New onset acute pulmonary edema after methylergonovine given during cesarean delivery of a patient with undiagnosed Raynaud's disease

Raynaud's disease is a medical condition in which arterial spasm causes episodes of reduced blood flow, in the setting of certain triggers such as cold weather. Patients with this condition are at risk of adverse reactions if they receive medications with vasoactive properties. Methylergonovine maleate is one drug used during cesarean delivery to treat postpartum hemorrhage due to uterine atony. By acting directly on uterine and vascular smooth muscle, it produces cardiovascular responses such as coronary vasospasm, myocardial infarction, and even cardiac arrest. However, pulmonary events have rarely been reported. We report our anesthetic management of a 36-year-old patient, with undiagnosed Raynaud's disease and undergoing cesarean delivery, who experienced new onset acute pulmonary edema after methylergonovine administration to manage postpartum hemorrhage.

Parkinson's disease and the risk of osteoporotic vertebral compression fracture: a nationwide population-based study

Patients with Parkinson's disease (PD) were at higher risk of osteoporotic vertebral compression fractures (OVCF) compared to controls and had elevated mortality rates. Compared to conservative treatment, surgical treatment for OVCF in PD patients seemed to be associated with better outcomes.

INTRODUCTION

The purpose of this study was to evaluate the risk of OVCF in patients with PD.

METHODS

Data from patients over the age of 60 years who were diagnosed with PD were collected between 2004 and 2013 from the Korean National Health Insurance Database (n = 3370). The comparison group (non-PD) consisted of randomly selected patients (five per patient with PD; n = 16,850) matched to the PD group, who were newly diagnosed annually according to age and sex. Cox proportional hazard regressions were used to examine the relationships between osteoporosis, OVCF, surgery for OVCF, and PD. Household income and residential area of patients were also assessed. Overall survival rates were calculated after adjusting for confounding factors, such as hypertension, diabetes mellitus, and chronic kidney disease.

RESULTS

OVCF was developed in 12.5% of patients in the PD group and in 7.4% of patients in the control group. PD was associated with increased risk of osteoporosis (hazard ratio [HR], 1.32; 95% confidence interval [CI], 1.21-1.43; p < 0.001), OVCF (HR 1.66; 95% CI, 1.47-1.87; p < 0.001), and surgery for OVCF (HR 2.69; 95% CI, 1.78-4.08; p < 0.001). Household income was not significantly related with development of osteoporosis, incidence of OVCF, or surgery for OVCF. Residential area was statistically associated with osteoporosis, OVCF, and surgery for OVCF. The mortality rate of the PD group was about 1.7 times higher than that of the non-PD group after adjusting for potential confounders, and the mortality rate of the PD with OVCF group was higher than that of the non-PD group, but not significantly (p = 0.09). The survival rate of the PD group with surgery for OVCF showed a trend toward a more positive prognosis compared with that of the PD group with conservative treatment.

CONCLUSIONS

Patients with PD had significantly increased risk of osteoporosis and OVCF. Surgical treatment for OVCF in PD patients was associated with a better prognosis than conservative treatment.

Serum LDH and LDH Isoenzymes in Chronic Renal Failure: Effect of Hemodialysis

Serum levels of several commonly measured enzymes are abnormal in patients with end-stage renal disease (ESRD). In the present study we measured serum total LDH activity and LDH isoenzymes in a group of 25 ESRD patients shortly before, during, and immediately after hemodialysis. Baseline serum total LDH activity in the ESRD group was midly but significantly higher than that found in the normal control group. The observed elevation was associated with an isomorphic pattern. Single passage of blood through the extracorporeal apparatus led to a rise in total LDH, LDH-3, LDH-2 and LDH-4, a pattern consistent with release from the platelets. A steady increase was noted in total LDH, LDH-5 and LDH-1 of arterial blood during hemodialysis. This was thought to be due to ultrafiltration-induced hemoconcentration, enzyme release from the formed elements within the extracorporeal circuit and complement-mediated leukocyte activation and pulmonary leukostasis. These observations should be taken into consideration with regards to interpretation of LDH and LDH isoenzyme values and proper time of blood sampling in ESRD patients.

Complete mitochondrial genome sequence of Macromia daimoji Okumura, 1949 (Odonata: Macromiidae)

The dragonfly Macromia daimoji Okumura, 1949 (Odonata: Macromiidae) has been listed as an Endangered insect in South Korea. We sequenced the complete 15,198 bp mitochondrial genome (mitogenome) of this organism, which is the first mitogenome sequence reported from the family Macromiidae. The genome includes a typical set of genes [13 protein-coding genes (PCGs), 2 rRNA genes, and 22 tRNA genes) and one non-coding region with an arrangement identical to that observed in most insect genomes. Phylogenetic analyses using concatenated sequences of the 13 PCGs and 2 rRNA genes using the Bayesian inference (BI) method placed Macromiidae, represented by M. daimoji, as a sister group to Libellulidae with the highest nodal support [Bayesian posterior probabilities (BPP) = 1]. Unlike conventional phylogenetic analysis, the suborders Anisozygoptera and Zygoptera formed a strong sister group (BPP =1), justifying the use of different molecular markers for phylogenetic analysis.

Different Stroke Volumes for the Left and Right Ventricles in the Moving-Actuator Type Total Artificial Heart

A new electromechanical moving-actuator type total artificial heart (TAH) has been developed to solve the imbalance problem without an extra compliance chamber. A different stroke volume was achieved by the large left sac size and the asymmetry of the actuator motion referred to the center position. The left ventricle consists of a double sac with the outer sac attached to the actuator providing active diastolic filling, while the double sac of the right ventricle being free from the actuator, and having sufficient suction produced due to the rigid pump housing. The stroke volume difference between the left and right sac is compensated through the air in the interventricular space of the variable volume (VV) space. Computer simulation based on the geometrical relationships between the blood sacs and the actuator was performed to simulate the physical mechanisms of the moving-actuator type TAH. Results were then compared with the measured pressure changes in various chambers of the pump and the stroke volume differences in mock circulation test. In two acute calf experiments, the balanced left and right atrial pressures were achieved in the moving-actuator type TAH without an extra compliance chamber

Complete mitochondrial genome sequence of Cicindela anchoralis Chevrolat, 1845 (Coleoptera: Carabidae)

The tiger beetle, Cicindela anchoralis Chevrolat, 1845 (Coleoptera: Carabidae), has been listed as an Endangered insect in South Korea. We sequenced the complete mitochondrial genome (mitogenome) of this organism (16,388 bp). The genome includes a typical set of genes (13 protein-coding genes (PCGs), 2 rRNA genes, and 22 tRNA genes) and 1 non-coding region with an arrangement identical to that observed in most insect genomes. Twelve PCGs had the typical ATN start codon, whereas ND1 had the atypical TTG codon. The AT-rich region is 1629-bp long, composed of 80.0% A + T nucleotides, and has no long repeat sequences. Phylogenetic analyses with concatenated sequences of the 13 PCGs and 2 rRNA genes, using the Bayesian inference (BI) method, placed C. anchoralis as a sister to the within-subfamilial species Habrodera capensis, with the highest nodal support presented by both BI and maximum likelihood (ML) methods. Three subfamilies represented by more than one species (Cicindelinae, Harpalinae, and Carabinae) were all determined by both BI and ML analyses to form strong monophyletic groups.

Abstract P1-07-25: Differences among young breast cancer patients based on subtype: A study from the Korean Breast Cancer Society – Running head: Do breast cancers in 20s have worse prognosis than 30s?

Purpose Numerous studies demonstrated that breast cancer in young women (BCY) has unfavorable prognostic features and unfavorable subtype. However, there were few studies to evaluate the effect on the prognosis of breast cancer according to the subtype disparities by age especially BCY. We analyzed breast cancer mortality stratified tumor subtype according to age among the patients with less than 50 year-old. Patients and Methods Data obtained from the Korean Breast Cancer Society Registry (KBCSR), patients diagnosed with invasive breast cancer were retrospectively between 2003 and 2010. We excluded patients with male breast cancer, underwent neoadjuvant chemotherapy, distant metastasis or inflammatory breast cancer at presentation, and other histopathology except invasive ductal or invasive lobular carcinoma. We also excluded patients with lack of immunohistochemistry data and short-term follow-up duration (&lt;12 months). Results We identified 37,865 patients, and excluded by study protocol. Among those, 30,793 patients with breast cancer for eligible for analysis, 793 (2.6%) were 20-29 years and 8,926 (28.8%) were 30-39 years of age. Median follow-up duration was 84 months. Mean age was 42.4 years old. Younger patients with breast cancer were more likely to have advanced stage, higher nuclear grade, present lymphovascular invasion, and more likely to be unfavorable subtype such as triple negative breast cancer (TNBC)

Table 1. Baseline Characteristics Age at Presentation 20-29, N(%)30-39, N(%)40-49, N(%)P-valueOverall793 (2.6)8,133 (26.4)21,867 (71.0) Pathologic stage   &lt;.0001I295 (37.2)2,928 (36.0)9,288 (42.5) II373 (47.0)3,644 (44.8)9,078 (41.5) III119 (15.0)1,442 (17.7)3,211 (14.7) Family history   &lt;.0001Yes81 (10.2)674 (8.3)1,391 (6.4) No712 (89.8)7,459 (91.7)20,476 (93.6) Nuclear grade   &lt;.0001Low85 (10.2)941 (11.6)3,824 (17.5) Intermediate288 (36.3)3,340 (41.1)9,688 (44.3) High331 (41.7)3,165 (38.9)6,650 (30.4) LVI   &lt;.0001Yes249 (31.4)2,840 (34.9)6,711 (30.7) No433 (54.6)4,367 (53.7)13,005 (59.5) Subtype   &lt;.0001Luminal A314 (39.6)3,529 (43.4)11,716 (53.6) Luminal B190 (24.0)1,895 (23.3)4,775 (21.8) Her-252 (6.6)724 (8.9)1,723 (7.9) TNBC237 (29.8)1,895 (24.4)3,653 (16.7) HER-2, human epidermal growth factor-2; TNBC, triple negative breast cancer

. Patients with younger age group showed worse prognosis than patients with older age patients. In multivariate analysis for overall survival, as patients were younger group, hazard ratio was increased, and the patients with TNBC showed higher HR than HER-2, Luminal B, and Luminal A subtype (P&lt; .0001, P&lt; .0001, P&lt; .0001, and P&lt; .0001, respectively). Stratified by subtype, luminal subtype showed significant worse prognosis as the age group was younger, while as, Her-2 and TNBC subtype showed no significantly difference by the age group. Conclusion Patients with 20s breast cancer showed unfavorable characteristics and worse prognosis than 30s and older aged group. Stratified by tumor subtype, breast cancer in 20s with luminal subtype showed worse prognosis, while as HER-2 and TNBC showed no significantly different compare to breast cancer in 30s.

Citation Format: Ryu JM, Yu J, Nam SJ, Kim I, Lee JE, Lee SK, Kim JM, Choi HJ, Kim SW. Differences among young breast cancer patients based on subtype: A study from the Korean Breast Cancer Society – Running head: Do breast cancers in 20s have worse prognosis than 30s? [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 P1-07-25.

Abstract P3-07-10: Modulation of FASN under obese conditions

Introduction: Obesity is known to be associated with a worse breast cancer prognosis, in part through altering metabolism in cells of the tumor microenvironment. In particular, changes in metabolism associated with fatty acid utilization have been noted in not only breast cancer, but also several other cancer types. This includes changes to both expression and activity of the Fatty Acid Synthase enzyme (FASN), which is responsible for production of long chain fatty acids, including palmitate. These changes in long chain fatty acid production can modulate tumor behavior through modulation of energy utilization such as beta-oxidation, as well as plasma membrane modulation with phospholipids. Our previous studies have demonstrated that exposure to obese conditions induces significant changes in breast cancer cell proliferation. Additionally, obesity modulates activity of other cells within the tumor microenvironment, including adipocytes, which might influence the cancer cell itself. We hypothesize one particular mechanism that supports these changes is obesity-induced upregulation of FASN and that FASN may be a viable target to limit obesity-induced progression.

Methods and Results: FASN has been shown to promote cancer cell proliferation through generating fatty acid precursors required for cell proliferation, altering membrane fluidity, and activating oncogenic signaling pathways. To determine if modulation of FASN is an important mechanism by which obesity promotes disease progression, MCF-7 breast cancer cells and human pre-adipocyte cells (ASC) were exposed to 2% sera from obese postmenopausal women and 2% sera from non-obese (control) women. Preliminary quantitative PCR results demonstrated that exposure to the obese sera resulted in increased expression of FASN in both the cancer cells as well as the ASC. Current studies are on-going to determine if 1) FASN up-regulation results in increased long-chain and free fatty acid production in both the cancer and adipocyte cells, 2) whether changes in long chain and free fatty acid production results in altered metabolism and plasma membrane status and 3) whether targeting FASN with a new generation of FASN inhibitors currently being investigated in the clinic can modulate obesity-induced disease progression.

Conclusions: Our findings indicate that obesity promotes upregulation of FASN in several cells within the tumor microenvironment, including adipocytes and the cancer cell itself. We have also found that using a FASN inhibitor is effective in limiting cancer cell viability and proliferation. Our on-going studies will confirm if this is an important mechanism by which obesity promotes disease progression. Since FASN inhibitors are currently being investigated in the clinic, the results of these studies will provide a better understanding of how obesity alters the biology of the disease, and may identify a novel target for improving patient outcomes.

Citation Format: Pham T, Oberman A, Kim I, Lee G, Quach D, Galván G, Jolly C, Cavazos D, Brenner A, deGraffenried L. Modulation of FASN under obese conditions [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 P3-07-10.

Complete mitochondrial genome of Saturnia jonasii (Lepidoptera: Saturniidae): Genomic comparisons and phylogenetic inference among Bombycoidea

The complete mitochondrial genome (mitogenome) of Saturnia jonasii (Lepidoptera: Saturniidae) was sequenced and compared to those of 19 other bombycoid species. Furthermore, the mitogenome sequences were used to infer phylogenetic relationships among bombycoid species. The 15,261-bp Saturnia jonasii mitogenome contained the typical sets of genes and gene arrangements found in majority of Lepidoptera. All Bombycoidea species, including Saturnia jonasii, have a 15-33-bp spacer sequence at the trnS₂-ND1 junction. The phylogenetic reconstruction of bombycoid species consistently and strongly supported monophylies of the families, Saturniidae, Bombycidae, and Sphingidae, based on Bayesian inference (BI) and maximum-likelihood (ML) methods. Among these families, the Bombycidae and Sphingidae species consistently showed a sister relationship, regardless of data partitions; the BI method strongly supported this relationship, whereas it was moderately supported using the ML method.

Assessment of Tocilizumab (Anti-Interleukin-6 Receptor Monoclonal) as a Potential Treatment for Chronic Antibody-Mediated Rejection and Transplant Glomerulopathy in HLA-Sensitized Renal Allograft Recipients

Extending the functional integrity of renal allografts is the primary goal of transplant medicine. The development of donor-specific antibodies (DSAs) posttransplantation leads to chronic active antibody-mediated rejection (cAMR) and transplant glomerulopathy (TG), resulting in the majority of graft losses that occur in the United States. This reduces the quality and length of life for patients and increases cost. There are no approved treatments for cAMR. Evidence suggests the proinflammatory cytokine interleukin 6 (IL-6) may play an important role in DSA generation and cAMR. We identified 36 renal transplant patients with cAMR plus DSAs and TG who failed standard of care treatment with IVIg plus rituximab with or without plasma exchange. Patients were offered rescue therapy with the anti-IL-6 receptor monoclonal tocilizumab with monthly infusions and monitored for DSAs and long-term outcomes. Tocilizumab-treated patients demonstrated graft survival and patient survival rates of 80% and 91% at 6 years, respectively. Significant reductions in DSAs and stabilization of renal function were seen at 2 years. No significant adverse events or severe adverse events were seen. Tocilizumab provides good long-term outcomes for patients with cAMR and TG, especially compared with historical published treatments. Inhibition of the IL-6-IL-6 receptor pathway may represent a novel approach to stabilize allograft function and extend patient lives.

Complete mitochondrial genome of the lappet moth, Kunugia undans (Lepidoptera: Lasiocampidae): genomic comparisons among macroheteroceran superfamilies

The mitochondrial genome (mitogenome) characteristics of the monotypic Lasiocampoidea are largely unknown, because only limited number of mitogenomes is available from this superfamily. In this study, we sequenced the complete mitogenome of the lappet moth, Kunugia undans (Lepidoptera: Lasiocampidae) and compared it to those of Lasiocampoidea and macroheteroceran superfamilies (59 species in six superfamilies). The 15,570-bp K. undans genome had one additional trnR that was located between trnA and trnN loci and this feature was unique in Macroheterocera, including Lasiocampoidea. Considering that the two trnR copies are located in tandem with proper secondary structures and identical anticodons, a gene duplication event might be responsible for the presence of the two tRNAs. Nearly all macroheteroceran species, excluding Lasiocampoidea, have a spacer sequence (1-34 bp) at the trnS2 and ND1 junction, but most lasiocampid species, including K. undans, have an overlap at the trnS2 and ND1 junction, which represents a different genomic feature in Lasiocampoidea. Nevertheless, a TTAGTAT motif, which is typically detected in Macroheterocera at the trnS2 and ND1 junction, was also detected in all Lasiocampoidea. In summary, the general mitogenome characteristics of Lasiocampoidea did not differ greatly from the remaining macroheteroceran superfamilies, but it did exhibit some unique features.