Structure and function of retinal ganglion cells in subjects with a history of repeated traumatic brain injury

This study tested whether repeated traumatic brain injuries (TBIs) alter the objective structure or the objective function of retinal ganglion cells (RGCs) in human subjects recruited from an optometry clinic. Case subjects (n = 25) with a history of repeated TBIs (4.12 ± 2.76 TBIs over 0-41 years) and healthy pair-matched control subjects (n = 30) were prospectively recruited. Retinal nerve fiber layer (RNFL) thickness was quantified with spectral-domain optical coherence tomography, and scanning laser polarimetry measured RNFL phase retardation. Measurements of the photopic negative response were made using full-field flash electroretinography. There was no statistically significant difference (p = 0.42) in global RNFL thickness between the case cohort (96.6 ± 9.4 microns) and the control cohort (94.9 ± 7.0 microns). There was no statistically significant difference (p = 0.80) in global RNFL phase retardation between the case cohort (57.9 ± 5.7 nm) and the control cohort (58.2 ± 4.6 nm). There were no statistically significant differences in the peak time (p = 0.95) of the PhNR or in the amplitude (p = 0.11) of the PhNR between the case cohort (69.9 ± 6.9 ms and 24.1 ± 5.1 μV, respectively) and the control cohort (70.1 ± 8.9 ms and 27.8 ± 9.1 μV, respectively). However, PhNR amplitude was more variable (p < 0.025) in the control cohort than in the case cohort. Within the case cohort, there was a strong positive (r = 0.53), but not statistically significant (p = 0.02), association between time since last TBI and PhNR amplitude. There was also a modest positive (r = 0.45), but not statistically significant (p = 0.04), association between time since first TBI and PhNR amplitude. Our results suggest that there were no statistically significant differences in the objective structure or in the objective function of RGCs between the case cohort and the control cohort. Future large, longitudinal studies will be necessary to confirm our negative results and to more fully investigate the potential interaction between PhNR amplitude and time since first or last TBI.

Reliable and valid robot-assisted assessments of hand proprioceptive, motor and sensorimotor impairments after stroke

Background

Neurological injuries such as stroke often differentially impair hand motor and somatosensory function, as well as the interplay between the two, which leads to limitations in performing activities of daily living. However, it is challenging to identify which specific aspects of sensorimotor function are impaired based on conventional clinical assessments that are often insensitive and subjective. In this work we propose and validate a set of robot-assisted assessments aiming at disentangling hand proprioceptive from motor impairments, and capturing their interrelation (sensorimotor impairments).

Methods

A battery of five complementary assessment tasks was implemented on a one degree-of-freedom end-effector robotic platform acting on the index finger metacarpophalangeal joint. Specifically, proprioceptive impairments were assessed using a position matching paradigm. Fast target reaching, range of motion and maximum fingertip force tasks characterized motor function deficits. Finally, sensorimotor impairments were assessed using a dexterous trajectory following task. Clinical feasibility (duration), reliability (intra-class correlation coefficient ICC, smallest real difference SRD) and validity (Kruskal-Wallis test, Spearman correlations \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\rho$$\end{document}ρ with Fugl-Meyer Upper Limb Motor Assessment, kinesthetic Up-Down Test, Box & Block Test) of robotic tasks were evaluated with 36 sub-acute stroke subjects and 31 age-matched neurologically intact controls.

Results

Eighty-three percent of stroke survivors with varied impairment severity (mild to severe) could complete all robotic tasks (duration: <15 min per tested hand). Further, the study demonstrated good to excellent reliability of the robotic tasks in the stroke population (ICC>0.7, SRD<30%), as well as discriminant validity, as indicated by significant differences (p-value<0.001) between stroke and control subjects. Concurrent validity was shown through moderate to strong correlations (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\rho$$\end{document}ρ=0.4-0.8) between robotic outcome measures and clinical scales. Finally, robotic tasks targeting different deficits (motor, sensory) were not strongly correlated with each other (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\rho \le$$\end{document}ρ≤0.32, p-value>0.1), thereby presenting complementary information about a patient’s impairment profile.

Conclusions

The proposed robot-assisted assessments provide a clinically feasible, reliable, and valid approach to distinctly characterize impairments in hand proprioceptive and motor function, along with the interaction between the two. This opens new avenues to help unravel the contributions of unique aspects of sensorimotor function in post-stroke recovery, as well as to contribute to future developments towards personalized, assessment-driven therapies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12984-021-00904-5.

Antiviral Actions of 25-Hydroxycholesterol in Fish Vary With the Virus-Host Combination

Cholesterol is essential for building and maintaining cell membranes and is critical for several steps in the replication cycle of viruses, especially for enveloped viruses. In mammalian cells virus infections lead to the accumulation of the oxysterol 25-hydroxycholesterol (25HC), an antiviral factor, which is produced from cholesterol by the cholesterol 25 hydroxylase (CH25H). Antiviral responses based on CH25H are not well studied in fish. Therefore, in the present study putative genes encoding for CH25H were identified and amplified in common carp and rainbow trout cells and an HPLC-MS method was applied for determination of oxysterol concentrations in these cells under virus infection. Our results give some evidence that the activation of CH25H could be a part of the antiviral response against a broad spectrum of viruses infecting fish, in both common carp and rainbow trout cells in vitro. Quantification of oxysterols showed that fibroblastic cells are capable of producing 25HC and its metabolite 7α,25diHC. The oxysterol 25HC showed an antiviral activity by blocking the entry of cyprinid herpesvirus 3 (CyHV-3) into KFC cells, but not spring viremia of carp virus (SVCV) or common carp paramyxovirus (Para) in the same cells, or viral haemorrhagic septicaemia virus (VHSV) and infectious pancreatic necrosis virus (IPNV) into RTG-2 cells. Despite the fact that the CH25H based antiviral response coincides with type I IFN responses, the stimulation of salmonid cells with recombinant type I IFN proteins from rainbow trout could not induce ch25h_b gene expression. This provided further evidence, that the CH25H-response is not type I IFN dependent. Interestingly, the susceptibility of CyHV-3 to 25HC is counteracted by a downregulation of the expression of the ch25h_b gene in carp fibroblasts during CyHV-3 infection. This shows a unique interplay between oxysterol based immune responses and immunomodulatory abilities of certain viruses.

Characteristics of Gun Advertisements on Social Media: Systematic Search and Content Analysis of Twitter and YouTube Posts

Background

Although gun violence has been identified as a major public health concern, the scope and significance of internet gun advertising is not known.

Objective

This study aimed to quantify the characteristics of gun advertising on social media and to compare the reach of posts by manufacturers with those of influencers.

Methods

Using a systematic search, we created a database of recent and popular Twitter and YouTube posts made public by major firearm manufacturers and influencers. From our sample of social media posts, we reviewed the content of the posts on the basis of 19 different characteristics, such as type of gun, presence of women, and military or police references. Our content analysis summarized statistical differences in the information conveyed in posts to compare advertising approaches across social media platforms.

Results

Sample posts revealed that firearm manufacturers use social media to attract audiences to websites that sell firearms: 14.1% (131/928; ±2.9) of Twitter posts, 53.6% (228/425; ±6.2) of YouTube videos, and 89.5% (214/239; ±5.1) of YouTube influencer videos link to websites that facilitate sales. Advertisements included women in efforts to market handguns and pistols for the purpose of protection: videos with women included protection themes 2.5 times more often than videos without women. Top manufacturers of domestic firearms received 98 million channel views, compared with 6.1 billion channel views received by the top 12 YouTube influencers.

Conclusions

Firearm companies use social media as an advertising platform to connect viewers to websites that sell guns. Gun manufacturers appropriate YouTube servers, video streaming services, and the work of YouTube influencers to reach large audiences to promote the widespread sale of consumer firearms. YouTube and Twitter subsidize gun advertising by offering server and streaming services at no cost to gun manufacturers, to the commercial benefit of Google and Twitter’s corporate ownership.

Comparison of methods for determining the effectiveness of antibacterial functionalized textiles

Antimicrobial functionalization of textiles is important for various applications, such as protection of textile materials from decomposition, generation of more effective wound dressings, and the prevention of infections or malodors resulting from bacterial growth. In order to test the efficacy of new products, their antibacterial activity needs to be evaluated. At present, several different procedures are being used for this purpose, hindering comparisons among different studies. The present paper compares five of these assays using a sample panel of different textiles functionalized with copper (Cu) and silver (Ag) as antibacterial agents, and discusses the suitability of these methods for different analytical requirements. Bacterial viability was determined by measuring the optical density at 600 nm, a colorimetric assay based on MTT (3-[4, 5-dimethylthiazol-2-yl]-2, 5 diphenyl tetrazolium bromide) conversion, an agar diffusion assay, and colony formation, either after culturing in media containing textile samples, or after recovery from textiles soaked with bacterial suspension. All experiments were performed with a Gram-negative (Escherichia coli) and a Gram-positive (Staphylococcus warneri) model organism. In general, the results yielded by the different methods were of good comparability. To identify the most suitable test system for the particular type of antibacterial coating, several factors need to be taken into account, such as choosing appropriate endpoints for analyzing passive or active antibacterial effects, selection of relevant microorganisms, correcting for potential interference by leaching of colored textile coatings, required hands on time, and the necessary sensitivity.

Abstract P4-02-07: Preoperative assessment of breast cancer survival using ultrasound diameter and shear wave elastography

This abstract was not presented at the symposium.

Assessment of the Systemic Effects, Primary Dermal Irritation, and Ocular Irritation of Chlorhexidine Acetate Solutions

The biologic effects of various chlorhexidine acetate (ClAc) solutions containing isopropyl alcohol, Synperonic NP8, and carmoisin were evaluated (1) following intraperitoneal (IP) administration in rats for 5 consecutive days followed by a 5-day recovery period, (2) by measuring the primary irritation of the skin by a patch-test technique on intact and abraded skin of rabbits, and (3) following instillation into the eyes or rabbits followed by washing 50% of the treated eyes with lukewarm water in order to evaluate ocular irritation. Physiologic saline solution served as the control article throughout the studies. There was a high incidence of deaths (i.e., 28/32 and 11/16 for ClAc solutions with and without Synperonic NP8, respectively) among rats receiving IP treatment at a dosage of 40 ml/kg per day for 5 consecutive days. No toxicologically significant treatment-related changes were observed in rats treated IP with either surfactant or isopropyl alcohol with Synperonic NP8. Toxicity of ClAc solution appears to be due to a chemically induced peritonitis with no evidence of systemic toxicity. ClAc solution or the respective surfactants elicited either no reaction or a mild dermal irritation in the rabbit. Likewise, ClAc solution with or without Synperonic NP8 and the three respective surfactants did not cause any significant ocular irritation changes that are considered of toxicologic significance. It is concluded that (1) the multiple IP administration of ClAc solution elicited a toxic response in rats, and thus, caution must be exercised when the solution is used for the purposes of peritoneal lavage, and (2) ClAc solution is a mild dermal and ocular irritant in the rabbit.

Subjective well-being amongst migrant children in China: unravelling the roles of social support and identity integration

BACKGROUND

Migrant children refer to rural children who accompany one or both parents to urban area. Empirical evidence showed that compared with their urban counterparts, migrant children had poorer developmental, emotional and psychological health.

METHOD

A sample of 1306 migrant children were recruited to examine the characteristics of migrant children and investigate the effects of identity integration, support and socioeconomic factors (e.g. age, gender, type of school, family socioeconomic status, city type) on their subjective wellbeing.

RESULTS

Children with higher levels of identity integration, social support, family socioeconomic status, who attended public school and who lived in the third-tiered city of Weihai demonstrated better subjective wellbeing. Social support remained a strong predictor for subjective wellbeing, despite a significant mediating effect of identity integration.

CONCLUSIONS

These results highlight the need for policymakers and practitioners alike to address individual factors pertaining to psychological adjustments, as well as social determinants of subjective wellbeing in the context of migration.

Chronic periodontitis can affect the levels of potential oral cancer salivary mRNA biomarkers

BACKGROUND AND OBJECTIVE

More than 100 salivary constituents have been found to show levels significantly different in patients with oral squamous cell carcinoma (OSCC) from those found in healthy controls, and therefore have been suggested to be potential salivary biomarkers for OSCC detection. However, many of these potential OSCC salivary biomarkers are also involved in chronic inflammation, and whether the levels of these biomarkers could be affected by the presence of chronic periodontitis was not known. The objective of this pilot study was therefore to measure the levels of seven previously reported potential OSCC salivary mRNA biomarkers in patients with chronic periodontitis and compare them to levels found in patients with OSCC and healthy controls. The seven salivary mRNAs were interleukin (IL)-8, IL-1β, dual specificity phosphatase 1, H3 histone family 3A, ornithine decarboxylase antizyme 1, S100 calcium-binding protein P (S100P) and spermidine/spermine N1-acetyltransferase 1.

MATERIAL AND METHODS

Unstimulated whole saliva samples were collected from a total of 105 human subjects from the following four study groups: OSCC; CPNS (chronic periodontitis, moderate to severe degree, non-smokers); CPS (chronic periodontitis, moderate to severe degree, smokers); and healthy controls. Levels of each mRNA in patient groups (OSCC or chronic periodontitis) relative to the healthy controls were determined by a pre-amplification reverse transcription-quantitative polymerase chain reaction approach with nested gene-specific primers. Results were recorded and analyzed by the Bio-Rad CFX96 Real-Time System. Mean fold changes between each pair of patient vs. control groups were analyzed by the Mann-Whitney U-test with Bonferroni corrections.

RESULTS

Only S100P showed significantly higher levels in patients with OSCC compared to both patients with CPNS (p = 0.003) and CPS (p = 0.007). The difference in S100P levels between patients with OSCC and healthy controls was also marginally significant (p = 0.009). There was no significant difference in the levels of salivary IL-8, IL-1β and dual specificity phosphatase 1 mRNAs between patients with OSCC and patients with CPNS (p = 0.510, 0.058 and 0.078, respectively); no significant difference in levels of salivary ornithine decarboxylase antizyme 1 and spermine N1-acetyltransferase mRNAs between patients with OSCC and patients with CPS (p = 0.318 and 0.764, respectively); and no significant difference in levels of the H3 histone family 3A mRNA between patients with OSCC and either CPS (p = 0.449) or healthy controls (p = 0.107).

CONCLUSIONS

Salivary S100P mRNA could be a reliable biomarker for OSCC detection, regardless of the presence of chronic periodontitis. The presence of chronic periodontitis could significantly affect the levels of the other six mRNAs, and negatively influence reliability for using them as biomarkers for oral cancer detection.

Abstract P4-19-02: Early experience of patient donation and researcher use of tissues donated to a national breast cancer tissue bank

The need for a specialist breast cancer biobank was recognised through a Gap Analysis conducted by the UK charity, Breast Cancer Campaign (Thompson AM et al., Breast Cancer Res 2008: 10(2); R26). As a result The Breast Cancer Campaign Tissue Bank (www.breastcancertissuebank.org) was launched in 2010 as a coalition of 4 centres of excellence for breast cancer research in the UK. Breast cancer patients presenting to these centres are offered the opportunity to donate surplus tissue and bloods to The Breast Cancer Campaign Tissue Bank. Researchers can apply for these samples by completing a simple on line application form. Here we describe our early experience of patient donation to The Breast Cancer Campaign Tissue Bank and outline the sample requests received from researchers to date. Most of the first year of operation (2010) was spent developing SOPs and ensuring collection protocols were robust, with some limited prospective collection. The collection was pump-primed from existing resources. By 2011 all sites were operational and working to the same standards. Over a 2 year period (Jan 2011 - Dec 2012), over 90% of suitable patients (1803) consented to tissue donation. From these we derived 3951 frozen tissue aliquots, 1517 formalin-fixed paraffin-embedded cases and 2012 blood derivatives (serum, plasma and whole blood). Asian patients were less likely to consent while younger patients tended not to donate blood, but were happy to donate tissue. All male patients consented to tissue and blood donation. At Dec 2012, the total numbers of sample aliquots derived from these donated tissue and blood samples was 22, 127. This includes frozen and formalin-fixed paraffin-embedded tissues, serum, plasma and whole blood. At present, application for tissue samples is restricted to the UK and Ireland but we aim to open to international applications in the near future. All applications are reviewed by an international Tissue Access Committee which includes appropriate clinical and scientific expertise plus representation by patient advocates. At 1st June 2013, seventeen applications had been received, of which 14 were approved. Three applications were rejected, made on the basis that the applicants were not making the best use of the donated material. Thus far, tissues have been dispatched to 9 researchers with 5 in preparation. These include 465 formalin-fixed paraffin-embedded cases and 158 frozen samples, all provided with a basic minimum dataset. Early experience of patient consent was encouraging with patients overall very enthusiastic and willing to donate to our biobanking programme. More research is needed to help understand the barriers in preventing ethnic minorities to donate and the reluctance in some young people to donate blood samples. Interest by the breast cancer research community in accessing samples is steadily rising as the resource becomes more widely known and increased website traffic is translating into applications for tissues. This has been an ambitious multidisciplinary endeavour but we are building a valuable resource to service the needs of the breast cancer research community with the goal of helping translate laboratory results into clinical benefit.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P4-19-02.

New directions in capacity building: incorporating cultural competence into the interactive systems framework

The UMBC Psychology Department's Center for Community Collaboration (CCC) provides training and support for capacity building to promote substance abuse and mental health treatment as well as adherence improvement in community agencies funded through the Ryan White Act serving persons living with HIV/AIDS. This article describes an approach to dissemination of Evidence Based Practices (EBPs) for these services that uses the Interactive Systems Framework (ISF) and incorporates a collaborative process involving trainer cultural competence, along with a comprehensive assessment of organizational needs, culture, and climate that culminates in tailored training and ongoing collaboration. This article provides: (1) an overview of the CCC's expanded ISF for the effective dissemination of two EBPs-motivational interviewing and the stages of change perspective; (2) an examination of the role of trainer cultural competence within the ISF framework, particularly attending to organizational culture and climate; and (3) case examples to demonstrate this approach for both general and innovation-specific capacity building in two community based organizations.

Differentiating benign from malignant solid breast masses: value of shear wave elastography according to lesion stiffness combined with greyscale ultrasound according to BI-RADS classification

Background:

The aim of this study was to assess the performance of shear wave elastography combined with BI-RADS classification of greyscale ultrasound images for benign/malignant differentiation in a large group of patients.

Methods:

One hundred and seventy-five consecutive patients with solid breast masses on routine ultrasonography undergoing percutaneous biopsy had the greyscale findings classified according to the American College of Radiology BI-RADS. The mean elasticity values from four shear wave images were obtained.

Results:

For mean elasticity vs greyscale BI-RADS, the performance results against histology were sensitivity: 95% vs 95%, specificity: 77% vs 69%, Positive Predictive Value (PPV): 88% vs 84%, Negative Predictive Value (NPV): 90% vs 91%, and accuracy: 89% vs 86% (all P>0.05). The results for the combination (positive result from either modality counted as malignant) were sensitivity 100%, specificity 61%, PPV 82%, NPV 100%, and accuracy 86%. The combination of BI-RADS greyscale and shear wave elastography yielded superior sensitivity to BI-RADS alone (P=0.03) or shear wave alone (P=0.03). The NPV was superior in combination compared with either alone (BI-RADS P=0.01 and shear wave P=0.02).

Conclusion:

Together, BI-RADS assessment of greyscale ultrasound images and shear wave ultrasound elastography are extremely sensitive for detection of malignancy.

NT5E CpG island methylation is a favourable breast cancer biomarker

BACKGROUND

Relapse risk assessment and individual treatment recommendations remain suboptimal for breast cancer patients. In the light of existing preclinical and clinical data, we studied NT5E (5'-nucleotidase, ecto) expression and NT5E CpG island methylation in breast cancer.

METHODS

We used RT-PCR, qPCR, methylation-specific PCR and pyrosequencing to analyse NT5E in breast carcinoma cell lines and primary and breast carcinomas.

RESULTS

NT5E CpG island methylation was inversely associated with NT5E expression in breast carcinoma cell lines. In clinical series, patients whose primary tumours had NT5E CpG island methylation were less likely to develop metastasis (P=0.003, OR=0.34, 95% CI: 0.17-0.69). In 3/4 paired samples, NT5E was methylated in primary tumours and demethylated in CNS metastases. Patients progressing to non-visceral as compared with visceral metastases were more likely to have NT5E CpG island methylation in primary tumours (P=0.01, OR=11.8). Patients with tumours lacking detectable methylation had shorter disease-free survival (DFS) (P=0.001, HR=2.7) and overall survival (OS) (P=0.001, HR=3). The favourable prognostic value of NT5E methylation was confirmed in oestrogen receptor negative (P=0.011, HR=3.27, 95% CI: 1.31-8.12) and in triple negative cases (P=0.004; HR=6.2, 95% CI: 1.9-20). Moreover, we observed a more favourable outcome to adjuvant chemotherapy in patients whose tumours were positive for NT5E CpG island methylation: DFS (P=0.0016, HR=5.1, 95% CI: 1.8-14.37) and OS (P=0.0005, HR=7.4, 95% CI: 2.416-23.08).

CONCLUSION

NT5E CpG island methylation is a promising breast cancer biomarker.

P5-21-03: The Breast Cancer Campaign Tissue Bank

The breast cancer research community has recognised that access to a source of carefully collected well-annotated human breast tissue is essential for translational research. Research institutions often face barriers in gaining access to this resource as collections typically have restrictive access policies or an over burdensome application process. This was formally recognised by around 50 prominent breast cancer researchers through a Gap Analysis conducted in London, UK in 20061. As a direct result of this report, 4 leading UK centres (Barts Cancer Institute, the Universities of Dundee, Leeds and Nottingham) with multi disciplinary expertise in pathology, basic science, bioinformatics and computer science have collaborated with a leading breast cancer charity to form the Breast Cancer Campaign Tissue Bank (BCCTB; http://www.breastcancercampaigntissuebank.org). BCCTB is a unique resource of biological materials and supportive clinical data, efficiently and ethically collected from patients with breast cancer, to provide researchers with high quality, relevant materials, helping to raise the standard of breast cancer research and facilitating the co-ordinated translation of scientific findings into the clinical setting. A wide range of biological materials are banked, including fresh frozen tumour and surrounding tissue, isolated purified cell populations (which can be provided for culture or DNA/RNA/protein extraction), whole blood and serum samples, as well as formalin-fixed paraffin-embedded material. Specialised collections are also available through the Bank on a collaborative basis. BCCTB has a centralised IT system allowing efficient tracking of samples and recording of raw data from studies, and providing a user-friendly web-based search portal to view material available. A purpose-built Bioinformatics platform allows mining breast cancer literature data from multiple sources and integrating different types of -omics and clinical data alongside publically relevant annotations from a growing number of biological resources such as NCBI, Ensembl, UniProt and Reactome. This platform is also fully interoperable with the International Cancer Genome Consortium (ICGC) and can be automatically cross-queried from the ICGC data portal which allows direct cross-comparison of experimental findings generated from the ICGC breast cancer projects with literature-derived information stored in our portal. Together this results in the highly efficient and co-ordinated use of samples, reducing duplication of effort and facilitating data mining and analysis. As science is constantly evolving we have an inbuilt R&D program, including cell immortalisation, investigating improved sample storage and collection methods and on-going IT development, all of which will ensure the bank remains cutting-edge. Tissue is released following review by a Tissue Access Committee comprising clinical and non-clinical breast cancer researchers and patient advocates. Direct interaction with end users ensures the materials and data supplied meets the researcher needs. Currently BCCTB is accepting applications from UK based researchers with projects funded by Breast Cancer Campaign. It will launch to the wider breast cancer community in the next 18 months.

1Thompson A et al., Breast Cancer Research 2008, 10:R26.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-21-03.

P3-12-04: Involved Anterior Margins after Breast Conserving Surgery: Is Re-Excision Required?

Background: Complete tumour excision in breast conserving surgery (BCS) is critical for successful treatment; involved circumferential resection margins are associated with increased disease recurrence. However, the importance of an involved anterior margin is less clear. The purpose of this study was to audit an aggressive approach to involved anterior margins and hence assess whether anterior margin re-excision yields clinical benefit.

Material and Methods: A retrospective case note and pathology review was performed for all patients who underwent BCS between 2006 and 2010 through a single cancer centre. An involved margin was defined as &lt;1mm clearance of invasive or in situ breast cancer. Results: 1667 patients underwent BCS for invasive and/or in-situ disease, of whom 114 (6.8%) underwent re-excision, most commonly for mixed invasive and in-situ pathology. The annual re-excision rate rose significantly (p&lt;0.001), with no change in whole tumour diameter, specimen weight or specimen volume. A total of 170 involved margins were identified: most commonly the anterior margin (59 margins, 30.6%) followed by the posterior (39 22.9%) or inferior (31, 18.3%) margin. Patients with anterior margin involvement were more likely to have grade 3 invasive disease (p=0.0323) but less likely to have residual disease found at re-excision (2/49 vs. 32/101 margins, p=0.0033); there were no differences when in-situ characteristics were compared.

Conclusions: Re-excision of involved anterior margins rarely excises residual disease and may be unnecessary. Multidisciplinary teams should consider whether further therapy for an involved anterior margin is required on a patient by patient basis.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-12-04.

NF-kB Complex Activation and Association of αB-Crystallin and Vimentin with Poor Prognosis in Primary Breast Cancer

Background: Nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB) is a protein complex found in almost all animal cell types and is involved in cellular responses to stimuli such as stress, free radicals, cytokines et.c. NF-kB plays a key role in regulating the immune response and incorrect regulation of NF-kB has been linked to the development of cancer, several inflammatory and autoimmune diseases. The role of NF-kB, its subunits and pathways in breast cancer and in the surrounding stromal tissues remains uncertain. αB-crystallin is a heat shock protein, which function as stress-induced molecular chaperones to inhibit the aggregation of denatured proteins. Previous studies have identified αB-crystallin as a marker of poor prognosis for breast cancer and have suggested that it is an excellent marker for tumours of basal origin. The aim of this study is to examine, for the first time, NF-kB and αB-crystallin, vimentin and HSPs in the same set of breast cancers and stroma and relate this to clinical parameters including outcome.Methods: Tissue Micro Arrays of 0.6mm cores of 246 breast cancers were stained with antibodies to αB-crystallin, vimentin, HSP27 (antibody ERD5) and HSP27 82P and 12 subsequent antibodies for NF-kB (IKKa, Ser276, Ser32/36, 180/181, P52, 1kkygmma, P65, RELB, P100/P52, IkBa, cREL, and P50) and scored using the Quick Score Method.Results: Positive associations have been found between αB-crystallin and IKBA (P=0.001 Fishers exact test (FET)), RELB (P&lt;0.001 (FET)) and SER32/36 (P=0.03 (FET)) whereas Vimentin was positively associated IKBA (P=0.003 (FET)), IKKA (P=0.001 (FET)), P50 (P=0.002 (FET)), RELB (P&lt;0.001 (FET)) and SER32/36 (P=0.01 (FET)). Positive associations have also been found between HSP27 and P50 (P=0.002 (FET)), SER32/36 (P&lt;0.001 (FET)). Antibodies such as 180/181 (P=0.04 Kaplan Meier Log Rank (KM), cREL (P=0.03 (KM)), IKBA (P=0.03 (KM)) and IKKA (P=0.01 (KM)) was associated with good survival and P50 (P=0.002 (KM)) and P65 (P=0.01 (KM)) to poor survival. Expression of αB-crystallin was associated with vimentin (P&lt;0.001 (FET)). Its expression was linked to a low expression of the estrogen receptor. Vimentin expression was associated with estrogen receptor (ER) negative cancers and poor survival (P &lt;0.001 (FET)), P=0.002 (KM Log Rank) respectively). In contrast to αB-crystallin, low expression of HSP27 was associated with low ER and progesterone receptor (PGR).Conclusions: Associations were found between various antibodies within the NF-kB pathway as well as the heat shock proteins αB-crystallin, vimentin and HSP27 with varying implications for overall survival. We aim to clarify the mechanisms to prevent the aggregation of stress-accumulated misfolded proteins and apoptosis resulting better survival.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2143.

The Effect of Neoadjuvant Metformin on Breast Cancer Related Genes Clinical Trial – A Preliminary Result

Other authoring group: Dougal Adamson, Lee Baker, Douglas C Brown, Sally Chalmers, Amanda Degabriele, Janet Flinn, Kenneth Fowler, Avril Gunning, Grahame Hardie, Julie Lindsay, Gillian Little, Denis McLean, Robert Murdoch, Colin Purdie, Marta Reis, Valerie Walker.IntroductionMetformin, used in the treatment of diabetes for 50 years, has been linked to a reduced incidence of breast cancer and to an enhanced pathological response when administered concurrent with neoadjuvant chemotherapy. It has been postulated that the anti-neoplastic effect of metformin is through activation of AMP-activated protein Kinase (AMPK). The aim of this open label, randomised clinical trial was to investigate the effect of neoadjuvant metformin on gene expression in primary breast cancer.MethodsNon-diabetic women with histologically proven, operable, primary invasive breast cancer of ≥1cm in size were offered the trial following regional Research Ethics Committee approval.The trial had 2 arms, A and B: in arm A (8 patients), patients had core biopsies at three time points: one at presentation; one after a week of no treatment (internal control); and a further biopsy at the time of definitive surgery after at least 2 weeks of metformin. In trial arm B (47 patients), patients had core biopsies at two time points: one before randomisation to either take metformin or not, and one at the time of definitive breast surgery. Metformin was given as 500mg o.d. orally for one week, increased to 1g b.d. orally for at least another week and until the day prior to excisional breast surgery.RNA was extracted from formalin fixed cores and examined using a Disease-Specific Array for breast cancer on an Affymetrix platform (ALMAC Diagnostics Group, Craigavon, UK). Subsequent confirmatory polymerase chain reaction and immunohistochemistry techniques were used to examine the histological material.ResultsType of results expected:[Change of target gene expression in response to neoadjuvant metformin; symptomatic drug toxicities; potential for therapeutic effects of metformin in non-diabetic patients in vivo.]Results from the first arm:The triplet of core biopsies from 6/8 (75%) of the A arm patients passed the GeneGhip QC and data integrity assessment. Patients were 41-65 (mean: 53) years, with IDC NST, grade II-III, and all ER positive. 270 genes were differentially expressed significantly by wounding, and 63 by metformin. Among the genes significantly over-expressed by metformin were AMPK-beta and PI3K; and those down regulated by metformin were AMPK-gamma and ADCY1. Samples from the B arm patients are in analysis.ConclusionThe gene expression changes identified in response to neoadjuvant metformin suggest that metformin improves DNA damage recognition and repair and regulates cancer cell metabolism. These results suggest mechanisms by which metformin could be efficacious in the treatment of breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3145.

Scotin expression and survival in breast cancer

e22006

Background: The Scotin gene (3p21.3) is directly trans-activated by p53 in response to ionising radiation and produces a 25kD trans-membrane protein located in the endoplasmic reticulum and nuclear membrane which induces a caspase- dependent apoptosis. This study examines the expression of scotin and scotin isoforms in breast cancer in relation to clinical and pathological parameters. Methods: Scotin was examined in 145 breast cancers by DNA sequencing, nested PCR for mRNA expression and using novel antibodies to scotin (pantropic), the C-terminal or N-terminal domain, and the scotin-5 isoform with western blotting and immunohistochemistry on a tissue microarray of breast cancers. Results: Scotin was mutated in 10% of cancers and mRNA expression lost in a further 10%. Moreover, Scotin-5 was expressed in 40% of cancers, while it was not detectable in normal breast epithelium. We established that Scotin-5 is anti-apoptotic and inhibits scotin-mediated apoptosis. Cytoplasmic staining of scotin on TMAs demonstrated that loss of scotin expression was associated with earlier relapse (Mantel-Cox log rank p<0.01) and poor survival (Mantel-Cox log rank p<0.002). Furthermore, loss of Scotin expression identified 50% of the WTp53 patients or 50% of the ER+ patients who also had a poor survival. Conclusions: Scotin may be used as an independent biomarker in breast cancer. Loss of Scotin function may account for a significant proportion of p53 malfunction even in the presence of wild type p53 in breast cancer and adds a further level of complexity to p53 directed therapy in breast cancer.

No significant financial relationships to disclose.

Minority youth access to tobacco: a neighborhood analysis of underage tobacco sales

The geographic and racial-ethnic inequities in health in the US are concerning, and their reduction is a priority for the national health initiative: Health People 2010. Though voluntary, life-style factors, such as smoking, are partially a cause of unevenness in health outcomes, targeting tobacco to minority youth raises questions about the extent to which behaviors are exacerbated by the local retail environment. In this case study, a GIS analysis of neighborhoods where businesses sold tobacco to minors was conducted with 2005 Florida Department of Health, and US census data, finding that in Miami, underage tobacco sales were significantly more concentrated in Hispanic majority neighborhoods.

αB-crystallin, vimentin and increased p53 expression levels in breast cancer is associated with poor prognosis

Abstract #5070

Background: Previous studies have identified αB-crystallin as a marker of poor prognosis for breast cancer and have suggested that it is an excellent marker for tumours of basal origin. Increased expression of αB-crystallin has been associated with anchorage-independent growth and metastasis leading to the suggestion that αB-crystallin is an oncoprotein. We have considered whether the αB-crystallin binding proteins, vimentin and HSP27 also show a similar association with poor prognosis. We also investigated whether either HSP27 phosphorylation HSP27 or p53 expression could be associated with αB-crystallin expression.&#x2028; Methods: Tissue Micro Arrays of 0.6x0.6mm cores of 205 breast cancers were stained with antibodies to αB-crystallin, vimentin, p53 (antibodies DO1, FP3), HSP27 (antibody ERD5) and HSP27 82P. The levels of protein expressions were then compared with clinical and pathological parameters.&#x2028; Results: The expression of αB-crystallin was positively associated with vimentin (P&lt;0.001 Fisher's exact test (FET)). We have confirmed that αB-crystallin expression is linked to a low expression of the estrogen receptor and reduced survival (P&lt;0.001 (FET), P=0.002 Kaplan Meier Log Rank (KM) respectively). Vimentin expression was similarly associated with estrogen receptor (ER) negative cancers and poor survival (P &lt;0.001 (FET), P= 0.002 (KM Log Rank) respectively). Low expression of HSP27 resulted in poor three-year survival (P=0.007 (KM Log Rank)), but longer-term survival was unaffected (P=0.09 (KM Log Rank)). In contrast to αB-crystallin, low expression of HSP27 was associated with ER and progesterone receptor (PGR) negativity (P&lt;0.001 (FET), P=0.001 (FET)). HSP27 82P similarly resulted in poor three-year survival (P=0.01 (KM Log Rank)) compared with longer-term survival (P=0.05 (KM Log Rank)). In samples positive for either αB-crystallin or vimentin, a strong association with increased p53 expression (p53 antibodies: DO1(P&lt;0.001 (FET)) and FP3(P&lt;0.001 (FET))) was found.&#x2028; Conclusions: The increased expression of the protein chaperone, αB-crystallin was linked with reduced survival as well as it's binding partner, vimentin. We found that within this patient subgroup, there was an increased level of p53. The potential functional significance of this interaction for metastasis will be discussed in the context of other predictive markers for breast cancer. A similar association was not found for HSP27 expression.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5070.