A case-control study to identify risk factors for totally implantable central venous port-related bloodstream infection

PURPOSE

To date, the risk factors for central venous port-related bloodstream infection (CVPBSI) in solid cancer patients have not been fully elucidated. We conducted this study in order to determine the risk factors for CVP-BSI in patients with solid cancer.

MATERIALS AND METHODS

A total of 1,642 patients with solid cancer received an implantable central venous port for delivery of chemotherapy between October 2008 and December 2011 in a single center. CVP-BSI was diagnosed in 66 patients (4%). We selected a control group of 130 patients, who were individually matched with respect to age, sex, and catheter insertion time.

RESULTS

CVP-BSI occurred most frequently between September and November (37.9%). The most common pathogen was gram-positive cocci (n=35, 53.0%), followed by fungus (n=14, 21.2%). Multivariate analysis identified monthly catheter-stay as a risk factor for CVP-BSI (p=0.000), however, its risk was lower in primary gastrointestinal cancer than in other cancer (p=0.002). Initial metastatic disease and long catheter-stay were statistically significant factors affecting catheter life span (p=0.005 and p=0.000). Results of multivariate analysis showed that recent transfusion was a risk factor for mortality in patients with CVP-BSI (p=0.047).

CONCLUSION

In analysis of the results with respect to risk factors, prolonged catheter-stay should be avoided as much as possible. It is necessary to be cautious of CVP-BSI in metastatic solid cancer, especially non-gastrointestinal cancer. In addition, avoidance of unnecessary transfusion is essential in order to reduce the mortality of CVP-BSI. Finally, considering the fact that confounding factors may have affected the results, conduct of a well-designed prospective controlled study is warranted.

First Report of Powdery Mildew Caused by Golovinomyces sonchicola on Ixeris chinensis in Korea

Ixeris chinensis (Thunb.) Nakai, known as Chinese ixeris, is distributed from Siberia to Japan, including Korea, Taiwan, and China. The whole plant has been used in folk medicine in Asia (4). In Korea, the plants of Chinese ixeris have been gathered and used as a wild root vegetable. During summer to autumn of 2011, Chinese ixeris leaves were found to be heavily infected with a powdery mildew in several locations of Korea. Symptoms first appeared as thin white colonies, which subsequently developed into abundant hyphal growth on both sides of the leaves, leading to drying of the leaves. The same symptoms on Chinese ixeris leaves were continuously observed in 2012 and 2013. Voucher specimens (n = 10) were deposited at Korea University Herbarium (KUS). Hyphal appressoria were moderately lobed or nipple-shaped. Conidiophores arose from the lateral part of the hyphae, measured 100 to 270 × 10 to 12.5 μm, and produced 2 to 6 immature conidia in chains with a sinuate outline. Basal parts of foot-cells in conidiophores were curved. Conidia were barrel-shaped to ellipsoid, measured 26 to 36 × 13 to 19 μm (length/width ratio = 1.7 to 2.4), lacked fibrosin bodies, and showed reticulate wrinkling of the outer walls. Primary conidia were ovate with conical-obtuse apex and subtruncate base. Germ tubes were produced on the perihilar position of conidia. Chasmothecia were not observed. The morphological characteristics were typical of the Euoidium type anamorph of the genus Golovinomyces, and the fungus measurements and structures were consistent with those of G. sonchicola U. Braun & R.T.A. Cook (1). To confirm the identification, internal transcribed spacer (ITS) region of rDNA sequences from a representative material (KUS-F26212) was amplified using primers ITS5/P3 and sequenced (3). The resulting 416-bp sequence was deposited in GenBank (Accession No. KF819857). A GenBank BLAST search revealed that the isolate showed >99% sequence similarity with those of G. cichoracearum from Sonchus spp. (e.g., AB453762, AF011296, JQ010848, etc.). G. sonchicola is currently confined to G. cichoracearum s. lat. on Sonchus spp., based on molecular sequence analyses (1). Pathogenicity was confirmed through inoculation by gently pressing a diseased leaf onto leaves of five healthy potted Chinese ixeris. Five non-inoculated plants served as controls. Inoculated plants developed symptoms after 6 days, whereas the controls remained symptomless. The fungus present on the inoculated plants was identical morphologically to that originally observed on diseased plants. Powdery mildew infections of I. chinensis associated with Golovinomyces have been known in China (2). To our knowledge, this is the first report of powdery mildew disease caused by G. sonchicola on I. chinensis in Korea. Farming of Chinese ixeris has recently started on a commercial scale in Korea. Though no statistical data are available, we postulate the cultivation area in Korea to be approximately 200 ha, mostly growing without chemical controls. Occurrence of powdery mildews poses a potential threat to safe production of this vegetable, especially in organic farming. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) F. L. Tai. Bull. Chinese Bot. Sci. 2:16, 1936. (3) S. Takamatsu et al. Mycol. Res. 113:117, 2009. (4) S. J. Zhang et al. J. Nat. Prod. 69:1425, 2006.

First reported case of interferon-alpha-induced sarcoidosis in an Asian patient with malignant melanoma

Anticancer agents can induce sarcoidosis. Interferon-alpha, which is used for the treatment of malignant melanoma and renal cell cancer, is one causative agent of sarcoidosis. However, there are few reports of interferon-alpha-induced sarcoidosis in patients with malignant melanoma. Clinically, it is important to consider the possibility of sarcoidosis in such patients because it could be easily regarded as a metastatic lesion due to underlying malignancy and given unnecessary treatment. Here, we report on the first case of interferon-alpha-induced sarcoidosis in an Asian melanoma patient.

Acupuncture modulates the neuro-endocrine-immune network

As a nonspecific physical stimulation, the effect of acupuncture on diseases is produced by motivating the inherent regulatory system in the body, having the characteristics of whole regulation, dual directional regulation, etc. Modern scientific researches show that body's inherent regulatory system is neuro-endocrine-immune (NEI) network. Hence, we speculate that the regulatory effect of acupuncture may be produced through its regulation of NEI network. In this article, we reviewed the recent researches about acupuncture's effect on the NEI network, to find out the evidence of acupuncture adjusting NEI network and provide some evidences for revealing the mechanism of acupuncture.

Clinical features and treatment of collecting duct carcinoma of the kidney from the korean cancer study group genitourinary and gynecology cancer committee

Purpose

Collecting duct carcinoma (CDC) of the kidney is an aggressive disease with a poor prognosis, accountings for less than 1% of all renal cancers. To date, no standard therapy for CDC has been established. The aim of this study is an investigation of clinicopathologic findings of CDC and correlation of the disease status with a prognosis.

Materials and Methods

From 1996 to 2009, 35 patients with CDC were treated at eight medical centers. The diagnosis of CDC was made based on nephrectomy in 27 cases and renal biopsy in eight cases.

Results

Median PFS and OS for all patients were 5.8 months (95% CI 3.5 to 9.2) and 54.4 months (95% CI 0 to 109.2), respectively. The OS of patients with Stages I-III was 69.9 months (95% CI 54.0 to 85.8), while that of patients with Stage IV was 8.6 months (95% CI 0 to 23.3), which showed a statistically significant difference (p=0.01). In addition, among patients with Stage IV, the OS of patients who received a palliative treatment (immunotherapy, chemotherapy, or targeted therapy) was 18.4 months, which was higher than the OS of patients without treatment of 4.5 months.

Conclusion

CDC is a highly aggressive form of renal cell carcinoma. Despite most of the treatments, PFS and OS were short, however, there were some long-term survivors, therefore, conduct of additional research on the predictive markers of the several clinical, pathological differences and their treatments will be necessary.

Current status of standardization of acupuncture and moxibustion in China

With the wide-spread and application of acupuncture and moxibustion, the demand of its standardization construction is increasingly prominent. On the basis of further investigation into the standards of acupuncture and moxibustion in China, this article summarize the research status of Chinese standardization of acupuncture and moxibustion, analyse some problems existing in current construction of acupuncture and moxibustion standardization, and put forward several strategies for moving forward, in order to show an overall and objective understanding of acupuncture and moxibustion standardization.

High-dose-rate brachytherapy for the treatment of vaginal intraepithelial neoplasia

Purpose

Vaginal intraepithelial neoplasia (VAIN), a rare premalignant condition, is difficult to eradicate. We assess the effectiveness of high-dose rate intracavitary brachytherapy (HDR-ICR) in patients with VAIN or carcinoma in situ (CIS) of the vagina after hysterectomy.

Materials and Methods

We reviewed 34 patients treated for posthysterectomy VAIN or CIS of the vagina by brachytherapy as the sole treatment. All patients underwent a coloposcopic-directed punch biopsy or had abnormal cytology, at least 3 consecutive times. All patients were treated with a vaginal cylinder applicator. The total radiation dose was mainly 40 Gy in 8 fractions during the periods of 4 weeks at a prescription point of the median 0.2 cm (range, 0 to 0.5 cm) depth from the surface of the vaginal mucosa.

Results

Acute toxicity was minimal. Seven patients had grade 1/2 acute urinary and rectal complications. There were 15 cases of late toxicity, predominantly vaginal mucosal reaction in 12 patients. Of these patients, two patients suffered from grade 3 vaginal stricture and dyspareunia continuously. After a median follow-up time of 48 months (range, 4 to 122 months), there were 2 recurrences and 2 persistent diseases, in which a second-line therapy was needed. The success rate was 88.2%. The average prescription point in failure patients was 1.1 mm from the surface of the vagina compared to an average of 2.6 mm in non-recurrent patients (p=0.097).

Conclusion

HDR-ICR is an effective treatment method in VAIN patients. In spite of high cure rates, we should consider issues regarding vaginal toxicity and radiation techniques to reduce the occurrence of failure and toxicity.

Tagging endogenous loci for live-cell fluorescence imaging and molecule counting using ZFNs, TALENs, and Cas9

The programmable ZFN, TALEN, and Cas9 nucleases allow genome editing of any cell line or organism. In this chapter, we describe methods to create gene fusions at endogenous loci in mammalian cells to express fluorescent fusions of proteins of interest at endogenous levels. The donor DNA, which includes the sequence encoding a fluorescent protein, is provided to the cell to repair a double-strand break induced by a nuclease. The engineered donor sequence is integrated by homology-directed repair into the genome in frame with the coding region of the gene of interest, resulting in expression of a fusion protein at physiological levels. We further describe techniques to study protein dynamics and numbers using the genome-edited cell lines. In contrast to cell lines stably overexpressing fusion proteins from modified cDNAs, genes encoding fluorescent proteins are targeted to the endogenous genetic locus, avoiding perturbation of alternative splicing and expression levels.

A case of right sinus of valsalva rupture with dissection into interventricular septum causing left ventricular outflow tract obstruction

Sinus of Valsalva aneurysm (SVA) is an uncommon anomaly of the aorta. Rupture of SVA often precipitates dramatic clinical complications, including heart failures. Right SVAs are the most common type, and when they rupture, they usually rupture into the right ventricle or right atrium. Rupture into left ventricle or interventricular septum is rare. Herein, we report a case of right SVA rupture with dissection into interventricular septum, which produced significant left ventricular outflow tract obstruction and aortic regurgitation. The case was successfully treated by surgical operation.

Abstract B41: Different clinical outcomes of systemic chemotherapy in non-small cell lung cancer without EGFR and K-ras mutation according to smoking status

Background: The current treatment strategy in non-small cell lung cancer (NSCLC) adenocarcinoma without epidermal growth factor receptor (EGFR) activating mutation or anaplastic large cell kinase gene (ALK) rearrangement does not differentiate between genotype or smoking status even though resent advances in molecular study in NSCLC. In terms of second line treatment, pemetrexed is considered as a standard treatment in non-squamous NSCLC without EGFR activating mutation or ALK rearrangement. We retrospectively analyzed clinical outcomes of systemic chemotherapy according to molecular characteristics.

Methods: Between 2006 and 2012, 131 patients with stage 4 NSCLC adenocarcinoma patients who were enrolled in a Seoul St. Mary's hospital lung cancer multidisciplinary center registry were available for molecular pathology regarding EGFR and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation status. Mutations in EGFR (exons 18 to 21) and KRAS (codons 12 and 13) were determined by direct sequencing.

Results: Among 131 patients, the frequency of EGFR mutations, KRAS mutations, and no mutations in both genes (double negative [DN]) was 28.2%, 5.3% and 66.4% respectively. Among the DN genotype, 47.1%were never smoker and 37.9% were female. The median progression free survival (PFS) with 1st line platinum based combination chemotherapy was 5.4 months (95% CI: 3.7-7.02) for DN genotype and 7.4 months (95% CI: 5.73-9.06) for EGFR mutation group (p=0.047). According to smoking status, the median PFS with 1st line platinum based combination chemotherapy for never smokers in EGFR mutation group was significantly longer than the DN group (DN-N) (8.4 vs 6.7 months: p=0.018). However among the smokers, no significant difference in median PFS with 1st line chemotherapy between EGFR mutation and DN group (DN-S) were found (6.7 vs 4.6 months: p=0.515). In terms of second line treatment except EGFR tyrosine kinase inhibitors (EGFR-TKI), 64% of DN group and 70.3% of EGFR mutation group received pemetrexed, 21% of DN group and 29.7% of EGFR mutation group received docetaxel. 15.1% of DN group received EGFR-TKIs. The median PFS with second line treatment in DN-N group was 7.7 months (95% CI: 2.1-18.9), 3.1 months (95% CI: 1.4-4.8) and 4.4 months (95% CI: 2.2-6.5) for pemetrexed, docetaxel and EGFR-TKI respectively (p=0.009). However, no significant differences in median PFS between second line treatments was found in DN-S group [3.0 vs 2.8 vs 1.7 months for pemetrexed, docetaxel and EGFR-TKI respectively (p=0.100)]. In EGFR mutation group, no significant difference between pemetrexed and docetaxel was found according to the smoking status.

Conclusions: NSCLC without EGFR and K-ras mutation (DN group) had different clinical outcomes according to smoking history. Smoking history could be a useful clinical marker to choose a second-line treatment. However, further genomic study to find a druggable target in this group should be conducted.

Citation Information: Mol Cancer Ther 2013;12(11 Suppl):B41.

Citation Format: Sook Hee Hong, JinHyoung Kang, Eun kyung Jeon, Seung Joon Kim, Kyo-Young Lee, Sang young Roh. Different clinical outcomes of systemic chemotherapy in non-small cell lung cancer without EGFR and K-ras mutation according to smoking status. [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2013 Oct 19-23; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2013;12(11 Suppl):Abstract nr B41.

Prediction of newly developed acute renal failure using serum phosphorus concentrations after living-donor liver transplantation

OBJECTIVE

This retrospective study investigated the predictive role of serum phosphorus concentration for acute renal failure (ARF), defined by the Risk Injury Failure Loss End-stage kidney disease (RIFLE) criteria, after living-donor liver transplantation (LDLT).

METHODS

Perioperative factors, including serum phosphorus concentrations, in LDLT recipients without pre-existing renal dysfunction were retrospectively analysed and compared between patients with or without post-LDLT ARF.

RESULTS

A total of 45 patients out of 350 (12.9%) met the RIFLE ARF criteria and experienced significantly higher postoperative mortality, longer intensive care unit stay and more frequent graft dysfunction than those patients without post-LDLT ARF. Multivariate logistic regression analyses showed that a serum phosphorus concentration ≥ 4.5 mg/dl on postoperative day 1 (relative risk [RR] 5.31; 95% confidence interval [CI] 2.56, 11.03), a preoperative model for end-stage liver disease score 20 points (RR 4.17, 95% CI 2.04, 8.52), and packed red blood cell transfusion 10 units (RR 2.55, 95% CI 1.13, 5.88) were independent risk factors for post-LDLT ARF.

CONCLUSIONS

Hyperphosphataemia on postoperative day 1 could be an early and simple indicator of ARF occurrence after LDLT.

First Report of Powdery Mildew Caused by Podosphaera xanthii on the Invasive Weed, Bidens pilosa, in Korea

Bidens pilosa L., known as Spanish needle or cobbler's peg, is a cosmopolitan weed, originating from South America and common in all tropical and subtropical areas of the world. In Korea, this plant was first reported in 1992 (3), and has become naturalized widely by replacing indigenous plants and disrupting native ecosystems. In the autumn of 2012, hundreds of Spanish needles growing around an industrial complex in Milyang in southern Korea were observed to be severely infected with a powdery mildew. Symptoms first appeared as circular to irregular white patches, which subsequently showed abundant hyphal growth on both sides of the leaves, and on young stems and inflorescences. Red-purplish discoloration and crinkling of the leaves were also observed. Appressoria on the mycelium were nipple-shaped or nearly absent. Conidiophores measured 100 to 190 × 11 to 13 μm, and produced 2 to 5 immature conidia in chains with a crenate outline, at the end of 2 to 3 straight cells of the conidiophore. Conidia were hyaline, ellipsoid to barrel-shaped, measured 28 to 42 × 16.5 to 21 μm (length/width ratio of 1.4 to 2.0), and had distinct fibrosin bodies. Dark brown chasmothecia were found partly embedded in the mycelial felt on leaves and stems, were spherical, gregarious to scattered, and 80 to 100 μm in diameter. Each contained a single ascus and had a terminal oculus 17 to 23 μm wide. Asci were sessile, 70 to 90 × 52 to 65 μm, and contained eight ascospores, each 22 to 28 × 16 to 20 μm. The structures and measurements were consistent with those of Podosphaera xanthii (Castagne) U. Braun & Shishkoff (1). Specimens were deposited in the Korea University Herbarium (KUS). To confirm identity of the causal fungus, the complete internal transcribed spacer (ITS) region of rDNA of isolate KUS-F27201 was amplified with primers ITS5 and P3 (4), and sequenced directly. The resulting 476-bp sequence was deposited in GenBank (Accession No. KC484700). A GenBank BLAST search of this sequence revealed >99% similarity with those of many P. xanthii isolates on plants in the Asteraceae. Pathogenicity was confirmed through inoculation by gently pressing diseased leaf onto leaves of five healthy, potted, young Spanish needle plants. Five non-inoculated plants served as a control treatment. Plants were maintained in a greenhouse at 25 ± 2°C. Inoculated plants developed symptoms after 8 days, whereas the control plants remained symptomless. The fungus present on the inoculated plants was identical morphologically to that originally observed on diseased plants, fulfilling Koch's postulates. Powdery mildews of B. pilosa caused by Podosphaera species have been reported in North America, Africa, and Asia (India and China), but not from Korea (2). To our knowledge, this is the first report of powdery mildew caused by P. xanthii on Spanish needles in Korea. The field observations suggest that the powdery mildew could limit expansion of this invasive weed in Korea. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No. 11. CBS, Utrecht, The Netherlands, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, USDA ARS, retrieved 28 February 2013. (3) S. H. Park. Colored Illustrations of Naturalized Plants of Korea. Ilchokak Publishers, Seoul, Korea, 1995. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

First Report of Powdery Mildew Caused by Golovinomyces asterum var. solidaginis on Invasive Weed Solidago gigantea in Korea

Solidago gigantea Aiton (syn. S. serotina Aiton), known as giant goldenrod, is native to North America and has been invasive in Europe and Asia. In Korea, this plant was accidentally introduced around the 1960s and has become widely naturalized by replacing indigenous plants and disrupting the native ecosystem (3). In October 2012, hundreds of giant goldenrod plants growing wild in riverine areas and roadsides were found affected by a powdery mildew in Busan, Korea. Voucher specimens were deposited in the Korea University Herbarium (KUS). Symptoms first appeared as circular to irregular white patches, which subsequently showed abundant hyphal growth on both sides of the leaves. Appressoria on the mycelium were nipple-shaped to moderately lobed. Conidiophores measured 120 to 240 × 10 to 12.5 μm, were arising laterally from hyphal mother cells, and produced 2 to 6 immature conidia in chains with a sinuate outline, followed by 2 to 3 cells. Foot-cells in conidiophores were 42 to 70 μm long and characterized by a distinctly curved base. Conidia were hyaline, ellipsoid to ovate, measured 28 to 42 × 17 to 24 μm (length/width ratio = 1.4 to 2.1), contained small oil drops, lacked distinct fibrosin bodies, and produced germ tubes on the subterminal position. No chasmothecia were observed. The morphological characteristics described above were typical of the Euoidium type anamorph of the genus Golovinomyces, and the fungus measurements and structures were consistent with those of G. asterum var. solidaginis U. Braun (1). To confirm the identity of the causal fungus, the complete ITS region of rDNA from isolate KUS-F27219 was amplified with primers ITS5 and P3 (4) and sequenced. The resulting 508-bp sequence was deposited in GenBank (Accession No. KC513763). A GenBank BLAST search of this sequence revealed >99% similarity with the ITS sequences of G. cichoracearum from Australia (GQ183940 ex Solidago sp.) and Japan (AB077625 ex S. altissima L. and AB077627 ex S. virgaurea subsp. asiatica Kitam. ex Hara). The G. cichoracearum isolates on Solidago spp. listed above are now placed in G. asterum var. solidaginis (1). Pathogenicity was confirmed through inoculation by gently pressing diseased leaves onto leaves of five healthy potted giant goldenrods. Five non-inoculated plants served as controls. Plants were maintained in a greenhouse at 24 to 30°C. Inoculated plants developed signs and symptoms after 7 days, whereas the control plants remained symptomless. The fungus present on inoculated plants was morphologically identical to that originally observed, fulfilling Koch's postulates. Association of S. gigantea with Golovinomyces powdery mildews has been known in North America, South America, Europe, New Zealand, Central Asia (Iran, Kazakhstan, and Kyrgyzstan), and Japan (2). To our knowledge, this is the first report of powdery mildew caused by G. asterum var. solidaginis on S. gigantea in Korea. Our field observations suggest that the powdery mildew could be a limiting factor to suppress the expansion of this invasive weed in Korea. References: (1) U. Braun and R. T. A. Cook. Taxonomic Manual of the Erysiphales (Powdery Mildews), CBS Biodiversity Series No.11. CBS, Utrecht, 2012. (2) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, retrieved January 22, 2013. (3) S. M. Oh et al. Kor. J. Weed Sci. 22:280, 2002. (4) S. Takamatsu et al. Mycol. Res. 113:117, 2009.

First Report of Zonate Leaf Spot Caused by Hinomyces moricola on Japanese Hop in Korea

Japanese hop (Humulus japonicus Siebold & Zucc. = H. scandens (Lour.) Merr.), native to East Asia, is an annual, climbing or trailing vine. The vines can spread to cover large areas of open ground or low vegetation, eventually blanketing the land and vegetation. Pollen of H. japonicus is allergenic, and this species is considered as one of the important causes of pollinosis in Korea and China. It is a notorious invasive weed in the United States and also in France, Hungary, and Italy (1). In September 2012, zonate leaf spots were observed on Japanese hops growing in wetlands in Yeongdong County of Korea. A voucher specimen was preserved in the Korea University Herbarium (KUS-F26901). Initial symptoms included grayish-green to grayish-brown spots without border lines. As the lesions enlarged, they coalesced, leading to leaf blight. Sporophores on the leaf lesions were dominantly hypophyllous, rarely epiphyllous, solitary, erect, easily detachable, and as long as 700 μm. The upper portion of the sporophores consisted of a pyramidal head was ventricose, 320 to 520 μm long and 110 to 150 μm wide. The fungus was isolated from leaf lesions and maintained on potato dextrose agar (PDA). Sclerotia were produced on PDA after 4 to 5 weeks at 18°C without light, but conidia were not observed in culture. These morphological and cultural characteristics were consistent with those of Hinomyces moricola (I. Hino) Narumi-Saito & Y. Harada (= Cristulariella moricola (I. Hino) Redhead) (3,4). An isolate was preserved in the Korean Agricultural Culture Collection (Accession No. KACC46955). Genomic DNA was extracted using the DNeasy Plant Mini DNA Extraction Kit (Qiagen Inc., Valencia, CA). The complete internal transcribed spacer (ITS) region of rDNA was amplified with the primers ITS1/ITS4 and sequenced. The resulting sequence of 452 bp was deposited in GenBank (Accession No. KC460209). A BLAST search in GenBank revealed that the sequence showed an exact match with those of C. moricola (JQ036181 ex Acer negundo and JQ036182 ex Glycine max). To determine the pathogenicity of the fungus, according to the procedure of Cho et al. (2), sporophores with the pyramidal head were carefully detached from a lesion on the naturally infected leaf using a needle. Each sporophore was transferred individually onto five places of four detached healthy leaves. The leaves were placed in dew chambers and incubated at 16°C. Symptoms were observed after 2 days on all inoculated leaves. A number of sporophores and immature sclerotia which were morphologically identical to the ones observed in the field were formed on the abaxial surface of the leaf 2 weeks after inoculation. The pathogen was reisolated from lesions on the inoculated leaves, confirming Koch's postulates. No symptoms were observed on the control leaves kept in humid chambers for 2 weeks. H. moricola was known to cause zonate leaf spots and defoliation on a wide range of woody and annual plants (3). To the best of our knowledge, this is the first report of Hinomyces infection on Japanese hops in Korea. References: (1) Anonymous. Humulus japonicus (Cannabaceae): Japanese hop. Eur. Medit. Plant Prot. Org. (EPPO). 2012. (2) S. E. Cho et al. Plant Dis. 96:906, 2012. (3) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication, ARS, USDA, Retrieved December 8, 2012. (4) S. A. Redhead. Can. J. Bot. 53:700, 1975.

Treatment outcomes of systemic chemotherapy for peritoneal carcinomatosis arising from gastric cancer with no measurable disease: retrospective analysis from a single center

BACKGROUND

Few studies of systemic chemotherapy have focused on gastric cancer with peritoneal carcinomatosis (PC) without measurable lesions. In the present study, we characterized the outcomes of systemic chemotherapy and prognostic factors for gastric cancer with PC, particularly in patients without measurable disease.

METHODS

Clinical data from 211 gastric cancer patients with PC (137 without and 74 with measurable disease) who had received systemic chemotherapy between January 2003 and December 2010 at a single center were reviewed.

RESULTS

The median overall survival (OS) rate of gastric cancer patients with PC with no measurable disease was significantly longer than that of patients with measurable disease (18.0 vs. 11.6 months, p = 0.010). On multivariate analysis, poor performance status [hazard ratio (HR) = 2.15, p < 0.001], the presence of metastatic lymphadenopathy (HR = 2.17, p < 0.001), and high-grade PC (HR = 1.83, p = 0.001) were associated with significantly decreased OS. When patients with low-grade PC were stratified by clinical PC grade, the median OS of those without measurable disease was 19.6 months. The median OS of patients with low-grade PC with no measurable disease was longer than those of patients with high-grade PC without measurable disease, patients with low-grade PC with measurable disease, and patients with high-grade PC with measurable disease (p = 0.001, p = 0.029, and p < 0.001, respectively). Among the patients with low-grade PC, patients who received a gastrectomy had longer survival than patients who did not receive a gastrectomy (p < 0.001).

CONCLUSIONS

In our study, clinically low-grade PC without measurable disease was associated with better outcomes of systemic chemotherapy than the outcomes in the other groups examined. Clinical trials in patients with gastric cancer with PC should be stratified according to PC grade.

Phase II study of paclitaxel and capecitabine (PX) combination as neoadjuvant chemotherapy for unresectable locally advanced gastric cancer

e15164

Background: Unresectable locally advanced adenocarcinoma (AGC) of the stomach is associated with poor prognosis due to the lack of effective treatment. Neoadjuvant chemotherapy (NAC) has drawn more attention to the treatment of locally AGC in the current multidisciplinary treatment model. Paclitaxel and capecitabine (PX) has been used in palliative setting with good response rates but its role in a neoadjuvant setting is not well established. This phase II study was performed to evaluate the efficacy and safety of neoadjuvant PX chemotherapy in patients with unresectable locally AGC. Methods: Patients with AGC, clinically unresectable because of local invasion and/ or conglomerated regional lymph nodes (station 7, 8, and 9) metastasis on based on laparoscopic staging, were enrolled. PX consisted of paclitaxel 175 mg/m2 i.v. on day 1, and capecitabine 835 mg/m2 twice daily p.o. on days 1–14 every 21 days. After three cycles of NAC, patients with clinically resectable AGC underwent surgical resection. Results: This trial was stopped for poor accrual after 18 patients were enrolled; 50% patients had tumors located in the proximal third of the stomach. Seventeen patients finished three cycles of chemotherapy. The overall response rate was 41.2% (7/17 cases), of which 71.4% (10/14 cases) metabolic response. Fourteen (77.8%) of the 18 patients enrolled underwent surgery, and 12 (85.7%) had an R0 resection. Pathological complete response was observed in one (7.1%) of patients. Toxicity was mild to moderate and there were no treatment-related deaths and no major surgical complications. With a median follow-up of 28.6 months (range 6.4-38.4 months), the 2-year survival rate for all patients was 71.1%. Subgroup analysis found R0 resection (35.7 months vs. 20.6 months, P= 0.005) and patients with pathologic N downstaging (P < 0.001) to have improved overall survival. Conclusions: Neoadjuvant chemotherapy with PX shows promising results in unresectable locally AGC patients without increased morbidity and mortality. Neoadjuvant PX may permit a larger chance of curative resection in unresectable locally AGC patients.

R497K of EGFR and BIM deletion polymorphisms as predictive biomarkers to EGFR TKIs in NSCLCs harboring wild-type EGFR

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Background: Activating EGFR mutations are strongly predictive of EGFR tyrosine kinase inhibitor (TKI) activity in NSCLCs, however, some patients having wild type EGFRdo not infrequently show clinically favorable outcome to EGFR TKIs. The key proapoptotic proteins have been reported to be involved in TKI-induced cell death. The up-regulation of BIM, a pro-apoptotic protein of BCL2 family, is required for TKIs to induce apoptosis in cancers. Methods: For 150 advanced or metastatic NSCLC pts. receiving gefitinib or erlotinib, we assayed mutation status of EGFR in paraffin embedded tumor tissue using PNA clamping (PANAGENE, Korea) and direct sequencing. Six different genetic variants of EGFR (-191C>A, -216 G>T, CA repeat number, R497K, 2607G>A, and D994D) and BIMdeletion in genomic DNA extracted from peripheral blood were analyzed. Results: M:F ratio was 72:78 and median age was 63 (35~82). Histological subtypes are as follows: 131 adenocarcinoma (87.3%), 16 squamous cell ca. (10.7%) and 3 large cell ca. (1.3%). Objective tumor response (CR+PR) was observed in 60 pts. (40.0%) and SD in 44 pts. (29.3%). Median PFS and OS were 4.3 (0.4~67.4) and 18.6 (0.9~78.1) months, respectively. Of 129 pts. in whom EGFR mutation could be analyzed, 41 pts. (31.8%) had activating EGFR mutation. In univariate analysis, only gender was associated with objective response to EGFR TKI in activating EGFR mutant group (P=0.048). In wild type EGFR group (n=88), R497K (P=0.04) and BIM (P=0.04) as well as gender (P=0.05) were significantly correlated with objective response. In addition, multivariate analysis demonstrated that gender, R497K and BIM were associated with objective response to EGFR TKIs in wild type EGFR group with statistical significance (P=0.023, 0.027 and 0.018, repectively). Neither six EGFR polymorphisms nor BIM was correlated with PFS and OS in activating EGFR mutant group. Meanwhile, in wild type EGFR group, R497K was significantly associated with OS (P=0.028). Conclusions: Taken together, our data suggest that R497K of EGFR and BIM deletion polymorphisms are useful pharmacogenetic biomarkers to predict objective tumor response for EGFR TKIs in advanced NSCLC pts. harboing wild type EGFR.

Abstract 2372: Predictive markers in patients with non-small cell lung cancer with pemetrexed treatment

Background: This study is desiged to evaluate biomarkers that are correlated with the efficacy of pemetrexed in patients with non-small-cell lung cancer (NSCLC).

Methods: Patients with stage III or IV NSCLC who received pemetrexed monotherapy after failure of one or more chemotherapy regimen between January 2003 and August 2011 were included. Polymorphism of reduced folate carrier gene (SLC19A, rs1051298), 5,10-methylenetetrahydroflate reductase (MTHFR, rs1801133) and thymidylate synthase (TS, rs45445694, rs16430) gene were analyzed by PCR and direct sequencing method using peripheral blood.

Results: Total 123 patients were included. The median age was 61 years (range 35-82). Fifty eight (47.2%) patients were female. Predominant histology was adenocarcinoma (92.7%). Metastatic diseases were 114 (80.5%) patients. Patients received one or more lines of systemic therapy before pemetrexed therapy, one line in 53 (43.1%) patients, two in 51(41.5%), three in 14 (11.02%), and four in 4 (3.3%). Median 4 cycles of chemotherapy were given (range 1-44). Response rate was 22.7% (CR, n=2, PR, n=26) and stable disease was detected in 54 patients (43.9%). Median follow up duration was 28.7months (range 4.07-84.33months). Median progression free survival (PFS) was 4.2 months (95% CI: 2.9-5.6) and median overall survival (OS) was 18.9 months (95% CI: 13.3-24.6). Clinical factors like, sex, histology of tumor (adenocarcinoma vs, nonadenocarcinoma), differentiation, smoking status and EGFR mutation status (active mutation vs. other mutation vs. wild type) did not have any significant difference on response and PFS. Only polymorphisms of TS promoter enhancer region (TSER) were related with PFS. 2R/2R repeat in the TSER (2R/2R vs 2R/3R, 3R/3R 1.0m vs 4.3m, p&lt;0.01) and CC homozygote variant in second repeat of the 3R allele (CC vs GC, GG 2.8m vs 5.0m, p=0.04) had poor PFS. All polymorphism did not have effect on response rate and overall survival.

Conclusions: This study suggests that polymorphisms of TSER associated PFS in pemetrexed treatment. Further prospective studies will be needed to validate these polymorphism as a useful biomarker of pemetrexed treatment in NSCLC patients.

Citation Format: Hiun S. Chae, Yoon Ho Ko, Eun Kyoung Jeon, Sook Hee Hong, Jeong-Oh Kim, Seung Joon Kim, Kyo Young Lee, Young Kyoon Kim, HoonKyo Kim, Seok young Park, In Sook Woo, Jin Hyoung Kang. Predictive markers in patients with non-small cell lung cancer with pemetrexed treatment. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2372. doi:10.1158/1538-7445.AM2013-2372

Abstract 2357: Prognostic value of placental growth factor expression in patients with metastatic or recurrent non-small cell lung cancer

Background: Placental growth factor (PIGF) is a proangiogenic factor, belonging to the VEGF family. It binds to VEGF receptor 1(VEGFR-1) and stimulates the growth, migration and survival of endothelial cells. PIGF also activates and attracts macrophages that release angiogenic molecules. Increased expression of PIGF has correlated with poor survival of patients in several solid tumors. However, PIGF expression is not consistently elevated in all malignancies. No reports on the clinical implications of PIGF expression in metastatic or recurrent non-small cell lung cancer (NSCLC) are currently available. We investigate the clinical significance of PIGF expression in metastatic or recurrent NSCLC.

Patients and methods: A retrospective review was done for seventy four patients with metastatic or recurrent NSCLC. Immunohistochemical staining for PIGF and its receptor VEGF-R1, neurophilin-1 was performed. Results: Of 74 patients with NSCLC, 73 patients were positive for PIGF, and 72 patients were positive for neurophilin-1. For PIGF expression, significant correlations were demonstrated with female (p=0.007) and nonsquamous histology (p=0.045). Thirty five patients (47%) were classified into low PIGF expression groups, whereas 38 patients (51%) were grouped as showing high PIGF expression. Survival time for patients with high PIGF expressing NSCLC was significantly longer than that for patients displaying low PIGF expression (median survival time, 15.1 months vs. 9.0 months[log-rank, p=0.01]). However, the difference in time to progression between two groups was not statistically significant (median time to progression, 5.1 months vs. 3.9 months [log-rank, p=0.24]).

Conclusions: Low expression of PIGF is associated with poor prognosis in patients with metastatic or recurrent NSCLC. Further studies on larger patients populations are warranted to validate the utility of PIGF as a prognostic biomarker in lung cancer.

Citation Format: Jung Hoon Kim, Tae Jung Kim, Kyu Sang Lee, Yun Hwa Jung, In Sook Woo, Sook Hee Hong, Chi Wha Han, Jae Kil Park, Jae Ho Byun. Prognostic value of placental growth factor expression in patients with metastatic or recurrent non-small cell lung cancer. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 2357. doi:10.1158/1538-7445.AM2013-2357

Glucose transporter 1 (GLUT1) of anaerobic glycolysis as predictive and prognostic values in neoadjuvant chemoradiotherapy and laparoscopic surgery for locally advanced rectal cancer

PURPOSE

We investigated the relationships between biomarkers related to anaerobic glycolytic metabolism (GLUT1, LDH5, PDK1, and HIF-1α proteins), pathologic response, and prognosis.

METHODS

All stage II and stage III rectal cancer patients had 50.4 Gy (1.8 Gy/day in 28 fractions) over 5.5 weeks, plus 5-fluorouracil (425 mg/m(2)/day) and leucovorin (20 mg/m(2)/day) bolus on days 1 to 5 and 29 to 33, and surgery was performed at 7 to 10 weeks after completion of all therapies. Expression of GLUT1, LDH5, PDK1, and HIF-1α proteins was determined by immunohistochemistry and was assessed in 104 patients with rectal cancer treated with neoadjuvant chemoradiotherapy.

RESULTS

This study included stage II and III rectal cancer patients, and each stage accounted for each 50 % of the total cases. A high expression of GLUT1 protein was associated with a significantly lower rate of ypCR compared with low expression of GLUT1 protein (4.0 % vs. 27.8 %, respectively; p = 0.012). GLUT1 expression was also significantly higher in the poor response group (Grade 0, 1) than in the good response group (Grade 2, 3) (34.0 % vs. 14.8 %, respectively; p = 0.022). In recurrence analysis, the expression of GLUT1 protein demonstrated a significant correlation with time to recurrence, based on a log-rank method (p = 0.016). When analyzed by multiple Cox regression, the positive expression of GLUT1 was the most significant and independent unfavorable prognostic factor (p = 0.004).

CONCLUSIONS

GLUT1 expression is a predictive and prognostic factor for pathologic complete response and recurrence in rectal cancer patients treated with 5-flurouracil and leucovorin neo-adjuvant chemoradiotherapy.

Papillary fibroelastoma mimicking vegetation of the mitral valve

Although cardiac papillary fibroelastoma is rare, it is the most common primary tumor of cardiac valves. The clinical presentation of these tumors varies from asymptomatic to embolic complications. We report an asymptomatic case of papillary fibroelastoma of mitral valve which was diagnosed by transthoracic echocardiography. The tumor was successfully resected by surgery.

First Report of Leaf Spot Caused by Septoria erigerontis on Erigeron strigosus in Korea

Erigeron strigosus Muhl. ex Willd., known as daisy fleabane, is native to North America and was accidently introduced to Korea in the 1990s (2). It is increasingly invasive in natural and managed ecosystems throughout Korea. In June 2011, a leaf spot was first observed on daisy fleabanes growing wild in Hongcheon County of Korea. A voucher specimen was deposited in the Korea University Herbarium (KUS-F25759). Symptoms developed on lower leaves as small, distinct, reddish brown lesions, which enlarged progressively and turned into pale, dull brown spots surrounded by dark purplish-brown margins. Black pycnidia became visible in the lesions. Pycnidia were epigenous, occasionally hypogenous, scattered, dark brown to rusty brown, globose, embedded in host tissue or partly erumpent, 60 to 160 μm in diameter, with ostioles measuring 10 to 30 μm in diameter. Conidia were straight to mildly curved or even flexuous, guttulate, hyaline, 30 to 75 × 1.5 to 2 μm, and one- to seven-septate. Based on the morphological characteristics, the fungus was consistent with Septoria erigerontis Peck (3,4). Conidia were harvested from cirrhi of pycnidia on leaf lesions with a drop of sterile water and then directly streaked onto water agar media using a bacterial loop. Isolates were incubated at 24°C for 48 h. Germinating conidia were individually transferred to potato dextrose agar (PDA) plates. An isolate was deposited in the Korean Agricultural Culture Collection (Accession No. KACC46120). Genomic DNA was extracted using the DNeasy Plant Mini DNA Extraction Kit (Qiagen Inc., Valencia, CA). The internal transcribed spacer (ITS) region of rDNA was amplified using the ITS1/ITS4 primers and sequenced. The resulting sequence of 505 bp was deposited in GenBank (Accession No. JX480493). A GenBank BLAST search was conducted with the 505-bp sequence showing 100% identity with the sequences of S. erigerontis ex Erigeron annuus (EF535638, GU269862). Pathogenicity was tested by spraying leaves of three potted plants with a conidial suspension (2 × 10⁵ conidia/ml) harvested from a 4-week-old PDA culture. Control leaves were sprayed with sterile distilled water. The plants were placed in a dew chamber at 26°C in darkness and continuous dew for the first 24 h and then moved to a greenhouse bench. After 7 days, leaf spot symptoms identical to those observed in the field developed on the leaves inoculated with the fungus. No symptoms were observed on control plants. S. erigerontis was reisolated from the lesions of inoculated plants, fulfilling Koch's postulates. A leaf spot disease of E. strigosus associated with S. erigerontis has been reported in the United States and Canada (1). To our knowledge, this is the first report of leaf spot on E. strigosus caused by S. erigerontis outside of North America as well as in Korea. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab., Online publication. ARS, USDA, Retrieved June 2, 2012. (2) S. H. Park. Colored Illustrations of Naturalized Plants of Korea. Ilchokak Publishers, Seoul, Korea, 1995. (3) M. J. Priest. Fungi of Australia: Septoria. ABRS/CSIRO Publishing, Melbourne, Australia, 1997. (4) E. Radulescu et al. Septoriozele din Romania. Ed. Acad. Rep. Soc. Romania, Bucuresti, Romania, 1973.

A comparison of intra-operative blood loss and acid-base balance between vasopressor and inotrope strategy during living donor liver transplantation: a randomised, controlled study

Administration of vasopressors or inotropes during liver transplant surgery is almost universal, as this procedure is often accompanied by massive haemorrhage, acid-base imbalance, and cardiovascular instability. However, the actual agents that should be used and the choice between a vasopressor and an inotrope strategy are not clear from existing published evidence. In this prospective, randomised, controlled and single-blinded study, we compared the effects of a vasopressor strategy on intra-operative blood loss and acid-base status with those of an inotrope strategy during living donor liver transplantation. Seventy-six adult liver recipients with decompensated cirrhosis were randomly assigned to receive a continuous infusion of either phenylephrine at a dose of 0.3-0.4 μg.kg(-1).min(-1) or dopamine and/or dobutamine at 2-8 μg.kg(-1).min(-1) during surgery. Vascular resistance was higher over time in the phenylephrine group than in the dopamine/dobutamine group. Estimated blood loss was significantly lower in the phenylephrine group than in the dopamine/dobutamine group (mean (SD) 4.5 (1.8) l vs 6.1 (3.4) l, respectively, p=0.011). Patients in the phenylephrine group had lower lactate levels in the late pre-anhepatic and the early anhepatic phase and needed less bicarbonate administration than those in the dopamine/dobutamine group (median (IQR [range]) 40 (0-100 [0-160]) mEq vs 70 (40-163 [0-260]) mEq, respectively, p=0.018). Postoperative clinical outcomes and laboratory-measured hepatic and renal function did not differ between the groups. Increased vascular resistance and reduction of portal blood flow by intra-operative phenylephrine infusion is assumed to decrease the amount of intra-operative bleeding and thereby ameliorate the progression of lactic acidosis during liver transplant surgery.