042. THE EFFECT OF THE INSECTICIDE PYRIPROXYFEN ON OVARY SYNTHESIS IN THE CHRISTMAS ISLAND RED CRAB, GECARCOIDEA NATALIS; A POSSIBLE CASE OF ENDOCRINE DISRUPTION?

The yellow crazy ant, Anopholepis gracilipes is an invasive species on Christmas Island, Indian Ocean whose population needs to be controlled before there is irrevocable environmental damage. The insecticide, pyriproxyfen, a compound which mimics juvenile hormone of insects, has been proposed to do this. Before it can be used in the field, its effects on non target species such as the endemic red crab, Gecarcoidea natalis, need to be investigated. Land crabs, like all decapods, may utilise a similar hormone called methyl farnesoate which is thought to be involved in controlling early ovary development. Pyriproxyfen may also mimic methyl farnesoate and thus disrupt this process. The effect of pyriproxyfen on early ovary synthesis in G. natalis was investigated by feeding crabs a mixture of leaf litter and bait containing 0.5% pyriproxyfen (experimental groups) or a mixture of leaf litter and bait containing no pyriproxyfen (control groups) at simulated baiting doses (2 kg ha–1 and 4 kg ha–1). Two additional groups of crabs were fed ad libitum, either bait containing 0.5% pyriproxyfen or the control bait. Experiments were conducted from July to September of 2007. Red crabs synthesise their ovaries annually over two months (July to September) in the dry season. This situation of high nitrogen demand is funded from small excesses of nitrogen assimilated from a mainly leaf litter diet. Pyriproxyfen affected early ovary development. Ovaries from crabs in the experimental groups at all baiting levels had a higher total nitrogen content and dry mass than that of the control animals. The ovaries from the experimental animals were also more mature; they contained more previtellogenic and early vitellogenic oocytes, of a larger diameter, than ovaries of the control animals. Significant amounts of pyriproxyfen were accumulated in the target tissues, the midgut gland and ovary. Minor amounts of pyriproxyfen were accumulated in muscle, a non-target tissue. By mimicking methyl farnesoate, pyriproxyfen may have caused endocrine disruption in G. natalis. In particular it may have stimulated early ovary development and synthesis of yolk protein.

Buttock cellulitis as a presentation of psoas abscess: a clinical reminder

Cellulitis is a common condition that is frequently managed by the general physicians on an acute medical take. This case report describes buttock cellulitis as a presentation of an iliopsoas abscess and illustrates the importance of considering a deep abscess when there are atypical features, when the cellulitis is in an unusual location or when the patient fails to improve with standard anti-microbial therapy.

Grade 3 Status Dominates Prognosis in Breast Cancer

Background: Histological grading (HG) is probably the most important clinico-pathological parameter that will provide information about tumour intrinsic characteristics and aggressiveness. HG is included in prognostic guidelines for treatment decision making such as St Gallen, Nottingham Prognostic Index and Adjuvant!Online. Grade 3 (G3) Breast cancer (BC) is associated with poor prognosis in terms of survival and recurrence. G3 BC reflects independent biological entities rather than being the end of the spectrum of cancer progression. Our aim is to establish the clinical relevance of HG as prognostic factor in a specific cohort of BC patients and define its relation with survival and recurrence endpoints.Method: This is a retrospective cohort analysis from 1489 operable Breast Cancer patients attending the Oncology Service at Singleton Hospital, Wales, UK between 1996 and 2002.HG was recorded for 1339 cases and outcome data were available on 1213 cases. Correlation of clinical variables with Overall Survival (OS), Distant Disease Free Survival (DDFS) and Disease Free Survival (DFS) was performed using Cox regression model.Results:The median follow-up for the cohort was 5.43 years (range 0.09 to 10.14 years) Patients were characterised according to age, HG, tumour size (TNM-T), nodal status, ER status and systemic treatment received (polychemotherapy/tamoxifen). Independent Cox regression models for each endpoint were developed based on univariate analyses. Multivariate analysis results are presented in Figure 1.Subgroup analysis of G3 cases showed a younger population: median age G3 59.4y vs G1/G2 62.9 y p:< 0.001); 47.5% of G3 cases were ER positive against 94.5% of Grade 1/2 (p < 0.001). Patients with G3 tumours died more rapidly from all causes (median time to death 2.22 vs 3.42 y, p <0.001) and from BC (median time to death from BC 2.22 y vs 3.82 y in G1/G2, p <0.001) than other HG. Similarly, G3 also relapsed quicker both distantly, (median time 1.64 vs 2.54 y G1/G2 (p<0.04) and locally, median time to relapse 1.6 vs 2.35 y for G1/G2 (p<0.036). There was also a significant association between grade and tumour size (median G1/G2 1.7cm vs G3 2.2cm(p< 0.001); and nodal involvement and tumour size, median 1.5cm N-ve, 2.2 cm N+ve (p< 0.001).Conclusion: Patients with G3 tumours tended to be younger, had a more advanced TNM staging at diagnosis and relapsed and died more rapidly than other histological grades. In our cohort, G3 tumours were adversely associated with OS, DDFS and DFS with a stronger association with these endpoints than node positivity. It is perhaps time to reconsider the HG as a prognostic factor as important as nodal status for the selection of adjuvant chemotherapy regimens.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6005.

Molecular Heterogeneity of Grade 3 Breast Cancer

Background: Histological grade (HG) is one the main prognostic factors used in clinical practice, along with nodal status and tumour size, for the classification of patients into different prognostic groups that support the clinical decision making process and to tailor adjuvant treatment according to specific risk of death or relapse. The aim of this study was to examine the effect of Grade in prognosis in an unselected series of breast cancers, and to examine copy number alteration (CNA) specifically in Grade 3 (G3) breast cancer and its relationship to nodal status (N-ve/N+ve) and clinical outcome, to seek genetically determined markers of prognosis for treatment tailoring in this poor prognosis group.Method: We established a clinical database of 1489 operable Breast Cancer patients attending the Oncology Service at Singleton Hospital, Wales, UK between 1996 and 2002. HG was known for 1339 of these cases, and outcome in 1213, with a median of 5.32 years (range 0.09 - 10.14 years) follow-up. From the 466 G3 cases of primary breast cancer, we analysed 81 cases using 1Mb BAC array CGH for genomic copy number alterations. Spatial normalisation, circular binary segmentation and the CGHcall algorithm was used to generate CGH profiles. Unsupervised hierarchical clustering, supervised, correlation and survival analyses were carried out using packages and tests within the R statistical platform.Results: Patients were characterised according to grade, ER and nodal status. Kaplan Meier analysis for overall survival (OS) and disease specific survival (DFS) confirmed the poor prognosis of G3 (Cox proportional hazards regression, Wald-test p-value << 0.05). The majority of G1 (98%) and G2 (93%) cases were ER +ve, whereas 52.5% G3 cases were ER-ve. ER status was known for 316 of the 466 G3 cases, and ER negativity was significantly associated with a decreased OS (p-value 0.02), but not DFS (p-value: 0.13). Similarly N+vity also showed significant correlation with both OS and DFS (p-values < 0.05). BAC aCGH analysis showed significant copy number gains on chromosomes 1,4,5,7,11 and 21 in N+ve and losses on chromosomes 1,6 and 10 in N-ve G3. One region of chromosome 1 (1p36 – 1p35) in particular was lost in N0 but gained in N+ve, and this was significantly associated with ER-ve/N+ve cases (FDR p-value < 0.05). BAC aCGH profiles did not significantly associate with ER status in G3 disease. Two clusters, delineated on unsupervised hierarchical cluster analysis, correlated with OS. Neither correlated with nodal or ER status, indicating that further analysis may discover genes of prognostic potential within these profiles.Conclusion HG was significantly associated with clinical outcome and ER status. Genomic copy number analysis (CNA) in G3 breast cancer revealed significant associations between DNA alterations and nodal status and OS. The study is currently being extended to investigate the relationship between specific CNA and clinical outcome in G3 disease.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5167.

Determinants of bednet ownership and use in visceral leishmaniasis-endemic areas of the Indian subcontinent

OBJECTIVE

To document ownership and use of bednets with its determinants in the visceral leishmaniasis (VL)-endemic region where mainly non-insecticide impregnated nets are available through commercial channels, and bednets are being considered as a leishmaniasis vector control measure.

METHODS

In August-September 2006, semi-structured household (HH) questionnaires and observation guides were used in a random sample of 1330 HHs in VL-endemic districts of India and Nepal to collect data on VL knowledge, HH socio-economic status, bednet ownership and use patterns. An asset index was constructed to allow wealth ranking of the HH. A binary logistic response General Estimating Equations model was fitted to evaluate the determinants of bednet ownership and use.

RESULTS

The proportion of HHs with at least one bednet purchased on the commercial market was 81.5% in India and 70.2% in Nepal. The bednets were used in all seasons by 50.6% and 54.1% of the Indian and Nepalese HH owning a bed net. There was striking inequity in bednet ownership: only 38.3% of the poorest quintile in Nepal owned at least one net, compared to 89.7% of the wealthiest quintile. In India, the same trend was observed though somewhat less pronounced (73.6%vs. 93.7%). Multivariate analysis showed that poverty was an important independent predictor for not having a bednet in the HH [OR 5.39 (2.90-10.03)].

CONCLUSION

Given the inequity in commercial bednet ownership, free distribution of insecticide-treated bednets to the general population seems imperative to achieve a mass effect on vector density.

Varenicline and suicidal behaviour: a cohort study based on data from the General Practice Research Database

OBJECTIVE

To determine whether varenicline, a recently licensed smoking cessation product, is associated with an increased risk of suicide and suicidal behaviour compared with alternative treatments bupropion and nicotine replacement therapy.

DESIGN

Cohort study nested within the General Practice Research Database.

SETTING

Primary care in the United Kingdom.

PARTICIPANTS

80,660 men and women aged 18-95 years were prescribed a new course of a smoking cessation product between 1 September 2006 and 31 May 2008; the initial drugs prescribed during follow-up were nicotine replacement products (n=63 265), varenicline (n=10 973), and bupropion (n=6422).

MAIN OUTCOME MEASURES

Primary outcomes were fatal and non-fatal self harm, secondary outcomes were suicidal thoughts and depression, all investigated with Cox's proportional hazards models.

RESULTS

There was no clear evidence that varenicline was associated with an increased risk of fatal (n=2) or non-fatal (n=166) self harm, although a twofold increased risk cannot be ruled out on the basis of the upper limit of the 95% confidence interval. Compared with nicotine replacement products, the hazard ratio for self harm among people prescribed varenicline was 1.12 (95% CI 0.67 to 1.88), and it was 1.17 (0.59 to 2.32) for people prescribed bupropion. There was no evidence that varenicline was associated with an increased risk of depression (n=2244) (hazard ratio 0.88 (0.77 to1.00)) or suicidal thoughts (n=37) (1.43 (0.53 to 3.85)).

CONCLUSION

Although a twofold increased risk of self harm with varenicline cannot be ruled out, these findings provide some reassurance concerning its association with suicidal behaviour.

Cost analysis of an integrated care model in the management of acute exacerbations of chronic obstructive pulmonary disease

Home treatment models for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) proved to be a safe alternative to hospitalization. These models have the potential to free up resources; however, in the United Kingdom, it remains unclear to whether they provide cost savings compared with hospital treatment. Over a 12-month period from August 2003, 130 patients were selected for the integrated care group (total admissions with AECOPD = 546). These patients were compared with 95 retrospective controls in the hospital treatment group. Controls were selected from admissions during the previous 12 months (total of 662 admissions) to match the integrated care group in age, sex, and postal code. Resource use data were collected for both groups and compared using National Health Service (NHS) perspective for cost minimization analysis. In the integrated care group (130 patients), 107 (82%) patients received home support with average length of stay 3.3 (SD 3.9) days compared with 10.4 (SD 7.7) in the hospital group (95 patients). Average number of visits per patients in the integrated care group was 3.08 (SD = 0.95; 95% CI = 2.9—3.2). Cost per patient in the integrated care group was £1653 (95% CI, £1521—1802) compared with £2256 (95% CI, £2126— 2407) in the hospital group. The integrated care group resulted in cost saving of approximately £600 (P < 0.001) per patient. This integrated care model for the management of patients with AECOPD offered cost savings of £600 per patient over the conventional hospital treatment model using the new NHS tariff from an acute trust provider perspective.

L-selectin ligands in human endometrium: comparison of fertile and infertile subjects

BACKGROUND

L-selectin ligands, localized to the luminal epithelium at the time of implantation, may support the early stages of blastocyst attachment. We have assessed the expression of two L-selectin ligands, defined by MECA-79 and HECA-452 monoclonal antibodies, and the sulfotransferase GlcNAc6ST-2, involved in generation of L-selectin ligand epitopes, in the secretory phase of the endometrium from fertile and infertile patients.

METHODS

Endometrial samples were obtained from 33 fertile, 26 PCOS, 25 endometriosis and 33 patients diagnosed with unexplained infertility. L-selectin ligands and GlcNAc6ST-2 expression was assessed by immunohistochemistry and immunoblotting.

RESULTS

Immunohistochemical staining of uterine epithelium, from fertile and infertile women, demonstrated differential expression of MECA-79 and HECA-452 epitopes. In fertile women in the secretory phase MECA-79 was more strongly expressed, particularly on the lumen, than in infertile women. HECA-452 staining was significantly stronger in the glands in PCOS and endometriosis patients than in fertile women. GlcNAc6ST-2 expression was reduced in infertile patients, correlating with MECA-79 expression.

CONCLUSIONS

This study demonstrated significant differences in expression of L-selectin ligands between fertile and infertile women in natural cycles, and could contribute to patient assessment prior to initiating fertility treatment.

Questionnaire survey on Canine Leishmaniosis in southeastern Spain

A veterinary practitioner's questionnaire survey on Canine Leishmaniosis (CanL) was carried out in southeast Spain to provide information on disease incidence, diagnosis and recommended preventive measures. A third of 101 responding veterinarians reported seeing more than 20 CanL cases during the previous year and clinical signs considered frequent or very frequent included weight loss, areas of exfoliative dermatitis, lymphadenomegaly, kidney dysfunction, onychogryphosis, cutaneous ulcers, anaemia, asthenia and apathy. Almost a third of veterinarians reported diagnosing CanL solely on the basis of lack of response to treatment for other chronic illnesses. The frequency of individual signs did not always reflect their diagnostic value. The majority of veterinarians, considered lymphadenomegaly, exfoliative dermatitis, onychogryphosis, weight loss and epistaxis to be the best disease indicators. However, up to 93% of veterinarians reported using laboratory tests to confirm infection, including indirect (biochemical and antibody assays) and direct (PCR and microscopy) methods. Among recommended measures to prevent CanL, insecticide impregnated collars and topical spot-on capsules were prescribed by 92% and 74% of respondents; however, at least 11% of veterinarians believed existing CanL preventive measures were ineffective. Multivariable statistical analysis indicated that seeing more than 20 CanL cases during the previous year was independently associated with being located in Alicante province, having a rural clientele and recognising that dogs with no other sign but a lack of response to other chronic disease treatments may be infected with CanL. There was a weak association between CanL incidence and rainfall in the months prior to typical sandfly peak abundance.

Susceptibility of ascites tumor cells to ex-vivo killing by the oncolytic virus JX-963 in epithelial ovarian cancer

e16537

Background: Epithelial ovarian cancer (EOC) has a poor prognosis, and novel therapies are urgently needed. One-third of patients with EOC will develop clinical ascites, an adverse prognostic factor. The ascitic fluid is rich in tumor cells which can be purified and used as a valuable source of patient material for in vitro analysis. In this study, we describe a method to evaluate the efficacy of ascitic tumor cell killing by the oncolytic virus, JX-963 (vaccinia strain) currently approved for use in a NCIC-CTG phase I trial. Methods: Research ethics approval and patient consent was obtained for this study. 15 samples were collected prospectively with relevant clinicopathologic information. Infection with JX-963 was performed using viral doses ranging from a multiplicity of infection (MOI) of 0.5 to 8. Following a seven-day infection period, viability was assessed using the Alamar Blue metabolic assay and tracked by virally encoded green fluorescent protein (eGFP) expression, immunohistochemistry (IHC) and flow cytometry. Results: A standardized protocol was developed for the collection and purification of EOC cells from patient ascites for subsequent infection and quantification of viral killing. Qualitative analysis using phase contrast imaging of the total cell content showed greater opaque dead cell aggregates with increasing MOI over time. Although variable between individual samples, there was a strong correlation between escalating MOI and enhanced cell death in all patient ascites samples, when quantified by Alamar Blue assay and confirmed by flow cytometry and IHC. Similar cell killing profiles by JX-963 were observed for ascites tumor cells derived from both chemotherapy-naïve patients and chemotherapy-exposed (>1 prior line of chemotherapy) patients. Conclusions: EOC cells from patient ascites show effective but differential susceptibility to viral oncolysis by the JX-963 virus that appears to be independent of prior exposure to chemotherapy. The relevance of this work is that in an individual patient, this assay will allow the testing of panels of oncolytic viruses to identify candidate viral therapeutics which may predict response to treatment.

No significant financial relationships to disclose.

Joint report of the Third International Bovine Lymphocyte Antigen (BoLA) Workshop, Helsinki, Finland, 27 July 1986

Two hundred and eighty-two alloantisera were submitted by 20 participating laboratories from 13 countries and tested against lymphocytes of 1298 cattle. The cell panel consisted of samples from 38 Bos taurus breeds, 11 Bos taurus crossbreeds, 4 Bos indicus breeds, 6 Bos taurus x Bos indicus, and a variety of other crossbred populations. Using a standardized lymphocytotoxicity test, all 17 previously identified BoLA specificities were confirmed. The workshop produced agreement on 16 new lymphocyte alloantigenic specificities. Three of the new specificities behaved as splits of previously identified BoLA specificities. Four of the new specificities behaved as alleles at the agreed BoLA-A locus. Seven new specificities are tentatively assigned to the BoLA-A locus but require further definition. Two new specificities may represent products of a second closely-linked BoLA locus.

A pilot evaluation of saline sonohysterography for postmenopausal bleeding with thickened endometrium

The aim of this study was to assess the clinical and cost implications of pilot introduction of saline sonohysterography for postmenopausal bleeding with thickened endometrium (>or= 5 mm), at the Royal Glamorgan Hospital. The investigation was attempted in 48 patients who were found to have a thickened endometrium (>or= 5 mm) on transvaginal ultrasound scanning. The attempt was successful in 45 patients (93.8%). Failures were due to (1) cervical stenosis and (2) leakage of saline from the cervix. Difficult catheterisation of the cervix causing pain was encountered in a minority of cases. Two-thirds of patients were found have focal lesions and were booked for hysteroscopic resection. These patients included 30 with polyps, which were precisely described in all of them. In view of this low complication rate and high accuracy, the technique was integrated as a standard method of investigation for postmenopausal bleeding at the hospital.

Further clinical and molecular delineation of the 9q subtelomeric deletion syndrome supports a major contribution of EHMT1 haploinsufficiency to the core phenotype

BACKGROUND

The 9q subtelomeric deletion syndrome (9qSTDS) is clinically characterised by moderate to severe mental retardation, childhood hypotonia and facial dysmorphisms. In addition, congenital heart defects, urogenital defects, epilepsy and behavioural problems are frequently observed. The syndrome can be either caused by a submicroscopic 9q34.3 deletion or by intragenic EHMT1 mutations leading to haploinsufficiency of the EHMT1 gene. So far it has not been established if and to what extent other genes in the 9q34.3 region contribute to the phenotype observed in deletion cases. This study reports the largest cohort of 9qSTDS cases so far.

METHODS AND RESULTS

By a multiplex ligation dependent probe amplification (MLPA) approach, the authors identified and characterised 16 novel submicroscopic 9q deletions. Direct sequence analysis of the EHMT1 gene in 24 patients exhibiting the 9qSTD phenotype without such deletion identified six patients with an intragenic EHMT1 mutation. Five of these mutations predict a premature termination codon whereas one mutation gives rise to an amino acid substitution in a conserved domain of the protein.

CONCLUSIONS

The data do not provide any evidence for phenotype-genotype correlations between size of the deletions or type of mutations and severity of clinical features. Therefore, the authors confirm the EHMT1 gene to be the major determinant of the 9qSTDS phenotype. Interestingly, five of six patients who had reached adulthood had developed severe psychiatric pathology, which may indicate that EHMT1 haploinsufficiency is associated with neurodegeneration in addition to neurodevelopmental defect.

Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood

SUMMARY

The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

Use of a leucocyte filter to remove tumour cells from intra-operative cell salvage blood

SUMMARY

The intra-operative blood loss of 50 consecutive gynae-oncology patients undergoing surgery for endometrial, cervical or ovarian cancer was cell salvaged and filtered. In each case blood samples were taken from the effluent tumour vein, a central venous line, the cell saver reservoir, the cell salvage re-transfusion bag after processing but before filtration and from the cell salvage re-transfusion bag after processing and filtration. Samples were examined using immunohistochemical monoclonal antibody markers for epithelial cell lines. Viable, nucleated malignant cells were detected in 2/50 central venous samples, 34/50 reservoir samples and 31/50 unfiltered cell salvaged samples. After passage through a Pall RS leucocyte depletion filter no remaining viable, nucleated malignant cells were detected in any sample. The clinical risks of cell salvage in these circumstances should be reviewed in the light of the risks of allogeneic blood transfusion.

Studies on encapsidated viroid-like RNA I. Characterization of velvet tobacco mottle virus

Velvet tobacco mottle virus (VTMoV) isolated from Nicotiana velutina growing wild in arid Central Australia was transmitted by inoculation to a limited number of plant species of which N. clevelandii was the most convenient experimental host. The virus was also transmitted from field-grown plants toN. velutina and N. clevelandii by the mirid Cyropeltis nicotianae. VTMoV preparations purified by clarification with organic solvents and differential centrifugation contained polyhedral particles about 30 nm in diameter sedimenting as a single component at about 115 S. The particles were shown to be located in the nucleus, cytoplasm, and vacuoles of infected plant cells. Virus dissociated in the presence of mercaptoethanol and sodium dodecyl sulfate (SDS) separated into one major and two minor polypeptides with estimated molecular weights of 33,000, 36,000 and 31,000, respectively. Single-stranded RNA isolated from VTMoV by extraction with phenol was separated into five components with apparent molecular weights of 1.5 x 10(6), 0.63 x 10(6), 0.25 x 10(6), 0.16 x 10(6), and 0.12 x 10(6) referred to as RNAs 1, 1a, 1b, 2, and 3, respectively. It appears that RNAs 1a and 1b are breakdown products of RNA 1, as shown elsewhere, and electron microscopic examination of the other species showed that whereas RNAs 1 and 3 are linear molecules, RNA 2 is circular. The similarity of RNAs 2 and 3 to the RNA of viroids is discussed. VTMoV has been compared with several RNA plant viruses with small polyhedral particles. Only solanum nodiflorum mottle virus appears to share some of its unique features and the two have been shown to be antigenically related.