[Influence of body mass index on histopathological and intraoperative criteria in a consecutive series of patients after robotic-assisted radical prostatectomy]

BACKGROUND

In various studies it has been shown that obesity enhances the risk for a unfavorable pathological tumour stages, higher Gleason scores (GS), positive surgical margins (PSM), and certain perioperative parameters (higher blood loss, higher length of surgery, higher complication rates) after radical prostatectomy. However, for robot-assisted radical prostatectomy (RARP) there are only a few studies addressing this topic with partially conflicting results. Furthermore, none of these studies actually represents the clinical practice pattern as performed in a European centre.

MATERIAL AND METHODS

Beside further clinical and histopathological parameters, also body mass index (BMI) of patients undergoing RARP was recorded. The following categories were registered: BMI of < 25 kg/m², ≥ 25-29.9 kg/m², and ≥ 30 kg/m² defined as normal weight, overweight, and obesity, respectively. The potential correlation between BMI on the one hand and various criteria of aggressive tumour biology and specific perioperative parameters on the other hand has been examined on univariate and multivariable analyses.

RESULTS

22.8% (n=79), 59% (n=204), and 18.2% (n=63) of patients of the study group presented with normal weight, overweight, and obesity, respectively. Based on the results of various multivariable regression models there was no significant influence of obesity on pathological tumour stage, pN category, undifferentiated tumour growth (≥ GS7b), upgrading, or PSM rates. Furthermore, obese patients showed a significantly higher intraoperative blood loss and a higher length of surgery, which, however, did not result in a higher rate of grade 3a/b complications according to Clavien-Dindo classification after 90 days.

CONCLUSIONS

In the present series of consecutive patients undergoing RARP there was no evidence for a more aggressive tumour biology or a higher complication rate in obese patients.

Abstract 3120: RUNX2 rescues the inhibitory effect of FGFR-2 silencing and increases the metastatic potential of IBH-6 human breast cancer xenografts

Carcinoma associated fibroblasts participate in the regulation of breast cancer growth. We have shown that FGF2 is one of the growth factors involved in tumor progression that activates FGFR-2 and progesterone receptors (PR) increasing the proliferation of breast cancer cells (Cerliani et al, Cancer Res 2011). In addition, we have also shown an increased expression of RUNX2 in tumor cells with acquired hormone independence. It has been suggested that RUNX2 regulates the expression of FGFR2, and on the other hand that FGF2 increases RUNX2 expression. The aim of this study was to evaluate the interplay between FGFR-2 and RUNX2 using a human breast cancer xenograft model. IBH-6 cells express ERα, PR, FGFR 1 to 4 and RUNX2 and grow in vivo in immunocompromised mice without hormone supply giving rise to invasive carcinomas. IBH-6 cells were stably transfected with a specific plasmid designed to knock down the expression of FGFR-2 (shFGFR-2) or with a control plasmid (Scrambled, SC). The decrease of FGFR-2 was confirmed by Western Blot and immunohistochemistry. No differences were found between both cell lines in the proliferation assays performed in vitro. For the in vivo experiments, 3.106 cells were s.c. inoculated into the flank of nude mice (nu/nu). The shFGFR-2 tumors were significantly smaller than control tumors (p&lt;0.001), showed a less aggressive phenotype, a lower proliferation index (Ki67, p&lt;0.01), diminished ratio of pErk/Erk and pAkt/Akt (p&lt;0.05) and a decrease in CCND1 and RUNX2 expression as compared with control SC tumor samples. In order to evaluate if RUNX2 was able to bypass the inhibitory effect of shFGFR-2, cells were cotransfected with the expression plasmid for RUNX2 and were then inoculated in mice as previously described. An increase in tumor size and in aggressiveness associated with higher levels of CCND1 was observed in shFGFR-2/RUNX2 as compared with control (p&lt;0.05) or shFGFR-2 (p&lt;0.01) tumors. Interestingly, a high number of lung and liver metastases were observed in all the shFGFR-2/RUNX2 animals. Our results indicate that FGFR-2 is a key protein involved in mammary tumor growth. The fact that no changes were registered between shFGFR-2 and control cells growing in plastic lends support to our hypothesis postulating a paracrine effect between stromal and parenchymal tissue involving FGFR-2. Since RUNX2 bypasses the inhibitory effect induced by shFGFR-2 we propose that the signaling pathways involved are FGFR-2-independent supporting the hypothesis that FGF2 activates FGFR-2 and in turn RUNX2. Currently we are studying the signaling pathways involved in RUNX2 mediated tumor growth. The results reported here emphasize the use of FGFR-2 inhibitors in combination with standard therapy in breast cancer.

Citation Format: Cecilia Pérez Piñero, María May, Isabel A. Lüthy, Claudia Lanari. RUNX2 rescues the inhibitory effect of FGFR-2 silencing and increases the metastatic potential of IBH-6 human breast cancer xenografts. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 3120. doi:10.1158/1538-7445.AM2014-3120

Pacemaker current inhibition in experimental human cardiac sympathetic activation: a double-blind, randomized, crossover study

Hyperpolarization-activated, cyclic nucleotide-gated 4 (HCN4) channels comprise the final pathway for autonomic heart rate (HR) regulation. We hypothesized that HCN4 inhibition could reverse autonomic imbalance in a human model of cardiac sympathetic activation. Nineteen healthy men ingested oral metoprolol+reboxetine, ivabradine+reboxetine, or placebo+reboxetine in a double-blind, randomized, crossover fashion. We assessed HR, blood pressure (BP), stroke volume, and cardiac output during rest and profound orthostatic stress. HR variability, BP variability, and baroreflex sensitivity were analyzed. Metoprolol, but not ivabradine, decreased resting HR and BP. Ivabradine attenuated the HR increase to orthostatic stress, albeit to a lesser extent than metoprolol. Stroke volume and cardiac output at a given HR were significantly lower with metoprolol. Unlike metoprolol, ivabradine did not affect HR variability, BP variability, or baroreflex sensitivity. Ivabradine attenuates sympathetic influences on HR at the sinus node level, leaving myocardial sympathetic activation unopposed. Reversal of parasympathetic dysfunction by ivabradine appears limited.

Abstract P5-09-19: Progesterone receptor isoform A as a predictive marker of antiprogestin therapy in breast cancer: A tissue culture method to evaluate drug responsiveness

Two thirds of breast cancers express steroid hormone receptors and are susceptible to an endocrine therapy usually aimed to target the estrogen receptors (ER). There is however compelling evidence suggesting that progesterone receptors (PR) participate together with ER, modulating breast cancer growth. Based on our results obtained in an experimental breast cancer model in which antiprogestins induce complete regression of carcinomas with higher levels of PR isoform A (PR-A) than isoform B (PR-B), we propose that antiprogestins such as mifepristone (MFP) might be a possible therapeutic option for patients expressing high levels of PR-A. The goal of our study is to correlate the ratio of PR isoform expression, with the in vitro responsiveness of human breast cancer samples to MFP. Preliminary studies indicated that primary cultures of breast cancer samples overexpressing PR-A were responsive to MFP (10 nM) in vitro. However, since the rate of successful primary cultures was not encouraging (7%), we decided to develop a tissue culture assay to evaluate MFP responsiveness of breast cancer samples in vitro.

Forty five breast cancer samples obtained from the General Pacheco´s Hospital, Buenos Aires, were kept in culture medium at room temperature and in dry ice. The former were cut in slices of 100 μm using a tissue chopper usually used to slice mouse nervous tissue for short incubations, and were incubated on filters in the presence of growth medium (fetal calf serum 10%) with or without MFP (10 nM), for 48 hs at 37º C. The slices were then fixed, paraffin embedded, and processed for Ki-67 staining to evaluate proliferating cells. Frozen samples were processed for Western blotting and the ratio of both PR isoforms was determined in nuclear extracts. In 17/45 (38%) of the samples valuable information was obtained. This was related with the quality (size and amount of viable cells) of the sample. The number of Ki-67 positive cells over the total viable cells was evaluated by a pathologist (M. May) in at least six different control or MFP-treated slices. From nine cases in which the Ki-67 index in control slices doubled the value obtained in MFP-treated slices (p&lt;0.05), 8 were samples in which PR-A was higher than PR-B. MFP increased (p&lt;0.05) the Ki-67 index in one sample with higher levels of PR-B than PR-A. No significant differences were observed in the remaining cases (null, equimolar or higher levels of PR-B than PR-A). We still plan to increase the number of samples in our study. Our data suggest that the tissue culture method developed is much more efficient than the primary cultures to evaluate drug or hormone responsiveness in breast cancer tissue. The results obtained herein support the proposal of PR-A as a predictive marker of antiprogestin therapy in breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-19.

Abstract P4-19-04: Biobank management and tracking web-based system for a breast cancer oriented biobank v2.0: Preliminary analysis

The quality of biospecimens and associated data accuracy in a Biobank must be collected and consistent according to standardized methods in order to achieve international harmonization and coordination among biobanking networks.

Sharing successful strategies between the Baylor College of Medicine (BCM) Breast and Cancer Centers and Breast Center Buenos Aires (BCBA) was the fundamental stone for the creation of an Argentinean Breast Cancer oriented Biobank with a shared data management system. We have designed, developed and implemented a computer system to easily manage sensible associated data. This innovative system, allows the data entry in a visual, intuitive, friendly and orderly way, integrating all the information for further analysis and easy use of samples for translational research.

Objective: Develop and improve (v2.0) a bilingual web-based tool for biospecimen management, inventory, clinical and breast cancer data registration according with international standards of data security quality assurance and ISBER Best Practices for Biorepositories.

Methods: System Characteristics:

Multi-tier architecture, relying on a SQL server 2008 R2 data base. Operating System: Windows Server Series. Programmer Language .net 4.0 C#.. The system operates with Internet Explorer as flat client or similar.

Bilingual English/Spanish system, fully configurable by modules, HIPPA compliant sensible data confidentiality, with de-identification of samples through 2D bar codes.

Results : System Capabilities and Improvements v2.0:

• Security Module: Allows to manage predetermined profiles (Clinical Research Coordinator Clinical staff as Phlebotomist, Pathologist, PA, MDs, PhDs, Researchers), audit controls implemented through permits according to the profile.

• Master Tables: allows to insert/add/change data associated into master tables, providing system user independence.

• General Registration Module: Online statistics allows to see immediately the number of consented individuals, types of samples and their classification.

• Sample Management: Assigns unequivocally identification of each sample in a 2D bar code for freezer lab labels(LabExpert®). Has online statistical information on the number of samples and tubes used, for an easy supply management. Automatically assigns the location of samples per product type in the freezer. Allows to know the occupancy rate online.

• Breast Cancer Module: A comprehensive data base in an attractive visual environment of eight screens: Clinical data, Biopsy, Definitive Surgery, Systemic Treatment, Radiation Treatment, Cancer Events, follow up and Summary screen. Includes path reports and sample collection forms attached in each corresponding biopsy or surgery screen for easy view and data entry quality assurance.

Conclusion: This Biobank Management System was designed in a friendly and intuitive data entry environment by a multidisciplinary team including breast surgeons, pathologists, oncologists, statisticians, system engineers and programmers from BCM and BCBA. It could be adapted to be used in full or in separate modules by Breast Centers and Breast Cancer Oriented Biobanks.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-04.

Abstract P4-19-03: Breast cancer oriented biobank and associated biobank management system: Preliminary analysis on 9043 samples from 274 individuals

Four years ago, after our Baylor College of Medicine (BCM) Breast and Cancer Centers experience, we decided to initiate a related translational research Project at the Breast Center Buenos Aires (BCBA) in Argentina. This included the development of a breast cancer-oriented Management System for clinical and lab data attached to a biorepository of tumor and normal breast tissue with matched blood specimens. We strictly followed ISBER Best Practices for Biorepositories, and shared the same protocols and strategies with BCM to facilitate international collaborative breast cancer research, being extremely aware of international standards.

Objectives: Creation of a breast cancer-oriented blood, breast tissue and tumor biobank for translational research purposes. Creation of a Biobank Management and Tracking System, with a breast cancer database for associated epidemiological, pathological, clinical, and follow-up data of each patient.

Methods: From April 2011 to June 2013 we processed blood and tissue samples from BCBA. Blood is collected at several time points during the breast cancer disease process: pre-surgical, pre-systemic treatment, and, if applicable, in the metastatic setting. Blood products are stored as whole blood, plasma, buffy coat, red blood cell pellet, serum and clot at -80°C or in GenPlates®. Fresh tissue and tumor samples were collected during surgical or core biopsy proceedings and stored fresh at -80°C in 1 ml cryovials and as FFPE (formalin-fixed paraffin embedded) tissue. Upon enrollment, participants completed an extensive epidemiological and risk factor questionnaire, which is supplemented by medical record abstraction for relevant pathological and clinical data, and re-contacted once a year for follow-up.

Preparation and adaptation processes were compliant with the Population Sciences Biorepository and Smith Breast Center Tumor Bank at BCM: 1) IRB-approved informed consent documents 2) Epidemiological and risk factor questionnaires (Core/Breast module); 3) Blood and tissue collection and processing protocols.

A web-based data management and tracking system was specifically designed for the BCBA biobank.

Results:

To date, we have collected 9043 samples, from 274 individuals, in 293 sample collections. Of 5449 frozen samples, 5054 (92.7%) are blood and 395 (7.3%) are tissue. We also collected 3264 blood samples in GenPlate® wells from 68 patients on 17 plates, and extracted DNA from them into Gentegra® tubes, all stored at room temperature.

230 FFPE breast cancer tissue biopsies from 20 surgical specimens, given by the pathologist after diagnosis, stored in cassettes at room temperature in our lab, were also included in the system starting from January 2013.

All of them have been classified by the physician into three categories: Healthy Control 15.3% (n = 42), Benign 55.1% (n = 151) and Cancer 29.6% (n = 81). We collected epidemiological, and cancer data from all of them in our system.

Conclusion: It took nearly 4 years from inception to realization for this biobank; however, the potential benefit to translation breast cancer research is large. The overall value of this biobank will depend on the number of individuals/samples accrued, the follow-up attained and data accuracy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-03.

Carotid CTA: radiation exposure and image quality with the use of attenuation-based, automated kilovolt selection

BACKGROUND AND PURPOSE

CTA is considered the imaging modality of choice in evaluating the supraaortic vessels in many institutions, but radiation exposure remains a matter of concern. The objective of the study was to evaluate a fully automated, attenuation-based kilovolt selection algorithm in carotid CTA in respect to radiation dose and image quality compared with a standard 120-kV protocol.

MATERIALS AND METHODS

Ninety-eight patients were included: 53 examinations (patient age, 66 ± 12 years) were performed by use of automated adaption of tube potential (80-140 kV) on the basis of the attenuation profile of the scout scan (study group), and 45 examinations (patient age, 67 ± 11 years) were performed by use of a standard 120-kV protocol (control group). CT dose index volume and dose-length product were recorded from the examination protocol. Image quality was assessed by ROI measurements and calculations of SNR and contrast-to-noise ratio. Subjective image quality was evaluated by 2 observers with the use of a 4-point scale (3, excellent; 0, not diagnostic).

RESULTS

Subjective image quality was rated as "excellent" or "good" in all examinations (study group, 2.8; control group, 2.8). The algorithm automatically selected 100 kV in 47% and 80 kV in 34%; 120 kV was retained in 19%. An elevation to 140 kV did not occur. Compared with the control group, overall CT dose index volume reduction was 33.7%; overall dose-length product reduction was 31.5%. In the low-kilovolt scans, image noise and mean attenuation of ROIs inside the carotid arteries were significantly higher than in 120-kV scans, resulting in a constant or increased (80-kV group) contrast-to-noise ratio.

CONCLUSIONS

The attenuation-based, kilovolt selection algorithm enables a dose reduction of >30% in carotid artery CTA while maintaining contrast-to-noise ratio and subjective image quality at adequate levels.

Oncological outcome of primary versus secondary muscle-invasive bladder cancer is comparable after radical cystectomy

BACKGROUND

High-risk non-muscle-invasive bladder cancer (NMIBC) progressing to muscle-invasive bladder cancer (MIBC) is associated with adverse tumour biology. It is unclear, however, whether outcome of NMIBC progressing to MIBC is adverse compared to primary MIBC and whether NMIBC of higher risk of progression to MIBC is adverse compared to NMIBC of lower risk.

OBJECTIVE

Our objective was to assess cancer-specific survival (CSS) following radical cystectomy (RC) for primary MIBC and for NMIBC progressing to MIBC in dependence of EORTC risk score.

MATERIALS AND METHODS

Clinical and histopathological characteristics and CSS of 150 patients were assessed. Secondary MIBCs were stratified by EORTC risk score at the last transurethral resection of bladder tumour for NMIBC.

RESULTS

CSS did not differ significantly between primary and secondary MIBC (p = 0.521). Secondary MIBC with high EORTC score had significantly shorter CSS compared to secondary MIBC with intermediate EORTC score (p = 0.029). In multivariable analysis, pathological tumour stage (HR = 3.77; p = 0.020) and lymph node stage (HR = 2.34; p = 0.022) were significantly correlated with CSS.

CONCLUSION

While the outcome of secondary MIBC is not generally adverse compared to primary MIBC, the EORTC risk score not only reflects high risk of progression of NMIBC to MIBC, but also worse outcome following RC for secondary MIBC. Timely RC should thus be debated in high-risk NMIBC.

Novel, low cost, highly effective, handmade steroid pellets for experimental studies

The basic component of Silastic® glue (Dow Corning) used to prepare Silastic® pellets is polydimethylsiloxane. This compound is also present in other commercial adhesives such as FASTIX® (Akapol SA) that are available in any store for that category. In the present study we developed low cost, easy to prepare handmade steroid pellets (HMSP) by mixing 17β-estradiol, progesterone or other synthetic steroids with FASTIX® adhesive. We assessed serum levels of 17β-estradiol, progesterone, prolactin and luteinizing hormone in ovariectomized mice treated for 24 and 48 h or 7, 14 and 28 days with 20 µg or 5 mg of 17β-estradiol or 5 mg progesterone HMSP. We found a time dependent and significant increase in the levels of both natural hormones, and a downregulation of serum luteinizing hormone levels, while both 17β-estradiol doses increased serum prolactin. Uterine weights at sacrifice and histological examination of the uteri and the mammary glands correlated with estrogen or progestin action. Finally, we evaluated the biological effects of HMSP compared to commercial pellets or daily injections in the stimulation or inhibition of hormone dependent mammary tumor growth, and found that HMSP were as effective as the other methods of hormone administration. These data show that HMSP represent a useful, low cost, easily accessible method for administering steroids to mice.

Development of an electronic medical record based intervention to improve medical care of osteoporosis

Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. An EMR-based intervention (osteoporosis order set) was developed with physician and patient input. There was a trend toward greater calcium supplementation from July 2008 to April 2009 (s = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.

INTRODUCTION

Osteoporosis is infrequently addressed during hospitalization for osteoporotic fractures. The study population consisted of patients over 50 years of age.

METHODS

Northwestern Memorial Hospital is a tertiary care academic hospital in Chicago. This study was conducted from September 1, 2007 through June 30, 2009.

RESULTS

Physicians reported that barriers to care comprised nonacute nature of osteoporosis, belief that osteoporosis should be addressed by the PCP, low awareness of recurrent fractures, and radiographs with terms such as "compression deformity", "wedge deformity", or "vertebral height loss" which in their opinion were not clearly indicative of vertebral fractures. An EMR-based intervention was developed with physician and patient input. Over the evaluation period, 295 fracture cases in individuals over the age of 50 years in the medicine floors were analyzed. Mean age was 72 ± 11 years; 74% were female. Sites of fracture included hip n = 78 (27%), vertebral n = 87 (30%), lower extremity n = 61 (21%), upper extremity n = 43 (15%) and pelvis n = 26 (9%). There was no increase in documentation of osteoporosis in the medical record from pre- to post-EMR implementation (p = 0.89). There was a trend toward greater calcium supplementation from July 2008 to April 2009 (p = 0.058); however, use of antiresorptives (13%) or discharge instructions for BMD testing and osteoporosis treatment (10%) remained low.

CONCLUSION

An electronic medical record intervention without electronic reminders created with physician input achieves an increase in calcium supplementation but fails to increase diagnosis or treatment for osteoporosis at the time of hospitalization for a fragility fracture.

[Simultaneous robot-assisted laparoscopic cystectomy and laparoscopic nephrectomy: first experience on 3 patients with short-term follow-up]

BACKGROUND

The standard treatment for the muscle-invasive bladder cancer (MIBC) adheres to the open radical cystectomy (RC), although in the last few years the RC was established in some centres. The MIBC with simultaneous renal pathology (carcinoma, loss of function) can be a reason for an RC in combination with a nephrectomy. In the present paper we give a report about our first 3 patients in whom we combined the robotic RC with a laparoscopic nephrectomy as a minimally invasive treatment.

PATIENTS AND METHODS

Between January and September 2010 3 male patients (average age 66 years) with MIBC and an associated renal pathology (2×loss of function, 1×upper tract carcinoma) were treated by the simultaneous robot-assisted RC and laparoscopic nephrectomy at our hospital. Clinical and pathological criteria, surgical techniques and preoperative complications were recorded prospectively. Follow-up of the 3 patients continued for at least of 18 months.

RESULTS

In all 3 cases primarily the kidney was prepared in a transperitoneal-laparoscopic way and clipped by the vessel pedicle, then the robot-assisted RC followed and specimens were removed through a 10-cm median laparotomy. In all cases an ileum conduit was built extracorporally in using this way. The median OP time (including nephrectomy, connection of Da-Vinci, RC with extended lymph node dissection) amounted to 7 h (6.5-7.5 h) in total. The intraoperative blood loss was 330 mL on average. One of our patients showed a grade 2 complication following the Clavien-Dindo classification (1×grade 1, 1×without perioperative complications). On average 32 (22-46) lymph nodes were taken out, whereby all patients showed a pN0 status. The pathological stagings of MIBC were pT3a, pT4a and pT4b. With one patient the cancer of the renal pelvis was limited to the lamina propria, with another patient an incidental prostate cancer was detected. All histopathological findings of the different cancers showed negative surgical margins. The median hospitalisation time was 17 (16-19) days. In an 18- to 26-month follow-up period all patients ­remained without any further postoperative complications and ­without a tumour relapse.

CONCLUSION

In this paper we have described the surgical steps of a small series of simultaneous robot-assisted RC and laparoscopic nephrectomy as a minimally invasive treatment in case of a specific indication. As a result of our report, we show that this surgical technique is possible without essential perioperative morbidity and with satisfying oncological results. Long-term data of our patients and results of any further studies are crucial to evaluate the efficiency of this complex surgical method.

Broadly reactive polymerase chain reaction for pathogen detection in canine granulomatous meningoencephalomyelitis and necrotizing meningoencephalitis

Background

Granulomatous meningoencephalomyelitis (GME) and necrotizing meningoencephalitis (NME) are common inflammatory conditions of the central nervous system of dogs. Infectious pathogens, particularly viruses, are suspected to contribute to the etiopathogenesis of GME and NME.

Hypothesis

Broadly reactive PCR might aid in the identification of infectious agents in GME and NME.

Animals

Sixty‐eight client‐owned dogs evaluated by necropsy at 1 university referral hospital.

Methods

A mixed prospective/retrospective case‐control study was performed. Brain tissue prospectively collected at necropsy from GME, NME, and control cases was evaluated by broadly reactive polymerase chain reaction (PCR) for adenoviruses, bunyaviruses, coronaviruses, enteroviruses, flaviviruses, herpesviruses, paramyxoviruses, and parechoviruses. In addition, these tissues were retrospectively evaluated for the presence of mycoplasmas by PCR, culture, and immunohistochemistry (IHC).

Results

Brain tissue was collected from 11 GME and 27 NME cases and 30 controls. Viral nucleic acids were not identified in the 6 GME cases, 25 NME cases, and 2 controls evaluated by viral PCR. Mycoplasma canis was identified by Mycoplasma genus PCR in 1/5 GME and 4/25 NME cases and subsequently was cultured from 4/5 GME and 4/8 NME cases as well as 2/9 controls. The IHC did not detect M. canis in any of the 11 GME and 27 NME cases or 14 controls evaluated with strain PG14 polyclonal antiserum.

Conclusions and Clinical Importance

The negative results suggest that viral pathogens are not common in the brain tissue of dogs with GME and NME. Further investigation is warranted to determine the importance of M. canis in cases of GME and NME.

Effect of sample storage on blood crossmatching in horses

BACKGROUND

Blood samples banked for up to 1 month are typically used to perform pretransfusion testing in humans and small animals, but this has not been validated using blood from horses.

HYPOTHESIS

Compatibility of equine blood samples is repeatable using fresh samples, and reproducible using donor blood samples stored for up to 4 weeks.

ANIMALS

Six healthy adult horses.

METHODS

Randomized, blinded experimental study. Immunologic compatibility of the blood of all horses was assessed using a major and minor saline agglutination and hemolysin crossmatch using blood samples refrigerated for 0-4 weeks and fresh blood from the same horses. Crossmatch results were scored and then compared to identify changes of compatibility in each of the 4 tests. In addition, repeatability of the crossmatch technique itself was assessed by performing 6 iterations of this procedure in immediate succession with fresh blood from 3 horses.

RESULTS

No significant difference in crossmatch results was found using fresh blood (P = .39-1.00). Reproducibility was poor using blood stored for 1-4 weeks, especially in tests using stored erythrocytes (major antigen crossmatches), with significant differences from baseline at all weeks (P < .05); 13 of these differences were positive, indicating poorer compatibility.

CONCLUSIONS AND CLINICAL IMPORTANCE

Equine blood crossmatching is repeatable using fresh blood, although decreased apparent compatibility after storage makes exclusion of compatible donors more likely than mistaken administration of incompatible blood. These data suggest that fresh samples should be collected from potential donors before crossmatching equine blood.

Collecting system invasion and Fuhrman grade but not tumor size facilitate prognostic stratification of patients with pT2 renal cell carcinoma

PURPOSE

The 7th edition of TNM for renal cell carcinoma introduced a subdivision of pT2 tumors at a 10 cm cutoff. In the present multicenter study the influence of tumor size as well as further clinical and histopathological parameters on cancer specific survival in patients with pT2 tumors was evaluated.

MATERIALS AND METHODS

A total of 670 consecutive patients with pT2 tumors (10.4%) of 6,442 surgically treated patients with all tumor stages were pooled (mean followup 71.4 months). Tumors were reclassified according to the current TNM classification, and subdivided in stages pT2a and pT2b. Cancer specific survival was analyzed using the Kaplan-Meier method, and univariable and multivariable analyses were used to assess the influence of several parameters on survival.

RESULTS

Tumor size continuously applied and subdivided at 10 cm or alternative cutoffs did not significantly influence cancer specific survival. In addition to N/M stage, Fuhrman grade and collecting system invasion also had an independent influence on survival. Integration of a dichotomous variable subsuming Fuhrman grade and collecting system invasion (grade 3/4 and/or collecting system invasion present vs grade 1/2 and collecting system invasion absent) into multivariate models including established prognostic parameters resulted in improvement of predictive abilities by 11% (HR 2.3, p <0.001) for all pT2 cases and 151% (HR 3.1, p <0.001) for stage pT2N0M0 cases.

CONCLUSIONS

Tumor size did not have a significant influence on cancer specific survival in pT2 tumors, neither continuously applied nor based on various cutoff values. To enhance prognostic discrimination, multifactorial staging systems including pathological features should be implemented. The prognostic relevance of the variable subsuming Fuhrman grade and collecting system invasion should be considered for future evaluation.