Long-term efficacy of entecavir therapy in chronic hepatitis B patients with antiviral resistance to lamivudine and adefovir

No studies have reported the long-term effects of entecavir switching in patients with multidrug resistance who developed resistance after lamivudine/adefovir sequential therapy. We evaluated the efficacy of 96 weeks of entecavir therapy in patients with resistance to lamivudine/adefovir sequential therapy. In total, 33 patients with chronic hepatitis B virus (HBV) infection with evidence of active viral replication (HBV DNA levels ≥ 10(5) copies/mL) or a history of treatment failure to lamivudine/adefovir sequential therapy between April 2007 and July 2009 were treated with entecavir (1.0 mg daily) for at least 48 weeks. The rates of alanine transaminase (ALT) normalization and HBV DNA negativity were 66.7% (14/21) and 24.2% (8/33) at 48 weeks, respectively. The initial HBV DNA level was the only factor that was inversely associated with serum HBV DNA negativity after 48 weeks of entecavir therapy (P < 0.023). At 96 weeks, the rates of ALT normalization and HBV DNA negativity were 77.8% (7/9) and 16.7% (3/18), respectively. Viral breakthrough occurred in 21.2% (7/33) and 78.9% (15/19) of patients at 48 and 96 weeks, respectively. Patients who achieved a HBV DNA level of <4 log(10) copies/mL at 48 weeks maintained a similar HBV DNA level and a normal ALT level until 96 weeks. Entecavir monotherapy for 96 weeks was not efficacious for patients with lamivudine/adefovir-resistant HBV. The initial HBV DNA level was the only predictive factor for antiviral efficacy. However, patients who achieved a HBV DNA level of <4 log(10) copies/mL with a normal ALT level at 48 weeks should maintain, rather than stop, entecavir therapy.

Missed diagnosis of influenza B virus due to nucleoprotein sequence mutations, Singapore, April 2011

A new influenza B variant was discovered in Singapore in April 2011 during diagnostic testing of a 3-year-old boy with respiratory symptoms. Influenza B virus was isolated from culture and confirmed by standard immunofluorescence testing, but was not detected by the routine, in-house influenza screening reverse-transcription polymerase chain reaction assay that targets the nucleoprotein (NP) gene. Subsequent sequencing investigations demonstrated that several other published assays targeting NP could also fail to detect this novel variant.

Missed diagnosis of influenza B virus due to nucleoprotein sequence mutations, Singapore, April 2011

A new influenza B variant was discovered in Singapore in April 2011 during diagnostic testing of a 3-year-old boy with respiratory symptoms. Influenza B virus was isolated from culture and confirmed by standard immunofluorescence testing, but was not detected by the routine, in-house influenza screening reverse-transcription polymerase chain reaction assay that targets the nucleoprotein (NP) gene. Subsequent sequencing investigations demonstrated that several other published assays targeting NP could also fail to detect this novel variant.

Carboplatin-paclitaxel-induced leukopenia and neuropathy predict progression-free survival in recurrent ovarian cancer

BACKGROUND

We assess the prognostic value of chemotherapy-induced leukopenia and sensory neuropathy in the CALYPSO trial patients treated with carboplatin-paclitaxel (CP) or carboplatin-liposomal doxorubicin (CPLD).

METHODS

We performed a landmark analysis at first month after randomisation to correlate leukopenia (nadir white blood cell <4.0 × 10(9) per litre or severe infection) during cycle 1 of chemotherapy with progression-free survival (PFS). Using time-dependent proportional-hazards models, we also investigated the association between neuropathy and PFS.

RESULTS

Of 608 patients with nadir blood and did not receive growth factors, 72% (CP=70%, CPLD=73%) had leukopenia. Leukopenia was prognostic for PFS in those receiving CP (adjusted hazard ratio (aHR) 0.66, P=0.01). Carboplatin-liposomal doxorubicin was more effective than CP in patients without leukopenia (aHR 0.51, P=0.001), but not those experiencing leukopenia (aHR 0.93, P=0.54; interaction P=0.008).Of 949 patients, 32% (CP=62%, CPLD=28%) reported neuropathy during landmark. Neuropathy was prognostic for PFS in the CP group only (aHR 0.77, P=0.02). Carboplatin-liposomal doxorubicin appeared to be more effective than CP among patients without neuropathy (aHR 0.70, P<0.0001), but not those with neuropathy (aHR 0.96, P=0.81; interaction P=0.15).

CONCLUSION

First-cycle leukopenia and neuropathy were prognostic for patients treated with CP. Efficacy of CP treatment was similar to CPLD in patients who developed leukopenia. These findings support further research to understand the mechanisms of treatment-related toxicity.

An update of blood donor recruitment and retention in Hong Kong

A healthy blood donor pool has to be well maintained in order to achieve self sufficiency in blood supply. Not only should new and young donors should be attracted and recruited into the pool so as to compensate the loss from drop out and deferred donors. At the same time, previous donors should be also actively retained to ensure they can come regularly. The status of donor recruitment and retention in Hong Kong is reviewed here to highlight the current difficulties in coping with increasing blood demand from an ageing population, stringent donor eligibility criteria and quality requirement in the blood collection. With a systemic analysis of the donation pattern, proposal is put forward to tackle the challenging problems.

A nomogram to predict survival time in women starting first-line chemotherapy for advanced breast cancer

Women starting first-line chemotherapy for advanced breast cancer have differing baseline characteristics and survival times. We sought to develop and validate a pragmatic prognostic nomogram to predict overall survival (OS) by using available clinical and laboratory data. The prognostic model was developed in a training cohort (n=693) from two first-line chemotherapy trials (ANZ8101 and ANZ8614) and validated in two other trials (ANZ0001 and ANZ9311) with 324 and 233 patients, respectively. The proportional-hazards model was constructed from pretreatment demographic and disease characteristics. Patients were classified into good (score <88), medium (88-157), and poor (>157) prognostic groups. A nomogram was constructed (n=1250) from the combined datasets of all four trials, based on the predictors identified in the training cohort. The nomogram predicted OS with a concordance index of 0.65 (95%CI, 0.62-0.67). Factors in the nomogram were age, performance status, estrogen receptor status, number of involved organs (lung, liver and brain), hemoglobin concentration, neutrophil count, and serum alkaline phosphatase. The median survival for good, medium, and poor prognosis was 15.4 months (95%CI, 12.7-19.1), 10.2 months (95%CI, 9.0-11.6), and 6.1 months (95%CI, 4.4-6.7), respectively. The actual and model-predicted probabilities of 18-month survival agreed well, after recalibration for the new baseline survival functions for each validation cohort. A nomogram combining seven readily available baseline characteristics enabled stratification of advanced breast cancer patients into three groups with significantly different survival times. This nomogram could be useful for individualising treatment and for stratifying patients in future randomized trials.

301 IMPRINTED GENE EXPRESSION PATTERNS IN CULTURED PRIMORDIAL GERM CELLS DERIVED FROM PORCINE EMBRYOS BETWEEN DAY 25 AND 30

Although epigenetic reprogramming during germ cell development has extensively been studied in the mouse, little is known about the timing of imprinting accomplishment in the pig. Therefore, the aim of this study was to investigate the timing of epigenetic reprogramming in porcine primordial germ cells (PGC) through short-term culture as well as to confirm the differences of epigenetic features between PGC and embryonic germ cells (EGC). The present study aimed to investigate mRNA expression pattern of imprinted genes in cultured PGC that were derived from embryos at Day 25 to 30 of pregnancy. The overall expression pattern can be separated into 3 different features: no changes in all PGC regardless of embryonic day, gradual increases through embryonic day, and extreme increases in PGC derived from embryos at Day 30. Of 8 imprinted genes, Grb10, Peg10, and Snrpn transcripts were retained through all stages. The expression level of H19, Igf2, Igf2r, and Peg1/Mest progressively increased in PGC derived at later stages of embryo development. Interestingly, Xist and Nnat transcripts showed extremely high levels of expression in PGC derived from embryo at Day 30 of pregnancy. The expression level of these transcripts was 3- to 4-fold higher in PGC derived from embryo at Day 30 of pregnancy compared with that of the others. Our results indicated that analysis of the imprinted gene expression level in short-term cultured PGC may in part reflect epigenetic modifications during germ cell development in pig. This study could help us understand how epigenetic reprogramming is maintained or lost during germ cell development. Further study will be carried out to compare imprinted gene expression patterns between the porcine PGC and EGC. This work was supported by the BioGreen 21 Program (#20070401034031, #20080401034031), Rural Development Administration, Republic of Korea (HK).

Abstract P5-09-02: How Long Have I Got? Estimating Post-Progression Survival after First Line Chemotherapy for Metastatic Breast Cancer Based on Data from Randomized Trials

Background: Two recent systematic reviews have reported that median post-progression survival (mPPS) was typically double the median progression free survival (mPFS) in contemporary randomized trials of first line chemotherapy for metastatic breast cancer (MBC). We sought to determine the ratio of PPS to PFS and the accuracy of using simple multiples of PFS to estimate PPS in an independent dataset. Methods: We analysed survival data from 323 women in a randomized trial of capecitabine versus CMF as first line chemotherapy for MBC, both for the trial overall (using the median Kaplan Meier estimates: mPFS and mPPS), and for each individual woman (using her own PFS and PPS). PPS was estimated for each woman by (i) doubling her PFS (as per the systematic reviews), and (ii) by multiplying her PFS by the median of the individual patient ratios of PPS:PFS for this trial. Estimates were deemed accurate if they were within 0.75 to 1.33 times the actual value. The primary population of 221 women excluded 27 censored for progression, 65 censored for death, 8 with PFS &lt;2 weeks, and 2 with PFS = OS. The secondary population included all 323 patients. Distributions were summarized by their medians and percentiles reflecting the typical range (25th to 75th, IQR), worst case (90th) and best case (10th) scenarios. Results: The median age was 62, ECOG PS was 0-1 in 87%, 46% had liver metastases and 64% had hormone receptor positive disease. Kaplan Meier estimates of survival times in months for the primary population (secondary population) were mPFS 5.3 (6.3), mPPS 8.8 (11), and mOS 16 (21). The ratio of mPPS:mPFS for the trial overall was 1.7. Ratios of PPS:PFS for individual women were lower with medians of 1.5 (IQR 0.6 - 3.1) in the primary population and 1.3 (IQR 0.5 — 3.0) in the secondary population. Estimates of a woman's PPS as double her PFS were accurate in 17% of women. Estimates of a woman's PPS as 1.5 times her PFS were accurate in 20% of women. When each woman's PPS was estimated as 1.5 times her PFS, 10% of women survived for less than 0.18 times their estimate (&lt;0.18 x 1.5PFS), 10% survived for longer than 4 times their estimate (&gt;4 x 1.5PFS)and the middle 50% survived between 0.37 to 2.1 their estimate (0.37 x 1.5PFS to 2.1x 1.5PFS). Analysis of accuracy in the secondary population gave similar results.

Conclusion: The ratio of mPFS:mPPS in this randomized trial was similar to that seen in recent systematic reviews, but higher than the individual ratios of PFS:PPS for most women in the trial. A woman's PPS was typically 1.5 times her PFS, but estimates based on this ratio were imprecise and better explained in terms of a typical range (50% living for half to double the estimate), best case scenario (10% living beyond 4 times the estimate) and worst case scenario (10% dying within one sixth of the estimate).

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P5-09-02.

Production and Optimization of Cellulase Enzyme Using Aspergillus niger USM AI 1 and Comparison with Trichoderma reesei via Solid State Fermentation System

Novel design solid state bioreactor, FERMSOSTAT, had been evaluated in cellulase production studies using local isolate Aspergillus niger USM AI 1 grown on sugarcane bagasse and palm kernel cake at 1 : 1 (w/w) ratio. Under optimised SSF conditions of 0.5 kg substrate; 70% (w/w) moisture content; 30°C; aeration at 4 L/h · g fermented substrate for 5 min and mixing at 0.5 rpm for 5 min, about 3.4 U/g of Filter paper activity (FPase) was obtained. At the same time, comparative studies of the enzymes production under the same SSF conditions indicated that FPase produced by A. niger USM AI 1 was about 35.3% higher compared to Trichoderma reesei. This shows that the performance of this newly designed SSF bioreactor is acceptable and potentially used as prototype for larger-scale bioreactor design.

Inventory management

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

Delayed ascending aortic pseudoaneurysm in an adult onset Still's disease patient with previous mitral valve and aortic root replacement

A 59-year-old female patient with adult onset Still's disease (AOSD) presented with hemoptysis and pseudoaneurysm from an aortic root vent cannulation site that was created 4 years earlier for combined mitral and aortic valve surgery. The pseudoaneurysm was successfully repaired and the patient remained well during a follow-up period of 20 months.

Implementation and performance evaluation of mobile ad hoc network for Emergency Telemedicine System in disaster areas

So far we have developed Emergency Telemedicine System (ETS) which is a robust system using heterogeneous networks. In disaster areas, however, ETS cannot be used if the primary network channel is disabled due to damages on the network infrastructures. Thus we designed network management software for disaster communication network by combination of Mobile Ad hoc Network (MANET) and Wireless LAN (WLAN). This software maintains routes to a Backbone Gateway Node in dynamic network topologies. In this paper, we introduce the proposed disaster communication network with management software, and evaluate its performance using ETS between Medical Center and simulated disaster areas. We also present the results of network performance analysis which identifies the possibility of actual Telemedicine Service in disaster areas via MANET and mobile network (e.g. HSDPA, WiBro).

387 DERIVATION OF PUTATIVE EMBRYONIC STEM CELLS FROM PORCINE PARTHENOGENETIC BLASTOCYSTS AND THE LOSS OF PARENTAL-SPECIFIC EXPRESSION PATTERNS IN Igf2/H19 GENES

Porcine embryonic stem cells (ESC) can be a useful tool for the production of a transgenic animal and the study of developmental gene regulation. The study of porcine parthenogenetic ESC might also provide advantages in the understanding of changes in human parthenogenetic embryonic stem cells in the culture environment. Because human embryonic stem cells must be maintained stably for therapeutic uses, parthenogenetic porcine embryonic stem cells can give us precious information to help understand human parthenogenetic embryonic stem cells. Three putative porcine embryonic stem cell lines were derived from 99 parthenogenetic embryos. Cumulus-oocyte complexes were collected from prepubertal gilt ovaries and matured in vitro. Diploid parthenogenetic zygotes were produced by electrical activation followed by cytochalasin B treatment to suppress second polar body extrusion. Embryos were cultured to the blastocyst stage. Hatched blastocysts were directly cultured on mitomycin C-inactivated murine embryonic fibroblasts as feeder layers. Primary colonies were formed after 7 days of culture, and the colonies were transferred to new culture dishes 7 days after. They were passsaged every 5 days by physical dissociation, with one colony divided into small clumps and maintained for over 30 passages. These cells morphologically resembled human embryonic stem cells and consistently expressed the markers of pluripotent cells such as alkaline phosphatase, NANOG, OCT-4, SSEA-1, SSEA-4, TRA-1-60, and TRA-1-81. They could be maintained holding the previous characteristics after cryopreservation. Furthermore, we conducted experiments to confirm the expression patterns of the imprinted genes Igf2 and H19 in these ESC and IVF/parthenogenetic blastocysts using quantitative real-time PCR. At the blastocyst stage, the 2 genes were expressed in a parental-specific manner according to their origins in normal fertilized embryos and uniparental embryos. The putative parthenogenetic ESC, on the other hand, showed a high expression of Igf2, the paternally expressed gene, when compared with their blastocyst counterparts. Current work aims to confirm the authenticity of these ESC via teratoma formation in severe combined immunodeficiency mice following injection with these putative parthenogenetic ESC. This work was supported by the BioGreen 21 Program (#20070401034031, #20080401034031), Rural Development Administration, Republic of Korea (HK).