Is a short arm cast appropriate for stable distal radius fractures in patients older than 55 years? A randomized prospective multicentre study

We conducted a prospective randomized, multicentre study to compare short arm and long arm plaster casts for the treatment of stable distal radius fracture in patients older than 55 years. We randomly assigned patients over the age of 55 years who had stable distal radius fracture to either a short arm or long arm plaster cast at the first review 1 week after their injury. Radiographic and clinical follow-up was conducted at 1, 3, 5, 12 and 24 weeks following their injury. Also, degree of disability caused by each cast immobilization was evaluated at the patient's visit to remove the cast. There were no significant differences in radiological parameters between the groups except for volar tilt. Despite these differences in volar tilt, neither functional status as measured by the Disabilities of the Arm, Shoulder and Hand, nor visual analogue scale was significantly different between the groups. However, the mean score of disability caused by plaster cast immobilization and the incidence rate of shoulder pain were significantly higher in patients who had a long plaster cast. Our findings suggest that a short arm cast is as effective as a long arm cast for stable distal radius fractures in the elderly. Furthermore, it is more comfortable and introduces less restriction on daily activities.

LEVEL OF EVIDENCE

II.

Staged lengthening and reconstruction for children with a leg-length discrepancy after excision of an osteosarcoma around the knee

AIMS

Children treated for osteosarcoma around the knee often have a substantial leg-length discrepancy at skeletal maturity. The aim of this study was to investigate the results of staged skeletal reconstruction after a leg lengthening procedure using an external fixator in these patients.

PATIENTS AND METHODS

We reviewed 11 patients who underwent staged reconstruction with either an arthroplasty (n = 6) or an arthrodesis (n = 5). A control group of 11 patients who had undergone wide excision and concurrent reconstruction with an arthroplasty were matched for gender, location, and size of tumour. We investigated the change in leg-length discrepancy, function as assessed by the Musculoskeletal Tumor Society Scale (MSTS) score and complications.

RESULTS

A mean 5.2 cm (1.7 to 8.9) of lengthening was achieved. The mean MSTS scores significantly improved after staged reconstruction (p = 0.003) but were still worse than those of the control group (p = 0.049). However, the MSTS scores of the arthroplasty subgroup were comparable with those of the controls, although the extensor lag was greater and the range of movement was less. The patient group experienced more complications, but all of these resolved.

CONCLUSION

Approximately 5 cm of lengthening and significant functional improvement can be achieved by staged reconstruction and lengthening, without major complications. Although it has limitations, this method of treatment seems to be a satisfactory surgical option for growing children with a significant leg-length discrepancy after excision of an osteosarcoma around the knee. Cite this article: Bone Joint J 2017;99-B:401-8.

Randomised clinical trial: the efficacy and safety of oltipraz, a liver X receptor alpha-inhibitory dithiolethione in patients with non-alcoholic fatty liver disease

BACKGROUND

Oltipraz is a synthetic dithiolethione with an antisteatotic effect by inhibiting the activity of liver X receptor alpha (LXR-α). Recent studies demonstrated the disruptive role of oltipraz on LXR-α-dependent lipogenesis in hepatocytes and a high-fat diet mouse model.

AIM

To evaluate the efficacy and safety of oltipraz for reducing liver fat in subjects with non-alcoholic fatty liver disease (NAFLD).

METHODS

We performed a multicentre, double-blind, placebo-controlled, phase II study. Subjects with a liver fat >20% and hypertransaminasemia were randomised to the three groups: placebo (n = 22), 30 mg of oltipraz (n = 22) or 60 mg of oltipraz (n = 24) twice daily for 24 weeks. Changes in the liver fat from baseline to 24 weeks quantified using magnetic resonance spectroscopy were the primary outcome.

RESULTS

Compared with the placebo group (-3.2 ± 11.1%), absolute changes in the liver fat content increased in a dose-dependent manner: -7.7 ± 7.0% and -13.9 ± 10.7% for the low-dose and high-dose groups (P = 0.13 and P < 0.01). Per cent reduction in the liver fat content was also significantly greater in the high-dose group than in the placebo group (-34.6 ± 29.4% vs. -0.6 ± 62.9%, P = 0.046). Body mass indices (-1.0 ± 0.9% vs. -0.5 ± 1.4%, P = 0.04) significantly decreased in the high-dose group compared to the placebo group. However, absolute changes in insulin resistance, liver enzymes, lipids and cytokines were not significantly different among groups. The incidence of adverse events was comparable among groups.

CONCLUSIONS

Twenty-four-week oltipraz treatment significantly reduced the liver fat content in patients with NAFLD. Clinicaltrials.gov (NCT01373554).

Four-Year Experience With Extracorporeal Membrane Oxygenation for Kidney Transplant Patients With Severe Refractory Cardiopulmonary Insufficiency

BACKGROUND

Kidney transplant (KT) recipients are vulnerable to infections because of their immunosuppressive treatments, and they occasionally exhibit serious acute cardiopulmonary dysfunction. The purpose of this study was to report the clinical outcomes of using extracorporeal membrane oxygenation (ECMO) in KT recipients and to identify risk factors for ECMO weaning failure.

METHODS

We retrospectively reviewed the electronic medical records of KT patients who experienced severe cardiopulmonary dysfunction refractory to conventional therapy and received ECMO at the Asan Medical Center Surgical Intensive Care Unit between December 2010 and December 2014.

RESULTS

During the 4-year study period, 12 KT patients required ECMO management. Six of these patients were successfully weaned from ECMO; the mean duration of ECMO support was 9.1 days (range, 3.5-15.1 days). Indications for ECMO included pneumonia (8 cases required venovenous ECMO and 1 case required venoarterial [VA] ECMO), stress-induced cardiomyopathy due to fungemia (1 case required VA ECMO), and septic shock due to either urinary tract infection or unknown origin (2 cases required VA ECMO). In assessing risk factors leading to a failure of ECMO weaning, the pH on arterial blood gas analysis performed just before the beginning of this intervention was significantly lower in the nonsurvivors than in the survivors (P = .046).

CONCLUSIONS

ECMO can be a beneficial rescue therapy in immunosuppressed patients with cardiopulmonary dysfunction refractory to treatment. Severe acidosis before the administration of EMCO is a major determinant of ECMO weaning failure.

Application of emitter-sample hybrid terahertz time-domain spectroscopy to investigate temperature-dependent optical constants of doped InAs

We investigate temperature-dependent carrier dynamics of InAs crystal by using reflection-type terahertz time-domain spectroscopy, particularly with a recently developed emitter-sample hybrid structure. We successfully obtain the optical conductivity in a terahertz frequency of bulk InAs whose dc conductivity is in the range of 100-150  Ω^-1 cm^-1. We find that both real and imaginary parts of the optical conductivity can be fit well with the simple Drude model, and the free-carrier density and the scattering rate obtained from the fit are in good agreement with corresponding values obtained by using other techniques, such as the Hall measurement and the dc-resistivity measurement. These results clearly demonstrate that the proposed technique of adopting the emitter-sample hybrid structure can be exploited to determine temperature-dependent optical constants in a reflection geometry and hence to investigate electrodynamics of bulk metallic systems.

Risk factors to predict the development of chronic kidney disease in patients with lupus nephritis

Objectives

We analyzed the clinical follow-up results of 88 lupus nephritis patients to find prognostic factors for the development of chronic kidney disease in ethnically homogeneous Korean patients with biopsy-proven lupus nephritis.

Methods

Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. Renal biopsy specimens were reclassified according to the International Society of Pathology/Renal Pathology Society classification, separately, by two renal pathologists blinded to the previous classification. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model to identify independent risk factors for chronic kidney disease in lupus nephritis patients.

Results

Eighteen of 88 patients (20.5%) developed chronic kidney disease during a mean follow-up of 47.6 months (range: 12–96 months). Patients who developed chronic kidney disease were older at onset of lupus nephritis, had less education, and were more likely to have hypertension; they had lower serum albumin levels, lower platelet levels, higher serum creatinine levels, lower estimated glomerular filtration rate, higher chronicity index, and lower frequency of anti-ribosomal P antibodies, and they were less likely to be in complete remission in the first year. In stepwise multivariable analyses, hypertension, lower glomerular filtration rate, and failure to achieve complete remission in the first year of treatment were significant predictors of the development of chronic kidney disease in lupus nephritis patients.

Conclusions

These findings suggest that patients with hypertension and decreased kidney function at the onset of lupus nephritis and showing a poor response to immunosuppressive drugs in the first year should be monitored carefully and managed aggressively to avoid deterioration of kidney function.

A novel missense mutation in NR0B1 causes delayed-onset primary adrenal insufficiency in adults

A novel missense mutation (c.775T>C; p.ser259Pro) in the NROBI gene cause a late-onset adrenal insufficiency without hypogonadism.

Abstract P5-16-25: Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy

Background:According to prior studies, the role of serum vitamin D3 has been inconsistentand clinical implications of 25-hyrdoxyvitamin D (25-OHD) have been little studiedin breast cancer patients receiving neoadjuvant chemotherapy (NCT).

Objectives: The aims of study were to investigate changes in 25-OHD levels before and after NCT and to determine the association of 25-OHD and oncologic outcomes including pathological complete response (pCR) in breast cancer patients.

Patients and Materials: From January 2010 to December 2013, serum 25-OHD levels at pre- and post-NCT were measured in 377 breast cancer patients. The association of serum 25-OHD levels with clinicopathological data including breast cancer subtypes, pCR and survival were retrospectively analysed. Delta 25-OHD was calculated as serum 25-OHDlevels before minus after NCT.

Results: Mean ageof study population was 48.7 yearsand mean follow-up periods were 35.9months.Mean baseline serum 25-OHD concentration was 14.60 ng/mL (standard deviation, 7.44) and more than 80% of patients showed insufficient 25-OHD levels. The mean 25-OHDat post-NCT was 12.16 ng/mL (standard deviation, 6.87).There was a significant decrease in serum 25-OHD after NACT (p&lt;0.001).The pCR rates were 25.7% among study cohort.However, 25-OHD levels at baseline and post-NCT were not related to pCR and survival outcomes. No associations were found between pCR and delta 25-OHD. According to stratification by breast cancer subtypes, however, patients with ≥ -2.67 (median value) of delta 25-OHD revealed a trend of higher achievement of pCR and better survival in luminal A subtype. No associations were found among the other subtypes.

Conclusions: Many Korean breast cancer patients showed insufficient serum 25-OHD levels at diagnosis of malignancy and a significant decrease in serum vitamin D3 after NACT was observed.No significant association of 25-OHD 3 with pCR and survival was found. Therefore, correction or maintenance of appropriate serum 25-OHD levels should be focused for bone health as comprehensive management of breast cancer during NCT.In addition, possible oncological aspects of 25-OHD should further researched individually considering breast subtypes.

Citation Format: Park S, Lee JS, Kim JH, Lim SM, Park HS, Kim SI. Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy [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 P5-16-25.

Abstract P4-12-11: Up-regulation of SPARC is associated with breast tumor progression and epithelial SPARC expression is correlated with poor survival and MMP-2 expression in patients with breast carcinoma

Background: Secreted protein acidic and rich in cysteine (SPARC) plays a crucial role in the process of tumor invasion and metastasis in many cancers. Matrix metalloproteinases (MMPs) degrade the extracellular matrix and participate in several key processes of invasion and metastasis. The aims of this study were to evaluate the potential involvement of SPARC in the progression of breast tumor and to determine its association with outcome variables and MMPs expression in patients with breast carcinoma (BC).

Materials and Methods: SPARC expression was examined in 8 pairs of BC tissues and surrounding normal tissues at mRNA and protein levels by quantitative real-time PCR (qRT-PCR), RNAscope in situ hybridization (ISH), Western blotting, and immunohistochemistry techniques. Immunohistochemical staining of SPARC on tissue microarray was done in 26 normal breasts, 76 ductal carcinoma in situ (DCIS), and 198 BC samples. In addition, we performed immunohistochemical staining for MMP-2 and MMP-9 in BC.

Results: SPARC expression at mRNA and protein levels by qRT-PCR and Western blotting was significantly increased in BC tissues compared to the surrounding normal tissues (p &lt; 0.05 and p &lt; 0.01, respectively). RNAscope ISH and immunohistochemistry of SPARC confirmed that SPARC expression was increased in BC tissues compared with their normal tissues and its expression was more pronounced in the stromal compartment than in epithelial compartment. SPARC expression was different among the normal, DCIS and BC groups and epithelial SPARC expression increased progressively from normal breast through DCIS to BC (p &lt; 0.001). In patients with BC, high epithelial SPARC expression was associated with worse disease-free and overall survival (p = 0.002 and p = 0.048, respectively) and independently predicted worse disease-free survival (p = 0.002). Epithelial SPARC expression was significantly correlated with MMP-2 expression (p &lt; 0.05).

Conclusion: Our results suggest that up-regulation of SPARC contributes to breast tumor progression. SPARC expression may be a useful biomarker for the prognostic prediction in patients with BC. SPARC can control extracellular matrix degradation through up-regulation of MMP-2.

Citation Format: Lee JS, Kim G-E, Park MH, Yoon JH. Up-regulation of SPARC is associated with breast tumor progression and epithelial SPARC expression is correlated with poor survival and MMP-2 expression in patients with breast carcinoma [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 P4-12-11.

Abstract P6-09-38: Interaction between body mass index and hormone receptor status as a prognostic factor in node-positive breast cancer

Purpose: The aim of this study was to investigate the interaction between BMI at breast cancer diagnosis and the various factors including hormone-receptor, menopausal and nodal status, and to find a specific subgroup where BMI has an effect on breast cancer prognosis.

Methods: We retrospectively analyzed the data of 8,763 non-metastatic invasive breast cancer patients from the Asan Medical Center's research database. Overall survival (OS) and breast cancer-specific survival (BCSS) among BMI groups were compared using the Kaplan-Meier method and Cox proportional hazard model with interaction term.

Results: Only in node-positive breast cancer, there was a significant interaction between obesity (BMI ≥ 30.0 kg/m2) at diagnosis and positive hormone receptor which showed worse overall survival (OS) and breast cancer specific survival (BCSS) than normal weight patients (adjusted hazard ratio [HR] = 1.65, 95% confidence interval [CI] = 1.01 to 2.69 and HR = 1.90, 95% CI = 1.15 to 3.15, respectively). Underweight (BMI&lt;18.50 kg/m2) which interacted with negative hormone receptor status in node-positive breast cancer was associated with decreased OS (HR = 2.01, 95% CI = 1.02 to 3.98) and BCSS (HR = 2.15, 95% CI = 1.08 to 4.26). There was no significant interaction between BMI and hormone receptor status in node-negative setting and BMI did not interact with menopausal status in any population.

Conclusions: BMI interacts with hormone receptor status in node positive setting, thereby playing a role in the breast cancer prognosis.

Citation Format: Chung IY, Lee JW, Lee JS, Park YR, Lee Y, Lee SB, Kim HJ, Ko BS, Son BH, Ahn SH. Interaction between body mass index and hormone receptor status as a prognostic factor in node-positive breast cancer [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 P6-09-38.

Prevalence and risk of fracture diagnoses in women across the adult life span: a national cross-sectional study

In a national sample of women veterans, the rate of lower limb fracture diagnosis was the highest across ages 18-74 years; rates of fracture diagnosis of other skeletal sites peaked in women aged 75+. Women with two or more primary care visits or mental healthcare visits had elevated odds of fracture diagnosis.

INTRODUCTION

We assessed the prevalence and healthcare utilization characteristics associated with a diagnosis of any fracture in women of all adult ages within the Veterans Health Administration.

METHODS

In 344,488 women during fiscal year 2012, logistic regression models for fracture diagnosis included age, race/ethnicity, residence, number of primary care visits, number of mental healthcare visits, and degree of service-connected disability.

RESULTS

Lower limb fracture diagnosis was most prevalent across ages 18-74 years and peaked in women aged 55-64 years. In women aged 75+, the prevalence rates of fracture diagnosis at the hip (102, 95 % CI = 88-115 per 10,000 women), upper limb (100, 95 % CI = 87-114 per 10,000 women), and lower limb (84, 95 % CI = 72-97 per 10,000 women) were the highest. Fractures at other skeletal sites peaked in those aged 75+ years. Black women had the lowest odds of a fracture diagnosis, followed by Asian/Pacific Islander and Hispanic women compared to non-Hispanic White (by 25-51 %, P < 0.05). Having two or more primary care visits or any mental health visit was each associated with an increased risk. Women with five or more primary care visits had a 3.36-fold (95 % CI = 3.02-3.75) greater odds than those with no such visit, and separately, women with five or more mental health visits had a 1.51-fold (95 % CI = 1.43-1.60) greater odds. Women with a fracture diagnosis had higher overall healthcare costs than those without (P < 0.001).

CONCLUSIONS

Prevalence of fracture diagnosis differed by age, race/ethnicity, and skeletal site of fracture. Fracture diagnosis may identify women veterans with greater overall healthcare needs.

Effects of dietary mixture of garlic (Allium sativum), coriander (Coriandrum sativum) and probiotics on immune responses and caecal counts in young laying hens

This study was conducted to evaluate the effects of a combined mixture of phytogenic extracts (garlic and coriander) and probiotics on growth performance and immune responses in laying hens based on the results of in vitro studies to screen for immunomodulatory potency of each ingredient. Several parameters of immunomodulatory potency were estimated using lamina propria leucocytes (LPLs) isolated from rat intestinal mucosa tissue. Results show that the combined mixture enhanced LPLs proliferation, increased LPL-mediated cytotoxicity against YAC-1 tumour cells, and decreased lipopolysaccharide (LPS)-induced cytokine production including tumour necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) in LPLs. For in vivo study, laying hens (n = 50/each diet group) were fed with control diet, a diet containing antibiotics (0.01% per kg feed) or the combined mixture (0.02% per kg feed) for 21 days. The dietary combined mixture improved egg production (p < 0.05) but not growth performance and carcass traits. Interestingly, the patterns of suppressing plasma IFN-γ productions during inflammation by LPS injection and decreasing caecal E. coli counts in the combined mixture group were comparable to those in the antibiotics group. Taken together, our results suggested that the 0.02% of combined mixture of phytogenic extracts and probiotics as ingredients has potential immunomodulatory effects in laying hens.

Effect of Intracranial Atherosclerotic Disease on Endovascular Treatment for Patients with Acute Vertebrobasilar Occlusion

BACKGROUND AND PURPOSE

Although intracranial atherosclerotic disease is often encountered during endovascular treatment for acute vertebrobasilar occlusions, its clinical implication is not well-known. We aimed to evaluate whether intracranial atherosclerotic disease influences the clinical outcomes following endovascular treatment of acute vertebrobasilar occlusive stroke.

MATERIALS AND METHODS

Fifty-one patients with acute vertebrobasilar occlusive stroke were included. The onset-to-groin puncture time was ≤12 hours, and aspiration- or stent-based thrombectomy was used as the primary treatment method. Following primary endovascular treatment, intracranial atherosclerotic disease (IAD group) was angiographically diagnosed when a fixed focal stenosis was observed at the occlusion site, whereas embolism (embolic group) was diagnosed if no stenosis was observed. Clinical and treatment variables were compared in both groups, and IAD was evaluated as a prognostic factor for clinical outcomes.

RESULTS

The baseline NIHSS score tended to be lower (14 versus 22, P = .097) in the IAD group (n = 19) than in the embolic group (n = 32). The procedural time was longer in the IAD group (96 versus 61 minutes, P = .002), despite similar rates of TICI 2b-3 (89.5% versus 87.5%, P = 1.000). The NIHSS score at 7 days was higher (21 versus 8, P = .060) and poor outcomes (mRS 4-6 at 3 months) were more frequent in the IAD group (73.7% versus 43.8%, P = .038). IAD (odds ratio, 5.469; 95% CI, 1.09-27.58; P = .040) was independently associated with poor outcomes.

CONCLUSIONS

An arterial occlusion related to IAD was associated with a longer procedural time and poorer clinical outcome. Further studies are warranted to elucidate the appropriate endovascular strategy.

Effects of age, replicative lifespan and growth rate of human nucleus pulposus cells on selecting age range for cell-based biological therapies for degenerative disc diseases

Autologous disc cell implantation, growth factors and gene therapy appear to be promising therapies for disc regeneration. Unfortunately, the replicative lifespan and growth kinetics of human nucleus pulposus (NP) cells related to host age are unclear. We investigated the potential relations among age, replicative lifespan and growth rate of NP cells, and determined the age range that is suitable for cell-based biological therapies for degenerative disc diseases. We used NP tissues classified by decade into five age groups: 30s, 40s, 50s, 60s and 70s. The mean cumulative population doubling level (PDL) and population doubling rate (PDR) of NP cells were assessed by decade. We also investigated correlations between cumulative PDL and age, and between PDR and age. The mean cumulative PDL and PDR decreased significantly in patients in their 60s. The mean cumulative PDL and PDR in the younger groups (30s, 40s and 50s) were significantly higher than those in the older groups (60s and 70s). There also were significant negative correlations between cumulative PDL and age, and between PDR and age. We found that the replicative lifespan and growth rate of human NP cells decreased with age. The replicative potential of NP cells decreased significantly in patients 60 years old and older. Young individuals less than 60 years old may be suitable candidates for NP cell-based biological therapies for treating degenerative disc diseases.

Papular angiolymphoid hyperplasia and lymphoplasmacytic plaque: a clinical and histological spectrum

Acral pseudolymphomatous angiokeratoma of children (APACHE) is a rare form of cutaneous pseudolymphoma characterized byangiomatous papules with a predilection for the acral regions of children. Classically, a dense dermal lymphocytic infiltrate composed of both T and B cells is seen in histological specimens, together with prominent vessels lined by plump endothelial cells. Increasing evidence suggests that this condition is neither necessarily acral, pseudolymphomatous, nor angiokeratomatous. It may not always be a pediatric disease. Therefore, the correctness of its nomenclature has been questioned. Herein, we report threecases whose clinical and histological features were consistent with the diagnosis of APACHE. To our knowledge, this is the first report of APACHE from Southeast Asia. We also discuss why we believe "APACHE" to be a misnomer and support "papular angiolymphoid hyperplasia" as a more accurate and encompassing term. In addition, we illustrate a case with significant overlapping features with lymphoplasmacytic plaque in children, suggesting that both entities may exist on a clinical andhistological spectrum.

Asthma and COPD overlap syndrome is associated with increased risk of hospitalisation

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is associated with poor prognosis and a high health care burden. The incidence of asthma and COPD overlap syndrome is increasing, and contributes to a high financial burden and poor prognosis.

OBJECTIVE

To investigate clinical features of the overlap syndrome among Asian patients and to analyse its impact on hospitalisation due to respiratory problems or death compared to COPD alone.

DESIGN

We performed a retrospective cohort analysis of 2933 COPD patients presenting at the Asan Medical Center from 1 January 2000 to 31 December 2009. Kaplan-Meier and Cox proportional hazard models were used to analyse the significance of clinical parameters, including age, sex, smoking history, body mass index (BMI), severity of airflow limitation, airway obstruction reversibility and overlap syndrome with hospitalisation due to respiratory problems or death.

RESULTS

Overlap syndrome patients were older, included smaller proportions of males and of smokers and had lower forced expiratory volume in 1 s (FEV1) (% predicted). Shorter hospitalisation-free and survival periods were noted among overlap syndrome patients. Overlap syndrome was significantly associated with risk of hospitalisation due to respiratory problems after adjusting for age, smoking history, BMI, FEV1 (% predicted) and changes in FEV1 (P < 0.001).

CONCLUSION

Asthma and COPD overlap syndrome is associated with a higher risk of hospitalisation due to respiratory problems than COPD alone.

Abstract P2-07-06: Periostin is associated with breast tumor progression and epithelial periostin expression is correlated with poor survival in patients with invasive breast carcinoma

Background: Invasion and metastasis are the direct causes of mortality in patients with breast cancer and require reciprocal interactions between cancer cells and the extracellular matrix (ECM). Periostin, a fasciclin-containing adhesive ECM glycoprotein, is frequently overexpressed in various types of human cancer, and its overexpression in cancer-associated stroma and/or cancer cells is usually associated with poor clinical outcomes. However, the expression of periostin in the successive steps of breast tumorigenesis and its association with outcome variables have not been well established in breast carcinoma. The purposes of the present study were to assess the role of periostin alteration in breast tumorigenesis and evaluate the putative prognostic value of periostin as a function of its compartmentalization.

Materials and Methods: Immunohistochemical staining with anti-periostin antibody was performed in a total of 300 patients (26 patients with normal breasts, 76 patients with ductal carcinoma in situ [DCIS], and 198 patients with invasive breast carcinoma [IBC]) using tissue microarray. Periostin immunoreactivity was assessed in both epithelial tissue and the surrounding stromal compartment. In addition, the mRNA and protein expression of periostin was analyzed in 10 paired normal/invasive cancer frozen specimens by quantitative real time-polymerase chain reaction and western blot analysis, respectively.

Results: Periostin mRNA and protein expression in cancer tissues was increased compared with that in adjacent normal tissues. Both epithelial and stromal periostin staining scores were significantly increased with disease progression in a stepwise manner to DCIS and IBC compared with those in normal breast tissues (P = 0.000 and 0.000, respectively). High epithelial and stromal periostin expression was observed in 109 of 189 (57.7%) and 158 of 189 (83.6%) cases of IBC, respectively. High epithelial periostin expression was more frequently observed in the distant metastatic relapse-positive group than in the distant metastatic relapse-negative group (41 [80.4%] of 51 cases versus 68 [49.3%] of 138 cases [P = 0.000]). Furthermore, high epithelial periostin expression was associated with reduced disease-free and overall survival on univariate and multivariate analyses.

Conclusion: Periostin might play an important role in the progression of breast tumor, and epithelial periostin expression may serve as a new parameter for prognostic prediction in patients with IBC. Further study of periostin expression and its potential as a target of therapy for IBC appears warranted.

Citation Format: Lee JS, Kim G-E, Park MH, Yoon JH. Periostin is associated with breast tumor progression and epithelial periostin expression is correlated with poor survival in patients with invasive breast carcinoma. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-07-06.

Failure to restore sagittal tibiotalar alignment in total ankle arthroplasty: Its relationship to the axis of the tibia and the positioning of the talar component

The purpose of this study was to evaluate the change in sagittal tibiotalar alignment after total ankle arthroplasty (TAA) for osteoarthritis and to investigate factors affecting the restoration of alignment. This retrospective study included 119 patients (120 ankles) who underwent three component TAA using the Hintegra prosthesis. A total of 63 ankles had anterior displacement of the talus before surgery (group A), 49 had alignment in the normal range (group B), and eight had posterior displacement of the talus (group C). Ankles in group A were further sub-divided into those in whom normal alignment was restored following TAA (41 ankles) and those with persistent displacement (22 ankles). Radiographic and clinical results were assessed. Pre-operatively, the alignment in group A was significantly more varus than that in group B, and the posterior slope of the tibial plafond was greater (p < 0.01 in both cases). The posterior slope of the tibial component was strongly associated with restoration of alignment: ankles in which the alignment was restored had significantly less posterior slope (p < 0.001). An anteriorly translated talus was restored to a normal position after TAA in most patients. We suggest that surgeons performing TAA using the Hintegra prosthesis should aim to insert the tibial component at close to 90° relative to the axis of the tibia, hence reducing posterior soft-tissue tension and allowing restoration of normal tibiotalar alignment following surgery.

Ultrasound-Guided Percutaneous Radiofrequency Lesioning When Treating Recalcitrant Plantar Fasciitis: Clinical Results

PURPOSE

We evaluated the effects of ultrasound (US)-guided percutaneous radiofrequency thermal lesioning (RTL) and the impact of obesity when treating patients with recalcitrant plantar fasciitis.

MATERIALS AND METHODS

30 consecutive patients were enrolled. The visual analog scale (VAS), American Orthopedic Foot-Ankle Society (AOFAS) Ankle-Hindfoot Score, and plantar fascia thickness measured using US were recorded at baseline and at follow-up 1, 3, 6, and 12 months after surgery under local anesthesia.

RESULTS

12 patients in the obese (BMI ≥ 30 kg/m(2)) group and 18 patients in the non-obese group. There were significant postoperative decreases in VAS scores and in fascial thickness, and an increase in the AOFAS scores (all p < 0.001). The obese group showed delayed pain and functional improvement within the first 3 months after the index procedure (p < 0.01). Significant pain reduction and functional improvement were apparent earlier (after 1 month, p < 0.001) in the non-obese group than in the obese group (after 3 months, p < 0.05). Fascia thickness was positively correlated with the VAS score and negatively correlated with the AOFAS score (both p < 0.001).

CONCLUSION

US should be regarded as a useful objective tool to guide RTL and to monitor the effectiveness of treatment. US-guided percutaneous RTL for recalcitrant PF is a minimally invasive treatment option that yields satisfactory results. Therefore, it should at least be considered before using more invasive procedures. Moreover, obesity leads to delayed improvement but does not affect overall outcome after 12 months. Plantar fascial thickness was correlated with VAS and AOFAS scores.

A Study of Piezoelectric Field Related Strain Difference in GaN-Based Blue Light-Emitting Diodes Grown on Silicon(111) and Sapphire Substrates

We investigate the strain difference in InGaN/GaN multiple quantum wells of blue light-emitting diode (LED) structures grown on silicon(1 11) and c-plane sapphire substrates by comparing the strength of piezo-electric fields in MQWs. The piezo-electric fields for two LED samples grown on silicon and sapphire substrates are measured by using the reverse-bias electro-reflectance (ER) spectroscopy. The flat-band voltage is obtained by measuring the applied reverse bias voltage that induces a phase inversion in the ER spectra, which is used to calculate the strength of piezo-electric fields. The piezo-electric field is determined to be 1.36 MV/cm for the LED on silicon substrate and 1.83 MV/cm for the LED on sapphire substrate. The ER measurement results indicate that the strain-induced piezo-electric field is greatly reduced in the LED grown on silicon substrates consistent with previous strain measurement results by micro-Raman spectroscopy and high-resolution transmission electron microscopy.

SATB2-associated syndrome presenting with Rett-like phenotypes

The SATB2-associated syndrome (SAS) was proposed recently, after the SATB2 gene was initially discovered to be associated with isolated cleft palate. This syndrome is characterized by intellectual disability with delayed speech development, facial dysmorphism, cleft or high-arched palate, and dentition problems. Here, we describe two novel SATB2 sequence variants in two unrelated patients presenting with Rett-like phenotypes. We performed trio-based whole-exome sequencing in a 17-month-old girl presenting with severe retardation and Rett-like phenotypes, which revealed a de novo missense variant in SATB2 (p.Glu396Gln). Moreover, targeted sequencing of the SATB2 gene was performed in a 2-year-old girl with severe psychomotor retardation, facial hypotonia, and cleft palate who also exhibited some features of Rett syndrome. A nonsense variant in SATB2 was identified in this patient (p.Arg459*). This study expanded the clinical and genetic spectrum of SAS. SATB2 variants should be considered in cases with psychomotor retardation alone or in any cases with Rett-like phenotypes, regardless of the typical features of SAS such as cleft palate.

Hybrid Percolation Transition in Cluster Merging Processes: Continuously Varying Exponents

Consider growing a network, in which every new connection is made between two disconnected nodes. At least one node is chosen randomly from a subset consisting of g fraction of the entire population in the smallest clusters. Here we show that this simple strategy for improving connection exhibits a more unusual phase transition, namely a hybrid percolation transition exhibiting the properties of both first-order and second-order phase transitions. The cluster size distribution of finite clusters at a transition point exhibits power-law behavior with a continuously varying exponent τ in the range 2<τ(g)≤2.5. This pattern reveals a necessary condition for a hybrid transition in cluster aggregation processes, which is comparable to the power-law behavior of the avalanche size distribution arising in models with link-deleting processes in interdependent networks.

Vertebral compression fractures may increase mortality in male patients with chronic obstructive pulmonary disease

BACKGROUND

Vertebral compression fracture (VCF) is frequent in chronic obstructive pulmonary disease (COPD) patients. However, little is known about whether VCF affects mortality in COPD patients.

OBJECTIVE

To investigate whether VCFs might increase death in COPD patients.

METHODS

In this retrospective cohort study, we enrolled 254 COPD patients with a recent history of hospitalisation due to respiratory problems. Patients were assessed for VCF using quantitative morphometric analyses of lateral chest radiographs; 211 patients received follow-up examinations for 2 years.

RESULTS

Of the 211 COPD patients analysed, 60 (28.4%) had VCF at enrolment. During the follow-up period, 33/60 (55.0%) patients with and 46/151 patients (30.5%) without VCF died (P = 0.003, log-rank test). Cox proportional hazard analysis revealed that VCF is an independent risk factor for death after adjusting for age, sex, body mass index, smoking, dyspnoea scale, forced expiratory volume in 1 sec (FEV1) and comorbidities (hazard ratio for VCF = 1.79, 95%CI 1.11-2.89, P = 0.02).

CONCLUSION

VCF might be an independent risk factor for death in male COPD patients.