GRN300–001: Phase 1/1B evaluation of the safety, pharmacokinetics, and efficacy of GRN-300, a salt-inducible kinase inhibitor, alone and in combination with paclitaxel, in recurrent ovarian, primary peritoneal, and fallopian tube cancers

TPS5616

Background: Salt-induced kinase 2 (SIK2) is a serine-threonine kinase that regulates centrosome splitting, activation of PI3 kinase and phosphorylation of Class IIa HDACs. SIK2 is overexpressed in 30% of ovarian cancers and associated with decreased progression-free survival (Ahmed et al., 2010). Treatment with GRN-300, an orally bioavailable small-molecule inhibitor of SIK2, was shown to improve the response to paclitaxel in human ovarian cancer cells grown in culture and in immunocompromised mice (Zhou et al., 2017). Methods: Part 1 of the study will evaluate the safety, MTD, RP2D (Recommended Phase 2 Dose), and PK of daily GRN-300 monotherapy. For the dose-escalation enrollment of patients with advanced solid tumors of any histology, four dose levels of GRN-300 are planned: 100, 200, 300, and 400 mg BID. Subsequently, GRN-300 will be administered at the determined RP2D in an ovarian cancer expansion cohort. Part 2 will evaluate the safety, PK, and preliminary clinical activity in an open-label study of the combination of GRN-300 and paclitaxel weekly x3. Paclitaxel will be administered in one of two different dosing levels: 60 mg/m2 initially, then dose escalated to 80 mg/m2. In the combination regimen, GRN-300 will be administered at the RP2D dose as determined in Part 1 of this study. The two dose findings will be conducted independently using the BOIN design (Liu 2015, Yuan 2016). Study drug may be administered per protocol for continuous 28-day cycles until disease progression, adverse events, or other criteria as described in the protocol. Tumor biopsies and blood plasma samples including peripheral blood mononuclear cells (PBMCs) will be collected for exploratory biomarker analysis to predict and to monitor responses to GRN-300 treatment. Major eligibility criteria At least 18 years of age. Recurrent or persistent, locally non-resectable or metastatic ovarian, primary peritoneal or fallopian tube epithelial cancer (advanced solid tumors of any other histology only for the monotherapy dose escalation enrollment in Part 1) In Part 2, diagnosis of recurrent or persistent, locally non-resectable or metastatic ovarian, primary peritoneal or fallopian tube epithelial cancer for which treatment with paclitaxel is indicated. Received at least one prior second-line treatment. The first 3 dose groups (100, 200, and 300 mg BID of GRN-300) have been completed without DLT and preliminary PK analysis indicate dose proportionality. Enrollment to dose group 4 (400 mg BID) began in February 2022. Clinical trial information: NCT04711161.

126 The Theatre Training Checklist: A Toolkit to Improve Operative Training

Aim

The operating theatre is expensive, costing approximately £1200 per hour to run. It is a crucial learning environment for many different trainees: anaesthetists, surgeons, operation department practitioners, etc. For individuals to achieve their training requirements, the operating theatre as a training environment must be shared between all trainees, requiring excellent teamwork and leadership. This could be improved by the adoption of innovative training strategies.

Method

The Theatre Training Checklist is a simple framework that aims to facilitate awareness, understanding, coordination and cooperation of training for all team members. It is a practical strategy that can be adopted in any setting. Usually, trainers discuss informally with their trainees about their individual skills, experience, expectations and what is achievable in a theatre list. However, there is currently limited opportunity to discuss this between different disciplines and the wider team. This tool aims to refine communication, optimize training, manage expectations, and ensure equity across the board.

Results

The checklist is completed at the start of the list during the theatre brief. It identifies all trainees and their specific needs within the operating theatre session to the whole team. An agreed strategy is developed on how to achieve identified training goals. Feedback undertaken from the MDT after local trailing of the checklist has been positive.

Conclusions

The toolkit is available for use and consists of the checklist tool and an instructional video. The checklist is being piloted in some centres and we hope to have the opportunity to present some early findings to the ASiT Innovation Summit.

941 Post-Operative Outcomes of Patients Undergoing Surgery During the Acceleration Period of COVID-19 Infection

Introduction

There are concerns around the safety of performing surgery during COVID-19 outbreaks with few sources of robust evidence.

Method

We analysed 5020 consecutive patients who underwent surgery during the acceleration phase of COVID-19 at our hospital from 31st January to 13th April 2020. Data were also analysed for all patients who had a COVID-19 positive test result during the same study period.

Results

156 patients (3%) developed COVID-19 symptoms after surgery; 28 patients (<1%) subsequently had a positive swab result. All-cause mortality was 44 patients (0.9%); 33 deaths (75%) were due to non COVID-19 diagnoses. There were no adverse COVID-19 related outcomes in any of the 648 patients who had cancer operations. Of 28 COVID-19 positive patients, 11 died (8 orthopaedic, 2 urology, 1 vascular surgery) of which 10 had an emergency admission; all were over 70 years of age. Recent surgery was not an independent prognostic factor for survival after COVID-19 infection. 12% of positive COVID-19 swabs were from long-stay patients.

Conclusions

Of 5020 operative patients, 0.2% died from COVID-19 and most complications were not related to the infection. With careful consideration, surgery can be provided safely during times of COVID-19 outbreaks with particular emphasis on avoiding in-hospital transmission.

920 Long Term Outcomes After Resection of A 'Normal' Appendix

Introduction

Recent studies have suggested that there should be diagnostic confirmation of appendicitis prior to surgical resection to reduce the rate of negative (normal) appendicectomy. There are few long-term analyses of morbidity after negative appendicectomy.

Method

All appendicectomy specimens removed for suspected appendicitis from June 2010 to August 2015 at a single-centre surgical unit were identified. Patients with a histologically 'normal' appendix were analysed. Demographics, pre-operative and operative details and post-operative outcomes (Clavien-Dindo system) were recorded. Minimum follow-up was 5 years.

Results

There were 1977 patients. Most (1938 patients, 98%) had a laparoscopic procedure. There were 241 normal specimens (12.1%); none of these patients had pre-operative CT imaging. Thirty-two patients had at least one re-admission in the 5 years after surgery; 12 of these patients had multiple re-admissions (range, 2-5 re-admissions). 22 patients (69%) had a re-admission within 30 days after primary surgery. 4 patients (&lt;1%) required further surgery and mortality was 0%. 6 patients (2%) had a Grade III complication, and none had a Grade IV complication.

Conclusions

There was low long-term morbidity after negative appendicectomy in this study. The cost of confirming a normal diagnosis by way of mandatory pre-operative CT does not represent a cost-effective method of management.

Gemeindenotfallsanitäter als innovatives Einsatzmittel in der Notfallversorgung – erste Ergebnisse einer Beobachtungsstudie

Hintergrund

Rettungsdienst und Notaufnahmen werden zunehmend durch nichtlebensbedrohlich erkrankte Patienten belastet. In England und den USA wurden zur Versorgung vor Ort bereits vor einigen Jahren Community-paramedic-Systeme etabliert.

Auf diesen Konzepten basierend wurde ein an das deutsche Rettungswesen adaptierte System „Gemeindenotfallsanitäter“ (G-NFS) entwickelt. Das Ziel des G‑NFS ist, eine unnötige Disponierung höherwertiger Rettungsmittel zu reduzieren.

Ziel

Deskriptive Analyse der in den ersten 12 Monaten erhobenen Daten.

Methodik

Es handelt sich um eine retrospektive Beobachtungsstudie auf Basis der Einsatzdokumentation im Jahr 2019.

Ergebnisse

Es wurden 3703 Einsatzprotokolle ausgewertet. Das Durchschnittsalter betrug 62,2 ± 24,7 Jahre. Bei 2186 (61,1 %) Patienten wurde die Behandlungspriorität „0“ gewählt, d. h.: Es lag keine Dringlichkeit der Versorgung vor. 2134 (59 %) Patienten benötigten kein weiteres Rettungsmittel, eine ambulante Versorgung vor Ort war ausreichend. Am häufigsten wurde den Patienten die Vorstellung beim Hausarzt (n = 1422, 38 %) sowie die Vorstellung in der Notaufnahme (n = 1222, 33 %) empfohlen. Aus Sicht der G‑NFS wurden 3058 (85 %) Einsätze von den Leitstellendisponenten richtig kategorisiert.

Diskussion

Durch die gezielte Alarmierung der neu geschaffenen Ressource „Gemeindenotfallsanitäter“ können Patienten ambulant vor Ort versorgt werden und folglich die Institutionen der Notfallversorgung entlastet werden. Im weiteren Projektverlauf ist zu untersuchen, was die Einsatzindikationen bei den 1480 (41 %) Einsätzen mit einer Nachalarmierung von Rettungsmitteln sind und wie die Einschätzung der Leitstelle verbessert werden kann.

An Irish National Diabetes in Pregnancy Audit: aiming for best outcomes for women with diabetes

AIMS

The purpose of this study was to identify the number of pregnancies affected by pre-gestational diabetes in the Republic of Ireland; to report on pregnancy outcomes and to identify areas for improvement in care delivery and clinical outcomes.

METHODS

Healthcare professionals caring for women with pre-gestational diabetes during pregnancy were invited to participate in this retrospective study. Data pertaining to 185 pregnancies in women attending 15 antenatal centres nationally were collected and analysed. Included pregnancies had an estimated date of delivery between 1 January and 31 December 2015.

RESULTS

The cohort consisted of 122 (65.9%) women with Type 1 diabetes and 56 (30.3%) women with Type 2 diabetes. The remaining 7 (3.8%) pregnancies were to women with maturity-onset diabetes of the young (MODY) (n = 6) and post-transplant diabetes (n = 1). Overall women were poorly prepared for pregnancy and lapses in specific areas of service delivery including pre-pregnancy care and retinal screening were identified. The majority of pregnancies 156 (84.3%) resulted in a live birth. A total of 103 (65.5%) women had a caesarean delivery and 58 (36.9%) infants were large for gestational age.

CONCLUSIONS

This audit identifies clear areas for improvement in delivery of care for women with diabetes in the Republic of Ireland before and during pregnancy.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Seagrass habitat in Tarawa Lagoon, Kiribati: Service benefits and links to national priority issues

This paper presents a review around seagrass habitat in Tarawa Lagoon, Kiribati and explores the links between seagrass occurrence and the national priority issues of climate change, urban development, human health, nearshore fisheries, threatened species, ocean policy, research capacity and awareness. The contribution of healthy seagrass habitats to many aspects of these national issues is often overlooked and there is need to establish the knowledge gaps and priority actions that can enable mitigation of issues that impact on valuable seagrass resources and their management. Research data on seagrass habitats in Kiribati, and the wider Pacific Island region, is limited and this hinders informed decisions at local, national and regional levels. We present a comprehensive review on seagrass within a national context to aid prioritisation and uptake of information for resource owners, and wider stakeholders, in Kiribati while acknowledging local expertise. The paper highlights data and knowledge gaps that if addressed, will provide information useful to Kiribati nationals, communities and government stakeholders. Recommendations for actions that fill these gaps and build understanding of seagrass resources in Kiribati are provided.

Mushroom productivity trends in relation to tree growth and climate across different European forest biomes

Although it is logical to think that mycorrhizal mushroom production should be somehow related to the growth of the trees from which the fungi obtain carbohydrates, little is known about how mushroom yield patterns are related to tree performance. In this study, we delved into the understanding of the relationships between aboveground fungal productivity, tree radial growth patterns and climatic conditions across three latitudinally different bioclimatic regions encompassing Mediterranean, temperate and boreal forest ecosystems in Europe. For this purpose, we used a large assemblage of long-term data of weekly or biweekly mushroom yield monitoring in Spain, Switzerland and Finland. We analysed the relationships between annual mushroom yield (considering both biomass and number of sporocarps per unit area), tree ring features (tree ring, earlywood and latewood widths), and meteorological conditions (i.e. precipitation and temperature of summer and autumn) from different study sites and forest ecosystems, using both standard and partial correlations. Moreover, we fitted predictive models to estimate mushroom yield from mycorrhizal and saprotrophic fungal guilds based on climatic and dendrochronological variables. Significant synchronies between mushroom yield and climatic and dendrochronological variables were mostly found in drier Mediterranean sites, while few or no significant correlations were found in the boreal and temperate regions. We observed positive correlations between latewood growth and mycorrhizal mushroom biomass only in some Mediterranean sites, this relationship being mainly mediated by summer and autumn precipitation. Under more water-limited conditions, both the seasonal wood production and the mushroom yield are more sensitive to precipitation events, resulting in higher synchrony between both variables. This comparative study across diverse European forest biomes and types provides new insights into the relationship between mushroom productivity, tree growth and weather conditions.

Subjective emotional responses to IAPS pictures in patients with borderline personality disorder, cluster-C personality disorders, and non-patients

According to Linehan (1993), emotion dysregulation is a central feature of borderline personality disorder (BPD). We hypothesized that patients with BPD are emotionally hyperresponsive. For BPD treatment, it is important to evaluate this hypothesis, because, if it is supported, therapeutic interventions could be designed to help patients to better manage hyperemotional reactions. We investigated the subjective reactions (in terms of valence and arousal) of patients with BPD to visual emotional stimuli of the International Affective Picture System (IAPS). We hypothesized that, compared to patients with Cluster-C personality disorders and non-patients, BPD patients would show higher scores on the arousal dimension and higher negative scores on the valence dimension when rating IAPS pictures with varying degrees of arousal and valence. Ratings of valence and arousal for 40 IAPS pictures were collected from 39 borderline personality disorder (BPD), 36 patients diagnosed with Cluster-C personality disorders (PD), and a group of 226 non-patients. Contrary to expectations, BPD patients did not differ from the non-patients. This indicates that their self-report scores do not reflect hypersensitivity. We found that patients with BPD showed lower scores on arousal than Cluster-C PD patients. The scores on valence suggested that Cluster-C PD patients also experienced more positive emotions than BPD patients.

Catalytic abatement of CO species from incomplete combustion of solid fuels used in domestic cooking

This study reveals a first time approach to catalytic based interventions primarily on indoor air pollution emanating from commercial and household solid fuel burning in a region in Nigeria. An intensive survey of the temperatures at different locations in the common stoves used for cooking was conducted so as to ascertain temperatures suitable for catalyst efficiency and stability. Furthermore, cobalt and iron based catalysts were prepared using ultra stable Y type zeolite as supports. The synthesized catalysts were characterized for its physico-chemical properties. The catalytic efficiency of the supported catalysts was tested using simulated exhaust gases in a fix bed reactor. The study further explored real time testing of the catalyzed ceramic monolith using two different wood species. First, the best catalyst in terms of simulated exhaust testing was selected. Consequently, a small layer of zeolite Y was deposited at 3% of the monolith weight to enhance the subsequent adhesion of the best catalyst powder to the structured monolith. Then to catalyze the zeolite Y wash-coated monolith with the cobalt precursor, the dip coating technique was used. From the results, the average values of temperatures observed from the surveyed cook stoves using wood and plant residue as fuel were confirmed to be in the range of 203–425 °C which is considered suitable for catalysts activity. The Co/ZY catalyst showed approximately 100% CO conversion (T₁₀₀) at 250 °C for initial CO concentration of 1000 ppm, making it the most effective, while T₁₀₀ was increased to 275 °C and 325 °C for Fe/ZY and Co-Fe/ZY catalyst respectively at an exhaust residence time of 20000 h⁻¹. The catalytic converter in real time testing for CO abatement performed well for both wood species. Only minor differences have been noticed.

The use of a novel adhesive tissue patch as an aid to anastomotic healing

Introduction One of the most feared complications of colorectal surgery is anastomotic leak. Numerous techniques have been studied in the hope of decreasing leakage. This study was designed to assess the handling characteristics of a novel adhesive tissue patch (TissuePatch™; Tissuemed, Leeds, UK) applied to colorectal anastomoses in a pilot study. This was with a view to assessing its potential role in aiding anastomotic healing in subsequent trials. Methods A patch was applied to colorectal anastomoses after the surgeon had completed the anastomosis and prior to abdominal closure. Handling characteristics and patient outcomes were recorded prospectively. Results Nine patients were recruited before the study was prematurely terminated. In one patient, the patch fell off and in another patient, the surgeon omitted to apply it. Six patients had significant postoperative problems (1 confirmed leak necessitating return to theatre and excision anastomosis, 3 suspicious of leak on computed tomography delaying discharge, 2 perianastomotic collections). One patient had an uneventful recovery. Conclusions Although the handling characteristics of this novel tissue patch were deemed satisfactory, it appears that wrapping a colorectal anastomosis with an adhesive hydrophilic patch has significant deleterious effects on anastomotic healing. This could be a consequence of the creation of a microenvironment between the patch and the anastomosis that impairs healing. Further research is required to better understand the mechanisms involved. At present, the use of such patches on colorectal anastomoses should be discouraged outside the confines of a well monitored trial.

Functional profiling and distribution of the forest soil bacterial communities along the soil mycorrhizosphere continuum

An ectomycorrhiza is a multitrophic association between a tree root, an ectomycorrhizal fungus, free-living fungi and the associated bacterial communities. Enzymatic activities of ectomycorrhizal root tips are therefore result of the contribution from different partners of the symbiotic organ. However, the functional potential of the fungus-associated bacterial communities remains unknown. In this study, a collection of 80 bacterial strains randomly selected and isolated from a soil-ectomycorrhiza continuum (oak-Scleroderma citrinum ectomycorrhizas, the ectomycorrhizosphere and the surrounding bulk soil) were characterized. All the bacterial isolates were identified by partial 16S rRNA gene sequences as members of the genera Burkholderia, Collimonas, Dyella, Mesorhizobium, Pseudomonas, Rhizobium and Sphingomonas. The bacterial strains were then assayed for β-xylosidase, β-glucosidase, N-acetyl-hexosaminidase, β-glucuronidase, cellobiohydrolase, phosphomonoesterase, leucine-aminopeptidase and laccase activities, chitin solubilization and auxin production. Using these bioassays, we demonstrated significant differences in the functional distribution of the bacterial communities living in the different compartments of the soil-ectomycorrhiza continuum. The surrounding bulk soil was significantly enriched in bacterial isolates capable of hydrolysing cellobiose and N-acetylglucosamine. In contrast, the ectomycorrhizosphere appeared significantly enriched in bacterial isolates capable of hydrolysing glucopyranoside and chitin. Notably, chitinase and laccase activities were found only in bacterial isolates belonging to the Collimonas and Pseudomonas genera. Overall, the results suggest that the ectomycorrhizal fungi favour specific bacterial communities with contrasting functional characteristics from the surrounding soil.

Drought and air warming affects abundance and exoenzyme profiles of Cenococcum geophilum associated with Quercus robur, Q. petraea and Q. pubescens

The present study aimed to elucidate the influence of drought and elevated temperature on relative abundance and functioning of the ectomycorrhizal fungus Cenococcum geophilum on three oak species differing in adaptation to a warm and dry climate. The experiment QUERCO comprised three Quercus species (Q. robur, Q. petraea, Q. pubescens) grown for 3 years under four treatments: elevated air temperature, drought, a combination of the two, and control. Fine root samples were analysed for relative abundance and potential extracellular enzyme activities of ectomycorrhizae of C. geophilum, a fungal species known to be drought resistant. The relative abundance of C. geophilum on the roots of the oak species was significantly increased by temperature, decreased by drought, but unchanged in the combined treatment compared to the control. Although the extent of treatment effects differed among oak species, no significant influence of tree species on relative abundance of C. geophilum was detected. Exoenzyme activities of C. geophilum on Q. robur and Q. petraea (but not Q. pubescens) significantly increased in the combined treatment, but for all oak species were reduced under drought and air warming alone compared to the control. There was a significant negative correlation between abundance of C. geophilum and its leucine aminopeptidase activity. As this enzyme is not frequent among ectomycorrhizal fungi, this emphasises the functional importance of C. geophilum in the ectomycorrhizal community. Our results indicate that increased temperature and drought will influence the relative abundance and enzyme activity of C. geophilum. However, both the Quercus species and C. geophilum tolerated warming and strong drought.

Induction of immediate early genes in the mouse auditory cortex after auditory cued fear conditioning to complex sounds

Immediate early genes (IEGs) are widely used as markers to delineate neuronal circuits because they show fast and transient expression induced by various behavioral paradigms. In this study, we investigated the expression of the IEGs c-fos and Arc in the auditory cortex of the mouse after auditory cued fear conditioning using quantitative polymerase chain reaction and microarray analysis. To test for the specificity of the IEG induction, we included several control groups that allowed us to test for factors other than associative learning to sounds that could lead to an induction of IEGs. We found that both c-fos and Arc showed strong and robust induction after auditory fear conditioning. However, we also observed increased expression of both genes in any control paradigm that involved shocks, even when no sounds were presented. Using mRNA microarrays and comparing the effect of the various behavioral paradigms on mRNA expression levels, we did not find genes being selectively upregulated in the auditory fear conditioned group. In summary, our results indicate that the use of IEGs to identify neuronal circuits involved specifically in processing of sound cues in the fear conditioning paradigm can be limited by the effects of the aversive unconditional stimulus and that activity levels in a particular primary sensory cortical area can be strongly influenced by stimuli mediated by other modalities.

Adverse effect of noise in the operating theatre on surgical-site infection

Background

The aim of this pilot study was to evaluate the noise level in an operating theatre as a possible surrogate marker for intraoperative behaviour, and to detect any correlation between sound level and subsequent surgical-site infection (SSI).

Methods

The sound level was measured during 35 elective open abdominal procedures. The noise intensity was registered digitally in decibels (dB) every second. A standard questionnaire was used to evaluate the behaviour of the surgical team during the operation. The primary outcome parameter was the SSI rate within 30 days of surgery.

Results

The overall rate of SSI was six of 35 (17 per cent). Demographic parameters and duration of operation were not significantly different between patients with, or without SSI. The median sound level (43·5 (range 26·0–60·0) versus 25·0 (25·0–60·0) dB; P = 0·040) and median level above baseline (10·7 (0·6–33·3) versus 0·6 (0·5–10·8); P = 0·001) were significantly higher for patients who developed a SSI. The sound level was at least 4 dB above the median in 22·5 per cent of the peaks in patients with SSI compared with 10·7 per cent in those without (P = 0·029). Talking about non-surgery-related topics was associated with a significantly higher sound level (P = 0·024).

Conclusion

Intraoperative noise volume was associated with SSI. This may be due to a lack of concentration, or a stressful environment, and may therefore represent a surrogate parameter by which to assess the behaviour of a surgical team.

[Knee cartilage lesions and occupational load. Results of an arthroscopic study]

AIM

Numerous epidemiological studies have suggested a relationship between knee osteoarthritis and occupational load or, respectively, a kneeling or squatting position at work. Cartilage breakdown was clearly identified as the main mechanism of the osteoarthritic process. This arthroscopic study was aimed to evaluate the relationship between frequency and grade of knee cartilage damage compared with occupational load. It was hypothesised that heavy work conditions cause higher cartilage degeneration in diverse age groups. Furthermore, it was suggested that kneeling or squatting work positions (analogous to the BK 2112) produce more severe cartilage damage or other distributions thereof compared with patients in low knee-loading professions.

METHODS

A total of 1199 patients with knee pain (history of 3 months or more) underwent arthroscopic operations. Cartilage lesions were classified according to the ICRS (International Cartilage Repair Society) protocol. The grading of joint degeneration was quantified by using the WOAKS (whole organ arthroscopic knee score). Patients were divided into 5 age groups (24-39-51-64-75 years) by analysis of cluster centres.

RESULTS

In 80.6% (n = 1086) the preoperative radiography suggested signs of a knee osteoarthritis. There was a range from grade I to grade III osteoarthritis according to the Kellgren-Lawrence score. Older female patients had knee osteoarthritis significantly (p = 0.027) more frequently. The grade of osteoarthritis correlated significantly with the patients' age (p > 0.001). The mean WOAKS was 16.6 +/- 13.7 points. There was a continuous increase of WOAKS from 8.2 +/- 5.1 in 24-year-old patients to 24.2 +/- 16.3 points in 75-year-old patients (p < 0.001). In about half of the cases cartilage lesions within the patella and trochlea were evaluated. Most frequently we recorded cartilage lesions within the mean bearing zone of the medial femoral condyle (96.2%) and the medial tibia (57.7)%. Only about a third of our patients suffered from cartilage lesions within the mean bearing zone of the lateral condyle and tibia. The frequency of cartilage lesions and the severity of the lesions grade was significantly less within the non-loaded margin of the surfaces. In 45 knees (3.8%) we found intraarticular osteophytes located: medial (n = 9) and lateral (n = 3) patella margin, intracondylar notch (n = 12), medial tibia (n = 9) and lateral margin of the lateral tibia (n = 4), lateral femoral condyle at the intersection to the lateral trochlea margin (n = 3). The occurrence of osteophytes correlated with the patients' age and the radiological grade of the osteoarthritis. There were no differences with respect to the profession within the age groups. In the non-adjusted WOAKS, patients with hard knee-loading work had a WOAKS of 16.8 +/- 13.9 points and patients with soft work a score of 17.2 +/- 14.3 points (p = 0.583). Differences in the frequency of cartilage distributions within the judged regions of the knee with respect to professional burden were also not evaluated. The same held for the frequency of intraarticular osteophytes.

CONCLUSION

Despite there is a known relation between occupational load and knee osteoarthritis no relation to cartilage degeneration was found in our arthroscopic investigation. For better understanding of work-related knee osteoarthritis prospective studies are needed urgently.

[Causes and course of fornix rupture]

PURPOSE

Fornix rupture is a urological emergency situation. In most cases ureteral stones represent the underlying cause. We present the largest series ever reported.

MATERIAL AND METHODS

Between 1994 bis 2005 a total of 162 patients were diagnosed with a fornix rupture. There were 121 men and 41 women with a median age of 53 years (range: 20-79 years). We investigated the following parameters: underlying cause of fornix rupture, symptoms, diagnostic and therapeutic procedures.

RESULTS

In 60% of cases a ureteral stone was found as cause and in another 28% we found no reason for fornix rupture. 93% of patients had one or more symptoms at the time of diagnosis. In all patients primary endoscopic therapy (96%) or insertion of a nephrostomy tube was performed (4%). Also, antibiotic treatment was given in 92% of patients. No patient developed a perirenal abscess or other relevant complication requiring open operative revision.

CONCLUSIONS

We confirm that ureteral stones are the most frequent causes of fornix rupture. With a low pressure system and antibiotic treatment, secondary complications can be effectively prevented.

Rapid quantification of conjugated and unconjugated bile acids and C27 precursors in dried blood spots and small volumes of serum

The aim of the study was to develop a method for fast and reliable diagnosis of peroxisomal diseases and to facilitate differential diagnosis of cholestatic hepatopathy. For the quantification of bile acids and their conjugates as well as C(27) precursors di- and trihydroxycholestanoic acid (DHCA, THCA), in small pediatric blood samples we combined HPLC separation on a reverse-phase C18 column with ESI-MS/MS analysis in the negative ion mode. Analysis was done with good precision (CV 3,7%-11.1%) and sufficient sensitivity (LOQ: 11-91 nmol/L) without derivatization. Complete analysis of 17 free and conjugated bile acids from dried blood spots and 10 microL serum samples, respectively, was performed within 12 min. Measurement of conjugated primary bile acids plus DHCA and THCA as well as ursodeoxycholic acid was done in 4.5 min. In blood spots of healthy newborns, conjugated primary bile acids were found in the range of 0.01 to 2.01 micromol/L. Concentrations of C(27) precursors were below the detection limit in normal controls. DHCA and THCA were specifically elevated in cases of peroxysomal defects and one Zellweger patient.

Peri-Operative Suppression of Immune-Regulatory Blood Cells Predicts Wound Complications in Breast Cancer Patients

IntroductionWe have previously demonstrated an association between post-operative wound complications and systemic breast cancer recurrence (p&lt;0.0001), Murthy et al (2007) Br J Cancer 97, 1211-7. The aim of this study was to examine the potential role of the immune system in establishing this association, and therefore whether immune factors might be used to predict either wound complications or cancer recurrences.MethodsPatients with primary operable breast cancer were prospectively recruited to the study. Serial blood investigations were performed pre-operatively, peri-operatively and post-operatively. Absolute numbers of various lymphocyte cell populations were measured using multi-colour flow-cytometry including CD45+lymphocytes, CD19+ B lymphocytes, CD3+ T lymphocytes, CD4+ helper T cells, CD8+ cytotoxic T cells and CD56+ NK cells. We also measured the levels of the NK cytotoxicity receptors NKp30 and NKp46 on the NK cell population.ResultsOne hundred and nine patients were recruited to the study and there was a wound complication rate of 13.4%. Absolute numbers of CD3+ T lymphocytes, CD4+ helper T cells, CD8+ cytotoxic T cells and CD56+ NK cells were significantly lower 4 hours post-operatively compared to pre-operative levels (p&lt;0.05), although levels had typically recovered after 24 hours. However, NKp30 expression remained significantly reduced at 24 hours (p&lt;0.05). Mastectomy patients had a significantly greater fall in T lymphocyte numbers than those having breast conserving surgery (p&lt;0.05). Patients who went on to develop wound complications post-operatively had a significantly greater fall in their CD4+ helper T cells at 4 hours post-operatively, than those patients who did not go on to develop wound complications (p&lt;0.05).ConclusionsBreast cancer surgery results in severe disruption to the immune system, with dramatic changes in levels of immune regulatory blood cells populations. Changes are predominantly immuno-suppressive. The greater the immune disruption as a result of surgery, the more likely the patient is to develop a wound complication. We believe that this peri-operative immuno-suppression may also provide a window of opportunity for the successful dissemination of tumour cells post-operatively thereby increasing the risk of future metastases; we are maintaining follow up on this patient cohort in order to test correlations between peri-operative immuno-suppression and systemic recurrences.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4132.

Pathological and Patient Factors Affecting the Accuracy of Ultrasound Combined with Fine Needle Aspiration Cytology in Pre-Operative Staging of the Axilla in Breast Cancer

Introduction:Ultrasound combined with fine needle aspiration cytology is effective in pre-operative staging of the axilla in breast cancer. Accurate pre-operative diagnosis of lymph node metastases allows for a one stage axillary operation and may also influence decisions regarding neo-adjuvant chemotherapy and breast reconstruction. The aim of this study is to identify pathological and patient factors that influence the accuracy of ultrasound and FNAC in determining the status of the axilla pre-operatively.Methods:Three hundred patients with primary operable invasive breast cancer had an axillary ultrasound pre-operatively. If the ultrasound was normal the patient was offered a sentinel node biopsy. If it identified equivocal or pathological nodes a fine needle aspirate cytology was performed. If the cytology was malignant then an axillary node clearance was performed.Results:Ultrasound combined with FNAC correctly determined the status of the axilla pre-operatively in 78% of cases. Sensitivity for the detection of metastases was 32% with 100% specificity. Factors affecting the accuracy of ultrasound and FNAC were the pathological size of tumour (p&lt;0.05) and the size of the metastases (p&lt;0.05). Age of the patient, pathological grade and type of tumour did not significantly affect the accuracy of the procedure.Conclusion:Ultrasound combined with fine needle aspirate cytology can be used effectively to determine the status of the axilla pre-operatively. All patients regardless of age or their particular tumour characteristics should be offered this procedure pre-operatively.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 5020.

Case report of bilateral inflammatory breast cancer

Inflammatory breast cancer (IBC) is a rare entity that makes up 1-3% of breast cancers. As the diagnosis of IBC is mainly clinical, for the inexperienced the clinical appearance can mimic mastitis leading to diagnostic delay and it is often associated with a poor prognosis. Very few cases of bilateral IBC are reported in the literature, all of which have been synchronous. We report an unusual case of bilateral metachronous IBC each with complete clinico-pathological response after treatment with neoadjuvant chemotherapy and surgery on both occasions.