Experience of an anatomic femoral stem in a UK orthopaedic centre beyond 20 years of follow-up

INTRODUCTION

Increasing interest in the use of anatomical stems has developed as the prevalence of periprosthetic fractures (PPFs) continues to increase. The primary aim of this study was to determine the long-term survivorship and PPF rate of an anatomical femoral stem in a single UK centre.

PATIENTS AND METHODS

Between 2000 and 2002, 94 consecutive THAs were performed using the 170 mm Lubinus SP II anatomical femoral stem in our institution. Patient demographics, operative details and clinical outcomes were collected prospectively in an arthroplasty database. Patient records and national radiographic archives were reviewed finally at a mean of 21.5 years (SD 0.7) following surgery to identify occurrence of subsequent revision surgery, dislocation or periprosthetic fracture.

RESULTS

Mean patient age at surgery was 65.8 years (SD 12.5, 34-88 years). There were 48 women (51%). Osteoarthritis was the operative indication in 88 patients (94%). Analysis of all-cause THA failure demonstrated a survivorship of 98.5% (95% confidence interval [CI], 98.0-99.3%) at 10 years and 96.7% (94.5-98.9%) at 21 years. The 20-year stem survival for aseptic loosening was 100% with no cases of significant lysis found (lucent line > 2 mm) and no stems required revision. Patient demographics did not appear to influence risk of revision (p > 0.05). There were 2 revisions in total (2 for acetabular loosening with original stems retained). There were no PPFs identified at mean 21.5 year follow-up and 5 dislocations (5%).

CONCLUSIONS

The Lubinus SP II 170 mm stem demonstrated excellent survivorship and negligible PPF rates over 20 years following primary THA.

Exploring the appearance of and messaging on antibiotics to address inappropriate antibiotic use - public and pharmacists views

Introduction

The purpose of medicines labelling and packaging is to provide clear unambiguous identification of the medicine and the conditions for its safe use, allowing patients to understand and act on the information.1 Inappropriate antibiotic usage, (deviation from directions provided to the patients by the prescriber, resulting in sub-optimal treatment) may result in exposing bacteria to sub-therapeutic plasma concentrations and/or environment, which are one of the main drivers of Antibiotic Resistance.2 A recent comprehensive analysis showed the global burden associated with drug-resistant infections in 2019 was an estimated 4.95 million deaths.3

Aim

To ascertain the support from pharmacists and the public and their perceptions on the likely barriers to harmonising or standardising physical appearance and/or messaging on antibiotic packaging to reduce inappropriate antibiotic usage.

Methods

This study received ethics approval from the University of Huddersfield. In partnership with NHS England Antimicrobial Stewardship lead for North-East and Yorkshire, two questionnaires (public and pharmacist) were piloted. The final version was transferred to Qualtrics (online questionnaire format). During a 5-week period public questionnaires were distributed via posters with QR codes and social media. Pharmacist questionnaires were emailed to consenting pharmacists (community, hospital, GP practice, industry) around Huddersfield, Doncaster, Rochdale, Dewsbury and Leeds. The data underwent descriptive statistical analysis.

Results

Inappropriate antibiotic usage (saving for future use) was admitted by 23.5% of the 174 public participants, sharing with others (2.5%), throwing their antibiotics in the bin (32.7%) and other inappropriate usage was reported. This compared to 22.2% returning antibiotics to the pharmacy for disposal. 100% of pharmacists (40) think inappropriate antibiotic use needs to be addressed; the majority of pharmacists (55.5%) and the public (61.4%) think a harmonised antibiotic appearance would reduce inappropriate use. ‘Putting the word “ANTIBIOTICS” on the packaging would improve antibiotic packaging appearance’ was the top improvement selected by pharmacists (38.3%) and public (35.3%). Pharmacists (38.9%) thought antibiotic manufacturers would be the greatest obstacle to harmonised packaging. The majority of public (70.5%) and pharmacists (85.3%) think a standardised messaging system would help reduce inappropriate antibiotic use. Both pharmacists (41.1%) and public (47%) highlighted that a standard leaflet for appropriate use could improve antibiotic use. Pharmacists (47.8%) thought that multiple stakeholders (e.g., MHRA, manufacturers, etc) would be the barriers to a standardised messaging.

Discussion/Conclusion

Inappropriate antibiotic use by individuals who re-use leftovers or share their antibiotics may result in a treatment failure and could to increase AMR. Improvements in antibiotic packaging and patient information leaflets with appropriate disposal instructions could help minimise AMR. Limitations of this study include the low number of practice and industrial pharmacist respondents compared to community and hospital pharmacists. Public and pharmacist respondents supported the wording “ANTIBIOTIC” on antibiotic packaging and a standardised leaflet covering increasing adherence and appropriate disposal of leftovers. This study warrants further evaluation with regulators, manufacturers and other key stakeholders.

References

1. HM Government. Best practice guidance on the labelling and packaging of medicines. Available from: https://www.gov.uk/government/publications/best-practice-in-the-labelling-and-packaging-of-medicines (Accessed: 10/09/22).

2. Gullberg, E., et al. Selection of resistant bacteria at very low antibiotic concentrations. PLoS Pathogens, 2011;7(7):e1002158. https://doi.org/10.1371/journal.ppat.1002158

3. Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022. https://doi.org/10.1016/S0140-6736(21)02724-0.

77 EXPERIENCES OF OLDER PEOPLE AND CARERS REFERRED TO AMBULATORY OUTREACH TEAM WITHIN INTEGRATED CARE PROGRAMME FOR OLDER PERSONS (ICPOP) SERVICE

Background

Ambulatory outreach services are part of new pathways to reduce reliance on secondary care as outlined in the Integrated Care Programme for Older Persons. Multidisciplinary outreach teams provide urgent medical and rehabilitation services in the person’s home to stabilise a health crisis.

Methods

The study aimed to explore the experiences of older people accessing a ambulatory outreach service and identify development opportunities. Interpretive description, an inductive analytic approach, was used to seek an understanding of clinical phenomena that illuminate their characteristics, patterns and structure. Data collection used qualitative telephone interviews. A purposeful sample of older people and carers were recruited following discharge from the outreach service over a three-month period.

Results

Sixteen participants (patients n=9 and carers n=7) were interviewed, 77% were female with a mean age of 83 years. Three major themes and seven sub-themes were identified:

Theme 1: Gratitude for specialised care: a) Moment of crisis “It was absolutely brilliant”; b) Care in my home: physical and psychological benefits

Theme 2: Living with and managing complexity: c) Resilience and resignation: living in the moment “Well she’s doing good at the moment, God forbids if there is more injuries”, d) Work of patients: maintain motivation & control; task and service boundaries e) Work of Families “We’re doing it so far”.

Theme 3:Scope for pro-active planning & Integration: f) What happens next? an unpredictable future; h) Integration with GP & community, g) Unspoken plan- sub-conscious advanced care planning “Nobody makes the decision on their own they call someone else”

Conclusion

The Outreach Team was highly valued by participants and was seen as vital in regaining functional capability and confidence to cope. Future developments need to examine task and service boundaries that undermine resilience, post outreach follow-up, integration with primary care, and opportunities for advanced care conversations.

Forest yield prediction under different climate change scenarios using data intelligent models in Pakistan

This study aimed to develop and evaluate data driven models for prediction of forest yield under different climate change scenarios in the Gallies forest division of district Abbottabad, Pakistan. The Random Forest (RF) and Kernel Ridge Regression (KRR) models were developed and evaluated using yield data of two species (Blue pine and Silver fir) as an objective variable and climate data (temperature, humidity, rainfall and wind speed) as predictive variables. Prediction accuracy of both the models were assessed by means of root mean squared error (RMSE), mean absolute error (MAE), correlation coefficient (r), relative root mean squared error (RRMSE), Legates-McCabe's (LM), Willmott's index (WI) and Nash-Sutcliffe (NSE) metrics. Overall, the RF model outperformed the KRR model due to its higher accuracy in forecasting of forest yield. The study strongly recommends that RF model should be applied in other regions of the country for prediction of forest growth and yield, which may help in the management and future planning of forest productivity in Pakistan.

Payment for ecosystem services (PES): a holistic tool for sustainable forest management-a case study from Pakistan

Economic valuation of ecosystem services is a new concept in forest management. Economic valuation provides basis for payment for ecosystem services (PES). Therefore, objective of this study was to evaluate eco-tourism and carbon stock services of the Maindam valley, District Swat, Pakistan. For the carbon stock calculation, a sample size of 155 plots of 0.1 hectare (Ha) was taken using preliminary survey at 95% confidence interval and 10% allowable error. The data for tourism services was collected from owners of all the hotels, 100 tourists and key informants of the area at 10% sampling intensity on pretested questionnaire for twenty years period (1997-2017). Results showed that Miandam valley has carbon stock worth US$ 16,306,000 while the value of eco-tourism was US$ 1,578,458 on annual basis. The results also showed that trend of tourism has drastically declined after the 9/11 incident for foreigners and locals and the situation was further deteriorated during the era of Talibanization or militancy from 2008-2011. This study recommends implementation of PES strategy at the rate of 5%, thus a total of US$ 78,922 can be earned from eco-tourism and carbon crediting in the study area annually, which could play important role in sustainable forest management.

Major threats and habitat use status of Demoiselle crane (Anthropoides virgo), in district Bannu, Pakistan

Cranes are the large and attractive Creatures of nature with long necks, legs, and life-span. Adults of both sexes are the same with similar color patterns. Demoiselle cranes spend most of their lifespan on dry grasses. They are also found around the stream, rivers, shallow lakes, natural wetlands, and depressions. To evaluate the current status of habitat use and major threats a study was conducted in tehsil Domel district Bannu. Line transect method and water quality tests (temperature, PH, contamination of E-coli bacteria) were used. To determine the major threats questionnaire method was used. The whole data was analyzed by using SPSS 21 version. Based on the distribution four study sites were selected and four water samples from each study site were taken. Most sites were moderate to highly degraded except Kashoo and kurram river mixing point which was low degraded with livestock grazing and human activities. Water quality tests showed PH ranges from 7-9, temperature 6.5-8.5, and contamination of E-coli in all samples. The social survey revealed that hunting, habitat degradation, and pollution as major threats. Effective long-term conservation and management in the study area are needed to focus on the protection of disturbance-free habitat.

Identification and crop damage assessment of indian crested porcupine (Hystrix indica) in selected zones of Abbottabad, Pakistan

Indian crested porcupine is the largest rodent pest that damages a wide variety of crops, vegetables, and tree species which ultimately causes huge economic loss in Pakistan, which is an agricultural country. It prefers to live in hilly terrain but common in temperate and tropical forests, shrublands, and grasslands. This study focused on the identification and assessment of crops damaged along with the main precautionary measures used by the local farmers. The data was collected from twenty-four villages of two union councils i.e. Chamhad and Slahad of district Abbottabad. Two types of data (primary and secondary) were collected from the study area. Primary data was collected for identification and estimation calculation of total crop damaged through direct field observation by taking random quadrates in each village of the study area. The damage in the crop was assessed by randomly selecting a quadrate of 1x1 m2 for the wheat, pearl millet, and Sorghum fields. While 4x4 m2 quadrates were taken for maize and vegetables. At least three quadrate samples were taken from each field including one quadrate taken from the center of the field area. In union council Chamhad, damage to maize (11.31%) and wheat (0.73%) by the Indian crested porcupine while in union council Salhad, damage of maize (6.95%) and wheat (1.6%) was observed. In the entire study area, overall damage to maize crop (8.01%) and wheat (0.88%) was calculated. Based on information obtained from the farmers, the Indian porcupine inflicted damage to potato, tomato, cauliflower, chili pepper, turnip, radish, pea, and onion, etc. Secondary data obtained through a questionnaire survey to explore the human porcupine conflict and precautionary measures used by the farmers and landowners. Open and close-ended questionnaires (159) highlighted the presence of Indian crested porcupine in the study area and 96% of the respondents have seen porcupine directly. Many types of precautionary measures were used by the farmers such as fencing, night stay, night firing, and dogs to decrease the crop damage, respondents (63.91%) use guns for hunting. however, due to the largely agricultural area and nocturnal behavior of Indian crested porcupine majority of the respondents (51.57%) did not use any precautionary measure. Biological control of Indian porcupine is recommended in the study area. Farmers should be encouraged and provide incentives and killing through current should be banned while proper hunting license should be issued to overcome overhunting. Scientific studies are required to control the reproduction of porcupine specifically in the more damaged areas.

1002 Calcium administration in Major haemorrhage Protocol

Introduction

Calcium gluconate is an essential part of the major haemorrhage protocol (MHP). It minimizes the exacerbation of transfusion coagulopathies due to the citrate preservative. As fifty percent of trauma patients present with hypocalcaemia prior to transfusion, the risk is pertinent. Given the importance of the issue, surprisingly current guidelines remain sparse. We analysed the percentage of patients who received calcium and their hypocalcaemia incidence.

Method

A Retrospective review of red traumas during June to August 2019. The frequency of MHP and the patient’s ionised plasma calcium levels on VBG (1.15-1.26mmol/L) were identified. Our standard stated 100% of MHP should receive calcium. A massive transfusion was defined as 10 red blood cells units in 24 hours or 4 blood products within 30mins.

Results

27 red traumas were accepted to audit, MHP was activated in 85%. Out of these 75% received calcium and on average after 6.4 units of blood products. The incidence of ionised hypocalcaemia in all MHP patients was 67%.

Conclusions

We identified a standard that supplementary calcium should be supplemented in all MHPs. Hypocalcaemia was more frequency than our research stipulated. Improvement needs to be made to meet standards. We recommend incorporation of Calcium gluconate into major haemorrhage pack and transfusion guidelines.

A lay provider delivered behavioral intervention for Syrian refugees and their children in Jordan

Background

Refugees and their children are exposed to many distressing events, including detention in refugee camps. Not surprisingly, refugees are at high risk for common mental disorders. A major barrier to addressing mental health problems in refugees is that most host countries lack sufficient mental health specialists to provide high-intensity treatments.

A recent trend has focused on training non-specialists to deliver simple psychosocial programs to those with distress. One such program is Problem Management Plus (PM+) which was developed by the World Health Organization; it comprises 5 small-group sessions that teach behavioural skills to reduce distress. This study reports the first evaluation of group PM+ in a refugee camp. We investigated the extent to which PM+ provided to adult Syrian refugees can benefit their children.

Methods

480 Adult Syrian refugees in the Azraq Refugee Camp were randomized to either PM+ or Treatment as Usual (TAU). Participants were independently assessed prior to the program, immediately following the program, and 3 months later. Outcome variables included anxiety, depression, functioning, posttraumatic stress, and grief and parenting behaviours. Children's psychological wellbeing was assessed in one child of each participant.

Results

Of the 650 adult refugees were screened in the camp, 96% met the cut-off for psychological distress and 76% met criteria for functional impairment. 480 participants were randomized to PM+ or TAU. The baseline assessment indicated 85% of refugees met criteria for depression, 84% met criteria for anxiety, and 84% met criteria for posttraumatic stress disorder. The 3-month assessment will be presented following linear mixed modelling to determine the relative gains made by refugees and their children in PM+ and TAU.

Conclusions

These findings will be discussed in terms of implementation of scalable programs in refugee settings, and specifically how these can benefit participants and their children.

Understanding and comparison of self-reported problems of Syrian refugees in three countries

Background

Syrian refugees have high levels of mental disorders. They face multiple stressors before, during and after migration which affect their psychosocial wellbeing. Stressors after flight may vary due to different geographic, economic, cultural, socio-political contexts. Previous studies demonstrate that displacement-related factors are as likely as war exposure to contribute to distress after migration and hence, are pivotal to include in public health policy. Assessments in mental health care are mainly through nomothetic measurements, often developed in western countries. A growing body of literature recognizes the importance of clients' own perspective, especially in cross-cultural settings. The aim of this multi-country study was to describe and compare self-reported problems of Syrian refugees between Jordan, Turkey and Switzerland.

Methods

Using the semi-structured client-generated outcome measurement PSYCHLOPS enabled to identify and compare problems in various study settings: camp-based in Jordan (N = 61), community-based in Turkey (N = 46) and Switzerland (N = 57), respectively. Questionnaires were analyzed following thematic analysis. The developed coding framework allowed to qualitatively illustrate the meaning and quantitatively compare the frequency of codes.

Results

Almost all the emerged themes are related to post-migration stressors. Over half of the participants reported practical problems with an emphasis on financial, employment, government regulations, followed by psychological and physical health problems. For participants in Turkey, finances are of much more concern than in Jordan and Switzerland, whereas in Switzerland, problems with government regulations stand out.

Conclusions

This study underlines the importance of displacement-related factors with special regard to local key factors on psychosocial wellbeing. Consequently, when planning mental health care services and preventive measures such factors must be considered and addressed.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Abstract D056: Differences in breast cancer survival by race, age, and tumor estrogen receptor status

Background: Breast cancer survival advancement can be ascribed to various efforts including community screening programs and educational outreach resulting in earlier diagnosis, treatment advances, and more accessible care. However, racial disparities continue to persist. Identification of populations susceptible to adverse health outcomes is substantial to construct health disparities resolutions. The purpose of the study is to identify trends in breast cancer disease specific survival (DSS) in black patients compared to white patients by age at diagnosis, year of diagnosis, and tumor estrogen receptor (ER) status. Methods: The Surveillance, Epidemiology, and End Results database was utilized to identify patients of black or white race diagnosed with stage I-III, ER positive (+) or ER negative (-) breast cancer between 1990 and 2009. The Kaplan-Meier method was used to determine 14-year breast cancer DSS. Changes in DSS were analyzed over the study’s time period and in 3 age groups to evaluate women who were of pre-menopausal age (< 50 years), perimenopausal or postmenopausal and of the average age for breast cancer diagnosis (50-64 years), and elderly (65 + years). Results: The total study sample was 344,142 patients; 309,415 identified as white (89.9%) and 34,727 identified as black (10.1%) women. All patients diagnosed most recently had stable or improving DSS (p<0.05). White patients with ER+ or ER- disease had significantly higher DSS compared to blacks in all age groups and years of diagnosis (p<0.05); more specifically all black patients diagnosed in 2005-2009, had significantly lower disease specific survival (DSS) compared to white patients diagnosed a decade earlier in 1995-1999 (p<0.05). For women 65+ with ER+ cancer, black patients diagnosed between 2005-2009 had a DSS of 86% compared to 91% in white patients diagnosed between 1995-2000. In ER- patients less than 50 years of age, black patients diagnosed between 2005-2009 had 78% DSS compared to white patient DSS of 84% within the same period. Among black patients, young women <50 years of age ER+ and ER- women aged 50-64 years had consistent and most improvement in DSS over the study’s 4 time intervals; for ER+ cancer, DSS was 68% for those diagnosed in 1990-1994, 71% for 1995-1999, 75% for 2000-2005, and 79% for 2006-2009 and for ER- cancer, the DSS was 60% for those diagnosed in 1990-1994, 67% for 1995-1999, and 72% for 2000-2005, and 75% for 2006-2009 (p<0.05). Conclusion: Improvements in breast cancer DSS are evidenced in black and white women, most especially black patients < 50 years of age with ER+ and 50-64 with ER- disease. However, findings demonstrate DSS remain lower in all black patients compared to white patients, independent of year of diagnosis, age, and tumor receptor status. Continued efforts are crucial to identify and address the causes of continued disparities in breast cancer DSS, particularly in subsets of black patients not having survival improvements.

Citation Format: Ewune Ewane, M Yi, A Akhtar, A M Brewster, Lorna McNeil-Haughton, Kelly K Hunt, Dalliah M Black. Differences in breast cancer survival by race, age, and tumor estrogen receptor status [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D056.

Abstract C039: Differences in breast cancer survival by race, age, and tumor estrogen receptor status

Background: Improvements in breast cancer survival can be attributed to screening programs resulting in earlier diagnosis, treatment advances, and more accessible care. However, racial disparities continue to persist. Identifying the most vulnerable populations can help strategize efforts of programs focused on improving disparities. The purpose of this study is to determine trends in breast cancer disease-specific survival (DSS) in black patients compared to white patients by age at diagnosis, year of diagnosis, and tumor estrogen receptor (ER) status.

Methods: The Surveillance, Epidemiology, and End Results database was utilized to identify patients of black or white race diagnosed with stage I-III, ER-positive (+) or ER-negative (-) breast cancer between 1990 and 2005. The Kaplan-Meier method was used to determine 10-year breast cancer DSS. Changes in DSS were analyzed over the study's time period and in 4 age groups to evaluate women who were of premenopausal age (< 50 years), perimenopausal or postmenopausal and of the average age for breast cancer diagnosis (50-64 years), elderly (65-79 years), and most elderly (≥80 years).

Results: The study included 634,434 white (89.8%) and 72,124 black (10.2%) women. In all age groups and years of diagnosis, white patients with ER+ or ER- disease had significantly higher DSS compared to blacks (p<0.05); in patients 50-64 years old diagnosed in 2000-2005, white patients with ER+ cancer had an 88% DSS compared to 77% DSS for black patients and, for ER- disease, whites had a 76% DSS compared to 67% for blacks. All patients diagnosed most recently had stable or improving DSS, except for black patients age ≥80 years who had a significantly lower DSS of 47% for those diagnosed in 2000-2005 compared to 52% for those diagnosed in 1990-1994 (p>0.05). All black patients diagnosed in 2000-2005, independent of age and tumor receptor status, had significantly lower disease-specific survival (DSS) compared to white patients diagnosed a decade earlier in 1990-1994 (p<0.05). For women <50 years of age with ER+ cancer, black patients diagnosed between 2000-2005 had a DSS of 75% compared to 81% in white patients diagnosed between 1990-1994. Among black patients, only young women <50 years of age with ER+ or ER- cancer had consistent and the most improvement in DSS over the study's 3 time intervals; for ER+ cancer, DSS was 68% for those diagnosed in 1990-1994, 71% for 1995-1999, and 75% for 2000-2005 and for ER- cancer, the DSS was 60% for those diagnosed in 1990-1994, 63% for 1995-1999, and 67% for 2000-2005 (p<0.05).

Conclusion: Black and white women have experienced improvements in breast cancer DSS, particularly in young black patients < 50 years of age with ER+ or ER- disease. However, DSS remained lower in all black patients compared to white patients, independent of year of diagnosis, age, and tumor receptor status. Future efforts are needed to identify and address the causes of continued disparities in breast cancer DSS, particularly in subsets of black patients not having survival improvements.

Citation Format: Ewune Ewane, Min Yi, A. Akhtar, Abenaa M. Brewster, Lorna McNeil-Haughton, Kelly K. Hunt, Dalliah M. Black. Differences in breast cancer survival by race, age, and tumor estrogen receptor status [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C039.

Multiple Primary Dedifferentiated Liposarcoma of the Jejunal Mesentery: A Case Report and Review of Literature

Liposarcoma arising primarily from the intestinal mesentery is a rare malignancy. Malignancy is said to be synchronous when there is occurrence of two or more tumours that have not spread from a common site or recurred and show no evidence of metastasis. Multiple synchronous primary liposarcoma of the mesentery is a very unusual clinical finding. Here, we report a rare case of synchronous multiple primary dedifferentiated liposarcoma of jejunal mesentery in a 36-year-old female patient. Radiological investigations aided in making a provisional diagnosis of an ovarian malignancy. A staging laparotomy was performed and general surgeon's help was sought due to the presence of three separate jejunal mesenteric masses of sizes 8x6 cms, 6x6 cms and 25x20 cms respectively. Complete excision of mesenteric masses with one feet of involved jejunum was done and a jejuno-jejunal anastomosis made. The histopathology report was indicative of multiple dedifferentiated liposarcoma of jejunal mesentery. Postoperatively patient received Doxorubicin, Dacarbazine and Ifosfamide based adjuvant chemotherapy in view of poorly differentiated tumour. Patient remains tumour free for the last 12 months of follow up.

Malignant Peripheral Nerve Sheath Tumour of Small Intestine Presenting as Ileo-Ileal Intussusception - A Rare Tumour with Unusual Complication

Malignant Peripheral Nerve Sheath Tumours (MPNST) arises from a peripheral nerve or exhibit nerve sheath differentiation on histology. Proximal portions of the upper and lower extremities and the trunk are the most common sites of occurrence. Around 50% are associated with Neurofibromatosis Type 1 (NF1) with incidence of two to five per cent in patients with NF1. The estimated incidence in general population without NF1 is 0.0001% of which gastrointestinal MPNST are extremely rare. A 45-year-old lady without pathological antecedent for NF1 was admitted with pain in right lower abdomen and multiple episodes of vomiting for 3 months. Preoperatively intussusception was diagnosed in the small bowel with USG and CECT abdomen showing characteristic target sign. On laparotomy Ileo-ileal intussusception (proximal ileum telescoping into distal ileum) was found 2 feet proximal to ileo-caecal junction with surrounding inflammed mesentery and presence of intraluminal tumour as lead point. Resection of involved segment of ileum along with its mesentery was done followed by ileo-ileal anastomosis. Histopathology was suggestive of high grade MPNST. Postoperative course and follow up for last 10 month is uneventful. This case is unique in terms of a rare tumour presenting with unusual complication and only one case had been reported so far in western literature.

Sialolipoma of the parotid gland: a rare entity

Lipomatous neoplasms of the parotid gland are rare tumours contributing from 0.6% to 4.4% to all parotid neoplasms with most series reporting an incidence of 1%. It is extremely rare in females, being 10 times more common in males, and the most common age of presentation is the five to sixth decade. Numerous histological variants of salivary gland lipoma have been described. Sialolipoma is a rare variant having proliferation of mature adipocytes with secondary entrapment of the normal salivary gland element. We report a rare case of sialolipoma in the right parotid of a 45-year-old woman who was treated with superficial parotidectomy. Postoperative recovery as well as follow-up has been uneventful.

Non-functional paraganglioma of retroperitoneum mimicking pancreatic mass with concurrent urinary bladder paraganglioma: an extremely rare entity

Paragangliomas are extra-adrenal tumours of the autonomic nervous system, which rarely present as primary retroperitoneal mass mimicking pancreatic malignancy (incidence 2-8 per million populations). Urinary Bladder Paraganglioma are also extremely rare (0.06% of all Bladder Tumour and 6% of Paragangliomas) with most being malignant and high grade tumours. Non-functional varieties of both tumours are usually incidentally diagnosed. The possibility for malignant transformation in them makes surgical excision the treatment of choice. A 45-year-old lady with abdominal pain was investigated to have a complex retroperitoneal mass behind head of pancreas and a urinary bladder mass. Complete excision of retroperitoneal and bladder lesion was done. Histopathological examinations of both specimens were suggestive of Paraganglioma with no abnormal mitotic activity and capsular/vascular invasion. Although concurrent non functional paragangliomas had been reported but the synchronous non-functional paragangliomas of retroperitoneum and urinary bladder reported in this case is extremely rare and is not reported so far in English literature.

Pyrido- and benzisothiazolones as inhibitors of histone acetyltransferases (HATs)

We present structure–activity studies on pyrido- and benzisothiazolones as histone acetyltransferase (HAT) inhibitors. Distinct subtype-selectivity profiles were obtained in vitro that correlate with cytotoxicity profiles on cancer cells.

A history of shoulder surgery

Shoulder surgery has emerged from being a marginalised sub-speciality to being an area of much research and advancement within the last seventy years. This has been despite the complexity of the joint, and success majorly rests on parallel development of biomedical technology. This article looks at the past and present of shoulder surgery and discusses future directions in the speciality.

WITHDRAWN: MUA with steroid injection vs. arthroscopic capsular release for adhesive capsulitis: A prospective randomised study

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Abstract P6-05-02: Endocrine biomarkers in response to AR-inhibition with bicalutamide for the treatment of AR(+), ER/PR(−) metastatic breast cancer (MBC) (TBCRC011)

Background: Our group and others have identified a subset of ER/PR(−) breast cancers characterized by expression of the androgen receptor (AR) and androgen-dependent growth (Doane 2006). We conducted a proof-of-concept multicenter phase II study to test the efficacy of the AR-antagonist, bicalutamide for the treatment of AR(+) ER/PR(−) MBC (NCT00468715). Results of the primary endpoint, clinical benefit rate (CBR), were presented at ASCO (Gucalp 2012). Data for the impact of bicalutamide on circulating hormone levels in women are limited. Elevations in serum testosterone (T) and estradiol (E) have been observed for men treated with bicalutamide. We hypothesized comparable patterns of change in circulating endocrine markers in response to bicalutamide for women with MBC.

Methods: Patients (pts) with AR(+) (IHC ≥10%), ER/PR(−) (IHC <10%) MBC were eligible for treatment (tx) if ECOG performance status ≤2 and normal organ function regardless of menopausal status. There was no limit to prior tx except prior trastuzumab required if HER2(+). Tx consisted of bicalutamide 150mg orally daily in 28-day cycles (C). Toxicity assessed q4 weeks, response q12wks. Primary endpoint was CBR. Peripheral blood was collected for total and free T, E and sex hormone binding globulin (SHBG) at baseline, start of C2 (C2) and at end of study (EOS). Standard institutional assays were used. A Wilcoxon signed-rank test was done to compare baseline to C2 and EOS values.

Results: 26 patients with AR(+) ER/PR(−) MBC were treated on study. Evaluable number (n) of pts at baseline, C2 and EOS are 26, 26 and 19 respectively. Two pts remain on study. Menopausal status: pre=2, post=24. Baseline median total and free T and estradiol were consistent with expected norms, however a wide range was observed (Table). There were no significant differences observed for median free T, total T, E or SHBG between baseline and C2 or baseline and EOS. Changes in hormone levels could not be stratified by menopausal status or response to bicalutamide given small sample size. Given the wide range of baseline values, we examined the percent change for each endocrine biomarker from baseline to C2 and EOS. As shown in the Table, there was no difference in median percent change observed across time points for each biomarker.

Males absent on the first (MOF): from flies to humans

Histone modifications such as acetylation, methylation and phosphorylation have been implicated in fundamental cellular processes such as epigenetic regulation of gene expression, organization of chromatin structure, chromosome segregation, DNA replication and DNA repair. Males absent on the first (MOF) is responsible for acetylating histone H4 at lysine 16 (H4K16) and is a key component of the MSL complex required for dosage compensation in Drosophila. The human ortholog of MOF (hMOF) has the same substrate specificity and recent purification of the human and Drosophila MOF complexes showed that these complexes were also highly conserved through evolution. Several studies have shown that loss of hMOF in mammalian cells leads to a number of different phenotypes; a G2/M cell cycle arrest, nuclear morphological defects, spontaneous chromosomal aberrations, reduced transcription of certain genes and an impaired DNA repair response upon ionizing irradiation. Moreover, hMOF is involved in ATM activation in response to DNA damage and acetylation of p53 by hMOF influences the cell's decision to undergo apoptosis instead of a cell cycle arrest. These data, highlighting hMOF as an important component of many cellular processes, as well as links between hMOF and cancer will be discussed.

MSL proteins and the regulation of gene expression

Epigenetics describes changes in genome function that occur without a change in the DNA sequence. Dosage compensation is a prime example of the regulation of gene expression by an epigenetic mechanism. Dosage compensation has evolved to balance the expression of sex-linked genes in males and females, which possess different numbers of sex chromosomes. However, the genetic sequence of the chromosomes is the same in both sexes. This mechanism therefore needs (1) to function in a sex-specific manner, (2) to target the sex chromosome from amongst the autosomes and (3) to establish and maintain through development a precise, equalised level of gene expression in one sex compared to the other. The process by which dosage compensation is orchestrated has been well characterised in fruit flies and mammals. Although each has evolved a specific dosage-compensation mechanism, these systems share some underlying themes; the molecular components that mediate dosage compensation in both include non-coding RNA molecules, which act as nucleation points for the compensation process. Both systems utilise chromatin-modifying enzymes to remodel large domains of a chromosome. This review will discuss the mechanism of dosage compensation in Drosophila in light of recent developments that have brought into question the previous model of dosage compensation.

Symptomatic fibroid uterus in a 15-year-old girl

A 15 year-old gravida 1, abortus 1 black girl presented with chief complaints of menorrhagia, severe dysmenorrhea, and progressively worsening abdominal pain, which was caused by a very large uterine leiomyoma. The symptoms began 6 months earlier, shortly after a 10-week spontaneous abortion at age 14. A solitary 25-cm uterine leiomyoma was removed uneventfully with an abdominal laparotomy. In the English literature of the past 50 years, this case represents the sixth, and we believe, the largest, documented uterine fibroid among teenagers, which required corrective surgery.

The histone H4 acetyltransferase MOF uses a C2HC zinc finger for substrate recognition

Site-specific acetylation of histone H4 by MOF is central to establishing the hyperactive male X chromosome in Drosophila. MOF belongs to the MYST family of histone acetyltransferases (HATs) characterized by an unusual C2HC-type zinc finger close to their HAT domains. The function of these rare zinc fingers is unknown. We found that this domain is essential for HAT activity, in addition to the established catalytic domain. MOF uses its zinc finger to contact the globular part of the nucleosome as well as the histone H4 N-terminal tail substrate. Point mutations that leave the zinc-finger structure intact nevertheless abolish its interaction with the nucleosome. Our data document a novel role of the C2HC-type finger in nucleosome binding and HAT activity.

Chromodomains are protein-RNA interaction modules

In Drosophila, compensation for the reduced dosage of genes located on the single male X chromosome involves doubling their expression in relation to their counterparts on female X chromosomes. Dosage compensation is an epigenetic process involving the specific acetylation of histone H4 at lysine 16 by the histone acetyltransferase MOF. Although MOF is expressed in both sexes, it only associates with the X chromosome in males. Its absence causes male-specific lethality. MOF is part of a chromosome-associated complex comprising male-specific lethal (MSL) proteins and at least one non-coding roX RNA. How MOF is integrated into the dosage compensation complex is unknown. Here we show that association of MOF with the male X chromosome depends on its interaction with RNA. MOF specifically binds through its chromodomain to roX2 RNA in vivo. In vitro analyses of the MOF and MSL-3 chromodomains indicate that these chromodomains may function as RNA interaction modules. Their interaction with non-coding RNA may target regulators to specific chromosomal sites.

Activation of transcription through histone H4 acetylation by MOF, an acetyltransferase essential for dosage compensation in Drosophila

Dosage compensation in Drosophila involves a 2-fold increase in transcription from the single male X relative to the two female X chromosomes. Regulation at the level of the chromosome involves alterations in chromatin organization: male X chromosomes appear decondensed and are marked by acetylation of histone H4 at lysine 16. We demonstrate that MOF, a protein required for dosage compensation with significant sequence similarity to the MYST family of acetyltransferases, is a histone acetyltransferase that acetylates chromatin specifically at histone H4 lysine 16. This acetylation relieves chromatin-mediated repression of transcription in vitro and in vivo if MOF is targeted to a promoter by fusion to a DNA-binding domain. Acetylation of chromatin by MOF, therefore, appears to be causally involved in transcriptional activation during dosage compensation.

Use of V79 cells with stably transfected cytochrome P450 cDNAs in studying the metabolism and effects of cytotoxic drugs

PURPOSE

Studying the metabolism of cytotoxic drugs has become increasingly necessary to predict clinically significant drug-drug interactions and to understand the basis of interindividual variations in the pharmacokinetics of anticancer agents. The aim of this study was to determine the feasibility of using V79 Chinese hamster fibroblasts, which are stably transfected with cytochrome P450 (CYP) cDNAs, to study the metabolism of cytotoxic drugs in vitro.

METHODS

The 3-[4,5-dimethylthiazol-2yl]-2,5-diphenyltetrazolium bromide (MTT) assay was used to determine cell survival after incubation with drugs. Gas chromatography/mass spectroscopy was used for the quantitation of metabolites of cyclophosphamide and ifosfamide in culture medium. The coculture technique was used to study the generation of cytotoxic metabolites in culture medium.

RESULTS

After treatment with either cyclophosphamide or ifosfamide (100 microM to 1 mM) cytotoxicity was demonstrated in only cytochrome CYP2B1- and cytochrome CYP3A4-expressing cells. Treatment of parental nontransfected cells that were cocultured with CYP-expressing cells with cyclophosphamide resulted in increased sensitivity to this drug. All active and inactive metabolites of cyclophosphamide and ifosfamide were detected in the culture medium. Cyclophosphamide-induced cytotoxicity in CYP2B1- and CYP3A4-expressing cells was abrogated by metyrapone and midazolam/ troleandomycin, respectively. Paclitaxel showed greater cytotoxicity against parental V79 cells than against the CYP2BI-, 2E1-, or 3A4-expressing cells, which was also influenced by cotreatment with CYP inhibitors.

CONCLUSIONS

Stable expression of CYP cDNAs by V79 cells provided an in vitro system to study cytotoxic drug metabolism. Cell viability and metabolite assays were used to determine the differential metabolism and effects in different CYP-transfected cell lines treated with cytotoxic drugs. The potential use of this V79 cell expression system is in studying enzymes involved in the metabolism of cytotoxic drugs, especially early in drug development. In addition, this system may be used to determine drug interactions that may influence the outcome of therapy in patients with cancer.

Serum lipids : new biological markers in depression ?

Several studies suggest that a low cholesterol concentration is associated with depression. The authors sought to determine whether an association exists between serum lipid concentrations and depression. 28 drug-naive patients of major depression diagnosed according to DSMlll- R criteria were included in the study and severity of depression was measured on Hamilton Rating Scale for Depression. Suicidal intent was assessed on Suicidal Intent Questionnaire. 28 normal healthy controls were selected and matched for age, sex and body-mass index with the depressives. Serum lipid estimations were done in each subject after 12 hours overnight fasting. The main finding of the study is that total serum cholesterol, serum triglycerides and serum LDL cholesterol are decreased while serum HDL cholesterol is increased in depression and these changes were more marked in depressed subjects with definite suicidal intent. On regression analysis, total serum cholesterol was the most important predictive variable of the severity of depression.

Successful allogeneic bone marrow transplantation in selected patients over 50 years of age--a single institution's experience

As allogeneic bone marrow transplantation (BMT) is a procedure with a higher risk of morbidity and mortality in older patients, many institutions place a limit of 50 to 55 years for allogeneic BMT. Consequently, older patients may not be offered potentially curative treatment for otherwise poor prognosis diseases such as AML or myelodysplastic syndrome. We compared the outcome of 59 patients aged over 50, 124 aged 40-50, and 253 aged 18-39 years who underwent allogeneic BMT in our institution between August 1987 and April 1996. Our results show little influence of age on outcome when comparing patients over 50 years with patients 40-50 years. Apart from an initial higher transplant mortality rate, overall survival was not significantly different between the three age groups. The 1-year and 2-year overall survival rates were 57% and 48%, 57% and 48%, and 62% and 58% for the >50 years, 40-50 years, and <40 years patients, respectively. The incidence of GVHD was also comparable. We conclude that allogeneic BMT can be performed in selected patients over the age of 50 years with acceptable morbidity and mortality and that older patients should not be denied this treatment based on age alone.

Distinct activated and non-activated RNA polymerase II complexes in yeast

We used a transcriptional run-on assay in permeabilized yeast cells to study the distribution of RNA polymerase II (pol II) complexes before and after activation by Gal4. Polymerases were found engaged on the gene at the 5' end before activation, but only appeared at the 3' end after activation. Mutations of the pol II C-terminal domain (CTD), the CTD kinase Kin28 and the holoenzyme subunit Srb2 all inhibited the formation of 3' polymerases in response to activator. However, these mutations did not inhibit the establishment of polymerases at the 5' end. The differences between 3' and 5' ternary complexes suggest that they represent qualitatively distinct 'activated' and 'non-activated' forms of polymerase. The results implicate CTD phosphorylation in a switch from 'non-activated' transcription, which is confined to the 5' end, to an 'activated' mode that traverses the length of the gene.

Isolation and characterization of the human and mouse homologues (SUPT4H and Supt4h) of the yeast SPT4 gene

To study gene regulation mediated by chromatin in mammals, we isolated the human (SUPT4H) and murine (Supt4h) counterparts of the yeast gene encoding SPT4; the product of this gene presumably interacts with the products of the mammalian homologues (which we have also cloned) of yeast SPT5 and SPT6, thereby modulating chromatin formation and activity. We isolated two different sized human SUPT4H cDNA clones (1464 and 728 nt) and one murine Supt4h (688 nt) cDNA clone; all three encode the same 117-amino-acid protein with conservation of the zinc finger motif found in SPT4. Conservation of this zinc finger motif from yeast to mouse and human implies functional importance. Although the overall sequence homology at the DNA level between the human 728-nt transcript and the murine 688-nt transcript is only 78.4%, the DNA sequence homology is 97.7% within the coding region. At the protein level, the amino acid sequences of the translated murine Supt4h and the human SUPT4H gene products are identical. The likely functional copy of SUPT4H, which has at least two introns, maps to human chromosome 17, with candidate intronless pseudogenes on chromosomes 2, 12, and 20. Buttressing the hypothesis that this is a gene required constitutively, both the human SUPT4H transcripts and the murine Supt4h transcript are expressed widely, although not at equal levels (e.g., such as most histones), in all fetal and adult tissues that we examined.

Inhibition of spontaneous metastasis in a rat prostate cancer model by oral administration of modified citrus pectin

BACKGROUND

Prostate cancer is the most common cancer diagnosed in U.S. men and remains incurable once it has metastasized. Many stages of the metastatic cascade involve cellular interactions mediated by cell surface components, such as carbohydrate-binding proteins, including galactoside-binding lectins (galectins). Modified citrus pectin (pH-modified), a soluble component of plant fiber derived from citrus fruit, has been shown to interfere with cell-cell interactions mediated by cell surface carbohydrate-binding galectin-3 molecules.

PURPOSE

The aim of this study was to determine whether modified citrus pectin, a complex polysaccharide rich in galactosyl residues, could inhibit spontaneous metastasis of prostate adenocarcinoma cells in the rat.

METHODS

The ability of modified citrus pectin to inhibit the adhesion of Dunning rat prostate cancer MAT-LyLu cells to rat endothelial cells was measured by 51Cr-labeling. Modified citrus pectin inhibition of MAT-LyLu cell anchorage-independent growth was measured by colony formation in agarose. The presence of galectin-3 in rat MAT-LyLu cells and human prostate carcinoma was demonstrated by immunoblotting and immunohistochemistry. One million MAT-LyLu cells were injected subcutaneously into the hind limb of male Copenhagen rats on day 0. Rats were given 0.0%, 0.01%, 0.1%, or 1.0% (wt/vol) modified citrus pectin continuously in their drinking water (from day 4 until necropsy on day 30). The number of MAT-LyLu tumor colonies in the lungs were counted.

RESULTS

Compared with 15 or 16 control rats that had lung metastases on day 30, seven of 14 rats in the 0.1% and nine of 16 rats in the 1.0% modified citrus-pectin group had statistically significant (two-sided; P < .03 and P < .001, respectively) reductions in lung metastases. The lungs of the 1.0% modified citrus pectin-treated rats had significantly (two-sided; P < .05) fewer metastatic colonies than control groups (9 colonies +/- 4 [mean +/- SE] in the control group compared with 1 colony +/- 1 in the treated group). Modified citrus pectin had no effect on the growth of the primary tumors. In vitro, modified citrus pectin inhibited MAT-LyLu cell adhesion to rat endothelial cells in a time- and dose-dependent manner as well as their colony formation in semisolid medium.

CONCLUSIONS

We present a novel therapy in which oral intake of modified citrus pectin acts as a potent inhibitor of spontaneous prostate carcinoma metastasis in the Copenhagen rat.

IMPLICATIONS

Further investigations are warranted to determine the following: 1) the role of galectin-3 in normal and cancerous prostate tissues and 2) the ability of modified citrus pectin to inhibit human prostate metastasis in nude mice.