Vecuronium requirements according to the operative phase during living donor liver transplantation under desflurane anesthesia

INTRODUCTION

The requirements of nondepolarizing neuromuscular blocking agent during liver transplantation show conflicting results. We sought to evaluate the requirements according to the operative phase and find extrahepatic factors that influence neuromuscular blocking agent requirements.

METHODS

We enrolled 35 patients undergoing living donor liver transplantation. Continuous infusion of vecuronium was adjusted every 15 minutes for consistent neuromuscular blockade aimed at T1/Tc of 0.10 monitored with a neuromuscular transmission module. We compared the mean infusion dose in each phase, and investigated whether it is correlated with preoperative Model for End-Stage Liver Disease (MELD) score, Child-Turcotte-Pugh (CTP) score, graft-recipient weight ratio (GRWR), or time to recovery of first twitch response to train-of-four (TOF) stimulation.

RESULTS

There was a significant difference between vecuronium doses during each phase (P < .001): 0.48 ± 0.16 μg/kg/min, preanhepatic; 0.38 ± 0.14 μg/kg/min, anhepatic and 0.26 ± 0.07 μg/kg/min, neohepatic phase. There was a significant positive correlation between vecuronium infusion dose in the preanhepatic phase and CTP scores (P = .006, correlation coefficient = 0.465). There was also a significant negative correlation between the time to recovery of first twitch response of TOF stimulation and vecuronium infusion dose in the preanhepatic phase (P = .001, correlation coefficient = -0.546). The infusion dose during the preanhepatic phase was not associated with the MELD score, and that of neohapatic phase not with GRWR.

CONCLUSIONS

The vecuronium infusion dose requirement during the anhepatic decreased compared with that in the preanhepatic phase. It further decreased during the neohepatic phase compared with the previous phases. Vecuronium infusion dose reduction is suggested especially during the neohepatic phase for early extubation. The dose during the preanhepatic phase is suggested to be determined considering the CTP score and the time to recovery of the TOF response.

Pneumothorax in neonates: Trends, predictors and outcomes

OBJECTIVE

To examine rates, trends, predictive risk factors, and outcomes associated with pneumothorax in neonates.

STUDY DESIGN

Retrospective analyses were used to estimate rates and assess trends in pneumothorax among early preterm (GA <32 weeks), moderate-late preterm (GA 32-36), and term (GA ≥37 weeks) neonates admitted to neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network™ from 2005 to 2011. For each GA group, multivariable logistic regression models were derived to predict pneumothorax using risk factors with known clinical relevance. Additional logistic regression analyses assessed associations between pneumothorax and mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage.

RESULTS

The study included 71,237 neonates; of them 16,985 (24%) early preterm, 27,709 (39%) moderate-late preterm, and 26,543 (37%) term neonates. The overall rate of pneumothorax by GA was bimodal with estimates of 4.0%, 2.6%, and 6.7% respectively. No significant temporal trends were detected. Risk factors for pneumothorax included: a) for the overall lpopulation- Score for Neonatal Acute Physiology, version II >20, surfactant use, and respiratory distress syndrome; b) for early preterm infants-chorioamnionitis; c) for moderate-late preterm infants-higher birth weight, male sex, rupture of membranes >24 hours, and outborn status; and d) for term infants- male sex, outborn status, and meconium aspiration in term neonates. In early preterm neonates, pneumothorax was associated with mortality, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged NICU stay.

CONCLUSIONS

Pneumothorax rates were higher among term and early preterm neonates admitted to the NICU. Predictors of pneumothorax varied between GA groups. Pneumothorax-associated mortality and morbidity were significantly greater in early preterm infants.

Abstract P2-09-19: Zerumbone suppresses IL-1b-induced cell migration and invasion through inhibition of IL-8 expression and MMP3 expression in human triple negative breast cancer cells

Background: Inflammation is a key regulatory process in breast cancer progression and severity. Several studies have demonstrated that prolonged exposure of breast tumor cells to inflammatory cytokines leads to epithelial-mesenchymal transitions (EMT), which is the principle mechanism involved in metastasis and tumor invasion. Disruption of the signaling pathways involved in EMT may therefore provide an effective treatment strategy for currently difficult to treat or untreatable cancers such as TNBC. The interleukin (IL)-1 plays a pivotal role on breast cancer proliferation, invasion and/or inflammation. Here, we investigated the correlation of MMP-3 and IL-8 on IL-1b-induced cell migration and invasion as well as the inhibitory effect of zerumbone on IL-1β-induced MMP-3 and IL-8.

Methods: Triple negative breast cancer cells (Hs578T and MDA-MB231) were cultured DMEM with 10% FBS and 1% antibiotics. The levels of IL-8 and MMP-3 mRNA were analyzed by real-time PCR. The levels of secreted IL-8 and MMP-3 protein expression were analyzed by ELISA and western blot analysis, respectively. Cell viabilities by drug were analyzed by MTT assay. Cell invasion and migration was detected by Boyden chamber assay.

Results: The level of IL-8 and MMP-3 mRNA and protein expression significantly increased by IL-1β treatment in both Hs578T cells and MDA-MB231 cells. In addition, IL-1β-induced cell migration and invasion also increased in Hs578T and MDA-MB231 cells. On the other hand, the levels of basal and IL-1β-induced IL-8 and MMP-3 expression were decreased by zerumbone.

Conclusion: IL-1β induces the migration and invasion of breast cancer cells through IL-8 and MMP-3 expression. These effects are significantly suppressed by zerumbone. Therefore, we suggest that zerumbone may act as a useful therapeutic agent for treatment of triple negative breast cancer.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-09-19.

Abstract P5-09-17: Prognostic significance of progesterone receptor in hormonal receptor-positive breast cancer: Association with endocrine resistance

Background: Endocrine therapy has dramatic improvements of prognosis in patients with hormonal receptor positive breast cancer. However, long-term follow up shows that endocrine resistance is still major clinical concern. Although the value of estrogen receptor (ER) level can predict response to endocrine treatment in hormonal receptor positive breast cancers, few markers are available that can predict response to endocrine treatment. We attempted to identify molecular markers, especially progesterone receptor (PR), associated with endocrine failure in breast cancer.

Methods: We reviewed the medical records of 2513 breast cancer patients who underwent breast surgery and endocrine therapy at Samsung Medical Center between March 2007 and July 2011. Patients were compared according to ER and PR expression and to assess the clinical and biological features of ER+positive/PR-negative breast cancers to understand how PR might be a useful marker of these activities. ER and PR expression accessed using Allred score, the ‘positive” was defined that total score is larger than 2.

Results PR negative tumors were found more frequently in postmenopausal women (post- 11.2% vs. pre- 2.5%, P &lt; 0.001) and PR negative tumors were significantly associated with higher grade, higher level of Ki 67 and more expression of EGFR and CK5/6. In Kaplan-Meier analysis and multivariate analysis, PR negativity was significantly poorer prognostic factor of DFS (HR 3.1, 95% CI 1.2-8.2, P = 0.021) and OS (HR 89.8, 95% CI 3.4-2352.3, P = 0.007). Stratified by the menopausal status, there was not shown significant difference of survival between the PR+ and PR- tumor in postmenopausal women (DFS, HR 2.1, 95% CI 0.4-10.8, P = 0.381; OS, HR 10.6, 95% CI 0.6-171.4, P = 0.096). However, PR negative tumors showed an association with poor outcome in premenopausal women (DFS, HR 7.2, 95% CI 2.5-20.6, P &lt;0.001; OS, HR 24.6, 95% CI 2.2-275.6, P = 0.009).

Conclusion: In HR positive breast cancers, PR negative tumors were found more frequently in elderly, postmenopausal women. However, PR negative tumors are shown more aggressive and poorer survival than PR positive tumors despite of endocrine therapy, especially in premenopausal women.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-17.

Abstract P2-18-04: No further axillary dissection in sentinel lymph node-negative breast cancer after neoadjuvant chemotherapy in patients with initial cytologically-proven axillary node metastasis

Background

In patients with fine needle aspiration (FNA)-proven axillary lymph node metastasis at diagnosis (cN+), the current standard surgical procedure is axillary lymph node dissection (ALND) at definitive surgery after neoadjuvant chemotherapy (NAC). However, growing evidences suggest that SLNB after NAC is feasible and may demonstrate acceptable performance in selected patients. We performed sentinel lymph node biopsy in patients treated with cytologically-confirmed axillary lymph nodes metastases at presentation, who converted to a clinically negative axillary status after NAC (ycN0).

Patients and methods

We retrospectively evaluated 240 patients with invasive breast cancer with ultrasound-guided FNA-proven axillary nodal metastases at the time of diagnosis. All patients received NAC and underwent surgery at Samsung medical center between October 2007 and May 2013. Among these patients, 75 patients underwent SLNB. These patients converted to clinically node-negative disease (ycN0) after NAC on breast MRI or PET/CT scan. A combined detection technique was used with radioisotope and blue dye for the detection of SLN. Patients with negative SLN on frozen pathology and low clinical suspicion of metastasis during operation were not performed further ALND.

Results

The detection rate of SLNB was 93.3% (70/75), and median number of retrieved sentinel lymph nodes was 3.0 (range 1-8). False negative rate was 6.7% (1/15). Of these 75 patients, 35 (46.6%) patients had positive sentinel lymph nodes (ypN+) and underwent ALND. Thirty-five (46.6%) patients had tumor-free sentinel lymph nodes (ypN0sn) and 20 patients of them were followed without subsequent ALND. In these SLN-negative patients without further ALND, 9 patients were HER2-enriched subtypes and 9 patients, TNBC subtypes. Only two of them were Luminal B subtypes. The median follow-up period was 12.0 months (range 0-26 months) with 2 events; 1 regional recurrence in ipsilateral supraclavicular node and 1 systemic recurrence in brain on postoperative 7 months and 5 months, respectively. There has not occurred an ipsilateral axillary recurrence so far.

Conclusions Although the follow-up was not long enough to conclude, this study tried to demonstrate that SLNB after NAC was feasible and further ALND may not be necessary in patients with SLN-negative disease (ypN0sn).

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-18-04.

Use of the radial groove view intra-operatively to prevent damage to the extensor pollicis longus tendon by protruding screws during volar plating of a distal radial fracture

The aims of this study were to assess the efficacy of a newly designed radiological technique (the radial groove view) for the detection of protrusion of screws in the groove for the extensor pollicis longus tendon (EPL) during plating of distal radial fractures. We also aimed to determine the optimum position of the forearm to obtain this view. We initially analysed the anatomy of the EPL groove by performing three-dimensional CT on 51 normal forearms. The mean horizontal angle of the groove was 17.8° (14° to 23°). We found that the ideal position of the fluoroscopic beam to obtain this view was 20° in the horizontal plane and 5° in the sagittal plane. We then intra-operatively assessed the use of the radial groove view for detecting protrusion of screws in the EPL groove in 93 fractures that were treated by volar plating. A total of 13 protruding screws were detected. They were changed to shorter screws and these patients underwent CT scans of the wrist immediately post-operatively. There remained one screw that was protruding. These findings suggest that the use of the radial groove view intra-operatively is a good method of assessing the possible protrusion of screws into the groove of EPL when plating a fracture of the distal radius.

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

INTRODUCTION

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

HYPOTHESIS

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

PATIENTS AND METHODS

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

RESULTS

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

DISCUSSION

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

Nomogram for predicting invasion in patients with a preoperative diagnosis of ductal carcinoma in situ of the breast

Background

The aim of this study was to identify risk factors for invasive breast cancer in patients diagnosed with ductal carcinoma in situ (DCIS) on a preoperative biopsy. These factors were used to develop a nomogram for predicting the risk of invasion in the preoperative setting.

Methods

This was a retrospective analysis of patients who underwent surgical treatment for DCIS diagnosed before surgery between 1997 and 2009. Multivariable analysis was used to identify clinical, radiological and histopathological factors that may predict upstaging. A nomogram was developed to predict the probability of invasion using multiple logistic regression analysis. This nomogram was subsequently validated using another cohort of patients with a preoperative diagnosis of DCIS between 2010 and 2012.

Results

Upstaging to invasive cancer occurred in 123 (24.9 per cent) of 493 women treated between 1997 and 2009. A larger DCIS lesion (at least 15 mm), lack of hormone receptor expression, intermediate or high nuclear grade, diagnosis on core biopsy compared with vacuum-assisted biopsy, and non-cribriform subtype of DCIS were significantly associated with upstaging. A nomogram developed using these factors demonstrated good predictive performance (area under the receiver operating characteristic (ROC) curve (AUC) 0·823, 95 per cent confidence interval 0·787 to 0·860). The nomogram showed similar predictive performance in the validation data set, based on another 149 women (AUC 0·700, 0·613 to 0·786).

Conclusion

Upstaging to invasive cancer in women with a preoperative diagnosis of DCIS is common. A nomogram based on the five most significant factors related to upstaging accurately predicted invasive cancer. This nomogram may be useful when deciding whether to pursue axillary staging with sentinel lymph node biopsy in patients with DCIS.

Flexor tendon excursion and load during passive and active simulated motion: a cadaver study

The aim of this study was to quantify the amount of tendon excursion and load experienced during simulated active and passive rehabilitation exercises. Six cadaver specimens were utilized to examine tendon excursion and load. Lateral fluoroscopic images were used to measure the excursions of metal markers placed in the flexor digitorum superficialis and profundus tendons of the index, middle, and ring fingers. Measurements were performed during ten different passive and active simulated motions. Mean tendon forces were higher in all active versus passive movements. Blocking movements placed the highest loads on the flexor tendons. Active motion resulted in higher tendon excursion than did passive motion. Simulated hook position resulted in the highest total tendon excursion and the highest inter-tendinous excursion. This knowledge may help optimize the management of the post-operative exercise therapy regimen.

Onion extract structural changes during in vitro digestion and its potential antioxidant effect on brain lipids obtained from low- and high-fat-fed mice

This study investigated the effects of onion (Allium cepa, L.) extract on the antioxidant activity of lipids in low-and high-fat-fed mouse brain lipids and its structural change during in vitro human digestion. The onion extracts were passed through an in vitro human digestion model that simulated the composition of the mouth, stomach, and small intestine juice. The brain lipids were collected from low- and high-fat-fed mouse brain and then incubated with the in vitro-digested onion extracts to determine the lipid oxidation. The results confirmed that the main phenolics of onion extract were kaempferol, myricetin, quercetin, and quercitrin. The quercetin content increased with digestion of the onion extract. Antioxidant activity was strongly influenced by in vitro human digestion of both onion extract and quercetin standard. After digestion by the small intestine, the antioxidant activity values were dramatically increased, whereas the antioxidant activity was less influenced by digestion in the stomach for both onion extract and quercetin standard. The inhibitory effect of lipid oxidation of onion extract in mouse brain lipids increased after digestion in the stomach. The inhibitory effect of lipid oxidation of onion extract was higher in the high-fat-fed mouse brain lipids than that in the low-fat-fed mouse brain lipids. The major study finding is that the antioxidative effect of onion extract may be higher in high-fat-fed mouse brain lipids than that in low-fat-fed mouse brain lipids. Thus, dietary onion may have important applications as a natural antioxidant agent in a high-fat diet.

The effects of statins on the clinical outcomes of Clostridium difficile infection in hospitalised patients

BACKGROUND

An association between exposure to statin drugs and favourable treatment outcomes for various types of infections has been established.

AIM

To determine the clinical characteristics and treatment outcomes of Clostridium difficile infection (CDI) among hospitalised patients taking statin drugs.

METHODS

The medical records were reviewed for consecutive in-patients with CDI confirmed by positive toxin assay (A or B), C. difficile culture, or the presence of pseudomembrane on endoscopy. Treatment success was defined as the resolution of diarrhoea within 6 days of therapy. The primary end points were assessed by average symptom recovery time and treatment response (success or failure).

RESULTS

Among 949 patients, the overall response to metronidazole was 91.9%. The baseline characteristics showed some differences between statin users and statin non-users with respect to mean disease severity score. In the multivariate analysis, successful treatment response was significantly associated with the absence of exposure to proton pump inhibitors (PPIs) (OR = 0.690, 95% CI = 0.513-0.929, P = 0.014) and with exposure to statins (OR = 1.449, 95% CI = 1.015-2.070, P = 0.041). Contrary to the treatment response, univariate and multivariate analyses failed to show that exposure to PPIs or statins affected symptom recovery times. Sixty-day CDI recurrence rates for those patients with statin exposure were significantly lower compared with those patients without statin exposure (3% vs. 7.3%, respectively; RR = 0.393, 95% CI = 0.167-0.926, P = 0.033).

CONCLUSION

Prior statin exposure in patients with C. difficile infection is associated with a successful response to treatment.

First Report of Powdery Mildew Caused by Podosphaera xanthii on Hibiscus mutabilis in Korea

Hibiscus mutabilis L., known as cotton rose, is a deciduous shrub native to China. Horticultural varieties of the species are widely planted throughout the world (4). In September 2012, typical powdery mildew symptoms on the cotton rose were observed in a public garden of Jeju City, Korea. Powdery mildew colonies were circular to irregular white patches on both sides of the leaves and also on young stems and sepals. As the disease progressed, white mycelial growth covered the entire shoot portion, causing leaf distortion. In the middle of November, numerous chasmothecia were formed on the lesions. Voucher specimens (n = 4) were deposited in the Korea University Herbarium (KUS). Hyphal appressoria were only swollen part of hyphae or occasionally nipple-shaped. Conidiophores were 140 to 275 × 10 to 11.5 μm and produced 2 to 8 immature conidia in chains with a crenate outline. Foot-cells of conidiophores were straight, 30 to 65 μm long, and cylindric. Conidia were hyaline, ellipsoid-ovoid, and measured 27 to 42 × 17.5 to 21 μm with a length/width ratio of 1.5 to 2.4, and had distinct fibrosin bodies. Chasmothecia were amphigenous, cauligenous, 85 to 110 μm in diameter, and contained one ascus each. Peridium cells of chasmothecia were irregularly polygonal, large, and 15 to 38 μm wide. Appendages were mycelioid, 1- to 6-septate, brown at the base, and becoming paler. Asci were sessile, oval to broadly fusiform, with terminal oculus of 15 to 20 μm wide. Ascospores numbered eight per ascus were ellipsoidal, 19 to 25 × 14 to 16 μm. The morphological characteristics were consistent with previous records of P. xanthii (Castagne) U. Braun & Shishkoff (1). To confirm the identification, the complete internal transcribed spacer (ITS) region of rDNA from isolate KUS-F27134 was amplified with the primers ITS5 and P3 and sequenced (3). The resulting sequence of 477 bp was deposited in GenBank (Accession No. KC460208). The Korean isolate showed >99% similarity with dozens of sequences of P. xanthii ex cucurbitaceous hosts (e.g., JQ912061, JQ409565, HM070403, etc.) as well as Podosphaera sp. ex H. mutabilis from Japan (AB040308). Pathogenicity was confirmed through inoculation tests by gently pressing diseased leaves onto young leaves of three asymptomatic, potted 2-year-old seedlings. Three non-inoculated seedlings were used as controls. Plants were maintained in a greenhouse at 24 to 30°C. Inoculated leaves developed symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on the inoculated leaves was morphologically identical to that observed on the original diseased leaves, fulfilling Koch's postulates. Powdery mildew infections of H. mutabilis associated with P. xanthii (including P. fuliginea in broad sense) have been known in China, Japan, and Taiwan (1,2). To our knowledge, this is the first report of powdery mildew caused by P. xanthii on H. mutabilis in Korea. Since Jeju, the southmost island of Korea, is the only habitat of cotton rose in Korea and is the northmost natural habitat in Asia, powdery mildew is a new threat to the health of wild populations of cotton rose. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved January 18, 2013. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) D. A. Wise. J. Hered. 64:285, 1973.

Mice selectively bred for high voluntary wheel running have larger midbrains: support for the mosaic model of brain evolution

Increased brain size, relative to body mass, is a primary characteristic distinguishing the mammalian lineage. This greater encephalization has come with increased behavioral complexity and, accordingly, it has been suggested that selection on behavioral traits has been a significant factor leading to the evolution of larger whole-brain mass. In addition, brains may evolve in a mosaic fashion, with functional components having some freedom to evolve independently from other components, irrespective of, or in addition to, changes in size of the whole brain. We tested whether long-term selective breeding for high voluntary wheel running in laboratory house mice results in changes in brain size, and whether those changes have occurred in a concerted or mosaic fashion. We measured wet and dry brain mass via dissections and brain volume with ex vivo magnetic resonance imaging of brains that distinguished the caudate-putamen, hippocampus, midbrain, cerebellum and forebrain. Adjusting for body mass as a covariate, mice from the four replicate high-runner (HR) lines had statistically larger non-cerebellar wet and dry brain masses than those from four non-selected control lines, with no differences in cerebellum wet or dry mass or volume. Moreover, the midbrain volume in HR mice was ~13% larger (P<0.05), while volumes of the caudate-putamen, hippocampus, cerebellum and forebrain did not differ statistically between HR and control lines. We hypothesize that the enlarged midbrain of HR mice is related to altered neurophysiological function in their dopaminergic system. To our knowledge, this is the first example in which selection for a particular mammalian behavior has been shown to result in a change in size of a specific brain region.

Association of a single nucleotide polymorphism in the akirin 2 gene with economically important traits in Korean native cattle

The akirin 2 gene, located on chromosome 9 in cattle, was previously reported to be associated with nuclear factor-kappa B (NF-κB), involved in immune reactions and marbling of meat. To determine whether a single nucleotide polymorphism (SNP) in akirin 2 is associated with economically important traits of Korean native cattle, the c.*188G>A SNP DNA marker in the 3'-UTR region of akirin 2 was analyzed for its association with carcass weight, longissimus muscle area and marbling. The c.*188G>A SNP was genotyped by polymerase chain reaction restriction fragment length polymorphism, and the frequency of the AA, AG, and GG genotypes were 6.82%, 71.29% and 21.88% respectively. This SNP was significantly associated with longissimus muscle area (Bonferroni corrected P < 0.05), and marbling score (Bonferroni corrected P < 0.01). These results suggest that the c.*188G>A SNP of akirin 2 might be useful as a DNA marker for longissimus muscle area and marbling scores in Korean native cattle.

A single nucleotide insertion in exon 2 produces a novel HLA-B*13 null allele, HLA-B*13:63N

A single nucleotide insertion in codon 171 of the human leukocyte antigen HLA-B*13:01:01 results in a novel null allele, HLA-B*13:63N.

Discovery of the novel HLA-DRB1*10:04 allele in a Taiwanese volunteer bone marrow donor and identification of the probable HLA-A, -B, -C and -DRB1 haplotype in association with DRB1*10:04

We report here a novel variant of HLA-DRB1*10, DRB1*10:04, discovered in a Taiwanese volunteer bone marrow donor by a sequence-based typing (SBT) method. The DNA sequence of DRB1*10:04 differs from DRB1*10:01:01, in exon 2, at nucleotide positions 296 (G fi A) and 303 (T fi G). The nucleotide changes caused an amino acid substitution at amino acid residue 70 (R fi Q). We hypothesize that the formation of DRB1*10:04 was probably the result of a gene recombination event where DRB1*10:01:01 received a minimum length of DNA sequence from DRB1*04:05:01, as the sequence of DRB1*10:04 is identical to DRB1*10:01:01 in exon 2 except the sequence from nucleotide 296 to nucleotide 303, which is identical to DRB1*04:05:01. The plausible HLA-A, -B, -C and - DRB1 haplotypes in association with DRB1*10:04 was deduced as A*01:01-B*37:01-C*06:02-DRB1*10:04.

Discovery of the rare HLA-B*39:77 allele in an unrelated Taiwanese bone marrow stem cell donor using the sequence-based typing method

We detected a rare HLA-B locus allele, B*39:77, in a Taiwanese unrelated marrow stem cell donor in our routine HLA sequence-based typing (SBT) exercise for a possible haematopoietic stem cell donation. In exons 2, 3 and 4, the DNA sequence of B*39:77 is identical to the sequence of B*39:01:01:01 except one nucleotide at nucleotide position 733 (G->A) in exon 4. The nucleotide variation caused one amino acid alteration at residue 221 (Gly->Ser). B*39:77 was probably derived from a nucleotide substitution event involving B*39:01:01:01. The probable HLA-A, -B, -C, -DRB1 and -DQB1 haplotype in association with B*39:77 may be deduced as A*02:01-B*39:77-C*07:02-DRB1*08:03-DQB1*06:01. Our discovery of B*39:77 in Taiwanese adds further polymorphism of B*39 variants in Taiwanese population.

Factors affecting completion of laparoscopic myomectomy

PURPOSES

This study aimed to elucidate the factors affecting completion of laparoscopic myomectomy without unintended surgery.

MATERIALS AND METHODS

The medical records of 143 patients who underwent laparoscopic myomectomy desiring to retain their uterus were retrospectively reviewed. Unintended surgery was defined as the need for conversion to other surgical methods including laparotomy or laparoscopic hysterectomy at any time during the procedures. All variables associated with completion of laparoscopic myomectomy in the univariate analysis were selected at the threshold ofp < 0.25 and then tested in a multiple-logistic regression model.

RESULTS

The rate of unintended surgery was 13.3%. Univariate analysis revealed that age, previous abdomino-pelvic surgery, current medical disease, transfusion, > five myomas, myoma size > 8.2 cm, posterior wall location of myoma, intramural type of myoma, and the presence of adenomyosis were statistically significant risk factors for unintended surgery. Multivariate logistic regression analysis demonstrated that completion of laparoscopic myomectomy was significantly influenced by a history of previous abdomino-pelvic surgery (odds ratio; 6.46, 95% CI, 0.03-0.41; p value 0.04).

CONCLUSION

The risk of unintended surgery during laparoscopic myomectomy is associated with a history of previous abdomino-pelvic surgery.

Abstract P3-11-01: Matched-pair analysis of patients with male and female breast cancer

Purpose: Male breast cancer (MBC) is extremely rare, accounting for less than 1% of all malignancies in men and only 1% of all breast carcinomas. The treatment and surveillance guidelines on male breast cancers are less recognized. The aim of this study is to evaluate our single institution's experience with MBC over the past 15 years and to contrast differences between female and MBC.

Methods: MBC diagnosed from 1994 to 2010 at the Department of Surgery, Samsung Medical Center (Seoul, Korea) was retrospectively analyzed. Clinical data and tumor characteristics were examined. Each MBC was matched with female counterparts by 1:N varied matching ratio that showed accordance in seven variables (year of diagnosis, age, tumor stage, nodal stage, tumor grade, estrogen receptor(ER), progesterone receptor(PR)).

Results: 39 male/184 female matched-pairs were available for analysis. The median duration of follow-up was 3.8 years. The median age of MBC patients was 50 years and the median size of tumor was 2.0cm. The proportion of positivity of ER and PR status was 97.4% and 84.6%, respectively. Despite of higher positive rate of hormone receptor, the rate of hormone therapy in MBC patients was significant lower than female conterpart (p = 0.002). Men and women with breast cancer had similar disease-free survival (DFS) and disease-specific overall survival (DSS). Five MBC patients had a recurrence during follow up period and 4 of them were expired. The 10-years DFS was 73.1% in men and 80.5% in women (p = 0.348). The 10-years DSS was 74.1% in men and 87.1% in women, respectively (p = 0.207).

Conclusion: This study showed no disease free and overall survival differences between male and female breast cancer patients and revealed that gender is no predictor for survival in breast cancer. Male patients receive obviously less adjuvant treatment compared their female matched patients. It would be better to do more aggressive treatment in MBC to improve the survival outcome.

Abstract P2-10-41: The prediction of invasion in ductal carcinoma in situ: developing prediction model and validation

Background: The aim of the study was to determine factors and develop the model that predict the risk of invasion in patients with ductal carcinoma in situ (DCIS) diagnosed by preoperative biopsy.

Methods: We selected 497 patients underwent surgical treatment for preoperatively diagnosed DCIS of the breast between 1997 and 2009. Multivariate analysis was used to identify relevant clinical, radiological and pathological factors that may predict upstaging. A prediction model was developed based on significant factors and measured using the area under the receiver operating characteristics (ROC) curve. This prediction model was subsequently validated using the dataset of 149 cases who were diagnosed with DCIS preoperatively between 2010 and 2012.

Results: Of 24.75%, there was an upstaging to the invasive cancer. We found that larger size (≥1.5cm) of DCIS was most significant factor, followed by palpable lesion on physical examination, no expression of estrogen receptor (ER)/progesterone receptor (PR), high nuclear grade, non-cribriform subtype and absence of necrosis significantly associated with presence of invasion.

Biological evaluation of intervertebral disc cells in different formulations of gellan gum-based hydrogels

Gellan gum (GG)-based hydrogels are advantageous in tissue engineering not only due to their ability to retain large quantities of water and provide a similar environment to that of natural extracellular matrix (ECM), but also because they can gelify in situ in seconds. Their mechanical properties can be fine-tuned to mimic natural tissues such as the nucleus pulposus (NP). This study produced different formulations of GG hydrogels by mixing varying amounts of methacrylated (GG-MA) and high-acyl gellan gums (HA-GG) for applications as acellular and cellular NP substitutes. The hydrogels were physicochemically characterized by dynamic mechanical analysis. Degradation and swelling abilities were assessed by soaking in a phosphate buffered saline solution for up to 170 h. Results showed that as HA-GG content increased, the modulus of the hydrogels decreased. Moreover, increases in HA-GG content induced greater weight loss in the GG-MA/HA-GG formulation compared to GG-MA hydrogel. Potential cytotoxicity of the hydrogel was assessed by culturing rabbit NP cells up to 7 days. An MTS assay was performed by seeding rabbit NP cells onto the surface of 3D hydrogel disc formulations. Viability of rabbit NP cells encapsulated within the different hydrogel formulations was also evaluated by Calcein-AM and ATP assays. Results showed that tunable GG-MA/HA-GG hydrogels were non-cytotoxic and supported viability of rabbit NP cells.

Laser-driven proton acceleration enhancement by nanostructured foils

Nanostructured thin plastic foils have been used to enhance the mechanism of laser-driven proton beam acceleration. In particular, the presence of a monolayer of polystyrene nanospheres on the target front side has drastically enhanced the absorption of the incident 100 TW laser beam, leading to a consequent increase in the maximum proton energy and beam charge. The cutoff energy increased by about 60% for the optimal spheres' diameter of 535 nm in comparison to the planar foil. The total number of protons with energies higher than 1 MeV was increased approximately 5 times. To our knowledge this is the first experimental demonstration of such advanced target geometry. Experimental results are interpreted and discussed by means of 2(1/2)-dimensional particle-in-cell simulations.

Identification of the novel HLA-B*40:221 allele in a Taiwanese hematopoietic stem cell donor using a sequence-based typing method

Using DNA sequence-based typing method, we found a new HLA-B*40 variant, B*40:221, in a Taiwanese hematopoietic stem cell donor. The allele sequence of B*40:221 is identical to the sequence of B*40:01:01 in exons 2, 3 and 4 except the nucleotides at codon 265 (GGG→AGG). The sequence variation caused one amino acid exchange at residue 265 where Gly was replaced by Arg. The probable HLA-A, -B, -C, -DRB1 and -DQB1 haplotype in association with B*40:221 may be deduced as HLA-A*11:01-B*40:221-C*03:04-DRB1*14:54-DQB1*05:02. The generation of B*40:221 is thought as a result of a nucleotide point mutation involving B*40:01:01. Our discovery of B*40:221 increases the polymorphism of B*40 in Taiwanese.

A conserved HLA-A*02:28 associated HLA haplotype, A*02:28-B*15:11-DRB1*09:01, restricted to Taiwanese

HLA-A*02:28, found in a Korean and a Japanese, was reported independently to the IMGT/HLA database in 2003 and 2005, respectively. We report here eight Taiwanese unrelated bone marrow hematopoietic stem cell donors carrying A*02:28 detected during our routine HLA typing exercise. The probable HLA-A, -B and -DRB1 haplotype in association with A*02:28 may be deduced from the eight marrow stem cell donor as A*02:28-B*15:11-DRB1*09:01. Our result suggests A*02:28-B*15:11-DRB1*09:01 is a conserved HLA haplotype restricted to Taiwanese.