P96 Screening for cerebrovascular pathology on the basis of positive family history in the paediatric population

Objectives

Neurovascular disorders are uncommon, complex conditions in children. We reviewed the screening practice and outcome of children referred to the neurovascular service on the basis of positive family history.

Design

Retrospective review of prospectively maintained database.

Subjects

Children referred to the neurovascular service on the basis of family history, for screening at our hospital.

Methods

We retrospectively examined our database between July 2008 and April 2018 for the reasons for referral, family history, investigations performed, and the outcome of the screening process.

Results

44 children were reviewed (23 male, median age 10). Thirty-one children had an MRI/MRA brain. One child subsequently had uncomplicated digital subtraction angiography. Thirty children were referred due to a family history of subarachnoid haemorrhage, of which 17 had a single first-degree relative, and two had two first-degree relatives. Nine children were referred with a family history of arteriovenous malformation, (2 were associated with hereditary haemorrhagic telangiectasia). Five children were discussed due to a family history of non-specific haemorrhagic stroke. Seven children had a history of headache, (4 were prescribed Pizotifen for migraine). No neurovascular pathology was detected following screening within our cohort.

Conclusions

A consensus screening policy does not exist but is required both to guide clinical practice and to assuage parental or patient concerns. We will survey UK paediatric centres to commence this process.

Abstract P3-03-11: Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients

Introduction

The intraoperative assessment of the sentinel node in women with breast cancer enables an immediate axillary node clearance to be done as part of the same operative procedure if the sentinel node is positive. This has significant benefits for the Patient, the Surgeon and the Health Care Provider. There are a variety of methods for the intra-operative assessment of the sentinel node which include: Touch Imprint Cytology, Frozen Section Analysis and Polymerase Chain Reaction (PCR) based molecular assays. OSNA is an automated molecular assay using a Polymerase Chain Reaction (PCR), which detects the presence of cytokeratin 19 in the sentinel node. We report our experience of OSNA for the intraoperative assessment of the sentinel node in our institution with 1148 patients.

Methods

All patients with operable breast cancer who were found to be node negative on clinical and radiological assessment of the axilla, and who had their axilla staged by a sentinel node biopsy at the Breast Unit at Warwick Hospital, UK over a 7 year period were included in this study. Data was collected from a prospective database maintained at the Breast Unit. The axillary node positivity rate and the number of patients with macrometastatic and micrometastatic disease as detected by OSNA was collected and compared with a group of 411 patients who had the intraoperative assessment by Touch Imprint Cytology and final histology by conventional Haematoxylin & Eosin (H&E) assessment, prior to the introduction of OSNA. The Chi-square test were used for statistical significance.

Results

1148 patients had their sentinel node assessed intraoperatively using OSNA in this 7 year study period. The sentinel node was positive in 376 patients (32.8%). Of those who had a positive node, 183 (15.9%) had macro-metastatic disease and 193 (16.8%) had micro-metastatic disease. When compared to 411 patients in the pre-OSNA period, that were assessed by Touch Imprint Cytology and H&E sections, the node positivity rate increased from 23.8% to 32.8% (p<0.05) with the introduction of OSNA. Whilst there was no significant increase in the rate of macrometastatic disease – 20.4% versus 15.9 % ( p0.038), there was a significant increase in the patients who had micrometastases detected on OSNA - 3.4% versus 16.8 % ( p<0.05) as shown in the table.

Conclusion

Our results demonstrate that OSNA is a more sensitive test for picking up metastatic disease, especially micrometastatic disease, in the sentinel node. Whilst this did cause some anxiety initially, the results of recent trials like ACSOG Z-11 and IBCSG 23-01 have shown that small volume disease or micrometastases in the sentinel node do not require an axillary node clearance. Intraoperative assessment of the sentinel node with OSNA significantly upstages the axillary nodal status, especially with regard to micrometastatic disease, but the ability to proceed to an axillary node clearance at the same operation as the sentinel node biopsy, still has significant advantages for the Patient, Surgeon and Health Care Providers.

Citation Format: Clarke D, Sinha A, Ion L, Weston S, Jones L, Kham M, Harries S. Intraoperative assessment of the sentinel node in breast cancer by one step nucleic acid assay: Experience of over 1100 patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-03-11.

Proteasome lid bridges mitochondrial stress with Cdc53/Cullin1 NEDDylation status

Cycles of Cdc53/Cullin1 rubylation (a.k.a NEDDylation) protect ubiquitin-E3 SCF (Skp1-Cullin1-F-box protein) complexes from self-destruction and play an important role in mediating the ubiquitination of key protein substrates involved in cell cycle progression, development, and survival. Cul1 rubylation is balanced by the COP9 signalosome (CSN), a multi-subunit derubylase that shows 1:1 paralogy to the 26S proteasome lid. The turnover of SCF substrates and their relevance to various diseases is well studied, yet, the extent by which environmental perturbations influence Cul1 rubylation/derubylation cycles per se is still unclear. In this study, we show that the level of cellular oxidation serves as a molecular switch, determining Cullin1 rubylation/derubylation ratio. We describe a mutant of the proteasome lid subunit, Rpn11 that exhibits accumulated levels of Cullin1-Rub1 conjugates, a characteristic phenotype of csn mutants. By dissecting between distinct phenotypes of rpn11 mutants, proteasome and mitochondria dysfunction, we were able to recognize the high reactive oxygen species (ROS) production during the transition of cells into mitochondrial respiration, as a checkpoint of Cullin1 rubylation in a reversible manner. Thus, the study adds the rubylation cascade to the list of cellular pathways regulated by redox homeostasis.

Facile synthesis of oligo anilines as permanent hair dyes: how chemical modifications impart colour and avoid toxicity

Chemical modification of the hair dye para-phenylenediamine results in colors that avoid in situ oxidation and toxicity.

MnIV-Oxo complex of a bis(benzimidazolyl)-containing N5 ligand reveals different reactivity trends for MnIV-oxo than FeIV-oxo species

Using the pentadentate ligand (N-bis(1-methyl-2-benzimidazolyl)methyl-N-(bis-2-pyridylmethyl)amine, 2pyN2B), presenting two pyridyl and two (N-methyl)benzimidazolyl donor moieties in addition to a central tertiary amine, new MnII and MnIV-oxo complexes were generated and characterized. The [MnIV(O)(2pyN2B)]2+ complex showed spectroscopic signatures (i.e., electronic absorption band maxima and intensities, EPR signals, and Mn K-edge X-ray absorption edge and near-edge data) similar to those observed for other MnIV-oxo complexes with neutral, pentadentate N5 supporting ligands. The near-IR electronic absorption band maximum of [MnIV(O)(2pyN2B)]2+, as well as DFT-computed metric parameters, are consistent with the equatorial (N-methyl)benzimidazolyl ligands being stronger donors to the MnIV center than the pyridyl and quinolinyl ligands found in analogous MnIV-oxo complexes. The hydrogen- and oxygen-atom transfer reactivities of [MnIV(O)(2pyN2B)]2+ were assessed through reactions with hydrocarbons and thioanisole, respectively. When compared with related MnIV-oxo adducts, [MnIV(O)(2pyN2B)]2+ showed muted reactivity in hydrogen-atom transfer reactions with hydrocarbons. This result stands in contrast to observations for the analogous FeIV-oxo complexes, where [FeIV(O)(2pyN2B)]2+ was found to be one of the more reactive members of its class.

Relapse following use of Ponseti method in idiopathic clubfoot

PURPOSE

We assessed the pattern of relapse as well as the correlation between the number of casts required for correction and Pirani and Dimeglio scores at presentation, and age at presentation. We hypothesized that the Ponseti method would be effective in treatment of relapsed clubfoot as well.

METHODS

We evaluated 115 idiopathic clubfeet in 79 children presenting with relapse following treatment by the Ponseti method. The mean age was 33.8 months with mean follow-up of 24 months. All patients were assessed for various patterns of relapsed deformities. Quantification of deformities was done using the Pirani and Dimeglio scores. All relapsed feet were treated by a repeat Ponseti protocol.

RESULTS

Non-compliance to a foot abduction brace was observed to be the main contributing factor in relapse, in 99 clubfeet (86%). Combination of three static deformities (equinus, varus and adduction) together was observed most commonly (38.3% feet). Overall, relapse of equinus deformity was noted most commonly followed by adduction. A painless plantigrade foot was obtained in all 115 feet with a mean of five casts. In all, 71 feet (61.7%) underwent percutaneous tenotomy. A total of 15 feet (13%) required tibialis anterior tendon transfer. Re-relapse rate in group 1 was 21% compared with 12.6% in group 2 and overall 16.5%.

CONCLUSION

We conclude that the Ponseti method is effective and the preferred initial treatment modality for relapsed clubfeet. Surgical intervention should be reserved for residual deformity only after a fair trial of Ponseti cast treatment. Regular follow-up and strict adherence to brace protocol may reduce future relapse rates. Further research is required to identify high-risk feet and develop individualized bracing protocol.

LEVEL OF EVIDENCE

IV.

Posttransplant Lymphoproliferative Disorder: Experience from a Pediatric Nephrology Unit in North India

Posttransplant lymphoproliferative disorder (PTLD) is reported in 1%–3% among pediatric renal allograft recipients. We report the experience of PTLD among pediatric renal allograft recipients at a pediatric nephrology center in North India. Four cases of PTLD were identified from among records of 95 pediatric renal allograft recipients over a period of 21 years. Constitutional and localizing symptoms were present in three patients each. The diagnosis was suggested on positron emission tomography in three patients and confirmed by histopathology in all. Sites affected included tonsils, cervical lymph nodes, duodenum, and para-aortic lymph nodes in one patient each. The lymphocytic infiltrate was polymorphic in three patients and monomorphic in one. Immunostaining suggested B-cell origin in all patients. There was evidence of Epstein–Barr virus infection in only one patient. The patients were successfully managed with reduction of immunosuppression (in all), rituximab (in 3), and excision of affected tissue (in 1). Over a follow-up period of 30–88 months, there were no episodes of disease recurrence or allograft rejection, and renal function was preserved.

A Study to Assess the Quality of Life of Postoperative Patients With Oral Cancer in B.R.A I.R.C.H., AIIMS, New Delhi

Introduction: Cancer is a leading cause of death in both developed and underdeveloped countries in the world. The Indian subcontinent accounts for one-third of the world burden of head and neck cancer. Surgery is the standard treatment of choice for head and neck cancers. It is imperative to give supportive care to improve the quality of life. Aim: To assess the quality of life of postoperative patients with oral cancer in B.R.A I.R.C.H, AIIMS, New Delhi. Methodology: The study was conducted at B.R.A.I.R.C.H, AIIMS, New Delhi. The data were collected by convenience sampling from 50 adults who underwent surgery for oral during June 2017 to December 2017. Standardized self-structured EORTC QOL(H&N) was used to assess the perceived level of the quality of life of postoperative patients with oral cancer during hospital stay and at one month follow-up. Ethical clearance was obtained from institutional ethics committee. Results: 80% patients were male. Majority of the patients underwent mandibulectomy (66%) modified neck dissection (60%) and regional flap reconstruction (56%). The major symptoms perceived during hospital stay were pain (98%), speech problem (84%), problem in opening mouth (82%), felt ill (80%), weight loss (74%), etc. and at one month follow-up were problem in opening mouth (90.6%), pain (90.5%), speech problem (83.6%), weight loss (82%), among many others. There was a significant decrease in the perceived pain (11.2 ± 2.99) at one month follow-up (9.12 ± 3.42). Conclusion: Most of the patients experience pain, problem in opening mouth, sticky saliva, speech problem, trouble in social contact, weight loss, etc.

Risk of desmoid formation after laparoscopic versus open colectomy and ileorectal anastomosis for familial adenomatous polyposis

Background

Laparoscopy is used increasingly in prophylactic surgery for patients with familial adenomatous polyposis (FAP) undergoing colectomy with ileorectal anastomosis (IRA). Little is known about the impact of laparoscopy on subsequent desmoid risk. This study documented the risk of desmoid in patients undergoing laparoscopic and open IRA.

Methods

This was an observational study of patients with FAP and known germline APC mutation, undergoing IRA at a tertiary referral centre between 1996 and 2016. Patients were retrieved from a prospectively maintained polyposis registry. Data included genotype, family history of desmoid, sex, surgical approach at IRA and postoperative complications. The main outcome was development of either a clinically or radiologically significant desmoid.

Results

Some 112 patients (61 female) underwent colectomy and IRA. A laparoscopic approach was used in 69 patients (61·6 per cent). Baseline characteristics did not differ between patients having an open or laparoscopic approach. Median follow‐up was 5·8 (i.q.r. 2·4–11·2) years. Patients who underwent laparoscopic IRA had a reduced risk of desmoid formation (3 of 69 (4 per cent) versus 7 of 43 (16 per cent) in the open group; P = 0·043).

Discussion

Laparoscopic IRA may reduce risk of subsequent desmoid formation in patients with FAP.

Cross-sectional associations of albuminuria among Aboriginal and Torres Strait Islander adults: the eGFR Study

OBJECTIVE

To describe the detailed associations of albuminuria among a contemporary cohort of Aboriginal and Torres Strait Islander people to inform strategies for chronic kidney disease prevention and management.

METHODS

A cross-sectional analysis of Indigenous participants of the eGFR Study.

MEASURES

Clinical, biochemical and anthropometric measures were collected (including body-circumferences, blood pressure (BP); triglycerides, HbA1c, liver function tests, creatinine; urine- microscopic-haem, albumin: creatinine ratio (ACR), prescriptions- angiotensin converting enzyme inhibitor or angiotensin receptor II antagonist (ACEI/ARB). Albuminuria and diabetes were defined by an ACR>3.0 mg/mmol, and HbA1c≥48 mmol/mol or prior history respectively. Waist: hip ratio (WHR), and estimated glomerular filtration rate (eGFR) were calculated. ACR was non-normally distributed; a logarithmic transformation was applied (in base 2), with each unit increase in log2-albuminuria representing a doubling of ACR.

RESULTS

591 participants were assessed (71% Aboriginal, 61.6% female, mean age 45.1 years, BMI 30.2 kg/m² , WHR 0.94, eGFR 99.2 ml/min/1.73m² ). The overall prevalence of albuminuria, diabetes, microscopic-haem and ACEI/ARB use was 41.5%, 41.5%, 17.8% and 34.7% respectively; 69.3% of adults with albuminuria and diabetes received an ACEI/ARB. Using multivariable linear regression modelling, the potentially modifiable factors independently associated with log2-albuminuria were microscopic-haem, diabetes, WHR, systolic BP, alkaline phosphatase (all positive) and eGFR (inverse).

CONCLUSION

Albuminuria is associated with diabetes, central obesity and haematuria. High ACEI/ARB prescribing for adults with diabetes and albuminuria was observed. Further understanding of the links between fat deposition, haematuria and albuminuria is required.

Relationship between Hydrogen-Atom Transfer Driving Force and Reaction Rates for an Oxomanganese(IV) Adduct

Hydrogen atom transfer (HAT) reactions by high-valent metal-oxo intermediates are important in both biological and synthetic systems. While the HAT reactivity of Fe^IV-oxo adducts has been extensively investigated, studies of analogous Mn^IV-oxo systems are less common. There are several recent reports of Mn^IV-oxo complexes, supported by neutral pentadentate ligands, capable of cleaving strong C-H bonds at rates approaching those of analogous Fe^IV-oxo species. In this study, we provide a thorough analysis of the HAT reactivity of one of these Mn^IV-oxo complexes, [Mn^IV(O)(2pyN2Q)]²⁺, which is supported by an N5 ligand with equatorial pyridine and quinoline donors. This complex is able to oxidize the strong C-H bonds of cyclohexane with rates exceeding those of Fe^IV-oxo complexes with similar ligands. In the presence of excess oxidant (iodosobenzene), cyclohexane oxidation by [Mn^IV(O)(2pyN2Q)]²⁺ is catalytic, albeit with modest turnover numbers. Because the rate of cyclohexane oxidation by [Mn^IV(O)(2pyN2Q)]²⁺ was faster than that predicted by a previously published Bells-Evans-Polanyi correlation, we expanded the scope of this relationship by determining HAT reaction rates for substrates with bond dissociation energies spanning 20 kcal/mol. This extensive analysis showed the expected correlation between reaction rate and the strength of the substrate C-H bond, albeit with a shallow slope. The implications of this result with regard to Mn^IV-oxo and Fe^IV-oxo reactivity are discussed.

Cardiovascular outcomes of Nephrotic syndrome in childhood (CVONS) study: a protocol for prospective cohort study

BACKGROUND

Nephrotic syndrome (NS) is characterized by dyslipidemia which is a well-known risk factor for atherogenesis. Atherosclerosis in childhood is mostly subclinical and endothelial dysfunction is known to precede this. Evidence for screening for endothelial dysfunction and cardiovascular risk factors and early identification of premature onset of atherosclerosis in childhood NS remains tenuous in the absence of well-designed prospective studies addressing cardiovascular comorbidity in NS. The objective of our study is to examine endothelial dysfunction and short-term cardiovascular outcomes in a carefully phenotyped cohort of patients with Nephrotic syndrome as compared to healthy controls.

METHODS

In a multi-centric prospective cohort study, 70 Steroid Resistant NS (SRNS), 70 Steroid Sensitive (SSNS) patients along with 70 Healthy Controls are being recruited. After a baseline assessment of functional and structural status of heart (2D Echocardiography), arteries (Carotid Doppler and Intima Media Thickness measurements) and microcirculation [a combination of 2D Echocardiography, Laser Doppler Flowmetry (LDF) and Brachial Artery Flow mediated dilation (FMD) and Nail Fold Capillaroscopy (NFC)], the patients are being investigated for endothelial dysfunction. Venous blood sample (15 ml) is being collected for routine investigations and assay of biochemical endothelial markers through Flow Cytometry. The patients will be followed up at 12 months and 24 months after the recruitment to look for any change from baseline period.

DISCUSSION

This study will able to provide a better understanding of the epidemiology of endothelial dysfunction and associated subclinical cardiovascular co-morbidity in childhood NS. Findings on characterization of prevalence of endothelial dysfunction and subclinical markers may be used to design future randomized controlled trials for evaluating the efficacy of preventive and therapeutic interventions in reducing the incidence of cardiovascular disease.

Volatility and Chain Length Interplay of Primary Amines: Mechanistic Investigation on the Stability and Reversibility of Ammonia-Responsive Hybrid Perovskites

Hybrid organic-inorganic perovskites possess promising signal transduction properties, which can be exploited in a variety of sensing applications. Interestingly, the highly polar nature of these materials, while being a bane in terms of stability, can be a boon for sensitivity when they are exposed to polar gases in a controlled atmosphere. However, signal transduction during sensing induces irreversible changes in the chemical and physical structure, which is one of the major lacuna preventing its utility in commercial applications. In the context of developing alkylammonium lead(II) iodide perovskite materials for sensing, here we address major issues such as reversibility of structure and properties, correlation between instability and properties of alkylamines, and relation between packing of alkyl chains inside the crystal lattice and the response time toward NH₃ gas. The current investigation highlights that the vapor pressure of alkylamine formed in the presence of NH₃ determines the reversibility and stability of the original perovskite lattice. In addition, close packing of alkyl chains inside the perovskite crystal lattice reduces the response toward NH₃ gas. The mechanistic study addresses three important factors such as quick response, reversibility, and stability of perovskite materials in the presence of NH₃ gas, which could lead to the design of stable and sensitive two-dimensional hybrid perovskite materials for developing sensors.

Abstract P3-09-05: Getting the most out of the 21-gene recurrence score assay: Increasing actionable results with a combined pathologic-genomic model

Introduction: The 21-gene recurrence score (RS) assay categorizes hormone receptor positive, node negative breast cancers (BC) into 3 risk groups for recurrence. We previously showed that the AAMC Model, using only standard pathology data, accurately does the same. This study compares the recurrence rate of the AAMC Model's risk groups to RS-based risk groups. A 2-step approach then is used, in which the AAMC model is applied first, and the RS assay is used only for AAMC intermediate risk cases. AAMC intermediate cases were reclassified by RS into low or high risk groups.

Methods: From a prospective registry of newly diagnosed BC, we selected invasive, hormone receptor positive, HER2 negative, lymph node negative cases from 2005 to 2015 tested with RS assay. Five-year Kaplan-Meier distant recurrence rates were calculated for each risk category.

Results: 1268 cases were included. Five-year recurrence rates were similar between the AAMC Model's low risk group and RS<18 low risk group, as well as between the AAMC Model's high risk group and the RS>30 high risk group. Applying the RS assay to the 715 cases in the AAMC Model's intermediate group resulted in re-classifying 417 (58%) as low risk and 41 (6%) as high risk. Using RS alone, 33% of cases were intermediate risk (n=424), whereas in the 2-step approach 20% were intermediate risk (n=257). For the 2-step approach, the 5-year distant recurrence rate was 3.3% for the low risk group (n=740) and 24.4% for the high risk group (n=271).

Conclusions: Five-year recurrence rates in the AAMC Model's low and high risk groups were similar to those in RS-based risk groups. The 2-step approach, with RS used only for AAMC intermediate cases, resulted in larger low and high risk groups with equivalent prognostic accuracy, compared to use of the RS assay alone. The 2-step approach reliably identifies a large number of patients unlikely to benefit from 21 gene assay and provides substantial cost savings.

Kaplan-Meier Calculated 5-year Distant Recurrences Rates for 4 Models: 1268 Patients Oncotype DXTAILORxAAMC Model2 Step Model with OncotypeDX for AAMC IntermediatesLow RiskRS < 18 (n=703)RS < 11 (n=250)Grade 1 and PR ≥ 1% (n=323)AAMC Low or AAMC intermediate/RS <18 (n=740) 3.4% (95% CI 1.6 – 5.1%, nf=17)4.0% (95% CI 0.8 – 7.2%, nf=8)2.7% (95% CI 0.0 – 5.4%, nf=5)3.3% (95% CI 1.4 – 5.2%, nf=16)Intermediate RiskRS 18 - 30 (n=424)RS 11 - 25 (n=787)Not meeting AAMC definition for low or high risk (n=715)AAMC Intermediate and RS 18-30 (n=257) 15.2% (95% CI 10.3 – 20.1%, nf=38)7.3% (95% CI 4.7 – 9.9%, nf=35)8.4% (95% CI 5.4 – 11.3%, nf=36)12.0% (95% CI 5.8 – 18.1%, nf=15)High RiskRS > 30 (n=141)RS > 25 (n=231)Grade 3 or ER < 20% (n=230)AAMC High or AAMC intermediate/RS > 30 (n=271) 23.0% (95% CI 14.7 – 31.3%, nf=27)22.9% (95% CI 15.9 – 29.9%, nf=39)22.8% (95% CI 16.1 – 29.5%, nf=41)24.4% (95% CI 18.0 – 30.7%, nf=51)RS= Recurrence Score, nf=number of recurrences, CI = confidence interval.

Citation Format: Mylander C, Rosman M, Gage M, Fujii T, Le Du F, Raghavendra A, Sinha A, Espinosa Fernandez JR, James A, Ueno N, Tafra L, Jackson R. Getting the most out of the 21-gene recurrence score assay: Increasing actionable results with a combined pathologic-genomic model [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 P3-09-05.

Fluoride-associated ultrastructural changes and apoptosis in human renal tubule: a pilot study

The susceptibility of the kidneys to fluoride toxicity can largely be attributed to its anatomy and function. As the filtrate moves along the complex tubular structure of each nephron, it is concentrated in the proximal and distal tubules and collecting duct. It has been frequently observed that the children suffering from renal impairments also have some symptoms of dental and skeletal fluorosis. The findings suggest that fluoride somehow interferes with renal anatomy and physiology, which may lead to renal pathogenesis. The aim of this study was to evaluate the fluoride-associated nephrotoxicity. A total of 156 patients with childhood nephrotic syndrome were screened and it was observed that 32 of them had significantly high levels ( p ≤ 0.05) of fluoride in urine (4.01 ± 1.83 ppm) and serum (0.1 ± 0.013 ppm). On the basis of urinary fluoride concentration, patients were divided into two groups, namely group 1 (G-1) ( n = 32) containing normal urine fluoride (0.61 ± 0.17 ppm) and group 2 (G-2) ( n = 32) having high urine fluoride concentration (4.01 ± 1.83 ppm). Age-matched healthy subjects ( n = 33) having normal levels of urinary fluoride (0.56 ± 0.15 ppm) were included in the study as control (group 0 (G-0)). Kidney biopsies were taken from G-1 and G-2 only, who were subjected to ultrastructural (transmission electron microscopy) and apoptotic (terminal deoxynucleotidyl transferase deoxyuridine triphosphate nick end labeling) analysis. Various subcellular ultrastructural changes including nuclear disintegration, chromosome condensation, cytoplasmic ground substance lysis, and endoplasmic reticulum blebbing were observed. Increased levels of apoptosis were observed in high fluoride group (G-2) compared to normal fluoride group (G-1). Various degrees of fluoride-associated damages to the architecture of tubular epithelia, such as cell swelling and lysis, cytoplasmic vacuolation, nuclear condensation, apoptosis, and necrosis, were observed.

Bilirubin concentration is positively associated with haemoglobin concentration and inversely associated with albumin to creatinine ratio among Indigenous Australians: eGFR Study

Low serum bilirubin concentrations are reported to be strongly associated with cardio-metabolic disease, but this relationship has not been reported among Indigenous Australian people who are known to be at high risk for diabetes and chronic kidney disease (CKD).

HYPOTHESIS

serum bilirubin will be negatively associated with markers of chronic disease, including CKD and anaemia among Indigenous Australians.

METHOD

A cross-sectional analysis of 594 adult Aboriginal and Torres Strait Islander (TSI) people in good health or with diabetes and markers of CKD. Measures included urine albumin: creatinine ratio (ACR), estimated glomerular filtration rate (eGFR), haemoglobin (Hb) and glycated haemoglobin (HbA1c). Diabetes was defined by medical history, medications or HbA1c≥6.5% or ≥48mmol/mol. Anaemia was defined as Hb<130g/L or <120g/L in males and females respectively. A multivariate regression analysis examining factors independently associated with log-bilirubin was performed.

RESULTS

Participants mean (SD) age was 45.1 (14.5) years, and included 62.5% females, 71.7% Aboriginal, 41.1% with diabetes, 16.7% with anaemia, 41% with ACR>3mg/mmol and 18.2% with eGFR<60mL/min/1.73m². Median bilirubin concentration was lower in females than males (6 v 8μmol/L, p<0.001) and in Aboriginal than TSI participants (6 v 9.5μmol/L, p<0.001). Six factors explained 35% of the variance of log-bilirubin; Hb and cholesterol (both positively related) and ACR, triglycerides, Aboriginal ethnicity and female gender (all inversely related).

CONCLUSION

Serum bilirubin concentrations were positively associated with Hb and total cholesterol, and inversely associated with ACR. Further research to determine reasons explaining lower bilirubin concentrations among Aboriginal compared with TSI participants are needed.

Exhaled breath profiles in the monitoring of loss of control and clinical recovery in asthma

BACKGROUND

Asthma is a chronic inflammatory airway disease, associated with episodes of exacerbations. Therapy with inhaled corticosteroids (ICS) targets airway inflammation, which aims to maintain and restore asthma control. Clinical features are only modestly associated with airways inflammation. Therefore, we hypothesized that exhaled volatile metabolites identify longitudinal changes between clinically stable episodes and loss of asthma control.

OBJECTIVES

To determine whether exhaled volatile organic compounds (VOCs) as measured by gas-chromatography/mass-spectrometry (GC/MS) and electronic nose (eNose) technology discriminate between clinically stable and unstable episodes of asthma.

METHODS

Twenty-three patients with (partly) controlled mild to moderate persistent asthma using ICS were included in this prospective steroid withdrawal study. Exhaled metabolites were measured at baseline, during loss of control and after recovery. Standardized sampling of exhaled air was performed, after which samples were analysed by GC/MS and eNose. Univariate analysis of covariance (ANCOVA), followed by multivariate principal component analysis (PCA) was used to reduce data dimensionality. Next paired t tests were utilized to analyse within-subject breath profile differences at the different time-points. Finally, associations between exhaled metabolites and sputum inflammation markers were examined.

RESULTS

Breath profiles by eNose showed 95% (21/22) correct classification for baseline vs loss of control and 86% (19/22) for loss of control vs recovery. Breath profiles using GC/MS showed accuracies of 68% (14/22) and 77% (17/22) for baseline vs loss of control and loss of control vs recovery, respectively. Significant associations between exhaled metabolites captured by GC/MS and sputum eosinophils were found (Pearson r≥.46, P<.01).

CONCLUSIONS & CLINICAL RELEVANCE

Loss of asthma control can be discriminated from clinically stable episodes by longitudinal monitoring of exhaled metabolites measured by GC/MS and particularly eNose. Part of the uncovered biomarkers was associated with sputum eosinophils. These findings provide proof of principle for monitoring and identification of loss of asthma control by breathomics.

Tuberculosis treatment outcomes among disadvantaged patients in India

Setting: Urban slums and poor rural areas in India, 2012-2014. Objective: To describe the characteristics of tuberculosis (TB) patients enrolled in treatment through Operation ASHA, a non-governmental organisation serving disadvantaged populations in India, and to identify risk factors for unfavourable treatment outcomes. Design: This was a retrospective cohort study. Patient characteristics were assessed for their relationship with treatment outcomes using mixed effects logistic regression, adjusting for clustering by treatment centre and Indian state. Outcomes were considered favourable (cured/treatment completed) or unfavourable (treatment failure, loss to follow-up, death, switch to multidrug-resistant TB treatment, transfer out). Results: Of 8415 patients, 7148 (84.9%) had a favourable outcome. On multivariable analysis, unfavourable outcomes were more common among men (OR 1.31, 95%CI 1.15-1.51), older patients (OR 1.12, 95%CI 1.04-1.21) and previously treated patients (OR 2.05, 95%CI 1.79-2.36). Compared to pulmonary smear-negative patients, those with extra-pulmonary disease were less likely to have unfavourable outcomes (OR 0.72, 95%CI 0.60-0.87), while smear-positive pulmonary patients were more likely to have unfavourable outcomes (OR 1.38, 95%CI 1.15-1.66 for low [scanty/1+] and OR 1.71, 95%CI 1.44-2.04 for high [2+/3+] positive smears). Conclusion: The treatment success rate within Operation ASHA is comparable to that reported nationally for India. Men, older patients, retreatment cases and smear-positive pulmonary TB patients may need additional interventions to ensure a favourable outcome.

Abstract PD7-03: A model using grade and hormone receptor staining defines groups at low vs. high risk for distant metastasis: Comparison to the 21-gene recurrence score

Background: The 21-gene recurrence score (RS) combines breast cancer (BC) expression of multiple genes into a single number which is prognostic for BC recurrence. We previously showed that a model using standard pathology data (AAMC Risk Groups) has substantial overlap with RS Risk Groups. The present study compared the recurrence rate of AAMC Risk Groups to that of RS-based Risk Groups as defined by the TAILORx trial and OncotypeDX (ODX) assay.

Methods: From a prospective registry of BC treated at MD Anderson Cancer Center (2/2005 – 5/2015), we selected cases tested with ODX. Cases were excluded for: other cancer in the past 5 years, T4 stage, node positivity, missing grade, missing ER%, ER&PR&lt;1% or HER2 positivity. Three methods were used to categorize distant metastatic risk: ODX and TAILORx Risk Groups were defined using RS, and AAMC Risk Groups were defined using grade and ER/PR level (Tables). For each method, the proportion of patients experiencing metastasis was calculated within Risk Groups.

Results: 1296 cases were included, with a mean follow-up of 3.5 years (25% had ≥ 4.9 years of follow-up). 82 cases (6.3%, 95% CI 5.1 – 7.8%) experienced distant metastasis, with a mean time-to-metastasis of 2.7 years. The proportion of patients experiencing distant metastasis was similar between the AAMC Low Risk Group (1.5%) and the TAILORx (3.2%) and ODX (2.4%) Low Risk Groups. The AAMC Low Risk Group was less than half the size of the ODX Low Risk Group. Of the 5 recurrences in the AAMC Low Risk Group, 1 was ODX Low Risk and 4 were ODX Intermediate Risk; 2 had 1% PR staining. Of the 17 recurrences in the ODX Low Risk Group, 1 was AAMC Low Risk and 5 (all grade 3) were AAMC High Risk; 3 had PR staining &lt; 10%. The proportion of patients experiencing distant metastasis was similar between the AAMC High Risk Group (17.4%) and the TAILORx (16.4%) and ODX (18.2%) High Risk Groups. The number of patients in the AAMC High Risk Group was greater than the ODX High Risk Group.

Table 1: Distant Metastasis in Low Risk GroupsAAMC Definition (n=329)TAILORx Definition (n=250)OncotypeDX Definition (n=704)Low Risk DefinitionGrade 1 & PR ≥1%RS &lt; 11RS &lt;18% with Distant Metastasis1.5% (95% CI 0.6–3.7%; n=5)3.2% (95% CI 1.5-6.4%, n=8)2.4% (95% CI 1.5-3.9%, n=17)% in Common with AAMC Low Risk Group100% (329/329)31.7% (80/250)33.3% (235/704)

Table 2: Distant Metastasis in High Risk GroupsAAMC Definition (n=235)TAILORx Definition (n=238)OncotypeDX Definition (n=148)High Risk DefinitionGrade 3 or ER &lt;20%RS &gt; 25RS &gt; 30% with Distant Metastasis17.4% (95% CI 12.9-23.0%, n=41)16.4% (95% CI 12.0-21.8%, n=39)18.2% (95% CI 12.6– 25.6%, n=27)% in Common with AAMC High Risk Group100% (235/235)56.7% (135/238)70.3% (104/148)

Conclusions: AAMC Low and High Risk Groups were prognostic of the likelihood of distant metastasis, and performed similarly to TAILORx and ODX Low and High Risk Groups. If RS were omitted for AAMC Low and High Risk cases, 44% [(329+235)/1296] of cases in the present cohort could have been spared ODX testing. The AAMC Risk Groups, using standard pathology data, can reliably identify a large number of patients unlikely to benefit from ODX testing and thus provide substantial cost savings.

Citation Format: Mylander C, Jackson RS, Rosman M, Fujii T, Le Du F, Raghavendra A, Sinha A, Ueno NT, Tafra L. A model using grade and hormone receptor staining defines groups at low vs. high risk for distant metastasis: Comparison to the 21-gene recurrence score [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 PD7-03.

Development of X-ray CCD camera based X-ray micro-CT system

Availability of microfocus X-ray sources and high resolution X-ray area detectors has made it possible for high resolution microtomography studies to be performed outside the purview of synchrotron. In this paper, we present the work towards the use of an external shutter on a high resolution microtomography system using X-ray CCD camera as a detector. During micro computed tomography experiments, the X-ray source is continuously ON and owing to the readout mechanism of the CCD detector electronics, the detector registers photons reaching it during the read-out period too. This introduces a shadow like pattern in the image known as smear whose direction is defined by the vertical shift register. To resolve this issue, the developed system has been incorporated with a synchronized shutter just in front of the X-ray source. This is positioned in the X-ray beam path during the image readout period and out of the beam path during the image acquisition period. This technique has resulted in improved data quality and hence the same is reflected in the reconstructed images.

Inter-ligand electronic coupling mediated through a dimetal bridge: dependence on metal ions and ancillary ligands

The metal–metal bond orbitals and the ancillary ligands influence inter-ligand charge transfer through the dimetal bridge.

Measured Glomerular Filtration Rate at Dialysis Initiation and Clinical Outcomes of Indian Peritoneal Dialysis Patients

The optimal time for dialysis initiation remains controversial. Studies have failed to show better outcomes with early initiation of hemodialysis; even a few had shown increased adverse outcomes including poorer survival. Few studies have examined the same in patients on peritoneal dialysis (PD). Measured glomerular filtration rate (mGFR) not creatinine-based estimated GFR is recommended as the measure of kidney function in end-stage renal disease (ESRD) patients. The objective of this observational study was to compare the outcomes of Indian patients initiated on PD with different residual renal function (RRF) as measured by 24-h urinary clearance method. A total of 352 incident patients starting on chronic ambulatory PD as the first modality of renal replacement therapy were followed prospectively. Patients were categorized into three groups as per mGFR at the initiation of PD (≤5, >5–10, and >10 ml/min/1.73 m²). Patient survival and technique survival were compared among the three groups. Patients with GFR of ≤5 ml/min/1.73 m² (hazard ratio [HR] - 3.42, 95% confidence interval [CI] - 1.85–6.30, P = 0.000) and >5–10 ml/min/1.73 m² (HR - 2.16, 95% CI - 1.26–3.71, P = 0.005) had higher risk of mortality as compared to those with GFR of >10 ml/min/1.73 m². Each increment of 1 ml/min/1.73 m² in baseline GFR was associated with 10% reduced risk of death (HR - 0.90, 95% CI - 0.85–0.96, P = 0.002). Technique survival was poor in those with an initial mGFR of ≤5 ml/min/1.73 m² as compared to other categories. RRF at the initiation was also an important factor predicting nutritional status at 1 year of follow-up. To conclude, initiation of PD at a lower baseline mGFR is associated with poorer patient and technique survival in Indian ESRD patients.

Estimation of Photon Specific Absorbed Fractions in Digimouse Voxel Phantom using Monte Carlo Simulation Code FLUKA

BACKGROUND

Most preclinical studies are carried out on mice. For internal dose assessment of a mouse, specific absorbed fraction (SAF) values play an important role. In most studies, SAF values are estimated using older standard human organ compositions and values for limited source target pairs.

OBJECTIVE

SAF values for monoenergetic photons of energies 15, 50, 100, 500, 1000 and 4000 keV were evaluated for the Digimouse voxel phantom incorporated in Monte Carlo code FLUKA. The organ sources considered in this study were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal, eye and brain. The considered target organs were lungs, skeleton, heart, bladder, testis, stomach, spleen, pancreas, liver, kidney, adrenal and brain. Eye was considered as a target organ only for eye as a source organ. Organ compositions and densities were adopted from International Commission on Radiological Protection (ICRP) publication number 110.

RESULTS

Evaluated organ masses and SAF values are presented in tabular form. It is observed that SAF values decrease with increasing the source-to-target distance. The SAF value for self-irradiation decreases with increasing photon energy. The SAF values are also found to be dependent on the mass of target in such a way that higher values are obtained for lower masses. The effect of composition is highest in case of target organ lungs where mass and estimated SAF values are found to have larger differences.

CONCLUSION

These SAF values are very important for absorbed dose calculation for various organs of a mouse.

Development of a core outcome set for epilepsy in pregnancy (E-CORE): a national multi-stakeholder modified Delphi consensus study

OBJECTIVE

To develop a set of core outcomes for studies on pregnant women with epilepsy.

DESIGN

Delphi consensus study.

POPULATION

Healthcare professionals, and patient representatives with lived experience of epilepsy in the UK.

METHODS

We used a modified Delphi method and a consultation meeting to achieve consensus. Potential outcomes were identified by systematic review, and were scored using a Likert scale anchored between 1 (least important) and 5 (most important). We included outcomes that scored ≥4 by >70% of participants, and outcomes that scored ≤2 by <15% of participants.

MAIN OUTCOME MEASURES

Outcomes in studies on epilepsy in pregnancy.

RESULTS

Seventy-five healthcare professionals completed the first round, 48 (64%) completed the second round, and 37 (49%) completed the third round of the survey. Twenty-four patient representatives participated. The final core outcome set included 31 outcomes in three domains: neurological, offspring, and obstetric. Outcomes in the neurological domain were seizure control in pregnancy and postpartum, status epilepticus, maternal mortality, drowning, sudden unexpected death in epilepsy, postnatal depression, and quality of life. Offspring domain included congenital abnormalities (major and minor), fetal anticonvulsant syndrome, neurodevelopment, autism disorder, neonatal clinical complications, admission to a neonatal intensive care unit, and anthropometric measurements. The obstetric domain included live birth, stillbirth, miscarriage, ectopic, termination of pregnancy, admission to a high dependency or intensive care unit, breastfeeding, mode of delivery, preterm birth, pre-eclampsia, and eclampsia. Outcomes specific for studies on anti-epileptic drugs (AEDs) included maternal AED toxicity, AED compliance, neonatal withdrawal symptoms, and neonatal haemorrhagic disease.

CONCLUSION

Embedding this core set in future clinical trials will promote the standardisation of reporting to inform clinical practice.

TWEETABLE ABSTRACT

A Delphi method identifying core outcomes for epilepsy in pregnancy. Final core set includes 31 outcomes.

Translating translation into patient benefit for atopic eczema

This review considers, in the context of British Skin Foundation (BSF)-funded translational research into atopic eczema conducted in Newcastle, the complex interactions between clinical and non-clinical scientists in both academia and industry and how this may have impacted on clinical care. However, research in individual centres does not occur in isolation and clinically relevant outcomes from collaborative research are increasingly supported through regional and national networks. This is illustrated by our trial of azathioprine in adults with atopic eczema conducted across centres in the North East of England that employed pharmacogenetic dosimetry. Correspondingly the formation of a UK Translational Network for Translational Research in Dermatology (UK TREND) has facilitated the development of a UK-wide network to support atopic eczema projects based on an e-Delphi prioritisation exercise.

Metformin: an Old Therapy that Deserves a New Indication for the Treatment of Obesity

Metformin is not currently used for weight loss or diabetes prevention because it lacks an FDA indication for obesity and/or pre-diabetes treatment. Based on the evidence, metformin has been shown to decrease the incidence of type 2 diabetes, and compares favorably to other weight-loss medications in terms of efficacy as well as safety. Thus, metformin should be considered for a treatment indication in patients with these conditions.

Mid-term outcome of total elbow replacement for rheumatoid arthritis

PURPOSE

To review the outcome of total elbow replacement (TER) in 21 patients after a mean of 64 months.

METHODS

Records of 12 women and 9 men aged 32 to 78 (mean, 59.1) years who underwent 22 TERs for rheumatoid arthritis by a single surgeon were reviewed. Functional outcome was assessed using the disability of the arm, shoulder and hand (DASH) questionnaire. The range of movement and Kaplan- Meier survival curve was determined. Adequacy of cementation was assessed on immediate postoperative radiographs. Aseptic loosening was assessed on radiographs using the Mayo clinic scoring system.

RESULTS

After a mean follow-up of 64 (range, 10-145) months, the mean DASH score improved from 72.3 to 46.8, mean flexion improved from 96.9º to 128.1º, and mean extension lag from 37.3º to 24.0º. The 5-year survival rate with symptomatic aseptic loosening as the end point was 100%, and the revision rate for all reasons was 69%. Cement mantle was adequate in 17, marginal in 4 (most lacked cement around the prosthesis tip), and inadequate in one who was clinically asymptomatic. At the latest follow-up, 4 patients had a type-1 radiolucent line and one had a type-2 radiolucent line of both components; all remained clinically asymptomatic. Two patients developed transient radial nerve neuropraxia. One patient underwent revision for peri-operative fracture. One patient underwent a 2-stage revision for deep infection. One patient underwent revision for bilateral periprosthetic fracture. One patient underwent revision for symptomatic aseptic loosening. No patient had elbow dislocation.

CONCLUSION

TER is a viable option for pain relief and functional improvement in patients with rheumatoid arthritis.

Synchronous Sporadic Carcinoma and Primary Hyperplasia of the Parathyroid Glands: A Case Report and Review of the Literature

Parathyroid carcinoma is the least common endocrine malignancy. Although it has been noted to be associated with certain clinical factors, such as familial hyper-parathyroidism, its etiology remains unknown. In rare instances, particularly in patients with chronic renal failure, it has been proposed that parathyroid carcinoma can arise from malignant transformation of benign lesions. We present a case of synchronous malignant and primary hyperplastic parathyroid disease in a patient with normal renal function. A 46-year-old woman was seen with symptomatic refractory hypercalcemia. Investigations suggested a hyperactive parathyroid gland. Operative findings were of a low-grade parathyroid carcinoma in concurrence with diffuse hyperplasia of the remaining glands. To our knowledge this represents the fifth reported case. The possibility of malignant change in hyperplastic parathyroid tissue has implications for patient management and follow-up, particularly if tissue is left in situ to maintain hormonal function.

An audit of consenting practices in a district general hospital. Can we improve?

INTRODUCTION

Informed consent, as the declaration of patients' will, forms the basis of legality of medical procedures. A standard form based on the Department of Health model is widely used in the National Health Service (NHS). The aim of this audit process was to assess the current consent practice in comparison to the UK's General Medical Council guidance and local policy and make any appropriate improvements.

PATIENTS AND METHODS

254 adult consent forms were reviewed during the patients' admission. Data collected included legible documentation, grade of health professional completing the consent form, providing additional written information, use of abbreviations, securing the consent form in the medical records and, providing a copy to the patient. After initial assessment, interventions in an attempt to improve adherence to guidelines were introduced. A repeat audit of a further set of 110 notes was completed to assess the effectiveness of our interventions.

RESULTS

Our baseline assessment of 254 consent forms comprised of 198 (78%) elective and 56 (22%) emergency procedures. 87 (34%) consent forms were secure in the medical records. Grade of health professional was recorded in 211 (83%). 191 (75%) forms were legible. 48 (19%) patients were given copy of the consent. Only 24 (9%) patients were given additional written information. Abbreviations were used in 68 (27%) forms. Only 12 (5%) of consent forms met all criteria simultaneously. Re-audit after intervention assessed 110 consent forms; 30 (27%) for elective and 80 (72%) for emergency procedures. 52 (47%) of consent forms were secure in medical records, grade of health professional was recorded in 94 (85%), 101 (75%) forms were legible, 42 (38%) patients received copy of consent and 41 (37%) of patients received additional written information.

CONCLUSION

Initially only 5% of consent forms completely met GMC guidelines. This demonstrates an alarmingly poor adherence to such guidance that plays a vital role in patient safety, patient ethics autonomy, not to mention potential medico-legal and clinical governance implications for surgical practice. Our intervention has improved the quality of consenting within our hospital according to these guidelines. With these interventions set to continue and further develop, we expect that the quality of the consenting process will continue to provide patients with all that it is designed to.

Does the working temperature affect the outcome following microwave endometrial ablation?

BACKGROUND

Menorrhagia is a common gynaecological complaint, with significant burden to both its sufferers and health service providers. The first line of treatment is usually medical/pharmaceutical although in some cases surgery is required. There are now a number of minimally invasive surgical techniques available that ablate the uterine lining and prevent the need for the removal of the uterus. Microwave endometrial ablation (MEA) is one of these techniques, and this paper investigates the effect of the working temperature on outcome.

METHODS

A retrospective case note review of women who underwent MEA between June 2000 and August 2004. All women had a hysteroscopy followed by MEA. The duration of the procedure and mean working temperature of the MEA treatment was calculated. Women were followed up 6-8 months after surgery.

FINDINGS

Two hundred and eleven women underwent the procedure, with an average duration of menorrhagia of 30 months prior to the procedure. Eighty-nine percent attended follow-up, 80 % were satisfied with the procedure and 40 % were amenorrhoeic. When the procedure was performed at higher working temperature within the manufacturers guidelines women were more likely to be amenorrhoeic (78.4 vs. 77.1 °C, p = 0.014).

CONCLUSION

MEA is more effective in treating menorrhagia when used at a higher operating temperature.

Synchrotron X-ray phase contrast imaging of leaf venation in soybean (Glycine max) after exclusion of solar UV (280-400 nm) radiation

The hydraulic efficiency of a leaf depends on its vascular structure as this is responsible for transport activities. To investigate the effect of exclusion of UVAB and UVB radiation from the solar spectrum on the micro-structure of leaves of soybean (Glycine max, variety JS-335), a field experiment was conducted using synchrotron-based phase contrast imaging (PCI). Plants were grown in specially designed UV exclusion chambers, and wrapped with filters that excluded UVB (280-315 nm) or UVAB (280-400 nm), or transmitted all the ambient solar UV (280-400 nm) radiation (filter control). Qualitative observation of high-resolution X-ray PCI images obtained at 10 keV has shown the differences in major and minor vein structures of the leaves. The mid-rib width of the middle leaflet of third trifoliate leaves, for all treatments, were obtained using quantitative image analysis. The width of the mid-rib of the middle leaflet of third trifoliate leaves of UVB excluded plants was found to be more compared to leaves of filter control plants, which are exposed to ambient UV. The mid-rib or the main conducting vein transports water and sugars to the whole plant; therefore, mid-rib enhancement by the exclusion of solar UV radiation possibly implies enhancement in the leaf area which in turn causes an increased rate of photosynthesis.

Validity of nutrition risk index as a malnutrition screening tool compared with subjective global assessment in end-stage renal disease patients on peritoneal dialysis

We undertook this study to compare subjective global assessment (SGA) and nutrition risk index (NRI) as malnutrition screening tools in peritoneal dialysis (PD) patients. Nutrition status of the patients was categorized into low, moderate and high risk of malnutrition based on both NRI and SGA. The sensitivity, specificity and predictive values of NRI were compared with SGA, an already validated tool of nutrition status assessment in PD patients. Two hundred and eighty-three end-stage renal disease patients (age 50.02 ± 13.76 years; 204 males, 150 diabetic) were included. Based on SGA, 71/283 (25.08%) had normal nutrition, 192/283 (67.84%) mild-moderate and 20/283 (7.07%) severe malnutrition. Based on NRI, 38/283 (13.43%) patients had normal nutritional status, 193/283 (68.20%) mild-moderate and 52/283 (18.37%) severe malnutrition. Twenty-three of 283 (8.1%) were correctly classified as normal by NRI (true negative) and 197/283 (69.6%) as malnourished (true positive), 15/283 (5.3%) as false negative, 48/283 (16.96%) were misclassified as malnourished (false positive). NRI has sensitivity of 92.9% and specificity of 32.39%. Positive predictive value and Negative predictive values (NPVs) of NRI are 80.41% and 60.53%, respectively. Accuracy of the test is 78%. The receiver operating characteristic curve of NRI is 0.63. To conclude, NRI carries high sensitivity but low specificity as compared to SGA. It can be used as screening tool but not as a diagnostic tool for assessment of nutritional status in PD patients because of its low specificity and NPV.

Abstract P4-10-09: Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience

Background:

Stage I-III TNBC patients have a high risk of disease relapse during the first 5 years after diagnosis. However, there is limited data on the risk of late relapse in TNBC survivors who are disease free at 5 years or more from diagnosis. We sought to characterize this risk in a cohort of TNBC long-term survivors from a large institutional database.

Methods:

The MD Anderson Breast Cancer Management System database was queried for TNBC survivors who were disease free 5 years or more from diagnosis. Demographic, tumor, and treatment data was extracted. Electronic medical records were searched to confirm pathology reports for invasive breast cancer diagnosis, triple negative receptor status, and hormone receptor percentage (%). The primary and secondary outcomes of interest were relapse free survival (RFS) and distant relapse free survival (DRFS). Patients were censored at time of developing a second primary breast cancer or at last follow-up time for those who were alive during the study. We used ACP-ASCO definition of ER and PR &lt;1% and HER2/neu negative (IHC 0-1 or ratio &lt;2 and average copy number &lt;4) but also included patients with low ER/PR(1-9%) and HER2 normal. Kaplan-Meier analysis was performed to compare RFS and DRFS for the overall population and categorized by ER/PR &lt;1%, and ER/PR 1-9%.

Results:

We identified 1038 patients who had a median follow-up of 8.0 years. Receptor % information was available on 69% of patients, with 78% of them meeting current TNBC definition. From the total cohort of 130, 12.5% suffered event(s) that occurred after 5 years from diagnosis, with 86.2% of them occurring within 5-10 years of diagnosis. The event rate was 16.4% among patients with ER/PR 1-9% versus 11.3% among patients with ER/PR &lt;1%. Table 1 shows RFS and DRFS by year from diagnosis for the entire cohort and categorized by % receptor. 18 patients developed second primary breast cancer as first event and were censored. Of total events recorded, 53(40.8%) were deaths and 77(59.2%) were recurrences, of which 51(66%) were distant and 26(34%) local, of whom 12(46.2%) subsequently developed distant metastases. Among patients who initially presented with distant recurrence, frequencies of initial sites of metastases are shown in Table 2.

Conclusions:

TNBC long term survivors are still at risk for relapse events after 5 years from diagnosis, and it is important to quantity this risk when counseling our patients. Frequency of late events was higher among patients with low hormone receptor positivity. Multivariate modeling of predictors of late recurrence is ongoing.

Table 1: RFS and DRFS by Year from Diagnosis All PatientsER/PR &lt;1%ER/PR 1-9%Year From DiagnosisRFSDRFSRFSDRFSRFSDRFS4-51.01.01.01.01.01.05-60.950.960.940.950.940.956-70.930.940.930.940.910.927-80.900.920.900.920.870.898-90.860.880.870.890.810.849-100.840.870.840.860.800.8310-120.810.840.810.830.800.8312-150.730.780.730.750.670.74

Table 2: Site of Initial Distant RecurrenceSiteN (%)Lung/Pleura28 (54.9)Bone19 (37.3)Distant Lymph Nodes19 (37.3)Liver11 (21.6)Brain/Spinal Cord8 (15.7)Colorectal/Pancreas/Kidney/Adrenal6 (11.7)Other2 (3.9)*Patients presenting with multiple sites of distant recurrence are counted in each category.

Citation Format: Reddy SM, Sinha A, Syed M, Barcenas C, Valero V. Relapse-free survival of triple negative breast cancer long term survivors and characterization of late events in MD Anderson experience. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-09.

Endoscopic-CT: Learning-Based Photometric Reconstruction for Endoscopic Sinus Surgery

In this work we present a method for dense reconstruction of anatomical structures using white light endoscopic imagery based on a learning process that estimates a mapping between light reflectance and surface geometry. Our method is unique in that few unrealistic assumptions are considered (i.e., we do not assume a Lambertian reflectance model nor do we assume a point light source) and we learn a model on a per-patient basis, thus increasing the accuracy and extensibility to different endoscopic sequences. The proposed method assumes accurate video-CT registration through a combination of Structure-from-Motion (SfM) and Trimmed-ICP, and then uses the registered 3D structure and motion to generate training data with which to learn a multivariate regression of observed pixel values to known 3D surface geometry. We demonstrate with a non-linear regression technique using a neural network towards estimating depth images and surface normal maps, resulting in high-resolution spatial 3D reconstructions to an average error of 0.53mm (on the low side, when anatomy matches the CT precisely) to 1.12mm (on the high side, when the presence of liquids causes scene geometry that is not present in the CT for evaluation). Our results are exhibited on patient data and validated with associated CT scans. In total, we processed 206 total endoscopic images from patient data, where each image yields approximately 1 million reconstructed 3D points per image.

Readmission rates and financial penalties after ear, nose and throat surgery: how can we improve?

INTRODUCTION

Since April 2011, all patient readmissions within 30 days have resulted in a financial penalty to the hospital trust, and therefore the responsible department. These costs may be substantial and potentially preventable.

METHODS

A service evaluation of readmissions within 30 days of discharge, over a 12-month period (January-December 2012), was performed in the ear, nose and throat department of a district general hospital, and findings were used as a basis to suggest areas for potential quality improvement.

AIMS

To determine the number of readmissions, causes of readmission and resulting costs, and to explore how these readmissions may be prevented.

RESULTS

The departmental 30-day readmission rate over the study period was 3.12% (81/2606). The commonest causes of readmission (33.3%) were complications following tonsillectomy (27/81) such as pain, infection or bleeding. Over a third of these patients (30/81) were readmitted for less than 24 hours, with the average length of stay being less than 2.5 days. Financial implications: In 2011 the trust had 7526 emergency readmissions which were eligible for penalty within the 30-day time frame. This resulted in a loss of income of more than £60 000 to the ear, nose and throat department.

CONCLUSIONS

Optimizing postoperative care and improving patient understanding of common complications may reduce readmission rates, thus limiting the financial burden on the trust. These areas could serve as a basis for future quality improvement projects.