PP179. The influence of prior abortion on rates of gestational hypertension/pre-eclampsia and spontaneous preterm delivery in nulliparous women

INTRODUCTION

Gestational hypertension/preeclampsia (GH) is clearly a heterogeneous condition of which the pathogenesis could be different in women with various risk factors. Nulliparity is a known risk factor for GH, however a previous abortion (spontaneous or induced) may be associated with a lower risk of GH.

OBJECTIVES

To examine the effect of abortion history on rates of GH and spontaneous preterm delivery (SPTD) and in nulliparous women.

METHODS

Nulliparous women with an initial prenatal screening at <13 weeks' gestation and a current singleton gestation delivering between 6/2006 and 6/2011 that voluntarily enrolled for risk assessment-case management services were identified from a database of clinical information. Excluded were women reporting a history of both spontaneous (SAB) and induced (IAB) abortions, or with a priori diagnosis of diabetes. Rates of SPTD and GH were compared between women with SAB or IAB history (AB group) and a reference group of primigravid women using Pearson's chi-square, Student's t, Kruskal-Wallis H, and Mann-Whitney U statistics.

RESULTS

Of the 75,487 women studied, 5.7% (n=4288) reported a history of IAB and 24.3% (n=18,328) reported a history of SAB. Overall, 301 women (0.4%) experienced a SAB at <20 weeks in the index pregnancy. Of those 75,186 with delivery ⩾20 weeks, the incidence of SPTD was 6.1% in controls vs. 6.0% in the IAB/SAB group (p=0.550). Rates of GH were 10.2% in controls vs. 8.0% (p<0.001) in the AB group despite the AB group having significantly (p<0.001) higher rates of women of African-American race (8.5% vs. 5.5%); age >34years (23.9% vs. 10.0%); and obesity (19.6% vs. 16.6%). For women with >2 AB's significant differences were observed in rates of SPTD vs. controls (8.2% vs. 6.0%, p<0.001), but rates of GH were similar (9.2% vs. 10.2%, p=0.188). (1)p<0.001 vs. 0 AB group.

CONCLUSION

In nulliparous women, prior AB is associated with a reduction in risk for GH. Risk for SPTD increases only in those with >2 prior AB's.

Bile vomiting in paediatrics: what do we really know?

Bile vomiting is clinically significant in neonates and children, indicating intestinal obstruction until proven otherwise. The aim of this study was to assess whether nursing staff within a children's hospital were able to accurately identify bilious vomiting and if a deficiency existed, whether educational posters could rectify this problem. A primary audit was conducted in the Royal Aberdeen Children's Hospital evaluating the ability of nursing staff to identify bile vomit and its significance. Educational posters were distributed and a secondary audit was conducted after six months to complete the audit cycle. The second audit also compared the knowledge of different medical professionals. In the primary audit, 41% of nurses selected the colour yellow, compared with 18% of nurses in the second audit with approximately 70% selecting dark-green. Thirty-three percent of nurses in the primary audit confirmed intestinal obstruction as the cause of bile vomiting, compared with 64% of nurses in the secondary audit. In conclusion, this study identified a deficiency in the recognition of bile vomiting among nurses, but demonstrates that the use of educational posters can significantly improve knowledge. This can be beneficial in the early recognition of this potential surgical emergency.

Critical role of chemokine (C-C motif) receptor 2 (CCR2) in the KKAy + Apoe -/- mouse model of the metabolic syndrome

AIMS/HYPOTHESIS

Chemokines and their receptors such as chemokine (C-C motif) receptor 2 (CCR2) may contribute to the pathogenesis of the metabolic syndrome via their effects on inflammatory monocytes. Increased accumulation of CCR2-driven inflammatory monocytes in epididymal fat pads is thought to favour the development of insulin resistance. Ultimately, the resulting hyperglycaemia and dyslipidaemia contribute to development of the metabolic syndrome complications such as cardiovascular disease and diabetic nephropathy. Our goal was to elucidate the role of CCR2 and inflammatory monocytes in a mouse model that resembles the human metabolic syndrome.

METHODS

We generated a model of the metabolic syndrome by backcrossing KKAy ( + ) with Apoe ( -/- ) mice (KKAy ( + ) Apoe ( -/- )) and studied the role of CCR2 in this model system.

RESULTS

KKAy ( + ) Apoe ( -/- ) mice were characterised by the presence of obesity, insulin resistance, dyslipidaemia and increased systemic inflammation. This model also manifested two complications of the metabolic syndrome: atherosclerosis and diabetic nephropathy. Inactivation of Ccr2 in KKAy (+) Apoe ( -/- ) mice protected against the metabolic syndrome, as well as atherosclerosis and diabetic nephropathy. This protective phenotype was associated with a reduced number of inflammatory monocytes in the liver and muscle, but not in the epididymal fat pads; circulating levels of adipokines such as leptin, resistin and adiponectin were also not reduced. Interestingly, the proportion of inflammatory monocytes in the liver, pancreas and muscle, but not in the epididymal fat pads, correlated significantly with peripheral glucose levels.

CONCLUSIONS/INTERPRETATION

CCR2-driven inflammatory monocyte accumulation in the liver and muscle may be a critical pathogenic factor in the development of the metabolic syndrome.

Patent data mining: a tool for accelerating HIV vaccine innovation

Global access to advanced vaccine technologies is challenged by the interrelated components of intellectual property (IP) management strategies, technology transfer (legal and technical) capabilities and the capacity necessary for accelerating R&D, commercialization and delivery of vaccines. Due to a negative association with the management of IP, patents are often overlooked as a vast resource of freely available, information akin to scientific journals as well as business and technological information and trends fundamental for formulating policies and IP management strategies. Therefore, a fundamental step towards facilitating global vaccine access will be the assembly, organization and analysis of patent landscapes, to identify the amount of patenting, ownership (assignees) and fields of technology covered. This is critical for making informed decisions (e.g., identifying licensees, building research and product development collaborations, and ascertaining freedom to operate). Such information is of particular interest to the HIV vaccine community where the HIV Vaccine Enterprise, have voiced concern that IP rights (particularly patents and trade secrets) may prevent data and materials sharing, delaying progress in research and development of a HIV vaccine. We have compiled and analyzed a representative HIV vaccine patent landscape for a prime-boost, DNA/adenoviral vaccine platform, as an example for identifying obstacles, maximizing opportunities and making informed IP management strategy decisions towards the development and deployment of an efficacious HIV vaccine.

Abstract P1-03-06: Population Based In Vivo Biomarker Discovery Using Engineered Human Tumors

Background:

Tumors from patients exhibit significant inter-tumor variation, where each tumor harbors a unique set of genetic alterations that impact prognosis and response to treatment. Unfortunately, this variation contributes to low response rates in the clinic and creates significant challenges for treating patients with appropriate drugs. Cancer cell line based xenografts have traditionally been the preclinical model of choice to assess the efficacy of clinical compounds; however, such in vitro models exhibit inherent artifacts, and are unable to adequately capture natural variation seen in human tumor populations. It has therefore become a priority in oncology and personalized medicine to match patients to drugs that will result in a favorable treatment outcome. In this report, we describe a population based approach for response prediction featuring naturally occurring variation in tumors derived from genetically defined human-in-mouse models of cancer. Materials and Methods:

A population of De novo human breast tumors were generated by genetically engineering normal primary human breast epithelial cells with HER2 and SV40 early region (HER2/SV40er) or KRAS and SV40 early region (KRAS/SV40er) in an in vivo Human-In-Mouse (HIM) tissue transgenic model (Wu et al, Proc Natl Acad Sci U S A 2009, 106: 7022-2027). Each tumor of the population has been comprehensively characterized histopathologically, and at the RNA and DNA level. Furthermore, the population has been adapted to conduct quantitative efficacy studies of anti-cancer agents and combinations. Results:

The HER2/SV40er and the KRAS/SV40er HIM tumors develop as invasive human breast adenocarcinoma that are histologically similar to those observed in patients. Microarray and CGH profiling demonstrated significant inter-tumor variation among the established tumors, as has been reported for patient tumors. Moreover, the KRAS/SV40er tumors clustered with basal type breast cancers from patients, a poor prognosis human breast cancer subtype. Both HER2/SV40er and KRAS/SV40er tumors exhibited variable responses to treatments with the potent selective triple VEGFR inhibitor, tivozanib. Further characterization of those tumors, both pre-and post-treatment, identified potential biomarkers for tumor response to tivozanib. Discussion:

The genetically defined human-in-mouse tumors exhibited natural variations similar to that occurs in human cancer. This population-based HIM system enables us to identify and validate biomarkers of therapeutic response in an in vivo human tumor model. Figure available in online version.