Measles and Varicella Vaccination Program in a Hospital: Implementation and Impact on Contact Tracing

Healthcare workers are recommended to get vaccinated against measles and varicella. This study aims to describe the implementation process of a measles and varicella vaccination program and report on the reduction in the number of susceptible healthcare workers exposed to measles, varicella, and disseminated herpes zoster at a tertiary hospital. The Consolidated Framework for Implementation Research (CFIR) model was used to describe the vaccination program implemented from October 2015 to September 2018. The number of exposed, reviewed, and susceptible healthcare workers during contact tracing for exposure to (a) measles and (b) varicella and disseminated herpes zoster in 2016, 2017, and 2018 is reported. A total of 6770 (95%) out of 7083 healthcare workers completed their immunization review by 2018. In 2016, 20 (10%) out of 198 healthcare workers exposed to measles were considered susceptible. In 2018, no one was found susceptible out of the 51 staff members exposed to measles (p < 0.01). For exposure to varicella and disseminated herpes zoster, seven (5%) out of 154 exposed healthcare workers were susceptible in 2016. In comparison, only two (1%) out of 377 exposed healthcare workers in 2018 were susceptible (p < 0.01). The vaccination program effectively reduced number of healthcare workers susceptible to measles, varicella, and disseminated zoster.

Role of Occupational Health Services in Planning and Implementing of Staff COVID-19 Vaccination Clinic: A Tertiary Hospital Experience in Singapore

CONTEXT

Healthcare workers all over the world were prioritized for vaccination against COVID-19 in view of the high-risk nature of their job scopes when vaccines were first available in late 2020. Vaccine hesitancy was an important problem to tackle in order to achieve a high vaccination rate, especially for vaccines that were developed using mRNA technology. We aimed to use the '3Cs' model to address vaccine hesitancy to ensure maximal uptake of the Pfizer-BioNTech vaccine among healthcare workers in a tertiary hospital in Singapore.

METHODS

Various measures were used to reduce the confidence, complacency, and convenience barriers. The staff vaccination clinic was on-site and centralized, with appointments given in advance to ensure vaccine availability and to reduce wait time, providing convenience to staff. Direct and repeated communications with the staff via multiple channels were used to address vaccine safety and efficacy so as to promote confidence in the vaccines and overcome complacency barriers. To further encourage staff to get vaccinated, staff were allowed time off for vaccination when at work. Staff with a high risk of exposure to COVID-19 or those caring for immunocompromised patients were prioritized to take the vaccines first. The collection of data on adverse events was via on-site monitoring and consultation at Occupational Health Clinic (OHC).

RESULTS

Nearly 80% of staff had completed vaccination when the vaccination exercise ended at the end of March 2021. With the loosening of the contraindications to vaccination over time, staff vaccination rates reached 89.3% in early July and nearly 99.9% by the end of the year. No major or serious vaccine-related medication or administration errors were reported. No staff had anaphylaxis.

CONCLUSIONS

By using the '3Cs' model to plan out the vaccination exercise, it is possible to achieve a high vaccination rate coupled with effective and customized communications. This multi-disciplinary team approach can be adapted to guide vaccination efforts in various settings in future pandemics.

Nosocomial outbreak of Achromobacter spp. bacteremia due to germicide contamination: a systematic review

OBJECTIVE

Achromobacter spp. are aerobic, non-fermentative Gram-negative bacilli that can be widely found in aquatic environments. Nosocomial outbreaks and pseudo-outbreaks of Achromobacter spp. bacteremia have been recognized for decades. Notably, commonly used germicides in hospital settings constitute important sources for these outbreaks. This review aims at summarizing the latest studies and presents the characteristics of nosocomial outbreaks of Achromobacter spp. bacteremia caused by germicide contamination.

MATERIALS AND METHODS

A systematic search of the PubMed and EMBASE databases was conducted for articles published in English between January 1, 2000, and June 10, 2022.

RESULTS

Overall, 170 articles were retrieved, and 7 studies were finally included in the systematic review. Whether true or pseudo-bacteremia, positive blood culture results were most commonly reported in immunosuppressed patients or those with indwelling catheters. The most commonly reported contaminated germicide was chlorhexidine solution used as both an antiseptic and disinfectant. Atomizers, dispensers, and various product containers were identified as reservoirs. The prognoses of the affected patients were generally favorable.

CONCLUSIONS

Awareness about the high survival ability of Achromobacter spp. in germicides and the possible hospital reservoirs of these microbes will help to improve infection control and prevent nosocomial outbreaks or pseudo-outbreaks caused by Achromobacter spp.

Safety and side effect profile of Pfizer-BioNTech COVID-19 vaccination among healthcare workers: A tertiary hospital experience in Singapore

ABSTRACT Introduction: Vaccination remains a key strategy to living endemically with COVID-19. The Pfizer-BioNTech COVID-19 vaccine was first granted interim authorisation for use in Singapore in December 2020. With overseas studies published about the safety and side effect profiles of mRNA COVID-19 vaccines focusing mainly on non-Asian populations, we described the side effects of Pfizer-BioNTech COVID-19 vaccination experienced by the healthcare workers (HCWs) in a tertiary hospital in Singapore. Methods: Data were obtained from the Occupational Health Clinic (OHC) at the National University Hospital in Singapore, which monitored staff for any adverse effects within 30 minutes postvaccination on-site and any adverse effects after that. A cross-sectional study among the vaccinated HCWs was conducted using an online survey, which established basic demographics, histories of allergies or atopic disorders, and adverse events encountered after dose 1 and dose 2 of vaccination. Results: No anaphylaxis was reported. Most common symptom was giddiness (32.7%) experienced by HCWs within 30 minutes. Adverse events attended post-vaccination by OHC were generally mild and self-limiting. From the survey, odds of experiencing an adverse event after dose 2 was significantly higher than after the first dose, especially for fever/chills (odds ratio [OR] 22.5). Fever/chills, injection site reactions, headache, aches and pains, and feeling unwell were significantly more common in HCWs below 60 years compared to those ≥60 years. An allergy to food (adjusted OR 2.7) and a history of eczema/sensitive skin (adjusted OR 2.6) were associated with a skin reaction not at injection site. Conclusion: The side effects experienced after Pfizer-BioNTech COVID-19 vaccines are generally self-limiting and mild, with no anaphylaxis reported. Keywords: COVID-19, infectious diseases, occupational medicine, side effects, vaccination

Fluctuation of BCR-ABL1 qPCRIS level beyond 0.1%IS after stopping tyrosine kinase inhibitor in chronic myeloid leukaemia patients with deep molecular response for at least two years

Fluctuation of BCR-ABL1 real-time quantitative polymerase chain reaction in International Scale (qPCR^IS) level below major molecular response (MMR) (0.1%^IS) is a known phenomenon after stopping tyrosine kinase inhibitor (TKI) in chronic myeloid leukaemia (CML) patients who are attempting treatment free remission (TFR). We report here four cases of fluctuation beyond MMR during conduct of a Malaysia Stop TKI Trial (MSIT) to examine the validity of the commonly used relapse criterion - loss of MMR for one reading - aiming to provide evidence in setting relapse criteria for future CML patients who want to attempt TFR.

Factors associated with self-reported burnout level in allied healthcare professionals in a tertiary hospital in Singapore

BACKGROUND

Burnout has adverse implications in healthcare settings, compromising patient care. Allied health professionals (AHPs) are defined as individuals who work collaboratively to deliver routine and essential healthcare services, excluding physicians and nurses. There is a lack of studies on burnout among AHPs in Singapore. This study explored factors associated with a self-reported burnout level and barriers to seeking psychological help among AHPs in Singapore.

METHODS

We conducted a cross-sectional study in a sample of AHPs in a tertiary hospital from October to December 2019. We emailed a four-component survey to 1127 eligible participants. The survey comprised four components: (1) sociodemographic characteristics, (2) Maslach Burnout Inventory (MBI-HSS), (3) Areas of Worklife Survey, and (4) Perceived Barriers to Psychological Treatment (PBPT). We performed a multiple logistic regression analysis to identify factors associated with burnout. Adjusted odds ratios (AORs) and associated 95% confidence intervals (CIs) were computed.

RESULTS

In total, 328 participants completed the questionnaire. The self-reported burnout level (emotional exhaustion>27 and/or depersonalization>10) was 67.4%. The majority of the respondents were female (83.9%), Singaporean (73.5%), aged 40 years and below (84.2%), and Chinese ethnicity (79.9%). In the multiple logistic regression model, high burnout level was negatively associated with being in the age groups of 31 to 40 (AOR 0.39, 95% CI 0.16-0.93) and 40 years and older (AOR 0.30, 95% CI 0.10-0.87) and a low self-reported workload (AOR 0.35, 95% CI 0.23-0.52). High burnout level was positively associated with a work experience of three to five years (AOR 5.27, 95% CI 1.44-20.93) and more than five years (AOR 4.24; 95% CI 1.16-16.79. One hundred and ninety participants completed the PBPT component. The most frequently cited barriers to seeking psychological help by participants with burnout (n = 130) were 'negative evaluation of therapy' and 'time constraints.'

CONCLUSIONS

This study shows a high self-reported burnout level and identifies its associated factors among AHPs in a tertiary hospital. The findings revealed the urgency of addressing burnout in AHPs and the need for effective interventions to reduce burnout. Concurrently, proper consideration of the barriers to seeking help is warranted to improve AHPs' mental well-being.

Letter to the Editor: Effects of the COVID-19 Pandemic on COVID-19 Negative Geriatric Patients with Hip Fractures

Since December 2019, the novel coronavirus (COVID-19) had affected millions globally, particularly putting elderly and persons with chronic diseases at risk (1). 95% of all COVID-19 deaths in Singapore are older adults (2). As public health policymakers try to control the pandemic by focusing resources on COVID-19, the general population fear contracting coronavirus from hospitals, resulting in changes in their healthcare seeking behaviour. We describe two cases demonstrating the direct and indirect impact of COVID-19 to our geriatric patients in Singapore who have sustained hip fractures.

Responding to COVID-19: how an academic infectious diseases division mobilized in Singapore

BACKGROUND

On January 30, COVID-19 was declared a Public Health Emergency of International Concern-a week after Singapore's first imported case and 5 days before local transmission. The National University Hospital (NUH) is Singapore's third largest hospital with 1200 beds, heavy clinical workloads, and major roles in research and teaching.

MAIN BODY

With memories of SARS still vivid, there was an urgent requirement for the NUH Division of Infectious Diseases to adapt-undergoing major reorganization to face rapidly changing priorities while ensuring usual essential services and standards. Leveraging on individual strengths, our division mobilized to meet the demands of COVID-19 while engaging in high-level coordination, strategy, and advocacy. We present our experience of the 60 days since the nation's first case. During this time, our hospital has managed 3030 suspect cases, including 1300 inpatients, 37 confirmed cases, and overseen 4384 samples tested for COVID-19.

CONCLUSION

Complex hospital adaptations were supported by an unprecedented number of workflows and coordination channels essential to safe and effective operations. The actions we describe, aligned with international recommendations and emerging evidence-based best practices, may serve as a framework for other divisions and institutions facing the spread of COVID-19 globally.

Knowledge, attitudes and behaviour towards needlestick injuries among junior doctors

BACKGROUND

Needlestick injuries (NSIs) are common healthcare-related injuries and possible consequences include blood-borne infections. Despite that, a large proportion of NSIs are not reported.

AIMS

To estimate the prevalence of under-reporting of NSIs and to evaluate the knowledge, attitude and behaviour towards NSIs among junior doctors in a tertiary hospital in Singapore.

METHODS

An explanatory sequential mixed-methods design was employed. Quantitative data were collected through questionnaires completed by 99 junior doctors. Descriptive statistics and bivariate analysis were performed to evaluate socio-demographic characteristics, NSI history and NSI reporting practices. Qualitative data were collected through 12 in-depth interviews. Participants were purposively recruited, and semi-structured topic guides were developed. Data were analysed using a thematic approach.

RESULTS

Fifty-two per cent of respondents had history of NSI. Of those with history of NSI, 31% did not report injury. NSI reporters were 1.52 times as likely to be aware of how to report injury (P < 0.05), and 1.63 times as likely to feel that reporting benefits their health (P < 0.01) compared with non-reporters. NSI reporters were 83% more likely to report a clean NSI (P = 0.05). For non-reporters, the main reasons for not reporting were perceived low risk of transmission (41%) and lack of time to report (35%). Themes identified in the qualitative data include perceived benefits, perceived barriers, perceived threats, cues to action and organizational culture.

CONCLUSION

Under-reporting of NSIs may have significant implications for patients and healthcare workers. Addressing identified factors and instituting targeted interventions will help to improve reporting rates.

Responding to the COVID-19 pandemic: The role of occupational health services in a tertiary hospital in Singapore

With coronavirus disease 2019 declared a Public Health Emergency of International Concern on 30 January 2020, occupational health services in a tertiary hospital in Singapore stepped up via a three-pronged approach, namely, protection of individual staff, protection of staff workforce, and prevention of nosocomial spread so as to support business continuity plans. Despite the multiple new challenges brought by the COVID-19 pandemic, the hospital's occupational health services were able to adapt and keep all employees and patients safe with strong support from senior management and close collaboration with various departments.

Need for a new workplace safety and health (WSH) strategy for the fourth Industrial Revolution

We are on the cusp of the fourth Industrial Revolution which promises to revolutionize the way we live and work. Throughout history, as society and technology progress, so too have our workplace safety and health (WSH) strategies in regard to better knowledge and enhanced regulation. In this paper, we argue for a new WSH 4.0 strategy which requires us to adopt an adaptive and highly responsive approach to promote Total Worker Health in the face of rapid technological advancements and changes in employment relationships. To do so, we propose a multi-pronged strategy comprising (i) adaptive WSH solutions in regard to surveillance, risk assessment, and control measures leveraging on new technologies; (ii) effective multi-stakeholder dialogues for collaborative and sustainable solutions; (iii) an anticipatory WSH governance framework based upon shared values and cooperative responsibility; and (iv) professional development among WSH practitioners. This new WSH 4.0 strategy will enable WSH professionals to remain effective in this coming Industrial Revolution.

Astrocytic water channel aquaporin-4 modulates brain plasticity in both mice and humans: a potential gliogenetic mechanism underlying language-associated learning

The role of astrocytes in brain plasticity has not been extensively studied compared with that of neurons. Here we adopted integrative translational and reverse-translational approaches to explore the role of an astrocyte-specific major water channel in the brain, aquaporin-4 (AQP4), in brain plasticity and learning. We initially identified the most prevalent genetic variant of AQP4 (single nucleotide polymorphism of rs162008 with C or T variation, which has a minor allele frequency of 0.21) from a human database (n=60 706) and examined its functionality in modulating the expression level of AQP4 in an in vitro luciferase reporter assay. In the following experiments, AQP4 knock-down in mice not only impaired hippocampal volumetric plasticity after exposure to enriched environment but also caused loss of long-term potentiation after theta-burst stimulation. In humans, there was a cross-sectional association of rs162008 with gray matter (GM) volume variation in cortices, including the vicinity of the Perisylvian heteromodal language area (Sample 1, n=650). GM volume variation in these brain regions was positively associated with the semantic verbal fluency. In a prospective follow-up study (Sample 2, n=45), the effects of an intensive 5-week foreign language (English) learning experience on regional GM volume increase were modulated by this AQP4 variant, which was also associated with verbal learning capacity change. We then delineated in mice mechanisms that included AQP4-dependent transient astrocytic volume changes and astrocytic structural elaboration. We believe our study provides the first integrative evidence for a gliogenetic basis that involves AQP4, underlying language-associated brain plasticity.

Abstract P2-05-07: Whole exome sequencing of extreme responders reveals low mutation burden in metastatic breast cancer

Background: Extreme responders to anticancer therapy are rarely encountered in the treatment of advanced breast cancer patients, but their treatment response have not been investigated on the whole exome level. We performed whole exome analysis to characterize genomic landscape of extreme responders in metastatic breast cancer patients.

Methods: Clinical samples were obtained from patients who showed exceptional response to anti-HER2 therapy or hormonal therapy. Non-responders were selected among those who did not respond. Matched breast tumor tissue (somatic DNA) and blood samples (germline DNA) were collected from a total of 18 responders (12 ER+, 6 HER2+) and 8 non-responders (6 ER+, 1 HER2+, 1 TNBC). Whole exome sequencing using Illumina HiSeq2500 was performed on the 26 patients (52 samples). Somatic single nucleotide variants (SNVs), indels and copy number variants (CNVs) were identified for each patient genome. Group specific somatic variants and mutation burden were statistically analyzed.

Findings: Cancer exomes were characterized by 1,455 somatic single-nucleotide variants (1,327 missense, 80 nonsense, 36 splice-site, 12 start/stop-lost), 149 insertions/deletions (108 frameshift, 41 inframe), with a median of 1 mutations per Mb (0.2 to 2.7 mutations per Mb) in all patients. Responders harbored a significantly lower non-synonymous mutation burden than non-responders (median, 27 vs. 90.5, P=0.01), and copy number variation burden was also lower (median 23 vs. 31, P=0.14). Multivariate analyses of factors influencing progression-free survival showed that high mutation burden and visceral metastases were significantly related with progression.

Interpretation: Extreme responders of metastatic breast cancer are characterized by low nonsynonymous mutational burden.

Citation Format: Sohn J, Lim SM, Kim E, Kim S, Koo JS, Kim SI, Park S, Park HS, Kwon N-J, Kim GM, Kim S. Whole exome sequencing of extreme responders reveals low mutation burden in metastatic breast cancer [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 P2-05-07.

Abstract OT2-01-03: A prospective randomized study comparing surgery using electrosurgical bipolar sealing devices and surgery using conventional electro-cautery

Background: Seroma and lymphorrhea are the most common complication following mastectomy and/or axillary lymph node dissection (ALND). The manifestation of seroma accelerates complications such as post-operative bleeding, wound infection, prolonged recovery period. Sealing blood vessels and lymph drainages adequately during mastectomy and/or ALND may play a main role in reducing complication. Therefore, adequate sealing vessels and lymphatics during the surgery is important to reduce seroma and lymphorrhea related complications in patients with breast cancer. Objective: This study aims to show that electrosurgical bipolar sealing device for mastectomy could provide clinical benefit in reducing seroma formation. Design: ELBCE (ELectrosurgical Bipolar Devices VS Convention Electronicautery, NCT03166384)is a prospective, randomized, two-arm assignment controlled trial of application of electrosurgical bipolar sealing device for mastectomy in patients with breast cancer. Patients is randomized in 1:1 ratio to conventional suture and tie group or electrosurgical bipolar sealing devices group. Randomization is performed using opening sealed envelope before enrollment. The primary end point is to compare the total drainage volume until drain tube removal. The time to drain removal is also measured. The secondary end points is the total amount of aspiration from seroma after drain tube removal, and the frequency of seroma aspiration. Statistical consideration: A sample size 44 subjects per each arm was planned to provide a 90% power to detect a 25% decrease of the total amount of drainage fluid after surgery by using an electrosurgical bipolar sealing device when compared to a conventional suture and tie technique. In our experience, the average total volume of fluid after conventional suture and tie technique is 220 mL, with a standard deviation of 80. Eligibility criteria:Inclusion criteria are patients older than 20 years and those who planned to undergo total mastectomy and/or ALND. Exclusion criteria are bilateral breast cancer patients, male patients, patients who underwent ipsilateral axillar surgery or radiation therapy, recurrent breast cancer patients, patients without drain catheter, and patients with ductal carcinoma in situ who have not undergone ipsilateral sentinel lymph node biopsy or ALND.Present accrual and target accrual:ELSEBA study has an accrual target of 88 patients. To date, 8 patients have been randomized. Contact information:Dr. Hyung Seek Park, E-mail: hyungseokpark.md@gmail.com; imgenius@yuhs.ac, Telephone: +82-2-2228-2100

Citation Format: Yoon KH, Park HS, Kim JH, Kim JY, Lim SM, Kim SI, Cho YU. A prospective randomized study comparing surgery using electrosurgical bipolar sealing devices and surgery using conventional electro-cautery [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-01-03.

Abstract P6-11-13: Not presented

This abstract was not presented at the symposium.

Light chain multiple myeloma: an evaluation of its biochemical investigations

Multiple myeloma is a type of plasma cell dyscrasia, characterised by presence of paraprotein or monoclonal (M)-protein in serum or urine. The M-protein may consist of an intact immunoglobulin, the heavy chain only or the light chain only. The latter, designated as light chain multiple myeloma (LCMM) makes up almost 20% of myelomas. Clinical manifestation is often heralded by hypercalcaemia, renal impairment, normocytic normochromic anaemia and bone lesions, reflecting end-organ damage, collectively known as the acronym CRAB. In particular, free light chain nephrotoxicity accounts for the high prevalence of renal impairment seen in LCMM. This case illustrates a typical presentation of LCMM with focal discussion on its initial and diagnostic, as well as prognostic biochemical investigations.

Posterior Elbow Dislocation with Brachial Artery Thrombosis Treated Non-surgically: A Case Report

The brachial artery is rarely injured in closed posterior dislocation of the elbow, unlike the high rate of vascular injury seen after dislocation of the knee. Despite the anatomical proximity of the brachial artery to the elbow joint, most cases of brachial artery injury after dislocation of the elbow are related to an associated fracture, an open injury or high-energy trauma. A high index of suspicion should be maintained as well as a thorough neurovascular examination with regards this potentially disastrous complication. We describe an unusual case of complete thrombosis of the brachial artery presenting with a posterior elbow dislocation following a fall (low energy trauma) that was treated nonoperatively. At three months follow-up, patient had good circulation over the affected limb, no complaints of ischemic pain or cold intolerance, no signs of Volkmann’s ischemic contracture, and a range of motion that was comparable to the contralateral limb.

Determination of the 99th percentile upper reference limit for high-sensitivity cardiac troponin I in Malaysian population

Introduction of high-sensitivity cardiac troponin I (hscTn I) assays for routine clinical use in Malaysia requires determination of the 99^th percentile upper reference limit (URL) for each assay to suit local context. Hence, this study aimed to determine the 99^th percentile URL for hscTn I in the Malaysian population. A total of 250 (120 males and 130 females) healthy Malaysian blood donors aged 18 to 60 years old were recruited. Blood samples for hscTn I were measured using Abbott Diagnostics hscTn I assay on Architect i2000sr analyser. The 99^th percentile was calculated using a non-parametric method and gender specific results were compared. The 99^th percentile URL for hscTn I for the overall population was 23.7 ng/L, with gender specific values being 29.9 ng/L and 18.6 ng/L for male and female, respectively. Females had significantly lower hscTn I compared to males. This study confirms the use of gender specific 99^th percentile URL for hscTn I for clinical use in a multi-ethnic Malaysian population.

Serologic evidence of West Nile virus and Usutu virus infections in Eurasian coots in the Netherlands

West Nile virus (WNV) and Usutu virus (USUV) are arboviruses that are maintained in enzootic transmission cycles between mosquitoes and birds and are occasionally transmitted to mammals. As arboviruses are currently expanding their geographic range and emerging in often unpredictable locations, surveillance is considered an important element of preparedness. To determine whether sera collected from resident and migratory birds in the Netherlands as part of avian influenza surveillance would also represent an effective source for proactive arbovirus surveillance, a random selection of such sera was screened for WNV antibodies using a commercial ELISA. In addition, sera of jackdaws and carrion crows captured for previous experimental infection studies were added to the selection. Of the 265 screened serum samples, 27 were found to be WNV-antibody-positive, and subsequent cross-neutralization experiments using WNV and USUV confirmed that five serum samples were positive for only WNV-neutralizing antibodies and seven for only USUV. The positive birds consisted of four Eurasian coots (Fulica atra) and one carrion crow (Corvus corone) for WNV, of which the latter may suggest local presence of the virus, and only Eurasian coots for USUV. As a result, the screening of a small selection of serum samples originally collected for avian influenza surveillance demonstrated a seroprevalence of 1.6% for WNV and 2.8% for USUV, suggesting that this sustained infrastructure could serve as a useful source for future surveillance of arboviruses such as WNV and USUV in the Netherlands.

Abstract P5-16-25: Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy

Background:According to prior studies, the role of serum vitamin D3 has been inconsistentand clinical implications of 25-hyrdoxyvitamin D (25-OHD) have been little studiedin breast cancer patients receiving neoadjuvant chemotherapy (NCT).

Objectives: The aims of study were to investigate changes in 25-OHD levels before and after NCT and to determine the association of 25-OHD and oncologic outcomes including pathological complete response (pCR) in breast cancer patients.

Patients and Materials: From January 2010 to December 2013, serum 25-OHD levels at pre- and post-NCT were measured in 377 breast cancer patients. The association of serum 25-OHD levels with clinicopathological data including breast cancer subtypes, pCR and survival were retrospectively analysed. Delta 25-OHD was calculated as serum 25-OHDlevels before minus after NCT.

Results: Mean ageof study population was 48.7 yearsand mean follow-up periods were 35.9months.Mean baseline serum 25-OHD concentration was 14.60 ng/mL (standard deviation, 7.44) and more than 80% of patients showed insufficient 25-OHD levels. The mean 25-OHDat post-NCT was 12.16 ng/mL (standard deviation, 6.87).There was a significant decrease in serum 25-OHD after NACT (p&lt;0.001).The pCR rates were 25.7% among study cohort.However, 25-OHD levels at baseline and post-NCT were not related to pCR and survival outcomes. No associations were found between pCR and delta 25-OHD. According to stratification by breast cancer subtypes, however, patients with ≥ -2.67 (median value) of delta 25-OHD revealed a trend of higher achievement of pCR and better survival in luminal A subtype. No associations were found among the other subtypes.

Conclusions: Many Korean breast cancer patients showed insufficient serum 25-OHD levels at diagnosis of malignancy and a significant decrease in serum vitamin D3 after NACT was observed.No significant association of 25-OHD 3 with pCR and survival was found. Therefore, correction or maintenance of appropriate serum 25-OHD levels should be focused for bone health as comprehensive management of breast cancer during NCT.In addition, possible oncological aspects of 25-OHD should further researched individually considering breast subtypes.

Citation Format: Park S, Lee JS, Kim JH, Lim SM, Park HS, Kim SI. Serum 25-hydroxyvitamin D levels and oncologic outcomes of breast cancer patients receiving neoadjuvant chemotherapy [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P5-16-25.

Abstract OT2-04-01: Study on the usefulness of the skin wound therapeutic agent 'Neo dermal activator' in breast cancer surgery

Background : Wound infection after breast cancer surgery is considered to be factors that increase the discomfort of the patient and increase of the extension and the use of antibiotics in the treatment time period, in particular breast cancer postoperative wound infection resulting slow the implementation of adjunctive therapy such as radiation therapy or chemotherapy after surgery can cause, it is important to effectively prevent, there has been a development of a variety of skin wound therapeutic agent to reduce them. The purpose of this study was to evaluate the effects of the wound dressing with existing wound dressing Neo dermal activator compared to the patients receiving preoperative chemotherapy.

Methods : A total of 54 breast cancer patients who recieved BCS & mastectomy devided two group(each 27 patients) through the random assignment between Jan, 2016 and June, 2016. Day one weeks after surgery to examine the wound infection rate (surgical site infection, SSI rate). After six months of outpatient surgery visits to check the wounds of patients, using the VAS records the scar of the wound satisfaction. For patients who underwent radiation therapy, check out the time it took to begin radiation therapy after surgery.

All tests were two-sided. All statistical analyses were performed using SPSS version 20.0 (SPSS Inc., Chicago, Illinois, USA).

Eligbility criteria is :

- one side breast cancer

- not inflammatory breast cancer

- recieved BCS and mastectomy only (without immediate reconstruction surgery)

- stage IV breast cancer.

Citation Format: Kim JH, Lim SM, Kim SI, Park SH, Park HS, Kim JY. Study on the usefulness of the skin wound therapeutic agent 'Neo dermal activator' in breast cancer surgery [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 OT2-04-01.

Pediococcus acidilactici LAB4 and Lactobacillus plantarum LAB12 assimilate cholesterol and modulate ABCA1, CD36, NPC1L1 and SCARB1 in vitro

There is growing interest in the use of probiotic lactic acid bacteria (LAB) for prevention of hypercholesterolaemia. This study assessed the cholesterol lowering ability of Pediococcus acidilactici LAB4 and Lactobacillus plantarum LAB12 in growth media. Both LAB yielded >98% (39.2 μg/ml) cholesterol lowering in growth media. Nile Red staining indicated direct assimilation of cholesterol by the LAB. The LAB were then explored for their prophylactic (pre-treatment of HT29 cells with LAB prior to cholesterol exposure) and biotherapeutic (treatment of HT29 cells with LAB after exposure to cholesterol) use against short and prolonged exposure of HT29 cells to cholesterol, respectively. For HT29 cells pre-treated with LAB, cholesterol lowering was accompanied by down-regulation of ATP-binding cassette family transporter-type A1 (ABCA1), cluster of differentiation 36 (CD36) and scavenger receptor class B member 1 (SCARB1). HT29 cells treated with LAB after prolonged exposure to cholesterol source, on the other hand, was associated with up-regulation of ABCA1, restoration of CD36 to basal level and down-regulation of Neimann-Pick C1-Like 1 (NPC1L1). The present findings implied the potential use of LAB4 and LAB12 as part of the strategies in prevention and management of hypercholesterolaemia.

Comparison of cytotoxicity test models for evaluating resin-based composites

OBJECTIVES

This study compared different cytotoxicity test models for evaluating resin-based composites (RBCs) and assessed the biocompatibility of standard and bulk-fill RBCs.

METHODS

A standard (spectrum TPH) and a bulk-fill (smart dentin replacement (SDR)) RBC were selected. Disc-shaped specimens (7 mm diameter) of 2 and 4 mm thickness were polymerized for 20 s with a LED curing light of 700 mW/cm² irradiance. The specimens ( n = 5) were subjected to micro-hardness testing and three cytotoxicity test models (direct contact, indirect contact and extract tests) with the established L-929 cell line. Hardness ratios of top and bottom surfaces of specimens were computed to assess the effectiveness of cure. For the direct and indirect contact tests, the cells were stained and zones of inhibition were analyzed after material contact for 24 h. For the extract test, cells were exposed to extracts for 24 h, and cell viability was measured. Data was analyzed using analysis of variance/Scheffe's post hoc test and Pearson's correlation ( p < 0.05).

RESULTS

The lowest mean hardness ratio and highest cytotoxicity were observed for TPH at 4 mm. At 4-mm thickness, SDR was found to be biocompatible with all three models. Correlations between hardness ratio and cell viability ranged from r = 0.89-0.96 for the various tests. A significant correlation ( r = 0.97) was also observed between the three test models.

CONCLUSION

Our data indicated consistency between direct contact, indirect contact and extract test models for cytotoxicity testing of RBCs. Bulk placement and curing at 4 mm for the bulk-fill RBC evaluated did not result in undue cytotoxicity.

The prevalence of fatigue and associated health and safety risk factors among taxi drivers in Singapore

INTRODUCTION

Driver fatigue is one of the biggest health and safety concerns within the road transport sector. This study aimed to find out the prevalence of fatigue among taxi drivers in Singapore, to better understand the general working and health conditions of this group of people and to determine the risk factors associated with fatigued driving.

METHODS

A total of 340 taxi drivers were randomly selected for participation in this self-administered questionnaire survey, with height and weight measurements. The response rate was 68.2%. The survey consisted of four main categories: personal particulars; social habits; work patterns and sleep profile; and Epworth Sleepiness Scale, which was used to estimate the level of daytime sleepiness and fatigue. Multiple logistic regression analysis was used to estimate the adjusted odd ratios and 95% confidence intervals associated with the risk factors related to fatigue among the taxi drivers.

RESULTS

A high proportion of the taxi drivers were obese and had self-reported hypertension, diabetes mellitus and high cholesterol. Driver fatigue was associated with very poor/poor self-rating of the quality of sleep, having an additional part-time job, drinking three or more caffeinated drinks daily, and driving more than 10 hours a day.

CONCLUSION

We hope that the findings of the present study will improve the awareness regarding the work and health conditions of taxi drivers, and contribute toward the effort to achieve a healthier workforce. A lower prevalence of fatigued driving will lead to lower risks of road traffic accidents, decreased economic loss, increased productivity, and safer roads for all.

Predisposition to and effects of methamphetamine use on the adolescent brain

Adolescence is a period of heightened vulnerability both to addictive behaviors and drug-induced brain damage. Yet, only limited information exists on the brain mechanisms underlying these adolescent-specific characteristics. Moreover, distinctions in brain correlates between predisposition to drug use and effects of drugs in adolescents are unclear. Using cortical thickness and diffusion tensor image analyses, we found greater and more widespread gray and white matter alterations, particularly affecting the frontostriatal system, in adolescent methamphetamine (MA) users compared with adult users. Among adolescent-specific gray matter alterations related to MA use, smaller cortical thickness in the orbitofrontal cortex was associated with family history of drug use. Our findings highlight that the adolescent brain, which undergoes active myelination and maturation, is more vulnerable to MA-related alterations than the adult brain. Furthermore, MA-use-related executive dysfunction was greater in adolescent MA users than in adult users. These findings may provide explanation for the severe behavioral complications and relapses that are common in adolescent-onset drug addiction. Additionally, these results may provide insights into distinguishing the neural mechanisms that underlie the predisposition to drug addiction from effects of drugs in adolescents.

Antimicrobial and in vitro wound healing properties of novel clay based bionanocomposite films

The present study investigates the development of methyl cellulose (MC)-sodium alginate (SA)-montmorillonite (MMT) clay based bionanocomposite films with interesting wound healing properties. The differential scanning calorimetry analysis of the composite films revealed presence of single glass transition temperature (Tg) confirming the miscible nature of the ternary blended films. The increase in MMT ratio in the composite films reduced the mobility of biopolymer chains (MC/SA) which increased the Tg of the film. Thermogravimetric analysis showed that dispersion of clay (MMT) at nano level significantly delayed the weight loss that correlated with higher thermal stability of the composite films. It was observed that the developed films were able to exhibit antimicrobial activity against four typical pathogenic bacteria found in the presence of wound. The developed films were able to significantly inhibit (10 mg/ml) the growth of Enterococcus faecium and Pseudomonas aeruginosa. In vitro scratch assay indicated potential wound closure activities of MC-2-4 bionanocomposite films at their respective highest subtoxic doses. In conclusion, these ternary bionanocomposite films were found to be promising systems for wound healing applications.

Synthesis, antimicrobial and anticancer evaluation of N'-(substituted benzylidene)-2-(benzo[d]oxazol-3(2H)-yl)acetohydrazide derivatives

A series of N'-(substituted benzylidene)-2-(benzo[d]oxazol-3(2H)-yl)acetohydrazide derivatives was synthesized and evaluated for its in vitro antimicrobial and anticancer activities. Antimicrobial activity results revealed that compound 12 was found to be the most potent antimicrobial agent. Results of anticancer study indicated that the synthesized compounds exhibited average anticancer potential. Compound 7 (IC 50 =3.12 µM) and compound 16 (IC 50 =2.88 µM) were found to be most potent against breast cancer (MCF7) cell lines. In conclusion, compound 12 and 16 have the potential to be selected as lead compound for the developing of novel antimicrobial and anticancer agents respectively.

Autotransplantation of mesiodens for missing maxillary lateral incisor with cone-beam CT-fabricated model and orthodontics

AIM

Autotransplantation is a viable treatment option for a missing tooth when there is a suitable donor, especially in adolescents with remaining facial growth. This report presents the aesthetic restoration of a missing maxillary lateral incisor through orthodontic treatment and autotransplantation of a mesiodens using a CBCT-fabricated rapid-prototyping model.

SUMMARY

A 14-year-old male patient with a congenitally missing maxillary lateral incisor was referred from the Department of Orthodontics. The teeth were moved orthodontically to regain space for the missing lateral incisor and to close the space of the mesiodens after transplantation. A replica of the donor tooth was fabricated from a cone-beam computed tomography scan through a rapid-prototyping machine before autotransplantation surgery. The model was used to create a socket for the graft tooth, thereby shortening the extra-oral time and minimizing the damage to the root surface. After transplantation and orthodontic tooth movement, the mesiodens was finally restored with an aesthetic laminate restoration. Over 3 years, the aesthetics remained excellent, and the transplant functioned normally without any signs or symptoms of root resorption.

KEY LEARNING POINT

Missing anterior teeth may be replaced through a combination of orthodontics, autotransplantation with a rapid-prototyping model and prosthodontic restoration, in growing patients.

The frequency and impact of ROS1 rearrangement on clinical outcomes in never smokers with lung adenocarcinoma

BACKGROUND

To determine the frequency and predictive impact of ROS1 rearrangements on treatment outcomes in never-smoking patients with lung adenocarcinoma.

PATIENTS AND METHODS

We concurrently analyzed ROS1 and ALK rearrangements and mutations in the epidermal growth factor receptor (EGFR), and KRAS in 208 never smokers with lung adenocarcinoma. ROS1 and ALK rearrangements were identified by fluorescent in situ hybridization.

RESULTS

Of 208 tumors screened, 7 (3.4%) were ROS1 rearranged, and 15 (7.2%) were ALK-rearranged. CD74-ROS1 fusions were identified in two patients using reverse transcriptase-polymerase chain reaction. The frequency of ROS1 rearrangement was 5.7% (6 of 105) among EGFR/KRAS/ALK-negative patients. Patients with ROS1 rearrangement had a higher objective response rate (ORR; 60.0% versus 8.5%; P = 0.01) and a longer median progression-free survival (PFS; not reached versus 3.3 months; P = 0.008) to pemetrexed than those without ROS1/ALK rearrangement. The PFS to EGFR-tyrosine kinase inhibitors in patients harboring ROS1 rearrangement was shorter than those without ROS1/ALK rearrangement (2.5 versus 7.8 months; P = 0.01).

CONCLUSIONS

The frequency of ROS1 rearrangements in clinically selected patients is higher than that reported for unselected patients, suggesting that ROS1 rearrangement is a druggable target in East-Asian never smokers with lung adenocarcinoma. Given the different treatment outcomes to conventional therapies and availability of ROS1 inhibitors, identification of ROS1 rearrangement can lead to successful treatment in ROS1-rearranged lung adenocarcinomas.

Spinal arteriovenous fistulas of the filum terminale

The filum terminale is an anatomic structure at the end of the spinal cord. Only a few cases of AVFs of the filum terminale have been reported. These AVFs usually consist of a single communication between the anterior spinal artery and a single draining vein. We retrospectively analyzed the clinical and radiologic features and treatment of 4 patients with spinal AVFs of the filum terminale. Clinical manifestations and MR images are similar to those of spinal dural AVFs. All patients underwent surgical or endovascular treatment, resulting in complete occlusion. Clinical outcomes were good to excellent in all patients.

Transthoracic needle biopsy using a C-arm cone-beam CT system: diagnostic accuracy and safety

OBJECTIVE

The purpose of this study was to evaluate the diagnostic accuracy and safety of performing transthoracic needle biopsy (TNB) under combined fluoroscopy and CT guidance using a C-arm cone-beam CT (CBCT) system.

METHODS

We evaluated the diagnostic accuracy and safety of performing TNB using a C-arm CBCT system. We retrospectively evaluated 99 TNB cases performed in 98 patients using a C-arm CBCT system with an 18-gauge automated cutting needle. We reviewed the diagnostic accuracy according to the size and depth of the lesion, incidence of complications, additional treatment for complications, procedure time, number of needle passes per biopsy and radiation dose.

RESULTS

The final diagnoses revealed 72 malignant and 27 benign lesions. The overall malignancy sensitivity, malignancy specificity and diagnostic accuracy were 95.8%, 100% and 97.0%, respectively, and those for small pulmonary nodules <20 mm in size were 94.1%, 100% and 96.6%, respectively. There was no significant difference in the correct diagnosis of malignancy according to lesion size (p = 0.634) or depth (p = 0.542). For benign lesions, a specific diagnosis was obtained in 14 cases (51.9%). TNB induced complications in 19 out of 99 procedures (19.2%), including pneumothorax (16.2%), immediate haemoptysis (2.0%) and subcutaneous emphysema (1.0%). Among these, four patients with pneumothorax required chest tube insertion (2.0%) or pig-tail catheter drainage (2.0%). The mean procedure time, number of needle passes and radiation doses were 11.9 ± 4.0 min, 1.2 ± 0.5 times and 170.0 ± 67.2 mGy, respectively.

CONCLUSION

TNB using a C-arm CBCT system provides high diagnostic accuracy with a low complication rate and a short procedure time, particularly for small pulmonary nodules.

Dissecting aneurysms of the distal segment of the posterior inferior cerebellar arteries: clinical presentation and management

BACKGROUND AND PURPOSE

Dissecting aneurysms of the distal segment of the PICA are rare. The purpose of this study was to evaluate the clinical presentations, imaging features, treatment options, and clinical outcomes of dissecting PICA aneurysms.

MATERIALS AND METHODS

Six patients with dissecting aneurysms in the distal segments of PICA were found in the database of a single medical center, from November 1996 to December 2008, and retrospectively evaluated. Treatment mode and follow-up clinical outcomes were analyzed.

RESULTS

Five patients with dissecting PICA aneurysms presented with acute intracranial hemorrhage and 1 patient presented with a large mass from an intramural hematoma. All 5 patients with intracranial hemorrhage were treated with endovascular occlusion of both the dissecting PICA aneurysm and the distal parent artery. The patient with the intramural hematoma underwent surgical trapping with end-to-end anastomosis. In 1 patient, the dissecting aneurysm recurred twice within a 5 year 3 month period, despite endovascular occlusion of both the aneurysm and the parent artery. The clinical outcome postprocedure was excellent in all patients, without permanent neurologic complication.

CONCLUSIONS

For the endovascular treatment of dissecting aneurysms in the distal PICA segments, we recommend occlusion of both the dissecting aneurysm and the parent artery to avoid leaving the point of initial intimal tear untreated. All of our patients had excellent clinical outcomes; however, our experience with recanalization illustrates the need for close follow-up of patients.

Spinal epidural arteriovenous fistula: a unique pathway into the perimedullary vein. A case report

SUMMARY

Spinal dural arteriovenous fistulas (AVFs) are rare vascular malformations in the spinal dura, fed by dural branches of the radicular arteries, and drain primarily into intradural venous plexuses. They may cause elevated medullary venous pressure and produce a progressive myelopathy. We describe a case of AVF in the epidural space of the previous surgery site of L3 and it showed a unique complex venous pathway into the perimedullary vein, leading to classic clinical symptoms of venous congestion in the spinal cord. The shunt was draining into bilateral epidural venous plexus and then to the paravertebral veins at the level of L2. The venous outflow entered to the epidural space again and finally refluxed into the intradural perimedullary vein.

The effects of acute temperature change on cost of transport at maximal labriform speed in bluegill Lepomis macrochirus

The effects of acute temperature change on the cost of bluegill Lepomis macrochirus swimming were quantified. At 14 degrees C, maximum labriform swimming speed (U(lab,max)) was reduced relative to that at the acclimation temperature of 22 degrees C, but total cost of transport (T(TC)) remained unchanged. At 30 degrees C, U(lab,max) was the same as at 22 degrees C, but T(TC) was 66% greater.

Risk factors associated with low birth weight infants in the Malaysian population

This study aimed to identify the risk factors which were significantly associated with low birth weight (LBW, <2500 g) infants among the Malaysian population. This was a case-control study carried out at the Tuanku Jaafar Hospital, Seremban, Malaysia over a five-month period. Cases were all infants born with birth weight less than 2500 g. Control infant were selected with the help a random sampling table from among infants with birth weight of > or =2500 g born on the same day in the hospital. Of 3341 livebirths delivered in the hospital, 422 (12.6%) were LBW infants. Logistic regression analysis showed that, after controlling for various potential confounders, the only significant risk factors associated with infants of LBW were gestational age (adjusted odds ratio (OR)=0.6, 95% C.I.: 0.5, 0.6; < 0.0001), maternal pre-pregnancy weight (adjusted OR = 0.97, 95% C.I.: 0.95, 0.99; p < 0.0001), nulliparity (adjusted OR = 3.4, 95% C.I.: 2.2, 5.1; p < 0.0001), previous history of LBW infants (adjusted OR = 2.3, 95% C.I.: 1.4, 3.8; p=0.001) and PIH during current pregnancy (adjusted OR=3.3, 95% C.I.: 1.6, 6.6; p = 0.001). A number of potentially preventable or treatable risk factors were identified to be associated with LBW infants in Malaysia.

Preparation of 153Sm-chitosan complex for radiation synovectomy

A samarium 153-chitosan complex was prepared by simply mixing acidic solutions of chitosan and (153)SmCl(3). When a solution of this complex was injected into the knee joints of rabbits, minimal extra-articular leakage was observed. This can be attributed to the rapid change in the pH of the complex solution from acidic to neutral, resulting in the formation of gel followed by the subsequent retention in the administered site. Thus, the complex solution represents a promising candidate for radiation synovectomy.