Dynamic Octreotide Scintigraphy in Neuroendocrine Tumours

The purpose of the present study was to investigate the optimal time for scintigraphy after injection of the radio-labelled somatostatin analogue, Octreotide. A secondary purpose was to evaluate the value of SPECT. One SPECT study and up to 4 whole body scans were performed in 22 patients with neuroendocrine tumours 0.5, 5, 24 and 48 hours after an injection of 110 MBq In-DTPA Octreotide. A total of 98 scintigrams were studied. A pathological uptake was found in 19 of the 22 patients. In 3 cases, early scintigrams (0.5 and 5 hours after injection) were of the most value whereas late scintigrams (24 and 48 hours) were the best in 4 cases. SPECT was found to be of value in 13 of 21 cases. For correct interpretation of Octreotide scintigraphy it is necessary to obtain both early and late scintigrams as well as a SPECT study.

Distribution and Dosimetry of 111In Dtpa-D-Phe-Octreotide in Man Assessed by Whole Body Scintigraphy

The distribution and dosimetry of the somatostatin analog 111In-DTPA-octreotide was evaluated in 6 patients. Whole body scintigraphy in anterior and posterior projections was performed 0.5, 5, 24 and 48 hours after injection. Region-of-interest analysis for different organs and the whole body was used to determine 111In octreotide half-life-corrected uptake in absolute and relative terms. A rapid initial uptake was seen in the kidneys (2–7%), the spleen (2–6%) and in the liver (4–8%). A lower uptake was seen in the pituitary gland (maximum 0.3%), the thyroid (maximum 0.07%), in the female breast (maximum 1.2%), in the urinary bladder and in the intestinal tract. The elimination pattern varied between different organs. The effective dose equivalent was evaluated to be in the range 0.08 to 0.13 mSv/MBq (average 0.10 mSv/MBq). The behavior of 111In-DTPA-octreotide suggests follow-up scintigraphy in a period extending up to at least 24 hours after injection.

Abstract PD4-03: Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study

Background: While breast cancer incidence rates have declined in non-Hispanic Caucasian populations, rates have remained stable in African American women, who are often affected by more aggressive subtypes. Previous studies have found that adherence to the World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR) cancer prevention recommendations, and the similar American Cancer Society (ACS) guidelines, is associated with lower incidence of breast cancer. However, few African American women were included in these studies, and guidelines are based primarily on research among Caucasian women.

Objective: To evaluate the association between adherence to the WCRF/AICR cancer prevention recommendations and breast cancer incidence among African American women.

Design: The Black Women's Health Study is an ongoing prospective study of African American women from across the United States who were 21-69 years of age at baseline in 1995. They are followed biennially through health questionnaires. Among 49,103 women who were free of cancer at baseline and who provided relevant dietary and data on the baseline questionnaire, 1,827 incident cases of breast cancer were ascertained during follow-up through 2011. Questionnaire data on physical activity, body composition and diet were used to compute adherence scores for seven WCRF/AICR recommendations involving those factors. For each individual recommendation, participants were categorized as adherent (1 point), partially adherent (0.5 points) or non-adherent (0 points). Scores were summed to a total adherence score (maximum score: 7 points) and a diet only adherence score (maximum score: 5 points). Adherence scores (categorical and continuous) based on baseline data only and on time-varying data were assessed in relation to breast cancer incidence using Cox proportional hazards regression models, with control for potential confounding factors.

Results: In the analytic cohort, 8.5% of participants had an adherence score of 4.5-7.0, while 46% had a score less than 3.0. For individual recommendations, 15.2% were adherent to body weight recommendations, 24.7% were adherent to physical activity, and 5.4% were adherent to more than 4 diet recommendations. Participants were most likely to adhere to the alcohol recommendation (94.3%). In the time varying model, higher overall adherence (per 0.5 unit increase) was associated with lower breast cancer incidence (HR: 0.90, 95% CI: 0.84-0.96), with greater adherence to diet overall, physical activity, sugar beverage intake, and red and processed meat recommendations all significantly associated with reduced risk. The adherence score based on baseline variables was not associated with significantly reduced risk (HR: 0.96, 95% CI: 0.90-1.02), although meeting physical activity recommendations was associated.

Conclusions: Our findings suggest that adherence to the WCRF/AICR guidelines may lower risk of developing breast cancer in African American women. However, body weight and alcohol, factors that are widely considered important for breast cancer prevention appear to be less relevant in this population.

Citation Format: Nomura SJO, Yu J, Dash C, Rosenberg L, Palmer J, Adams-Campbell L. Adherence to diet, physical activity and body composition guidelines and breast cancer in the black women's health study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr PD4-03.

Potential use of feedlot cattle manure for bioethanol production

This paper reports on processing options for the conversion of feedlot cattle manures into composite sugars for ethanol fermentation. Small-scale anaerobic digestion trials revealed that the process significantly reduces the content of glucan and xylan (ca. 70%) without effecting lignin. Moreover, anaerobic digestate (AD) fibres were poor substrates for cellulase (Cellic® CTec 2) saccharification, generating a maximum combined sugar yield of ca. 12% per original dry weight. Dilute acid pretreatment and enzyme saccharification of raw manures significantly improved total sugar recoveries, totalling 264 mg/g (79% theoretical). This was attained when manures were pretreated with 2.5% H2SO4 for 90 min at 121°C and saccharified with 50 FPU CTec 2/g glucan. Saccharomyces cerevisiae efficiently fermented crude hydrolysates within 6 h, yielding 7.3 g/L ethanol, representing glucose to ethanol conversion rate of 70%. With further developments (i.e., fermentation of xylose), this process could deliver greater yields, reinforcing its potential as a biofuel feedstock.

Safety of outpatient autologous hematopoietic cell transplantation for multiple myeloma and lymphoma

Autologous hematopoietic cell transplantation (Auto-HCT) is commonly an in-patient procedure. However, Auto-HCT is increasingly being offered on an outpatient basis. To better characterize the safety of outpatient Auto-HCT, we compared the outcome of 230 patients who underwent Auto-HCT on an in-patient vs outpatient basis for myeloma or lymphoma within a single transplant program. All outpatient transplants occurred in a cancer center day hospital. Hematopoietic recovery occurred earlier in the outpatient cohort, with median time to neutrophil recovery of 10 vs 11 days (P<0.001) and median time to platelet recovery of 19 vs 20 days (P=0.053). Fifty-one percent of the outpatient cohort never required admission, with this percentage increasing in later years. Grade 3-4 non-hematologic toxicities occurred in 29% of both cohorts. Non-relapse mortality at 1 year was 0% in the outpatient cohort and 1.5% in the in-patient cohort (P=0.327). Two-year PFS was 62% for outpatient vs 54% for in-patient (P=0.155). One- and two-year OS was 97% and 83% for outpatient vs 91% and 80% for in-patient, respectively (P=0.271). We conclude that, with daily outpatient evaluation and aggressive supportive care, outpatient Auto-HCT can result in excellent outcomes for myeloma and lymphoma patients.

Ethanol production from cotton gin trash using optimised dilute acid pretreatment and whole slurry fermentation processes

Cotton ginning trash (CGT) collected from Australian cotton gins was evaluated for bioethanol production. CGT composition varied between ginning operations and contained high levels of extractives (26-28%), acid-insoluble material (17-22%) and holocellulose (42-50%). Pretreatment conditions of time (4-20 min), temperature (160-220 °C) and sulfuric acid concentration (0-2%) were optimised using a central composite design. Response surface modelling revealed that CGT fibre pretreated at 180 °C in 0.8% H2SO4 for 12 min was optimal for maximising enzymatic glucose recoveries and achieved yields of 89% theoretical, whilst the total accumulated levels of furans and acetic acid remained relatively low at <1 and 2 g/L respectively. Response surface modelling also estimated maximum xylose recovery in pretreated liquors (87% theoretical) under the set conditions of 150 °C in 1.9% H2SO4 for 23.8 min. Yeast fermentations yielded high ethanol titres of 85%, 88% and 70% theoretical from glucose generated from: (a) enzymatic hydrolysis of washed pretreated fibres, (b) enzymatic hydrolysis of whole pretreated slurries and (c) simultaneous saccharification fermentations, respectively.

Extra-hepatic manifestations of autochthonous hepatitis E infection

BACKGROUND

Autochthonous (locally acquired) hepatitis E is increasingly recognised in developed countries, and is thought to be a porcine zoonosis. A range of extra-hepatic manifestations of hepatitis E infection have been described, but have never been systematically studied.

AIM

To report the extra-hepatic manifestations of hepatitis E virus.

METHODS

Retrospective review of data of 106 cases of autochthonous hepatitis E (acute n = 105, chronic n = 1).

RESULTS

Eight (7.5%) cases presented with neurological syndromes, which included brachial neuritis, Guillain-Barré syndrome, peripheral neuropathy, neuromyopathy and vestibular neuritis. Patients with neurological syndromes were younger (median age 40 years, range 34-92 years, P = 0.048) and had a more modest transaminitis (median ALT 471 IU/L, P = 0.015) compared to cases without neurological symptoms [median age 64 years (range 18-88 years), median ALT 1135 IU/L]. One patient presented with a cardiac arrhythmia,twelve patients (11.3%) presented with thrombocytopenia, fourteen (13.2%) with lymphocytosis and eight (7.5%) with a lymphopenia, none of which had any clinical consequence. Serum electrophoresis was performed in 65 patients at presentation, of whom 17 (26%) had a monoclonal gammopathy of uncertain significance. Two cases developed haematological malignancies, acute myeloid leukaemia and duodenal plasmacytoma, 18 and 36 months after presenting with acute hepatitis E infection.

CONCLUSIONS

A range of extra-hepatic manifestations can occur with hepatitis E. Neurological and haematological features of hepatitis E infection are relatively frequent in this UK cohort, and result in significant morbidity which warrants further study.

Insulin secretion measured by stimulated C-peptide in long-established Type 1 diabetes in the Diabetes Control and Complications Trial (DCCT)/ Epidemiology of Diabetes Interventions and Complications (EDIC) cohort: a pilot study

AIMS

To evaluate whether clinically relevant concentrations of stimulated C-peptide in response to a mixed-meal tolerance test can be detected after almost 30 years of diabetes in people included in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications cohort.

METHODS

Mixed-meal tolerance tests were performed in a sample of 58 people. C-peptide levels were measured using a chemiluminescent immunoassay. This sample size assured a high probability of detecting C-peptide response if the true prevalence was at least 5%, a level that would justify the subsequent assessment of C-peptide in the entire cohort.

RESULTS

Of the 58 participants, 17% showed a definite response, defined as one or more post-stimulus concentrations of C-peptide > 0.03 nmol/l, and measurable concentrations were found in all participants.

CONCLUSIONS

These results show that a stimulated C-peptide response can be measured in some people with long-term Type 1 diabetes. Further investigation of all participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study will help relate long-term residual C-peptide response to glycaemia over time and provide insight into the relevance of this response in terms of insulin dose, severe hypoglycaemia, retinopathy, nephropathy and macrovascular disease. Establishing the clinical relevance of long-term C-peptide responses is important in understanding the impact that therapy to preserve or improve β-cell function may have in patients with long-term Type 1 diabetes.

Laser patterning of platinum electrodes for safe neurostimulation

OBJECTIVE

Laser surface modification of platinum (Pt) electrodes was investigated for use in neuroprosthetics. Surface modification was applied to increase the surface area of the electrode and improve its ability to transfer charge within safe electrochemical stimulation limits.

APPROACH

Electrode arrays were laser micromachined to produce Pt electrodes with smooth surfaces, which were then modified with four laser patterning techniques to produce surface structures which were nanosecond patterned, square profile, triangular profile and roughened on the micron scale through structured laser interference patterning (SLIP). Improvements in charge transfer were shown through electrochemical impedance spectroscopy (EIS), cyclic voltammetry (CV) and biphasic stimulation at clinically relevant levels. A new method was investigated and validated which enabled the assessment of in vivo electrochemically safe charge injection limits.

MAIN RESULTS

All of the modified surfaces provided electrical advantage over the smooth Pt. The SLIP surface provided the greatest benefit both in vitro and in vivo, and this surface was the only type which had injection limits above the threshold for neural stimulation, at a level shown to produce a response in the feline visual cortex when using an electrode array implanted in the suprachoroidal space of the eye. This surface was found to be stable when stimulated with more than 150 million clinically relevant pulses in physiological saline.

SIGNIFICANCE

Critical to the assessment of implant devices is accurate determination of safe usage limits in an in vivo environment. Laser patterning, in particular SLIP, is a superior technique for improving the performance of implant electrodes without altering the interfacial electrode chemistry through coating. Future work will require chronic in vivo assessment of these electrode patterns.

Diabetes autoantibodies do not predict progression to diabetes in adults: the Diabetes Prevention Program

AIMS

To determine if the presence of diabetes autoantibodies predicts the development of diabetes among participants in the Diabetes Prevention Program.

METHODS

A total of 3050 participants were randomized into three treatment groups: intensive lifestyle intervention, metformin and placebo. Glutamic acid decarboxylase (GAD) 65 autoantibodies and insulinoma-associated-2 autoantibodies were measured at baseline and participants were followed for 3.2 years for the development of diabetes.

RESULTS

The overall prevalence of GAD autoantibodies was 4.0%, and it varied across racial/ethnic groups from 2.4% among Asian-Pacific Islanders to 7.0% among non-Hispanic black people. There were no significant differences in BMI or metabolic variables (glucose, insulin, HbA(1c), estimated insulin resistance, corrected insulin response) stratified by baseline GAD antibody status. GAD autoantibody positivity did not predict diabetes overall (adjusted hazard ratio 0.98; 95% CI 0.56-1.73) or in any of the three treatment groups. Insulinoma-associated-2 autoantibodies were positive in only one participant (0.033%).

CONCLUSIONS

These data suggest that 'diabetes autoimmunity', as reflected by GAD antibodies and insulinoma-associated-2 autoantibodies, in middle-aged individuals at risk for diabetes is not a clinically relevant risk factor for progression to diabetes.