 mediates neuronal RNA transport by tethering RNA granules to actively-transported lysosomes, performing a critical cellular function that is disrupted in ALS.

Prevalence of and factors related to latent tuberculous infection among all employees in a referral hospital

SETTING

Referral hospital, South Korea.

OBJECTIVE

To investigate the prevalence of and factors related to latent tuberculous infection (LTBI) among all hospital employees.

DESIGN

A cross-sectional study of 479 health care workers (HCWs) undergoing LTBI screening.

RESULTS

Overall prevalence of LTBI was 15.7%, 43.1% of whom initiated and completed LTBI treatment. Compared with HCWs without LTBI, those with LTBI were more likely to be older (P < 0.001), male (P = 0.003), work in low-risk departments (P = 0.013) and have more years of employment (P < 0.001). LTBI prevalence was highest in physicians (27.8%), followed by HCWs without patient contact (23.4%), nurses (8.3%) and other HCWs in contact with patients (6.9%). In multivariate analysis, compared with HCWs aged <20 years, those aged 40 years were 4.08 times more likely to have LTBI (P = 0.007). In addition, compared with HCWs working for <1 year, those working for 1-5 years or for 5 years were respectively 7.55 (P = 0.014) and 13.69 (P = 0.001) times more likely to have LTBI.

CONCLUSIONS

Our results suggest that modified LTBI screening strategies, including HCWs with no patient contact and encouraging LTBI treatment participation, might be helpful in improving LTBI control in HCWs.

Sex-Related Abnormalities in Substantia Nigra Lipids in Parkinson's Disease

Parkinson’s disease (PD) is a neurodegenerative movement disorder involving the selective loss of dopamine-producing neurons in the substantia nigra (SN). Differences in disease presentation, prevalence, and age of onset have been reported between males and females with PD. The content and composition of the major glycosphingolipids, phospholipids, and cholesterol were evaluated in the SN from 12 PD subjects and in 18 age-matched, neurologically normal controls. Total SN ganglioside sialic acid content and water content (%) were significantly lower in the male PD subjects than in the male controls. The content of all major gangliosides were reduced in the male PD subjects to some degree, but the neuronal-enriched gangliosides, GD1a and GT1b, were most significantly reduced. The distribution of phosphatidylethanolamine, phosphatidylcholine, and phosphatidylinositol was also significantly lower in the male PD subjects than in the male controls. However, the distribution of myelin-enriched cerebrosides and sulfatides was significantly higher in the male PD subjects than in the male controls suggesting myelin sparing in the male PD subjects. No elevation was detected for astrocytosis-linked GD3. These neurochemical changes provide evidence of selective neuronal loss in SN of the males with PD without robust astrocytosis. In contrast to the SN lipid abnormalities found in the male PD subjects, no significant abnormalities were found in the female PD subjects for SN water content or for any major SN lipids. These data indicate sex-related differences in SN lipid abnormalities in PD.

Augmented manipulation ability in humans with six-fingered hands

Neurotechnology attempts to develop supernumerary limbs, but can the human brain deal with the complexity to control an extra limb and yield advantages from it? Here, we analyzed the neuromechanics and manipulation abilities of two polydactyly subjects who each possess six fingers on their hands. Anatomical MRI of the supernumerary finger (SF) revealed that it is actuated by extra muscles and nerves, and fMRI identified a distinct cortical representation of the SF. In both subjects, the SF was able to move independently from the other fingers. Polydactyly subjects were able to coordinate the SF with their other fingers for more complex movements than five fingered subjects, and so carry out with only one hand tasks normally requiring two hands. These results demonstrate that a body with significantly more degrees-of-freedom can be controlled by the human nervous system without causing motor deficits or impairments and can instead provide superior manipulation abilities.

Overproduction of TNF-α and lung structural remodelling due to chronic exposure to volcanogenic air pollution

Volcanogenic air pollution studies and their effects on the respiratory system are still outnumbered by studies regarding the effects of anthropogenic air pollution, representing an unknown risk to human population inhabiting volcanic areas worldwide (either eruptive or non-eruptive areas). This study was carried in the archipelago of the Azores- Portugal, in two areas with active volcanism (Village of Furnas and Village of Ribeira Quente) and a reference site (Rabo de Peixe). The hydrothermal volcanism of Furnas volcanic complex is responsible for the release of 1000 t d^-1 of CO₂, H₂S, the radioactive gas - radon, among others. Besides the gaseous emissions, particulate matter and metals (Hg, Cd, Zn, Al, Ni, etc.) are also released into the environment. We tested a hypothesis whether chronic exposure to volcanogenic air pollution causes lung structural remodelling, in the house mouse, Mus musculus, as a bioindicator species. Histopathological evaluations were performed to assess the amount of macrophages, mononuclear leukocyte infiltrate, pulmonary emphysema, and the production of pro-inflammatory cytokine TNF-α. Also, the percentage of collagen and elastin fibers was calculated. Mice chronically exposed to volcanogenic air pollution presented an increased score in the histopathological evaluations for the amount of macrophages, mononuclear leukocyte infiltrate, pulmonary emphysema and production of TNF-α; and also increased percentages of collagen and elastin. For the first time, we demonstrate that non-eruptive active volcanism has a high potential to cause lung structural remodelling. This study also highlights the Mus musculus as a useful bioindicator for future biomonitoring programs in these type of volcanic environments.

Assessing bioavailability of ruminally protected methionine and lysine prototypes

Met and Lys are essential AA that can limit lactational performance in dairy cattle fed protein-sufficient diets. Thus, there is industry demand for ruminally protected (RP) sources of Met and Lys. One method of providing ruminal protection for Met and Lys is lipid encapsulation. The objective of this work was to assess 3 lipid-encapsulated Met prototypes (P1, P2, and P3) and 1 Lys prototype (P4) to determine ruminal protection, small intestine absorption (experiment 1), and animal production responses (experiment 2). Ruminal protection was estimated from 8-h in situ retention during ruminal incubation and intestinal absorption from plasma appearance after an abomasal bolus of the in situ retentate. Blood samples were collected over time to determine plasma Met and Lys concentration responses compared with unprotected Lys and Met infused abomasally. The prototypes were not exposed to the total diet or subjected to typical feed handling methods before evaluation. The bioavailability of P1, P2, and P3 Met prototypes was found to be 14, 21, and 18% of the initial AA material, respectively. The RP-Lys prototype had a bioavailability of 45%. To evaluate production responses, 20 Holstein cows were randomly assigned to 2 trials (n = 10 each) in a replicated Latin square design with 14-d periods. The base diet was predicted to be deficient in metabolizable Met (-14.8 g/d) and Lys (-16.1 g/d) per the Cornell Net Carbohydrate and Protein System (version 6.55). In the Met trial, the base diet was supplemented with RP-Lys to meet Lys requirements, and treatments were as follows: no added RP-Met (NCM), NCM plus Smartamine M (SM; Adisseo, Alpharetta, GA), and NCM plus P1, P2, or P3 at 148% of the Met content of SM. In the Lys trial, the base diet was supplemented with RP-Met to meet the Met requirement, and treatments were as follows: no added Lys (NCL), NCL plus AjiProL (AL; Ajinomoto Heartland Inc., Chicago, IL), and NCL plus P4 at 55, 78, or 102% of the reported absorbed Lys in AL. All products were top dressed on the diet without prior mixing or extended exposure to the rest of the diet. Milk protein concentration significantly increased when diets were supplemented with P2, P3, or SM (3.12, 3.12, and 3.11%, respectively) compared with NCM (3.02%). Only P1 (3.04%) was significantly lower than SM. Prototype P2 had the greatest numerical milk protein output response among the 3 RP-Met prototypes, suggesting that it may have had the greatest efficacy when supplemented into these rations. There was a numerical milk protein concentration response to AL and a linear increase in milk protein concentration for P4. The P4 and AL treatments resulted in comparable milk protein production regardless of P4 dose.

Infinite deflectometry enabling 2π-steradian measurement range

We present a novel deflectometry implementation termed Infinite Deflectometry. The technique provides a full aperture surface reconstruction sag map of freeform surfaces, including previously challenging to measure optics such as highly convex surfaces. The method relies on the creation of a virtual source enclosure around the tested optic, which creates a virtual 2π-steradian measurement range. To demonstrate the performance, a fast f/1.26 convex optical surface was measured with a commercial interferometer and with the Infinite Deflectometry system. After removing Zernike terms 1 through 37, the metrology tests resulted in absolute RMS surface values of 18.48 nm and 16.26 nm, respectively. Additionally, a freeform Alvarez lens was measured with the new technique and measured 22.34 𝜇m of surface sag RMS after piston, tip/tilt, and defocus had been removed. The result deviated by 488 nm RMS from a profilometer measurement while standard interferometry failed to measure the Alvarez lens due to its non-nulled wavefront dynamic range limitation.

Abstract P1-11-16: Efficacy and safety of acupuncture for the hot flashes in breast cancer patients taking adjuvant tamoxifen: A multicenter study in Korean women

Background : Tamoxifen is widely used in premenopausal patients with estrogen receptor positive (ER+) breast cancer. Among the side-effects of tamoxifen, hot flashes is a common and challenging one. Previous pilot study suggested the effectiveness of acupuncture for relief of symptoms. This study was performed to evaluate the efficacy and safety of acupuncture for treatment of hot flashes in Korean women breast cancer patients taking tamoxifen as adjuvant endocrine therapy.

Methods : Thirty(30) breast cancer patients taking tamoxifen and reported moderate to severe hot flashes were enrolled from two institutes. Patients were randomly assigned into acupuncture group(n=15) and control group(n=15). The acupuncture group received acupuncture 3 times a week for 4 consecutive weeks, at 5 predefined points(GV 20, M-HN-3, HT 8, KI 10 and LV 2) for 20 ± 5minutes at each session. Control group received no treatment. The score of hot flash visual analogue scale(VAS) and total hot flash score, EORTC QLQ-C30 and QLQ-BR 23 questionnaire were recorded before treatment, once every treatment week and 4 weeks after treatment for both groups.

Results : Acupuncture group showed significantly reduced severity of hot flashes during treatment assessed with either VAS and total hot flash score (p=0.000 and p=0.008, respectively). Also, acupuncture group showed improvement of global health status and physical functioning score assessed with EORTC QLQ-C30 (p=0.004 and p=0.027, respectively). Four weeks after the treatment, these trends were retained. No adverse events were notified

Conclusion : Acupuncture may have feasibility and safety for alleviate hot flashes of Korean women breast cancer patients taking tamoxifen as an adjuvant endocrine therapy. Long-term follow up results and further study with a larger sample size is required.

Citation Format: Choi H, Jeong Y-j, Park S-H, Kwak M-A, Kim K-S, Lee Y, Park S. Efficacy and safety of acupuncture for the hot flashes in breast cancer patients taking adjuvant tamoxifen: A multicenter study in Korean women [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-16.

Abstract PD4-11: [18F]Fluciclovine PET tracks cellular glutamine pool size in breast cancer and changes in response to metabolic inhibition

Background: Some forms of triple negative breast cancer (TNBC) rely on glutamine (Gln) metabolism for survival and growth (1), therefore, targeting this metabolic pathway provides a viable strategy for managing TNBC. Drugs that inhibit glutaminase (GLS), a key enzyme of glutaminolysis, are being developed (1,2). [18F]Fluciclovine is a PET imaging agent that enters/exits cells via glutamine transporters and undergoes minimal metabolism. Therefore, we hypothesize, that akin to our prior work with [18F]fluoroglutamine (3), the distribution volume (VT) of fluciclovine obtained from dynamic PET can be used to estimate the cellular glutamine level (pool size) and to mark the effect of pharmacological inhibitors of tumor glutaminase (GLS). We tested this hypothesis in human TNBC and ER+ breast cancer xenograft exhibiting a high and low GLS activity, respectively.

Methods: To make [18F]fluciclovine preparation suitable for mouse imaging, citrate in the formulation was removed and replaced with PBS by eluting through a column (Bio-Rad). Cellular uptake was performed in the presence and absence of Gln transporter inhibitors and GLS inhibitor. In vivo dynamic PET imaging were performed on mice bearing HCC1806 (TNBC) and MCF-7 (ER+ BC) xenografts. Dynamic PET images were analyzed by Logan Plot (PMOD) to estimate VT.

Results: Cellular uptake of [18F]fluciclovine in HCC1806 and MCF-7 cells were sensitively inhibited by cold glutamine (Gln) and GPNA (a pharmacologic inhibitor of ASCT-2), confirming that the uptake is mediated by Gln transporters. The peak uptake in MCF-7 cells was 5-fold higher than HCC1806. In mouse models, VT from in vivo [18F]Fluciclovine PET in MCF-7 tumor is 1.4-fold of HCC1806. These data are consistent with a higher cellular Gln pool size in MCF-7 as the result of its lower GLS activity. After inhibition of tumor GLS activity, VT of [18F]fluciclovine in HCC-1806 tumors was increased by 56% from baseline values (n=2), whereas VT in MCF-7 tumors decreased 1% after treatment (n=2). Only a small change of FDG PET signal (5% decrease, n=5) was detected in TNBC tumors after GLS inhibitor treatment.

Discussions: These data suggest that VT obtained from [18F]fluciclovine PET is sensitive to changes of the Gln pool size induced by GLS inhibition whereas FDG PET is not. Since the Gln pool size is inversely related to the GLS activity, increased VT is consistent with the increased intracellular Gln level when metabolic conversion of Gln to glutamate by GLS is inhibited. Our results suggest that [18F]fluciclovine, an imaging agent approved for prostate cancer imaging, may be useful for assessing glutamine pool size in breast cancer and changes in response to GLS inhibition

Support: R21CA198563, R01CA211337, and Komen SAC130060. We thank Blue Earth Diagnostics for supplies of [18F]fluciclovine.

1.Gross MI, Demo SD, Dennison JB, et al. Mol Cancer Ther 2014;13(4):890-901.

2.Le A, Lane AN, Hamaker M, et al. Cell Metab 2012;15(1):110-21.

3.Zhou R, Pantel AR, Li S, et al. Cancer Res 2017;77(6):1476-84.

Citation Format: Cao J, Choi H, Pantel A, Kranseler D, Lee H, Mankoff D, Zhou R. [18F]Fluciclovine PET tracks cellular glutamine pool size in breast cancer and changes in response to metabolic inhibition [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD4-11.

Length of hospital stay after hip fracture surgery and 1-year mortality

There is ongoing effort to discharge patients early after hip fracture surgery to reduce the medical and economic burden. We tried to find whether there is any related side effect, and discovered that early discharge, especially before 10 days after surgery, is associated with higher mortality.

INTRODUCTION

The aim of this study was to analyze the association between the length of hospital stay after hip fracture and 1-year mortality in older adults aged ≥ 65 years old.

METHODS

We conducted a retrospective cohort study using the Korean National Health Insurance Service data to identify patients who were discharged after hip fracture surgery from 2007 to 2009 among 487,460 older adults of age ≥ 65 years. The lengths of stay involving hip fracture surgery were categorized at 10-day interval, and analyzed in relation to 1-year mortality from the date of hospital discharge.

RESULTS

A total of 4213 patients were discharged after hip fracture surgery, of whom 604 (14.3%) died within 1 year of discharge. The average length of stay was 30.7 days (standard deviation 24.5 days). The 1-year mortality was the highest for the length of stay ≤ 10 days group at 21.7%, followed by 15.2%, 14.3%, 13.3%, and 12.4% for > 40, 21-30, 31-40, and 11-20 days groups, respectively (p value 0.05). On Cox proportional hazard regression, the adjusted hazard ratio for length of stay ≤ 10 days group was 1.56 (95% confidence interval 1.14-2.12) against the reference group (11-20 days), while other groups did not show statistical significance. Higher risk of death was associated with increasing age, male gender, Charlson comorbidity index ≥3, subtrochanteric fracture, and discharge to tertiary care hospitals and long-term care hospitals.

CONCLUSION

Older adults discharged within 10 days of hospital admission for hip fracture surgery have higher 1-year mortality after discharge.