Transfer parameters for ICRP's Reference Animals and Plants in a terrestrial Mediterranean ecosystem

A system for the radiological protection of the environment (or wildlife) based on Reference Animals and Plants (RAPs) has been suggested by the International Commission on Radiological Protection (ICRP). To assess whole-body activity concentrations for RAPs and the resultant internal dose rates, transfer parameters are required. However, transfer values specifically for the taxonomic families defined for the RAPs are often sparse and furthermore can be extremely site dependent. There is also a considerable geographical bias within available transfer data, with few data for Mediterranean ecosystems. In the present work, stable element concentrations (I, Li, Be, B, Na, Mg, Al, P, S, K. Ca, Ti, V, Cr, Mn, Fe, Co, Ni, Cu, Zn, As, Se, Rb, Sr, Mo, Ag, Cd, Cs, Ba, Tl, Pb and U) in terrestrial RAPs, and the corresponding whole-body concentration ratios, CR_wo, were determined in two different Mediterranean ecosystems: a Pinewood and a Dehesa (grassland with disperse tree cover). The RAPs considered in the Pinewood ecosystem were Pine Tree and Wild Grass; whereas in the Dehesa ecosystem those considered were Deer, Rat, Earthworm, Bee, Frog, Duck and Wild Grass. The CR_wo values estimated from these data are compared to those reported in international compilations and databases.

An International Position Statement on the Management of Frailty in Diabetes Mellitus: Summary of Recommendations 2017

AIM

The International Position Statement provides the opportunity to summarise all existing clinical trial and best practice evidence for older people with frailty and diabetes. It is the first document of its kind and is intended to support clinical decisions that will enhance safety in management and promote high quality care.

METHODS

The Review Group sought evidence from a wide range of studies that provide sufficient confidence (in the absence of grading) for the basis of each recommendation. This was supported by a given rationale and key references for our recommendations in each section, all of which have been reviewed by leading international experts. Searches for any relevant clinical evidence were generally limited to English language citations over the previous 15 years. The following databases were examined: Embase, Medline/PubMed, Cochrane Trials Register, Cinahl, and Science Citation. Hand searching of 16 key major peer-reviewed journals was undertaken by two reviewers (AJS and AA) and these included Lancet, Diabetes, Diabetologia, Diabetes Care, British Medical Journal, New England Journal of Medicine, Journal of the American Medical Association, Journal of Frailty and Aging, Journal of the American Medical Directors Association, and Journals of Gerontology - Series A Biological Sciences and Medical Sciences.

RESULTS

Two scientific supporting statements have been provided that relate to the area of frailty and diabetes; this is accompanied by evidence-based decisions in 9 clinical domains. The Summary has been supported by diagrammatic figures and a table relating to the inter-relations between frailty and diabetes, a frailty assessment pathway, an exercise-based programme of intervention, a glucose-lowering algorithm with a description of available therapies.

CONCLUSIONS

We have provided an up to date evidence-based approach to practical decision-making for older adults with frailty and diabetes. This Summary document includes a user-friendly set of recommendations that should be considered for implementation in primary, community-based and secondary care settings.

Environmental risk assessment of cobalt and manganese from industrial sources in an estuarine system

A total of 74 samples of soil, sediment, industrial sludge, and surface water were collected in a Mediterranean estuarine system in order to assess the potential ecological impact of elevated concentrations of Co and Mn associated with a Terephthalic (PTA) and Isophthalic (PIPA) acids production plant. Samples were analyzed for elemental composition (37 elements), pH, redox potential, organic carbon, and CaCO₃ content, and a group of 16 selected samples were additionally subjected to a Tessier sequential extraction. Co and Mn soil concentrations were significantly higher inside the industrial facility and around its perimeter than in background samples, and maximum dissolved Co and Mn concentrations were found in a creek near the plant's discharge point, reaching values 17,700 and 156 times higher than their respective background concentrations. The ecological risk was evaluated as a function of Co and Mn fractionation and bioavailability which were controlled by the environmental conditions generated by the advance of seawater into the estuarine system during high tide. Co appeared to precipitate near the river mouth due to the pH increase produced by the influence of seawater intrusion, reaching hazardous concentrations in sediments. In terms of their bioavailability and the corresponding risk assessment code, both Co and Mn present sediment concentrations that result in medium to high ecological risk whereas water concentrations of both elements reach values that more than double their corresponding Secondary Acute Values.

Abstract P2-09-03: Identifying clinically relevant subgroups of women with HER2-positive breast cancer: An analysis of Neo-ALTTO using the 41-gene TRAR score

BACKGROUND: As a neoadjuvant regimen for HER2-positive early breast cancer (BC), the use of two HER2-directed agents is more effective in producing pathological complete (pCR) responses than trastuzumab alone. Nevertheless, highly effective dual anti-HER2 combination may be unnecessary in patients who already benefit from a single agent. We previously reported that our 41-gene TRAR score is an accurate predictor of response to trastuzumab, with low scores being predictive of response to trastuzumab and favorable prognosis (Triulzi T. et al., 2015).

PATIENTS AND METHODS: Tissue specimens from HER2-positive BC patients of Neo-ALTTO trial who received neoadjuvant trastuzumab and/or lapatinib plus paclitaxel were included in this study. Analysing RNA from fresh tissue using the 41-gene signature test, the area under the ROC curve (AUC) and the corresponding 95% confidence interval was computed to evaluate the predictive ability of TRAR score with respect to pCR, the primary endpoint of Neo-ALTTO. The prognostic role of TRAR score was investigated using a Cox regression model in univariate fashion. The patterns of Event Free Survival (EFS) according to the dichotomized TRAR score were estimated using the Kaplan–Meier method.

RESULTS: The TRAR score was assessed for 226 of the 455 (49.7%) patients enrolled in the Neo-ALTTO study: 136 (60%) presented with T2 tumors, 188 (83%) with N0/1 and 128 (56.6%) with estrogen receptor negative BC. In details, basal TRAR score was available for 69, 79 and 78 patients assigned to neoadjuvant trastuzumab, lapatinib, and their combination, respectively. Overall, patients achieving a pCR showed significantly lower levels of TRAR score than those with residual disease (p <.0001). According to treatment arm, the classifier highly performed in discriminating responders (pCR) from non responders (no pCR) (trastuzumab: AUC = 0.74, 95% CI: 0.60–0.88; lapatinib: AUC = 0.76, 95% CI: 0.65–0.87; trastuzumab + lapatinib: AUC = 0.71, 95% CI: 0.59–0.83). Of note, the predictive value of the TRAR score was confirmed after adjustment for hormone receptor status. An AUC value of 0.70 (95% CI: 0.59–0.81) and 0.71 (95% CI: 0.62–0.80) was obtained in estrogen receptor positive and negative patients, respectively. We also evaluated the contribution to the predictive capability of TRAR levels and PAM50 by implementing a multivariate logistic regression model including both classifiers and clinically relevant variables. In this model the most predictive variable was TRAR. At a median follow-up of 7 years, with a total of 64 events, no statistically significant association was found between the TRAR score and EFS.

CONCLUSION: Overall, we show that our 41-gene signature is accurate in predicting patient response to neoadjuvant HER2 targeted therapy in terms of pCR. In particular, low levels of TRAR score can identify a HER2-positive breast cancer subgroup highly responsive to trastuzumab as monotherapy for whom combination with other HER2-targeted drugs does not appear justified and may be one tool used for exploring de-escalating strategies without sacrificing outcomes.

Citation Format: Di Cosimo S, Triulzi T, De Cecco L, Pizzamiglio S, de Azambuja E, Fumagalli D, Pusztai L, Harbeck N, Izquierdo M, de la Pena L, Huober J, Baselga J, Piccart M, Verderio P, Tagliabue E. Identifying clinically relevant subgroups of women with HER2-positive breast cancer: An analysis of Neo-ALTTO using the 41-gene TRAR score [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-03.

Abstract P2-05-04: Deregulation of A-to-I RNA editing is associated with poor prognosis in HER2+ breast cancers in the neoALTTO trial

Background

A-to-I RNA editing, a post-transcriptional modification of the RNA catalyzed by the ADAR family of enzymes, is emerging as a widespread phenomenon in breast cancer (BC). A-to-I RNA editing is more frequent in the highly repetitive Alu regions but can affect both coding and non-coding regions. It has been shown to greatly impact cell functionality. In a recent report, we have shown that A-to-I RNA editing is regulated both by ADAR copy number and type I interferon response (Fumagalli et al. Cell Rep 2015). The main aim of the current study was to investigate the extent and profile of A-to-I RNA editing in HER2+ BC patients (pts) treated in the NeoALTTO trial, and to explore its impact on pathologic complete response (pCR) and survival.

Methods

Aligned RNAseq reads of sufficient quality and quantity were obtained for 252 of the 455 pts enrolled in the study, as described previously (Fumagalli et al. JAMA Oncol 2016). Editing sites from the rediPortal database were assessed. The editing level at a given site was computed by counting the number of Gs and As. Sites with coverage more than 10 were considered for further analyses. Editing in normal tissues was obtained from the GTEx project of the rediPortal database. Tumor infiltrating lymphocytes (TILs) and copy number aberrations were previously reported. Correlations between different parameters were assessed using Spearman correlations (ρ). The Mann-Whitney test was used to relate binary and numerical features. Event-free survival (EFS) analysis was performed using the Cox proportional hazard model.

Results

There was a median of 71470 edited sites per sample. As expected, mean editing per sample correlated with ADAR expression (ρ=59%, p<10-16) and ADAR copy number (ρ=54%, p<10-16). It was also correlated with the IFN-gamma driven signature (ρ=22%, p=0.0005), as well as with ESR1 gene expression (ρ=24%, p=0.0002). Neither ADAR expression nor mean editing was correlated with TILs (ρ=-0.5% and ρ=3%). No relationship between mean editing and pCR or EFS was found. The correlations between editing in NeoALTTO tumor samples and GTEx normal tissues were computed, and the median editing per sample was taken. These median correlations, ranging from 32% to 56%, were not associated with ADAR expression (ρ=-25%, p=6x10-5) nor mean editing (ρ=8%, p=0.19). Of interest, patients whose tumors showed low correlation with editing in normal tissues were associated with poor EFS (p=0.028, HR=0.56 to 0.96) suggesting that deregulation of RNA editing may impact disease progression and outcome. Similar results were obtained when the correlations were assessed between tumor samples instead of between tumor and normal samples (ρ between the two median editing: 76%; p-value survival: 0.013). The median correlations were not predictive for pCR (p=0.44). There was no interaction between editing and treatment arm.

Conclusions

Our study shows for the first time that deregulated RNA editing, as compared to editing in normal tissues, is a widespread phenomenon in HER2+ BC patients treated in the NeoALTTO trial and is associated with poor outcome. These results may provide new perspectives for the treatment of HER2+ disease by developing therapies targeting RNA editing.

Citation Format: Venet D, Rothé F, Dupont F, Maetens M, Fumagalli D, Salgado R, Bradbury I, Pusztai L, Harbeck N, Izquierdo M, de la Pena L, Ignatiadis M, de Azambuja E, Huober J, Nuciforo P, Baselga J, Piccart M, Loi S, Sotiriou C. Deregulation of A-to-I RNA editing is associated with poor prognosis in HER2+ breast cancers in the neoALTTO trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-04.

Supplementation of arachidonic acid rich oil in European sea bass juveniles (Dicentrarchus labrax) diets: effects on growth performance, tissue fatty acid profile and lipid metabolism

The aim of this study was to evaluate the effects of increasing dietary arachidonic acid (ARA) levels (from 1 to 6% of total fatty acids) on European sea bass (Dicentrarchus labrax) juveniles' growth performance, tissue fatty acid profile, liver morphology as well as long-chain polyunsaturated fatty acids (LC-PUFA) biosynthesis, triglyceride and cholesterol synthesis and lipid transport. A diet with total fish oil (FO) replacement and defatted fish meal (FM) containing a 0.1-g ARA g^-1 diet was added to the experimental design as a negative control diet. Dietary ARA inclusion levels below 0.2 g ARA g^-1 diet significantly worsened growth even only 30 days after the start of the feeding trial, whereas dietary ARA had no effect on fish survival. Liver, muscle and whole body fatty acid profile mainly reflected dietary contents and ARA content increased accordingly with ARA dietary levels. Tissue eicosapentaenoic acid (EPA), docosapentaenoic acid (DPA) and docosahexaenoic acid (DHA) levels were positively correlated among them. Hepatic lipid vacuolization increased with reduced dietary ARA levels. Expressions of fatty acyl desaturase 2 and 3-hydroxy-3-methylglutaryl-coenzyme genes were upregulated in fish fed the negative control diet compared to the rest of the dietary treatments denoting the influence of ARA on lipid metabolism. Results obtained highlight the need to include adequate n-6 levels and not only n-3 LC-PUFA levels in European sea bass diets.

Uso de cascarilla de arroz durante el periodo de pre-montanera para dietas de bienestar. Resultados preliminares

En los sistemas de producción extensivos del cerdo Ibérico, la alimentación de los animales está restringida durante la premontanera. Con el propósito de incrementar el bienestar durante este periodo, tres dietas diferentes con niveles crecientes de fibra (5,0 %; 8,5 %; 12,0 %) procedentes de cascarilla de arroz, que es un subproducto infrautilizado, fueron evaluados en cerdo Ibérico durante la premontanera (desde los 9 a los 13 meses de edad). El bienestar animal fue evaluado mediante el test Welfare Quality©. Ninguno de los grupos de tratamientos tuvo problemas de diarrea, a pesar del contenido relativamente elevado en fibra de las dietas enriquecidas. El peso corporal al final de la premontanera no varió significativamente entre tratamientos. Sin embargo, la ganancia de peso desde el segundo mes del experimento hasta su conclusión fue significativamente superior en el grupo con el nivel de fibra más alto que en los otros 2 grupos. Por tanto, los resultados preliminares muestran que el uso de altos niveles de fibra (12 %) en dietas de cerdo Ibérico durante la premontanera podría ser usado para mejorar el bienestar animal en este periodo, lo que adicionalmente supondría un uso alternativo para este importante subproducto agrícola.

Estudios de caracteres de canal y carne de diferentes genotipos de cerdo Ibérico alimentados en un sistema tradicional extensivo

Caracteres de la canal y calidad de carne de tres genotipos distintos de ibérico puro, Retinto (R), Torbiscal (T) y Torbiscal*Retinto (TR), y un cruce de Duroc*Retinto (DR) han sido estudiados. Se han utilizado 48 cerdos, 12 por genotipo. El espesor de los diferentes depósitos de la grasa dorsal: interno (i), medio (m), externo (o) y total (t), medidos a nivel de la décima y decimo cuarta costilla (iBF10, mBF10, oBF10, tBF10, iBF14, mBF14, oBF14 y tBF14, respectivamente) se midieron en la canal así como el área del lomo (LA10 y LA14, respectivamente) y el porcentaje de grasa intramuscular (IMF) se determinó químicamente. Los pesos (W) y rendimientos (Y) de las piezas más importantes: jamón (H), paleta (F), lomo (L), y solomillo (TL) se recogieron (HW, FW, LW, TLW y HY, FY y LY, respectivamente). Los pesos y rendimientos de todas las piezas se calculó también (TCW y TCY). Como el genotipo DR creció más rápido de lo esperado, estos animales se finalizaron con un concentrado y no con bellota como los otros tres genotipos. Así, el genotipo DR solo se compara para caracteres de canal. Los datos se analizaron utilizando el procedimiento GLM de SAS, ajustando por el peso de canal dentro de cada genotipo como covariable. Como resultados el genotipo R tuvo valores de IMF, IBF10, MBF10 y TBF10, significativamente mayores que los otros genotipos y el genotipo T tuvo valores significativamente mayores que los otros genotipos para OBF10 y OBF14. Además, HW y HY obtuvieron valores semejantes para todos los genotipos, pero TR y DT obtuvieron paletas y lomos más pesados que los genotipos R y T. Dentro de los genotipos ibéricos puros TR obtuvo mejores TCW y TCY que R pero igual que T. Por otro lado, el genotipo DR fue el que obtuvo los mejores valores para TCW y TCY.

Adaptación de la inmunocastración a la montanera del macho de cerdo Ibérico: efectos en órganos reproductivos y características de canal

El fin voluntario de la castración de machos porcinos se prevé próximamente en la UE. Pero los protocolos habituales de inmunocastración (IC) necesitan ser modificados para los machos Ibéricos (IB) debido a su largo ciclo vital. Nuestro grupo desarrolló un protocolo de 3 dosis que pretendemos ajustar a la cronología de la montanera, basándonos en la hipótesis de que la uniformidad de la condición corporal al inicio de la montanera intensificará y homogeneizará la atrofia testicular. Machos IB puros (n=35) fueron alimentados de forma restringida durante la pre-montanera como es habitual. De ellos, los machos Control (C; n=18) fueron inmunizados contra la GnRH a los 10,5, 12 y 13,5 meses (m) de edad, y los Tratados (T; n=17) a los 10,5, 11,5 y 13 m, alimentándose estos últimos ad libitum (AL) durante 15 días desde la 3ª dosis. Ambos grupos comenzaron la montanera a los 13,5 m, coincidiendo con la 3ª dosis de C y el fin del periodo AL de T, sacrificándose ambos a los 16 m. Para corroborar el efecto del nivel nutricional, otro grupo fue alimentado ad libitum durante el pre-cebo y cebo en sistema extensivo regular (Adlib; n=15 machos IB x Duroc), inmunizándose a los 8, 9 y 11 m y sacrificándose a los 13 m (más temprano, debido al genotipo y alimentación). Los testículos y epidídimos fueron significativamente menores en los machos Adlib y T que en los C. Similarmente, las glándulas bulbouretrales fueron significativamente menores en los machos T que en los C. El color “a” (de verde a rojo) del parénquima testicular estuvo altamente correlacionado (r=0,87) con el peso testicular. La grasa dorsal resultó negativa a androstenona y escatol en todos los animales. Los rendimientos de paletas, lomos y piezas de primera fueron significativamente mayores en los machos Adlib que en los C y T. En conclusión, el nivel nutricional puede ser utilizado para mejorar la eficacia de la IC de machos, y la colorimetría testicular puede ser útil para evaluar dicha eficacia.

Cardiorespiratory Adaptations in Elderly Men Following Different Concurrent Training Regimes

BACKGROUND

This study aimed to investigate the effects of different intra-session exercise orders during concurrent training (CT) on endurance performance in elderly men, as well as to verify its influence on individual responses in endurance performance.

DESIGN

Twenty-five healthy elderly men (64.7 ± 4.1 years) were placed into two groups: strength training prior to endurance training (SE, n=13), and one in the reverse order (ES, n=12). CT was performed three times a week during 12 weeks. Before and after training, peak oxygen uptake (VO2peak), maximal workload (Wmax), absolute and relative cycling economy at 25, 50, 75 and 100 W (i.e., average VO2 at different stages) were assessed.

RESULTS

Similar increases in VO2peak were observed in the SE and ES groups (SE: 8.1 ± 9.9%; ES: 9.3 ± 9.8%; P<0.001), as well as in Wmax (SE: 19.9 ± 19.3%; ES: 24.1 ± 24.0%; P<0.001). Moreover, significant reductions were observed in the absolute VO2 at 100 W (P<0.05) in the SE and ES groups. No difference between groups was observed. In the ES group, one subject did not respond positively in terms of both VO2max and Wmax, whereas 4 subjects did not respond positively in terms of both VO2max and Wmax in SE group.

CONCLUSIONS

CT improved maximal and submaximal endurance performance in elderly men, independent of intra-session exercise order. However, it seems that the ES order elicited more individual responsiveness in terms of maximal endurance performance than SE order.

International Clinical Practice Guidelines for Sarcopenia (ICFSR): Screening, Diagnosis and Management

OBJECTIVES

Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR).

METHODS

To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process.

RECOMMENDATIONS

We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.

Disease resistance and response against Vibrio anguillarum intestinal infection in European seabass (Dicentrarchus labrax) fed low fish meal and fish oil diets

The aim of this study was to assess the effects of low levels of dietary fish meal (FM) and fish oil (FO) on disease resistance and gut associated lymphoid tissue (GALT) response after an experimental intestinal infection with V. anguillarum in European sea bass (Dicentrarchus labrax) For that purpose, sea bass juveniles were fed one of four diets containing combined levels of FO and FM as follows: 20%FM/6%FO, 20%FM/3%FO, 5%FM/6%FO and 5%FM/3%FO during 153 days. At the end of the feeding trial, fish were subjected to either an in vivo exposure to a sub-lethal dose of V. anguillarum via anal inoculation or to an ex vivo exposure to V. anguillarum. Additionally, inducible nitric oxide synthase (iNOS) and tumor necrosis factor α (TNFα) gut patterns of immunopositivity were studied. Growth performance was affected by dietary FM level, however ex vivo gut bacterial translocation rates and survival after the in vivo challenge test were affected by dietary FO level. After 5 months of feeding, low dietary FM levels led to a posterior gut up-regulation of interleukin-1β (IL-1β) and TNFα, major histocompatibility complex-II (MHCII) and cyclooxygenase-2 (COX2), which in turn reduced the gut associated lymphoid tissue (GALT) capacity of response after 24 h post infection and conditioned European sea bass capacity to recover gut homeostasis 7 days post infection. Immunoreactivity to anti-iNOS and anti-TNFα presented a gradient of increased immunopositivity towards the anus, regardless of the dietary FM/FO fed. Strong positive anti-TNFα isolated enterocytes were observed in the anterior gut in relation to low levels of dietary FM/FO. Submucosa and lamina propria immunoreactivity grade was related to the amount of leucocyte populations infiltrated and goblet cells presented immunopositivity to anti-iNOS but not to anti-TNFα. Thus, reducing FO content from 6% to a 3% by VO in European sea bass diets increases ex vivo and in vivo gut bacterial translocation rates, whereas reducing FM content from 20% down to 5% up-regulates the expression of several posterior gut inflammation-related genes conditioning fish growth and GALT capacity of response after bacterial infection.

Regional Nodal Irradiation After Breast Conserving Surgery for Early HER2-Positive Breast Cancer: Results of a Subanalysis From the ALTTO Trial

Background

Two randomized trials recently demonstrated that regional nodal irradiation (RNI) could reduce the risk of recurrence in early breast cancer; however, these trials were conducted in the pretrastuzumab era. Whether these results are applicable to human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with anti-HER2-targeted therapy is unknown.

Methods

This retrospective analysis was performed on patients with node-positive breast cancer who were enrolled in the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization phase III adjuvant trial and subjected to BCS. The primary objective of the present study was to examine the effect of RNI on disease-free survival (DFS). A multivariable cox regression analysis adjusted for number of positive lymph nodes, tumor size, grade, age, hormone receptors status, presence of macrometastatis, treatment arm, and chemotherapy timing was carried out to investigate the relationship between RNI and DFS.

Results

One thousand six hundred sixty-four HER2-positive breast cancer patients were included, of whom 878 (52.8%) had received RNI to the axillary, supraclavicular, and/or internal mammary lymph nodes. Patients in the RNI group had higher nodal burden and more frequently had tumors larger than 2 cm. At a median follow-up of 4.5 years, DFS was 84.3% in the RNI group and 88.3% in the non-RNI group. No differences in regional recurrence (0.9 % vs 0.6 %) or in overall survival (93.6% vs 95.3%) were observed between the two groups. After adjustment in multivariable analysis, there was no statistically significant association between RNI and DFS (hazard ratio = 0.96, 95% confidence interval = 0.71 to 1.29).

Conclusions

Our analysis did not demonstrate a DFS benefit of RNI in HER2-positive, node-positive patients treated with adjuvant HER2-targeted therapy. The benefit of RNI in HER2-positive breast cancer needs further testing within randomized clinical trials.

Sprint mechanics evaluation using inertial sensor-based technology: A laboratory validation study

Advances in micro-electromechanical systems have turned magnetic inertial measurement units (MIMUs) into a suitable tool for vertical jumping biomechanical evaluation. Thus, this study aimed to determine whether appropriate reliability and agreement reports could also be obtained when analyzing 20-m sprint mechanics. Four bouts of 20-m sprints were evaluated to determine whether the data provided by a MIMU placed at the lumbar spine could reliably assess sprint mechanics and to examine the validity of the MIMU sensor compared to force plate recordings. Maximal power (P₀ ), force (F₀ ), and velocity (V₀ ), as well as other mechanical determinants of sprint performance associated with the force-velocity, power-velocity, and ratio of forces-velocity, such as applied horizontal force loss (S_fv ) and decrease in ratio of forces (D_rf ), were calculated and compared between instrumentations. Extremely large-to-very large correlation levels between MIMU sensor-based sprint mechanics variables and force plate recordings were obtained (mean±SD, force plate vs MIMU; V_0, 8.61±0.85 vs 8.42±0.69; F₀ , 383±110 vs 391±103; P₀ , 873±246 vs 799±241; S_fv, -44.6±12.7 vs -46.2±10.7), ranging from 0.88 to 0.94, except for D_rf, which showed weak-to-moderate correlation level (r=.45; -6.32±1.08 vs -5.76±0.68). Step-averaged force values measured with both systems were highly correlated (r=.88), with a regression slope close to the identity (1.01). Bland and Altman graphical representation showed a no random distribution of measured force values. Finally, very large-to-extremely large retest correlation coefficients were found for the intertrial reliability of MIMU measurements of sprint performance variables (r value ranging from .72 to .96). Therefore, MIMUs showed appropriate validity and reliability values for 20-m sprint performance variables.

A quantitative structural and morphometric analysis of the Purkinje network and the Purkinje-myocardial junctions in pig hearts

The morpho-functional properties of the distal section of the cardiac Purkinje network (PN) and the Purkinje-myocardial junctions (PMJs) are fundamental to understanding the sequence of electrical activation in the heart. The overall structure of the system has already been described, and several computational models have been developed to gain insight into its involvement in cardiac arrhythmias or its interaction with implantable devices, such as pacemakers. However, anatomical descriptions of the PN in the literature have not enabled enough improvements in the accuracy of anatomical-based electrophysiological simulations of the PN in 3D hearts models. In this work, we study the global distribution and morphological properties of the PN, with special emphasis on the cellular and architectural characterization of its intramural branching structure, mesh-like sub-endocardial network, and the PMJs in adult pig hearts by both histopathological and morphometric evaluation. We have defined three main patterns of PMJ: contact through cell bodies, contact through cell prolongations either thick or piliform, and contact through transitional cells. Moreover, from hundreds of micrographs, we quantified the density of PMJs and provided data for the basal/medial/apical regions, anterior/posterior/septal/lateral regions and myocardial/sub-endocardial distribution. Morphometric variables, such as Purkinje cell density and thickness of the bundles, were also analyzed. After combining the results of these parameters, a different septoanterior distribution in the Purkinje cell density was observed towards the cardiac apex, which is associated with a progressive thinning of the conduction bundles and the posterolateral ascension of intramyocardial terminal scattered fibers. The study of the PMJs revealed a decreasing trend towards the base that may anatomically explain the early apical activation. The anterolateral region contains the greatest number of contacts, followed by the anterior and septal regions. This supports the hypothesis that thin distal Purkinje bundles create a junction-rich network that may be responsible for the quick apical depolarization. The PN then ascends laterally and spreads through the anterior and medial walls up to the base. We have established the first morphometric study of the Purkinje system, and provided quantitative and objective data that facilitate its incorporation into the development of models beyond gross and variable pathological descriptions, and which, after further studies, could be useful in the characterization of pathological processes or therapeutic procedures.

Abstract P4-21-09: Cardiac biomarkers for early detection and prediction of trastuzumab and/or lapatinib-induced cardiotoxicity in patients with HER2 positive early breast cancer (BIG 1-06)

Background:Anti-HER2 agents are associated with an increased risk of cardiotoxicity, occurring mostly during treatment and being generally reversible. To date, no cardiac biomarkers have been validated as predictive markers of cardiotoxicity in patients (pts) receiving anti-HER2 therapies. We evaluated high sensitivity (HS) troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in pts treated with neoadjuvant anti-HER2 therapies to evaluate if early elevation of cardiac biomarkers predicts early or late cardiac events.

Material and Methods: 455 pts were randomized to receive either lapatinib (154 pts), trastuzumab weekly (149 pts), or lapatinib with trastuzumab for a total of 6 weeks (152 pts). After this biological window, pts continued on the same targeted therapy plus 12-weekly paclitaxel until definitive surgery. After surgery, patients received adjuvant FEC (3x) followed by the same HER2 therapy as in the neoadjuvant phase for further 34 weeks (to complete 52 weeks in total). Eligible pts had an LVEF ≥50%. Cardiac biomarkers were centrally tested in plasma samples collected at baseline, week 2 (W2) and at surgery. Elevated biomarker was defined as either TNT &gt;0.015 μg/L or NT-proBNP &gt;125 pg/mL. The small number of pts and rarity of marker elevations allowed only descriptive analyses.

Results: At a median follow-up of 3.8 years, 280 pts had cardiac biomarkers tested at baseline (61.5%) and NT-proBNP was elevated in 39 pts (13.9%) while TNT was elevated in only 1 pt (0.35%). From those 39 pts with NT-proBNP elevated at baseline, only 1 pt experienced a cardiac event. Also, hypertension was presented in 14 pts (24.5%) with elevated NT-proBNP.

Serial measurements were available in 173 pts (61.7%) and NT-proBNP was elevated in 25, 10 and 21 pts at baseline, W2 and at surgery, respectively, while among 171 pts (61%) TNT was elevated in 1, 1 and 5 pts, respectively.

There were 13 cardiac events in 11 pts in the entire trial. Five of these pts had a measurement of cardiac biomarkers at baseline (non-elevated NT-prBNP and TNT were observed in 4 and 5 pts), 9 of them had a measurement at week 2 (non-elevated NT-prBNP and TNT were observed in 8 and 9 pts) and 3 of them at surgery (non-elevated NT-prBNP and TNT were observed in 3 and 3 pts), respectively. The following table show the low specificity of the cardiac biomarkers.

 Patients without cardiac event (N)Patients with cardiac event (N)Patients with elevated markerElevated NT-proBNP   Baseline38139Week 229130Surgery40040Elevated TNT   Baseline101Week 2101Surgery606

During adjuvant phase, 13 pts experienced LVEF drop to &lt;50% and none had either NT-proBNP elevated or TNT at surgery.

Conclusions: Despite the small sample size, we demonstrated that cardiac biomarkers are rarely elevated in pts receiving anti-HER2 therapies, which is probably due to the absence of myocyte necrosis with respect to TNT, and the lack of chamber dilation in the case of NT-proBNP after exposure to these drugs. In addition, few cardiac events were present in this population not previously exposed to anthracycline-based chemotherapy; therefore the use of cardiac biomarkers in this population may be unnecessary.

Citation Format: de Azambuja E, Bradbury I, Ewer M, Campbell C, Zardavas D, Ameels H, Baselga J, Huober J, Izquierdo M, Bozovic-Spasojevic I, Maetens M, Harbeck N, Pusztai L, Piccart M, Rodeheffer R, Sutter T. Cardiac biomarkers for early detection and prediction of trastuzumab and/or lapatinib-induced cardiotoxicity in patients with HER2 positive early breast cancer (BIG 1-06) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-09.

On-field prediction vs monitoring of aerobic capacity markers using submaximal lactate and heart rate measures

This study aimed to validate the use of a single blood lactate concentration measurement taken following a 5-minute running bout at 10 km·h^-1 (BLC₁₀ ) and the speed associated with 90% of maximal heart rate (S₉₀ ) to predict and monitor fixed blood lactate concentration (FBLC) thresholds in athletes. Three complementary studies were undertaken. Study I: A cross-sectional study examining the associations of BLC₁₀ and S₉₀ with running speeds at FBLC of 3 (S3mM) and 4 mmol·L^-1 (S4mM) in 100 athletes. Study II: A cross-validation study assessing the predictive capacity of BLC₁₀ and S₉₀ to estimate FBLC thresholds in real practice. Study III: A longitudinal study examining whether training-induced changes in FBLC thresholds could be monitored using BLC₁₀ and S₉₀ in 80 athletes tested before and after an intensified training period. Study I: BLC₁₀ (r=-.87 to -.89) and S₉₀ (r=.73-.79) were very largely (P<.001) related to FBLC thresholds. Study II: Predictive models yielded robust correlations between estimated and measured FBLC thresholds (r=.75-.91; P<.001). The limits of agreements, however, revealed that prediction of FBLC thresholds could be biased up to 9%-15%. Study III: BLC₁₀ was very largely related to training-induced changes in FBLC thresholds (r=-.72 to -.76; P<.001). Increases in S₉₀ were associated with improvements in FBLC thresholds, but decreases in S₉₀ led to unclear changes in FBLC thresholds. This study supports the use of BLC₁₀ as a simple, low-cost, non-fatiguing, and time-efficient functional variable to monitor, but not predict, FBLC thresholds in athletes. The present results also question the use of S₉₀ to detect declines in endurance performance.