Postpandemic immunity debt of influenza in the USA and England: an interrupted time series study

OBJECTIVES

The concept of "immunity debt" has gained attention in the public sphere, and some have argued that the recent out-of-season resurgence of respiratory syncytial virus demonstrates the presence of immunity debt. This study investigates the existence of immunity debt in the context of influenza.

STUDY DESIGN

Interrupted time series analysis.

METHODS

The positivity rate of influenza in the USA and England was gathered from the Centers for Disease Control and Prevention and the UK Health Security Agency. A time series model with an autoregressive approach was used to model the dynamics of positivity rate. Binary indicator variables were included in the model to account for the impact of non-pharmaceutical interventions (NPIs) and immunity debt.

RESULTS

The impact of NPIs and immunity debt on the positivity rate of influenza was found to be statistically significant.

CONCLUSIONS

This present work provides evidence supporting the existence of immunity debt in influenza in both the USA and England in the immediate month following the removal of NPIs such as lockdowns and facemask mandates.

Are in-hospital COVID-19-related mortality and morbidity in pregnancy associated with gestational age?

OBJECTIVE

Pregnancy involves dynamic changes in the maternal immune system, thus potentially affecting women's response to infection. The aim of this study was to investigate whether gestational age at the time of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with mortality and morbidity related to coronavirus disease 2019 (COVID-19) in hospitalized pregnant women.

METHODS

This was a cohort study of pregnant women with confirmed SARS-CoV-2 infection at any gestational age (categorized into trimesters) who were hospitalized in Brazil from February 2020 to November 2021. Sociodemographic and epidemiological characteristics, signs and symptoms, comorbidities, interventions, vaccination status and type of healthcare establishment were obtained from a nationwide database. Multivariate logistic and Cox regression analyses were used to identify independent risk factors for in-hospital COVID-19-related mortality and morbidity (defined as time from hospital admission to recovery).

RESULTS

A total of 7461 SARS-CoV-2-infected pregnant women were included in the study (9.3%, 28.4% and 62.3% in the first, second and third trimesters, respectively). After adjustment for sociodemographic, epidemiological and clinical characteristics, and intervention-related variables, gestational age at infection was found not to be associated with COVID-19-related mortality and morbidity. Women admitted to establishments with an obstetric center, compared to hospitals without, were 38% less likely to die from SARS-CoV-2 infection (adjusted odds ratio, 0.62; 95% CI, 0.48-0.80), while patients who received private not-for-profit healthcare had a 13% shorter time to recovery (adjusted hazard ratio, 1.13; 95% CI, 1.07-1.20) compared to those who received public healthcare.

CONCLUSIONS

Despite a higher percentage of women being admitted in the third trimester, we found no association between gestational age and COVID-19 mortality and morbidity. The previously reported increase in morbidity and mortality in the third trimester in pregnant women with COVID-19 may be attributable to other gestational-age-affected variables for which adjustment was made in our study. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

A repeating fast radio burst source in a globular cluster

Fast radio bursts (FRBs) are flashes of unknown physical origin¹. The majority of FRBs have been seen only once, although some are known to generate multiple flashes^2,3. Many models invoke magnetically powered neutron stars (magnetars) as the source of the emission^4,5. Recently, the discovery⁶ of another repeater (FRB 20200120E) was announced, in the direction of the nearby galaxy M81, with four potential counterparts at other wavelengths⁶. Here we report observations that localized the FRB to a globular cluster associated with M81, where it is 2 parsecs away from the optical centre of the cluster. Globular clusters host old stellar populations, challenging FRB models that invoke young magnetars formed in a core-collapse supernova. We propose instead that FRB 20200120E originates from a highly magnetized neutron star formed either through the accretion-induced collapse of a white dwarf, or the merger of compact stars in a binary system⁷. Compact binaries are efficiently formed inside globular clusters, so a model invoking them could also be responsible for the observed bursts.

Intracoronary imaging reduces target vessel failure in primary percutaneous coronary intervention

Background

Intracoronary imaging during percutaneous coronary intervention (PCI) allows better delineation of lesion characteristics and more accurate vessel sizing compared with angiogram alone. However, the benefit and safety of its use in primary percutaneous coronary intervention (PPCI) is uncertain.

Purpose

To determine whether the use of intracoronary imaging with intravascular ultrasound (IVUS) or optical coherence tomography (OCT)/ optical frequency domain imaging (OFDI) in PPCI is associated with better outcome.

Method

From Jan 2014 to Dec 2018, all patients with PPCI performed in our hospital were retrospectively studied. Baseline and procedural characteristics of angiographic-guided versus imaging-guided PCI were analyzed. Primary endpoint was target vessel failure, and procedural outcomes were contrast volume, number of stents implanted, mean stent length and diameter and use of post-dilatation. Safety outcomes were post-operative acute kidney injury (AKI), need for renal replacement therapy (RRT) and occurrence of no/slow reflow.

Results

A total of 408 patients were included, of which 223 (54.7%) used IVUS (n=176 80.3%) or OCT/OFDI (n=44 19.7%) during the procedure. Baseline and procedural characteristics were similar between both groups except more patients had history of PCI (12.6% vs 4.3% p=0.004) and left-main/ bifurcation lesions (12.6% vs 2.7% p<0.001). Intra-coronary imaging was associated with less target vessel failure during a median follow up of 22 months (Hazard ratio (HR): 0.59; 95% Confidence interval (CI): 0.36–0.97; p=0.036). Patients who had intra-coronary imaging during PPCI received more post-dilatation (77.1% vs 55.1% p<0.001), had longer (53mm vs 42mm p<0.001) and more stents (2 vs 1.67 p=0.003) implanted but had more contrast injected (151.2ml vs 130.6ml p=0.002). There was no statistically significant difference in mean stent diameter (3.07mm vs 3.02mm p=0.53), occurrence of slow/now reflow (15.3% vs 18.4% p=0.409), incidence of AKI (7.2% vs 10.8% p=0.197) or need for RRT (3.1% vs 5.4% p=0.254) between both groups.

Conclusion

Use of intra-vascular imaging during PPCI was associated with less target vessel failure, longer and more stents implanted and more frequent use of post-dilatation. Further prospective randomized controlled trial is suggested to confirm this benefit.

Funding Acknowledgement

Type of funding source: None

Effects of a Mindfulness-Based Intervention on Distress, Weight Gain, and Glucose Control for Pregnant Low-Income Women: A Quasi-Experimental Trial Using the ORBIT Model

Background

Stress can lead to excessive weight gain. Mindfulness-based stress reduction that incorporates mindful eating shows promise for reducing stress, overeating, and improving glucose control. No interventions have tested mindfulness training with a focus on healthy eating and weight gain during pregnancy, a period of common excessive weight gain. Here, we test the effectiveness of such an intervention, the Mindful Moms Training (MMT), on perceived stress, eating behaviors, and gestational weight gain in a high-risk sample of low income women with overweight/obesity.

Method

We conducted a quasi-experimental study assigning 115 pregnant women to MMT for 8 weeks and comparing them to 105 sociodemographically and weight equivalent pregnant women receiving treatment as usual. Our main outcomes included weight gain (primary outcome), perceived stress, and depression.

Results

Women in MMT showed significant reductions in perceived stress (β = − 0.16) and depressive symptoms (β = − 0.21) compared to the treatment as usual (TAU) control group. Consistent with national norms, the majority of women (68%) gained excessive weight according to Institute of Medicine weight-gain categories, regardless of group. Slightly more women in the MMT group gained below the recommendation. Among secondary outcomes, women in MMT reported increased physical activity (β = 0.26) and had lower glucose post-oral glucose tolerance test (β = − 0.23), being 66% less likely to have impaired glucose tolerance, compared to the TAU group.

Conclusion

A short-term intervention led to significant improvements in stress, and showed promise for preventing glucose intolerance. However, the majority of women gained excessive weight. A longer more intensive intervention may be needed for this high-risk population.

Clinical Trials.gov #NCT01307683.

Compliance with NICE guidelines when commissioning varicose vein procedures

Background

Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence-based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168.

Methods

Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes.

Results

Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a 'trial' of conservative treatment; 22 (10·8 per cent) used lifestyle-related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated.

Discussion

The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle-related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.

Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins

BACKGROUND

Clinical guidelines recommend endovenous laser ablation (EVLA) over surgery based on short-term evidence, yet there are few studies reporting mid- to long-term outcomes. The aim of this study was to report the 5-year outcomes from an RCT of surgery versus EVLA for treatment of symptomatic great saphenous varicose veins.

METHODS

Patients with symptomatic varicose veins due to great saphenous vein (GSV) incompetence were followed up 5 years after enrolment in a randomized trial of either surgery (saphenofemoral junction ligation, GSV strip to the knee and multiple avulsions of varicosities) or EVLA plus multiple avulsions. Outcomes included: clinical recurrence, defined as new varicose veins greater than 3 mm in diameter; Venous Clinical Severity Score (VCSS); quality of life measured by means of Short Form 36, EuroQol Five Dimensions (EQ-5D™) and Aberdeen Varicose Vein Questionnaire (AVVQ); patient satisfaction; and duplex ultrasound examination (DUS) findings.

RESULTS

Some 218 of the 276 patients enrolled in the trial (79·0 per cent) were available for follow-up. Clinical recurrence was more frequent following surgery than EVLA at 5 years (34·3 versus 20·9 per cent; P = 0·010). Both groups demonstrated sustained significant improvements at 5 years over baseline in VCSS (surgery: median (i.q.r.) 1 (0-2) from 4 (3-5), P < 0·001; EVLA: 0 (0-1) from 4 (3-5), P < 0·001), AVVQ (surgery: 4·59 (0·56-9·78) from 13·69 (9·81-18·11), P < 0·001; EVLA: 3·35 (0·17 to 6·55) from 12·73 (9·41-17·32), P < 0·001) and EQ-5D™ (surgery: 1·000 (0·796-1·000) from 0·859 (0·796-1·000), P = 0·002; EVLA: 1·000 (0·796-1·000) from 0·808 (0·796-1·000), P = 0·002). VCSS was better for EVLA than surgery at 5 years (P = 0·031). Technical success assessed by DUS remained high at 5 years (85·4 per cent for surgery and 93·2 per cent for EVLA; P = 0·074). DUS-detected anatomical patterns of recurrence differed between the groups.

CONCLUSION

EVLA was more effective than surgery in preventing clinical recurrence 5 years after treatment of great saphenous varicose veins. Patient-reported outcome measures were similar. Registration number: NCT00759434 (http://www.clinicaltrials.gov).

Efficacy and tolerability of trastuzumab emtansine in advanced human epidermal growth factor receptor 2-positive breast cancer

INTRODUCTION

The management of human epidermal growth factor receptor 2 (HER2)-positive breast cancer has changed dramatically with the introduction and widespread use of HER2-targeted therapies. There is, however, relatively limited real-world information about the effectiveness and safety of trastuzumab emtansine (T-DM1) in Hong Kong Chinese patients. We assessed the efficacy and toxicity profiles among local patients with HER2-positive advanced breast cancer who had received T-DM1 therapy in the second-line setting and beyond.

METHODS

This retrospective study involved five local centres that provide service for over 80% of the breast cancer population in Hong Kong. The study period was from December 2013 to December 2015. Patients were included if they had recurrent or metastatic histologically confirmed HER2+ breast cancer who had progressed after at least one line of anti-HER2 therapy including trastuzumab. Patients were excluded if they received T-DM1 as first-line treatment for recurrent or metastatic HER2+ breast cancer. Patient charts including biochemical and haematological profiles were reviewed for background information, T-DM1 response, and toxicity data. Adverse events were documented during chemotherapy and 28 days after the last dose of medication.

RESULTS

Among 37 patients being included in this study, 28 (75.7%) had two or more lines of anti-HER2 agents and 26 (70.3%) had received two or more lines of palliative chemotherapy. Response assessment revealed that three (8.1%) patients had a complete response, eight (21.6%) a partial response, 11 (29.7%) a stable disease, and 12 (32.4%) a progressive disease; three patients could not be assessed. The median duration of response was 17.3 (95% confidence interval, 8.4-24.8) months. The clinical benefit rate (complete response + partial response + stable disease, ≥12 weeks) was 37.8% (95% confidence interval, 22.2%-53.5%). The median progression-free survival was 6.0 (95% confidence interval, 3.3- 9.8) months and the median overall survival had not been reached by the data cut-off date. Grade 3 or 4 toxicities included thrombocytopaenia (13.5%), raised alanine transaminase (8.1%), anaemia (5.4%), and hypokalaemia (2.7%). No patient died as a result of toxicities.

CONCLUSIONS

In patients with HER2-positive advanced breast cancer who have been heavily pretreated with anti-HER2 agents and cytotoxic chemotherapy, T-DM1 is well tolerated and provided a meaningful progression-free survival of 6 months and an overall survival that has not been reached. Further studies to identify appropriate patient subgroups are warranted.

A randomized controlled trial to determine the efficacy of a high carbohydrate and high protein ready-to-eat food product for weight loss

Incorporating meal replacements has been shown to produce a significantly greater weight loss than a conventional reduced calorie diet. Ready-to-eat conventional foods may also be effective in this role and provide additional benefit because of their palatability, acceptance and enjoyment and thus increase dietary compliance. This trial investigated the efficacy of a ready-to-eat food product (Vita-Weat biscuit) that is both high in carbohydrate and high in protein as part of a diet prescription for weight loss in an overweight and obese population group. A total of 76 participants were randomized to a 6-week weight loss intervention including the ready-to-eat food product (intervention group) or advice on the 'Australian Guide to Healthy Eating' (control group). Both groups lost approximately 2 kg weight which equated to a reduction in body mass index of 0.70 kg m(-2) . There was no significant difference in percentage weight loss from screening to 6 weeks between the two groups; mean difference for the intervention vs.

CONTROL GROUP

-0.20% (95% confidence interval: -0.96, 1.36); P = 0.73. Both diets were nutritionally matched and well-accepted over the 6-week period. This study shows that the inclusion of a ready-to-eat food product can be included as part of a dietary programme to achieve a clinically significant weight loss over a short period. This may have benefit when incorporated into an individual's meal plan intermittently to assist weight control. It also provides support for current public health nutritional guidelines as the participants in this study following such advice were also successful in achieving a clinically meaningful weight loss.

Prediction and prevention of early-onset pre-eclampsia: impact of aspirin after first-trimester screening

OBJECTIVE

To examine the effect of a combination of screening and treatment with low-dose aspirin on the prevalence of early-onset pre-eclampsia (PE).

METHODS

This was a retrospective analysis of two consecutive cohorts of women screened for early PE. The first cohort was observed to determine whether algorithms developed to screen for PE at 11 to 13 + 6 weeks' gestation could be applied to our population. High-risk women in the second cohort were advised on their risk and offered aspirin (150 mg at night), with treatment starting immediately after screening. The prevalence of early PE and the proportion of women with PE delivering at 34-37 weeks' gestation were compared between the cohorts.

RESULTS

In the observational and interventional cohorts, 3066 and 2717 women, respectively, were screened. There were 12 (0.4%) cases of early PE in the observational cohort and one (0.04%) in the interventional cohort (P < 0.01). Among all women with PE delivering before 37 weeks, 25 (0.83%) were in the observational cohort and 10 (0.37%) in the interventional cohort (P = 0.03).

CONCLUSIONS

A strategy of first-trimester screening for early PE coupled with prescription of aspirin to the high-risk group appears to be effective in reducing the prevalence of early PE.

Systematic review of compression following treatment for varicose veins

Background

Consensus regarding compression following treatment of varicose veins has yet to be reached. This systematic review aims to establish the optimal compression regimen after venous treatment.

Methods

A systematic review of MEDLINE, Embase and CENTRAL was performed to identify randomized clinical trials (RCTs) investigating different compression strategies following treatment for superficial venous insufficiency.

Results

Seven RCTs comparing different durations and methods of compression fulfilled the inclusion criteria. The treatment modality was open surgery in three trials, foam sclerotherapy in two and endovenous laser ablation (EVLA) in two trials. The quality of the studies was variable, and significant sources of potential bias were present. Both the studies and compression regimens used were heterogeneous. Ten products were used in six general regimens for a duration of 0–42 days. One study suggested that 7 days rather than 2 days of stockings following EVLA was associated with superior quality of life and less pain at 1 week. Another study reported that, following surgery, application of a compression stocking after 3 days of bandaging was associated with a slightly longer recovery than no compression after 3 days. One study recorded compliance clearly, finding it to be only 40 per cent. The quality and heterogeneity of the studies precluded meta-analysis.

Conclusion

There is currently little quality evidence upon which to base any recommendations concerning compression following treatment for varicose veins.

Damage to enteric neurons occurs in mice that develop fatty liver disease but not diabetes in response to a high-fat diet

BACKGROUND

Disorders of gastrointestinal functions that are controlled by enteric neurons commonly accompany fatty liver disease. Established fatty liver disease is associated with diabetes, which itself induces enteric neuron damage. Here, we investigate the relationship between fatty liver disease and enteric neuropathy, in animals fed a high-fat, high-cholesterol diet in the absence of diabetes.

METHODS

Mice were fed a high-fat, high-cholesterol diet (21% fat, 2% cholesterol) or normal chow for 33 weeks. Liver injury was assessed by hematoxylin and eosin, picrosirius red staining, and measurement of plasma alanine aminotransaminase (ALT). Quantitative immunohistochemistry was performed for different types of enteric neurons.

KEY RESULTS

The mice developed steatosis, steatohepatitis, fibrosis, and a 10-fold increase in plasma ALT, indicative of liver disease. Oral glucose tolerance was unchanged. Loss and damage to enteric neurons occurred in the myenteric plexus of ileum, cecum, and colon. Total numbers of neurons were reduced by 15-30% and neurons expressing nitric oxide synthase were reduced by 20-40%. The RNA regulating protein, Hu, became more concentrated in the nuclei of enteric neurons after high-fat feeding, which is an indication of stress on the enteric nervous system. There was also disruption of the neuronal cytoskeletal protein, neurofilament medium.

CONCLUSIONS & INFERENCES

Enteric neuron loss and damage occurs in animals with fatty liver disease in the absence of glucose intolerance. The enteric neuron damage may contribute to the gastrointestinal complications of fatty liver disease.

Development, implementation and reliability assessment of an emergency physician performance evaluation tool

Evaluation of physician practice is necessary, both to provide feedback for self-improvement and to guide department heads during yearly evaluations.

OBJECTIVE

To develop and implement a peer-based performance evaluation tool and to measure reliability and physician satisfaction.

METHODS

Each emergency physician in an urban emergency department evaluated their peers by completing a survey consisting of 21 questions on effectiveness in 4 categories: clinical practice, interaction with coworkers and the public, nonclinical departmental responsibilities, and academic activities. A sample of emergency nurses evaluated each emergency physician on a subset of 5 of the questions. Factor analysis was used to assess the reliability of the questions and categories. Intra-class correlation coefficients were calculated to determine inter-rater reliability. After receiving their peer evaluations, each physician rated the process's usefulness to the individual and the department.

RESULTS

225 surveys were completed on 16 physicians. Factor analysis did not distinguish the nonclinical and academic categories as distinct; therefore, the survey questions fell into 3 domains, rather than the 4 hypothesized. The overall intra-class correlation coefficient was 0.43 for emergency physicians, indicating moderate, but far from perfect, agreement. This suggests that variability exists between physician evaluators, and that multiple reviewers are probably required to provide a balanced physician evaluation. The intra-class correlation coefficient for emergency nurses was 0.11, suggesting poor reliability. Overall, 11 of 15 physicians reported the process valuable or mostly valuable, 3 of 15 were unsure and 1 of 15 reported that the process was definitely not valuable.

CONCLUSION

Physician evaluation by a single individual is probably unreliable. A useful physician peer evaluation tool can be developed. Most physicians view a personalized, broad-based, confidential peer review as valuable.

Gastroenterology training in Australia: a perspective from the coal face

BACKGROUND

The Royal Australasian College of Physicians is developing curricula for training.

AIMS

We surveyed gastroenterology trainees on their training experience to establish whether training needs were being met.

METHODS

An online anonymous survey of all gastroenterology trainees in 2009.

RESULTS

Ninety-one per cent of trainees responded (105/115). Of these, 92% were adult, and 8% were paediatric trainees. Seventy four were core, and 31 were noncore trainees. Of those who had completed core training, the majority (86%) felt that their training had prepared them adequately for independent practice as a gastroenterologist. However, most respondents felt that core advanced training should be 3 years instead of 2 years. The majority (86%) saw a benefit in moving between hospitals during core training. Of the trainees managing inpatients, 57% were managing 10 or more per day, and 63% had three or more consultant ward rounds per week. The top three noncore fellowships were advanced endoscopy (44%), hepatology (28%) and inflammatory bowel disease (17%). Sixty-one per cent and 39% were undertaking a clinical and research fellowship respectively. Seventy-two per cent of core trainees attended up to three endoscopy lists per week, and 76% were on the on-call urgent endoscopy roster. For on-call endoscopy, 27% of third-year noncore trainees and 5% of core trainees were unsupervised.

CONCLUSIONS

The majority of trainees felt that their core training would prepare them adequately for independent practice as gastroenterologists. Overall, trainees valued movement between hospitals during training and felt that core training should be 3 years. Some trainees had inadequate consultant support for out-of-hours emergency endoscopy.

Gastroenterology training in Australia: how much is enough?

BACKGROUND

Advanced training in gastroenterology currently consists of 2 years of core training and 1 elective (non-core) year. We surveyed gastroenterologists 2-7 years following completion of training to determine the strengths and weaknesses of their training.

METHODS

All gastroenterologists were invited to participate in an anonymous online survey.

RESULTS

There was a 46% response rate (49/110). Eighty-one per cent were male with most aged 36-45. Respondents felt that the current training programme prepared them well for public practice and endoscopy but less well for private practice, ambulatory care, surgical aspects of gastroenterology and functional gastrointestinal disorders. Most had faced challenges transitioning to consultant practice. The majority (53%) spent more than the standard 3 years to complete training in gastroenterology. The top three subspecialty Fellowships were in endoscopy (45%), inflammatory bowel disease (29%) and hepatology (23%). In their elective year, 42% undertook a predominantly clinical year (registrar-type position in general or subspecialty gastroenterology), 28% engaged in research while 24% trained in another specialty. Seventy-eight per cent were in full-time work, and 36% were supervising trainees. Ninety-eight per cent felt that it was beneficial for trainees to move between hospitals during the core years of their advanced training.

CONCLUSIONS

The current Australian gastroenterology training programme is generally adequate in preparing trainees for consultant practice but could be improved by increased emphasis on areas such as private practice, ambulatory gastroenterology and functional gastrointestinal diseases. Exposure to a variety of experiences by training in several different hospitals during core training was universally viewed as being important.

Partial monosomy 9p (9p22.2-->pter) and partial trisomy 18q (18q21.32-->qter) in a female infant with anorectal malformations

We report a female infant with a karyotype of 46,XX,der(9)t(9;18)(p22.2;q21.32)pat and the phenotypic features of craniofacial dysmorphisms, developmental delay, hypotonia, horizontal nystagmus, strabismus, congenital heart defects, clubfoot, and anorectal malformations with an anterior ectopic anus and a stenosed anal opening. Array comparative genomic hybridization revealed a 16.93-Mb deletion at 9p24.3-p22.2 encompassing the FREM1 gene and a 20.43-Mb duplication at 18q21.32-q23 encompassing the PIGN gene. We speculate that dual genome imbalances in FREMI at 9p22.3 and in PIGN at 18q21.3 are most likely responsible for the abnormal development of anorectum in this patient.

Abstract P3-01-02: Quantitative Analysis and Diagnostic Significance of Methylated SLC19A3 DNA in the Plasma of Breast Cancer Patients

Background: Previously, we have examined the methylation status of SLC19A3 (solute carrier family 19, member 3) promoter and found that SLC19A3 was epigenetically down-regulated in gastric cancer. Here, we aim to develop a new biomarker for cancer diagnosis using methylated SLC19A3 DNA in plasma.

Methods: SLC19A3 gene expression was examined by RT-qPCR. Methylation status of SLC19A3 promoter was evaluated by methylation-specific qPCR. A robust and simple methylation-sensitive restriction enzyme digestion and real-time quantitative PCR assay was developed to quantify SLC19A3 DNA methylation in plasma. Results: Expression of SLC19A3 was significantly down-regulated in 80% (12/15) of breast tumors (P &lt; 0.005). Breast tumors had significant increase in methylation percentage when compared to adjacent non-tumor tissues (P &lt; 0.05). A total of 155 independent plasma samples from participants including 60 breast cancer, 45 gastric cancer patients and 60 healthy subjects were analyzed. Plasma methylated SLC19A3 DNA yielded a ROC curve area of 77%, sensitivity of 82% and specificity of 60% in discriminating breast cancer from control subjects. This marker yielded a ROC curve area of 87%, sensitivity of 90.0% and specificity of 62% in discriminating gastric cancer from control subjects. Elevated level in plasma has been detected not only in advanced stages but also early stages of tumors. Intriguingly, of all DCIS cases from breast cancer patients this plasma marker generated a ROC value of 92%, sensitivity of 100% and specificity of 78% in discriminating DCIS cases from controls. Conclusions: These results suggested that aberrant SLC19A3 promoter hypermethylation in plasma may be a novel biomarker for early breast cancer diagnosis.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P3-01-02.

Digitally tunable, wide-band amplitude, phase, and frequency detection for atomic-resolution scanning force microscopy

Frequency-modulation atomic force microscopy (FM-AFM) relies on an accurate tracking of the resonance frequency of a scanning probe. It is now used in environments ranging from ultrahigh vacuum to aqueous solutions, for slow and for fast imaging, with probes resonating from a few kilohertz up to several megahertz. Here we present a versatile experimental setup that detects amplitude, phase, and frequency of AFM probes for resonance frequencies up to 15 MHz and with >70 kHz maximum bandwidth for amplitude/phase detection. We provide generic parameter settings for variable-bandwidth frequency detection and test these using our setup. The signal-to-noise ratio of the frequency detector is sufficiently high to record atomic-resolution images of mica by FM-AFM in aqueous solution.

Role of miR-143 Regulating DNA Methyltransferases 3A in Breast Cancer

Background and Aims: MicroRNAs (miRNAs) are 19-25-nucleotides regulatory non-protein-coding RNA molecules that regulate the expressions of a wide variety of genes including some involved in cancer development. In particular, decreased expression of miR-143 has been reported in various human cancers including colorectal cancer and B-cell lymphomas. The aim of this study was to elucidate the role of miR-143 dysregulation in breast cancer.Methods: Expression levels of human mature microRNAs (miRNAs) were compared with paired breast carcinomas and adjacent normal tissues by TaqMan real-time PCR based expression arrays. Decreased expression of miR-143 was further confirmed in breast cancer cell lines and paired breast tumors and normal adjacent tissues by qRT-PCR. Potential targets of miR-143 were defined. The functional effect of miR-143 and its targets was performed in human breast cancer cell lines to confirm target association.Results: Down-regulation of miR-143 was verified in both human breast cancer cell lines and 80% (12/15) of breast tumors (P &lt; 0.001). DNA methyltranferase 3A (DNMT3A), one of a key enzyme involved in DNA methylation, was defined as a potential target of miR-143 by in-silico analysis. Overexpression of miR-143 in breast cancer cell lines down-regulated expression of DNMT3A, decreased tumor cell growth by MTT assay and soft agar colony formation assay. DNMT3A was demonstrated to be a direct target of miR-143 by luciferase reporter assay. Inverse correlation between DNMT3A protein and miR-143 was found in tumor and normal breast tissues.Conclusions: In this study, we show for the first time in breast cancer that miR-143 specifically targeted DNMT3A and the expression of miR-143 was inversely correlated with DNMT3A expression. Our findings demonstrated that down-regulation of miR-143 and up-regulation of DNMT3A are significant changes in breast tumors. These findings indicate a tumor suppressive role of miR-143 in epigenetic aberration of breast cancer.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3148.

The Epidemiology, Clinico-Pathologic and Prognostic Characteristics of Triple-Negative Breast Cancer Compared with Non Triple-Negative Breast Cancer

BackgroundTriple negative breast cancers (TNC) are increasingly reported to be associated with higher grade cancers and worse prognosis. TNC are also known to be associated with BRCA mutation. There have also been reports that apart from differences biologically, reproductive, socio-demographics factors such as age of menarche, age of pregnancy, parity, body mass index may influence the development of TNC. The importance of variations in different ethnicities based on studies on Caucasians and African-Americans (AA) have been emphasized. This study aims to look at the tumor characteristics and factors which may influence the presentation and prognosis of TNC in a cohort of Chinese women.Materials and MethodA retrospective review was performed in a prospectively collected database of breast cancer patients between 1996-2007. Clincopathological, epidemiological variables and clinical outcomes were evaluated.ResultsA total of 924 women with breast cancer were included in this cohort of which 142 (8.2%) had TNC and 782 (45.2%) had non TNC. There was no significant difference in age of presentation in both groups (mean age 52.5 vs 52.1 years old). TNC significantly more likely to be associated with higher grade (p&lt;0.01), and are more likely to have lymphovascular invasion (LVI)(p=0.018). There are no significant differences between nodal stage, histological type (invasive vs. in situ), and overall stage at presentation. The median follow up was 4 years. There is no statistically difference in disease free survival (DFS) (3 yr-DFS-61.1% vs. 76%) and Overall survival (OS) (3yr-OS 68.9% vs. 78.5%) although both DFS and OS are worse in TNC. Visceral relapse rate are similar in both groups but a slightly higher rate of bone relapse in TNC group (11.1% vs. 6.9%) though not statistically significant. Although there are no differences in the overall local relapse rate, subanalysis found that after lumpectomy, TNC are more likely to recur (17.7% vs. 3.4%). Higher BMI (p=0.08), shorter duration of breast feed p=0.034), lower parity (p=0.005) are all associated with TNC whereas there are no associations with age of menarche or menopause and age of first pregnancy. 23.7% of a subset of TNC patients who undertook BRCA testing were found to be mutation carriers.DiscussionThe percentage of TNC in this cohort is smaller than that reported in the West. Unlike the West, TNC did not present at a younger age. Although TNC and Non TNC have similar stage of presentation, the DFS and OS are worse in TNC which may be explained by the higher histological grade and likely more aggressive biological characteristics. Local recurrence rate after lumpectomy is also higher in TNC which may be related to higher rate of LVI. There are similarities and differences in associated socio-demographic factors compared to the West and a higher rate of BRCA mutation in TNC. Larger-scale study on different ethnicities will increase our understanding in TNC to achieve more personalized management.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3071.

Strength indices from pQCT imaging predict up to 85% of variance in bone failure properties at tibial epiphysis and diaphysis

Our primary objective was to validate the Bone Strength Index for compression (BSIC) by determining the amount of variance in failure load and stiffness that was explained by BSIC and bone properties at two distal sites in human cadaveric tibiae when tested in axial compression. Our secondary objective was to assess the variance in failure moment and flexural rigidity that was explained by bone properties, geometry and strength indices in the tibial diaphysis when tested in 4-point bending. Twenty cadaver tibiae pairs from 5 female and 5 male donors (mean age 74 yrs, SD 6 yrs) were measured at the distal epiphysis (4 and 10% sites of the tibial length from the distal end) and diaphysis (50 and 66% sites) by peripheral Quantitative Computed Tomography (pQCT; XCT 2000, Stratec). After imaging, we conducted axial compression tests on the distal tibia and 4-point bending tests on the diaphysis. Total bone mineral content and BSIC (product of total area and squared density of the cross-section) at the 4% site predicted 75% and 85% of the variance in the failure load and 52% and 57% in stiffness, respectively. At the diaphyseal sites 80% or more of the variance in failure moment and/or flexural rigidity was predicted by total and cortical area and content, geometry and strength indices corresponding to the axes of bending.