Oncologic outcomes of nephron-sparing surgery in patients with T1 multifocal renal cell carcinoma

OBJECTIVE

This study is performed to explore the pathological characteristics and oncologic outcomes of T1 multifocal renal cell carcinoma (RCC).

METHODS

The clinical data of 600 patients (442 males and 158 females) between the age of 29 and 73 years, diagnosed with T1 RCC were collected from three hospitals in China, out of which 421 cases had undergone nephron-sparing surgery (NSS) and 179 cases had undergone radical nephrectomy (RN) between December 2010 and January 2015.

RESULTS

Tumor was identified with multifocality in 32 patients (5.33%), out of which 21 were set to receive NSS, and 11 to receive RN, respectively; 21 cases of clear cell tumor, 8 cases of papillary tumor, 1 case of chromophobe tumor and 2 cases of Xp.11.2 translocation RCC. Among 568 cases of monofocal tumors, 400 patients underwent NSS, and the remaining 168 patients underwent RN, respectively. After a median follow-up of 5 years, 13 patients were found with recurrent tumors out of those who had undergone NSS, 11 with monofocal tumors and 2 with multifocal tumors containing satellite tumor nodules (p = 0.13). Out of the 32 individuals with multifocal RCC, 4 cases were reported to have died of cancer, 2 of NSS and 2 of RN. From these findings, the cancer-specific survival for NSS and RN was estimated to be 90.48% and 81.82%, respectively (p = 0.48).

CONCLUSION

The findings from the study suggested that there were pathological differences in multifocal renal tumors, and that papillary carcinoma may be more common than clear cell carcinoma. The recurrence rate and survival rate of multifocal RCC were similar to monofocal tumors. Tumor recurrence may be related to satellite tumor nodules, which can only be detected once surgery is performed.

Mild Hypothermia Pretreatment Attenuates Liver Ischemia Reperfusion Injury Through Inhibiting c-Jun NH2-terminal Kinase Phosphorylation in Rats

BACKGROUND

Mild hypothermia is known to be protected against ischemia reperfusion (IR) injury. But the exact mechanisms of protection have not yet been fully understood and its usage has been limited. Mild hypothermia pretreatment (MHP) is used to investigate the mechanisms of the protective effects against liver IR injury.

METHODS

Anesthetized male Sprague-Dawley rats were randomly divided into five groups including the normal group (N), sham group (S), MHP group, normothermia pretreatment (NP) + IR group, and the MHP + IR group. In the pretreatment groups, mild hypothermia (32.2 ± 0.3°C) and normothermia (37 ± 0.5°C) pretreatment were applied for 2 hours, respectively. Then the IR groups suffered partial (70%) hepatic ischemia for 1 hour and reperfusion for 6 hours. At last, hepatic injury, apoptosis, and protein expression were assessed.

RESULTS

Levels of serum alanine transaminase, hepatic injury, hepatocyte apoptosis, and c-Jun N-terminal kinase (JNK) phosphorylation were significantly higher in the IR groups. But when compared to NP, all these changes induced by IR were markedly attenuated by MHP. Serum alanine transaminase levels were 383.4 ± 13.1U/L in the MHP + IR group and 951.3 ± 39.4 U/L in the NP + IR group. The histologic score of liver injury in the MHP + IR group was 4.83 ± 1.17, whereas in the NP + IR group it was 10.5 ± 1.05. The proportion of apoptotic cells in the MHP + IR group was 11.58 ± 0.60, but in the NP + IR group, it was 44.95 ± 1.61. The phosphorylation of JNK was also significantly reduced in the MHP + IR group. All these differences are statistically significant (P < .05).

CONCLUSIONS

MHP could markedly reduce liver IR injury, and these protective effects may be mainly exerted via inhibition of JNK phosphorylation.

Histopathologic analysis of stage pT1b kidney neoplasms for optimal surgical margins of nephron-sparing surgery

Objective

To evaluate the pathological features and define the optimal surgical margins (SM) of nephron-sparing surgery (NSS) for kidney neoplasms 4–7 cm (stage pT1b) on preoperative imaging.

Materials and methods

The retrospective study included 748 patients who were diagnosed stage pT1b renal tumors and underwent either radical nephrectomy (RN, n = 475) or NSS (n = 273) from January 2004 to March 2017. The tumor size, pathological subtype, Fuhrman grade, status of peritumoral pseudocapsule (PC) and tumor multifocality were recorded. The relationship between peritumoral PC and positive SM was calculated statistically by Fisher’s exact probability test.

Results

The mean tumor diameter was 5.4 cm (range: 4.1–7.0 cm), 65 (8.7%) cases were discovered with multifocal lesions and 686 (91.7%) were surrounded with peritumoral PC in all 748 specimens. 57 (8.3%) of 686 cases were proved with tumor infiltrated beyond PC [infiltration (+)], and the presence of PC infiltration (+) was significantly correlated with positive SM (p = 0.016). The infiltrative depth of tumor cells into renal parenchyma beyond PC was all limited in 3 mm and the proportion of ≤ 1, 1–2 and 2–3 mm was 21.1% (12/57), 59.6% (34/57) and 19.3% (11/57), respectively.

Conclusions

Our report indicates a 3 mm excisional margin is acceptable to ensure negative SM when operating NSS on stage pT1b kidney neoplasms.

Abstract OT2-03-03: Delivery of a single fraction lumpectomy cavity boost using a novel immobilization device and treatment delivery system

Background: The lumpectomy cavity (LPC) boost has been shown in 2 randomized studies to improve local control in breast cancer. Hypofraction is now being used for delivery of the LPC boost in some early-stage patients. This trial delivers the LPC boost in a single fraction using a novel breast immobilization device/treatment delivery system.

Trial design: Patients are enrolled in this trial after standard resection with lumpectomy/sentinel lymph node biopsy (as appropriate) and chemotherapy (as indicated per standard of care). At the time of CT simulation for whole-breast radiation therapy (RT), the radiation oncologist evaluates breast size and LPC position. If consented for treatment, the patient receives a single fraction “boost” treatment of 8 Gy in 1 fraction followed by standard whole-breast RT to start within 7 days of completion of the boost. Whole-breast radiation is delivered in the supine or prone position with the following fractionation schemes: 4005 cGy in 15 fractions or 5000 cGy in 25 fractions.

On the day of the boost treatment, the patient is fitted with the breast immobilization device, with a plastic inner cup that is fitted so that the breast fills all or most of the cup. A rigid outer cup with a built-in stereotactic fiducial system is attached. Moderate negative pressure is applied to immobilize the breast within the cup system. Patients then undergo CT simulation in the prone position. Clip placement and LPC cavity location must meet eligibility criteria before proceeding with treatment planning and delivery.

Eligibility criteria:

Eligibility criteria: age &gt;60 yo; female only; dx of invasive ductal or lobular carcinoma or ductal carcinoma in situ; estrogen receptor positive; successful completion of lumpectomy ± sentinel lymph node biopsy with negative margins for invasive or noninvasive cancer; greatest tumor dimension &lt;4 cm before surgery; weight &lt;330 lb; height &lt;76 inches; nonlactating and nonpregnant. Various additional dosimetric factors must be met prior to treatment. If these are unable to be met, the patient will become ineligible for treatment.

Specific aims: The aim of this study is to demonstrate the feasibility and safety of delivering the LPC boost RT using a single fraction with a novel immobilization device/treatment delivery system while ensuring coverage of the target volume with appropriate dose homogeneity and conformity. Secondary aims are evaluation of patient comfort, acute toxicity (1 month), and late toxicity (1 year).

Statistical methods: A Simon 2-stage design is utilized for this trial. After evaluating the device and treatment on 8 patients in the first stage, the trial was designed to be terminated and device rejected if the dose distribution was acceptable for ≤5 patients. The first stage was completed in spring 2017 and progressed to the second stage, designed to include a total of 17 patients.

Accrual and target accrual: Target accrual for this study is 14 patients successfully treated while meeting all protocol constraints. As of 6/2017, 16 patients have been enrolled, of whom 13 have been successfully treated while meeting all protocol constraints.

Citation Format: Nichols EM, Becker S, Hong J, Cohen RJ, Mishra MV, Citron W, Cheston SB, Niu Y, Mutaf Y, Yu CX, Feigenberg SJ. Delivery of a single fraction lumpectomy cavity boost using a novel immobilization device and treatment delivery system [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-03-03.

Novel interstitial deletion in Xp22.3 in a typical X-linked recessive family with Kallmann syndrome

Kallmann syndrome (KS) is a clinically and genetically heterogeneous condition characterised by hypogonadotropic hypogonadism with anosmia or hyposmia. More than nineteen genes causing KS have been reported to date. KAL1, first identified to causing the X-linked form of KS, accounts for 10%-20% of KS patients. In this study, we designed a panel including 17 known genes causing KS for genetic diagnosis and research and report a typical and rare family of which three generations had been affected by KS. A novel CNV in Xp22.3 was identified through targeted next-sequencing technology and high-resolution microarray. The breakpoint (chrX:8536480 and chrX:8730416) was defined, and the size of deletion is about 0.24 Mb. The CNV including KAL1 and FAM9A had a negative effect on the expression of KAL1, resulting in decreased level of KAL1 mRNA in whole blood. In addition, the proband had significant improvement in testicular volumes and secondary sex characters except spermatogenesis after regular treatment, which indicates the CNV may have a negative effect on spermatogenesis. Our study expands the genotypic spectrum of KAL1 mutations associated with KS and provides a practical pipeline for genetic diagnosis or research.

Preliminary study of 1940 nm thulium laser usage in peroral endoscopic myotomy for achalasia

Esophageal achalasia is a type of motility disorder characterized by incomplete relaxation of lower esophageal sphincter (LES) and absence of esophageal peristalsis. Peroral endoscopic myotomy (POEM) is a new treatment option for achalasia that is less invasive, more effective, and safe as compared to surgery. High-frequency electrotome is commonly used in POEM, but takes longer time to make the tunnel in the esophagus and causes many complications. The thulium laser decreases the risk of bleeding and perforation in endoscopy but has not been reported in digestive diseases, especially in POEM. Therefore, the aim of this study is to evaluate the feasibility of the 1940 nm thulium laser in POEM. From March 2015 to August 2015, five patients with achalasia at the Digestive department, Beijing Friendship Hospital, Capital Medical University, Beijing, China were included. Before the procedure, the patients' gender, age, and duration of symptoms were recorded. Eckardt symptom score and LES thickness, which measured by endoscopic ultrasonography, were recorded. While the subtypes of achalasia (according to the Chicago classification), lower esophagus sphincter resting pressure (LESRP) and integrated relaxation pressure (IRP) were measured by HRM for all patients. Barium esophagram was also used to rule out anatomical lesions, esophageal varices, or neoplasia, which may cause similar symptoms. All examinations were performed one week before POEM. POEM was performed with the 1940 nm thulium laser under general anesthesia. Eckardt score, procedure duration, myotomy length, and complications were recorded one week after POEM. All the patients were followed-up at two weeks and four weeks after POEM. POEM was successfully performed in all five patients. The mean age of the patients was 38.8 years (24-54 years). Achalasia subtypes were type I (n = 1), II (n = 2), and III (n = 2). The operation duration was 186, 180, 111, 75, and 126 minutes for the five cases. Pre/postprocedure Eckardt scores were 3/0, 7/0, 5/1, 6/0, and 9/0. Pre/postprocedure LESRP (mmHg) were 45.3/26.4, 18.0/1.1, 25.8/10.4, 16.5/11.2, and 24.2/20.8. Pre/postprocedure IRP (mmHg) were 27.3/15.5, 15.4/4.2, 5.7/6.8, 15.5/10.1, and 13.1/14, respectively. No adverse events occurred during the procedure. After POEM, subcutaneous emphysema occurred in case 1 on the first day, which relieved spontaneously after two days without special intervention. Infection occurred in case 5 on the day of POEM was healed with antibiotics three days later. The 1940 nm thulium laser is feasible for POEM procedure. Further studies are needed to determine whether the 1940 nm thulium laser is better than high-frequency electrotome.

[Association between elective cesarean section and infants' developmental behaviors: a cohort study]

Objective: To investigate the effect of elective cesarean section (ECS) on infants' developmental behaviors. Methods: A total of 3 474 pregnant women living in Ma'anshan more than 6 months and accepting obstetric examination in Ma'anshan Maternal and Child Care Center were recruited from May 2013 to September 2014. Excluding participants with pregnancy termination (162), twin pregnancy (39), assisted delivery (14), emergency cesarean section (76) and unclear delivery mode (141), 3 042 pair of mother and infant entered the final analysis. Information of maternal basic demographic characteristics, pregnancy histories, pregnancy life style and pregnancy-related diseases were collected by using self-complied Maternal and Child Health Questionnaire. Information of infants' general condition and delivery modes were acquired from obstetric record. The Ages and Stages Questionnaires-third edition was used to assess infants' communication, gross motor, fine motor, problem solving and person-social function, which was completed at age of 6 months old and 18 months old, respectively. And multi-factor non-conditional logistic regression model was used to analyze the association between ECS and infants' developmental behaviors. Results: The prevalence of ECS was 47.5% (1 443/3 042), among which ECS without medical indication and ECS with medical indication were 27.2% (826/3 042) and 20.3% (617/3 042), respectively. After maternal demographic characteristics, pregnant exposure and infants' basic information adjusted, compared to women with vaginal delivery, both ECS with medical indication and without medical indication increased the risk of a delay in gross motor on infants at 6 months old (RR (95%CI: 1.72 (1.08-2.77) and 1.87 (1.11-3.15), respectively.) ECS without indication decreased the risk of a delay in fine motor on infants at 6 months old (RR (95%CI):0.48 (0.28-0.82)), both ECS without medical indication and with medical indication had no statistically significant effect on 18 months infants' communication, gross motor, fine motor, problem solving and person-social function, the RR (95%CI) for ECS without medical indication were 0.86 (0.43-1.74), 1.55 (0.86-2.78), 0.74 (0.49-1.15), 1.10 (0.68-1.78) and 1.17 (0.66-2.08), respectively; and the RR (95%CI) for ECS with medical indication were 0.33 (0.12-1.02), 1.10 (0.55-2.21), 0.79 (0.48-1.29), 0.58 (0.29-1.13) and 1.48 (0.78-2.81), respectively. Conclusion: ECS affected motor development in infants at the age of 6 months old, and no influence was found in infants at the age of 18 months old.

[Association of etheno-DNA adduct and DNA methylation level among workers exposed to diesel engine exhaust]

Objective: To investigate the association between etheno-DNA adduct and the promoter of DNA methylation levels of cyclin dependent kinase inhibitor 2A (P16), Ras association domain family 1 (RASSF1A) and O-6-methylguanine-DNA methyltransferase (MGMT) in workers with occupational exposure to diesel engine exhaust (DEE). Methods: We recruited 124 diesel engine testing workers as DEE exposure group and 112 water pump operator in the same area as control group in Henan province in 2012 using cluster sampling. The demographic data were obtained by questionnaire survey; urine after work and venous blood samples were collected from each subject. The urinary etheno-DNA adducts were detected using UPLC-MS/MS, including 1,N6-etheno-2'-deoxyadenosine (εdA) and 3,N4-etheno-2'-deoxycytidine(εdC). The DNA methylation levels of P16, RASSF1A, and MGMT were evaluated using bisulfite-pyrosequencing assay. The percentage of methylation was expressed as the 5-methylcytosine (5mC) over the sum of cytosines (%5mC). Spearman correlation and multiple linear regression were applied to analyze the association between etheno-DNA adducts and DNA methylation of P16, RASSF1A, and MGMT. Results: The median (P(25)-P(75)) of urinary εdA level was 230.00 (98.04-470.91) pmol/g creatinine in DEE exposure group, and 102.10 (49.95-194.48) creatinine in control group. The level of εdA was higher in DEE exposure group than control group (P<0.001). DNA methylation levels of P16, RASSF1A and MGMT were 2.04±0.41, 2.19 (1.94-2.51), 2.22 (1.94-2.46)%5mC in exposure group, and 2.19±0.40, 2.41 (2.11-2.67), 2.44 (2.15-2.91)%5mC in control group. DNA methylation levels were lower in exposure group (P values were 0.005, 0.002 and 0.001, respectively). Spearman correlation analysis showed that DNA methylation levels of P16, RASSF1A, and MGMT were negative associated with urinary εdA level (r values were -0.155, -0.137, and -0.198, respectively, P<0.05). No significant correlation was observed between the εdC level and any measured DNA methylation levels (P>0.05) . Multiple linear regression confirmed the negative correlation between εdA and DNA methylation levels of P16, RASSF1A, and MGMT in non-smoking group (β (95%CI) was -0.068 (-0.132--0.003), -0.082 (-0.159--0.004) and -0.048 (-0.090--0.007), P values were 0.039, 0.039 and 0.024, respectively). Moreover, εdC was negative associated with DNA methylation level of MGMT in non-smoking group (β (95%CI) was -0.094 (-0.179--0.008), P=0.032). Conclusion: DEE exposure could induce the increased of εdA and decreased of DNA methylation levels of P16, RASSF1A and MGMT.

Effect of supplemental fermented Ginkgo biloba leaves at different levels on growth performance, meat quality, and antioxidant status of breast and thigh muscles in broiler chickens

The present study was conducted to investigate the influence of dietary supplementation with different levels of fermented Ginkgo biloba leaves (FGBL) on growth performance, slaughter performance, meat quality, antioxidant enzyme capacity, and free radical scavenging activities of muscles in broiler chickens. A total of 648 one-d-old broiler chickens were randomly allocated into six dietary treatments, including control group (CON group: basal diet), FGBL1, FGBL2, FGBL3, FGBL4, and FGBL5 groups (basal diet containing 1.5, 2.5, 3.5, 4.5, and 5.5 g/kg FGBL, respectively). Body weight gain and feed intake were recorded at 1, 21, and 42 d. At 42 d, 2 birds from each replicate were slaughtered. The results indicated that 3.5 g/kg FGBL diet significantly increased (P < 0.05) ADFI and ADG in 1 to 42 d and ADFI in 22 to 42 d compared with the CON group. In 1 to 21 d, 4.5 g/kg FGBL diet improved (P < 0.05) ADFI and ADG. With dietary FGBL increasing, the feed: gain ratio (F/G) in 1 to 21 d was significantly decreased (P < 0.05). However, birds fed with 5.5 g/kg FGBL had a higher (P < 0.05) F/G compared with other groups in 22 to 42 d and 1 to 42 d. In addition, FGBL3 and FGBL4 showed lower (P < 0.05) L* value in breast muscle, cooking loss in thigh muscle and lower 24 h and 48 h drip loss in both breast and thigh muscles than those of other groups. Furthermore, birds in the FGBL3 and FGBL4 groups increased (P < 0.05) the activity of total superoxide dismutase and total antioxidant capability in muscles, and the scavenging activities of 2,2΄-azino-bis (3-ethylbenzothiazoline-6-sulfonic) acid radical, OH•, and O2•- in thigh muscle, decreased (P < 0.05) malondialdehyde concentration in thigh muscle, as compared to the CON group. In conclusion, FGBL had the potential to improve the growth performance, meat quality and antioxidant status of broiler chickens. The optimal dose in the present study of FGBL in broiler diets was from 3.5 to 4.5 g/kg.

Epidemiological investigation of outbreaks of fowl adenovirus infections in commercial chickens in China

One hundred and five fowl adenovirus (FAdV) strains were isolated in China from 2015 to 2016 from poultry with inclusion body hepatitis (IBH) and hydropericardium syndrome (HPS). Polymerase chain reactions determined that 68 were FAdV species C, five were FAdV species D, two were FAdV species E, and 30 contained two or more different FAdV strains. A phylogenetic analysis showed that the isolated FAdV strains clustered into three major groups: FAdV-C, FAdV-D and FAdV-E. Based on a hexon gene sequencing analysis, these viruses were genetically related to FAdV-4, FAdV-7, FAdV-8b and FAdV-11, of which FAdV-4 was dominant (93% of the strains). An epidemiological analysis showed that FAdVs had been circulating in broilers, domestic chickens, and layers, and co-infections with other immunosuppressive pathogens, such as chicken infectious anaemia virus, Marek's disease virus and reticuloendotheliosis virus, were identified. To control FAdVs, strict biosecurity protection measures are necessary, and a continued surveillance of FAdVs is needed to increase our understanding of the epidemiology of the viruses that are associated with IBH and HPS.

pLARmEB: integration of least angle regression with empirical Bayes for multilocus genome-wide association studies

Multilocus genome-wide association studies (GWAS) have become the state-of-the-art procedure to identify quantitative trait nucleotides (QTNs) associated with complex traits. However, implementation of multilocus model in GWAS is still difficult. In this study, we integrated least angle regression with empirical Bayes to perform multilocus GWAS under polygenic background control. We used an algorithm of model transformation that whitened the covariance matrix of the polygenic matrix K and environmental noise. Markers on one chromosome were included simultaneously in a multilocus model and least angle regression was used to select the most potentially associated single-nucleotide polymorphisms (SNPs), whereas the markers on the other chromosomes were used to calculate kinship matrix as polygenic background control. The selected SNPs in multilocus model were further detected for their association with the trait by empirical Bayes and likelihood ratio test. We herein refer to this method as the pLARmEB (polygenic-background-control-based least angle regression plus empirical Bayes). Results from simulation studies showed that pLARmEB was more powerful in QTN detection and more accurate in QTN effect estimation, had less false positive rate and required less computing time than Bayesian hierarchical generalized linear model, efficient mixed model association (EMMA) and least angle regression plus empirical Bayes. pLARmEB, multilocus random-SNP-effect mixed linear model and fast multilocus random-SNP-effect EMMA methods had almost equal power of QTN detection in simulation experiments. However, only pLARmEB identified 48 previously reported genes for 7 flowering time-related traits in Arabidopsis thaliana.

Nanoscale analysis of the oxidation state and surface termination of praseodymium oxide ultrathin films on ruthenium(0001)

The complex structure and morphology of ultrathin praseodymia films deposited on a ruthenium(0001) single crystal substrate by reactive molecular beam epitaxy is analyzed by intensity-voltage low-energy electron microscopy in combination with theoretical calculations within an ab initio scattering theory. A rich coexistence of various nanoscale crystalline surface structures is identified for the as-grown samples, notably comprising two distinct oxygen-terminated hexagonal Pr₂O₃(0001) surface phases as well as a cubic Pr₂O₃(111) and a fluorite PrO₂(111) surface component. Furthermore, scattering theory reveals a striking similarity between the electron reflectivity spectra of praseodymia and ceria due to very efficient screening of the nuclear charge by the extra 4f electron in the former case.

The influence of delipidation on triglyceride and LIPIN1 of porcine embryos derived from parthenogenetic activation

Proteins in the LIPIN family play key roles in lipid synthesis mainly on triacylglycerol (TAG) biosynthesis, and they also act as transcriptional coactivators to regulate the expression of genes involved in lipid metabolism with other nuclear factors. Hence, this study was designed to investigate LIPIN1 in pig oocytes and embryos by the delipidation. After delipidation, the content of lipids (LDs) and TAG in MII oocyte was significantly reduced; however, a similar increasing tendency of TAG was shown during embryos development. Subsequently, the expression of genes related to TAG biosynthesis including GPAT1, AGPAT1, AGPAT2, LIPIN1, DGAT and the nuclear factors interacted with LIPIN1 including PPARα and PPARγ was investigated. It is obvious that DGAT and GPAT1, and LIPIN1 increased significantly after delipidation at 1-cell and 4-cell stage, and the expression of PPARα and PPARγ also increased at 4-cell stage. By immunofluorescence staining and Western blots, LIPIN1 was found to exhibit a dynamic localization pattern and gradually increase with the development of delipated embryo. In the early developmental stages (1-, 2- and 4-cell stages), it was distributed over the cortical layer. But at the blastocyst stage, a homogeneous distribution of LIPIN1 was observed in cytoplasm. At 2-cell stage, the expression of PPARα decreased when LIPIN1 was interfered by small interfering RNA, but PPARγ has no significant difference. Therefore, in this study, we find after delipidation, the content of TAG and LIPIN1 will gradually increase during embryo development and nuclear factor PPARα and PPARγ can also be affected by delipidation. The interaction of LIPIN1 and PPARα exists in porcine embryo.