Peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms

Despite experience and technological improvements, stent-assisted coiling for intracranial aneurysms still has inherent risks. We evaluated peri-procedural morbidity and mortality associated with stent-assisted coiling for intracranial aneurysms. Patients with cerebral aneurysms that were broad-based (>4 mm) or had unfavorable dome/neck ratios (<1.5) were enrolled in this study between February and November 2011 at our center. Aneurysms were treated with the self-expanding neurovascular stents with adjunctive coil embolization. Seventy-two consecutive patients (27 men and 45 women; 22-78 years of age; mean age, 52.8 years) underwent 13 procedures for 13 ruptured aneurysms and 64 procedures for 73 unruptured aneurysms. Nine [11.7%, 95%CI(4.5%-18.9%)] procedure-related complications occurred: one and eight with initial embolization of ruptured and unruptured aneurysms, respectively. Complications included six acute in-stent thromboses, one spontaneous stent migration, one post-procedural aneurysm rupture, and one perforator occlusion. Three complications had no neurologic consequences. Two caused transient neurologic morbidity, two persistent neurologic morbidity, and two death. Procedure-related neurologic morbidity and mortality rates, respectively, were as follows: overall, 5.2% (95%CI, 0.2%-10.2%) and 2.6% (95%CI, 0%-6.2%); ruptured aneurysms, 7.7% (95%CI, 0%-36%) and 0%(95%CI, 0%-25%); unruptured aneurysms, 4.7% (95%CI, 0%-9.9%) and 3.1% (95%CI, 0%-7.3%). Combined procedure-related morbidity and mortality rates for ruptured and unruptured aneurysms were 7.7% (95%CI, 1.7%-13.7%) and 7.8% (95%CI, 1.8%-13.8%), respectively. Stent-assisted coiling is an attractive option for intracranial aneurysms. However, stent-assisted coiling for unruptured aneurysms is controversial for its comparable risk to natural history.

Decreased expression of microRNA-31 associates with aggressive tumor progression and poor prognosis in patients with bladder cancer

PURPOSE

MicroRNA-31 (miR-31) has different expression patterns in various human cancers. Especially in urothelial carcinoma of the bladder, it has been demonstrated to be decreased expression in the invasive tumors and homozygously deleted. However, its clinical significance in human bladder cancer has not yet been elucidated. Thus, the purpose of this study was to investigate the diagnostic and prognostic values of miR-31 in this disease.

METHODS

Expression levels of miR-31 in 126 pairs of bladder cancer and adjacent normal tissues were detected by real-time quantitative RT-PCR assay. To determine its prognostic value, overall survival (OS) and progression-free survival (PFS) were evaluated using the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard analysis.

RESULTS

MiR-31 expression in bladder cancer tissues was significantly lower than those in adjacent normal tissues (mean expression level: 2.1 ± 0.9 vs. 3.8 ± 1.2, P < 0.001). When categorized into low vs. high expression, low miR-31 expression was negatively associated with the tumor stage (P = 0.02), the status of recurrence (P = 0.01), progression (P = 0.01), and death (P = 0.006) of patients with bladder cancer. Moreover, low miR-31 expression clearly predicted poorer PFS (P = 0.001) and OS (P < 0.001). In the multivariate analysis, low miR-31 expression was an independent prognostic factor for both PFS (P = 0.01) and OS (P = 0.008).

CONCLUSION

These findings show that miR-31 may contribute to the progression of bladder cancer and its downregulation may be independently associated with unfavorable PFS and OS, suggesting that miR-31 might be a promising marker for further risk stratification in the treatment of this cancer.

Tubular stomach or whole stomach for esophagectomy through cervico-thoraco-abdominal approach: a comparative clinical study on anastomotic leakage

BACKGROUND

Esophagectomy through cervico-thoraco-abdominal approach is a useful surgical technique in treating patients with esophageal cancer. However, the cervical reconstruction is also known to have a high rate of anastomotic leakage, as well as anastomotic stricture, intrathoracic stomach syndrome, reflux esophagitis and other complications, thereby influencing postoperative recovery and quality of life.

AIMS

The objective of this study was to investigate whether tubular stomach is superior to whole stomach in reducing anastomotic leakage for esophageal reconstruction through the cervico-thoraco-abdominal (3-field) approach.

METHODS

A total of 850 patients undergoing the 3-field esophagectomy were retrospectively included in this study and divided into a tubular stomach reconstruction group (Group A, n=453) and a whole stomach reconstruction group (Group B, n=397). All patients underwent esophagectomy through right thorax, left cervical part, abdominal triple incisions and done in esophageal reconstruction by hand-sewn two-layer anastomosis.

RESULTS

Results revealed that in comparison with whole stomach, esophageal reconstruction with tubular stomach had a lower incidence of anastomotic leakage (5.5 vs. 9.3%, P<0.05), less manifestation of intrathoracic syndrome (3.3 vs. 9.8%, P<0.001) and less occurence of reflux esophagitis (5.1 vs. 11.1%, P<0.01). However, for the incidence of anastomotic stricture, there was no significant difference between the two groups (9.3 vs. 9.8%).

CONCLUSIONS

This observation study suggests that for esophageal cancer patients undergoing the 3-field esophagectomy tubular stomach is better than whole stomach for esophageal reconstruction as reflected by a reduced postoperative anastomotic leakage, intrathoracic syndrome and reflux esophagitis.

Prevalent cartilage damage and cartilage loss over time are associated with incident bone marrow lesions in the tibiofemoral compartments: the MOST study

OBJECTIVE

To assess the association of prevalent cartilage damage and cartilage loss over time with incident bone marrow lesions (BMLs) in the same subregion of the tibiofemoral compartments as detected on magnetic resonance imaging (MRI).

METHODS

The Multicenter Osteoarthritis Study is an observational study of individuals with or at risk for knee osteoarthritis (OA). Subjects whose baseline and 30-month follow-up MRIs were read for findings of OA were included. MRI was performed with a 1.0 T extremity system. Tibiofemoral compartments were divided into 10 subregions. Cartilage morphology was scored from 0 to 6 and BMLs were scored from 0 to 3. Prevalent cartilage damage and cartilage loss over time were considered predictors of incident BMLs. Associations were assessed using logistic regression, with adjustments for potential confounders.

RESULTS

Medially, incident BMLs were associated with baseline cartilage damage (adjusted odds ratio (OR) 3.9 [95% confidence interval (CI) 3.0, 5.1]), incident cartilage loss (7.3 [95% CI 5.0, 10.7]) and progression of cartilage loss (7.6 [95% CI 5.1, 11.3]) Laterally, incident BMLs were associated with baseline cartilage damage (4.1 [95% CI 2.6, 6.3]), incident cartilage loss (6.0 [95% CI 3.1, 11.8]), and progression of cartilage loss (11.9 [95% CI 6.2, 23.0]).

CONCLUSION

Prevalent cartilage damage and cartilage loss over time are strongly associated with incident BMLs in the same subregion, supporting the significance of the close interrelation of the osteochondral unit in the progression of knee OA.

Observation of two new N* resonances in the decay ψ(3686)→ppπ0

Based on 106×10(6)ψ(3686) events collected with the BESIII detector at the BEPCII facility, a partial wave analysis of ψ(3686)→ppπ0 is performed. The branching fraction of this channel has been determined to be B(ψ(3686)→ppπ0)=(1.65±0.03±0.15)×10(-4). In this decay, 7 N* intermediate resonances are observed. Among these, two new resonances, N(2300) and N(2570) are significant, one 1/2+ resonance with a mass of 2300(-30-0)(+40+109)  MeV/c2 and width of 340(-30-58)(+30+110)  MeV/c2, and one 5/2- resonance with a mass of 2570(-10-10)(+19+34)  MeV/c2 and width of 250(-24-21)(+14+69)  MeV/c2. For the remaining 5 N* intermediate resonances [N(1440), N(1520), N(1535), N(1650) and N(1720)], the analysis yields mass and width values that are consistent with those from established resonances.

Cationic microRNA-delivering nanovectors with bifunctional peptides for efficient treatment of PANC-1 xenograft model

Therapeutic strategies based on modulation of microRNA activity possess much promise in cancer therapy, but the in vivo delivery of microRNA to target sites and its penetration into tumor tissues remain great challenge. In this work, miR-34a-delivering therapeutic nanocomplexes with a tumor-targeting and -penetrating bifunctional CC9 peptide were proposed for efficient treatment of pancreatic cancers. In vitro study indicated that the nanoparticle-based miR-34a delivery systems could effectively facilitate cellular uptake and greatly up-regulate the mRNA level of miR-34a in PANC-1 cell lines. The up-regulation of miR-34a remarkably induced cell cycle arrest and apoptosis, suppressed the tumor cell migration and inhibited the target gene expressions such as E2F3, Bcl-2, c-myc and cyclin D1. More importantly, the in vivo systemic administration of the developed targeting miR-34a delivery systems in a pancreatic cancer model significantly inhibited tumor growth and induced cancer cell apoptosis. Such bifunctional peptide-conjugated miRNA-delivering nanocomplexes should have great potential applications in cancer therapy.

Thinning of large mammalian cells for cryo-TEM characterization by cryo-FIB milling

Focused ion beam milling at cryogenic temperatures (cryo-FIB) is a valuable tool that can be used to thin vitreous biological specimens for subsequent imaging and analysis by cryo-transmission electron microscopy (cryo-TEM) in a frozen-hydrated state. This technique offers the potential benefit of eliminating the mechanical artefacts that are typically found with cryo-ultramicrotomy. However, due to the additional complexity in transferring samples in and out of the FIB, contamination and devitrification of the amorphous ice is commonly encountered. To address these problems, we have designed a sample cryo-shuttle that directly and specifically accepts Polara TEM cartridges to simplify the transfer process between FIB and TEM. We optimized several parameters in the cryo-FIB and cryo-TEM processes using the quality of the samples' ice as an indicator and demonstrated high-quality milling with large mammalian cells. By comparing the results from HeLa cells to those from Escherichia coli cells, we discuss some of the artefacts and challenges we have encountered using this technique.

Clustering of gene expression data via normal mixture models

There are two distinct but related clustering problems with microarray data. One problem concerns the clustering of the tissue samples (gene signatures) on the basis of the genes; the other concerns the clustering of the genes on the basis of the tissues (gene profiles). The clusters of tissues so obtained in the first problem can play a useful role in the discovery and understanding of new subclasses of diseases. The clusters of genes obtained in the second problem can be used to search for genetic pathways or groups of genes that might be regulated together. Also, in the first problem, we may wish first to summarize the information in the very large number of genes by clustering them into groups (of hyperspherical shape), which can be represented by some metagenes, such as the group sample means. We can then carry out the clustering of the tissues in terms of these metagenes. We focus here on mixtures of normals to provide a model-based clustering of tissue samples (gene signatures) and of gene profiles.

Abstract P4-03-12: diagnostic value and clinical significance of integrin αvβ3 in breast mass

Background: Integrins are cell adhesion molecules that widely exists in cell surface, it is a hetero-dimeric protein bound non-covalently by α, β subunit. It plays the role of mediation during interaction of the αvβ3 and the corresponding receptor in signal transduction pathway, integrin αvβ3 is much richer in the surface of neovascular endothelial cells and tumor cells, while poor in the blood vessels and normal tissues. Therefore, it plays an important role in a variety of malignant tumors of the occurrence, development and metastasis processes. We find tumors constituted with neovascularization earlier by marker of integrin αvβ3.

Materials & Methods: We give patients who consider as breast mass intravenous injection of99mTc-3PRGD2 as a tracer preoperatively by SPECT/CT imaging and treat with surgery within a week, then make pathological examination with tumor tissues removed by needle biopsy. Then we make a retrospective analysis and evaluation of patients scanned completely by qualitative and semi-quantitative methods. All patients have signed the informed consent form before the test, together with the recognition of the Ethics Committee.

Results: From December 2011 to May 2012, a total of 245 patients were scanned and operated with clear paraffin pathological diagnosis by intravenous injection of99mTc −3PRGD2. Among them, a total of 106 patients (167 developing lesions) were positive with radionuclide imaging results, 139 patients were negative. Diseases of 106 patients are divided into four series: breast cancer, inflammation mastitis, phyllodes tumor and partly with fibroadenoma. They have in common that there is a clear flow signal in and around lesions by color Doppler ultrasound.

Discussion: After study on 245 patients, we created a molecular imaging tool to show expression of integration αvβ3 in order to assess tumor angiogenesis. Integrin αvβ3 plays an important role in physiological and pathological processes of malignant tumor, such as inflammation, tumor angiogenesis, invasion and metastasis etc. Therefore, its high expression is easy to find in cancer, mastitis, most of the phyllodes tumor and part of fiber adenoma with peripheral lesions. For patients with clear imaging, we make comprehensive analysis based on their ultrasound, mammography, MRI or CT results, which can generally contributes to the early diagnosis of disease in clinical. The detection of sentinel lymph node should be avoided for the patients with axillary lymph node imaging, who are clearly diagnosed as breast carcinoma with axillary lymph node metastases. These peptides are not only tumor receptor-targeted imaging agents with potential clinical value, but also laid a solid foundation for further development of receptor-targeted radionuclide therapy to solid tumors. The method marked with high expression of integrin αvβ3 in the tumor vascular endothelial cells by99mTc-3PRGD2 and SPECT/CT imaging mode has a broad prospect in the early diagnosis of tumor, lesion detection and efficacy evaluation. In the future, we may also find the new imaging agent with more accuracy and specificity. We believe that there will be more and more breast cancer patients benefit from the technology development of ECT/CT examination.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-03-12.

Abstract S3-6: Profiling of triple-negative breast cancers after neoadjuvant chemotherapy identifies targetable molecular alterations in the treatment-refractory residual disease

Background: Neoadjuvant chemotherapy (NAC) is increasingly used in patients with triple-negative breast cancer (TNBC). NAC can induce a pathologic complete response (pCR) in ∼30% of patients which portends a favorable prognosis. In contrast, patients with residual disease (RD) in the breast at surgical resection exhibit worse outcomes.

Objective: We hypothesized that profiling residual TNBCs after NAC would identify molecularly targetable lesions in the chemotherapy-resistant component of the tumor and that the persistent tumor cells would mirror micro-metastases which ultimately recur in such patients.

Methods: We utilized targeted next generation sequencing (NGS) for 182 oncogenes and tumor suppressors in a CLIA certified lab (Foundation Medicine, Cambridge, MA) and gene expression profiling (NanoString) of the RD after NAC in 102 patients with TNBC. The RD was stained for Ki67, which has been reported to predict outcome after NAC in unselected breast cancers.

Results: Thirteen tumors were not evaluable due to low tumor cellularity. Of 89 evaluable post-NAC tumors, 57 (64%) were basal-like; 19% HER2-enriched; 6% luminal A; 6% luminal B and 5% normal-like. Mean depth of coverage was 635 (range: 135–1207). Of 81 tumors evaluated by NGS, 72/81 (89%) demonstrated mutations in TP53, 22 were MCL1-amplified (27%), and 17 were MYC-amplified (21%). Alterations in the PI3K/mTOR pathway (AKT1-3, PIK3CA, PIK3R1, RAPTOR, PTEN, and TSC1) were identified in 27 tumors (33%). Cell cycle genes were altered in 25 tumors (31%), including amplifications of CDK2, CDK4, and CDK6, CCND1-3, and CCNE1 as well as RB loss. Alterations in the DNA repair pathway (BRCA1/2, ATM; 16 tumors; 20%) and the Ras/MAPK pathway (KRAS, RAF1, NF1; 10 tumors; 12%) were also common. Sporadic growth factor receptor amplifications occurred in EGFR, KIT, PDGFRA, PDGFRB, MET, FGFR1, FGFR2, and IGF1R. NGS identified 7 patients with ERBB2 gene amplification in the RD which was confirmed by FISH in both the pre- and post-treatment tissue, suggesting NGS could assist in the identification of ERBB2-overexpressing tumors misclassified at the time of diagnosis. In general, the gene amplifications identified by NGS corresponded to enhanced gene expression levels. Amplifications of MYC were independently associated with poor recurrence-free survival (RFS) and overall survival (OS). An interaction effect on survival was observed between MEK activation (assayed by a gene expression signature) and MYC amplification, suggesting cooperation between these pathways. Alterations in DNA repair also identified a subgroup with poor RFS and OS. In contrast, high post-NAC Ki67 score did not predict poor RFS or OS in this predominantly TNBC cohort.

Conclusions: The diversity of lesions in residual TNBCs after NAC underscores the need for powerful and broad molecular approaches to identify actionable molecular alterations and, in turn, better inform personalized therapy of this aggressive disease. Incorporation of this platform into clinical studies and eventually standards of care should aid in the prioritization of patients with RD after NAC into rational adjuvant studies.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S3-6.

Dissipation of difenoconazole in rice, paddy soil, and paddy water under field conditions

An analytical method for determining the residue of a broad-spectrum fungicide, difenoconazole, in soil and rice crop matrices is described. Mean recoveries and relative standard deviation (RSD) in paddy soil, water, rice plant, rice hull, and husked rice matrices at three spiking levels ranged 71.8-115.8% and 1.6-7.8%, respectively. The half-life of difenoconazole was determined at three different field sites in Guangxi, Hubei, and Zhejiang provinces in China via a dissipation experiment, in which a 30% aqueous suspension concentrate of difenoconazole and propiconazole (15% difenoconazole, 15% propiconazole) was applied at high dosages. The half-lives of difenoconazole in water, rice plant, and soil in Guangxi were 0.30, 2.59 and 23.26 days, 2.50, 1.77 and 2.82 days in Hubei, and 2.71, 1.39 and 6.61 days in Zhejiang, respectively. Difenoconazole concentrations in soil, rice hull, and husked rice samples were below the detection limit at pre-harvest intervals of 30, 40 and 50 days after fungicide application. The concentration in straw at pre-harvest intervals of 30, 40 and 50 days in the three experimental locations ranged from 0.037mg kg(-1) and 2.53mg kg(-1).

STK38 is a critical upstream regulator of MYC's oncogenic activity in human B-cell lymphoma

The MYC protooncogene is associated with the pathogenesis of most human neoplasia. Conversely, its experimental inactivation elicits oncogene addiction. Besides constituting a formidable therapeutic target, MYC also has an essential function in normal physiology, thus creating the need for context-specific targeting strategies. The analysis of post-translational MYC activity modulation yields novel targets for MYC inactivation. Specifically, following regulatory network analysis in human B-cells, we identify a novel role of the STK38 kinase as a regulator of MYC activity and a candidate target for abrogating tumorigenesis in MYC-addicted lymphoma. We found that STK38 regulates MYC protein stability and turnover in a kinase activity-dependent manner. STK38 kinase inactivation abrogates apoptosis following B-cell receptor activation, whereas its silencing significantly decreases MYC levels and increases apoptosis. Moreover, STK38 knockdown suppresses growth of MYC-addicted tumors in vivo, thus providing a novel viable target for treating these malignancies.

Increased peripheral RORα and RORγt mRNA expression is associated with acute-on-chronic hepatitis B liver failure

T helper cells17 (Th17) have accurate but inconclusive roles in the pathogenesis of acute-on-chronic hepatitis B liver failure (ACHBLF). Retinoic acid-related orphan receptor γ t(RORγt) and RORα are two lineage-specific nuclear receptors directly mediating Th17 differentiation. This study was aimed to evaluate the gene expression of RORα and RORγt and their potential role in ACHBLF. Forty patients with liver failure, 30 with chronic hepatitis B (CHB) and 20 healthy controls were studied. The mRNA levels of RORα and RORγt in peripheral mononuclear cells were determined by quantitative real-time polymerase chain reaction. The frequency of peripheral Th17 cells was determined using flow cytometry. The serum levels of interleukin-6(IL-6), transforming growth factor -β (TGF-β), interleukin-17(IL-17), interleukin-23(IL-23) and interferon-γ (IFN-γ) were measured by enzyme-linked immunosorbent assay. The frequency of peripheral Th17 cells in patients with liver failure was significantly increased compared to patients with CHB and controls. The peripheral mRNA levels of RORα and RORγt in hepatitis B-associated acute-on-chronic liver failure were significantly higher than in patients with CHB and controls as were the serum levels of IL-6 and TGF-β. The serum level of IFN-γ in patients with acute-on-chronic liver failure from HBV was significantly higher than patients with CHB but lower than controls. In patients with acute-on-chronic liver failure associated with HBV, RORγt, IL-6 and IL-23 were positively correlated with the frequency of Th17 cells, while RORα, TGF-β and IFN-γ had no correlation with the latter. The mRNA level of RORγt was positively correlated with model of end-stage liver disease (MELD) score, but there was no correlation of RORα and MELD score. RORγt plays an important role in the pathogenesis of acute-on-chronic HBV-associated liver failure and might be considered to be a candidate factor consistent with the severity of disease.