Association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan: a cohort study

Background

There is an ongoing controversy regarding the necessity of single-photon emission computed tomography (SPECT) for patients with ischemic heart diseases after the publication of the results of the ISCHEMIA trial.

Purpose

We aimed to evaluate the association of the extent of myocardial ischemia with outcomes in patients with suspected coronary artery disease in Japan.

Methods

From the data of 2780 patients with stable angina who were enrolled prospectively between January 2006 and March 2008 in Japan and had undergone physician-referred non-invasive imaging tests, 1205 patients managed with SPECT were stratified by 10% myocardial ischemia. Major adverse cardiac events (MACEs), including death, myocardial infarction, hospitalization for heart failure, and late revascularization, were followed-up for 1 year.

Results

Patients with ≥10% myocardial ischemia (n=173) were older than patients with <10% myocardial ischemia (n=1032) and had a significantly higher 1-year cumulative incidence of MACEs (9.1% vs. 1.2%, P<0.0001). After adjusting for confounders, the risk of ≥10% myocardial ischemia relative to <10% myocardial ischemia for MACEs remained significant (adjusted hazard ratio [95% confidence interval], 2.40 [1.09–5.26], P=0.029).

Conclusion

The presence of ≥10% myocardial ischemia was significantly associated with the 1-year risk for MACEs in Japanese patients with suspected coronary artery disease.

Funding Acknowledgement

Type of funding sources: None. Study flowchartOutcomes

Prognostic value of cardiac 123I-metaiodobenzylguanidine imaging for predicting cardiac events after transcatheter aortic valve replacement

Background

In patients with aortic valve stenosis (AS), cardiac sympathetic nervous (CSN) dysfunction and its improvement after TAVR have been reported; however, the prognostic impact of CSN function remains unclear. This study investigated the prognostic value of cardiac 123I-metaiodobenzylguanidine (MIBG) imaging for the prediction of cardiac events after transcatheter aortic valve replacement (TAVR).

Methods

This study was a single-center prospective observational study that enrolled patients with AS or failed surgical bioprostheses between July 2017 and May 2019. MIBG scintigraphy was performed before and after TAVR to evaluate the delayed heart–mediastinum ratio (d-H/M). Patients were classified into three pairs of groups based on the baseline and post-TAVR d-H/M (≥2.0 or <2.0) and on the presence of TAVR-related improvement of d-H/M. The study endpoints were major adverse cardiac events (MACE), including all-cause death, myocardial infarction, and hospitalization due to heart failure. The association of d-H/M with MACE following TAVR was based on a Cox proportional hazards ratio model adjusted for multiple prognostic variables.

Results

Of 187 consecutive patients who underwent TAVR, 111 (31 men; median age: 86 years) were evaluated. Over a median follow-up of 366 days, 16 (14.4%) patients had MACE. The incidence of MACE was significantly lower in patients with d-H/M improvement and/or the high post-TAVR d-H/M (≥2.0). Post-TAVR d-H/M had significant impacts on MACE, with an adjusted hazard ratio of 1.326 (95% confidence interval, 0.139–2.515; p=0.027).

Conclusions

Both d-H/M improvement and high post-TAVR d-H/M were associated with better prognosis in patients who underwent TAVR. Cardiac MIBG imaging was useful for predicting cardiac events after TAVR.

Funding Acknowledgement

Type of funding source: None

4089Prognostic value of cardiac metabolic activity assessed by 18F-FDG PET in patients with cardiac sarcoidosis

Background

Sarcoidosis is a systemic granulomatous disease that affects multiple organs. Among these,the presenceof cardiac involvementis recognized as a determinant of worse clinical outcomes. 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) is a valuable modality for detecting active inflammatory lesions associated with cardiac sarcoidosis (CS). Generally,the maximum standardized uptake value (SUV) is suitable for evaluating disease activity in CS, but this quantitative method had limitations because it does not integrate both volume and intensity of FDG uptake simultaneously. Cardiac metabolic activity (CMA), which is quantitative measures of FDG volume-intensity, could be a diagnostic tool in the evaluation of CS. However, its prognostic implication in patients with CS is unclear.

Purpose

We sought to investigate whether CMA assessed by FDG-PET was associated with long-term worse clinical outcomes in patients with CS.

Methods

A total of 76 consecutive patients suspected CS who underwent FDG-PET between January 2010 and April 2018 in our university hospital were registered. We excluded patients whodid not meet the Japanese Ministry of Health and Welfare 2007 criteria (n=9) and those who received oral corticosteroids at the time of FDG-PET (n=5). Ultimately, 62 CS patients with definitively diagnosed were included in this study.We used a dedicated software to analyze SUV. Cardiac metabolic volume (CMV) was defined as the volume within the boundary determined by the threshold (SUV mean of blood pool × 1.5). CMA was calculated by multiplying CMV by SUV mean. The primary outcome of interest was the composite of advanced atrioventricular block, ventricular tachycardia, ventricular fibrillation, heart failure hospitalization, and all-cause death.

Results

During a median follow-up period of 1287 (IQR 806–1809) days after the first FDG-PET, the adverse events occurred in 12 patients (19%). Events group had significantly higher CMA compared to no events group (83 [IQR 11–330] vs. 354 [IQR 70–577]) (Figure A). Based on ROC analysis, the optimal cut-off value of CMA for the discrimination of the adverse events was 244 ml, and c-index was 0.71 (95% CI, 0.55–0.87). Patients with high CMA (≥244 ml, n=23) had lower LVEF, and higher prevalence of New York Heart Association functional class III or IV, and higher plasma BNP level compared to those with low CMA (<244 ml, n=39). Kaplan-Meier analysis revealed that composite adverse events more frequently occurred in patients with high CMA compared to those with low CMA (Figure B).Univariable Cox regression analysis showed that higher CMA was associated with increased subsequent risk of adverse events (HR 1.47, 95% CI 1.06–2.24).

Conclusions

Higher CMA assessed by FDG-PET was associated with worse clinical long-term outcomes in patients with CS, suggesting that measurement of the volume-intensity of abnormal FDG uptake may be useful for risk stratification in patients with CS.

P1221Effect of transcatheter aortic valve implantation on cardiac sympathetic nervous function assessed by 123I-metaiodobenzylguanidine scintigraphy in patients with severe aortic stenosis

Background

Cardiac sympathetic nervous (CSN) function assessed by 123I-metaiodobenzylguanidine (MIBG) scintigraphy is associated with poor prognosis in patients with heart failure.

Purpose

The aim of this study was to investigate the effects of transcatheter aortic valve implantation (TAVI) on CSN function in patients with severe aortic stenosis (AS) using MIBG scintigraphy.

Methods

This was a single-center prospective observational study that enrolled patients between July 2017 and July 2018. Among 77 registered patients who scheduled to undergo TAVI, 35 patients (7 men; mean age: 87 years) were evaluated. The MIBG scintigraphy was performed at baseline and 6 months after TAVI procedure to evaluate the heart-mediastinum ratio (H/M) and washout rate (WR). The MIBG parameter changes were compared with B-type natriuretic peptide (BNP) levels and echocardiographic parameters, including aortic valve area (AVA), peak velocity (Vmax), mean pressure gradient (PG), and left ventricular ejection fraction (LVEF).

Results

All patients successfully underwent TAVI with improved BNP level (388±341 pg/mL vs. 167±118 pg/mL, p<0.001). The AVA, Vmax, mean PG and LVEF improved after TAVI (0.6±0.2 cm2 vs. 1.6±0.5 cm2, p<0.001; 4.6±0.8 m/s vs. 2.1±0.3 m/s, p<0.001; 54±20 mmHg vs. 9±3 mmHg, p<0.001; 58±11% vs. 63±9%, p=0.01, respectively). In the MIBG imaging, the delayed H/M significantly increased (2.5±0.6 vs. 2.6±0.7, p=0.03), and the WR decreased (32±8% vs. 29±8%, p=0.047) after TAVI. There was a correlation between the changes in the MIBG parameters and the change in mean PG from baseline to 6 months (delayed H/M: r=0.391, p=0.02; WR: r=0.347, p=0.04). Multivariate logistic regression analysis showed that baseline mean PG was an independent predictor of improved both delayed H/M and WR (odds ratio=1.062; 95% confidence interval: 1.009–1.137; p=0.042).

Conclusions

TAVI can improve the CSN function in patients with AS. Such CSN improvement was related with hemodynamic changes.

Acknowledgement/Funding

None

Abstract P5-01-03: Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography

Introduction

Recently “Dense breast” has attracted numerous attention because of diagnostic difficulty in mammography among those harboring dense breast, which is far more frequent in Asian than Caucasian women. Therefore, in this study, we retrospectively evaluated the risks of subsequent development of malignancy through comparing the detailed mammographic characteristics between Japanese subjects harboring dense and non dense breasts.

Methods

We retrospectively examined mammorgraphic findings taken from March 2013 to March 2016 at Nahanishi Clinic, Okinawa, Japan. We stratified its density according to the suggestion of the Japan Central Organization on Quality Assurance of Breast Cancer Screening, which was defined by the proportion of fat area as follows; extremely high dense:10-20%, heterogeneously dense:40-50%, scattered fatty:70-90%, fatty: almost all the breast fat. “Dense breast” includes extremely high and heterogeneous dense. We evaluated the detailed radiological findings of each phenotypes including the characteristics of the mass, calcification and focal asymmetric density(FAD) and architectural distortion. We also compared the rates of subsequent cancer development and sensitivity of detecting cancer between those harboring dense and non dense breasts.

Results

We reviewed the mammography findings of 7747 Japanese women including 857 with breast cancers. When adjusted for age, the rate of dense breast was significantly associated with age, 88.6% in women in their 20s(vs40s p&lt;0.001 OR3.402), with incremental decrease, 80.4% in 30s(P&lt;0.001 OR1.802), 69.5% in 40s, 55.9% in 50s(P&lt;0.001 OR0.512), 32.3% in 60s(P&lt;0.001 OR 0.108), 19.5% in 70s(P&lt;0.001 OR 0.106) and 5.3% in over 80s(P&lt;0.001 OR0.024). The rate of malignancies was 9.1% (385) in dense and 13.6% (472) in non dense breasts. We then compared the mammographic findings between dense and non dense breast. Abnormal calcifications were detected more frequent(7.6%vs5.3% P&lt;0.001 OR1.478) but masses less so(16.4%vs23.7% P&lt;0.001 OR 0.632) in dense breast, while no significant differences detected in FADs(4.9%vs4.6% P=0.35 OR1.074) and distortions(1.2%vs1.4% P=0.29 OR=0.859) between dense and non dense breast. The rate of carcinoma was less frequent in dense breast among those associated with mammographic calcification(19%vs27.3% P&lt;0.01 OR0.626) but more frequently in dense breast among those with masses (13%vs19% P&lt;0.001 OR0.628). The rate of carcinoma was not different between dense and non dense breast in those with FADs (21.6vs20.6% P=0.72 OR1.067) and distortions(71.7%vs74.7% P=0.64 OR0.857). In addition, among 37 breast cancer patients who did not harbor the mammographic findings above (26 dense and 11 non dense breasts), the average mass length was significantly larger in dense (13.6mm) than non-dense breast (9.9mm) (P=0.018 used Welch's t test), respectively.

Conclusion

Results of our present study did demonstrate that detection of malignancy in those with mammographic dense breast is more difficult. Therefore, in those harboring dense breast in mammography, addition of other modalities such as US could improve the detection of breast carcinoma.

Citation Format: Takigami N, Tamaki K, Kamada Y, Uehara K, Terukina S, Ishida T, Miyashita M, McNamara KM, Tamaki N, Sasano H. Comparison of mammography findings between dense and non dense breast in Japanese subjects: The potential limitation of routine mammography [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-01-03.

Use of ATP bioluminescence to survey the spread of aerosol and splatter during dental treatments

Aerosol and splatter produced during dental treatments (ultrasonic scaling and professional mechanical tooth cleaning) are potential sources of infection. Contamination patterns on the mask, goggles, chest and gowned right arm of operators, and on the goggles of patients before and after dental treatments were investigated using ATP bioluminescence analysis. Contamination on every surface tested increased significantly after dental treatment. Maximum contamination was found on the goggles of patients. Aerosol and splatter produced during dental treatments therefore have the potential to spread infection to operators and patients. ATP bioluminescence is a useful tool for monitoring surface contamination.

Abstract P6-11-01: Final results of the randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia

Aromatase inhibitors (AIs) have been used in the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer as a consequence of the significant benefit in DFS and OS when compared with tamoxifen. However the patients who receive AIs have an increased risk of arthralgia, at most 50% of patients did not take AIs and the 20% of the discontinued patients were within the first year of use. The HOPE study demonstrated that exercise was effective in improving AI-induced arthralgia. We conducted the AIAI (Arthralgia Improvement for the patients with Aromatase Inhibitors) study using wider eligibility criteria that the HOPE study to assess the impact on AI induced arthralgia in breast cancer patients.

Patients were randomly assigned, in a 3:1 ratio, to exercise intervention or usual care. Following randomization participants could choose from 3 types of exercise including group 1 (120-150 minutes per week of walking or running), group 2 (daily NIPPON HOSO KYOKAI: NHK broadcast exercise in Japan) and group 3 (going up the stairs- frequency, etc). The primary endpoint was the arthralgia change at 6 and 12 months, which was assessed using the BPI (Brief Pain Inventory). Secondary endpoints included the BPI according to the completion rate of exercise (70% and more or less than 70%), the BPI change of the patients with arthralgia (the patients who had arthralgia at the time they enrolled this study; BPI worst pain 3≤), the BPI of the each exercise group, the BPI according to the duration of AIs therapy (24 months and more or less than 24 months), the correlation between the BMI change and the BPI change, adherence of AIs and safety.

102 were randomly assigned to exercise intervention group (22 patients dropped out of this study) and 37 to usual care group (9 patients dropped out of this study).Trends for differentiations of pain interference at 12 months was detected between exercise intervention group and usual care group, but the differences did not reach statistical significance (p = .067). There was statistically better pain interference of the 70% and more exercise completion group than the usual care group at 12 months (-0.29±1.22 for exercise intervention group and 0.33±0.88 for usual care group, p= .002). The change of pain interference was statistically better for the exercise intervention group than the usual care group at 12 months (p= .017, -0.61±0.69 for exercise intervention group and 1.14±1.56 for usual care group). There was statistically significant difference of pain interference between group 1 exercise intervention group and the usual care group at 12 months (-0.14±0.68 for group 1 exercise intervention group and 0.33±0.88 for the usual care group, p= .009). Tendencies were detected in the AIs therapy less than 24 months group. Trends for the correlation between BPI and BMI were detected in worst pain at 6 month, pain severity at 6 month and pain interference at 12 month. There was a statistically significant difference of AIs adherence between the exercise intervention group (99%) and the usual care group (92%) (P=0.03).

Exercise may be effective in improving and preventing AI-induced arthralgia.

Citation Format: Tamaki K, Takaesu M, Nagamine S, Terukina S, Kamada Y, Uehara K, Takigami N, Arakaki M, Yamashiro K, Miyashita M, Ishida T, McNamara KM, Tamaki N, Sasano H. Final results of the randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-01.

Hepatitis B surface antigen reduction by switching from long-term nucleoside/nucleotide analogue administration to pegylated interferon

Hepatitis B surface antigen (HBsAg) reduction during nucleoside/nucleotide analogue (NA) therapy is slow and an alternative strategy for patients receiving ongoing NA to facilitate HBsAg reduction is required. We investigated whether switching to pegylated interferon (PEG-IFN) after long-term NA administration enhances HBsAg reduction. Forty-nine patients who switched from long-term NA to 48 weeks of PEG-IFN alfa-2a were studied. The mean duration of previous NA was 48 months (sequential group). A total of 147 patients who continued NA and matched for baseline characteristics were analysed for comparison (NA continuation group). The treatment response was defined as HBsAg reduction ≥1.0 logIU/mL at the end of PEG-IFN. HBsAg reduction at week 48 was 0.81±1.1 logIU/mL in the sequential group, which was significantly higher than that in the NA continuation group (0.11±0.3 logIU/mL, P < .001). The treatment response was achieved in 29% and 2% of the sequential group and NA continuation group (P < .001), and the odds ratio of sequential therapy for the treatment response was 19 compared with the NA continuation (P < .001). In patients tested positive for hepatitis B e antigen (HBeAg), HBeAg seroconversion was higher in the sequential group (44% vs 8%, P < .001). In HBeAg-negative patients, only patients in the sequential group achieved HBsAg loss. No patient needed to resume NA administration because of HBV DNA increase accompanied by alanine aminotransferase flares. In summary, sequential therapy with PEG-IFN after long-term NA enhances the reduction of HBsAg and may represent a treatment option to promote HBsAg loss.

Abstract P5-12-01: Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia

Purpose: Arthralgia sometimes occurs in the breast cancer patients treated with aromatase inhibitors (AIs). It is one of the most important reasons for poor AIs adherence.

Background; The HOPE study previously demonstrated that exercise was effective in improving AI-induced arthralgia in breast cancer patients. However, recruitment to this study was limited to severe cases (Criteria; physically inactive, &gt;6 months AT treatment, &gt;2 months arthralgia). To asses if these findings were more generalizable to all breast cancer contexts we conducted a randomized trial of exercise intervention using wider eligibility criteria that the hope study to assess the impact on AI induced arthralgia in breast cancer patients.

Methods: We examined Japanese breast cancer patients operated at Nahanishi Clinic, Okinawa, Japan. Following the informed consent the patients were randomly assigned to a 3:1 ratio to exercise intervention or usual care, . Eligibility criteria included receiving an AI for 0-4 years, no metastases, any arthralgia level and any exercise habits. Following randomization participants could choose from 3 types of exercise including strong (120-150 minutes per week of walking or running), intermediate (gentle calisthenics (daily NIPPON HOSO KYOKAI: NHK broadcast exercise)) and weak (going up the stairs- frequency). Arthralgia was assessed using the Brief Pain Inventory (BPI), in which the patients completed a baseline, 6month and 12 month BPI assessment. Primary endpoint was BPI change at 12 months.

Results: Among 227 women screened, we randomized 108 women, with 80 to exercise intervention (46 of strong, 19 of intermediate and 15 of weak) and 28 to usual care. Base line BPI were well balanced between exercise intervention and usual care. Overall exercise intervention reduced BPI scores relative to control. The BPI changes of worst pain, least pain, average pain and pain right now were 0.09, -0.25, -0.14 and 0 for exercise intervention group and 0.21, 0.46, 0.07 and 0.61 for usual care group, respectively. There was a statistically significant difference of AIs adherence between exercise intervention group (99%) and usual care group (92%) (P=0.03).

Conclusion: Exercise intervention tends to improve the AI-induced arthralgia and has a positive effect on AIs adherence.

Citation Format: Tajaesu M, Tamaki K, Nagamine S, Kamada Y, Uehara K, Arakaki M, Tamatsu Y, Yamashiro K, Miyashita M, Ishida T, Ohuchi N, McNamara K, Terukina S, Sasano H, Tamaki N. Randomized trial of exercise intervention vs. usual care for breast cancer patients with aromatase inhibitor to prevent and improve the aromatase inhibitor induced arthralgia [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-12-01.

Monitoring of bacterial contamination of dental unit water lines using adenosine triphosphate bioluminescence

Bacterial contamination of dental unit waterlines (DUWLs) was evaluated using ATP bioluminescence analysis and a conventional culture method. Water samples (N=44) from DUWLs were investigated for heterotrophic bacteria by culture on R2A agar, which gave counts ranging from 1.4×10³ to 2.7×10⁵ cfu/mL. The ATP bioluminescence results for DUWL samples ranged from 6 to 1189 relative light units and could be obtained within 1min; these correlated well with the culture results (r=0.727-0.855). We conclude that the results of the ATP bioluminescence assay accurately reflect the results of conventional culture-based testing. This method is potentially useful for rapid and simple monitoring of DUWL bacterial contamination.

Transvenous Embolizations of Venous Compartments of Dural Arteriovenous Fistulas within Venous Sinus Walls

Transvenous embolization of venous compartments within the venous sinus wall was the method initially attempted for closing dural arteriovenous fistulas in 15 patients (22 sinuses). The venous channel, separate from the sinus lumen and located in the venous sinus wall, could be embolized in 6 lesions (3 patients), including 3 superior sagittal sinus fistulas, 2 transverse sinus fistulas, and 1 straight sinus fistula.

This technique resulted in closure of the fistulas and preservation of sinus patency as well as immediate improvement of clinical symptoms. The embolizable venous compartment of the fistula within the venous sinus wall could be detected by preoperative angiography, magnetic resonance imaging, and intraoperative venography. This unique drainage of dural arteriovenous fistulas may develop concurrently with more obvious portions of the fistula.

Transvenous embolization of these venous compartments can close the fistulas and normalize impaired sinus function.

Transarterial Embolization of Cerebrospinal Lesions with Liquid Coils

We report our experience with endovascular embolization using liquid coils. Twenty-two transarterial embolization procedures were performed with these coils in 20 patients with cerebrospinal vascular or neoplastic lesions. The coils were delivered into the target vessels under fluoroscopic monitoring through a microcatheter by manual injection and flushing with saline.

Subsequent surgical resections of embolized lesions were performed in 14 cases, and radiosurgery for two. Complete obliteration of the target vessels were accomplished in all cases without complications. Passage through the microcatheter and delivery of the coil was smooth. Proximal protrusion of the coil occurred during the procedure, and a combination of other embolic materials was necessary to completely occlude large vessels in 9 cases.

The embolized lesions were easily resected in the following neurosurgery. Liquid coils were safe and effective as an embolic material in use prior to surgery or radiosurgery.

Abstract P3-06-20: The correlation between body mass index (BMI) and breast cancer in both premenopausal and menopausal women in Okinawa

Introduction

Much of the longevity advantage in Okinawa is thought to be related to a healthy lifestyle including traditional foods which is low in calories and dense in nutrition. However, dietary change since World War II has been largely deleterious, with younger Okinawan people developing a higher risk of obesity and other chronic disease risk factors than older Okinawan people. In addition, breast cancer incidence and mortality are gradually increasing in Okinawa. Therefore we examined the correlation between BMI and breast cancer in both premenopausal and postmenopausal women in Okinawa.

Methods

The cases were 3422 female breast cancer patients without any previous breast cancer history, and the control subjects were 5622 women, who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 1996 and March 2013. The median ages were 53 years old (21-99) in the breast cancer group and 44 years old (18-90) in the control group. Based on the World Health Organization classification, 25≤BMI&lt;30 is considered as overweight and 30≤BMI as obesity. We examined the association between BMI and breast cancer risk by odds ratio. In addition, we also stratified and examined the BMI according to menstruation and age by student t test.

Results

Table.1 summarized the results of the association between BMI and breast cancer risk.

Association between BMI and breast cancer risk. CancerControlP ValueOdds[95%CI]All patients34225622  Overweght10201028p&lt;0.0011.89 [1.72-2.10]Obesity285253p&lt;0.0011.93[1.62-2.30]Overweight+Obesity13051281p&lt;0.0012.09[1.90-2.29]Premenopausal    Overweight146498p = 0.0021.37[1.12-1.67]Obesity44141p = 0.0641.41[0.99-1.99]Overweight+Obesity190639p&lt;0.0011.42[1.18-1.70]Postmenopausal    Overweight618527p&lt;0.0011.59[1.38-1.83]Obesity179112p&lt;0.0011.96[1.54-2.51]

Being overweight, or obese, increased the odds of breast cancer, as well as these put together, in the postmenopausal group (p&lt;0.001, respectively). As for the premenopausal group, being overweight and also overweight grouped with obese increased the odds of breast cancer significantly (p = 0.002 and p&lt;0.001, respectively) and a tendency was detected in the obese (p = 0.064). Table.2 summarized the results of BMI according to menstruation and age.

BMI according to menstruation and age CancerControlp valueTotal24.3±4.122.7±3.8p&lt;0.001Premenopausal22.9±3.922.1±3.7p&lt;0.001Postmenopausal25.4±4.123.9±3.7p&lt;0.001Year&lt;3021.1±0.520.7±0.1p = 0.53930≤year&lt;4022.5±3.921.7±3.6p&lt;0.00140≤year&lt;5023.2±3.822.7±3.5p&lt;0.00150≤year&lt;6024.6±0.123.7±6.1p&lt;0.00160≤year&lt;7025.5±3.924.5±3.8p&lt;0.00170≤25.7±4.224.7±3.5p&lt;0.001

The BMI of the breast cancer group were statistically higher than that of the control group in those over 30 years old, and in the pre and post menopausal (p&lt;0.001, respectively).

Conclusion

The results of this study suggested that weight gain and consequently being overweight or obese might increase the odds for breast cancer in both premenopausal and postmenopausal women ages over 30 years old in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-06-20.

Abstract P2-12-07: The correlation between Myriad Genetic Laboratories, Inc. mutation prevalence table and clinicopathological characteristics of breast cancer patients in Okinawa

Introduction

The two major susceptibility genes for breast cancer and ovarian cancer, BRCA1 andBRCA2 were discovered in 1994 and 1995, respectively. Various risk prediction algorithms and models have been developed to identify putative BRCA1/2 mutation carriers. Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables (http://www.myriad.com/lib/brac/brca-prevalence-tables.pdf#search = ‘Myriad+Genetic+Laboratories%2C+Inc.+Mutation+Prevalence+Table’) through its clinical testingservice. To the best of our knowledge, this is the first study to examine the correlation between this risk prediction model and clinicopathological characteristics of breast cancer patients.

Methods

The cases were 148 female breast cancer patients without any previous breast cancer history who initially visited Nahanishi Clinic Okinawa in Okinawa, Japan, between May 2012 and March 2013. The median ages were 55 years old (26-84). We examined the correlation between Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables and clinicopathological characteristics including age, ER, PgR, HER2, triple negative status, histological grade and Ki67. The presence of ER and PgR was determined by nuclear staining with positive cases defined as more than 1% staining according to ASCO CAP. With regard to HER2 evaluation, membranous staining was graded as 0-1+, 2+, and 3+. Samples scored as 2+ were subjected to FISH. Positivity was defined as a HER2:CEP17 signal ratio&gt;2.2. Ki-67 labeling index was obtained by selecting the hot spots after evaluation at low power magnification and counting 1000 tumor cells in the hotspots.

Results

There was statistically negative correlation between the risk prediction rates and age (r = -0.480, r2 = 0.230, p&lt;0.001). The risk prediction rates of ER negative and positive were 2.93±4.12% and 4.06±9.53% with statistically significant differences (p = 0.049).On the other hand, tendency was detected in PgR status (p = 0.058), and the risk prediction rates were 3.21±1.92% of PgR negative and 4.24±3.34% of PgR positive, respectively. The risk prediction rates of triple negative cases and non triple negative cased were 2.58±0.94% and 4.06±3.11% with statistically significant differences (p&lt;0.001). There were not statistically significant differences in HER2 status, histological grade and Ki67, respectively.

Conclusion

Previous studies demonstrated that BRCA1/2 mutation was associated with triple negative and high grade malignant breast cancer. However, the results of this study suggested that Myriad Genetic Laboratories, Inc. released Mutation Prevalence Tables was not associated with triple negative and/or high risk breast cancer patients in Okinawa.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-12-07.

Abstract P2-03-02: A non-invasive modality the US virtual touch tissue quantification (VTTQ) for evaluation of breast cancer

Introduction

Acoustic radiation force impulse (ARFI) imaging is a newly developed ultrasound-based modality which could evaluate the wave propagation speed and tissue stiffness more precisely and objectively. ARFI does not require any external compression, and so even in deep tissues could, provide complementary information to conventional ultrasound (US), potentially improving the characterization of tissue and focal lesions. The generated waves can provide quantification of the shear wave velocity, termed Virtual Touch Tissue Quantification (VTTQ). VTTQ is an intrinsic and reproducible property of the tissue, and this tissue quantification could provide objective and reproducible data. This is the first study to evaluate the biological features of breast tissues using newly developed non-invasive diagnostic system VTTQ.

Methods

180 patients including 115 invasive ductal carcinoma (IDC), 30 ductal carcinoma in situ (DCIS), 4 mucinous carcinoma, 7 invasive lobular carcinoma (ILC), 8 fibroadenoma (FA), 12 fibrocystic change (FCC) and 4 intraductal papilloma were studied at Nahanishi Clinic Okinawa. We first compared results of VTTQ according to each histological subtype, and determined the optimal cutoff values for VTTQ to distinguish benign from malignant tissues using the receiver operating characteristic (ROC) method. In addition, we also examined the correlation between VTTQ velocities and Ki-67, estrogen receptor (ER), progesterone receptor (PgR) or human epidermal growth factor receptor 2 (HER2) in the cases of IDC using the linear regression analyses and Student's t test.

Results

There were statistically significant differences of VTTQ velocities between IDC and DCIS (P = 0.003), mucinous carcinoma (P = 0.009), FA (P&lt;0.001), papilloma (P&lt;0.001) or FCC (P&lt;0.001). There were significant differences between DCIS and FA (P = 0.016), papilloma (P&lt;0.001) or FCC (P&lt;0.001). Significant differences were also detected between mucinous carcinoma and papilloma (P&lt;0.001) or FCC (P = 0.003), between ILC and papilloma (P = 0.012) or FCC (P = 0.003) and between FA and papilloma (P = 0.030). VTTQ velocities were statistically higher in malignant cases than in benign cases (p&lt;0.05, respectively) and the best cutoff value for the VTTQ velocity which could differentiate benign from malignant cases was 2.89 m/second. There were statistically significant correlations between VTTQ velocity and Ki-67 labeling index (r = 0.338, r2 = 0.114 and P&lt;0.001), and significant inverse correlations between VTTQ and ER (r = -0.311, r2 = 0.097 and P&lt;0.001) or PgR (r = -0.361, r2 = 0.131 and P&lt;0.001) status of IDC. There was also a significant differences of the average velocities between HER2 positive (6.39±1.44 m/second) and negative (4.43±1.41 m/second) cases (P&lt;0.001).

Conclusion

VTTQ was valuable for examination of breast cancer pathology in a non-invasive fashion. The results still could suggest the value of VTTQ examination in the clinical management of breast cancer patients. VTTQ has huge potential for examining axillary lymph node status instead of sentinel lymph node biopsy, and examining the responsiveness of neoadjuvant chemotherapy in midcourse evaluation without invasive biopsy.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P2-03-02.

Oxidative stress and antibody levels to periodontal bacteria in adults: the Nagasaki Islands study

OBJECTIVE

Periodontitis is a chronic inflammatory disease of the tissues supporting the teeth and is caused by subgingival plaque. Systemic increases in reactive oxygen species are involved in pathogenesis of periodontitis. This study addressed the relationship between levels of serum oxidative stress and antibodies against putative periodontopathic bacteria and their association with periodontal conditions, in a community-based study.

SUBJECTS AND METHODS

Serum samples were measured for reactive oxygen metabolite (ROM) levels and anti-oxidant capacity. The serum levels of immunoglobulin G (IgG) antibodies to Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Aggregatibacter actinomycetemcomitans (Aa), and Eikenella corrodens (Ec) were determined by ELISA.

RESULTS

The participants with greater clinical attachment loss had higher serum ROM levels and IgG antibody titers to Pg. Serum ROM levels were positively correlated with antibody titers to Pg, Pi, and Ec. When the participants with greater probing pocket depth and clinical attachment loss were used as the dependent variables, high ROM levels showed a statistically significant associations in multivariate logistic analyses; the adjusted odds ratios were 2.9 (95% confidence interval = 1.0-8.5) and 6.0 (95% confidence interval = 2.0-17.6), respectively.

CONCLUSIONS

It was concluded that an increased oxidative stress may be detrimental to periodontitis in Japanese community-dwelling adults.

Noninvasive estimation of fibrosis progression overtime using the FIB-4 index in chronic hepatitis C

The FIB-4 index is a simple formula to predict liver fibrosis based on the standard biochemical values (AST, ALT and platelet count) and age. We here investigated the utility of the index for noninvasive prediction of progression in liver fibrosis. The time-course alteration in the liver fibrosis stage between paired liver biopsies and the FIB-4 index was examined in 314 patients with chronic hepatitis C. The average interval between liver biopsies was 4.9 years. The cases that showed a time-course improvement in the fibrosis stage exhibited a decrease in the FIB-4 index, and those that showed deterioration in the fibrosis stage exhibited an increase in the FIB-4 index with a significant correlation (P < 0.001). Increase in the ΔFIB-4 index per year was an independent predictive factor for the progression in liver fibrosis with an odds ratio of 3.90 (P = 0.03). The area under the receiver operating characteristic curve of the ΔFIB-4 index/year for the prediction of advancement to cirrhosis was 0.910. Using a cut-off value of the ΔFIB-4 index/year <0.4 or ≥ 0.4, the cumulative incidence of fibrosis progression to cirrhosis at 5 and 10 years was 34% and 59%, respectively in patients with the ΔFIB-4 index/year ≥0.4, whereas it was 0% and 3% in those with the ΔFIB-4 index/year <0.4 (P < 0.001). In conclusion, measurement of the time-course changes in the FIB-4 index is useful for the noninvasive and real-time estimation of the progression in liver fibrosis.

Moyamoya disease associated with basilar tip aneurysm

Direct surgical intervention to treat ruptured basilar tip aneurysms in patients with moyamoya disease has rarely been attempted, and patients who have undergone such treatment have not fully recovered. We review six cases of surgically treated ruptured basilar tip aneurysm associated with moyamoya disease, including our own case to illustrate aspects of surgical intervention and the difficulties encountered. Patients who underwent surgery after 4 weeks of the onset of symptoms showed impressive results. Of the patients who underwent surgery in the acute stage, two died, including our patient, and one showed excellent recovery. It is emphasized that to achieve satisfactory surgical outcome, the following factors should be considered: (i) delayed operation is preferable, with extracranial-intracranial bypass in selected patients; (ii) careful preservation of moyamoyas and transdural collaterals is mandatory; (iii) intraoperative rupture of the aneurysm should be avoided; and (iv) using a neuroanaesthetic technique of induced hypothermia and hypertension may be preferable.

Regional differences in hypertensive cardiovascular remodeling between fishing and farming communities in Japan

BACKGROUND

Effects of dietary n-3 polyunsaturated fatty acids (n-3 PUFA) intake on the cardiovascular system have been reported, and thus we hypothesized that the prevalence of hypertensive cardiovascular remodeling would be lower in a fishing than a farming community.

METHODS

We recruited 263 essential hypertensives from a fishing and 333 from a farming village; all subjects were ≥40 years (mean 73 years; 42% men). They were cross-sectionally examined for serum eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), asymmetric dimethylarginine (ADMA) levels, left ventricular mass index (LVMI), and common-carotid artery (CCA) and internal-carotid artery (ICA) intima-media thickness (IMT).

RESULTS

Compared to the patients in the farming village, those in the fishing village had higher serum EPA and DHA levels (63.3 vs.70.9 µg/ml, 137.2 vs.157.8 µg/ml) and lower ADMA levels (0.49 vs.0.47 nmol/ml; all P < 0.05). LVMI and both CCA-IMT and ICA-IMT levels were lower in the fishing than the farming village (113.2 vs.121.6 g/m(2), 0.88 vs.0.94 mm, 1.10 vs.1.17 mm: all P < 0.01) even after adjustment for age, sex, body mass index (BMI), duration of hypertensive medication, number of antihypertensive medications, and 24-h systolic blood pressure (SBP) level. The differences in LVMI and IMT levels between these communities also remained unchanged (all P < 0.01) after additional adjustment for the regional differences in EPA, DHA, and ADMA levels. A multivariable linear regression analysis showed that the difference in place of residence was independently associated with LVMI as well as with both CCA-IMT and ICA-IMT levels (all P < 0.01).

CONCLUSION

The prevalence of cardiovascular remodeling was significantly lower in patients in the fishing community than in those in the farming community. Further investigations are required to explain the mechanisms underlying this association.

Abstract P1-02-01: Vasohibin-1 in Human Breast Carcinoma: A Potential Negative Feedback Regulator of Angiogenesis

Background: Vasohibin-1 is a recently identified negative feedback regulator of angiogenesis induced by vascular endothelial growth factor (VEGF)-A. This is the first study to evaluate immunoreactivity and mRNA expression of Vasohibin-1 in human breast disorders. Material and Methods: We examined 251 breast specimens including invasive ductal carcinoma (IDC: 148), ductal carcinoma in situ (DCIS:62), fibroadenoma (FA:16), inflammatory lesion (6), fibrocystic change(9) and non-pathological breast tissue(7). We immunolocalized vasohibin-1 and compared its immunoreactivity to that of VEGF-A, VEGF receptor 2 (Flk-1), CD31 and Ki-67. The correlation of vasohibin-1 immunoreactibity with overall survival (OS), and disease free survival (DFS) of the breast carcinoma patients was also evaluated. In addition, we evaluated Ki-67 and CD31, and Ki-67 and vasohibin-1 double-immunostaining for further characterization of neovascularization. We also evaluated mRNA expression of Vasohibin-1 using a real-time quantitative RT-PCR with LightCycler system.

Results: Vasohibin-1 was detected in endothelial cells of human breast and its immunodensity was significantly higher in IDC and inflammatory lesion than the other types (P&lt;0.001). As for DCIS, there was a significant positive correlation between vasohibin-1 expression level and nuclear grade or Van Nuys classification of carcinoma cells (P&lt;0.001). In addition, a significant positive correlation was detected between vasohibin-1 and VEGF-A, Flk-1 or Ki-67 (P&lt;0.001). There was also positive associations between vasohibin-1 and OS (P=0.004) and DFS (P&lt;0.001). Results of double-immunostaining demonstrated the ratio of Ki-67-positive cells among vasohibin-1-positive endothelial cells (46.5%) was significantly higher than those among CD31-positive cells (23.5%). In addition, there was a significant positive correlation between Vasohibin-1 mRNA level and Ki-67 or high nuclear grade(P&lt;0.001).

Discussion: This is the first study demonstrating the status of vasohibin-1 in human breast lesions, which indicates that vasohibin-1 is associated with neovascularization and may especially play important roles in the regulation of intratumoral angiogenesis in human breast cancer. Vasohibin-1 is supposed to be induced in the downstream of VEGF-A/Flk-1 signaling pathway and considered an appropriate biomarker for intratumoral neovascularization. In addition, these results clearly indicated that vasohibin-1 expression may become one of the prognostic markers for metastasis and prognosis, and also become one of the appropriate biomarker of the potential of subsequent stromal invasion of carcinoma cells.

Figures available in online version.

Effects of topical application of lipopolysaccharide and proteases on hepatic injury induced by high-cholesterol diet in rats

BACKGROUND AND OBJECTIVE

Topical application of lipopolysaccharide and proteases to the gingival sulcus induced not only periodontal inflammation but also detectable liver changes in rats fed a normal diet. However, these changes in the liver were not sufficient to induce pathological consequences. The purpose of the present study was to investigate whether gingival inflammation-induced liver change would have more dramatic pathological consequences in rats fed a high-cholesterol diet compared with the effect of the high-cholesterol diet alone.

MATERIAL AND METHODS

Twenty-four male Wistar rats were divided into four groups. During an 8 week experimental period, two groups were fed a normal diet and the other two were fed a high-cholesterol diet containing 1% cholesterol (w/w) and 0.5% cholic acid (w/w). Four weeks prior to the end of the experimental period, one of each of the dietary groups received daily topical application of lipopolysaccharide and proteases to the gingival sulcus, while the other was treated with pyrogen-free water.

RESULTS

In the rats without application of lipopolysaccharide and proteases, the serum level of hexanoyl-lysine, scores of steatosis and inflammation, and concentration of 8-hydroxydeoxyguanosine in liver of rats fed a high-cholesterol diet were higher than in those fed a normal diet. In rats fed a high-cholesterol diet, the scores of steatosis and inflammation and the concentration of 8-hydroxydeoxyguanosine in the liver of rats with application of lipopolysaccharide and proteases were higher than in those without.

CONCLUSION

In a rat model, application of lipopolysaccharide and proteases to the gingival sulcus augmented the effect of a high-cholesterol diet on steatosis, inflammation and oxidative damage in the liver.

18F-Fluorothymidine (FLT) as tumor response predictor for anti-epidermal growth factor receptor (EGFR) antibody in human lung cancer xenograft

e22088

Background: Specific EGFR inhibition therapies are currently promising and advanced in the clinical setting. It is revealed patients with a colorectal cancer bearing mutated K-ras do not benefit from cetuximab, a chimeric mouse-human antibody to EGFR. However, appropriate evaluation of the therapeutic effects has not been clarified yet, because of the lack of reliable tumor response predictors. Measurement of tumor proliferative activity by PET using FLT may serve to assess early response of the therapy. The purpose of this study is to determine whether 18F- FLT is useful to evaluate very early response to cetuximab treatment in human lung cancer cell line xenograft. Methods: Human tumor xenograft model was established in male BALB/c athymic mice by human lung cancer cell line NCI-H1975, which expresses L858R/T790M-EGFR. These mice were assigned to two groups (n=5, each group): control and cetuximab-treated groups. Cetuximab was intra-peritoneally given 1.0mg/body once on the first day. Biodistribution of 3H-FLT (%Inject Dose/g/kg) were studied two days after the treatment. Immunohistochemical staining of EGFR, phosphorylated EGFR (pEGFR), and nuclear antigen Ki-67 as a tumor cell proliferation marker in tumor tissues were also studied to assess early effects of cetuximab. Results: FLT uptake was high in tumors compared with any other organs. Two days after the cetuximab therapy, the mean value of FLT uptake in tumor was significantly decreased to 55% of control value (0.38 ± 0.03 in control group vs. 0.21 ± 0.07 in cetuximab-treated group; p < 0.05). There were no statistical differences in the tumor volume and body weight of mice between each group. High expression of EGFR and Ki-67 were observed in this xenograft. As compared with control, Ki-67 expression was remarkably decreased in cetuximab-treated group, while there were no definite changes in expression of EGFR and pEGFR. Conclusions: In this animal model, FLT uptake and Ki-67 expression were decreased in cetuximab- treated group just two days after the treatment start. These results indicate FLT-PET can be a useful predictor to evaluate very early response to molecular targeted medicine such as cetuximab before significant change of tumor size.

No significant financial relationships to disclose.

Treatment selection for cerebral arteriovenous malformations: radiosurgery or microsurgery

The clinical results and patient characteristics of 318 cases of cerebral arteriovenous malformations (AVMs) were analyzed: 138 patients were treated by surgery including 98 cases of total removal and 17 cases of subtotal removal; 37 patients were treated conservatively; 139 patients were treated by gamma-knife and 6 patients were treated by linac-knife radiosurgery using stereotactic multi-converging arcs systems. Clinical data analysis was performed using the same protocol in both of the surgery and the radiosurgery groups. Operative mortality for total removal was one out of 98 cases (1%). There was one death by hemorrhage, one case of symptomatic rebleeding and two cases of asymptomatic bleeding in patients treated by radiosurgery. Thus, mortality was 1 out of 145 (0.7%). Patients with total resection of AVMs had the best clinical results in comparison with subtotal resection or with conservative treatment. Morbidity was the lowest in the patients treated by radiosurgery. However, the total obliteration rate was lower than the surgical cure rate. The decision for treatment should be based on an estimation of mortality, morbidity and cure rate for each treatment.

Effects of Ethanol Consumption on Periodontal Inflammation in Rats

Studies suggest a correlation between ethanol consumption and periodontal disease. We hypothesized that elevated levels of blood reactive oxygen species following ethanol consumption may increase inflammation in periodontal tissue. Rats were divided into 4 groups (6–7 rats/group). Two groups were fed an ethanol-containing liquid diet, and 2 groups were fed a pair-fed control diet. In one of each dietary group, periodontitis was ligature-induced, while the other group was left unligated. Chronic ethanol feeding alone decreased the ratio of reduced/oxidized glutathione and increased 8-hydroxydeoxy-guanosine and tumor necrosis factor (TNF)-α levels in the gingiva. Blood hydroperoxides were also increased. In ligature-induced periodontitis lesions, ethanol feeding enhanced polymorpho-nuclear leukocyte infiltration and TNF-α expression. The results suggest that chronic alcohol consumption increased periodontal inflammation, oxidative damage, and TNF-α production and had an additive effect on polymorphonuclear leukocyte infiltration and gingival oxidative damage, increasing the severity of periodontal inflammation in the ligature model.