Use of text-message reminders to improve participation in a population-based breast cancer screening program

To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.

Current status of prenatal diagnosis in Cuba: causes of low prevalence of Down syndrome

OBJECTIVES

To analyze trends in cytogenetic prenatal diagnosis in Cuba and to analyze possible causes leading to a low Down syndrome prevalence in a country where the triple test is not available.

METHODS

An analysis of the Cuban program in prenatal cytogenetic diagnosis from 1984 to 2012 was conducted. Results are described, with particular emphasis on indications, abnormal results, types of invasive procedures, and terminations of pregnancy.

RESULTS

Cytogenetic prenatal diagnostic analyses (n = 75,095) were conducted; maternal age was the indication for 77.9% of the amniocenteses and chorionic villus samplings. The detection rate of chromosomally abnormal pregnancies was 2.3% for maternal age and increased to 8-9% for other indications. When a chromosomal abnormality was identified, 88.5% terminated the pregnancy. In 2002, the live birth prevalence of Down syndrome was 8.4 per 10,000 live births, and in 2012, 7 per 10,000.

CONCLUSION

Prenatal diagnosis in Cuba has contributed to a significant reduction in chromosomal aberrations. The impact increased because of the demographic trends of the population, the high index of terminations of pregnancy, and the establishment of a network of cytogenetic laboratories throughout Cuba.

Targeting multiplicity: the key factor for anti-cancer nanoparticles

In this mini-review, we focus on different strategies to bring nanotools specifically to cancer cells. We discuss about a better targeting of tumor, combining the characteristics of tumor environment, the increase in nanoparticles life time, the biomarkers overexpressed on cancer cells and different physical methods for non invasive therapies. Here we detail the necessity of a synergy between passive and active targeting for an actual specificity of cancer cells.

[Outcome of laparoscopic Heller myotomy in children]

AIM

The appropriate management of achalasia in children remains debatable. The present study aimed to evaluate the outcome of laparoscopic Heller myotomy by assessing short- and mid-term issues.

METHODS

Children submitted to surgery from 2002 to 2010 were included. Surgery was proposed after failure of endoscopic dilatations. All patients underwent esophagocardiomyotomy (Heller) plus anterior fundoplication (Dor) by laparoscopy. Demographics, presentation symptoms and perioperative details were analyzed. The outcomes were assessed both by medical records and the application of a 14 items (score 0-worst to 4-best/normal) self-evaluation questionnaire (modified GIQLI - covering only upper gastrointestinal symptoms).

RESULTS

Six patients (5 males) with a median age of 12.2 years (range: 0.8-14.2) were submitted to surgery. The presenting symptoms were: dysphagia (83.3%), weight loss (50%), vomiting (33.3%), chronic cough (33.3%), and chest pain (16.7%). All patients were operated on by laparoscopy with no conversions; there were no intra or postoperative complications. At a median follow-up of 5 years (range: 2-10) none of the patients were re-operated. Five patients have normal eating habits; the remaining case presented recurrent episodes of dysphagia requiring regular endoscopic dilatations (every 6 months). The total GIQLI presented a mean score of 49.3 (range, 45-52) representing 88.1% of the theoretical maximum. The score for frequency of dysphagia episodes was 1.6 +/- 1.4; all patients scored 3 for the grade of dysphagia.

CONCLUSIONS

Laparoscopic Heller myotomy is effective and safe for achalasia in children, offering a good and durable quality of life; although frequent, the dysphagia episodes were mild.

[Functional neuroanatomy: sensorimotor system]

The sensorimotor flow of information can be divided in three steps: perception, processing and reaction. Environmental impulses are conducted through receptors to the central nervous system (CNS). The impulses arriving in the somatosensory cortex are processed through complex interactions between sensory and motor areas. The motor action in response to the environmental changes is transferred from the motor cortex via the pyramidal tract, spinal tracts and motor neurons to the respective muscles. With functional magnetic resonance imaging (fMRI) it is possible to assess somatosensory and motor activation in the different cortical areas involved. Clinically, this information is used to assess the local relationship between brain tumors and functionally important areas. This is important to ensure an optimal individual therapeutic approach with the aim of an as radical as possible tumor resection with preservation of the motor and somatosensory functions. Furthermore, fMRI enables the evaluation of pathological changes of cerebral activation. This review describes the functional somatosensory and motor systems and gives an insight into the potential of fMRI.

Serum vitamin D and parathyroid hormone in relation to cardiac structure and function: the ICELAND-MI substudy of AGES-Reykjavik

CONTEXT

Emerging evidence suggests that vitamin D and PTH may play a role in the development of cardiac diseases.

OBJECTIVE

We investigated whether 25-hydroxyvitamin D (25OHD) and PTH concentrations are cross-sectionally associated with cardiac structure and function using magnetic resonance imaging (MRI).

DESIGN, SETTING, AND PARTICIPANTS

ICELAND-MI is a substudy of the Age, Gene/Environment Susceptibility-Reykjavik Study, an older-aged community-dwelling cohort with oversampling of participants with diabetes (29%) and measurements between 2004 and 2007. Serum 25OHD concentrations were measured using an immunoassay (n = 992). Intact PTH concentrations were measured using a 2-site immunoassay (n = 203). We included 969 participants for this cross-sectional analysis (mean age 76 ± 5.3 years, 51% female). Mean 25OHD was 54.2 ± 25.5 nmol/L and the median PTH was 4.5 pmol/L (range 1.5-18).

MAIN OUTCOMES

MRI to measure cardiac structure and function was the main outcome.

RESULTS

The lowest 25OHD category (<25 nmol/L) compared with the highest category (≥75 nmol/L) was associated with a smaller left and right atrial area in unadjusted analyses; however, the associations became nonsignificant after adjustment for covariates. The highest PTH quartile compared with the lowest quartile was significantly associated with a 7.3 g (95% confidence interval 0.8, 13.8) greater left ventricular (LV) mass and a 5.1% (-9.1, -1.1) lower LV ejection fraction compared with the lowest PTH quartile in the fully adjusted model.

CONCLUSIONS

Serum 25OHD concentrations were not associated with MRI measures in an older white population. Higher PTH concentrations were associated with greater LV mass and lower systolic function and may point to a potential role for PTH as a determinant of cardiac remodeling.

Tentorial dural fistulas: endovascular management and description of the medial dural-tentorial branch of the superior cerebellar artery

BACKGROUND AND PURPOSE

TDAVFs are uncommon causes of spontaneous intracranial hemorrhage. A retrospective review of their management was performed after repeatedly observing a previously under-recognized medial dural-tentorial branch of the SCA.

MATERIALS AND METHODS

Thirteen patients were diagnosed with TDAVFs by CT/MR imaging and DSA during a 5.8-year period. Seven patients presented after intracranial hemorrhage. Twelve patients were treated endovascularly, and one, surgically.

RESULTS

Eleven TDAVFs were located in the midline (7 at the falx cerebelli and 4 at the torcular), and 2 were petrotentorial. All torcular TDAVFs were associated with sinus thrombosis and showed bidirectional drainage relative to the tentorium. No sinus thrombosis was seen in the falx cerebelli subtype, which drained infratentorially only, except in 1 patient who had had unrelated surgery previously. Venous drainage was directly to cortical veins except for 1 petrotentorial and 2 torcular TDAVFs. A branch of the SCA, the medial dural-tentorial artery, was observed in 5 midline TDAVFs. Its anatomy was defined with selective angiography. Endovascular therapy resulted in a cure in 5 and subtotal occlusion in 6, and staged treatment is ongoing in 1 patient. One patient was cured after surgery.

CONCLUSIONS

TDAVFs frequently cause intracranial hemorrhage and therefore warrant treatment. Endovascular therapy proved effective in this series, and arteriography was essential for understanding the various fistula subtypes and for treatment planning. We emphasize the importance of recognizing the medial dural-tentorial artery of the SCA with its characteristic course along the tentorium on angiography. This artery should be included in future anatomic descriptions of the cranial blood supply.

Aflatoxins B1 and G 1 solubility in standard solutions and stability during cold storage

In the present work we study the use of different solvents to store aflatoxins B1 and G1 standard solutions. We have obtained significant differences between aflatoxin B1 and G1 In ethyl acetate, methanol and water, with aflatoxin G1 being less stable. We recommend chloroform as the election solvent to store the aflatoxin solutions. The fact that aflatoxins are highly stable in water may have a potential use in experiments of biological activity.

Van-Gogh-like 2 antagonises the canonical WNT pathway and is methylated in colorectal cancers

Background:

Aberrant activation of the canonical WNT signaling is a feature of colorectal cancer (CRC). Van-Gogh-like 2 (VANGL2) belongs to the non-canonical WNT pathway whose activation inhibits canonical WNT signaling. In this study, we investigated the role of VANGL2 and its epigenetic regulation in CRC.

Methods:

Van-Gogh-like 2 expression and promoter methylation after 5-aza-2′-deoxycytidine (5-aza) treatment were evaluated in CRC cells. DNA samples from 418 sporadic CRCs were tested for VANGL2 promoter methylation and microsatellite instability (MSI). Proliferation, colony formation and activation of the WNT pathway were tested in cells after VANGL2 overexpression.

Results:

Van-Gogh-like 2 mRNA was significantly higher in 5-aza-treated RKO, LOVO and SW48, whereas no differences were found in SW480. Van-Gogh-like 2 was fully methylated in RKO, SW48, HCT116, DLD1 and Caco2; partially methylated in LOVO, LS174T and SW837; and unmethylated in SW480, SW620 and HT29. Higher expression of VANGL2 mRNA was found in the unmethylated cell lines. In CRC specimens (8.93% MSI), methylated VANGL2 was associated with MSI, higher grade, proximal colon location and BRAF mutation. Van-Gogh-like 2 overexpression in SW480 significantly decreased proliferation, colony formation and β-catenin levels.

Conclusion:

Van-Gogh-like 2 is frequently methylated in MSI-CRCs with BRAF mutation and may act as a tumour suppressor gene, counteracting WNT/β-catenin signaling.

Predicting survival after liver transplantation using up-to-seven criteria in patients with hepatocellular carcinoma

BACKGROUND

Liver transplantation is a controversial issue in the initial management of hepatocellular carcinoma (HCC). The aim of this study was to demonstrate that up-to-seven could be useful as a model in evaluating potential candidates for liver transplantation for HCC.

METHODS

Between January 1997 and December 2010, 84 patients undergoing liver transplantation were analyzed for HCC. Pathologic variables included the number of lesions, maximal tumor diameter, vascular invasion, and tumor grade. The following variables were recorded: Age, gender, recurrence of HCC, survival, donor age, incidental, Milan criteria, Model for End-Stage Liver Disease score, and alpha-fetoprotein (AFP) levels. To evaluate variables we used the Kaplan-Meier method, Cox regression and Kolmogorov-Smirnov test.

RESULTS

There were 68 (80.9%) patients within up-to-seven criteria and 16 (19.1%) beyond this criteria. AFP levels were 96.4 versus 464.3 ng/dL in patients within versus beyond up-to-seven criteria. The median diameter of the largest nodule was 22.2 versus 32.0 mm in patients within versus beyond up-to-seven criteria, respectively. The median sum of nodules was 1.8 and 5.6 nodules in patients within versus beyond up-to-seven criteria. Vascular invasion was present in 11 (13.0%) patients within versus 7 (8.3%) beyond. Recurrence was observed in 9 (10.7%) patients and only 3 were beyond up-to-seven criteria, 2 had vascular invasion, and another showed poor differentiation. Post liver transplantation survival rates were 87.7%, 74.5%, and 65.3% at 1, 3, and 5 years in patients within up-to-seven versus 80.7%, 51.7%, and 32.1% beyond (P = .03). Similar results were observed when we applied Milan criteria or expanded Milan criteria. The largest nodule was the only predictive factor after proportional hazard Cox regression application (Beta = 0.037; exponent = 1.0377; Wald = 4.542; P = .03). In the present study, up-to-seven criteria could be useful to evaluate potential liver transplant candidates due to HCC.

Rheology of human blood plasma: viscoelastic versus Newtonian behavior

We investigate the rheological characteristics of human blood plasma in shear and elongational flows. While we can confirm a Newtonian behavior in shear flow within experimental resolution, we find a viscoelastic behavior of blood plasma in the pure extensional flow of a capillary breakup rheometer. The influence of the viscoelasticity of blood plasma on capillary blood flow is tested in a microfluidic device with a contraction-expansion geometry. Differential pressure measurements revealed that the plasma has a pronounced flow resistance compared to that of pure water. Supplementary measurements indicate that the viscoelasticity of the plasma might even lead to viscoelastic instabilities under certain conditions. Our findings show that the viscoelastic properties of plasma should not be ignored in future studies on blood flow.

Early psychological care of the French victims of the Costa Concordia shipwreck

Most of the French passengers who survived the shipwreck of the cruise ship Costa Concordia were repatriatedfrom Italy to Marseille, one of the stopovers of the cruise. The shipwreck happened during the nightof 13th-14th January 2012 and entailed the forced evacuation of 4195 passengers and crewmembers.Thirty-two persons died and 2 others are still reported missing. The massive and unexpected inflow of402 French citizens in the port of Marseille required the quick setting up of welcome facilities, not only tosolve logistical problems, but also to address psychological and sometimes even medical problems. ThePrehospital Psychological Emergency Service (CUMP) and the Prehospital Emergency Medical Service(SAMU) of Marseille examined 196 persons in total, and were able to avoid a great number of emergencyadmissions deemed necessary because of difficult psychological situations (death, missing or lost persons,acute stress). The objective of this report is to rapidly present the emergency committee as a whole andto describe in more detail the work that the CUMP accomplished during the 36 hours necessary to takecharge of the majority of the French passengers of the Costa Concordia.

[Initial situation and approach to the care of migraine in neurology services in Spain: the PRIMERA study]

INTRODUCTION

Despite the high degree of disability it entails, many patients with migraine have never visited their doctor for this reason. It is necessary to conduct a study to examine the characteristics of first-time visits as a step that must be carried out prior to establishing specific intervention measures for this group of patients.

AIM

To determine the profile of the patients with migraine who visit a neurology service for the first time, together with the diagnostic and therapeutic attitudes that neurologists display towards them.

PATIENTS AND METHODS

We conducted a cross-sectional, multi-centre study of neurology services across the country. The research included 168 neurologists who recruited 851 patients (74.6% females; mean age: 34.0 ± 10.7 years). Disability was assessed by means of the specific migraine questionnaire (Headache Impact Test) and the generic disability questionnaire (Sheehan Disability Scale).

RESULTS

A third (66.5%) of the patients went for consultation following their doctor's advice, while the remaining 33.5% went on their own accord. Only 55.9% had been previously diagnosed with migraine. The main reasons for visiting were ineffective symptomatic treatment (25%) and an increase in the frequency or intensity of the attacks (23.4%). Although 70.3% of the patients had high disability scores on the Headache Impact Test, only 17.4% used specific treatment and only 13.3% were on preventive treatment.

CONCLUSIONS

The PRIMERA study confirms, once again, that migraine is an under-diagnosed and under-treated condition in our setting, which means that specific educational interventions and training are still required for this pathology.

The effects of six electronic apex locators on pacemaker function: an in vitro study

AIM

To assess the effects of six electronic apex locators (EALs) on pacemaker function in vitro.

METHODOLOGY

Six EALs (Mini Apex Locator®, Dentaport ZX®, Novapex®, Raypex5®, Root ZX mini®, and Justy II®) were tested for electromagnetic interference (EMI) with one pacemaker (Saint Jude Medical). The pacemaker, with a single electrode, was immersed in a saline solution bath adjusted to 400-800 hms to simulate the electrical resistance of the human body and to register the activity by the system. The pacemaker was tested with each of the EALs to analyse the presence of EMI with the EAL switched on, the EAL switched off and during EAL operation. Each series of tests began with a 15-second baseline recording (R0) and continued until all the recording conditions had been covered. The conditions were as follows: R1: recording with the lead of the EAL <2 cm from the tip of the electrode; R2: recording with the lead of the EAL <2 cm from the generator; R3: recording with the lead of the EAL <2 cm from the sensing arc; and R4: recording with the lead of the EAL 15 cm from the sensing arc. If any of the EALs produced interference, its characteristics were categorized.

RESULTS

When the lead of the EAL was <2 cm from the tip of the electrode, the majority of the EALs tested produced only background noise. Only one (the Mini Apex Locator) resulted in EMI that was detected as false heart activity. When the EAL was <2 cm from the generator, just one EAL detected background noise (the Mini Apex Locator). When the EAL was <2 cm from the sensing arc or 15 cm from the sensing arc, the recordings were not affected by any of the EALs. There were no significant differences amongst the EALs analysed with respect to the production of EMI.

CONCLUSIONS

EMI occurred when the EALs were placed close to the tip of the electrode and occasionally when close to the pacemaker; however, no EMI was detected when the EALs were placed near to or 15 cm from the sensing arc in this laboratory experimental model.

Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain

AIMS

To compare different methods in order to assess adherence and persistence with oral endocrine therapy in women diagnosed with breast cancer (BC) in Catalonia.

MATERIALS AND METHODS

This study covered all women newly diagnosed with stage I, II or IIIa BC and positive hormone receptors at six hospitals in Catalonia (Spain) in 2004. Adherence was assessed on the basis of physician report and patient self-report using a telephone questionnaire. Persistence was measured by refill prescriptions. We used the Kappa index to compare adherence measures and logistic regression to evaluate adherence-related risk factors.

RESULTS

The study covered a total of 692 women. Adherence ranged from 92% (self-report) to 94.7% (physician report), depending on the measure used; persistence was 74.7% at 5 years of follow-up. Low concordance between measures was observed (Kappa range: 0.018-0.267). Patients aged 50-74 years showed higher adherence than those aged <50 years. Adherence was also associated with: adjuvant chemotherapy and sequential hormonal therapy.

CONCLUSIONS

Concordance between the different measures was remarkably low, indicating the need for further research. Adherence is an issue in the management of BC patients taking oral drugs, and should be assessed in clinical practice.

Lifelong physical activity in maintaining bone strength in older men and women of the Age, Gene/Environment Susceptibility-Reykjavik Study

We examined if lifelong physical activity is important for maintaining bone strength in the elderly. Associations of quantitative computerized tomography-acquired bone measures (vertebral and femoral) and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study. Results conclude lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health later in life.

INTRODUCTION

Skeletal loading is thought to modulate the loss of bone in later life, and physical activity is a chief means of affecting bone strength by skeletal loading. Despite much discussion regarding lifelong versus early adulthood physical activity for preventing bone loss later in life, inconsistency still exists regarding how to maintain bone mass later in life (≥65 years).

METHODS

We examined if lifelong physical activity is important for maintaining bone strength in the elderly.

RESULTS

The associations of quantitative computerized tomography-acquired vertebral and femoral bone measures and self-reported physical activity in mid-life (mean age, 50 years), in old age (≥65 years), and throughout life (recalled during old age) were investigated in 2,110 men and 2,682 women in the AGES-Reykjavik Study.

CONCLUSION

Our findings conclude that lifelong physical activity with continuation into old age (≥65 years) best maintains better bone health in the elderly.

Permanent genetic resources added to Molecular Ecology Resources Database 1 December 2011-31 January 2012

This article documents the addition of 473 microsatellite marker loci and 71 pairs of single-nucleotide polymorphism (SNP) sequencing primers to the Molecular Ecology Resources Database. Loci were developed for the following species: Barteria fistulosa, Bombus morio, Galaxias platei, Hematodinium perezi, Macrocentrus cingulum Brischke (a.k.a. M. abdominalis Fab., M. grandii Goidanich or M. gifuensis Ashmead), Micropogonias furnieri, Nerita melanotragus, Nilaparvata lugens Stål, Sciaenops ocellatus, Scomber scombrus, Spodoptera frugiperda and Turdus lherminieri. These loci were cross-tested on the following species: Barteria dewevrei, Barteria nigritana, Barteria solida, Cynoscion acoupa, Cynoscion jamaicensis, Cynoscion leiarchus, Cynoscion nebulosus, Cynoscion striatus, Cynoscion virescens, Macrodon ancylodon, Menticirrhus americanus, Nilaparvata muiri and Umbrina canosai. This article also documents the addition of 116 sequencing primer pairs for Dicentrarchus labrax.

High-resolution 3D-constructive interference in steady-state MR imaging and 3D time-of-flight MR angiography in neurovascular compression: a comparison between 3T and 1.5T

BACKGROUND AND PURPOSE

High-resolution MR imaging is useful for diagnosis and preoperative planning in patients with NVC. Because high-field MR imaging promises higher SNR and resolution, the aim of this study was to determine the value of high-resolution 3D-CISS and 3D-TOF MRA at 3T compared with 1.5T in patients with NVC.

MATERIALS AND METHODS

Forty-seven patients with NVC, trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia were examined at 1.5T and 3T, including high-resolution 3D-CISS and 3D-TOF MRA sequences. Delineation of anatomic structures, overall image quality, severity of artifacts, visibility of NVC, and assessment of the SNR and CNR were compared between field strengths.

RESULTS

SNR and CNR were significantly higher at 3T (P < .001). Significantly better anatomic conspicuity, including delineation of CNs, nerve branches, and assessment of small vessels, was obtained at 3T (P < .02). Severity of artifacts was significantly lower at 3T (P < .001). Consequently, overall image quality was significantly higher at 3T. NVC was significantly better delineated at 3T (P < .001). Six patients in whom NVC was not with certainty identifiable at 1.5T were correctly diagnosed at 3T.

CONCLUSIONS

Patients with NVC may benefit from the higher resolution and greater sensitivity of 3T for preoperative assessment of NVC, and 3T may be of particular value when 1.5T is equivocal.

Lung involvement in rheumatologic diseases in children

BACKGROUND

Lung involvement in rheumatologic disease in children has been described with low frequency.

OBJECTIVE

To describe the lung function test and the radiological findings in a group of paediatric patients with rheumatologic diseases.

METHODS

Descriptive study. Pulmonary function was evaluated with spirometry, carbon monoxide diffusing capacity, blood arterial gas at rest and post exercise in addition to chest radiography and high resolution computed tomography were performed in children with rheumatologic disease.

RESULTS

Of the fourteen patients studied: 11 were diagnosed with juvenile idiopathic arthritis (JIA), two with systemic lupus erythematosus (SLE), and one with juvenile dermatomyositis (JDM). Mean age: 13 years (range 7-18 years). Nine females, duration of disease 4 ± 2.8 years (range 1-11 years). Four patients had any grade of abnormalities in one or more lung function tests and/or radiological test.

CONCLUSION

We recommend routine checks of pulmonary function in all patients with rheumatologic diseases even in the absence of respiratory symptoms.

Angiotensin-converting enzyme gene single polymorphism as a genetic biomarker of diabetic peripheral neuropathy: longitudinal prospective study

BACKGROUND

Identifying patients at risk of developing diabetic peripheral neuropathy (DPN) is of paramount importance in those with type 2 diabetes mellitus (T2DM) to provide and anticipate secondary prevention measures as well as intensify action on risk factors, particularly so in primary care. Noteworthy, the incidence of DPN remains unknown in our environment.

AIMS

(i) To analyze a single angiotensin-converting enzyme (ACE) gene polymorphism (D/I) as a genetic marker of risk of developing DPN, and (ii) to determine the incidence of DPN in our environment.

RESEARCH DESIGN AND METHODS

Longitudinal study with annual follow-up for 3years involving a group of T2DM (N=283) randomly selected. ACE gene polymorphism distribution (I=insertion; D=deletion) was determined. DPN was diagnosed using clinical and neurophysiology evaluation.

RESULTS

Baseline DPN prevalence was 28.97% (95% CI, 23.65-34.20). ACE polymorphism heterozygous genotype D/I presence was 60.77% (95% CI, 55.05-66.5) and was independently associated with a decreased risk of DPN (RR, 0.51; 95% CI, 0.30-0.86). DPN correlated with age (P<0.001) but not with gender (P=0.466) or time of evolution of T2DM (P=0.555). Regarding end point, DPN prevalence was 36.4% (95% CI, 30.76-42.04), and accumulated incidence was 10.4% 3years thereafter. In the final Poisson regression analysis, the presence of heterozygous genotype remained independently associated with a decreased risk of DPN (RR, 0.71; (95% CI, 0.53-0.96). DPN presence remained correlated with age (P=0.002), but not with gender (P=0.490) or time of evolution (P=0.630).

CONCLUSIONS

In our series, heterozygous ACE polymorphism (D/I) stands as a protective factor for DPN development. Accumulated incidence of DPN was relevant. Further prospective studies are warranted.

P3-16-15: Phase I Study with Biomarker Evaluation of Neoadjuvant Sunitinib in Combination with Exemestane in Post-Menopausal Women with Hormone-Sensitive, Her-2 Negative Primary Breast Cancer

Background

In preclinical models, oestrogen causes a rapid induction of VEGF in mammary tumours leading to tumour angiogenesis, tumor growth and cell migration whereas aromatase inhibitors (AI) have the opposite effect. Exemestane (E) is an AI, effective in metastatic hormone-dependent breast cancer, as well as in the adjuvant and neoadjuvant settings. Sunitinib (S) is an oral multitargeted tyrosine kinase inhibitor with antiangiogenic activities via inhibition of VEGFR, PDGFR, KIT, RET, CSF-1R and FLT-3, and direct antitumor activity shown in heavily pretreated subjects with advanced breast cancer. The use of antiangiogenic agents at initial stages of the disease, when fewer proangiogenic factors are present, may result in significantly greater efficacy than using these agents at a later stage. Safety profiles of both agents indicate only modest toxicity and do not overlap. We hypothesize that since antiangiogenic and hormonal agents use different mechanisms of action, combination will have additive activity. Regarding (S), continuous dosing (CD) at low doses might result in improved efficacy while maintaining good tolerability.

Methods: This is a phase I study to evaluate the safety of (S) in combination with (E) administered for 24 weeks (1cycle=4weeks) as neoadjuvant therapy for post-menopausal women with newly diagnosed hormone-sensitive, Her-2 negative primary breast cancer. We report the results of the first dose escalation part of the study intended to determine a safe dose level of (S) that can be combined with (E) at conventional fixed dose of 25mg/d. Preliminary efficacy data in terms of objective clinical response by WHO criteria will also be reported.

Results: 18 postmenopausal women with ER-positive invasive breast cancer, adequate organ function and ECOG 0–1 were enrolled in the study (median age 74, range 57–84) to be treated at two dose levels: 25 mg of (E) with either 25mg or 37.5mg of (S) CD. Two DLTs were identified: grade 3 mucositis at level 25mg of (S) and grade 3 asthenia at level 37.5mg of (S). Main toxicities were asthenia, leucopenia, mucositis, diarrhea and HBP. 78% of patients had grade 2 toxicities; 22% had grade 3. There were no serious adverse events reported. Median time on treatment with the combination was 23 weeks (range 2–24). 16% of patients needed one dose reduction of (S), 16% needed two or more and 28% suspended (S) administration due to toxicity. 50% of patients completed 24 weeks of treatment. None of the patients at 37.5mg (S) level could tolerate full doses for the entire treatment period, therefore in our study the recommended dosage of (S) that can be safely combined with (E) is 25mg. Concerning efficacy, 11 out of 18 patients had partial response (61%), 6 out of 18 had SD (33%) and only one patient had PD (5%) as best response.

Conclusion: Safety profile of the combination seems to be manageable in most patients. Toxicities were observed mainly within the two first cycles. Response rates were similar than those previously observed with (E) as monotherapy in the neoadjuvant setting. Biomarkers information will be provided.

This study was supported by an Independent Investigator Research grant from Pfizer, Inc.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-16-15.

Permanent genetic resources added to Molecular Ecology Resources Database 1 August 2011-30 September 2011

This article documents the addition of 299 microsatellite marker loci and nine pairs of single-nucleotide polymorphism (SNP) EPIC primers to the Molecular Ecology Resources (MER) Database. Loci were developed for the following species: Alosa pseudoharengus, Alosa aestivalis, Aphis spiraecola, Argopecten purpuratus, Coreoleuciscus splendidus, Garra gotyla, Hippodamia convergens, Linnaea borealis, Menippe mercenaria, Menippe adina, Parus major, Pinus densiflora, Portunus trituberculatus, Procontarinia mangiferae, Rhynchophorus ferrugineus, Schizothorax richardsonii, Scophthalmus rhombus, Tetraponera aethiops, Thaumetopoea pityocampa, Tuta absoluta and Ugni molinae. These loci were cross-tested on the following species: Barilius bendelisis, Chiromantes haematocheir, Eriocheir sinensis, Eucalyptus camaldulensis, Eucalyptus cladocalix, Eucalyptus globulus, Garra litaninsis vishwanath, Garra para lissorhynchus, Guindilla trinervis, Hemigrapsus sanguineus, Luma chequen. Guayaba, Myrceugenia colchagüensis, Myrceugenia correifolia, Myrceugenia exsucca, Parasesarma plicatum, Parus major, Portunus pelagicus, Psidium guayaba, Schizothorax richardsonii, Scophthalmus maximus, Tetraponera latifrons, Thaumetopoea bonjeani, Thaumetopoea ispartensis, Thaumetopoea libanotica, Thaumetopoea pinivora, Thaumetopoea pityocampa ena clade, Thaumetopoea solitaria, Thaumetopoea wilkinsoni and Tor putitora. This article also documents the addition of nine EPIC primer pairs for Euphaea decorata, Euphaea formosa, Euphaea ornata and Euphaea yayeyamana.