Abstract P6-06-08: Impact of initial surgical treatment delay on survival according to hormone responsiveness in breast cancer

Previous studies on the issue of the prognostic importance of treatment delay in breast cancer have shown inconsistent results. Furthermore, the association between the impact of treatment delay and molecular characteristics of tumors has not been adequately addressed. The purpose of this study is to examine the prognostic impact of initial surgical treatment delay after biopsy-proven cancer diagnosis in breast cancer patients.

A total of 1,393 consecutive invasive breast cancer patients, treated in Seoul National University Hospital, Seoul, Korea, between July 2006 and June 2008, were included in this study. Patients with in situ or metastatic carcinoma at the time of diagnosis and patients in whom the dates of the initial pathologic diagnosis were unknown were excluded.

The median time from biopsy-confirmed cancer diagnosis to initial surgical treatment was 25 days (range 0-134). When the patients were classified according to their treatment delay days (0 to 29, 30 to 59, and ≥60days), there was no difference in survival between ‘0-29days’ group and ‘30-59days’ group. However, for patients who experienced more than 60 days of initial delay in surgical treatment, the survival was significantly worse when compared to other groups (p = 0.034). The association between the treatment delay and poor outcome was only seen in patients with ER and PR negative tumors (p = 0.018) while patients with hormone-responsive tumors showed no such association. Patients with ER and PR negative tumors developed more recurrence and had shorter disease-free survival if they had treatment delay of more than 60 days. The prognostic importance of treatment delay of more than 60 days remained significant in predicting disease-free survival after adjusting for other known prognostic factors such as age, tumor size, nodal status, cancer stage, nuclear grade and Ki-67 expression (HR 5.127; 95% CI, 1.350 to 19.472; p = 0.016).

Our results suggest that having treatment delay of more than 60 days is associated with poor treatment outcome in patients with ER and PR negative breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-08.

Abstract P6-06-24: Intact p53 can predict more hormonal therapy benefit in invasive breast cancer: Evaluation of interactions between immunohistochemical p53 status and adjuvant therapy

Background: To confirm the prognostic and predictive values of p53 accumulation, particularly in invasive breast cancer patients sorted according to subgroup based on immunohistochemical hormone receptor (HR) and HER2 status.

Methods: A total of 15,598 immunohistochemical data for p53, ER, PgR, and HER2 were retrospectively retrieved from the web-based database of the Korean Breast Cancer Society. Overall survival (OS) and breast cancer-specific survival (BCSS) were calculated and compared with the Kaplan-Meier method with log-rank test. Multivariate analyses were performed using a stratified Cox proportional hazard regression model. A model evaluating interactions between p53 and both hormonal therapy and chemotherapy was used to determine the treatment benefit from both modalities.

Results: Prognostic value of p53 was most significant in the HR+/HER2- subgroup for OS and BCSS, with hazard ratios of 1.44 (95% CI, 1.08-1.93) and of 1.47 (95% CI, 1.09-1.99). The hazard ratios for p53 overexpression had borderline significance in the HR+/HER2+, and were invalid in the HR-/HER2+ and HR-/HER2- subgroups. The model with interaction terms revealed that hormonal therapy significantly interacts with p53 status (p = .002 and .007 for OS and BCSS), resulting in an insignificant prognostic value of p53 status (p = .268 and .296 for OS and BCSS). An interaction between chemotherapy and p53 status was not found in this model.

Conclusion: p53 overexpression has independent prognostic value, particularly in the HR+/HER2- invasive breast cancer, which is most likely caused by differential treatment benefits from hormonal therapy depending on p53 status.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-24.

Abstract P6-06-54: Analysis of treatment and survival of pathologic occult breast cancer with axillary lymph node metastasis: Nationwide retrospective study

Objective

Occult breast cancer (OBC) is a rare presentation which accounts for 0.3-1.0% of all breast cancers. In spite of limited information, there is no consensus regarding the prognostic factors and treatment of OBC. This retrospective study intends to evaluate the overall survival and prognostic factors of occult breast cancer (OBC) in Korea.

Method

This study included 142 pathologic occult breast cancer patients from January 1990 to December 2009, identified from Korean Breast Cancer Society cancer registry. All patients had pathologically positive axillary lymph node (N1-N3) along with pathologically & radiologically negative in-breast lesion (T0/Tx) based on retrospective review of database. Among 142 patients, 32 patients had only axillary lymph node dissection (ALND), 56 patients had breast conserving operation (BCO) with ALND and 54 patients had mastectomy with ALND. 96 patients (96%) had N1 disease, 23 patients (16.2%) had N2 disease and 23 patients (16.2%) had N3 disease.

Results

There was no significant statistical difference in overall survival among different operation method, which is ALND only, BCO with ALND, mastectomy with ALND (p = 0.061), considering that 12 patients (37.5%) among 32 patients who only had ALND had N3 disease comparing that only 7 (12.5%) out of 56 patients and 4 (7.4%) out of 54 patients had N3 disease in BCO with ALND and mastectomy with ALND group separately. Univariate analysis revealed that only nodal status was significant prognostic factor (p = 0.0004), and other factors including radiotherapy (p = 0.696), chemotherapy (p = 0.302), estrogen receptor positivity (p = 0.144), progesterone receptor positivity (p = 0.254), total number of removed lymph node (p = 0.586) didn't show statistical difference in overall survival.

Conclusions

This study suggests that OBC patients who only had ALND showed similar outcomes when comparing with patients who had BCO with ALND or mastectomy with ALND. Also only nodal status might be independent predictors for poor outcomes of occult breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-06-54.

Abstract P3-14-20: Neoadjuvant chemotherapy in young age breast cancer: Survival benefit over adjuvant chemotherapy in clinically T2 node positive patients

Background: The downstaging of the primary tumor and the increase in breast conservation rates seems to be the only clinical benefit of Neoadjuvant systemic therapy(NST) in breast cancer treatment, given that several studies failed to demonstrate an improvement of overall survival compared with postoperative adjuvant chemotherapy. In Europe, S6 trial showed better early outcome in survival in favour of the neoadjuvant chemotherapy group compared to adjuvant chemotherapy group in premenopausal patients without significantly modifying long-term event rates. The aim of this study was to assess a potential advantage in survival by neoadjuvant as compared to adjuvant chemotherapy in young age breast cancer patients.

Methods: Between January 2001 and December 2008, 1169 consecutive patients with breast cancer aged under 40 underwent adjuvant chemotherapy before or after surgery. Prospectively collected medical records for all patients were reviewed retrospectively. For the comparison of survival between neoadjuvant versus adjuvant chemotherapy group, cinically T2 and node positive patients were retrieved. Survival curves were derived from Kaplan-Meier estimates and compared by log-rank test.

Results: Of the 1169 patients, 203(17.3%) patients were treated with neoadjuvant chemotherapy, and they were grouped as ‘NST’ and ‘non-NST’ according to initial treatment. About 47% patients in each group were clinically T2 patients. (99(47.8%) in NST group, 453(46.9%) in non-NST group) Among them, clinically T2 and node positive patients were 188, 97 patients in NST group, 91 patients in non-NST group each. The median age was 35.11±3.9 years old and HER2 amplification was observed as 23.5%, and they were not different between two groups.(p = 0.146 and 0.941 each) Significant lower hormone receptor expression rate and higher Ki-67 level were observed in NST group(p = 0.03 and <0.0001 each) Breast conservation surgery rate was also significantly different between two groups, more favorable results in NST group.(67% in NST group, 37.4% in non-NST group, p<0.0001) During median follow-up period of 61 months (range 44 to 148 months), we observed a statistically significant difference (p = 0.011) in survival in favour of the NST group. This benefit of survival was presented consistently regardless of hormone receptor expression. A similar trend was seen when the time to distant disease recurrence was evaluated (p = 0.176). And this trend was more prominent in hormone receptor negative patients, but still not statistically significant. (p = 0.144) The mean total dose of chemotherapy administered was similar in both groups. Improved survival figures in the NST group could be the result of the early initiation of systemic treatment, but the trend in favour of decreased metastases was not statistically significant.

Conclusion: A potential advantage of primary over adjuvant chemotherapy in young age breast cancer patients’ survival might be proposed by this results.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-14-20.

Abstract P3-07-09: Breast cancer susceptibility associated single nucleotide polymorphisms (SNPs) and prognosis: GG genotype of a SNP rs3803662 (TOX3/TNRC9) associated with better survival

Backgrounds: After completion of human genome project, some genetic variants are discovered and highlighted by genome-wide association studies (GWAS). Single nucleotide polymorphisms (SNP) are considered to be the key variations leading to the various breast cancer susceptibility between each individuals. In 2011, our group has validated 5 SNPs as significant risk factor of breast cancer in Korean women for the first time. Recently, there has been some attempts to find clinical meaning of SNPs in each breast cancer patient. But it was not successful.

Methods: Consecutive patients with histologically confirmed primary breast cancer subjected to operative procedures between 2002 and 2009 in Seoul National University Hospital were included for analysis. Patients diagnosed with noninvasive breast cancer (ductal carcinoma in situ and lobular carcinoma in situ) or stage IV breast cancer were excluded. Peripheral venous blood samples were obtained and stored at the time of operation. The SNPs genotyped included rs2046210 (6q25.1), rs2981582 (FGFR2), rs889312 (MAP3K1), rs3803662 (TOX3/TNRC9), and rs4973768 (SLC4A7). SNP genotyping was carried out on an Applied Biosystems 7900HT realtime PCR system (Applied Biosystems). We made collaboration with the Korean Central Cancer Registry (KCCR) to improve the validity of the mortality data. Total of 3,209 patients were included for survival and recurrence analysis.

Results: 492 (15.33%) patients had recurrence. And there were 277 (8.63%) mortalities overall. The median follow-up was for 85.59 month (±29.979). The GG genotype of SNP rs3803662 showed better survival than other AA, AG genotypes (Cumulative survival was 89% vs 84% at 120 months f/u). And it is validated at multivariate analysis (p = 0.024).

Conclusion: This study showed strong association between a certain genotype of single SNP and survival of breast cancer patients for the first time. Further lab investigation including functional study or studies on other races should be performed to find a novel or alternative hidden pathways of cancer progression.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-07-09.

Abstract P4-04-09: Extensive novel hybrid isoforms revealed by RNA sequencing of 120 primary breast cancer samples

Introduction

Recent studies of next generation sequencing (NGS) have highlighted the extensive transcriptional heterogeneity of cancer cells. Alternative splicing is one of the evolutionary process by which cells and tissues achieve their specificity within central dogma. Also it is highly assumed to contribute to oncogenesis and thought to be a critical mechanism how cancer cells gain resistance to therapeutic agents and adapt to various circumstances. Relevance of differential splicing in breast cancer biology is mostly unknown. We performed whole transcriptome sequencing (RNA-Seq) to reveal novel splicing alterations among 120 primary breast cancer samples.

Materials and Method

Total RNA was prepared using the Illumina TrueSeq™ RNA sample Preparation Kit and TrueSeq mRNA library was constructed. Clustering and sequencing was done using Illumina HiSeq 2000. RNA-Seq reads were aligned to human reference genome(hg19) using TopHat software and expression was measured using cufflinks software. We used tissues extracted from previously collected 120 fresh-frozen primary breast cancer samples obtained after surgical resection whose clinicopathological data are available. Patients undergone neoadjuvant systemic therapies or stage lV disease at diagnosis were excluded. Thirty-six(30%) cases occurred distant metastasis during follow up. Hormone receptor(HR) was positive in 61(50.8%) samples, 20(16.7%) had HER2 oncogene overexpression and 36(30%) were triple negative breast cancer.

Results and discussion

Total 11345 novel isoforms were detected among 120 tumors. Isoforms of pseudo-genes and exon skipping of the ‘non-coding exon’ were excluded. Splice variants detected in normal reference were sorted out as well. 4045 were in-frame exon skipping and 4960 were off-frame exon skipping which may lead to protein truncation. 5036 were private exon skipping and 3969 isoforms were detected recurrently in more than 2 samples. To minimize false positivity we confined ‘exon skipping’ analysis to those with the expression level (Fragments per kilo-base of exon per million fragments mapped, FPKM) of the skipped exon below 0.1 compared to the adjacent exons. Mean number of exon skipping events per sample was 196.8 (range 75-299, SD 35.9). There were no differences in numbers of exon skipping event among breast cancer subtypes nor distant metastasis. We have identified novel exon skipping in ESR1, CHEK2, EIF3E, FGFR, MAP2K, PIK3R2, TERT, VAV3 genes which is strongly suspected to be novel driver isoforms and is under validation process.

Conclusion We performed whole-transcriptome sequencing with a large set of primary breast cancer samples and revealed extensive transcriptional heterogeneity by isoform profiling. As distinguishing the natural transcriptomic dynamics from oncogenic ‘driver’ isoform is a major challenge, validation and functional studies are ongoing.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-04-09.

Abstract PD4-2: Whole exome and transcriptome sequencing of 120 primary breast cancer to discover novel therapeutic target

Introduction: Many somatic mutations, structural alterations, and gene expression changes are causally implicated in oncogenesis and tumor progression, and as a result, affect clinical outcome. Although majority of breast cancer patients have benefits from therapeutics targeting tumor biology, such as estrogen receptor and HER-2, still many patients suffer from disease recurrence and metastasis. More kind of specific target therapies are needed, especially for hormone-resistant tumor and triple-negative breast cancer.

Materials and Method: To find novel therapeutic target in breast cancer, here we examine the both whole exome and whole transcriptome of fresh-frozen primary breast cancer tissues from 120 patients whose clinical, pathological, and survival data are available. Patients with Stage IV disease or who received neoadjuvant chemotherapy were excluded. 36 patients had distant metastasis within 5 years from surgery, and 84 patients were NED at least 5 years. RNA and DNA were extracted and qualities were assessed in all samples. Exome and transcriptome sequencing were done using NGS technology (Illumina HiSeq 2000). As a control, exome sequencing was done for 93 normal DNA from matched patients. Single nucleotide variations (SNV) identified in cancer samples on exonic region, nonsynonymous SNV or stop gain/loss, whose quality ≥20, and not found in 93 normal samples were included. SNVs registered in dbSNP135_common or 1000 genome allele frequency >0.001 were excluded.Results and Discussion: We identified 11,684 putative somatic mutations in 7,373 genes. Of them, 6,547 were deleterious or damaging mutation by Provean or SIFT analysis. Mutations were found in potential drug target genes, such as PIK3CA(25), PTEN(3), AKT1(3), ALK(3), ROS1(2), FGFR4(3), FGFR3(2), ERBB2(2), and IDH1(1) etc. In a pathway analysis, mutations in insulin signaling pathway were most dominant. We hypothesized that driver gene and therapeutic target has to have recurrent mutation and gene expression at least more than average expression. We calculated expression “Volume” according to the median normalized FPKM value of individual gene's RNA-seq data. With a cut-off of 3 or more mutations in each gene, 1,116 genes were selected. After the filtering of Volume<0.3, 696 genes were selected. Finally, 55 genes were selected which are druggable or potentially druggable using drug database (DrugBank, TOCRIS, Ingenuity) and Pubmed. DriverNet analysis result was also considered for the selection. All 342 tumor suppressor genes were filtered out. Interestingly, 18 of the 55 were genes involved in metabolism (fatty acid, glucose, amino acids). 12 were kinases and 4 were involved in insulin pathway. Excluding the previously confirmed therapeutic target, PIK3CA, AKT1, and NOTCHs, and considering the patients’ clinical data, our primary candidates for hormone-resistant breast cancer were NQO2, CELSR1, GLUD2, MYH9, PSMD2, NADK, IRS2, MAP3K5, and for triple-negative breast cancer were HSPG2, PHGDH, MYLK, etc. Validation with Sanger sequencing and functional study is on-going.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD4-2.

Abstract P5-15-04: Clinical benefits of using nomogram for predicting positive resection margins in breast conserving surgery

Achieving a clear resection margin in breast conserving surgery (BCS) is an important factor in tumor recurrence in breast cancer. To obtain clear resection margins and reduce re-excision rates, some surgeons obtain intraoperative assessments of the margins of excised specimens, using intraoperative frozen biopsy. But intraoperative frozen biopsy has several problems such as low sensitivity or longer operation time. We have previously reported a nomogram for prediction of positive resection margin by integrating preoperatively available clinical and pathologic information. The factors were the presence of microcalcification, mammographic density, tumor size discrepancy between magnetic resonance imaging and ultrasonography, and the presence of ductal carcinoma in situ or lobular carcinoma in needle biopsy specimens.

We conducted a prospective trial to examine the accuracy and clinical benefits of the nomogram in 442 breast cancer patients (nomogram group) who underwent BCS between Dec 2011 and March 2013, and compared the clinical outcome with that of the 253 patients (control group) who underwent BCS between Jan 2011 and Oct 2011. For nomogram group, the intraoperative frozen section biopsy was omitted in patients with low nomogram scores.

Applying our nomogram did not increase the rate of reoperation due to resection margin positivity when compared to the control group (6.56% vs. 4.25%, respectively, p = 0.22). In the nomogram group, the reoperation rate in patients with low nomogram score who did not undergo intraoperative frozen biopsy was 3.2%, and this is lower than the reoperation rate in the control group. Additionally, we experienced a significant reduction in operation time by 15 minutes when compared to the control group (p<0.001).

In conclusion, our results show that out nomogram for predicting positive resection margin for patients who receive BCS can significantly reduce the operation time without increasing reoperation rate.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-15-04.

Mitochondrial and microsatellite DNA analyses showed comparative genetic diversity between parent and offspring populations of Korean black rockfish in a hatchery facility

The black rockfish, Sebastes inermis (Sebastidae), is an important commercial fishery resource in Korea. As a preliminary investigation into the effect of artificial reproduction in a hatchery facility, the genetic divergence between parent and offspring populations of black rockfish was accessed using 10 polymorphic nuclear microsatellite DNA loci and a mitochondrial (mt) control gene. All loci that were screened showed marked polymorphisms. mtDNA control region sequences were also highly variable. Of approximately 350 base pairs (bp) sequenced, 52 variable sites, comprising 56 base substitutions, were found among 233 individuals. Offspring populations showed less genetic variability than the parent population in terms of numbers of microsatellite alleles and mtDNA haplotypes, as well as mtDNA haplotype diversity. Statistical analysis of the fixation index (ΦST and F(ST)) and analysis of molecular variance using both DNA markers showed significant genetic differences between the parent and offspring populations. These results suggest that random genetic drift and/or inbreeding events, as well as artificial selection and founder effects, occurred when the offspring strain was reproduced in a hatchery facility despite thousands of males and females from different hatcheries being maintained for artificial reproduction. Therefore, it is necessary to improve current hatchery programs by monitoring genetic variation in both the broodstock and progeny and controlling inbreeding within stocks in commercial breeding facilities to maintain the production of high-quality black rockfish. This information will be useful for determining suitable guidelines for establishing and maintaining cultured stocks and the aquaculture industry of S. inermis.

Comparative genetic variability between broodstock and offspring populations of Korean starry flounder used for stock enhancement in a hatchery by using microsatellite DNA analyses

Korean starry flounder, Platichthys stellatus (Pleuronectidae), is one of the most economically important fishery resources in Korea. We investigated the effect of current artificial reproduction in a hatchery facility, genetic divergence between the broodstock and their offspring populations of starry flounder in a hatchery strain to be stocked into natural sea areas was accessed using 9 polymorphic nuclear microsatellite DNA loci. High levels of polymorphism were observed between the 2 populations. A total of 96 alleles were detected at the loci, with some alleles being unique in the broodstock. Allelic variability ranged from 8 to 17 in the broodstock and from 7 to 12 in the offspring population. Average observed and expected heterozygosities were estimated at 0.565 and 0.741 in the broodstock samples and 0.629 and 0.698 in the offspring population, respectively. Although no statistically significant reductions were found in heterozygosity or allelic diversity in the offspring population, a considerable loss of rare alleles was observed in the offspring population compared with that in the broodstock. Significant genetic difference was detected between the broodstock and offspring populations (FST = 0.021, P < 0.05). These results suggest that more intensive breeding practices for stock enhancement might have resulted in a further decrease of genetic diversity. Thus, genetic variations of broodstock and progeny should ideally be monitored in both breeding and release programs as a routine hatchery operation in order to improve the starry flounder hatchery management. This information might be useful for fishery management and aquaculture industry of P. stellatus.

Is multimodal analgesia as effective as postoperative patient-controlled analgesia following upper extremity surgery?

INTRODUCTION

The present prospective study compared the clinical outcomes between a multimodal analgesia group and a patient-controlled analgesia (PCA) group for postoperative pain control in upper extremities surgery.

HYPOTHESIS

Multimodal analgesia including pre-emptive analgesic can provide similar or superior analgesic effects and a lower incidence of adverse reactions than PCA following upper extremity surgery.

PATIENTS AND METHODS

Sixty-one patients undergoing upper extremity surgery were randomized to 2 perioperative analgesic groups (multimodal analgesia and PCA). We compared the clinical outcomes: use of additional pain rescue, opioid-related complication rate, and patient's satisfaction between the 2 groups.

RESULTS

No significant differences on the resting and exercise pain scores between the two groups. Also, there were no differences regarding additional pain rescue during postoperative day (POD) 1, 2 and achievement of rehabilitation protocol in both groups. However, use of additional pain rescue in PCA group was increased significantly after PCA removal. Moreover, there was significant difference in the incidence of opioid-related complications on operation day and at POD 1. At discharge, multimodal analgesia group showed significantly greater satisfaction than PCA group.

DISCUSSION

Perioperative pain management following upper extremity surgery through the multimodal analgesia could be an acceptable alternative method that can provide good results.

Consensus in chronic ankle instability: aetiology, assessment, surgical indications and place for arthroscopy

Ankle sprains are the most common injuries sustained during sports activities. Most ankle sprains recover fully with non-operative treatment but 20-30% develop chronic ankle instability. Predicting which patients who sustain an ankle sprain will develop instability is difficult. This paper summarises a consensus on identifying which patients may require surgery, the optimal surgical intervention along with treatment of concomitant pathology given the evidence available today. It also discusses the role of arthroscopic treatment and the anatomical basis for individual procedures.

Effects of unilateral internal jugular vein removal on intraocular pressure

PURPOSE

To investigate the intraocular pressure (IOP) and retinal nerve fibre layer (RNFL) thickness after ipsilateral neck dissection with internal jugular vein (IJV) removal for head and neck tumours.

METHODS

A computer search was performed to identify all patients who were treated with neck dissection with unilateral IJV removal from 2005 to 2012. All patients underwent a complete ophthalmological examination including measurement of IOP by Goldmann applanation tonometry and the average RNFL thickness using a Spectralis optical coherence tomography. The following analyses were made between the eyes on the side of the IJV removal versus the eye on the contralateral side: gonioscopy, IOP, vertical cup-disc ratio (VCDR) and peripapillary RNFL. Correlation analysis between the year of operation and IOP was done using the Pearson correlation coefficient.

RESULTS

This prospective cross-sectional study recruited 38 patients. The median age at operation was 59.5 years (range 33-87 years). There were 26 males and 12 females. Exactly half of the patients had left IJV removal and the remaining half had right IJV removal. The median interval from neck dissection to eye assessment was 46.5 months (range 11-97 months). There was no significant difference between the ipsilateral and contralateral side in terms of gonioscopy, IOP, VCDR, and RNFL. There was no significant correlation between the duration of IJV removal and IOP (p=0.8).

CONCLUSIONS

Ipsilateral IJV removal after neck dissection did not result in any significant differences in the average peripapillary RNFL thickness or IOP compared to the contralateral eye at a mean of 46.5 months postoperatively.

Treatment of BK virus-associated hemorrhagic cystitis in pediatric hematopoietic stem cell transplant recipients with cidofovir: a single-center experience

BACKGROUND

BK virus (BKV)-associated hemorrhagic cystitis (BKV-HC) is a severe complication after hematopoietic stem cell transplantation (HSCT). Cidofovir (CDV) has emerged as an effective agent for the treatment of BKV nephropathy, but its use for BKV-HC in pediatric HSCT recipients has not yet been established as a standard therapy.

PATIENT AND METHODS

We retrospectively investigated the efficacy and safety of CDV therapy for patients with BKV-HC at a single institution and analyzed the clinical management outcomes.

RESULTS

From April 2009 to July 2011, 12 patients developed BKV-HC at a median of 37 days after transplant (range 15-59 days). The cumulative incidence was 9% and the median peak of the urine BKV load was 2.5 × 10(10) copies/mL (range 1.4 × 10(9) -1.2 × 10(11) copies/mL). Eleven patients received intravenous CDV (5 mg/kg/dose, with probenecid), whereas 1 patient received CDV (5 mg/kg/dose, without probenecid) intravesically. The median duration of therapy was 25 days (range 9-73 days), and a median of 2 doses was given (range 1-4). A reduction of ≥ 1 log in the BKV load was found in 11 patients, while 1 patient did not have any significant change in BKV load. Clinical improvement was observed in all cases, and no HC-related death was observed. CDV-related toxicity occurred in 1 patient (8%) and spontaneously resolved.

CONCLUSIONS

CDV appears to be an effective and safe treatment for BKV-HC in pediatric HSCT recipients, but prospective trials are warranted to support its use.

Evaluation of patient outcome after discontinuation of alfuzosin treatment for benign prostatic hyperplasia: a multicentre, prospective study

AIMS

The aim of this study was to assess patient outcome after discontinuation of alfuzosin treatment in patients with benign prostatic hyperplasia (BPH).

METHODS

This study included 200 BPH patients. Alpha-blockers were discontinued after 12 weeks of treatment when the International Prostatic Symptom Score (IPSS) was reduced to < 8 points, peak urine flow rate (Q(max)) was increased to ≥ 15 ml/s, the postvoiding residual (PVR) urine volume was ≤ 100 ml and the patient agreed to discontinue treatment. Urinary symptoms of the patients were assessed at 4, 8, 12 and 24 weeks after discontinuation of medication, and surveys were performed asking whether patients wanted to restart administration of medication.

RESULTS

Of 200 enrolled patients, 142 (71.00%) received 12 weeks of treatment with 10 mg of alfuzosin. The medication was discontinued in 58 of 142 patients (40.85%) because urinary symptoms had improved. Among these patients, follow-up observations were performed for 49 patients up to 24 weeks after treatment discontinued. Of these 49 patients, 28 (57.14%) showed correct urination without a need to restart treatment up to 24 weeks after the medication was discontinued. The discontinuation group demonstrated improved voiding symptoms, including Q(max) and PVR, relative to the re-administration group at baseline. Furthermore, the discontinuation group showed a smaller prostate volume than the re-administration group (p = 0.045).

CONCLUSION

When patients with BPH displayed symptomatic improvement upon treatment with alpha-blockers, the improvements were maintained in a select subpopulation of patients without the need to re-administer the alpha-blockers.

Optical properties of Dirac electrons in a parabolic well

A single electron transitor may be fabricated using qunatum dots. A good model for the confinement potential of a quantum dot is a parabolic well. Here we consider such a parabolic dot made of graphene. Recently, we found counter intuitively that resonant quasi-boundstates of both positive and negative energies exist in the energy spectrum. The presence of resonant quasi-boundstates of negative energies is a unique property of massless Dirac fermions. As magnetic field B gets smaller the energy width of these states become broader and for sufficiently weak value of B resonant quasi-bound states disappear into a quasi-continuum. In the limit of small B resonant and nonresonant states transform into discrete anomalous states with a narrow probability density peak inside the well and another broad peak under the potential barrier. In this paper we compute the optical strength between resonant quasi-bound states as a function of B, and investigate how the signature of resonant quasi-bound states of Dirac electrons may appear in optical measurements.

MDCT features in the differentiation of T4a gastric cancer from less-advanced gastric cancer: significance of the hyperattenuating serosa sign

OBJECTIVE

The purpose of our study was to evaluate CT findings to differentiate between T4a and less advanced gastric cancers.

METHODS

The institutional review board approved this study and waived informed consent. This study included 228 retrospectively identified patients with surgically confirmed gastric cancer (138 T1, 25 T2, 24 T3 and 41 T4a) and who had also undergone pre-operative CT scan. Transverse and multiplanar reconstruction scans were reviewed in consensus by two other blinded radiologists. The following CT findings that differentiate T4a from less advanced cancers were evaluated: nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and a hyperattenuating serosa sign. The CT features of T4a and less advanced gastric cancers were compared by means of univariate and multivariate analyses.

RESULTS

In univariate analysis, nodular or an irregular outer layer of the gastric wall, haziness of the perigastric fat and the hyperattenuating serosa sign were significant in differentiation between T4a and less advanced gastric cancers. In addition, nodular or an irregular outer layer of the gastric wall and the hyperattenuating serosa sign were significant in differentiation between T3 and T4a. In multivariate logistic analysis, the hyperattenuating serosa sign was the most significant finding in differentiation between T3 and T4a (odds ratio, 4.210; 95% confidence intervals, 1.581-11.214; p=0.004).

CONCLUSION

The hyperattenuating serosa sign may be a useful CT finding in differentiation between T4a and less-advanced gastric cancers.

ADVANCES IN KNOWLEDGE

The hyperattenuating serosa sign is associated with gastric cancer with invading the serosa and can facilitate planning of the optimal pre-operative evaluation and treatment.

Clinical utility of fluoride-18 positron emission tomography/CT in temporomandibular disorder with osteoarthritis: comparisons with 99mTc-MDP bone scan

OBJECTIVES

The purpose of this study was to compare the clinical utility of fluoride-18 positron emission tomography (¹⁸F-PET)/CT with that of conventional (99m)Tc-methylene diphosphonate (MDP) bone scan in temporomandibular disorder (TMD) with osteoarthritis.

METHODS

24 patients with TMD who underwent both ¹⁸F-PET/CT and (99m)Tc-MDP bone scans for diagnostic work-up were enrolled. The temporomandibular joint (TMJ)-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on ¹⁸F-PET/CT and the TMJ uptake ratio on bone scan were measured.

RESULTS

Of the 48 TMJs in 24 patients, 35 TMJs were diagnosed as TMD with osteoarthritis, 8 TMJs as TMD with anterior disc displacement (ADD), and the remaining 5 TMJs showed no evidence of TMD (NED). All three uptake ratios on ¹⁸F-PET/CT and the TMJ uptake ratio on the bone scan tended to be higher in TMD with osteoarthritis than in TMD with ADD or NED. Receiver operating characteristic (ROC) curve analysis for detecting TMD with osteoarthritis indicated that the TMJ-to-skull uptake ratio, TMJ-to-muscle uptake ratio and TMJ-to-spine uptake ratio on PET/CT (0.819, 0.771 and 0.813, respectively) showed higher area under the ROC curve value than the TMJ ratio on bone scan (0.714). The TMJ-to-skull uptake ratio on PET/CT showed the highest sensitivity (89%) and accuracy (81%) of all uptake ratios.

CONCLUSIONS

¹⁸F-PET/CT can help diagnose TMD with osteoarthritis with superior diagnostic ability and is a suitable alternative modality to a conventional (99m)Tc-MDP bone scan.

Randomized comparison of the Pentax AirWay Scope and Macintosh laryngoscope for tracheal intubation in patients with obstructive sleep apnoea

BACKGROUND

Patients with obstructive sleep apnoea (OSA) can often present difficulties in intubation. This study aimed to compare the efficacy of the Pentax AirWay Scope (AWS) with that of the Macintosh laryngoscope for tracheal intubation in patients with OSA.

METHODS

Forty-six patients undergoing uvulopalatopharyngoplasty were randomly allocated to tracheal intubation with either the Macintosh laryngoscope or the Pentax AWS. In all patients, intubation was performed by one of two anaesthetists experienced with both devices. The primary and secondary endpoints of this study were the intubation difficulty scale (IDS) score and success/failure and duration of the first successful intubation attempt.

RESULTS

With the Pentax AWS, tracheal intubation was successful on the first attempt in all patients whereas four patients required repeated attempts at intubation with the Macintosh laryngoscope. The IDS score was significantly lower using the Pentax AWS and glottic exposure was better (the Cormack and Lehane grade 1 in all patients vs grade 2 or higher in all patients, P<0.0001). Average duration of successful intubation was shorter (12.9 vs 29.9 s, P=0.0002), and fewer manoeuvres were needed to improve the glottic exposure (0 in all patients vs 1 or more in 16 patients, P<0.0001) with the Pentax AWS, compared with the Macintosh laryngoscope.

CONCLUSIONS

In this study of patients with OSA, tracheal intubation by experienced anaesthetists was facilitated using the Pentax AWS compared with the Macintosh laryngoscope.