[Analysis and prediction of disease burden of cirrhosis and other chronic liver diseases due to alcohol use in China from 1990 to 2030]

Objective: To comprehensively understand the disease burden of liver cirrhosis and other chronic liver diseases caused by alcohol use in China from 1990 to 2019, as well as to predict the trends in disease burden from 2020 to 2030. Methods: The analysis utilized data from the Global Burden of Disease study in 2019 (GBD2019). Key indicators such as incidence rate, mortality rate, disability-adjusted life years (DALY), years of life lost due to premature mortality, and years lived with disability were selected to describe the disease burden of alcohol-related liver cirrhosis and other chronic liver diseases in China from 1990 to 2019. The estimated annual percentage change (EAPC) was used to depict the temporal trends in disease burden. Furthermore, a Bayesian age-period-cohort (BAPC) model was constructed using R software to predict the age-standardized incidence rate (ASIR) and age-standardized mortality rate (ASMR) of alcohol-related liver cirrhosis and other chronic liver diseases in China from 2020 to 2030. Results: From 1990 to 2019, the incidence of alcohol-related liver cirrhosis and other chronic liver diseases in China showed an upward trend, with an EAPC of 0.31% (95%CI: 0.10%-0.52%). However, the DALY declined, with an EAPC of -2.81% (95%CI: -2.92% - -2.70%). The ASMR showed a downward trend, with an EAPC of -2.55% (95%CI: -2.66% - -2.45%). The highest incidence of cirrhosis of liver caused by alcohol and other chronic liver diseases was reported in the age group of 35-49 years, while the ASMR increased gradually with age, with a significant rise after the age of 30. The age-standardized DALY rate peaked between the ages of 55 and 64. The disease burden indicators for males were consistently higher than those for females during the same period. According to the predictions of the BAPC model, from 2020 to 2030, the ASIR for cirrhosis of liver caused by alcohol and other chronic liver diseases in the entire population of China was projected to increase from 3.45/100 000 in 2020 to 3.78/100 000 in 2030, a growth of 9.57%. Conversely, the ASMR was expected to decrease from 1.45/100 000 in 2020 to 1.24/100 000 in 2030, a reduction of 14.48%. Conclusions: The disease burden of cirrhosis of liver caused by alcohol and other chronic liver diseases remained serious in China, especially in men and the middle-aged to elderly population. There is a pressing need to prioritize attention and resources towards these groups. Despite the projected decrease in ASMR, the ASIR continued to rise and is expected to persist in its upward trend until 2030.

Magnetic resonance imaging assessment of substantia nigral iron deposition in Parkinson's disease: a meta-analysis

OBJECTIVE

The pathogenesis of Parkinson's disease (PD) is associated with abnormal iron accumulation. Magnetic resonance imaging (MRI) studies have shown that patients with Parkinson's disease have an increased amount of iron in their substantia nigra (SN). We have undertaken a meta-analysis of studies using MRI in PD, to explore the potential role of MRI in diagnosing PD using abnormal iron deposition in SN as a candidate biomarker.

MATERIALS AND METHODS

Searches of PubMed, Embase, and Medline databases revealed 16 studies that compared PD patients and healthy controls (HC). A sensitivity analysis and subgroup analysis were performed to evaluate the reliability of our results. Estimates were pooled by the fixed-effects model. As an expression of I2, we computed the proportion of variation due to heterogeneity.

RESULTS

We included 16 studies with sample sizes of 435 PD and 355 HC in our meta-analysis. Results showed that SN iron deposition was significantly elevated (p<0.00001) in patients with PD compared to HC ones (SMD=0.72, 95% confidence interval 0.57 to 0.87, p<0.00001).

CONCLUSIONS

Our findings, based on a homogeneous group-level analysis, suggest that MRI-based SN iron deposition could be used to distinguish PD from HC. For a more rigorous investigation of SN iron deposition in PD, larger cohort studies are needed.

[Progress in research of quantification of biological age]

Biological age has been proved to be better than chronological age to measure the real difference of aging among individuals, but no consensus has been reached in the quantification of biological age in the field of aging research. In this paper, we summarize some commonly used quantification methods of biological age and discuss the its future development.

[Effects of four efflux pump inhibitors on the activities of clarithromycin against Mycobacterium abscessus]

Objective: To detect the effects of four efflux pump inhibitors on the minimum inhibitory concentration of clarithromycin (CLA) against Mycobacterium abscessus (M. abscessus) in vitro, and to explore the role of efflux pump in CLA resistance of M. abscessus. Methods: Four frequently-used efflux pump inhibitors (Carbonyl Cyanide 3-chlorophenylhydrazone, CCCP, N, N'-dicyclohexylcarbodiimide, DCC, Verapamil, VP, Reserpine, RSP) were evaluated in this study. The minimum inhibitory concentration (MIC) values of clarithromycin against M. abscessus reference strain and 60 clinical strains with or without efflux pump inhibitors were detected by Alamar Blue method. Sequence analysis of erm(41) and rrl genes known to be associated with CLA resistance in M. abscessus was performed to analyze the correlation between the effect of efflux pump inhibitors on MIC and mutation of resistance-related genes. Results: CCCP, DCC, VP and RSP could reduce the MIC of M. abscessus to CLA, and the effect of RSP was weaker than the other three efflux pump inhibitors. Among the sixty M. abscessus clinical strains, ten strains were resistant to clarithromycin, seven of which had rrl gene mutation. The CLA resistance rate of smooth phenotype isolates was higher than that of rough phenotype isolates. At 3 day of clarithromycin incubation, the MICs of resistant strains were all reduced by efflux pump inhibitors. Compared with the strains with rrl gene mutation, efflux pump inhibitors had a greater effect on the strains without rrl gene mutation. At 14 day of clarithromycin incubation, 83% of M. abscessus subsp. abscessus, were induced to be resistant, and all of them were T28 sequence type of erm(41). With the occurrence of induced drug resistance, the effect of efflux pump inhibitor on CLA MIC decreased. Efflux pump inhibitors had no statistically significant diffence in the effect of effcux pump inhibitors on CLA MIC levels in different phenotypes of isolates. Conclusions: Efflux pump is involved in the resistance process of M. abscessus to CLA. Efflux pump inhibitors reduce the drug resistance to clarithromycin against M. abscessus in different degrees. The use of efflux pump inhibitors may provide a new way to alleviate the drug resistance of M. abscessus.

[Research progress on the relationship between HIV infection, antiretroviral therapy, and diabetes mellitus]

The expectancy and quality of life among people with HIV have improved remarkably with the widespread use of antiretroviral therapy (ART). In the meantime, the risks for HIV-related metabolic diseases have increased significantly, in particular diabetes mellitus. Multi-factors coeffect to increasing the risk of diabetes mellitus among HIV patients. Recently, growing of research has reported an association between HIV infections and ART and the development of diabetes mellitus. In this article, we summarize the recent studies investigating HIV infection and ART in diabetes mellitus to clarify their mechanism on the development of diabetes.

[G methods for handling time-varying confounding in the longitudinal study]

The conventional analytical methods cannot effectively adjust for time-varying confounding that occur in a longitudinal study and thus cannot correctly estimate the causal effects. This study explains the necessity of precisely controlling time-varying confounding and outlines G methods, including parametric g-formula, inverse probability of weighting, and G-estimation. We also compare the methods above to provide a reference for correctly estimating causal effects in the longitudinal study.

Assessment of the introduction of semi-digital consent into surgical practice

In this study, paper-based surgical consent is demonstrated to have significant errors of omission and legibility. These errors were improved by the introduction of a procedure-specific, patient-bespoke, semi-digital consent form application. Patient-reported experience of their involvement in shared decision-making is described for paper-based consent and the implications of future digital consent are discussed.

Abstract P2-14-16: Comparison of robotic nipple sparing mastectomy (R-NSM) to endoscopic assisted nipple sparing mastectomy (E-NSM) in the management of breast cancer

Background: Endoscopic assisted nipple sparing mastectomy (E-NSM) alone or followed by immediate breast reconstruction (IBR) with implants or autologous flaps were reported to be associated with small inconspicuous incision and good cosmetic outcome. Robotic nipple sparing mastectomy (R-NSM), which introduce da Vinci surgical platform through a small axillary wound to perform NSM with (or without) IBR, was reported to have potential to overcome the technique difficulty of E-NSM and showed promising cosmetic outcome. However, few evidence was available compared the effectiveness and safety of R-NSM compared with E-NSM in the management of breast cancer.

Methods: Patients with breast cancer received E-NSM or R-NSM performed from July 2010 to June 2018 were searched from breast surgery database at Changhua Christian Hospital (CCH), Taiwan. Data on clinicopathologic characteristics, type of surgery, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of R-NSM and E-NSM. Patient-reported cosmetic outcome result was also obtained and compared.

Results: A total of 127 E-NSM and 36 R-NSM procedures were found and data collected for analysis. About 77.8% of R-NSM group received breast reconstruction, and 78% of E-NSM group received breast reconstruction (P=0.982). The surgical margin involved rate was 2.8%(1/36) in R-NSM versus 3.4%(5/127) in E-NSM (P=1). The overall operation time was 281.5 ± 77.0 mins in R-NSM group versus 210.8 ± 55.5 mins in E-NSM group (P &lt;0.001). Blood loss was mean 36.5 ± 33.7 ml in R-NSM group versus 88.0 ± 61.0 ml in E-NSM group (P &lt;0.001). The hospital stay was 6.8 ± 1.3 days in R-NSM group versus 5.1 ± 1.3 in E-NSM group (&lt;0.001).

-From learning curve analysis, about 15-17 cases needed to significantly decrease operation time in E-NSM group, and in R-NSM group around 10-12 cases needed.

-About 50 E-NSM and 25 R-NSM patients received post-operative questionnaire survey for cosmetic outcome evaluation and acceptance of operations. Patient-reported outcome survey showed that the satisfaction rate of R-NSM 96.4% group versus 94.8 in E-NSM group (p=0.96). The will to receive the same operation again if they could chose again: 100% in E-NSM group versus 96.4% in R-NSM group.

-Cost analysis- The breast cancer operation cost was reimbursed by national insurance in Taiwan. The additional cost of E-NSM and IBR with Gel implant was 4,000-6,000 USD (according to different type of implants used). The cost of R-NSM and IBR with Gel implant was 10,000-12,000 USD (according to different type of implants used). The cost difference was about 2,500-3,300 USD higher in R-NSM group than in E-NSM group.

Conclusion: Both E-NSM and R-NSM were equally effectively in the management of breast cancer with no different surgical margin involved rate, however, longer follow-up remained mandatory for oncologic safety evaluation. Shorter learning curve indicated more friendly operation plateform of robotic surgery in performing NSM. Relative longer operation time, and higher cost of R-NSM compared with E-NSM was observed. Longer hospitalization is biased from personal insurance consideration due to higher cost of R-NSM.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Kuo S-J. Comparison of robotic nipple sparing mastectomy (R-NSM) to endoscopic assisted nipple sparing mastectomy (E-NSM) in the management of breast cancer [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 P2-14-16.

Abstract P6-02-13: Withdrawn

This abstract was withdrawn by the authors.

Citation Format: Huang C-S, Fann JC-Y, Chen H-H, Hsu G-C, Ho M-F, Chen S-C, Chen Y-J, Chen S-T, Chen C-Y, Sheen-Chen S-M, Chang H-T, Yeh D-C, Chao M, Yeh H-T, Cheng L, Chen D-R, Chang Y-C, Chang K-J. Withdrawn [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 P6-02-13.

Abstract P2-14-25: Application of robotic surgery (da Vinci) in the management of breast cancer- Preliminary results and experience sharing

Background: The experience of application of robotic surgery platform in the management of breast cancer was limited. The preliminary results of robotic surgery (da Vinci) in the management of breast cancer was reported in current study.

Methods: Patients with breast cancer received robotic breast surgeries from March 2017 to June 2018 were searched from robotic breast surgery database at Changhua Christian Hospital, Taiwan. Data on clinicopathologic characteristics, type of surgery, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of robotic breast surgery. Patient-reported cosmetic outcome result was also obtained.

Results: During the study period, a total of 41 robotic breast surgeries were performed in 35 female breast cancer patients, including 6 patients with bilateral disease. Among these 41 robotic breast procedures, 39 were R-NSM related. Four patients with bilateral R-NSM (two patients with bil. breast cancer, and another two patients received contralateral prophylatic mastectomy (CPM)) without breast reconstruction. The other 31 R-NSM were associated with immediate breast reconstruction (IBR). Two patients received R-NSM and IBR with robotic assisted harvest of latissimus dorsi flap (RAHLDF), and 29 patients received R-NSM and IBR with Gel implant procedures. One patient received robotic assisted quadrantectomy for upper outer located large breast cancer and immediate partial breast reconstruction with RAHLDF. The other patient received endoscopic assisted partial mastectomy for upper inner located multifocal breast cancer and immediate partial breast reconstruction with robotic assisted harvest of omentum flap.

Among those patients who received R-NSM, the mean operation time for R-NSM (after set-up of robotic breast surgery system) was 115.6 ± 50 mins, and 70.2 ± 23.2 mins for Gel implant reconstruction. The docking time was quickly dropped from 20 mins to 6-8 mins, and the time needed to complete R-NSM could usually be completed within 100mins after accumulated cases' experience. The mean blood loss was 35 ± 37.2 ml. The positive surgical margin rate for R-NSM was 2.6%(1/39), which was superficial margin involvement, and no further surgery was performed. About 13% patients suffered from transit nipple ischemia change, and no total nipple areolar complex necrosis case was observed.

Among those 3 patients who received RAHLDF, it took about 267 mins, 97 mins, and 90 mins to complete the 1st, 2nd, and 3rd RAHLDF, separately. All of them were event free, except seroma formation over the back, which relived after repeat aspiration.

No local recurrence, or mortality was found among these 35 patients during mean 8.9 ± 4.2 months follow-up. The patient-reported survey shows that 97%(32/33) of the patients who received robotic breast surgery with breast reconstruction satisfied the cosmetic outcome.

Conclusion: From our preliminary experience, robotic breast surgery is a feasible and safe option for some selected indications of breast cancer patients. R-NSM and IBR with Gel implant or RAHLDF were the most frequent performed operations. Bilateral R-NSM could be safely performed in bilateral breast cancer patients or unilateral breast cancer patients combined with CPM.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Kuo S-J, Lin S-L. Application of robotic surgery (da Vinci) in the management of breast cancer- Preliminary results and experience sharing [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 P2-14-25.

[Performance of matrix assisted laser desorption ionization time of flight biotyper system in clinical bacteria identification]

Objective: To evaluate the performance of MALDI Biotyper system in identification of clinically isolated pathogens so as to provide a new rapid identification method. Methods: Total 21 270 pathogens strains, isolated from the First Affiliated Hospital of Fujian Medical Universityduring Nov. 2015 to Dec. 2016, were identified by VITEK-Ⅱ, API and MALDI Biotyper system, respectively.The isolated strains were confirmed by DNA sequencing. Results: The identification of common bacteria with MALDI Biotyper and phenotypic system is highly consistent (>95% and >90%). Among 43 strains of anaerobic bacteria, MALDI Biotyper could identify 90.7% bacteria to species level and 97.7% bacteria to genus level with the statistical significance(χ(2)=6.76, P<0.01), while phenotypic system only identified 65.1% bacteria to species and 69.8% bacteria to genus. Also, no statistical significance was shown for Trichosporon and Candida(P>0.05). MALDI Biotyper could identify 76% filamentous fungi and all of Actinomycetes, Nocardia, Mycobacterium and Legionella to genus level. Conclusions: MALDI Biotyper is an easy-performed, sensitive method for the identification of clinically isolated pathogens. Additionally, the pretreatment and reference database has the effect on identification.

Age Estimation and Age-related Facial Reconstruction of Xinjiang Uygur Males by Three-dimensional Human Facial Images

OBJECTIVES

To search age-correlated facial features and construct an age estimation model based on the three-dimensional （3D） facial images of Xinjiang Uygur males, and to structure individual face images of old age and young age.

METHODS

Pretreatment was performed to collect 105 3D facial images of Xingjiang Uygur males aged between 17-57 years by Artec Studio software. The facial images were transferred to high-density 3D dot matrix data by FaceAnalysis software, and each image could be represented with 32 251 vertexes. Central correction of the facial images was done and all the data were aligned to a standard coordinate frame by generalized Procrustes analysis （GPA）. The age estimation model was established by partial least square regression （PLSR）. Furthermore, the changes of age-correlated facial features were presented on the heat map of average face, and the reconstruction of facial images at different ages was performed based on this model.

RESULTS

With age, the average faces showed a series of changes including the nasolabial sulcus deepening, cheek sinking, cheekbone protruding and eye corner drooping. The Pearson correlation coefficient （r） between estimated age and chronological age was 0.71. The mean absolute deviation （MAD） of age estimation was 6.37 years. The results of age estimation in >30-40 years group showed a best accuracy （MAD=4.27 years）, and the deviations increased with age after 40 years. The composite facial images represented a significant result with age on facial morphological features and aging.

CONCLUSIONS

The results of this study reveal the age-correlated facial features and aging markers in Uygur population, which help to construct a reliable age estimation model.

Abstract OT2-04-01: An open label, phase II trial of continuous low-irradiance photodynamic therapy (CLIPT) using verteporfin for the treatment of cutaneous breast cancer metastases

Background

Cutaneous metastases occur in approximately 20% of patients (pts) with metastatic breast cancer (mBC) and can be highly symptomatic and distressing. Radiation therapy is frequently used, but progression often occurs quickly. Systemic therapies are also typically used, but also often result in limited benefit. Photodynamic therapy is a promising approach with encouraging results in small studies. Here we will evaluate a novel Continuous Low-Irradiance Photodynamic Therapy (CLIPT) system that emits 690nm LED via a handheld Power Pack attached to a single-use sterile Light Patch to deliver a total energy level of 20J/cm2. Verteporfin (Visudyne®) is a photosensitizer approved for ophthalmological use that, when combined with CLIPT, generates activated oxygen species which can destroy tumor cells with limited normal tissue reaction.

Methods

This open label, Phase 2 study will evaluate the efficacy and safety of CLIPT with verteporfin in 15 patients with cutaneous lesions from mBC. Patients will receive a single IV injection of Verteporfin on day 1. The 9x9cm Light Patch with an adhesive border is placed over the treatment site and attached to the CLIPT portable Power Pack. The patient turns the device on at home 6 hours after the Verteprofin injection and it automatically turns off after 24 hours. The patient then removes the Light Patch and returns to clinic on day 3. The primary endpoint is objective response rate (RR) at 3 weeks following CLIPT using a modified RECIST which accounts for nodular or diffuse plaque-like lesions. Response will be confirmed by independent dermatologist review. Secondary endpoints include RR at 2, 8 and 12 weeks, toxicity, and quality of life (using FACT-B and Brief Pain Inventory). A novel Participant Symptom Scale (PSS) will also be used in which the first 8 patients will list their most distressing symptoms from cutaneous metastases and score the severity of the symptoms from 1 to 10. The six most common symptoms among the first 8 patients will then be used in the PSS for the remaining 7 patients. The PSS will be assessed at baseline and at subsequent visits to explore any improvement in severity of symptoms after treatment with CLIPT. Patients who derive clinical benefit may be retreated up to 3 times to the same or different region. Eligible patients will have: cutaneous metastases from mBC with measurable disease by protocol defined modified RECIST 1.1, ≥ 1 line of prior systemic or local therapy for mBC, ≥ 14 days from prior systemic therapy or 60 days from radiation to target lesion, and no expectation for systemic therapy for ≥ 14 days after CLIPT. RR will be reported with 95% CI. With 15 patients, if ≥ 3 responses (RR ≥ 20%) are observed, the null hypothesis of RR ≤ 5% will be rejected. At the time of abstract submission, 4 patients have been accrued. Clinical Trials Reg: NCT02939274

Citation Format: Isakoff SJ, Rogers GS, Hill S, McMullen P, Habin KR, Chen ST, Bartenstein DW, Barry W, Overmoyer BA. An open label, phase II trial of continuous low-irradiance photodynamic therapy (CLIPT) using verteporfin for the treatment of cutaneous breast cancer metastases [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 OT2-04-01.

Abstract P5-22-20: Oncologic safety of endoscopic assisted breast surgery compared with conventional breast surgery: An analysis of 1295 primary operable breast cancer patients from single institute

Background:Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to open surgery for certain patients with breast cancer. In this study, we report the oncologic safety results of EABS compared with conventional breast surgery (CBS).

Methods: The medical records of patients who underwent EABS for breast cancer during the period June 2010 to April 2017 were collected from the EABS database at Changhua Christian Hospital, a tertiary medical center in central Taiwan. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, margin involvement, locoregional recurrence, distant metastasis and overall survival were collected and compared to another cohort of patients, who received CBS at the same hospital, to determine the effectiveness and oncologic safety of EABS.

Results: A total of 1295 patients were enrolled in current study, including 214 patients receiving EABS and 1081 patients underwent CBS. The mean age of them were 50.4 ± 9.4 years-old in EABS group, and 52.5 ± 11.3 in CBS group (P=0.01). Patients who received EABS were associated with more early stage breast cancer than patients with CBS group (P&lt;0.01). The margin involved rate was 3.3% in EABS group, and 6.1% in CBS group (P=0.11). During a median follow-up of 57.7 ± 24.7 months, the locoregional recurrence was 3.7% in EABS group, and 7.3% in CBS group (P=0.06). The distant metastasis rate was 2.8% in EABS group and 10.3% in CBS group (P=0.001). The overall survival rate was 99.5% in EABS group, and 93.8% in CBS group.

Comparison of endoscopic assisted breast surgery (EABS) and conventaional breast surgery (CBS) EABSCBSP value N=214 (%)N=1081 (%) Pathology tumor size (cm)2.2 ± 1.62.3 ± 1.70.414Operation method   Mastectomy141 (65.9)530 (49.0)&lt;0.001Breast conserving surgery73 (34.1)551 (51.0) Lymph node surgery   SLNB only149 (69.6)534 (49.4)&lt;0.001SLNB then ALND40 (18.7)244 (22.6) ALND7 (3.3)259 (24.0) Not done18 (8.4)44 (4.1) Breast reconstruction   Yes108 (50.5)930 (86.0)&lt;0.001No106 (49.5)151 (14.0) Lymph node metastasis   Yes49 (24.7)375 (35.0).0.005No149 (75.3)797 (65.0) Stage   055 (25.7)160 (14.8)&lt;0.001I67 (31.3)340 (31.5) II84(39.2)439(40.7) III8(3.8)136(12.6) Grade   I35 (17.6)178 (17.2)0.365II118 (59.3)566 (54.8) III46 (23.1)288 (27.9) Margin status   Involved7 (3.3)66 (6.1)0.110Not-involved207 (96.7)1015 (93.9) Locoregional recurrence   Yes8 (3.7)79 (7.3)0.057No206 (96.3)1002 (92.7) Distance metastasis   Yes6 (2.8)111 (10.3)0.001No208 (97.2)970 (89.7) Survival   Yes213 (99.5)1014 (93.8)0.001No1 (0.5)67 (6.2) SLNB: sentinel lymph node biopsy, ALND: axillary lymph node dissection.

Conclusion: The preliminary oncologic safety analysis from our institution showed that EABS is a safe procedure and results in low margin involved rate, and no increase of locoregional recurrence, distant metastasis or mortality compared with conventional breast surgery. However, this study might be biased due to its retrospective nature and possible selection bias.Ongoing case controlled comparison study will be performed to further consolidate the oncologic safety of endoscopic assisted breast surgery.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Kuo S-J. Oncologic safety of endoscopic assisted breast surgery compared with conventional breast surgery: An analysis of 1295 primary operable breast cancer patients from single institute [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 P5-22-20.

Prescription trends and the selection of initial oral antidiabetic agents for patients with newly diagnosed type 2 diabetes: a nationwide study

OBJECTIVES

The aim of this study was to examine the characteristics of patients, physicians, and medical facilities, and their association with prescriptions that do not include metformin as the initial oral antidiabetic agent.

STUDY DESIGN

Observational, cross-sectional study.

METHODS

Patients with incident type 2 diabetes between January 1, 2006, and December 31, 2010, were identified from the Taiwan National Insurance Research Database. We describe trends in the initial prescription of antidiabetic medications that do not contain metformin during the study period. A multivariable logistic model and a multilevel linear model were used in the analysis of factors at a range of levels (patient, physician, and medical facility), which may be associated with the selection of oral antidiabetic drugs.

RESULTS

During the study period, the proportion of prescriptions that did not include metformin declined from 43.8% to 26.2%. Male patients were more likely to obtain non-metformin prescriptions (adjusted odds ratio [OR]: 1.15; 95% confidence interval [CI]: 1.08-1.23), and the likelihood that a patient would be prescribed a non-metformin prescription increased with age. Physicians aged ≥35 years and those with specialties other than endocrinology tended to prescribe non-metformin prescriptions. Metformin was less commonly prescribed in for-profit hospitals (adjusted OR: 1.34, 95% CI: 1.11-1.61) and hospitals in smaller cities (adjusted OR: 1.28, 95% CI: 1.05-1.57) and rural areas (adjusted OR: 1.83, 95% CI: 1.32-2.54).

CONCLUSIONS

Disparities continue to exist in clinical practice with regard to the treatment of diabetes. These inequalities appear to be linked to a variety of factors related to patients, physicians, and medical facilities. Further study will be required to understand the effects of continuing medical education in enhancing adherence to clinical guidelines.

Sensititre® MYCOTB MIC plate for drug susceptibility testing of Mycobacterium tuberculosis complex isolates

SETTING

National Tuberculosis Clinical Laboratory, China.

OBJECTIVE

To evaluate the accuracy and feasibility of the MYCOTB MIC plate in anti-tuberculosis drug susceptibility testing.

DESIGN

MYCOTB testing of Mycobacterium tuberculosis isolates, the Löwenstein-Jensen (LJ) proportion method and the resurazine microtitre assay (REMA), which is extensively used for in-house assay for minimal inhibition concentration (MIC) testing, were performed simultaneously for comparison. A total of 126 clinical isolates were tested using both MYCOTB and the LJ proportion method against 12 anti-tuberculosis drugs; 80 were also tested using REMA.

RESULTS

Categorical agreement between MYCOTB and the LJ proportion method was 99.2% for rifampicin, ofloxacin, amikacin, kanamycin and cycloserine, and 98.4% for isoniazid and para-aminosalicylic acid; ethambutol (EMB) had the lowest agreement (86.5%). The overall categorical agreement between MYCOTB and REMA ranged between 98.8% and 100%. MYCOTB outcomes, interpreted on day 10 and 21, were stable for all drugs except EMB.

CONCLUSION

MYCOTB is a rapid, convenient, quantitative and accurate method for testing both first- and second-line anti-tuberculosis drugs.

The diagnostic utility of preoperative breast magnetic resonance imaging (MRI) and/or intraoperative sub-nipple biopsy in nipple-sparing mastectomy

BACKGROUND

The necessity of routine sub-nipple biopsy was uncertain, and the role of preoperative magnetic resonance imaging (MRI) in detecting nipple invasion in patients who have been selected for nipple sparing mastectomy (NSM) has not been adequately evaluated.

METHODS

We retrospectively collected and analyzed the medical and surgical records of 434 patients with primary operable breast cancer who met the criteria for NSM and underwent breast surgery during the period January 2011 to December 2015. Patients were stratified into three risk groups (low, intermediate, and high) according to tumor size and tumor-to-nipple distance.

RESULTS

Among the 434 patients in this study, 29 (6.7%) had occult invasion of the nipple-areola complex (NAC). Sub-nipple biopsy had a sensitivity of 84.6%, a specificity of 100%, a false negative rate of 1.2%, a false positive rate of 0%, and an overall accuracy rate of 98.8% in confirming NAC invasion. The NAC invasion rate was 0% in the low-risk group, 5.1% in the intermediate-risk group, and 19.7% in the high-risk group (P < 0.01). The overall NPV of preoperative MRI for predicting NAC invasion was 94.8%. Cost analysis revealed that the cost of NSM with sub-nipple biopsy was significantly higher than that of NSM alone, with a mean difference in cost of USD 238.5 (P < 0.01).

CONCLUSION

The high negative predictive value of MRI for NAC invasion is useful for selection of patients receiving NSM. Sub-nipple biopsy is a reliable procedure to detect occult NAC invasion, however, routine use is not cost-effect for low risk patients.

Opposing effects of Sca-1(+) cell-based systemic FGF2 gene transfer strategy on lumbar versus caudal vertebrae in the mouse

Our previous work showed that a Sca-1⁺ cell-based FGF2 therapy was capable of promoting robust increases in trabecular bone formation and connectivity on the endosteum of long bones. Past work reported that administration of FGF2 protein promoted bone formation in red marrow but not in yellow marrow. The issue as to whether the Sca-1⁺ cell-based FGF2 therapy is effective in yellow marrow is highly relevant to its clinical potential for osteoporosis, as most red marrows in a person of an advanced age, are converted to yellow marrows. Accordingly, this study sought to compare the osteogenic effects of this stem cell-based FGF2 therapy on red marrow-filled lumbar vertebrae with those on yellow marrow-filled caudal vertebrae of young adult W⁴¹/W⁴¹ mice. The Sca-1⁺ cell-based FGF2 therapy drastically increased trabecular bone formation in lumbar vertebrae, but the therapy not only did not promote bone formation but instead caused substantial loss of trabecular bone in caudal vertebrae. The lack of an osteogenic response was not due to insufficient engraftment of FGF2-expressing Sca-1⁺ cells or inadequate FGF2 expression in caudal vertebrae. Previous studies have demonstrated that recipient mice of this stem cell-based FGF2 therapy developed secondary hyperparathyroidism and increased bone resorption. Thus, the loss of bone mass in caudal vertebrae might in part be due to an increase in resorption without a corresponding increase in bone formation. In conclusion, the Sca-1⁺ cell-based FGF2 therapy is osteogenic in red marrow but not in yellow marrow.

Abstract P2-12-16: Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group

Background: Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to conventional surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan.

Methods: The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. The Taiwan Endoscopic Breast Surgery Cooperative Group (T-EBSCG) was established to monitor the effectiveness of and clinical outcome associated with EABS in Taiwan. The T-EBSCG comprises members from three major endoscopic breast surgery centers, namely Changhua Christian Hospital, National Cheng-Kung University Hospital,and Taipei Medical University Hospital in Taiwan. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan.

Results: A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The mean tumor size of these 315 EABS was 2.2 ± 1.8 cm, and 44(13.9%) of them were multifocal/multicentric breast cancer. Lymph node metastasis was found during 23.3% of the procedures. The stage distribution of them were stage II cancer (n=103, 34.4%), followed by stage I cancer (n=92, 30.7%), ductal carcinoma in situ (stage 0) (n=86, 28.7%), and stage III breast cancer (n=19, 6.3%). The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Of the 269 patients who underwent EATM, 198 (73.6%) received immediate breast reconstruction. The majority (72.2%) of them received implant-based (cohesive Gel implant or tissue expander) reconstruction and the remaining 27.8% received autologous pedicled TRAM flap for breast reconstruction. Endoscopic assisted nipple sparing mastectomy with Gel implant reconstruction was the most frequently performed EABS now. During the six-year study period, there was an increasing trend toward more frequently use of EABS in the management of breast cancer when total mastectomy was indicated (EATM) than breast conserving surgery (EPM). Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. There were no major or life threatening complications. The positive surgical margin rate was 1.9%. During a median follow-up of 26.8 months (range, 3.3-68.6 months), there were 3 (1%) cases of local recurrence (1 ipsilateral breast recurrence, 1 axillary local recurrence, and 1 core needle biopsy tract recurrences), 1 (0.3%) case of distant metastasis, and 1 death.

Conclusion: The EABS program in Taiwan showed that EABS is a safe procedure and results in acceptable cosmetic outcome, these findings could help to promote this under-used surgical technique in the field of breast cancer.

Citation Format: Lai H-W, Kuo Y-L, Hung C-S, Chen S-T, Chen D-R. Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-16.

Abstract P4-02-03: The diagnostic accuracy of breast MRI in the prediction of malignant invasion of nipple areolar complex (NAC) of breast

Purpose: Nipple sparing mastectomy is increasingly used as a surgical treatment for breast cancer. To correctly predict the possibility of nipple invasion pre-operatively is critical important to prevent occult nipple invasion or early nipple recurrence. The objective of our study is to assess the diagnostic accuracy of breast MRI for the evaluation of malignant invasion of the nipple-areolar complex (NAC).

Material and Methods: From January 2011 to December 2013, patients with primary operable breast cancer diagnosed and treated at Changhua Christian Hospital (CCH), Taiwan were searched. The inclusion criteria were primary operable breast cancer patients, who received pre-operative breast MRI, and received breast cancer operation at CCH. The exclusion criteria were patients whose primary tumor was removed before definite cancer operation, those who received neoadjuvant chemotherapy, or patient's detailed data not available. Breast MRI examinations were retrospectively reviewed for nipple invasion or retraction, periareolar skin thickening, nipple areolar complex enhancement, relationship to the subareolar mass, malignant mass pattern, thickness of nipple-areolar complex enhancement, tumor-nipple distance and tumor size, and were correlated with pathologic findings. The accuracy of breast MRI to predict nipple invasion was compared with pre-operative image and post-operative pathologic reports.

Results: A total 704 primary operable breast cancers with pre-operative MRI and post operative pathologic reports were enrolled in our current study. In the total 704 patients, MRI showed signs of suspect NAC invasion in 160 (22.7%) patients. Total 41 (25.6%) patients were pathologic proven malignant invasion of NAC. In the final pathologic analysis, 57 pathologic confirmed NAC invasions were found in the 704 patients. The overall nipple invasion rate was 8.1% in this current study. The sensitivity of Breast MRI to predict NAC involvement was 71.9%. The Specificity of breast MRI to NAC invasion is 81.6%. The positive predictive value of breast MRI is 25.6%. The negative predictive value of breast MRI is 97.1%. The accuracy of breast MRI to predict NAC involvement is 80.8%. In univariate logistic regression analysis, tumor size, lymph node metastasis, central location of tumor, unilateral nipple enhancement, relationship to tumor, and HER-2 overexpression were prognostic factors for NAC invasion. In multivariate analysis, unilateral nipple enhancement (hazard ratio=4.944, CI: 1.938-12.616, P=0.001) was the most significant independently risk factor associated with the increased risk of NAC involvement.

Multivariate analysis of factors related to nipple invasion Multivariate analysisParametersOdds ratio95% CIpMRI tumor size0.8500.716-1.0090.063Distance to nipples (cm)1.1990.931-1.5440.160Location of tumor (Central)1.6830.724-3.9120.226Nipple enhancement (Unilateral)4.9441.938-12.6160.001Relationship (Yes)1.6160.625-4.1770.322MRI Lymph node metastasis (Yes)1.6740.870-3.2240.123

Conclusion: MRI is an useful diagnostic image method for the evaluation of malignant invasion of the nipple-areolar complex. Through preoperative breast MRI evaluation of NAC status, more personalized oncoplastic breast surgery could be performed.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Wu H-K, Kuo S-J. The diagnostic accuracy of breast MRI in the prediction of malignant invasion of nipple areolar complex (NAC) of breast. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-03.

Abstract P4-02-02: Did adding breast MRI decrease the surgical margin involved rate than conventional breast image? - A case controlled comparison analysis

Purpose: Resection of primary tumor with clear margin is the goal of surgical management for primary operable breast cancer. Surgical margin involvement was associated with increased local recurrence, and usually mandated further surgery. The objective of current study is to assess whether combining breast MRI would decrease the rate of margin involvement compared with conventional breast image.

Material and Methods: A retrospective, case controlled comparison study was conducted. Patients with primary operable breast cancer who received surgical management were searched from Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement was compared between two groups of patients with conventional breast image (Group A: mammogram and sonogram) or combined with breast MRI (Group B: mammogram, sonogram and MRI). Surgical margin involvement was defined as cancer cells present at surgical margin, or &lt; 1mm. To further evaluate the effect of breast MRI on surgeon's margin involved rates, the index surgeons, defined as with more than 100 breast cancer operations in both Group A and Group B, were selected and analyzed.

Results: Group A, conventional breast image group, consisted of 741 breast cancer patients. Among them, 381(51.4%) received partial mastectomy, and 360 (48.6%) received total mastectomy. Overall, 66 (8.9%) margin involved events were found in Group A. The margin involved rate in Group A patients received partial mastectomy or total mastectomy was 14.4% (55/381), and 3.1% (11/360), separately. The Group –B (combined with MRI) consisted of 736 breast cancer patients. Among them, 347 (47.1%) received partial mastectomy, and 389(52.9%) received total mastectomy. The margin involved rate in Group B was overall 4.8%(35/736). The margin involved rate in Group B patients who received partial mastectomy or total mastectomy was 6.1%(21/347), and 3.6% (14/ 389), respectively. The surgical margin involved rate was decreased after combination of MRI to conventional breast image as showed in table 1.

Margin involved rate with conventional breast image or combined with MRI Conventional Breast ImageCombined Breast MRI Patient741736P valuePartial mastectomy51.4%47.1%0.107Total mastectomy48.6%52.9% Rate of margin involvement  P valueOverall8.9%4.8%0.002Partial mastectomy14.4%6.1%0.001Total mastectomy3.1%3.6%0.834

Two index surgeons were selected for comparison of surgical margin involved rate before and after breast MRI. The "Surgeon A" 's margin involved rate in conventional breast image -&gt; combined MRI were: overall: 7.6% -&gt; 4.9%(0.202), partial mastectomy: 14.0% -&gt; 8.1%(P=0.151), and total mastectomy: 1.3% -&gt; 2.2%(P=0.8066). "Surgeon B" ‘s margin involved rate (from no MRI -&gt; MRI ) was: overall: 9.0% -&gt; 5.0%(P=0.121), partial mastectomy: 12.1% -&gt; 3.9%(P=0.034), and total mastectomy: 6.2% -&gt; 6.59%(P=0.722).

Conclusion: Adding breast MRI to conventional breast image decreased the surgical margin involved rate, with the cost of mild increase the mastectomy rate. This decreasing surgical margin involved rate was not mainly due to increase mastectomy rate, but due to the selection of patients who were not suitable for partial mastectomy to receive total mastectomy.

Citation Format: Lai H-W, Chen S-T, Chen D-R, Wu H-K, Ku S-J. Did adding breast MRI decrease the surgical margin involved rate than conventional breast image? - A case controlled comparison analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-02-02.

Cardiovascular risks associated with second-line oral antidiabetic agents added to metformin in patients with Type 2 diabetes: a nationwide cohort study

AIM

To compare the cardiovascular risks associated with second-line oral antidiabetic agents added to initial metformin therapy in a large nationwide observational study.

METHODS

We conducted a nationwide retrospective cohort study using the Taiwan National Health Insurance database. A total of 36 118 users of different add-on oral antidiabetic agents (sulphonylureas, glinides, pioglitazone, α-glucosidase inhibitors and dipeptidyl peptidase-4 inhibitors) after initial metformin therapy were included in the analysis. The reference group was sulphonylureas added to metformin, the most commonly used combination regimen. The main outcomes of interest were hospitalizations for any cardiovascular event including acute myocardial infarction, congestive heart failure and ischaemic stroke. In the main analysis, all patients were followed within their initiation groups until the study end, disregarding any changes in treatment status over time.

RESULTS

In intention-to-treat analyses, there was no difference in the risk of any cardiovascular event among the add-on combination treatment groups, but significantly lower risks of acute myocardial infarction were found for the glinides plus metformin treatment group (crude hazard ratio 0.52, adjusted hazard ratio 0.39; 95% CI 0.20-0.75) and for the α-glucosidase inhibitors plus metformin treatment group (crude hazard ratio 0.63, adjusted hazard ratio 0.54; 95% CI 0.31-0.95). No difference in risk of congestive heart failure or ischaemic stroke risk was found among the combination treatment groups. In secondary as-treated analyses, similar but less significant associations were found as compared with the primary intention-to-treat analyses for all treatment groups.

CONCLUSION

There were no differences in overall cardiovascular risks among several add-on second-line oral antidiabetic agents; however, glinide plus metformin and α-glucosidase inhibitors plus metformin combination therapies might be associated with lower risks of acute myocardial infarction.

Inhibition of adipogenic differentiation of bone marrow mesenchymal stem cells by erythropoietin via activating ERK and P38 MAPK

We examined whether erythropoietin (EPO) can inhibit adipogenic differentiation of mesenchymal stem cells (MSCs) in the mouse bone marrow and its underlying mechanism. We separated and extracted mouse bone marrow MSCs and induced adipogenic differen-tiation using 3-isobutyl-1-methylxanthine, insulin, and dexamethasone. Different concentrations of EPO were added to the cells and observed by Oil Red O staining on the 20th day to quantitatively analyze the degree of cell differentiation. mRNA expression levels of peroxysome proliferator-activated receptor γ (PPARγ), CCAAT enhancer binding protein α, and adiponectin were analyzed by real-time quantitative polymerase chain reaction, and the activity of PPARγ, extracellular sig-nal-regulated kinase (ERK), and p38 mitogen-activated protein kinase (p38 MAPK) were determined by western blotting. EPO significantly inhibited adipogenic differentiation of MSCs after 20 days and reduced absorbance values by Oil Red O staining without affecting proliferation activity. EPO downregulated the mRNA expression of PPARγ, CCAAT enhancer binding protein α, fatty acid binding protein 4, and adiponec-tin during adipogenesis and increased protein phosphorylation of ERK, p38 MAPK, and PPARγ during differentiation. EPO downregulated the mRNA expression of PPARγ, CCAAT enhancer binding protein α, fatty acid binding protein 4, and adiponectin by increasing protein phosphor-ylation of ERK, p38 MAPK, and PPARγ during differentiation, which inhibited adipogenic differentiation of MSCs.

Arecoline inhibits interleukin-2 secretion in Jurkat cells by decreasing the expression of alpha7-nicotinic acetylcholine receptors and prostaglandin E2

The purpose of the present study was to explore the effect of arecoline on phytohemagglutinin (PHA)-stimulated interleukin-2 (IL-2) secretion, the expression of alpha7-nicotinic acetylcholine receptors (α7-nAChRs), prostaglandin E2(PGE2) protein, and IL-2 mRNA in human lymphocyte cells (Jurkat cell line). The IL-2 and PGE2 were determined by enzyme-linked immunosorbent assay (ELISA). The expressions of phosphorylated extracellular signal-regulated kinase (ERK) and α7-nAChRs were determined by Western blotting. The level of IL-2 mRNA was determined by reverse-transcriptase polymerase chain reaction (RT-PCR). Arecoline, in a dose-dependent manner, significantly decreased IL-2 and PGE2 secretion by Jurkat cells incubated with 0 or 5 μg/ml 5 μg/ml PHA. PGE2 also significantly inhibited IL-2 secretion by Jurkat cells in a dose-dependent manner. In addition, reduced expression of PHA-induced ERK phosphorylation was observed in Jurkat cells treated with arecoline. PHA-enhanced IL-2 mRNA expression was also inhibited by arecoline. These results imply that arecoline inhibits the release of PGE2 and PHA-induced IL-2 secretion by Jurkat cells and that these effects seem to occur, at least in part, either through the attenuation of ERK in conjunction with a decrease of PHA-induced IL-2 mRNA expression. These results imply that arecoline inhibits the protein expression of α7-nAChRs , the release of PGE2 and PHA-induced IL-2 secretion by Jurkat cells.

Nutrition knowledge, attitude and practice of teachers in rehabilitation centres in northern Malaysia

INTRODUCTION

Persons with disabilities (PWD) are susceptible to malnutrition. Caregivers or teachers in rehabilitation centres may not be adequately trained in nutrition management of PWD. The aims of this study were (i) to assess the nutrition knowledge, attitude and practice among teachers in community-based rehabilitation centres for PWD; and (ii) to evaluate changes in the nutrition knowledge and attitude of the teachers before and after exposure to a training workshop on nutrition management for PWD.

METHODS

A cross-sectional survey was conducted using a guided self-administered Nutrition Knowledge, Attitude and Practice Questionnaire on Persons with Disabilities (KAP-nOKU), among a convenience sample of 210 teachers. Forty-five of them further participated in a nutrition training workshop and completed the post-test evaluation on knowledge and attitude of the same measures.

RESULTS

At baseline, the teachers' average knowledge, attitude and practice scores were 13.80 +/- 3.73 for knowledge (below 50th percentile); 51.49 +/- 4.08 for attitude (above 75th percentile); and 48.08 +/- 3.61 for practice (between 50th and 75th percentile). There was significant positive correlations between knowledge and attitude (r=0.343, p<0.05), as well as between attitude and practice (r=0.147, p<0.05). After exposure to a 3-day nutrition workshop, significant improvements in the teachers' knowledge and attitude were observed, whereby teachers' knowledge score increased from 14.20 +/- 3.80 to 25.38 +/- 2.36 and from 51.16 +/- 3.97 to 55.20 +/- 4.41 for attitude (p<0.001).

CONCLUSION

Nutrition intervention was associated with improvement in short term knowledge and attitude of the teachers. Sustainable interventional strategies are needed to enhance the nutrition knowledge and skills of teachers of PWD.

Capsaicin may induce breast cancer cell death through apoptosis-inducing factor involving mitochondrial dysfunction

The majority of breast cancer patients are resistant to chemotherapy or radiotherapy due to the down-regulation or lack of caspase-3 expression. Capsaicin was found to inhibit cancer cell growth in caspase-3-deficient human breast cancer cells. This study aimed to investigate the growth-inhibitive effect of capsaicin and its mechanisms in human breast cancer cell lines, MCF-7 and BT-20. The results showed that cell viability decreased in a dose-dependent manner in both the caspase-3-deficient and non-deficient cells through inducing cell apoptosis and arresting the cell cycle in the S phase. Capsaicin significantly decreased mitochondria membrane potential, induced the cleavage of PARP-1, and decreased procaspase-7 expression in both cells. Apoptosis-inducing factor (AIF) was distinctly released from mitochondria and translocated into the cytoplasm and nucleus in MCF-7 cells (52.9%), but not in BT-20 cells (2%) after treatment with 200 μM of capsaicin for 24 hours. Capsaicin inhibited breast cancer cell growth through inducing cell apoptosis and cell cycle arrest in the S phase. This apoptotic effect could be induced through the mitochondrial pathway, and PARP-1 subsequently cleaved by activation of caspase-7. The application of capsaicin in clinical therapy could be useful for breast cancer patients.

Abstract P4-07-10: Prognostic Significance of Triple Negative Breast Cancer at Tumor Size 1 Cm and Smaller

Triple negative breast cancer (TNBC) is an independent biomarker of poor prognosis, and associated with a higher predilection for visceral metastasis and early recurrence. However, the prognostic significance of TNBC with a tumor size ≥1 cm is unclear. Patients with primary operable breast cancer with a tumor size ≥1cm were retrospectively collected at Changhua Christian Hospital and National Cheng-Kung University Hospital in Taiwan. Tumors negative for ER, PR, and HER-2, determined by immunohistochemical stain, were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). From 1995 to 2006, a total of 377 (13%) patients with tumor size ≥1 cm were enrolled from 2835 primary breast cancer patients. The mean age at diagnosis and follow-up time were 50.86 and 4.04 ± 2.83 years, separately. Compared with non-TNBC patients, TNBC with a tumor size ≥1 cm as a whole or in lymph node-positive subgroup was not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS than the non-TNBC group. In multivariate Cox regression hazard analysis, lymph node invasion was the most important cause (hazard ratio: 19.89, 95% CI: 2.18-181.89, P=0.0081) of cancer-specific death.

Fig. (a) Disease-free survival (DFS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (b) Cancer-specific survival (CSS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (c) CSS in node-positive patients with a TNBC versus non-TNBC phenotype. (d) CSS in node-negative patients with TNBC versus non-TNBC. (e) DFS in patients with HR+/ERBB2-, ERBB2+, and TNBC. (f) CSS in patients of HR+/ERBB2- , ERBB2+, and TNBC. (g) CSS in node-positive patients with HR+/ERBB2-, ERBB2+, and TNBC. (h) CSS in node-negative patients with HR+/ERBB2- , ERBB2+, and TNBC.

TNBC is very likely an independent risk factor for CSS in small (≥1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller

AIMS

The purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm.

MATERIALS AND METHODS

Patients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS).

RESULTS

From 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death.

CONCLUSION

TNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Low viraemia at enrollment in children with chronic hepatitis C favours spontaneous viral clearance

The significance of hepatitis C viral (HCV)-RNA levels in long-term clinical outcomes of children with chronic HCV infection is not well understood. We conducted a long-term follow-up study of 42 children with chronic HCV infection that included clinical evaluation, biochemical tests, HCV genotyping and repeated quantitative HCV-RNA detection. Patients were divided into low and high viraemia groups according to RNA levels at enrollment (below/above 4.5 x 10(4) IU/mL), and clinical, biochemical and virological factors were evaluated. Overall, 14.3% (6/42) of patients developed spontaneous viral clearance during a median 10.1 years of follow-up. HCV-RNA levels at enrollment and mean RNA levels during follow-up for each patient were significantly correlated (R = 0.9018, 95% CI: 0.6637-0.9038, P < or = 0.001). HCV-RNA level fluctuation was within two log units in 76% of patients. Cumulative viraemia probability during follow-up could be predicted by viraemia levels at enrollment (P = 0.0092). Chronic HCV-infected children, with an RNA level below 4.5 x 10(4) IU/mL at enrollment, have a higher spontaneous viral clearance rate.

Hyperglycemia in vitro up-regulates growth-related cell cycle proteins of adult mouse pancreatic islets

To study effects of glucose on growth-related proteins of adult islets, we cultured mice islets in medium containing either 5.5 mmol/L (LG) or 20 mmol/L (HG) glucose. Total islet proteins were processed for sodium dodecyl sulfate polyacrylamide gel and Western blotting using antibodies against beta-actin (housekeeping), p27kip1 (G1/G0 checkpoint), cyclin D1 (G1/S), cyclin B1 (G2/M), and FoxM1. At day 1, protein levels p27, B1, D1, and FoxM1 of islets on LG and HG were 0.48- and 0.63-fold; 7.09- and 11.58-fold; 1.25- and 1.38-fold; and 1.75- and 1.75-folds, the value of day 0, determinations respectively. At day 3, the proteins of p27, B1, D1, and FoxM1 of islets in LG and HG were 0.84- and 0.84-fold; 3.08- and 17.17-fold; 1.41- and 1.54-fold; and 0.83- and 1.17-fold of those on day 0, respectively. On day 7 the values were 1.19- and 1.09-fold; 3.15- and 14.81-fold; 0.86- and 1.44-fold; and 2.75- and 3.42-fold that of day 0, respectively. At day 1, the ratios of protein in islets after HG verse LG were 1.25, 2.38, 0.94, and 1.00 for p27, B1, D1, and FoxM1, respectively. At days 3 and 7, the protein ratios of HG/LG were 0.81 and 0.82, 5.47 and 2.64, 0.81 and 1.51, and 1.11 and 1.24 for p27, B1, D1, and FoxM1, respectively. In conclusion, adult mouse islets rapidly respond to cultivation by reducing p27 and increasing B1; HG attenuates p27 elevation but enhances B1 and D1 elevations, which favor islet entry into the cell cycle.

T-box 3 negatively regulates osteoblast differentiation by inhibiting expression of osterix and runx2

T-box (Tbx)3, a known transcriptional repressor, is a member of a family of transcription factors, which contain a highly homologous DNA binding domain known as the Tbx domain. Based on the knowledge that mutation of the Tbx3 gene results in limb malformation, Tbx3 regulates osteoblast proliferation and its expression increases during osteoblast differentiation, we predicted that Tbx3 is an important regulator of osteoblast cell functions. In this study, we evaluated the consequence of transgenic overexpression of Tbx3 on osteoblast differentiation. Retroviral overexpression increased Tbx3 expression >100-fold at the mRNA and protein level. Overexpression of Tbx3 blocked mineralized nodule formation (28 +/- 8 vs. 7 +/- 1%) in MC3T3-E1 cells. In support of these data, alkaline phosphatase (ALP) activity was reduced 33-70% (P < 0.05) in both MC3T3-E1 cells and primary calvaria osteoblasts overexpressing Tbx3. In contrast, Tbx3 overexpression did not alter ALP activity in bone marrow stromal cells. Tbx3 overexpression blocked the increase in expression of key osteoblast marker genes, ALP, bone sialoprotein, and osteocalcin that occurs during normal osteoblast differentiation, but had little or no effect on expression of proliferation genes p53 and Myc. In addition, Tbx3 overexpression abolished increased osterix and runx2 expression observed during normal osteoblast differentiation, but the change in Msx1 and Msx2 expression over time was similar between control and Tbx3 overexpressing cells. Interestingly, osterix and runx2, but not Msx1 and Msx2, contain Tbx binding site in the regulatory region. Based on these data and our previous findings, we conclude that Tbx3 promotes proliferation and suppresses differentiation of osteoblasts and may be involved in regulating expression of key transcription factors involved in osteoblast differentiation.

Angiotensin-converting enzyme polymorphisms and risk of spontaneous deep intracranial hemorrhage in Taiwan

BACKGROUND AND PURPOSE

This study examines whether angiotensin-converting enzyme (ACE) gene polymorphisms are associated with the risk of spontaneous deep intracerebral hemorrhage (SDICH) in Taiwan using a case-control study.

METHODS

Totally, 217 SDICH patients and 283 controls were recruited. Associations of ACE A-240T and ACE I/D polymorphisms with SDICH were examined under the additive model and adjusted for gender, age, body mass index, total cholesterol level, smoking history, alcohol use, hypertension, and use of ACE inhibitors.

RESULTS

Hypertension, diabetes mellitus, family history of spontaneous intracerebral hemorrhage (SICH), and low cholesterol level increase risk of female SDICH, whereas hypertension, alcohol use, smoking history, family history of SICH, and low cholesterol level are an important risk factor for male SDICH. After adjusting for covariates, only haplotype ACE T-D (OR = 2.7, 95% CI, 1.1-6.5, P = 0.02) was associated with female SDICH.

CONCLUSIONS

This study demonstrates that environmental risk factors play a major role and ACE polymorphisms play a minor role in contributing risk of SDICH in Taiwan.

Ionophore-catalyzed cation transport between phospholipid inverted micelles manifest in DNMR

Studies of hyperfine shifts of lipid 31P resonances due to hydrated phospholipid inverted micelles in benzene are presented. Systems with distinct resonances from micelles containing no paramagnetic ions, and from micelles containing a single praseodymium(III) or a single europium(III) ion (and three nitrate counterions) have been generated. The addition of an ionophoric antibiotic from Streptomyces lasaliensis, lasalocid-A (X537A). causes both resonances to broaden and. with further additions, coalesce and eventually resharpen as a single line. Dilution of only the ionophore reverses these spectral changes. This is interpreted as a manifestation of dynamic NMR (DNMR. exchange broadening): i.e., that the ionophore catalyzes the equilibrium exchange of metal ions from micelle to micelle to the point where it becomes fast on the NMR time scale. This exchange is inhibited by protons or other competitive metal ions. We have simulated the spectra with a total lineshape analysis program and have thus extracted the average preexchange lifetimes for various concentrations of the antibiotic. We find a reasonably good first-order dependence on lasalocid-A concentration in each of several different experiments. This is in contrast to the higher order concentration dependences often observed by others using different techniques employing bilayer membranes. We favor a diffusional carrier mechanism involving surface aggregates of lasalocid-A for our process. This leads to the implication that a higher order concentration dependence found for a bilayer system arises from a different mechanism. The ionophore valinomycin does not catalyze rapid exchange in our system.

Hypokalemic thyrotoxic periodic paralysis: clinical characteristics and predictors of recurrent paralytic attacks

BACKGROUND AND PURPOSE

To study the clinical characteristics of hypokalemic thyrotoxic periodic paralysis (hoTPP) and identify the predictors of recurrent paralytic attacks before achieving the euthyroid status.

METHODS

We retrospectively analyzed 45 hoTPP patients who were admitted during the 7-year study period.

RESULTS

A tendency towards male predominance was observed among the 45 patients (91.1%, 41/45). The mean onset age was 32.9 +/- 10.0 years (range: 16-54 years). No significant differences were observed in the onset age between male and female patients. Precipitating factors included rest/sleep at night, hot weather, upper respiratory tract infections (URIs), and excessive physical activities. Atypical weakness was observed in nine (20%, 9/45) patients. One patient initially diagnosed with sporadic periodic paralysis eventually developed hoTPP.

DISCUSSION

In provocative tests, hypokalemia was not a consistent finding during paralytic attacks. Before achieving the euthyroid status, the rate of recurrent attacks was as high as 62.2%, and peaked in the first 3 months after hoTPP was diagnosed. Patients with URIs exhibited a higher incidence of recurrent paralytic attacks than those without (odds ratio = 13.00; 95% confidence interval = 1.08-156.08; P = 0.04).

Clinical features, vascular risk factors, and prognosis for transient global amnesia in Chinese patients

BACKGROUND

Transient global amnesia (TGA) is an intriguing clinical syndrome that has not been studied in a series of Chinese patients.

METHODS

From 1989 to 1995, we observed 28 consecutive patients with TGA. Their clinical characteristics, risk factors, and outcome were retrospectively reviewed and analyzed.

RESULTS

There were 13 men and 15 women with a mean age of 62 years (range, 39 to 76). The duration of amnesic attack ranged from 20 minutes to 24 hours (mean, 8 hours), with the majority (76%) of attacks lasting for 2 to 12 hours. In 9 (32%) of the 28 patients, the TGA was triggered by a potential precipitating factor including bathing, emotional stress, and headache. The most prominent symptom exhibited by patients during an attack was repetitive questioning, which occurred in 21 (75%) of the 28 patients. No focal neurological abnormality was noted during or after the attack. Electroencephalograms were obtained in 26 patients after experiencing TGA, which showed nonspecific findings in 6 patients and were normal in 20. In 21 patients who had cranial computed tomography scans, cortical atrophy was found in 5 (24%), focal infarction in 4 (19%), and the results were negative in 12 (57%). Hypertension was the predominant vascular risk factor (11 cases, 39%), then hyperlipidemia (7 cases, 25%), and smoking (3 cases, 11%). No vascular risk factor was found in 13 patients (46%). Recurrent TGA was found in 5 patients (18%), and stroke in 2 (7%).

CONCLUSION

Our study largely confirms the demographic pattern, clinical characteristics, and prognosis of TGA patients reported from the western countries. Although the cause is uncertain, TGA is a relatively benign entity.