Are educational interventions to prevent catheter-related bloodstream infections in intensive care unit cost-effective?

BACKGROUND

There is increasing interest in evidence-based educational interventions in central venous catheter care. It is unclear how effective these are at reducing the risk of bloodstream infections from the use of intravascular catheters (catheter-BSIs) and the associated costs and health benefits.

AIM

To estimate the additional costs and health benefits from introducing such interventions and the costs associated with catheter-BSIs.

METHODS

A comprehensive epidemiological and economic review was performed to develop the parameters for an economic model to assess the cost-effectiveness of introducing an educational intervention compared with clinical practice without the intervention. The model follows the clinical pathway of cohorts of patients from their admission to an intensive care unit (ICU), where some may acquire catheter-BSI, and estimates the associated costs, mortality and life expectancy.

FINDINGS

The additional cost per catheter-BSI episode was £3940. The results of this model demonstrate that introducing an additional educational intervention to prevent catheter-BSI improved patient life expectancy and reduced overall costs.

CONCLUSION

Introducing evidence-based education is likely to reduce the incidence of catheter-BSI and the model results suggest that the cost of introducing the interventions will be outweighed by savings related to reduced ICU bed occupancy costs.

An economic evaluation of anonymised information sharing in a partnership between health services, police and local government for preventing violence-related injury

OBJECTIVE

To assess the costs and benefits of a partnership between health services, police and local government shown to reduce violence-related injury.

METHODS

Benefit-cost analysis.

RESULTS

Anonymised information sharing and use led to a reduction in wounding recorded by the police that reduced the economic and social costs of violence by £6.9 million in 2007 compared with the costs the intervention city, Cardiff UK, would have experienced in the absence of the programme. This includes a gross cost reduction of £1.25 million to the health service and £1.62 million to the criminal justice system in 2007. By contrast, the costs associated with the programme were modest: setup costs of software modifications and prevention strategies were £107 769, while the annual operating costs of the system were estimated as £210 433 (2003 UK pound). The cumulative social benefit-cost ratio of the programme from 2003 to 2007 was £82 in benefits for each pound spent on the programme, including a benefit-cost ratio of 14.80 for the health service and 19.1 for the criminal justice system. Each of these benefit-cost ratios is above 1 across a wide range of sensitivity analyses.

CONCLUSIONS

An effective information-sharing partnership between health services, police and local government in Cardiff, UK, led to substantial cost savings for the health service and the criminal justice system compared with 14 other cities in England and Wales designated as similar by the UK government where this intervention was not implemented.

Repeat post-op voiding trials: an inconvenient correlate with success

AIMS

This study examined the association between the need for a repeat voiding trial after midurethral sling (MUS) surgery and 1-year success rates.

METHODS

We conducted this secondary analysis of the participants in the Urinary Incontinence Treatment Network trial of midurethral sling (TOMUS) study which compared retropubic versus transobturator MUS. A standard voiding trial was attempted on all subjects. The "repeat voiding trial" group included subjects discharged with catheterization. All others were considered "self voiding." Success rates between the groups at 1-year were compared, followed by multivariate analyses controlling for previously reported clinical predictors of success.

RESULTS

Most women (76%) were self-voiding, while 24% required a repeat voiding trial. The objective success rate at 1-year was 85.8% in the repeat voiding trial group and 75.3% in the self-voiding group (P = 0.01). Subjective success rate at 1-year was 61.0% in the repeat voiding trial group and 55.1% in the self-voiding group (P = 0.23). Women in the repeat voiding trial group continued to demonstrate greater objective success than the self-voiding group in multivariate analysis that controlled for previous incontinence surgery, pad weight, urethral mobility, urge score, and type of MUS (P = 0.04, OR 1.82, 95% CI 1.03-3.22).

CONCLUSIONS

Women who require a repeat voiding trial following MUS surgery have greater objective success at 1-year postoperatively when compared to those who are self-voiding at the time of discharge. These results may help reassure women who require catheterization after MUS surgery that their outcome is not compromised by this immediate transient post-operative result.

Factors facilitating and constraining the delivery of effective teacher training to promote health and well-being in schools: a survey of current practice and systematic review

Background

Schools are an important setting for health promotion and teachers have an integral role to play in promoting children and young people’s health and well-being. Adequate initial teacher training (ITT) and continuing professional development in health is therefore important.

Objectives

To conduct a survey of initial teacher training providers in England and a systematic review of effectiveness to assess how health and well-being is covered on courses, and to identify barriers and facilitators to effective training.

Methods

Methods included an online questionnaire survey with a sample of 220 ITT course managers in England; interviews with a purposive sample of 19 of the course managers responding to the questionnaire; and a two-stage systematic review comprising a descriptive map of the characteristics of international research studies of health teacher training and a detailed synthesis of a subset of studies specifically on pre-service training. Databases (including MEDLINE, EMBASE, The Campbell Library and PsycINFO) were searched from the period of database inception up to May 2011.

Results

The overall response rate for the survey was 34%. The majority (89%) of respondents agreed that it was either important or very important to cover health within the ITT curriculum. The most commonly covered topics on courses wereEvery Child Matters(100%), child protection (100%), emotional health (99%) and antibullying (97%). Fewer course managers reported covering healthy eating (63%), sex and relationships (62%), drugs (56%), alcohol (41%) and smoking (34%). Many interviewees expressed a holistic view of education and believed that health was important in the ITT curriculum. However, there was variability in how health was addressed across and within institutions. Trainee teachers' experience of addressing child health on school placement was also variable. Facilitators to covering health included interests and backgrounds of ITT staff; staff health-related professional experience; availability of health expertise from external agencies; supportive government policy frameworks; and interprofessional and interdepartmental working. The main barriers were limited curriculum time; health being perceived to be a lower priority than other aspects of training; health no longer a high government priority in education; and lack of funding. A total of 170 studies met the eligibility criteria for the descriptive map. The majority covered teacher training in relation to sexual and reproductive health, drugs and alcohol or mental and emotional health. A total of 21 publications (20 studies) were prioritised for the synthesis. All were evaluations of health training for pre-service teachers, and just under half were from the UK. Twelve studies reported outcomes (impact of training on teachers, but not pupils), many of which were single cohort before-and-after studies. Sixteen studies reported processes. Following training there were some increases in trainee teachers' factual knowledge of health and a general increase in their confidence to address health issues. In general, training was acceptable and well received by trainees. Evidence suggested that effective training should include practical experience and skills and be personally relevant and take into account individual needs. Barriers to health training identified from the studies included lack of time, balancing breadth and depth, and variation in training provision.

Conclusions

Among those surveyed there appears to be general support for health and well-being in ITT. However, further research on the longer-term impact of ITT around health and well-being is needed, particularly in the early career period. The main limitation of this research was the low response rate (34%) to the survey.

Study registration

PROSPERO number CRD42012001977.

Funding

The National Institute for Health Research Public Health Research programme.

The effect of atorvastatin and simvastatin on vitamin D, oxidative stress and inflammatory marker concentrations in patients with type 2 diabetes: a crossover study

The pleiotropic effect of statins may be mediated in part through raising 25 hydroxy vitamin D (25OHD) concentrations. It has also been shown that an increase in oxidative stress and inflammatory markers are a feature of the patients with type 2 diabetes (T2DM). A cross-over study of 26 patients with T2DM taking either simvastatin 40 mg or atorvastatin 10 mg was undertaken. After 3 months on one statin, lipids, C-reactive protein (hsCRP), 25OHD and malondialdehyde (MDA) were measured repeatedly. The same procedure was then followed taking the other statin. Despite similar lipid-lowering, the mean 25OHD was higher on atorvastatin compared with simvastatin and the mean MDA and hsCRP levels lower, irrespective of which statin the patients were taking before crossover. The changes in 25OHD predicted changes in CRP and MDA levels. Thus, compared with simvastatin, atorvastatin shows apparently beneficial pleiotropic effects with respect to 25OHD concentrations as well as markers of oxidative stress and inflammation in patients with T2DM.

Abstract 3124: Identification of transcription factors critical for the growth of basal-like breast cancer

Background: Intrinsic differences in gene expression between basal-like breast cancer (BLBC) and other breast cancer subtypes imply that transcriptional regulators are differentially activated in breast cancer subtypes and may be promising therapeutic targets. We hypothesized that genomic comparisons between BLBC and non-BLBC will identify transcription factors (TFs) critical for BLBC growth. We identified TFs using an integrative analysis comparing mRNA expression, frequency of TF response elements in differentially expressed genes, and DNA-binding activity of nuclear proteins in BLBC and non-BLBC. We then tested whether inhibition of these specific TFs suppresses the growth of BLBC.

Methods: We compared mRNA expression of 702 TFs in TNBC tumors compared to non-TNBC samples across 15 breast tumor datasets in Oncomine™ and identified TFs with a combined p-value <0.05 and higher expression in TNBC.

We used the online tool, CORE_TF, to identify TF response elements occurring more frequently within promoters (-1kb through first exon) of 117 genes significantly more highly expressed in BLBC tumors compared to non-BLBC samples (p<0.01 in 3 independent datasets) as compared to ∼1500 non-BLBC genes, with a p-value <0.05 using Fisher's exact test.

Nuclear protein was collected from BLBC (BT20, HCC1143, HCC1937, MDA468) and non-BLBC cells (BT474, MCF7, T47D, ZR75-1) in triplicate and binding of DNA motifs by nuclear protein was measured by protein/DNA Arrays (Affymetrix, Santa Clara, CA). TF motifs with a fold change of >1.2 and p <0.05 in BLBC compared to non-BLBC nuclear lysates were identified.

BLBC and non-BLBC cells transfected with control or specific siRNAs to each TF identified in at least 2/3 of the assays were grown in quadruplicate and cell counts at day 6 were compared.

Results: mRNA analysis identified 132 TFs significantly more highly expressed in TNBC compared to non-TNBC. Analysis of TF response elements identified 94 motifs seen more frequently in genes more highly expressed in BLBC. Analysis of protein-bound DNA motifs identified 11 motifs significantly more highly bound using BLBC protein than non-BLBC protein. Integrative analysis of these results identified two TFs that were detected in all three analyses: STAT1 and PPARα, an additional 26 TFs identified in both mRNA expression and DNA element analyses, and 5 identified in the RNA expression and DNA-binding protein analyses. siRNA knockdown of the identified TFs showed that several of the TFs are critical for BLBC growth.

Conclusions: This study identified TFs with differential expression and activity in BLBC and non-BLBC using an integrative analysis of RNA, DNA and proteins. Inhibition of specific TFs demonstrates that several of these TFs are critical for the growth of BLBC. Further investigation of the TFs identified in this study will improve our understanding BLBC and will identify novel targets for the treatment and prevention of BLBC.

Citation Format: Jonathan Shepherd, Ivan P. Uray, Abhijit Mazumdar, Anna Tsimelzon, Susan G. Hilsenbeck, Powel H. Brown. Identification of transcription factors critical for the growth of basal-like breast cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3124. doi:10.1158/1538-7445.AM2013-3124

Introduction of laparoscopic sacral colpopexy to a fellowship training program

INTRODUCTION AND HYPOTHESIS

Minimally invasive sacral colpopexy has increased over the past decade, with many senior physicians adopting this new skill set. However, skill acquisition at an academic institution in the presence of postgraduate learners is not well described. This manuscript outlines the introduction of laparoscopic sacral colpopexy to an academic urogynecology service that was not performing minimally invasive sacral colpopexies, and it also defines a surgical learning curve.

METHODS

The first 180 laparoscopic sacral colpopexies done by four attending urogynecologists from January 2009 to December 2011 were retrospectively analyzed. The primary outcome was operative time. Secondary outcomes included conversion to laparotomy, estimated blood loss, and intra- and postoperative complications. Linear regression was used to analyze trends in operative times. Fisher's exact test compared surgical complications and counts of categorical variables.

RESULTS

Mean total operative time was 250 ± 52 min (range 146-452) with hysterectomy and 222 ± 45 (range 146-353) for sacral colpopexy alone. When compared with the first ten cases performed by each surgeon, operative times in subsequent groups decreased significantly, with a 6-16.3% reduction in overall times. There was no significant difference in the rate of overall complications regardless of the number of prior procedures performed (p = 0.262).

CONCLUSIONS

Introduction of laparoscopic sacral colpopexy in a training program is safe and efficient. Reduction in operative time is similar to published learning curves in teaching and nonteaching settings. Introducing this technique does not add additional surgical risk as these skills are acquired.

Effectiveness of screening and brief alcohol intervention in primary care (SIPS trial): pragmatic cluster randomised controlled trial

OBJECTIVE

To evaluate the effectiveness of different brief intervention strategies at reducing hazardous or harmful drinking in primary care. The hypothesis was that more intensive intervention would result in a greater reduction in hazardous or harmful drinking.

DESIGN

Pragmatic cluster randomised controlled trial.

SETTING

Primary care practices in the north east and south east of England and in London.

PARTICIPANTS

3562 patients aged 18 or more routinely presenting in primary care, of whom 2991 (84.0%) were eligible to enter the trial: 900 (30.1%) screened positive for hazardous or harmful drinking and 756 (84.0%) received a brief intervention. The sample was predominantly male (62%) and white (92%), and 34% were current smokers.

INTERVENTIONS

Practices were randomised to three interventions, each of which built on the previous one: a patient information leaflet control group, five minutes of structured brief advice, and 20 minutes of brief lifestyle counselling. Delivery of the patient leaflet and brief advice occurred directly after screening and brief lifestyle counselling in a subsequent consultation.

MAIN OUTCOME MEASURES

The primary outcome was patients' self reported hazardous or harmful drinking status as measured by the alcohol use disorders identification test (AUDIT) at six months. A negative AUDIT result (score <8) indicated non-hazardous or non-harmful drinking. Secondary outcomes were a negative AUDIT result at 12 months, experience of alcohol related problems (alcohol problems questionnaire), health utility (EQ-5D), service utilisation, and patients' motivation to change drinking behaviour (readiness to change) as measured by a modified readiness ruler.

RESULTS

Patient follow-up rates were 83% at six months (n=644) and 79% at 12 months (n=617). At both time points an intention to treat analysis found no significant differences in AUDIT negative status between the three interventions. Compared with the patient information leaflet group, the odds ratio of having a negative AUDIT result for brief advice was 0.85 (95% confidence interval 0.52 to 1.39) and for brief lifestyle counselling was 0.78 (0.48 to 1.25). A per protocol analysis confirmed these findings.

CONCLUSIONS

All patients received simple feedback on their screening outcome. Beyond this input, however, evidence that brief advice or brief lifestyle counselling provided important additional benefit in reducing hazardous or harmful drinking compared with the patient information leaflet was lacking.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN06145674.

Serum placental-type alkaline-phosphatase levels in patients with epithelial ovarian-carcinoma

Serum placental alkaline phosphatase (PLAP)-type immunoreactivity was measured in 190 women with epithelial ovarian malignancy, 27 women with borderline ovarian cancer and 334 control subjects with non-neoplastic or benign gynaecological disease. Smoking, ABO blood group and menopausal status affect serum concentrations of PLAP and results were corrected for these. Circulating levels were elevated in patients with cancer and increased with stage. Levels were unaltered in borderline ovarian disease. Two-year stage corrected survival analysis demonstrated a significant worsening of prognosis in patients with serum PLAP-type levels greater than the 100th centile for controls.

What has been the United Kingdom's experience with retention of third molars?

BACKGROUND

In 2000, the first National Institute of Clinical Excellence (NICE) guidelines related to third molar (M3) surgery, a commonly performed operation in the United Kingdom, were published. This followed research publications and professional guidelines in the 1990 s that advised against prophylactic surgery and provided specific therapeutic indications for M3 surgery. The aim of the present report was to summarize the available evidence on the effects of guidelines on M3 surgery within the United Kingdom.

MATERIALS AND METHODS

Data from primary care dental services and hospital admissions in England and Wales during a 20-year period (Hospital Episode Statistics 1989/1990 to 2009/2010), and from private medical insurance companies were analyzed. The volume and, where possible, the nature of the M3 surgery activity over time were assessed together, as were the collateral effects of the guidelines, including patient age at surgery and the indications for surgery.

RESULTS

The volume of M3 removal decreased in all sectors during the 1990 s before the introduction of the NICE guidelines. During the 20-year period, the proportion of impacted M3 surgery decreased from 80% to 50% of admitted hospital cases. Furthermore, an increase occurred in the mean age for surgical admissions from 25.5 to 31.8 years. The change in age correlated with a change in the indications for M3 surgery during that period, with a reduction in "impaction," but an increase in "caries" and "pericoronitis" as etiologic factors, in accordance with the NICE guidelines.

CONCLUSION

The significant decrease in M3 surgery activity occurred before the NICE guidelines. Thus, M3 surgery has been performed at a later age, with indications for surgery increasingly in accordance with the NICE guidelines. The importance of clinical monitoring of the retained M3s is discussed.

An exploratory randomised controlled trial of a premises-level intervention to reduce alcohol-related harm including violence in the United Kingdom

Background

To assess the feasibility of a randomised controlled trial of a licensed premises intervention to reduce severe intoxication and disorder; to establish effect sizes and identify appropriate approaches to the development and maintenance of a rigorous research design and intervention implementation.

Methods

An exploratory two-armed parallel randomised controlled trial with a nested process evaluation. An audit of risk factors and a tailored action plan for high risk premises, with three month follow up audit and feedback. Thirty-two premises that had experienced at least one assault in the year prior to the intervention were recruited, match paired and randomly allocated to control or intervention group. Police violence data and data from a street survey of study premises’ customers, including measures of breath alcohol concentration and surveyor rated customer intoxication, were used to assess effect sizes for a future definitive trial. A nested process evaluation explored implementation barriers and the fidelity of the intervention with key stakeholders and senior staff in intervention premises using semi-structured interviews.

Results

The process evaluation indicated implementation barriers and low fidelity, with a reluctance to implement the intervention and to submit to a formal risk audit. Power calculations suggest the intervention effect on violence and subjective intoxication would be raised to significance with a study size of 517 premises.

Conclusions

It is methodologically feasible to conduct randomised controlled trials where licensed premises are the unit of allocation. However, lack of enthusiasm in senior premises staff indicates the need for intervention enforcement, rather than voluntary agreements, and on-going strategies to promote sustainability.

Trial registration

UKCRN 7090; ISRCTN: 80875696

Behavioural interventions for the prevention of sexually transmitted infections in young people aged 13-19 years: a systematic review

We systematically reviewed school-based skills building behavioural interventions for the prevention of sexually transmitted infections. References were sought from 15 electronic resources, bibliographies of systematic reviews/included studies and experts. Two authors independently extracted data and quality-assessed studies. Fifteen randomized controlled trials (RCTs), conducted in the United States, Africa or Europe, met the inclusion criteria. They were heterogeneous in terms of intervention length, content, intensity and providers. Data from 12 RCTs passed quality assessment criteria and provided evidence of positive changes in non-behavioural outcomes (e.g. knowledge and self-efficacy). Intervention effects on behavioural outcomes, such as condom use, were generally limited and did not demonstrate a negative impact (e.g. earlier sexual initiation). Beneficial effect on at least one, but never all behavioural outcomes assessed was reported by about half the studies, but this was sometimes limited to a participant subgroup. Sexual health education for young people is important as it increases knowledge upon which to make decisions about sexual behaviour. However, a number of factors may limit intervention impact on behavioural outcomes. Further research could draw on one of the more effective studies reviewed and could explore the effectiveness of 'booster' sessions as young people move from adolescence to young adulthood.

Judgment, resources, and complexity: a qualitative study of the experiences of systematic reviewers of health promotion

Systematic reviews play an increasingly important role in decision making in health promotion and public health. However, little has been published on how systematic reviewers acquire necessary knowledge and skills, and on the challenges they face in producing reviews. Semistructured interviews were conducted with a purposive sample of 17 systematic reviewers of health promotion. They described practice, training, and mentoring as being key ways that they learned reviewing skills, often in combination. Practice-based learning was considered to be particularly beneficial. Training was generally easy to access, though questions were raised about the feasibility of training stakeholders such as health professionals to become reviewers. It was suggested that an understanding of research methods is beneficial for novice reviewers. While funding opportunities for doing reviews are available, long-term investment is needed to support an infrastructure for the production of high-quality systematic reviews of important health promotion priorities.

P5-08-02: Mammographic Breast Texture Predicts Benign Biopsy Results and Composition

Purpose: Investigate the relationship between pathology diagnosis, biopsy composition, and breast texture measured in digital mammogram in women who have had previous benign findings in their breast. The long-term goal of this project is to determine whether or not global breast texture is associated with tissue composition and biopsy results. Such a finding would be of interest because it would provide evidence that mammography images contain information related to breast biology beyond average density.

Materials and Methods: A total of 124 women who had previously received benign biopsies underwent an additional dual-energy/low dose full-field digital mammography (DXA) scan of the unaffected breast. Three measures of breast density (percent dense area (PD), percent fibroglandular volume (%FGV), absolute fibroglandular volume (FGV) from mammogram, 15 biopsy types including apocrine metaplasia and non-secretory pituitary adenoma, and four tissue compositions (collagen percent area, fat percent area, ductal percent area, epithelial percent area) were estimated from biopsies for each participant. In addition 45 breast texture features were measured on each screening image taken during the dual-energy mammography using custom software. Tissue composition at the biopsy location was estimated based on the average percent area of stained collagen, fat, ductal, and epithelial from up to 3 slides taken from the biopsy. Pathology results from the three slides were taken to indicate the tissue type.

Results: Neither mammographic percent density, %FGV, nor FGV showed significant association with either biopsy type or tissue composition. However, some of breast texture features were significantly associated with tissue type and tissue composition. The strongest associations were found between collagen percent area and the neighborhood gray tone difference matrix texture strength (R=0.26, P=0.005) and ductal percent area and the gray level contrast matrix homogeneity (GLCM HOM) (R=-0.30, P=0.001). When classified according to biopsy type, the univariate association between ductal percent area and GLCM HOM for apocrine metaplasia increased. (R=-0.55, P=0.007)

Conclusion: 10 breast texture features of the unaffected breast were significantly associated with local tissue composition and biopsy type. Further study will be required to determine whether this association is related to masking effects related to breast complexity or changes in breast biology driving changes in breast morphology.

CLINICAL RELEVANCE The use of texture measures as biomarkers of variations in breast biology is potentially clinically significant. This work indicates that texture measures are associated with some biological outcomes. It is possible that this work could be used to improve diagnostic utility of computer-aided diagnosis by weighting the probability of various benign outcomes according to the measured breast texture.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-08-02.

Evaluating the extent of potential resistance to pre-exposure prophylaxis within the UK HIV-1-infectious population of men who have sex with men

OBJECTIVES

Recent studies have shown that pre-exposure prophylaxis (PrEP) can substantially reduce the chance of acquiring HIV infection. However, PrEP efficacy has been found to be compromised in macaque studies if the challenge virus is antiretroviral therapy (ART)-resistant. Our objective was to evaluate the likelihood that a UK man who has sex with men (MSM) would be exposed to PrEP-resistant HIV in a homosexual encounter with an HIV-infectious partner.

METHODS

Data from the UK Collaborative HIV Cohort (UK CHIC) study were linked to the UK HIV Drug Resistance Database for HIV-1-positive MSM patients seen between 2005 and 2008. Patients were categorized as undiagnosed; diagnosed but ART-naïve; ART-experienced and on treatment; and ART-experienced and on a treatment interruption. Considering current PrEP regimens, resistance to (a) tenofovir (TDF) alone, (b) TDF and emtricitabine (FTC), and (c) TDF or FTC was estimated. Patients without resistance tests had PrEP resistance imputed using bootstrapping and logistic regression models.

RESULTS

The population-level prevalence of PrEP resistance in HIV-infectious individuals in 2008 was estimated to be 1.6, 0.9 and 4.1% for PrEP resistance definitions a, b and c, respectively. Prevalence in ART-experienced patients was highest, with negligible circulating resistance amongst ART-naïve individuals. The levels of resistance declined over the period of study.

CONCLUSIONS

Our analysis indicates low levels of resistance to proposed PrEP drugs. The estimated PrEP resistance prevalence in UK HIV-infected MSM is towards the lower range of values used in simulation studies which have suggested that circulating PrEP drug resistance will have a negligible impact on PrEP efficacy at the population level.

The reliability of high resolution ultrasound in the identification of pus collections in head and neck swellings

Head and neck swellings often present to oral and maxillofacial surgeons. It is often unclear whether a collection of pus is present. This information is essential for decisions regarding surgical intervention. Although ultrasound scanning (USS) is widely used to investigate the presence of a collection, the reliability and validity of this investigation in this context is uncertain. A retrospective review of 4000 consecutive head and neck USS reports over a 4 year period in the Cardiff University Health Board produced 43 cases in which ultrasound had been used to look for evidence of pus collection. The management and treatment outcome of these patients were reviewed and the data analysed. 36 of 43 patients had their swelling incised in theatre, and in 92% of these cases USS and clinical findings corresponded. Of the seven not taken to theatre, four were USS negative and three USS positive; in all seven cases the swelling resolved with antimicrobial therapy. Sensitivity and specificity of USS imaging to identify pus collection were very high, 96% and 82%, respectively. The evidence in this study indicates that USS is a very reliable diagnostic tool in the diagnosis of a collection as well as providing evidence that small collections of pus can resolve without surgical drainage.

Abstract B85: Role of the TASK2 in regulating breast cancer cell proliferation

Selective estrogen receptor (ER) modulators (SERMs) such as tamoxifen and raloxifene, and aromatase inhibitors are able to partially reduce incidence in high-risk women to develop ER-positive breast cancer but not all ER-positive neither ER-negative breast cancers. Thus, effective targets and agents for the prevention of both ER-positive and ER-negative breast cancer are urgently needed. Potassium ion channels are essential in maintaining cellular homeostasis in terms of transmitting signal molecules, regulating cell volume and secreting ions and hormones. A family of potassium channels, TASKs, is differentially expressed in normal breast tissue and breast cancer tissues. In particular, TASK2 mRNA was found upregulated in human breast carcinoma but not in normal mammary gland tissue, and TASK2 is significantly up-regulated in ER-negative vs ER-positive breast cancers across multiple studies among the Oncomine databases. We hypothesized that TASK2 plays an important role in regulating growth of breast cancer cells. We then knocked down the TASK2 gene expression using siRNA in ER-positive and ER-negative breast cancer cells. Transient knockdown of TASK2 suppressed cell proliferation significantly in 7/8 ER-negative and moderately in 3/5 ER-positive breast cancer cell lines. However, proliferation of an immortal breast epithelial cell line, MCF-10A, was not affected. We are now investigating the phenotypic alterations in normal and malignant breast cells after overexpressing or knocking down the TASK2 gene. Current results suggest that TASK2 plays an important role in breast cell growth. Thus, TASK2 is a potential novel target for future breast cancer prevention and treatment.

Citation Information: Cancer Prev Res 2011;4(10 Suppl):B85.