Abstract OT2-01-03: A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction

Endoscopic breast surgery was expected to be an adequate technique to complete cancer clearance and preservation of the patient's body image. However, this technique has limitations including incomplete internal movements and unstable vision of a two dimensional camera due to inflexible endoscopic instruments especially during the skin flap formation. High resolution, ten-fold image magnification, and three-dimensional optics of robotic surgery help overcome the limitations of endoscopic surgery, and thus robotic surgery has been adopted in a wide range of intracorporeal procedures including breast surgery. However, few studies have evaluated feasibility and safety of robotic assisted nipple sparing mastectomy (RANSM) and immediate breast reconstruction (IBR) for the treatment of breast cancer. There were not any investigation to assess patients' satisfaction of cosmetic effect after performing RANSM and IBR. This study is aim to verify the feasibility and the safety of RANSM and IBR and to analyze cosmetic effect of the procedure and satisfaction of patients. The target number of enrollments is 15 patients. Patients who are diagnosed with early breast cancer or BRCA 1/2 mutation carriers are enrolled. Female patients over 20 years old who are candidates to preserve nipple areolar complex and considered to perform reconstruction with implants are prospectively collected. Written informed consents are mandatory. Patients who are considered the high possibility of postoperative radiation therapy according to preoperative stage are not included in this study. We exclude patients who want to undergo other methods of breast reconstruction than breast reconstruction with implants. Patients will undergo RANSM and IBR through a single axillary skin incision simultaneously. Regular follow-up at 1 month and 6 months after RANSM and IBR is scheduled to record recovery of a patient, amount of a drain, date of drain removal, and postoperative complications. Patient satisfaction questionnaire will be completed on the last follow-up day. To evaluate the safety of robotic assisted surgery, the oncologic safety (margin status of nipple areolar complex), postoperative recovery of a patient, and postoperative complications are investigated. We compare preoperative and postoperative 6 month photographs of patients and estimate the surgical outcome by objective indicators to evaluate the cosmetic grading by plastic surgeons. Patients' satisfaction are assessed by questionnaire (BREAST-Q) at the 6-month visit.

Citation Format: Lee J, Park HS, Kim JH, Lee DW, Song SY, Lew DH, Kim JY, Kim SI, Cho YU, Lee H, Lee KB, Yoon KH. A prospective pilot study of simultaneous robotic assisted nipple sparing mastectomy and immediate reconstruction [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT2-01-03.

Flexibility of Semitransparent Perovskite Light-Emitting Diodes Investigated by Tensile Properties of the Perovskite Layer

Organic-inorganic hybrid perovskites have been investigated extensively for use in perovskite-based solar cells and light-emitting diodes (LEDs) because of their excellent electrical and optical properties. Although the flexibility of perovskite LEDs has been studied through empirical methods such as cyclic bending tests, the flexibility of the perovskite layer has not been investigated systemically. Here, flexible and semitransparent perovskite LEDs are fabricated: a PEDOT:PSS anode and Ag nanowire cathode allow for flexible and semitransparent devices, while the use of a conjugated polyelectrolyte as an interfacial layer reduces the electron injection barrier between the cathode and the electron transport layer (SPW-111), resulting in enhanced device efficiency. Cyclic bending tests performed on the electrodes and in situ hole-nanoindentation tests performed on the constituent materials suggest that mechanical failure occurs in the perovskite MAPbBr₃ layer during cyclic bending, leading to a decrease in the luminance. Tensile properties of the MAPbBr₃ layer explain the critical bending radius ( r_b) of the perovskite LEDs on the order of 1 mm.

Incidence and Risk Factors of Immediate Hypersensitivity Reactions Associated With Low-Osmolar Iodinated Contrast Media: A Longitudinal Study Based on a Real-Time Monitoring System

OBJECTIVES

We investigated the incidence of immediate hypersensitivity reaction (HSR) caused by different types of low-osmolar contrast media (LOCM) and cumulative exposure to LOCM.

METHODS

This cohort study included all consecutive patients who underwent LOCM-enhanced computed tomography from 2012 through 2014. We assessed 5 LOCM (iobitridol, iohexol, iomeprol, iopamidol, and iopromide). All patients were monitored for adverse events, and new symptoms and signs were recorded in real time using the Contrast Safety Monitoring and Management System (CoSM2oS).

RESULTS

The overall incidence of immediate HSR to LOCM was 0.97% (2004 events resulting from 205 726 exposures). Incidence differed significantly depending on whether the patient had a previous history of HSR to LOCM (0.80% in patients with no history and 16.99% in patients with a positive history of HSR to LOCM, P=.001). The incidence of HSR to individual LOCM ranged from 0.72% (iohexol) to 1.34% (iomeprol), although there were no significant differences across the 5 LOCM. A longitudinal analysis demonstrated that the incidence of HSR increased gradually with more frequent previous exposure to LOCM (HR=2.006 [95%CI, 1.517-2.653], P<.001). However, this cumulative increase in risk was observed in patients who had experienced HSR to LOCM, but not in those who had not.

CONCLUSION

The incidence of HSR did not differ significantly across the 5 LOCM assessed in the study. Repeated exposure to LOCM did not increase the risk of HSR among patients who had never experienced HSR to LOCM.

Direct costs of severe cutaneous adverse reactions in a tertiary hospital in Korea

BACKGROUND/AIMS

There are only a few reports on the direct costs of severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN), despite the tremendous negative impact these reactions can have on patients. We estimated the direct costs of treating SCARs.

METHODS

Patients admitted to a tertiary teaching hospital for the treatment of SCARs from January 1, 2005 to December 31, 2010 were included. Patients who had experienced SCARs during their admission for other medical conditions were excluded. The direct costs of hospitalization and outpatient department visits were collected. Inpatient and outpatient care costs were calculated, and factors affecting inpatient care costs were analyzed.

RESULTS

The total healthcare cost for the management of 73 SCAR patients (36 with DRESS, 21 with SJS, and 16 with TEN) was 752,067 US dollars (USD). Most of the costs were spent on inpatient care (703,832 USD). The median inpatient care cost per person was 3,720 (range, 1,133 to 107,490) USD for DRESS, 4,457 (range, 1,224 to 21,428) USD for SJS, and 8,061 (range, 1,127 to 52,220) USD for TEN. Longer hospitalization significantly increased the inpatient care costs of the patients with DRESS (by 428 USD [range, 395 to 461] per day). Longer hospitalization and death significantly increased the inpatient care costs of the patients with SJS/TEN (179 USD [range, 148 to 210] per day and an additional 14,425 USD [range, 9,513 to 19,337] for the deceased).

CONCLUSION

The management of SCARs required considerable direct medical costs. SCARs are not only a health problem but also a significant financial burden for the affected individuals.

Measurement of Reactor Antineutrino Oscillation Amplitude and Frequency at RENO

The RENO experiment reports more precisely measured values of θ_{13} and |Δm_{ee}^{2}| using ∼2200 live days of data. The amplitude and frequency of reactor electron antineutrino (ν[over ¯]_{e}) oscillation are measured by comparing the prompt signal spectra obtained from two identical near and far detectors. In the period between August 2011 and February 2018, the far (near) detector observed 103 212 (850 666) ν[over ¯]_{e} candidate events with a background fraction of 4.8% (2.0%). A clear energy and baseline dependent disappearance of reactor ν[over ¯]_{e} is observed in the deficit of the measured number of ν[over ¯]_{e}. Based on the measured far-to-near ratio of prompt spectra, we obtain sin^{2}2θ_{13}=0.0896±0.0048(stat)±0.0047(syst) and |Δm_{ee}^{2}|=[2.68±0.12(stat)±0.07(syst)]×10^{-3}  eV^{2}.

PLOD3 promotes lung metastasis via regulation of STAT3

Procollagen-lysine, 2-oxoglutarate 5-dioxygenase (PLOD3), a membrane-bound homodimeric enzyme, hydroxylates lysyl residues in collagen-like peptides; however, its role in lung cancer is unknown. This study aimed to investigate the role of PLOD3 as a pro-metastatic factor and to elucidate the underlying mechanism. First, we experimentally confirmed the release of PLOD3 in circulation in animal models, rendering it a potential serum biomarker for lung cancer in humans. Thereafter, we investigated the effects of PLOD3 overexpression and downregulation on cancer cell invasion and migration in vitro and in vivo, using human lung cancer cell lines and a mouse tumor xenograft model, respectively. Further, PLOD3 levels were determined in lung tissue samples from lung cancer patients. Functional analyses revealed that PLOD3 interacts with STAT3, thereby expressing matrix metalloproteinases (MMP-2 and MMP-9) and with urokinase plasminogen activator (uPA) to enhance tumor metastasis. PLOD3 and the STAT3 pathway were significantly correlated in the metastatic foci of lung cancer patients; PLOD3–STAT3 levels were highly correlated with a poor prognosis. These results indicate that PLOD3 promotes lung cancer metastasis in a RAS-MAP kinase pathway-independent manner. Therefore, secreted PLOD3 serves as a potent inducer of lung cancer metastasis and a potential therapeutic target to enhance survival in lung cancer.

Poly(styrene)-supported N-heterocyclic carbene coordinated iron chloride as a catalyst for delayed polyurethane polymerization

An advanced organometallic catalyst based on N-heterocyclic carbene (NHC) coordinated FeCl3 has been synthesized and used to control the reaction rate in polyurethane (PUR) polymerization. The imidazolium (Im)-based NHC was functionalized on the surface of the supporting material of bead-type chloromethyl polystyrene (PS) resin. The PS-Im-FeCl3 catalyst was synthesized through the coordination reaction between Im and FeCl3. The successful formation, functional groups, structure, and geometry of the PS-Im-FeCl3 catalysts were confirmed by Fourier transform infrared and X-ray photoelectron spectroscopy techniques. A thin layer of Im was observed to be coated uniformly on the PS bead surface and FeCl3 nanoparticles were observed to cover the coating layer homogeneously, as determined by field-emission scanning electron microscopy, transmission electron microscopy, and energy dispersive X-ray spectroscopy measurements. The PUR polymerization reaction was investigated through viscosity measurements and non-isothermal activation energy calculations by differential scanning calorimetry analysis. Based on the viscosity measurements, delayed PUR polymerization was achieved using the PS-Im-FeCl3 catalyst system. The highest viscosity (6000 cP) was achieved without any catalyst, with triphenylene bismuth, and with the PS-Im-FeCl3 catalyst after 23, 5, and 25 h of reaction time, respectively. Furthermore, the calculated activation energies (E a) were 27.92 and 36.35 kJ mol-1 for the no-catalyst and the PS-Im-FeCl3 systems, respectively. Thus, the viscosity measurements and DSC analyses confirm that the PS-Im-FeCl3 catalyst considerably increases the PUR reaction time. The Im-FeCl3 catalyst supported by CMPS can control the reaction rate in PUR synthesis because of its high activity. Thus, the PS-Im-FeCl3 catalyst can be used as a curing retardant in the PUR industry.

Disparities in survival after trimodality therapy for esophageal adenocarcinoma

Trimodality therapy with neoadjuvant chemoradiation followed by surgery has emerged as the standard of care for the treatment of locally advanced esophageal cancer. Yet, there is considerable variation in survival within this population. We sought to analyze factors associated with survival after trimodality therapy in esophageal adenocarcinoma. We identified 4,679 patients from the National Cancer Database (NCDB) of the American College of Surgeons who received chemotherapy and radiation prior to surgery for esophageal adenocarcinoma from 2006 to 2013. We excluded patients with stage IV disease and unknown pathological nodal status. We performed regression analyses using a Cox proportional hazards model to identify independent predictors of overall survival. On multivariate analysis, pathologic characteristics associated with decreased overall survival included stage, lymphovascular invasion, and positive surgical margins. Insurance status, age, and comorbidity index were also associated with decreased survival. We found that pathologically node-positive patients who received additional adjuvant chemotherapy were associated with improved survival. Compared to private insurance, Medicaid (HR 1.45, CI 1.22-1.73, P < 0.0001), Medicare (HR 1.17, CI 1.04-1.31, P = 0.0082), or having no insurance (HR 1.50, CI 1.17-1.92, P = 0.0012) were all negative predictors of overall survival. In patients with esophageal adenocarcinoma who have undergone trimodality therapy, a number of different factors are associated with overall survival. In particular, socioeconomic factors relating to access to care are independent predictors of survival. Despite receiving the standard of care, treatment disparities persist in this population of patients.

Deinococcus irradiatisoli sp. nov., isolated from gamma ray-irradiated soil

Strain 17bor-2^T, a gamma-resistant, pink-to-red-coloured, aerobic, catalase-positive, oxidase-negative and Gram-stain-negative bacterium, was isolated from gamma ray-irradiated soil. The isolate grew aerobically at 18-37 °C (optimum, 28-30 °C), pH 6.0-8.0 (pH 6.5-7.5) and in the presence of 0-1 % (w/v) NaCl (0 % NaCl). Phylogenetic analysis based on its 16S rRNA gene sequence indicated that strain 17bor-2^T belonged to the genus Deinococcus with a highest sequence similarity of 96.4 % to Deinococcus alpinitundrae ME-04-04-52^T. The major fatty acids of the strain were summed feature 3 (C16 : 1ω7c and/or C16 : 1ω6c), C16 : 0 and cyclo C17 : 0. The only respiratory quinone was MK-8. The major polar lipids of the strain were phosphoglycolipid, aminophospholipid and an unknown glycolipid. The DNA G+C content of strain 17bor-2^T was 62.8 mol%. On the basis of its phenotypic, genotypic and chemotaxonomic characteristics, strain 17bor-2^T should be classified as a novel species in the genus Deinococcus, for which the name Deinococcusirradiatisoli sp. nov. is proposed. The type strain is 17bor-2^T (=KCTC 33907^T=NBRC 113037^T).

Pontibacter terrae sp. nov., isolated from soil

A bacterial strain, designated 17SD1-15^T, was isolated from soil. Cells of this strain were Gram-stain-negative and aerobic rods. The major fatty acids of strain 17SD1-15^T were iso-C15 : 0 and summed feature 4 (anteiso-C17 : 1 B and/or iso-C17 : 1 I). The polar lipids were phosphatidylethanolamine, one phospholipid and five unidentified lipids. The G+C content of the genomic DNA of strain 17SD1-15^T was 49.0 mol%. The 16S rRNA gene sequence analysis showed that strain 17SD1-15^T was phylogenetically related to Pontibacter saemangeumensis GCM0142^T, Pontibacter korlensis X14-1^T, Pontibacter yuliensis H9X^T, Pontibacter diazotrophicus H4X^T and Pontibacter humi SWU8^T (98.3, 96.4, 96.4, 96.4 and 96.0 % sequence similarity, respectively). DNA-DNA relatedness between 17SD1-15^T and the most closely related type strain of Pontibacter species was 42.9±0.8 %. The low level of DNA-DNA relatedness identified strain 17SD1-15^T as a member of a novel species in the genus Pontibacter. The results of genotypic and phenotypic data, including chemotaxonomic traits, showed that strain 17SD1-15^T could be distinguished from its phylogenetically related species. Therefore, strain 17SD1-15^T represents a novel species within the genus Pontibacter, for which the name Pontibacter terrae sp. nov. is proposed, with the type strain 17SD1-15^T (=KCTC 52915^T=NBRC 113057^T).

Roseomonas radiodurans sp. nov., a gamma-radiation-resistant bacterium isolated from gamma ray-irradiated soil

A bacterial strain, designated 17Sr1-1^T, was isolated from gamma ray-irradiated soil. Cells of this strain were Gram-stain-negative, strictly aerobic, motile and non-spore-forming rods. Growth occurred at 18-42 ˚C and pH 6.0-8.0, but no growth occurred at 2 % NaCl concentration. The major fatty acids of strain 17Sr1-1^T were summed feature 8 (C18 : 1ω7c and/or C18 : 1ω6c), iso-C17 : 1ω5c and C16 : 0. The polar lipid profile contained diphosphatidylglycerol, glycolipid, phosphatidylcholine, phosphatidylethanolamine, phosphatidylglycerol and four unidentified lipids. The G+C content of the genomic DNA of 17Sr1-1^T was 71.9 mol%. The 16S rRNA gene sequence analysis showed that strain 17Sr1-1^T was phylogenetically related to Roseomonas pecuniae N75^T and Roseomonas rosea 173-96^T (96.6 and 96.3 % sequence similarity, respectively). The genotypic and phenotypic data showed that strain 17Sr1-1^T could be distinguished from its phylogenetically related species, and that this strain represented a novel species within the genus Roseomonas, for which the name Roseomonas radiodurans sp. nov. (type strain 17Sr1-1^T=KCTC 52899^T=NBRC 112872^T) is proposed as the first reported gamma ray-resistant Roseomonas species.

Search for Boosted Dark Matter Interacting with Electrons in Super-Kamiokande

A search for boosted dark matter using 161.9 kt yr of Super-Kamiokande IV data is presented. We search for an excess of elastically scattered electrons above the atmospheric neutrino background, with a visible energy between 100 MeV and 1 TeV, pointing back to the Galactic center or the Sun. No such excess is observed. Limits on boosted dark matter event rates in multiple angular cones around the Galactic center and Sun are calculated. Limits are also calculated for a baseline model of boosted dark matter produced from cold dark matter annihilation or decay. This is the first experimental search for boosted dark matter from the Galactic center or the Sun interacting in a terrestrial detector.

Prediction of egg freshness during storage using electronic nose

The aim of the present study was to investigate the potential of a fast gas chromatography (GC) e-nose for freshness discrimination and for prediction of storage time as well as sensory and internal quality changes during storage of hen eggs. All samples were obtained from the same egg production farm and stored at 20 °C for 20 d. Egg sampling was conducted every 0, 3, 6, 9, 12, 16, and 20 d. During each sampling time, 4 egg cartons (each containing 10 eggs) were randomly selected: one carton for Haugh units, one carton for sensory evaluation and 2 cartons for the e-nose experiment. The e-nose study included 2 independent test sets; calibration (35 samples) and validation (28 samples). Every sampling time, 5 replicates were prepared from one egg carton for calibration samples and 4 replicates were prepared from the remaining egg carton for validation samples. Sensors (peaks) were selected prior to multivariate chemometric analysis; qualitative sensors for principal component analysis (PCA) and discriminant factor analysis (DFA) and quantitative sensors for partial least square (PLS) modeling. PCA and DFA confirmed the difference in volatile profiles of egg samples from 7 different storage times accounting for a total variance of 95.7% and 93.71%, respectively. Models for predicting storage time, Haugh units, odor score, and overall acceptability score from e-nose data were developed using calibration samples by PLS regression. The results showed that these quality indices were well predicted from the e- nose signals, with correlation coefficients of R² = 0.9441, R² = 0.9511, R² = 0.9725, and R² = 0.9530 and with training errors of 0.887, 1.24, 0.626, and 0.629, respectively. As a result of ANOVA, most of the PLS model results were not significantly (P > 0.05) different from the corresponding reference values. These results proved that the fast GC electronic nose has the potential to assess egg freshness and feasibility to predict multiple egg freshness indices during its circulation in the supply chain.

Predictive modeling for monitoring egg freshness during variable temperature storage conditions

The overall aim of this research was to develop egg freshness prediction models in terms of selected quality indices. Six experiments (4 constant temperatures and 2 variable temperatures) were carried out on hen eggs for a total period of 10, 21, 26, 13, and 105 d at storage temperatures of 30, 20, 20 to 10, 30 to 10, and 5 and 10°C, to observe trends in the relative weight loss (RWL), Haugh unit (HU), yolk index (YI), albumin index (AI), yolk pH, and albumin pH. The results showed that there was an increasing trend in the RWL and a decreasing trend in the YI, AI, and HU for all temperature conditions. The changes in the yolk and albumin pH were not uniform. The data from the constant temperature conditions were used to determine the coefficients of the egg quality prediction models, which consisted of the primary model controlling the change rate of the quality indicator at a temperature condition in differential equation form, and the secondary model controlling the change rate with temperature, which was in quadratic polynomial form. The models were applied to the data from the fluctuating temperature conditions, and the zeroth, third, and eighth order kinetic models described the stepwise change in the RWL, HU, and YI, respectively. The accuracy and bias factor values for the RWL, HU, and YI were 1.116 and 0.940, 1.028 and 1.001, and 1.038 and 0.966, respectively. It can be concluded that the models can be used to predict egg freshness in terms of the RWL, HU, and YI at any temperature condition with in the range of 5 to 30°C during storage.

Growth of Nanosized Single Crystals for Efficient Perovskite Light-Emitting Diodes

Organic-inorganic hybrid perovskites are emerging as promising emitting materials due to their narrow full-width at half-maximum emissions, color tunability, and high photoluminescence quantum yields (PLQYs). However, the thermal generation of free charges at room temperature results in a low radiative recombination rate and an excitation-intensity-dependent PLQY, which is associated with the trap density. Here, we report perovskite films composed of uniform nanosized single crystals (average diameter = 31.7 nm) produced by introducing bulky amine ligands and performing the growth at a lower temperature. By effectively controlling the crystal growth, we maximized the radiative bimolecular recombination yield by reducing the trap density and spatially confining the charges. Finally, highly bright and efficient green emissive perovskite light-emitting diodes that do not suffer from electroluminescence blinking were achieved with a luminance of up to 55 400 cd m^-2, current efficiency of 55.2 cd A^-1, and external quantum efficiency of 12.1%.

Therapeutic Potential of a Novel Necrosis Inhibitor, 7-Amino-Indole, in Myocardial Ischemia-Reperfusion Injury

Supplemental Digital Content is available in the text.

Opening of mitochondrial permeability transition pore and Ca²⁺ overload are main contributors to myocardial ischemia–reperfusion injury, which paradoxically causes a wide variety of myocardial damage. We investigated the protective role of a novel necrosis inhibitor (NecroX-7; NecX) against myocardial ischemia–reperfusion injury using in vitro and in vivo models. H9C2 rat cardiomyoblasts and neonatal cardiomyocytes were exposed to hypoxia–reoxygenation stress after pre-treatment with NecX, vitamin C, a combination of vitamin C and E, N-acetylcysteine, an apoptosis inhibitor (Z-VAD-fmk), or cyclosporine A. The main mechanism of cell death after hypoxia–reoxygenation stress was not apoptosis but necrosis, which was prevented by NecX. Protective effect of NecX was based on its potent reactive oxygen species scavenging activity, especially on mitochondrial reactive oxygen species. NecX preserved mitochondrial membrane potential through prevention of Ca²⁺ influx and inhibition of mitochondrial permeability transition pore opening, which was more potent than that by cyclosporine A. Using Sprague-Dawley rats exposed to myocardial ischemia for 45 minutes followed by reperfusion, we compared therapeutic efficacies of NecX with cyclosporine A, vitamin C, a combination of vitamin C and E, and 5% dextrose, each administered 5 minutes before reperfusion. NecX markedly inhibited myocardial necrosis and reduced fibrotic area to a greater extent than did cyclosporine A and other treated groups. In addition, NecX preserved systolic function and prevented pathological dilatory remodeling of left ventricle. The novel necrosis inhibitor has a significant protective effect against myocardial ischemia–reperfusion injury through inhibition of mitochondrial permeability transition pore opening, indicating that it is a promising candidate for cardioprotective adjunctive measure on top of reperfusion therapy.