Crossed raised arm position improves the flow of contrast medium in torso contrast-enhanced computed Tomography

INTRODUCTION

This retrospective cohort study examined the effects of the crossed raised arm (CRA) position in contrast-enhanced computed tomography (CECT) on contrast medium influx and image quality relative to the conventional position.

METHODS

Contrast medium influx into the collateral veins on CECT images was evaluated in 92 participants. The CT values of the pulmonary artery, descending aorta, and spleen were obtained in both positions and compared. Anatomical changes in the diameters and area of the subclavian vein and costoclavicular distance were also analyzed.

RESULTS

Contras 27 and 6 patients in the conventional and CRA positions, respectively. The influx risk ratio in the CRA position versus that in the conventional position was 0.22 (95% confidence interval, 0.10-0.51). Elevations in the median CT value of the pulmonary artery, descending aorta, and spleen in the CRA position were 7.0% (p < .001), 7.4% (p < .001), and 9.8% (p < .001), respectively. Enlargements in the major and minor diameters of the subclavian vein, subclavian vein area, and costoclavicular distance in the CRA position versus those in the conventional position were 19.3% (p < .001), 28.1% (p < .001), 53.6%, and 30.0% (p < .001), respectively.

CONCLUSION

The CRA position effectively prevented contrast medium influx into the collateral veins due to SVS and increased CT values in the target organs in CECT. The diameters and area of the subclavian vein and costoclavicular distance were enlarged at the thoracic outlet, which improved the flow of the contrast medium into the targeted organs.

IMPLICATIONS FOR PRACTICE

The CRA position can contribute to obtaining better CECT images during common clinical assessments at no additional cost.

Urinary biomarkers of kidney tubule injury, risk of acute kidney injury, and mortality in patients with acute ischaemic stroke treated at a stroke care unit

BACKGROUND AND PURPOSE

Urinary liver-type fatty-acid binding protein (L-FABP), which is a biomarker of kidney tubule injury, has been studied extensively and established as a risk marker of acute kidney injury (AKI). The aim of this study was to investigate whether kidney tubule injury is associated with the development of AKI and mortality in patients with acute ischaemic stroke.

METHODS

Acute ischaemic stroke patients hospitalized in the stroke care unit (SCU) within 24 h after symptom onset were prospectively investigated. AKI was defined on the basis of Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Baseline urinary L-FABP was measured on admission. We evaluated the associations among urinary L-FABP, incidence of AKI, and 90-day mortality adjusted for renal function, albuminuria and other potentially predictive variables, using multivariable analysis.

RESULTS

In total, 527 acute ischaemic stroke patients (342 men, median age 74 years) were enrolled in the study. Twenty-seven patients (5.1%) experienced AKI within 7 days of admission. In the univariate analysis, high urinary L-FABP level had positive associations with AKI [53.8 μg/g creatinine (Cr) vs. 3.9 μg/g Cr; P < 0.001] and 90-day mortality (15.5 μg/g Cr vs. 4.0 μg/g Cr; P < 0.001). In the multivariate analysis, elevated urinary L-FABP level (per 10-μg/g Cr increase) was independently associated with AKI (odds ratio 1.225, 95% confidence interval (CI) 1.083-1.454; P = 0.003) and 90-day mortality (hazard ratio 1.091, 95% CI 1.045-1.138; P < 0.001).

CONCLUSION

Urinary biomarkers of kidney tubule injury are independently associated with the development of AKI and 90-day mortality in patients with acute ischaemic stroke treated at the SCU.

Abstract P2-09-32: Ki-67 index value and progesterone receptor status predict prognosis and suitable treatment in node-negative breast cancer patients with estrogen receptor positive and HER2 negative tumors

Background: Breast cancer is no longer a single disease with high molecular heterogeneity. Gene profiling has identified at least 4 subtypes: Luminal A, Luminal B, HER2-enriched and basal-like breast cancer. Moreover, immunohistochemistry (IHC) classification is now considered a surrogate for establishing breast cancer subtypes. In previous report Luminal A was defined as ER and PgR positive, HER2 negative, Ki-67 low and recurrence risk low based on the multi-gene-expression assay. The distinction between Luminal A-like and Luminal B-like can be made by either using a high Ki-67 value (≥20%) or a low PgR value (&lt; 20%). In this study, patients with ER positive, HER2 negative and negative node were classified into 4 groups according to the PgR and the Ki-67 status (cutoff points: 20%) and examined retrospectively in relation to clinicopathological findings including the recurrence score (RS) and disease-free survival (DFS).

Methods: A total of 1866 invasive breast cancer patients from November 2001 to November 2016 were included in this study. The cases were classified as follows; LA as high PgR/low Ki-67 (850 cases), LB1 as high PgR/high Ki-67 (553 cases), LB2 as low PgR/high Ki-67 (226 cases), and LB3 as low PgR/low Ki-67 (237 cases). Out of all these cases, 1510 were treated with endocrine therapy alone. The median follow-up period was 78.1 months. Moreover, 23 of the cases underwent a 21-gene expression assay and the RS (&lt; 25 and &gt; 26) was compared with our classification.

Results: The median age was 57.4 years (range: 25 - 94). T1 tumors were more common in the LA group and rare in the LB2 group. Nuclear grade 3 and p53 overexpression were significantly correlated with LB2. Endocrine therapy alone was performed in 87.4% (LA), 77.4% (LB1), 58.8% (LB2) and 86.9% (LB3), retrospectively. There were significant differences in DFS between the LA group (5y DFS: 98%, 10 y DFS: 95.9%) and the LB2 group (5y: 89.9%, 10y: 83.6%; p&lt;0.0001) or LB1 (5y: 94.9%, 10y: 89.5%; p&lt;0.0001), but there was no difference with the LB3 group (5y: 98.6%, 10y: 94.7%; p=0.88). In the cases with endocrine therapy alone, LA showed a similar DFS with LB3 (p=0.25). LB2 had a significantly worse DFS in all the cases and in the cases with endocrine therapy. Chemotherapy was administered to cases with a higher nuclear grade in combination with endocrine therapy. In the LB2 group, there was no difference in DFS between the cases with endocrine therapy and in the cases with chemo-endocrine therapy. Moreover, most of the cases with LA (1/1) and LB1 (15/16) had a RS of &lt;25, and all of the LB2 (6/6) cases had a RS of &gt;26.

Conclusion: The patients with LA and LB3 (both: Ki-67&lt;20%) had a favorable DFS even in the endocrine therapy alone group. However, LB1 and LB2 (both: Ki-67≥20%) had a poorer DFS. Moreover, LB2 (PgR&lt;20% and Ki-67≥20%) was significantly correlated with a higher degree of malignancy and benefited from chemotherapy. LA and LB3 with low Ki-67 values were considered to be a part of the Luminal A group. These data suggest that PgR and the Ki-67 status are useful in predicting prognosis and deciding the treatment strategy for patients with ER-positive and HER2 negative breast cancer.

Citation Format: Arima N, Nishimura R, Osako T, Nishiyama Y, Okumura Y, Fujisue M, Toyozumi Y. Ki-67 index value and progesterone receptor status predict prognosis and suitable treatment in node-negative breast cancer patients with estrogen receptor positive and HER2 negative tumors [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 P2-09-32.

Effects of behavioural activation on the neural basis of other perspective self-referential processing in subthreshold depression: a functional magnetic resonance imaging study

BACKGROUND

It has been demonstrated that negatively distorted self-referential processing, in which individuals evaluate one's own self, is a pathogenic mechanism in subthreshold depression that has a considerable impact on the quality of life and carries an elevated risk of developing major depression. Behavioural activation (BA) is an effective intervention for depression, including subthreshold depression. However, brain mechanisms underlying BA are not fully understood. We sought to examine the effect of BA on neural activation during other perspective self-referential processing in subthreshold depression.

METHOD

A total of 56 subjects underwent functional magnetic resonance imaging scans during a self-referential task with two viewpoints (self/other) and two emotional valences (positive/negative) on two occasions. Between scans, while the intervention group (n = 27) received BA therapy, the control group (n = 29) did not.

RESULTS

The intervention group showed improvement in depressive symptoms, increased activation in the dorsal medial prefrontal cortex (dmPFC), and increased reaction times during other perspective self-referential processing for positive words after the intervention. Also, there was a positive correlation between increased activation in the dmPFC and improvement of depressive symptoms. Additionally, there was a positive correlation between improvement of depressive symptoms and increased reaction times.

CONCLUSIONS

BA increased dmPFC activation during other perspective self-referential processing with improvement of depressive symptoms and increased reaction times which were associated with improvement of self-monitoring function. Our results suggest that BA improved depressive symptoms and objective monitoring function for subthreshold depression.

Abstract P4-21-03: A randomized phase II study of Ki-67 response-guided preoperative chemotherapy for HER2-positive breast cancer

As for the HER2-positive breast cancer, there are many cases to be effective for neoadjuvant chemotherapy in comparison with other intrinsic subtypes. However, pCR is not provided by neoadjuvant chemotherapy in all cases. [Aim] This study evaluated the effectiveness of a therapeutic strategy that switches chemotherapy, based on Ki-67 tumor expression after initial therapy, relative to that of standard chemotherapy in patients with HER2-positive breast cancer. [patients and methods] Patients were randomly assigned to the control arm or the Ki-67 response-guided arm (Ki-67 arm). Primary tumor biopsies were obtained before treatment, and after three once-weekly doses of paclitaxel and trastuzumab to assess the interim Ki-67 index. In the control arm, paclitaxel and trastuzumab was continued for a total of 12 doses, regardless of the interim Ki-67 index. In the Ki-67 arm, subsequent treatment was based on the interim Ki-67 index. Early Ki-67 responders continued to received paclitaxel plus trastuzumab for a total of 12 doses, while early Ki-67 non-responders were switched to epirubicin plus cyclophosphamide every 3 weeks for three cycles with once-weekly trastuzumab for a total of 12 doses. The primary endpoint was the pathological complete response (pCR) rate. [Results] When 237 patients were enrolled, an interim analysis was conducted in 200 patients. There was almost linear correlation between the Ki-67 reduction rate at interim assessment and the pCR rate. The pCR rate in Ki-67 early non-responders in the Ki-67 arm (23.6%; 95% CI, 12.4 to 34.9) was inferior to that in the control arm (44.1%; 31.4 to 56.7; p=0.025). A strong correlation was not found between the Ki-67 reduction rate and the clinical response rate (Spearman's correlation coefficient 0.22).

pCR rate among Ki-67 early non-responders and responders TotalpCR nn%95%CIKi-67 early non responderControl arm59264431.4-56.7 Ki-67 response guided arm55132312.4-34.9Ki-67 early responderControl arm21104726.3-69.0 Ki-67 response guided arm2084018.5-61.5

Conclusions: The pCR rate in the Ki-67 arm was inferior to that in the control arm. A therapeutic strategy that switches chemotherapy, based on Ki-67 tumor expression after initial therapy, was not effective. The standard chemotherapy protocol remains as the recommended strategy for patients with HER2-positive breast cancer.

Citation Format: Takahashi M, Nishiyama Y, Hara F, Naito Y, Baba M, Sasaki M, Sato M, Watanabe K, Uemura Y, Yamaguchi T, Mukai H. A randomized phase II study of Ki-67 response-guided preoperative chemotherapy for HER2-positive breast cancer [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 P4-21-03.

Effectiveness of Cardiac Rehabilitation for Prevention and Treatment of Sarcopenia in Patients with Cardiovascular Disease - A Retrospective Cross-Sectional Analysis

OBJECTIVE

Sarcopenia is a syndrome characterized by progressive and generalized loss of skeletal muscle mass and strength, with the risk of frailty and poor quality of life. This study aimed to clarify the clinical characteristics of sarcopenia and to investigate the effects of comprehensive cardiac rehabilitation (CCR), including nutrition, physical exercise and medication, in patients with cardiovascular disease (CVD).

METHODS

We retrospectively studied 322 inpatients with CVD (age 72±12 years). Muscle mass, muscle strength and physical performance were assessed before and after exercise training in patients with and without sarcopenia, which was defined as either a gait speed of <0.8 m/s or reduced handgrip strength (<26 kg in males and <18 kg in females), together with lower skeletal muscle index (SMI) (<7.0 kg/m2 in males and <5.7 kg/m2 in females). The actual daily total calorie and nutrient intake was also calculated.

RESULTS

Sarcopenia was identified in 28% of patients with CVD, these patients having a higher prevalence of symptomatic chronic heart failure and chronic kidney disease. SMI was significantly associated with protein intake and statin treatment. The ratio of peak VO2 and SMI was significantly higher in the statin treatment group. Handgrip strength, gait speed, leg weight bearing index, and nutritional intake improved after exercise training in patients both with and without sarcopenia.

CONCLUSIONS

The present findings suggest that CCR is a promising strategy for prevention and treatment of sarcopenia in patients with CVD.

The first case of onychomycosis in a koala (Phascolarctos cinereus) due to atypical isolates of Microsporum gypseum, a diagnostic challenge

Background and Purpose:

Superficial mycotic infections have been only poorly described in koalas and there are no reliable mycologically confirmed data regarding clinical isolation of dermatophytes in this animal. We report an 11-year-old female koala, kept in a zoo in Tokyo, Japan, and presenting with hyperkeratotic lesions and scaly plaques on forepaw claws and pads reminiscent of fungal infection.

Case Report:

Direct microscopy of the scrapings was indicative of a dermatophyte infection. By culture and subsequent repeated subculturing of clinical specimens on Sabouraud dextrose agar, Mycobiotic agar, and potato dextrose agar, two distinct strains with different colony morphotypes (designed as types I and II) were identified. Macroscopic and microscopic characteristics of the strains were suggestive of three different species, i.e. Microsporum canis, M. gypseum, and M. fulvum. However, partial sequencing of internal transcribed spacer (ITS) region of rDNA, translation elongation factor-1α (Tef-1α), and beta-tubulin (BT2) genes confirmed the identity of both isolates as M. gypseum. The animal was treated with a continuous terbinafine regimen (250 mg/kg) once daily for 12 weeks.

Conclusion:

To the best of our knowledge, the present report is the first confirmed case of dermatophytosis in a koala. The genetics underlying a variety of phenotypic traits in most classical dermatophyte species are unknown, and further studies are needed to understand this phenomenon.

Abstract P4-09-26: The difference between metachronous and synchronous bilateral breast cancer in terms of clinical features and biology

Introduction

The recent diagnostic modality such as MRI can diagnose a tiny breast lesion even in healthy contralateral breasts. Recently, the rate of contralateral prophylactic mastectomy (CPM) is on the rise in the United States. In Japan, the CPM has been started for selected patients with a high risk. In this study, we divided bilateral breast cancers into the synchronous and the metachronous group and then compared the clinical features and biology.

Patients and Methods

Out of 216 bilateral breast cancer patients who underwent surgery between 1995 and March 2015, there were 101 synchronous breast cancer cases and 115 metachronous breast cancer cases (interval to the second tumor &gt; 1 year). The items examined were age, tumor size, lymph nodal status, histological type, and biological markers (ER, PgR, HER2, p53 and Ki-67 index values) in the cases with paired data.

Results

1. The incidence of metachronous tumors was relatively stable at 2.1–2.7% throughout the period. On the other hand, the incidence of synchronous tumors has increased to 4.4% in the most recent 5-year period and the median interval was 7.1 years.

2. There was no difference in the tumor size of both tumors in the synchronous group, but the second tumor was significantly smaller than the first tumor in the metachronous group (2.2cm to 1.7cm). The node negative rates showed no difference between two groups.

3. The cases with DCIS were seen in 20% and 25% of the synchronous group and 12% and 16% of the metachronous group. Most of the patients (94.3%) with invasive cancer received systemic adjuvant therapy in the metachronous group.

4. The ER positive rates of both tumors were 87.1% and 88.1% in the synchronous group and 71.6% and 68.4% in the metachronous group, respectively. The concordance rates were higher in the synchronous group (p=0.02). Moreover, there was a significant difference in ER positive rates between the two groups (p=0.01) and the ER negative tumors were more frequent in the second tumor of the metachronous group. The PgR negative tumors increased in the second tumor of metachronous cases. The shorter the interval (&lt; 5years), the more the ER positive rate decreased (p=0.002). However, the longer interval did not correlate with the change of receptor status.

5. The Ki-67 index values significantly increased in the second tumor of the metachronous group, especially in the cases with a shorter interval. However, there was no difference in the synchronous group. The p53 overexpression rates significantly increased in the cases with a shorter interval.

6. The postoperative prognosis for the first tumor did not differ in both groups.

Conclusion

The incidence of synchronous bilateral breast cancer cases have increased but have remained relatively stable in the metachronous group. The concordance rates of the ER, PgR, Ki-67 and p53 status were higher in the synchronous group but the cases with negative ER, negative PgR, higher Ki-67 values and positive p53 increased in the second tumor of the metachronous group. These findings suggest that adjuvant systemic therapy played a important role in the treatment of bilateral breast cancer but the secondary tumor was more aggressive in the metachronous cases.

Citation Format: Arima N, Nishimura R, Osako T, Nishiyama Y, Fujisue M, Okumura Y, Murakami K, Toyozumi Y. The difference between metachronous and synchronous bilateral breast cancer in terms of clinical features and biology. [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 P4-09-26.

Accurate NMR determination of C-H or N-H distances for unlabeled molecules

Cross-Polarization with Variable Contact-time (CP-VC) is very efficient at ultra-fast MAS (νR ≥ 60 kHz) to measure accurately the dipolar interactions corresponding to C-H or N-H short distances, which are very useful for resonance assignment and for analysis of dynamics. Here, we demonstrate the CP-VC experiment with (1)H detection. In the case of C-H distances, we compare the CP-VC signals with direct ((13)C) and indirect ((1)H) detection and find that the latter allows a S/N gain of ca. 2.5, which means a gain of ca. 6 in experimental time. The main powerful characteristics of CP-VC methods are related to the ultra-fast spinning speed and to the fact that most of the time only the value of the dipolar peak separation has to be used to obtain the information. As a result, CP-VC methods are: (i) easy to set up and to use, and robust with respect to (ii) rf-inhomogeneity thus allowing the use of full rotor samples, (iii) rf mismatch, and (iv) offsets and chemical shift anisotropies. It must be noted that the CP-VC 2D method with indirect (1)H detection requires the proton resolution and is thus mainly applicable to small or perdeuterated molecules. We also show that an analysis of the dynamics can even be performed, with a reasonable experimental time, on unlabeled samples with (13)C or even (15)N natural abundance.

Studies of minute quantities of natural abundance molecules using 2D heteronuclear correlation spectroscopy under 100 kHz MAS

Two-dimensional (1)H{(13)C} heteronuclear correlation solid-state NMR spectra of naturally abundant solid materials are presented, acquired using the 0.75-mm magic angle spinning (MAS) probe at spinning rates up to 100 kHz. In spite of the miniscule sample volume (290 nL), high-quality HSQC-type spectra of bulk samples as well as surface-bound molecules can be obtained within hours of experimental time. The experiments are compared with those carried out at 40 kHz MAS using a 1.6-mm probe, which offered higher overall sensitivity due to a larger rotor volume. The benefits of ultrafast MAS in such experiments include superior resolution in (1)H dimension without resorting to (1)H-(1)H homonuclear RF decoupling, easy optimization, and applicability to mass-limited samples. The HMQC spectra of surface-bound species can be also acquired under 100 kHz MAS, although the dephasing of transverse magnetization has significant effect on the efficiency transfer under MAS alone.

Theoretical study of CP-VC: a simple, robust and accurate MAS NMR method for analysis of dipolar C-H interactions under rotation speeds faster than ca. 60 kHz

We show that Cross-Polarization with Variable Contact-time (CP-VC) allows an accurate determination of C-H dipolar interactions, which permits an easy detailed analysis of bond lengths and local dynamics, e.g. in biomolecules. The method presents a large dipolar scaling factor of 1/√2, leading to a better determination of dipolar interactions, especially for long C-H distances, and it allows the observation of very small local details such as those related either to CH(2) three spin systems, or even to hydrogen bonds. CP-VC is very simple to set up and very robust with respect to most experimental parameters, such as: rf-offsets, chemical-shift anisotropies, imperfect Hartmann-Hahn setting, and rf-inhomogeneity. The only required condition is the use of a sufficiently fast MAS spinning speed of at least ca. 60 kHz.

Abstract P6-05-14: Prognostic significance of Ki-67 index value at primary breast tumor in recurrent breast cancer

Introduction: The Ki-67 index value is a prognostic factor in primary breast cancer and is a proliferation marker that also distinguishes between luminal type A and type B breast cancer. Moreover, change in Ki-67 index value due to treatment and recurrence is considered to be important in treating breast cancer. The evaluative procedure in this study was on two levels; first, we examined whether the baseline Ki-67 value at the primary tumor is useful as a prognostic factor after recurrence, and second, we looked at the changes in the values after recurrence.

Patients and Methods: Immunohistochemical (IHC) analysis of the Ki-67 index was performed on 4701 patients with primary breast cancer from 1987 until March 2013 at Kumamoto City Hospital. Out of these patients, there were 666 consecutive cases with recurrence after primary surgery. The fraction of proliferating cells (positive for Ki-67) was based on a count of at least 500 tumor cells in the area including the hot spot, and the Ki-67 values were divided into 2 or 3 groups; &lt;20% and ≥20% (and ≥50%). Items examined were ER, PgR, HER2, tumor size, nodal status at primary tumor, and recurrent site (soft tissue, bone and viscera) and disease-free interval (DFI). Cox's proportional hazard model was used to perform a univariate and multivariate analyses of the factors related to overall survival (OS) after recurrence. The median follow-up period was 65.9 months in the remaining survival group. In 101 recurrent cases from whom the recurrent lesion was resected, the change in biological markers (Ki-67, ER and PgR) were evaluated.

Results: The median Ki-67 value at baseline was 20% in all the cases and 27% in the recurrent cases. In terms of recurrent site, the values were low (23%) in patients with bone metastasis, whereas patients with liver or brain metastasis showed higher values (38% and 53%, respectively). Moreover, DFI was inversely correlated with Ki-67 values. Univariate and multivariate analyses were performed to identify the prognostic factors for OS after recurrence. The significant factors included tumor size, lymph node status, ER, PgR, DFI, recurrent site, and the Ki-67 index value. Among these factors, a multivariate analysis revealed that the Ki-67 index value at primary tumor was an independent significant factor. The hormone receptor positive rate from the primary tumor to recurrence decreased from 67.3% to 63.4% and 64.4% to 50% for ER and PgR, respectively. The Ki-67 index value increased significantly from a mean of 28.9% at primary tumor to 35.7% at relapse. Furthermore, the Ki-67 index value at primary tumor was a significant prognostic factor for OS after recurrence in this cohort.

Conclusion: The Ki-67 value at primary tumor was a significant prognostic factor for OS after recurrence. The Ki-67 index value increased significantly after recurrence. It is therefore important to take the Ki-67 index into consideration in the treatment and follow-up of breast cancer patients.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P6-05-14.

Abstract P5-05-06: Menopausal status: An important consideration in determining the biology and prognosis of estrogen receptor-positive and progesterone receptor-negative breast cancer

Background: Transcription of the progesterone receptor (PgR) gene is regulated by estrogen in the breast tissue. PgR loss is considered to be a result in the reduction of estrogen receptor (ER) activity, due to either low circulating estrogen in some older women or a high growth factor signaling. Among the ER-positive breast cancer patients, PR-negative cases frequently have a higher resistance to endocrine therapy, and have a poorer prognosis. Therefore, we examined the clinical significance of ER+/PgR- tumors in luminal/HER2 negative breast cancer and its relationship to menopausal status.

Methods: The sample for this study came from 1791 consecutive patients with HER2 negative primary breast cancer from January 2002 to March 2013. The ER and PgR expressions were evaluated using immunohistochemistry (IHC). 1586cases had ER+/PgR+ tumor, 205cases had ER+/PgR- tumor. The items examined were nuclear grade, Ki-67 index value, TP53, tumor size and number of lymph node involvement. The Ki-67 index value and TP53 were evaluated using IHC and the cut-off values were 20% and 50%, respectively. Recurrence free survival (RFS) and breast cancer-specific survival (BCSS) was calculated using the Kaplan-Meier method and evaluated by the log-rank test or generalized Wicoxon test in stage 1 and 2 breast cancer.

Results: In terms of the distribution of ER and PgR status, ER+/PgR- were frequently seen in postmenopausal patients (13.7% vs 6.8%, respectively). Patients with ER+/PgR-and HER2 negative tumors had significantly smaller tumors, lower Ki-67 values, and a lower nuclear grade in the postmenopausal group compared with those in the premenopausal group. Moreover, RFS trended to be better in the postmenopausal group (p = 0.06), but there was no significant difference. BCSS was significantly higher in the postmenopausal cases (p = 0.001). On the other hand, in patients with ER+/PgR+ tumors, there was no significant difference in RFS and BCSS between the post- and pre-menopausal groups.

Conclusion: The ER+/PgR- tumors were more commonly seen in postmenopausal patients. The biological characteristics of ER+/PgR- tumors were significantly different in terms of the Ki-67 index value, nuclear grade, and the prognosis (BCSS and RFS) between pre- and postmenopausal status. Moreover, the postmenopausal group had a more favorable biology and prognosis than the premenopausal group. Therefore, the findings in this study indicate that menopausal status is related to the biology and prognosis in patients with ER+/PgR- tumors.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-05-06.

Abstract P1-02-01: Pre-analytical setting is critical for an assessment of the Ki-67 labeling index for breast cancer

Background: The Ki-67 labeling index (LI) is useful in determining the efficacy of chemotherapy for patients with ER-positive and HER2-negative breast cancer. However, standardization of Ki-67 assessment has not yet been established. In terms of the factors that may affect Ki-67 LI, recent studies have focused on inter-observer variability in the interpretation of these values and insufficient attention has been given to the importance of handling the tissue. Therefore, this study focused on the effect of tissue fixation on Ki-67 LI.

Methods:

The effects of several pre-analytical conditions on the Ki-67 LI were studied as follows;

(1) Type of fixation: Each 173 surgically excised tumors were fixed with either 10% neutral buffered formalin or 15% formalin on the same condition, followed by assessment of Ki-67 LI.

(2) Time of fixation: Each study was repeated more than three times to confirm the result.

A: Time to fixation: A part of tumor, sliced from the surgically excised tumor, was kept in 4° for several hours to overnight before formalin fixation. Ki-67 LI was compared between the tumor with immediate and delayed fixation.

B: Time of fixation:

Insufficient fixation: A part of tumor, sliced from the surgically excised tumor, was fixed with formalin for 3 hours, followed by preparation of a paraffin-embedded block. Ki-67 LI was compared between the tumor with proper and shorter fixation.

Prolonged fixation: Some pieces of slice were prepared from the surgically excised tumor, followed by each preparation of a paraffin-embedded block at a designated fixation period. Ki-67 LI was compared among each sample fixed in a different period of time.

(3) Surgically excised tumors on Ki-67 LI:

A: Effect of cutting onto the tumor before fixation: Ki-67 LI in each 595 surgically excised tumor with or without cutting onto the tumor before fixation, was analyzed.

B: Comparison between core needle biopsy and surgically excised tissue: Ki-67 LI in each 136 pairs of core needle biopsy and surgically excised tissue originated from the same tumor was compared.

Results:

(1) Ki-67 LI was significantly higher when 10% neutral buffered formalin was used as a fixative compared to 15% formalin (p = 0.018).

(2) Ki-67 LI was reduced in some degree when time to fixation was delayed, while insufficient fixation caused dramatic reduction of Ki-67 LI compared to that seen in an either ER or HER2. A prolonged period of fixation caused gradual reduction of Ki-67 LI associated with diminished nuclear labeling.

(3) Ki-67 LI was significantly higher in the tumor cut onto before fixation (p = 0.018). There was no significant difference in Ki-67 LI between core needle and surgically excised specimens (p = 0.107), when the tumor was properly fixed.

Conclusion: Our results suggest that pre-analytical setting critically influences the Ki-67 labeling. In order to standardize Ki-67 LI assessment in breast cancer, the care in handling of the pre-analytical tissue is crucial in determining accurate Ki-67 values.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-02-01.

Suppression of streptozotocin-induced type-1 diabetes in mice by radon inhalation

We examined the protective effect of radon inhalation on streptozotocin (STZ)-induced type-1 diabetes in mice. Mice inhaled radon at concentrations of 1000, 2500, and 5500 Bq/m3 for 24 hours before STZ administration. STZ administration induced characteristics of type-1 diabetes such as hyperglycemia and hypoinsulinemia; however, radon inhalation at doses of 1000 and 5500 Bq/m3 significantly suppressed the elevation of blood glucose in diabetic mice. Serum insulin was significantly higher in mice pre-treated with radon at a dose of 1000 Bq/m3 than in mice treated with a sham. In addition, superoxide dismutase activities and total glutathione contents were significantly higher and lipid peroxide was significantly lower in mice pre-treated with radon at doses of 1000 and 5500 Bq/m3 than in mice treated with a sham. These results were consistent with the result that radon inhalation at 1000 and 5500 Bq/m3 suppressed hyperglycemia. These findings suggested that radon inhalation suppressed STZ-induced type-1 diabetes through the enhancement of antioxidative functions in the pancreas.

Cerebral blood flow and metabolism measurement using positron emission tomography before and during internal carotid artery test occlusions: feasibility of rapid quantitative measurement of CBF and OEF/CMRO(2)

Balloon test occlusion (BTO) of the internal carotid artery (ICA) combined with cerebral blood flow (CBF) study is a sensitive test for predicting the outcome of permanent ICA occlusion. However, false negative results sometimes occur using single photon emission tomography (SPECT). We have recently developed a rapid positron emission tomography (PET) protocol that measures not only the CBF but also the cerebral oxygen metabolism before and during BTO in succession. We measured acute changes in regional CBF and OEF/CMRO(2) before and during BTO in three cases with large or giant cerebral aneurysms using the rapid PET protocol. Although no patients showed ischemic symptoms during BTO, PET studies exhibited mildly to moderately decreased CBF (9∼34%) compared to the values obtained before BTO in all cases. The average OEF during BTO was significantly increased (21% and 43%) than that of before BTO in two cases. The two cases were considered to be non-tolerant for permanent ICA occlusion and treated without ICA sacrifice. Measurement of the CBF and OEF/CMRO(2) using a rapid PET protocol before and during BTO is feasible and can be used for accurate assessment of tolerance prediction in ICA occlusion.

Preventive and curative effects of radon inhalation on chronic constriction injury-induced neuropathic pain in mice

BACKGROUND

Radon therapy is clinically useful for the treatment of pain-related diseases. However, there have been no studies regarding the effects of radon inhalation on neuropathic pain. In this study, we aimed to determine whether radon inhalation actually induced a remission of neuropathic pain and improved the quality of life.

METHODS

First, we investigated the antinociceptive effects of radon inhalation in the chronic constriction injury (CCI) model of neuropathic pain. We evaluated pain behaviour in mice before and after CCI surgery, using von Frey test. Pretreated mice received CCI surgery immediately after 24-h inhalation of radon at background (BG) concentration (c. 19 Bq/m(3) ), or at a concentration of 1000 or 2000 Bq/m(3) , and post-treated mice inhaled similar levels of radon 2 days after CCI surgery.

RESULTS

CCI surgery induced mechanical allodynia and hyperalgesia on a plantar surface of mice, as assessed using von Frey test, and 2000 Bq/m(3) radon inhalation alleviated hyperalgesic conditions 22-37% compared to BG level concentration. Concurrently, CCI surgery increased norepinephrine (NE), tumour necrosis factor-alpha (TNF-α) and nitric oxide (NO) concentrations in plasma, and leukocyte migration in paws. Furthermore, CCI-induced neuropathy reduced superoxide dismutase (SOD) activity. Treatment with radon inhalation, specifically at a concentration of 2000 Bq/m(3) , produced antinociceptive effects, i.e., lowered plasma TNF-α, NE and NO levels and restored SOD activity, as well as pain-related behaviour.

CONCLUSIONS

This study showed that inhalation of 2000 Bq/m(3) radon prevented and alleviated CCI-induced neuropathic pain in mice.

Symptomatic middle cerebral artery stenosis treated by percutaneous transluminal angioplasty: improvement of cerebrovascular reserves

This study evaluated the recoveries of cerebrovascular reserves (CVR) after applying percutaneous transluminal angioplasty (PTA) to patients with symptomatic middle cerebral artery (MCA) stenosis of varying severity. The patients were submitted to single photon emission computed tomography (SPECT) to obtain their regional cerebral blood flows at resting stage (rCBF(rest)) and acetazolamide-challenged CBF in five regions of interest (ROIs), including the MCA, on the ipsilateral and contralateral sides of the hemisphere. rCVR values were then calculated from these CBF data to evaluate the CVR recoveries after PTA treatment. When the PTA effects were statistically analyzed of the patients dichotomized into more severe (n=9) and less severe (n=5) groups, distinctly significant ROI-specific PTA effectiveness was observed for CVR rather than CBF values in the patients of the severer group.

Impact of novel oncolytic virus HF10 on cellular components of the tumor microenviroment in patients with recurrent breast cancer

Oncolytic viruses are a promising method of cancer therapy, even for advanced malignancies. HF10, a spontaneously mutated herpes simplex type 1, is a potent oncolytic agent. The interaction of oncolytic herpes viruses with the tumor microenvironment has not been well characterized. We injected HF10 into tumors of patients with recurrent breast carcinoma, and sought to determine its effects on the tumor microenvironment. Six patients with recurrent breast cancer were recruited to the study. Tumors were divided into two groups: saline-injected (control) and HF10-injected (treatment). We investigated several parameters including neovascularization (CD31) and tumor lymphocyte infiltration (CD8, CD4), determined by immunohistochemistry, and apoptosis, determined by terminal deoxynucleotidyl transferase dUTP nick end labeling assay. Median apoptotic cell count was lower in the treatment group (P=0.016). Angiogenesis was significantly higher in treatment group (P=0.032). Count of CD8-positive lymphocytes infiltrating the tumors was higher in the treatment group (P=0.008). We were unable to determine CD4-positive lymphocyte infiltration. An effective oncolytic viral agent must replicate efficiently in tumor cells, leading to higher viral counts, in order to aid viral penetration. HF10 seems to meet this criterion; furthermore, it induces potent antitumor immunity. The increase in angiogenesis may be due to either viral replication or the inflammatory response.

Hepatocyte growth factor incorporated into herpes simplex virus vector accelerates facial nerve regeneration after crush injury

Hepatocyte growth factor (HGF) promotes regeneration of the central nervous system, but its effects on the peripheral nervous system remain unclear. This study was conducted to elucidate the effect of HGF on regeneration of the murine facial nerve after crush injury. To do so, a replication-defective herpes simplex virus vector that incorporated HGF was prepared (HSV-HGF). The main trunk of the facial nerve was compressed by mosquito hemostats, and HSV-HGF, control vector or medium was then applied to the compressed nerve. We found that mice in the HGF group required significantly fewer days for complete recovery from nerve compression. Furthermore, the amplitude of the evoked buccinator muscle compound action potential increased following HSV-HGF application. HGF expression in and around the compressed nerve was demonstrated by enzyme-linked immunoassay and immunohistochemistry. In addition, HSV-HGF introduction around the damaged nerve significantly accelerated recovery of function of the facial nerve. These data suggest a possible role of HGF in promoting facial nerve regeneration after nerve damage. Furthermore, this viral delivery method may be applied clinically for many types of severe facial palsy during facial nerve decompression surgery.

Radiation pneumonitis in patients with lung and mediastinal tumours: a retrospective study of risk factors focused on pulmonary emphysema

OBJECTIVES

To evaluate the impact of pulmonary emphysema (PE) on the incidence and severity of radiation pneumonitis (RP) in patients with lung and mediastinal tumours.

METHODS

92 patients were enrolled. Involved-field radiation therapy (non-small cell carcinoma or mediastinal tumours in 69 patients; median 70 Gy) and accelerated hyperfractionation (limited disease small cell carcinoma in 23 patients; median 45 Gy) were performed. Common Terminology Criteria for Adverse Events v.3.0 was used to evaluate RP and the relationship with the percentage of pulmonary volume irradiated to >20 Gy (V20) and PE. PE was diagnosed by the presence of low-attenuation areas (LAAs) on CT scans and was classified into Grades 0-4 according to the extent of the LAAs.

RESULTS

The median follow-up time was 16 months. The 6-month cumulative incidence of RP at Grade 3 or greater was 7.7% and 34.1% in patients with a V20 of <25% and ≥25%, respectively (p=0.017). In patients with PE Grades 0, 1, 2 and 3 or greater, the incidence of RP was 16.5%, 9.1%, 8.6% and 54.0%, respectively. As the PE Grade increased, the incidence of RP also increased significantly.

CONCLUSION

The incidence and severity of RP are significantly higher in patients with a high V20 value as well as in those with severe PE.

Recovery of cerebrovascular reserves after stenting for symptomatic carotid artery stenosis

Although a decrease in cerebrovascular reserves (CVR) is known to enhance the risk of stroke, changes in this parameter after carotid artery stenting (CAS) have rarely been investigated. The present study is the first to compare CVR recoveries after applying CAS to patients with symptomatic carotid artery disease. CAS was performed for 31 consecutive patients with symptomatic carotid artery disease. They underwent acetazolamide-challenged single photon emission computed tomography (SPECT) before and after CAS to obtain data on resting stage cerebral blood flow (CBF(rest) values) in various regions of interest (ROIs) defined by a three-dimensional stereotactic ROI template. CVR values on ipsilateral and contralateral hemispheric sides were then calculated based on the CBF(rest) data. The 31 patients were dichotomized into unilateral (n=22) and bilateral (n=9) lesion groups, and no significant between-group differences were observed in CBF(rest) before and after CAS. In the unilateral group, there were no differences in CVR values before and after CAS. In the bilateral group, however, the CVR values significantly increased in nearly all the investigated ROIs on the contralateral side. Also, the hemispheric CVR values on both sides significantly increased after CAS in the bilateral group, while no such increase was observed in the unilateral group. CAS in patients with symptomatic bilateral carotid artery disease has the potential utility for their haemodynamic improvement even on the contralateral hemispheric side.

Abstract P2-03-01: An Investigation of Factors Influencing Real-Time Tissue Elastography Score

[Purpose]

At 32nd SABCS, we reported that Real-time Tissue Elastography (EG) score was useful in the examinations of mass-forming breast lesions. The results suggested that a possibility of being invasive carcinoma may practically be ruled out when a mass-forming breast lesion scored 1 or 2 on EG. Because the stiffness is relatively visualized in EG, it is possible that the score is influenced by the state of the patient's breast. We examined the factors influencing EG scores in mass-forming breast lesions. [Subject and Method]

EG scores of 502 patients with breast lesions (150 malignant, 352 benign) whose tissues were diagnosed histopathologically from October 2007 to December 2009 were studied. The hardness was scored on a scale 1 to 5 on Tsukuba elasticity scoring system. [Results]

In the 502 cases of mass-forming breast lesions there was a significantly higher score for non-invasive carcinoma and invasive carcinoma than for benign lesions (&lt; 0.0001). No difference in score was observed in a comparison of the location (lateral quadrants, medial quadrants) of the mass-forming lesion. There were significantly lower scores (&lt; 0.0001) in 10 mm in diameter or smaller when comparing three groups of tumor mass diameters: 10 mm in diameter or smaller, 11-20 mm, and 21-30 mm. When the breast density of two groups were examined, “almost entirely fat or scattered fibroglandular tissue” group and “heterogeneously dense or extremely dense” group, there were significantly low scores in the “heterogeneously dense or extremely dense” group (&lt; 0.0001). When the two groups divided by median area of the mammography were examined, there were significantly low scores in the larger breast group (&lt; 0.0001). Although in the total cases examined, all cases were benign in score 1, 6% were malignant in score 2 (5 cases non-invasive carcinoma, 4 cases invasive carcinoma). When 3 cases in which pathology results of the surgical specimen were obtained were examined among the 4 cases of invasive carcinoma, widespread intraductal spread was observed in the surrounding invasive carcinoma. [Conclusion]

Through this investigation we ascertained that EG scores are influenced by lesion size and the state of the patient's breast. In addition, care must be taken given the possibility of low scores in invasive carcinoma with widespread intraductal spread.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-03-01.

Biomatrices and biomaterials for future developments of bioprinting and biofabrication

The next step beyond conventional scaffold-based tissue engineering is cell-based direct biofabrication techniques. In industrial processes, various three-dimensional (3D) prototype models have been fabricated using several different rapid prototyping methods, such as stereo-lithography, 3D printing and laser sintering, as well as others, in which a variety of chemical materials are utilized. However, with direct cell-based biofabrication, only biocompatible materials can be used, and the manufacturing process must be performed under biocompatible and physiological conditions. We have developed a direct 3D cell printing system using inkjet and gelation techniques with inkjet droplets, and found that it had good potential to construct 3D structures with multiple types of cells. With this system, we have used alginate and fibrin hydrogel materials, each of which has advantages and disadvantages. Herein, we discuss the roles of hydrogel for biofabrication and show that further developments in biofabrication technology with biomatrices will play a major part, as will developments in manufacturing technology. It is important to explore suitable biomatrices as the next key step in biofabrication techniques.

62 RECOVERY OF CELL NUCLEI FROM 15 000-YEAR-OLD MAMMOTH TISSUES AND INJECTION INTO MOUSE ENUCLEATED MATURED OOCYTES

Since the report of “Dolly” (Wilmut et al. 1997 Nature 385, 810-813), cloned animals have been successfully produced by somatic cell nuclear transfer (SCNT). In those reports, cultured or fresh cells were mainly used as nuclear donor cells in SCNT. Meanwhile, there was a report of the birth of offspring by SCNT with the nuclear donor cell derived from frozen whole body kept at -20°C for 16 years without cryoprotectant (Wakayama et al. 2008 Proc. Natl. Acad. Sci. USA 105, 17 318-17 322). This report suggests that if tissues or cells are cryopreserved postmortem without cryoprotectant, resurrection of the postmortem animal individual might be possible by SCNT. Furthermore, in cases of extinct or endangered species, it is difficult to use oocytes derived from same species as the recipient cytoplasm. However, there was a report of the birth of offspring by SCNT with oocytes derived from closely related species (Lanza et al. 2000 Cloning 2, 79-90). This result suggests that if oocytes from closely related species are available as the recipient cytoplasm, it would be possible to resurrect extinct or endangered species by SCNT. Woolly mammoth (Mammuthus primigenius) is a famous animal that existed during the ice ages and became extinct at the end of the last ice age. Its relics have been excavated from permafrost. Recently, the prospect of the resurrection of woolly mammoth by SCNT has heightened. However, even if the soft tissue of the woolly mammoth is excavated, it is not clear whether its cell nuclei retain their biological characteristics for more than several thousand years. In this study, we recovered cell nuclei from 15 000-year-old mammoth tissues and injected them into mouse enucleated matured oocytes as the nuclear donor in SCNT. Frozen mammoth legs were excavated from Northeast Siberian permafrost at the point of 71°34′56.9″ N and 141°37′37.6″ E. The conventional radiocarbon age of the sample after 13C correction was 13 100 to 12800 BC or 12400 to 11 800 BC. Cell nucleus-like structures were successfully recovered from skin and muscle tissues. Those nuclei were then injected into enucleated BDF1 mouse oocytes, and more than half of the injected oocytes were able to survive (67%; 12/18 for oocytes injected with skin-derived nucleus, 55%; 72/131 for oocytes injected with muscle-derived nucleus and 33%; 26/80 for oocytes injected with frozen-thawed mouse bone marrow-derived nucleus as the control group). Injected nuclei were not taken apart and retained their nuclear structure. Those oocytes did not show disappearance of nuclear membrane or premature chromosome condensation at 1 h after injection and did not form pronuclear-like structures at 7 h after injection. Because one-half of the oocytes injected with nuclei derived from frozen-thawed mouse bone marrow cells were able to form pronuclear-like structures (46%; 12/26), it might be possible to promote the cell cycle of nuclei from ancient animal tissues by suitable pretreatment in SCNT. This is the first report of SCNT with nuclei derived from mammoth tissues. This study was funded in part by Gifu Prefecture, Japan.