Chest X-ray evaluation using machine learning to support the early diagnosis of pulmonary TB

BACKGROUND

TB is a public health problem, and its diagnosis can be challenging. Among imaging methods, chest X-ray (CXR) is the leading choice for assessing pulmonary TB (PTB). Recent advancements in the field of artificial intelligence have stimulated studies evaluating the performance of machine learning (ML) for medical diagnosis. This study validated a new original Brazilian tool, the XmarTB, applied to CXR images to support the early diagnosis of PTB.

METHODS

An ML model was trained on 3,800 normal images, 3,800 abnormal CXRs without PTB and 1,376 with PTB manifestations from the publicly available TBX11K database.

RESULTS

The binary classification can distinguish between normal and abnormal CXR with a sensitivity of 99.4% and specificity of 99.4%. The XmarTB tool had a sensitivity of 98.1% and a specificity of 99.7% in detecting TB cases among CXRs with abnormal CXRs; sensitivity was 96.7% and specificity 98.7% in detecting TB cases among all samples.

CONCLUSION

This diagnostic tool can accurately and automatically detect abnormal CXRs and satisfactorily differentiate PTB from other pulmonary diseases. This tool holds significant promise in aiding the proactive detection of TB cases, providing rapid and accurate support for early diagnosis..

The development of new Electronic Health Record Exchange Format Use Cases - an evaluating perspective

 

The EU-funded X-eHealth project aims to lay the foundations for a common framework for medical imaging, discharge letters, laboratory results and rare diseases to advance an interoperable Common European Health Data Space for citizens and healthcare providers in accordance with privacy and cybersecurity regulations. To ensure sustainability of the project, it is crucial to assess whether X-eHealth is achieving its planned objectives and delivers tangible results. A key challenge in evaluating project outcomes lies in the partial lack of visibility of direct impacts due to a time lag of effects or attribution problems (i.e., identifying the main cause of a particular impact). In X-eHealth, we address this problem by defining a framework of Key Performance Indicators (KPI) that allows the monitoring of project outcomes. In addition, qualitative interviews with a focus on the following questions are conducted towards the end of the project to complement the evaluation:

• Does X-eHealth advance the integration process of eHealth services in Europe?

• Will X-eHealth lead to increased use of the new European Electronic Health Record Exchange Format (EEHRxF) specifications?

Although final results are not yet available, we expect X-eHealth to have a positive impact at all stakeholder levels by accelerating the implementation of EEHRxF through the harmonisation of health data, thus providing patients, health professionals and institutions with increased quality, safety and efficiency. There is little evidence to analyse the impact of eHealth policy interventions. For this reason, the present evaluation makes a significant contribution to impact research in this area. X-eHealth highlights the importance of international cooperation in creating a common framework for the future development of digital health in the EU. The continuous evaluation, moreover, facilitates a more efficient management of resources through KPI observance and the implementation of project results.

Key messages

• X-eHealth aims to accelerate the implementation of the European eHealth Record exchange Format (EEHRxF) through the standardisation and harmonisation of health data.

• By evaluating and monitoring the project processes, it is possible to ensure the progress of the project and to measure the potential impacts of the outcomes on stakeholders and other target groups.

Ticagrelor pretreatment in patients with non-ST elevation acute coronary syndrome undergoing percutaneous coronary intervention

Introduction

Dual antiplatelet therapy is recommended in non-ST elevation acute coronary syndrome (NSTACS), regardless of the treatment strategy (invasive vs. conservative). Although prasugrel pretreatment is not recommended due to safety concerns, the timing of ticagrelor administration is still debated.

Aim

To investigate the clinical effects of ticagrelor pretreatment in NSTACS patients (pts) undergoing percutaneous coronary intervention.

Methods

Retrospective multicentre study of 5213 NSTACS pts who underwent percutaneous coronary intervention (PCI) up to 72 hours following hospital admission, between January 2013 and December 2018. Patients with prior chronic exposure to oral antithrombotics (except acetylsalicylic acid), not acutely managed with ticagrelor, and those with missing data were excluded. A total of 415 pts were included for analysis, 256 (61.6%) received ticagrelor pretreatment (Group 1) and 159 (38.3%) were treated with ticagrelor only in the catheterization laboratory (Group 2). The primary safety endpoint was a composite of in-hospital major bleeding, need for red blood cell transfusion or haemoglobin drop ≥2g/dL and the secondary endpoint of periprocedural events was a composite of PCI failure, bailout use of GPIIb/IIIa inhibitors and in-hospital re-infarction. Multivariate analysis was performed to determine the correlates of ticagrelor pretreatment and each of the endpoints. One-year follow up was achieved in 103 pts (24.8%).

Results

Overall, mean age was 62±11 years and 20.7% were female. Crude event rates did not differ regarding primary endpoint (16.5 vs 11.5%; p=0.17), while secondary endpoint was more frequent among group 2 (2.1% vs 7.1%; p=0.01). Multivariate analysis showed no association between the timing of ticagrelor administration and the primary safety endpoint, while periprocedural events were less frequent in pretreated pts (Figure 1A). At the Kaplan-Meier analysis, one-year cumulative event-free (all-cause death, stroke or re-infarction) rates did not differ (Figure 1B).

Conclusion

In this cohort of NSTACS pts undergoing PCI in the first 72 hours after hospital admission, ticagrelor pretreatment was associated with less periprocedural events with no compromise regarding safety, compared to treatment in the catheterization laboratory. Additional data is still needed to clarify these findings.

Funding Acknowledgement

Type of funding source: None

The association between white blood cell count and outcomes in patients with idiopathic pulmonary fibrosis

BACKGROUND

The course of idiopathic pulmonary fibrosis (IPF) is uncertain with variable patterns of disease progression. We sought to evaluate the prognostic utility of the WBC, a routinely performed lab test, in a well-defined cohort of outpatient IPF subjects.

METHODS

We reviewed IPF patient records from two independent ILD centers (Inova Fairfax in Falls Church, VA, USA and Ege University Hospital in Izmir, Turkey) between 2007 and 2018. Demographics, CBC data, and patient outcomes were obtained. Survival differences were analyzed.

RESULTS

There were 436 IPF outpatients in the cohort with a median WBC of 8.9 × 10⁹ cells per liter. For pragmatic purposes, patients were categorized into two groups, WBC ≥9 or WBC <9. Patients with WBC <9 had a median transplant-free survival of 50.5 months from the time of the CBC, compared to 32.4 months for those with WBC ≥9 (p < 0.0001). The association between WBC and attenuated survival remained significant after adjusting for GAP stage, steroid use, and antifibrotic use when WBC was analyzed both as a continuous (HR: 1.11; 95% CI: 1.05-1.17) and a dichotomized variable (high (WBC ≥9) vs. low (WBC <9), (HR: 1.53; 95% CI:1.09-2.15). WBC and absolute neutrophil count (ANC) were highly correlated suggesting that PMNs account for most of this association (r = 0.92).

CONCLUSIONS

Baseline WBC may impart important and readily available prognostic information in outpatients with IPF. Further studies are warranted to validate this as a potential biomarker for IPF, as well as to define the biologic basis for the association.

Reduction of visual acuity decreases capacity to evaluate radiographic image quality

INTRODUCTION

To determine the impact of reduced visual acuity on the evaluation of a test object and appendicular radiographs.

METHODS

Visual acuity was reduced by two different magnitudes using simulation glasses and compared to normal vision (no glasses). During phase one phantom images were produced for the purpose of counting objects by 13 observers and on phase 2 image appraisal of anatomical structures was performed on anonymized radiographic images by 7 observers. The monitors were calibrated (SMPTE RP133 test pattern) and the room lighting was maintained at 7 ± 1 lux. Image display and data on grading were managed using ViewDEX (v.2.0) and the area under the visual grading characteristic (AUC_VGC) was calculated using VGC Analyzer (v1.0.2). Inferential statistics were calculated using SPSS.

RESULTS

For the evaluation of appendicular radiographs the total interpretation time was longer when visual acuity was reduced with 2 pairs of simulation glasses (15.4 versus 8.9 min). Visual grading analysis showed that observers can lose the ability to detect anatomical and contrast differences when they have a simulated visual acuity reduction, being more challenging to differentiate low contrast details. No simulation glasses, compared to 1 pair gives an AUC_VGC of 0.302 (0.280, 0.333), that decreases to 0.197 (0.175, 0.223) when using 2 pairs of glasses.

CONCLUSIONS

Reduced visual acuity has a significant negative impact on the evaluation of test objects and clinical images. Further work is required to test the impact of reduced visual acuity on visual search, technical evaluation of a wider range of images as well as pathology detection/characterization performance.

IMPLICATIONS FOR PRACTICE

It seems that visual performance needs to be considered to reduce the risks associated with incomplete or incorrect diagnosis. If employers or professional bodies were to introduce regular eye tests into health screening it may reduce the risk of misinterpretation as a result of poor vision.

P4624Predictive performance of CRUSADE bleeding score in non ST elevation acute coronary syndrome patients treated with ticagrelor versus clopidogrel

Introduction

CRUSADE score is commonly used for bleeding risk stratification in the context of acute coronary syndrome (ACS). However, the study validating it was performed before ticagrelor was available.

Purpose

To compare the predictive performance of CRUSADE score in two groups of non-ST elevation ACS (NSTEACS) patients, one treated with ticagrelor and another with clopidogrel.

Methods

Retrospective study of 2077 NSTEACS patients admitted between January 2014 and September 2017 and included in a multicentre national registry. Group 1 was composed by patients medicated with ticagrelor, and Group 2 with clopidogrel. Patients with bleeding history were excluded. The primary endpoint (PE) results from a composite which includes: in-hospital major bleeding (MB) according to the Registry criteria, need for red blood cell transfusion (RBCT), or haemoglobin drop ≥2g/dL (HbD). The groups were compared according to their demographic, clinical and laboratory characteristics. The occurrence of the PE (and its components) across CRUSADE risk categories was assessed by Chi-square for linear trend. The performance of CRUSADE score for PE prediction in each cohort was assessed by Receiver Operator Characteristics (ROC) curves.

Results

Group 1 included 662 (31.9%) and Group 2 1415 (68.1%) patients. Mean CRUSADE score was higher in Group 2 (23.1±14.7 versus (vs) 26.7±16.3, p=0.001). No difference was observed regarding the PE (14.8% vs 17.0%, p=0.200) and its components. With the exception of MB in Group 1 (p-trend=0.425), the relative occurrence of the PE and its components increased across CRUSADE risk categories [Figure 1. panel A]. In-hospital mortality was numerically superior in Group 2, but did not reach statistical significance (1.1% vs 1.6%, p=0.368). In both groups, the performance of CRUSADE score in predicting the PE was modest (Group 1 AUC=0.59 and p=0.006, Group 2 AUC=0.62 and p<0.001), and no difference was observed when comparing the two groups (P value for ROC curves comparison = 0.899) [Figure 1. panel B and C respectively].

Figure 1

Conclusion

In this study based on a national registry of NSTEACS patients, the use of ticagrelor did not influence the occurrence of bleeding related events and it did not change the predictive performance of the CRUSADE score. According to this analysis, CRUSADE score may be applied without limitation to NSTEACS patients managed with ticagrelor.

P3123Enoxaparin versus unfractionated heparin in ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention

Background

The use of intravenous enoxaparin (LBWH) in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI) was upgraded in the latest European Guidelines to a class IIa recommendation.

Purpose

The authors aim to compare safety and prognostic impact of LMWH versus unfractionated heparin (UFH) use in STEMI patients undergoing primary PCI.

Methods

Retrospective study of 3875 STEMI patients who underwent pPCI between October 2010 and September 2017 and were included in a national multicenter registry. Group A consisted of patients managed only with LMWH, and Group B patients were treated with UFH regardless of eventual LMWH associated exposure. The groups were compared according to their demographic, clinical and laboratory characteristics. The primary endpoint (PE) results from a composite which included: procedural failure (pPCI failure or bailout use of GPIIb/IIIa inhibitors), in-hospital mortality, re-infarction or major bleeding (according to the registry criteria). The secondary endpoint (SE) included: in-hospital major bleeding, need for red blood cell transfusion, or haemoglobin drop ≥2g/dL. A 1:1 propensity score (PS) analysis was performed according to demographic variables, medical history and previous medication, physical examination, electrocardiogram characteristics and left ventricular function, matching 1558 of the 3875 patients for later comparison between groups.

Results

Overall, Group A included 1083 (27.9%) and Group B 2792 (72.1%) patients. The mean age was 63±14 years, and 33.5% of the cohort were female. Despite the baseline characteristics heterogeneity between groups, this phenomenon was not observed after PS matching. The PE was more frequent in Group A, without reaching statistical relevance (15.6% vs 13.3%, p=0.07). The SE was superior in Group A (34.4 vs 29.4%, p=0.01). According to the PS matching analysis, there were no differences beetween groups in terms of the PE (13.9% vs 12.0%, p=0.28), while the SE kept more frequent among Group A (34.9% vs 28.5%, p=0.02) [Figure].

Propensity score: group comparison

Conclusion

In this study based on a national multicentric registry of STEMI patients, the use of LMWH was not associated with better in-hospital prognosis in terms of major cardiovascular events and was related with higher rates of bleeding related events in the scenario of pPCI, compared to UFH. According to these results, further studies are required to support the widespread use of LMWH in this clinical scenario.

Physiological responses of reared sea bream (Sparus aurata Linnaeus, 1758) to an Amyloodinium ocellatum outbreak

Amyloodiniosis represents a major bottleneck for semi-intensive aquaculture production in Southern Europe, causing extremely high mortalities. Amyloodinium ocellatum is a parasitic dinoflagellate that can infest almost all fish, crustacean and bivalves that live within its ecological range. Fish mortalities are usually attributed to anoxia, associated with serious gill hyperplasia, inflammation, haemorrhage and necrosis in heavy infestations; or with osmoregulatory impairment and secondary microbial infections due to severe epithelial damage in mild infestation. However, physiological information about the host responses to A. ocellatum infestation is scarce. In this work, we analysed the proteome of gilthead sea bream (Sparus aurata) plasma and relate it with haematological and immunological indicators, in order to enlighten the different physiological responses when exposed to an A. ocellatum outbreak. Using 2D-DIGE, immunological and haematological analysis and in response to the A. ocellatum contamination we have identified several proteins associated with acute-phase response, inflammation, lipid transport, homoeostasis, and osmoregulation, wound healing, neoplasia and iron transport. Overall, this preliminary study revealed that amyloodiniosis affects some fish functional pathways as revealed by the changes in the plasma proteome of S. aurata, and that the innate immunological system is not activated in the presence of the parasite.

The effect of live feeds bathed with the red seaweed Asparagopsis armata on the survival, growth and physiology status of Sparus aurata larvae

Larval rearing is affected by a wide range of microorganisms that thrive in larviculture systems. Some seaweed species have metabolites capable of reducing the bacterial load. However, no studies have yet tested whether including seaweed metabolites on larval rearing systems has any effects on the larvae development. This work assessed the development of Sparus aurata larvae fed preys treated with an Asparagopsis armata product. Live prey, Brachionus spp. and Artemia sp., were immersed in a solution containing 0.5% of a commercial extract of A. armata (Ysaline 100, YSA) for 30 min, before being fed to seabream larvae (n = 4 each). In the control, the live feed was immersed in clear water. Larval parameters such as growth, survival, digestive capacity (structural-histology and functional-enzymatic activity), stress level (cortisol content), non-specific immune response (lysozyme activity), anti-bacterial activity (disc-diffusion assay) and microbiota quantification (fish larvae gut and rearing water) were monitored. Fish larvae digestive capacity, stress level and non-specific immune response were not affected by the use of YSA. The number of Vibrionaceae was significantly reduced both in water and larval gut when using YSA. Growth was enhanced for YSA treatment, but higher mortality was also observed, especially until 10 days after hatching (DAH). The mortality peak observed at 8 DAH for both treatments, but higher for YSA, indicates larval higher susceptibility at this development stage, suggesting that lower concentrations of YSA should be used until 10 DAH. The application of YSA after 10 DAH onwards promotes a safer rearing environment.

The use of the color Doppler ultrasonography in the diagnosis and monitoring of an atypical case of giant-cell arteritis

Giant Cell Arteritis (GCA) is a large vessels vasculitis that is typically characterised by headache, scalp tenderness, jaw claudication and visual disturbances. Temporal arteries color Doppler ultrasonography (CDUS) is a sensitive and non-invasive image technique used in the diagnosis of this disease. This work highlights the importance of CDUS in the diagnostic workup of GCA and also demonstrates it´s usefullness in the evaluation and documentation of the response to corticosteroids therapy in an atypical case of ACG.

Abstract P5-17-10: Claudin -4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics

Introduction: Claudins are tight junction molecules and have been associated to breast cancer prognosis. Claudin-low intrinsic subtype of invasive carcinoma was described recently and has been related to high grade carcinoma, low junction molecules expression and worse chemotherapy response. However, it is unknown whether Claudins expression could be associated to carcinoma in situ prognostic. The aim of this study was evaluated the Claudin – 4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics.

Methods: A tissue microarray (TMA) block was constructed, using region of interesting, with 137 pure carcinoma in situ paraffin blocks of patients treated in the Women 's Hospital Prof. Dr. José Aristodemo Pinotti – UNICAMP from 1999 to 2009. The TMA was submitted to immunohistochemistry analyze to: Claudin-4, beta-catenin, e-caderin, estrogen receptor (ER), progesterone receptor (PR), HER-2 and Ki-67. It was calculated Claudin-4 score based in percentage and intensity of expression and categorized in: Claudin-4 low and Claudin – 4 high. The clinical data, treatment data (surgery, radiotherapy and tamoxifen use), local recurrence data (date and type) and death of each patient were reviewed in the medical records. The statistical analyze used Kaplan-Meier curve and log-rank test to disease free survival; qui-square and Fisher test to compare others variables; significance level of 5 % was used.

Results: It was possible to evaluate Claudin-4 expression in 86 cases, 88.4% were Claudin-4 high and 11.6% Claudin-4 low. The follow up mean was 69 months and local recurrence rate was 10.5 %. There was no significant difference in local recurrence rate between Claudin-4 high and Claudin-4 low (10.0% x 10.5% , p=1.0).The disease free survival was similar between Claudin-4 low and Claudin-4 high (p=0.559). The Claudin- 4 high was significantly more frequent in beta-catenin positive patients (p=0.048). There was no association significantly between Claudin-4 expression and: age (p=0.66), histology type (p=0.75), surgery (p=0.102), radiotherapy (p=0.29), tamoxifen use (p=0.432), ER (p=0.33), PR (p=1.0), HER-2 (p=0.23) and e-caderin (p=0.21).

Conclusion: Despite the Claudins are related to invasive carcinoma prognosis, our outcome did not show difference in local recurrence and disease free survival between Claudin-4 low and high in carcinoma in situ. The beta-catenin and claudin-4 expressions were significantly associated.

Citation Format: Duarte GM, Toucchet F, Espinola JP, Barreto CR, Paiva Silva GR, Almeida NR, Soares F, Pinto G, Marshall P. Claudin -4 expression in carcinoma in situ and its association with local recurrence, clinical and immunohistochemistry characteristics. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-17-10.

Virtual Kitchen Test. Assessing frontal lobe functions in patients with alcohol dependence syndrome

INTRODUCTION

This article is part of the Focus Theme of Methods of Information in Medicine on "New Methodologies for Patients Rehabilitation".

BACKGROUND

The ecological validity of paper-and-pencil neuropsychological tests is currently a matter of debate. Arguments in favor of alternatives indicate that paper-and-pencil forms are unable to account for both mental and functional aspects of cognitive functioning.

OBJECTIVES

In this study we developed a new neuropsychological evaluation test - the Virtual Kitchen Test (VKT) - devised to evaluate frontal brain functioning in cognitively impaired individuals. We designed this test according to the rationale of the Trail Making Test (TMT), in order to capture frontal lobe abilities during a more ecologically valid task.

METHODS

Forty-nine participants, 25 from a clinical sample of patients diagnosed with Alcohol Dependence Syndrome, plus 24 healthy participants.

RESULTS

Execution errors and task completion time were significantly higher in the clinical sample. Also, scores on the new VKT showed moderate to high positive correlations with scores on the TMT. Furthermore, the overall discriminant performance of the VKT was high for both of its indicators.

CONCLUSIONS

Overall results support the ability of the VKT to evaluate frontal lobe functions. The best cut-off scores based on this sample are discussed.

Development of an automatic electronic system to human blood typing

Blood typing has a vital contribution to the success of life-saving procedures, such as blood transfusions, and it can be critical, especially in emergency situations. For that, in this paper the main principles to the development of a miniaturized, low cost, portable and automatic system to human blood typing, in emergency situations, are presented. In a previous study, the authors validated a general experimental protocol to be applied in the automatic system. Now, the implementation of a specific light source system by using standard Light Emission Diodes (LEDs) was studied. Moreover, the specification of all electronic components to be used in the prototype device was performed.

Sarcoma in the thymus of juvenile meagre Argyrosomus regius reared in an intensive system

Juvenile meagre Argyrosomus regius (Asso, 1809) maintained in experimental conditions developed lateral and/or bilateral circular-shaped sarcoma within the opercular cavity. The sarcoma was dense, reddish and its growth from the branchial arch exerted pressure on the operculum forcing it to open. Histologically, the neoplasm exhibited marked proliferation of mesenchymal connective tissue composed largely of fusiform cells, which developed in a solid pattern accompanied by abundant mononuclear cell types. Multifocal areas of discrete necrosis were also observed, compatible with a sarcomatous proliferation. The immunological parameters analysed suggested an inflammatory response. No bacteria were isolated from the hematopoietic organs. However, Vibrio species, components of the normal seawater flora, were isolated from the tumour, which may have had a role in eliciting the immune response. No evidence of viral pathogens was found by electron microscopy. In order to look for cytogenetic alterations often linked to sarcomas, the diploid number and karyotype of this species were determined for the first time. An increase in the aneuploidy level was observed in sarcoma cell metaphase stages compared to other tissues. The aetiology of this tumour remains unknown.

Abstract P4-02-03: FDG PET/CT for early monitoring of response to neoadjuvant chemotherapy in breast cancer patients

Introduction: Neoadjuvant chemotherapy (NAC), initially used only for locally advanced breast cancer, is now commonly used in patients with operable but large breast cancer or unfavorable tumor/breast size index because increases the chances of performing breast conservative surgery (BCS) instead of mastectomy in this group of patients.

Patients and Methods: This is a prospective unicenter trial. FDG PET/CT were performed in 40 patients at baseline and after the second cycle of NAC. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response.

Pathologic complete response (pCR) was defined as no malignant cells (no invasive ductal carcinoma and no ductal carcinoma in situ) identifiable in sections from the site of the tumor in the breast and in the axillary lymph node.

Results: This prospectively study analyzed forty patients undergoing NAC, all female, age ranged 27–64 years (mean 41.0 years and median 38 years), all tumors were invasive ductal carcinoma, histological tumor grade 1, 2 and 3 were present respectively at 5%, 38.5% and 100% of the sample and nuclear grade 2 and 3 were present respectively at 12.5% and 87.5%. Estrogen receptor was positive in 60% of patients and the progesterone receptor was positive in 47.5% of patients. Her 2 was overexpressed in 12 patients (30%). Phenotype in this sample had the following distribution: 12.5% luminal A (5 patients), 50% Luminal B (20 patients: 14 patients with Ki-67&gt; 14% and 6 cases with HER 2 overexpression), 15 % HER 2 (6 patients) and cases triple negative 9 (22.5%). size of the primary tumor ranged from 4.10 cm to 12.0 cm (mean 7.10 cm). The size of the primary tumor ranged from had a mean of 6.7 cm and a median of 6.0 cm. This group showed great uniformity in relation to primary chemotherapy. NAC with cyclophosphamide and adriamycin were administered to 38 patients. In this study, pCR was obtained in 12 patients (30%). Baseline FDG SUV referring to pCR group was 11.26 and 7.26 in non-pCR group (p = 0.04). FDG SUV after second cycle was 2.73 in pCR group and 4.64 in non-pCR group (p = 0.048). When analyzing ΔSUV (difference between baseline SUV and SUV after second cycle), pCR group had a mean reduction of 81.58% and non-pCR group had a mean reduction of 81.58% (p = 0.001). Receiver operating curve analyses were performed to deter mine optimal differentiation cut-off values of ΔSUV for differentiation of pCR and non-pCR. After two courses of NAC the optimal cutoff value to early differentiation between pCR from non-pCR were 59,1% in decrease of SUV. The sensitivity and specificity were 64,3% and 100,0%, respectively.

Conclusion: The optimum role of FDG PET in predicting the response of breast cancers to neoadjuvant chemotherapy is still not clearly defined and the SUV cut-off needs to be validated. FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after two cycles of chemotherapy and FDG-PET may be helpful for individual treatment stratification in breast cancer patients.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P4-02-03.

Chromatin changes in papillary thyroid carcinomas may predict patient outcome

PURPOSE

New insights in prognostic predictions are urgently needed for papillary thyroid carcinoma (PTC). The present study aimed to investigate whether computerized analysis of chromatin texture allows the identification of PTC patients with a poor prognosis.

METHODS

We randomnly selected paraffin-embedded blocks from surgical specimens of 103 classic cases of PTC. During follow-up, 68 of the patients were classified as free of disease, whereas 35 presented with recurrences. Characteristics of chromatin were obtained from digitized images of at least 100 randomly selected tumor nuclei per patient. An independent series of 30 goiters was used to validate our observations.

RESULTS

Stage, age and distant metastases were found to serve as independent prognostic factors for survival. In addition, multivariate Cox regression confirmed variable cluster prominence as an independent prognostic factor. By comparing malignant and benign nodules, we found that the PTC lesions presented with higher nuclear perimeters, nuclear areas, Minkowski fractal dimensions, optical densities and nuclear longest chords.

CONCLUSION

From our results we conclude that, in conjunction with clinical and histopathological data, morphometric data may provide relevant prognostic information in PTC patients.

Approaches in injections for radicular pain: the transforaminal, epidural and transfacet approaches

Spinal injections must be carried out adhering to very strict conditions. However, these procedures have almost come to be seen as everyday and may be practised under quite questionable conditions. The recent reports of new and extremely serious neurological complications have changed the attitudes of those making referrals as well as the attitudes of the interventional radiologists carrying out these procedures. The range of indications for transforaminal injections has shrunk in favour of epidural injections. Where the transforaminal approach is still used, the needle must be positioned extremely accurately. A prior radioopaque contrast medium injection is essential from a safety perspective. The transforaminal epidural injection via the transfacet approach looks to be a promising alternative that is strictly avascular.

Is it possible to recognize cervical artery dissection on stroke brain MR imaging? A matched case-control study

BACKGROUND AND PURPOSE

Extracranial CAD accounts for nearly 20% of cases of stroke in young adults. The mural hematoma frequently extends cranially to the petrous carotid segment in cCAD or is distally located in vCAD. We hypothesized that standard brain MR imaging could allow the early detection of CAD of the upper portion of carotid and vertebral arteries.

MATERIALS AND METHODS

Our prospectively maintained stroke data base was retrospectively queried to identify all patients with the final diagnosis of CAD. In the 103 consecutive patients studied, analysis of cervical fat-suppressed T1-weighted sequences demonstrated that the mural hematoma was located in the FOV of brain MR imaging in 77 patients. Subsequent to enrollment of a patient, a control patient was extracted from the same data base, within a similar categories for sex, age, NIHSS score, and stroke on DWI. Two blinded observers independently reviewed the 5 brain MR sequences of each examination and determined whether a CAD was present.

RESULTS

Fifty-nine of the 77 patients with CAD (76.6%) and 73 of the 77 patients without CAD (94.8%) were correctly classified. Brain MR imaging demonstrated cCAD more frequently than vCAD in 54/58 (93.1%) and 5/19 (26.3%) patients, respectively, (P < .0001).

CONCLUSIONS

Initial brain MR imaging can correctly suggest CAD in more than two-thirds of patients. This may have practical implications in patients with stroke with delayed cervical MRA or in those who are not initially suspected of having CAD.

Hydrogenated Amorphous Silicon Speed Sensor Based on the Flying Spot Technique

In the past we have developed a transient technique, called the Flying Spot Technique (FST). FST allows, not only to infer the ambipolar diffusion length but also the effective lifetime of the photogenerated carriers once the light spot velocity and geometry of the structure were known.

In this paper, we propose to apply this technique backwards in order to detect the path and velocity of an object that is moving in the direction of a light source. The light reflected back from the object is analyzed through a p.i.n structure being the transient transverse photovoltage dependent on the movement of the object (position and velocity). Assuming that the transport properties of the material and the geometry of the device are known and using a triangulation method we show that it is possible to map the movement of the object. Details concerning material characterization, simulation and device geometry are presented.

Endocrine and milt response of Senegalese sole, Solea senegalensis, males maintained in captivity

Improving fertilization success in captive Senegalese sole broodstocks has been a challenge in the last years. Recent reports suggest that low sperm volume and quality could be one of the reasons leading to poor fertilization rates, although further studies are needed to reach a conclusive explanation. Here, we report on several experiments focused on this issue. Seasonal profiles of plasma androgen levels (testosterone and 11-ketotestosterone) and sperm production and quality parameters were assessed, although no statistical correlations among them were identified. The response of males to female presence/absence was also analyzed. Long-term isolation from females decreased male androgen levels at the peak of the reproductive period, suggesting some kind of disrupting effects on the endocrine system. On the other hand, short-term exposure of previously isolated males to ripe females decreased androgen levels, possibly reflecting a rapid steroidogenic shift promoting final maturation of spermatozoa, and increased sperm viability, motility and velocity, thus, supporting the concept of positive effects of female contact on male sole performance. Further evidence sustaining the relevant female-to-male communication in sole reproduction was obtained after treating the females with progestagen 17α,20β-dihydroxy-4-pregnen-3-one (regarded as pre-ovulatory pheromone in fish) and registering a significant increase in sperm viability, velocity and motility in surrounding males. Finally, we found that a single administration of a 20 μg/kg GnRH analogue in males was effective in stimulating androgen release and sperm quality, although the effects were transient and thus, the use of sustained hormone delivery methods were suggested for improving efficiency. Our results point to velocity, viability, and motility as the most sensitive parameters in sole sperm, although further studies will have to evaluate whether these parameters have any relation with fertilization success in captive broodstocks of this important aquaculture species.

Transcriptional Profile Changes Induced by Rapamycin in Breast Cancer Maintained in Organ Culture

Background: mTOR (mammalian target of rapamycin) is a serine threonine kinase, member of the AKT/PI3K pathway, which is involved in multiple biologic functions such as transcription, translation, protein degradation and ribosome biogenesis. The activation of this protein results in phosphorilation and activation of S6K1 and 4EBP1. Rapamycin is a potent fungicide, immunossupressive and anti-cancer agent that inhibits the mTOR pathway and is an emerging cancer therapeutic. Objective: The aim of this study was to determine genes regulated by rapamycin in samples of ductal invasive breast cancer to identify novel markers of rapamycin response. Material and Methods: Inhibition of some elements of AKT pathway was assessed by immunohistochemistry in samples of breast carcinoma maintained in organ culture of fresh cut slices that preserves the interaction between epithelium and stroma before and after treatment with rapamycin. Additionally changes of the gene expression profile was analyzed by microarray in these samples subdivided in positive and negative Erb-B2. Results: Immunohistochemistry analysis indicated a significant decrease of 4EBP1 in the samples of tumor treated with rapamycin compared with the control cases. Microarray analysis revealed that few common genes were regulated in both tumor types but rapamycin affected the expression of genes mainly involved in cellular transcription and translation in both groups. To confirm the results obtained through microarray technique, RT-PCR analysis was performed in independent samples and we validated the genes WWOX, EXT1 and GTF2E2 in 60% of our cases. Over expression of the autophagy related beclin 1 indicated a contribution of autophagy to cytotoxicity of rapamycin. Conclusion: The organ culture represents a simple method to determine the effects of rapamycin and using gene profile analysis, novel genes that possible could be used as markers of mTOR inhibition were identified. Supported by FAPESP nº 04/04607-8

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6129.

Fra-1 Expression in In Situ and Invasive Ductal Breast Carcinomas: Association with Worse Prognosis in Invasive Basaloid Tumors

Background: Fos-related antigen 1 (Fra-1) is an immediate early gene encoding a member of AP-1 family of transcription factors involved in cell proliferation, differentiation, apoptosis, and other biological processes. A high level of Fra-1 expression is found in various tumors and tumorigenic cell lines, suggesting that Fra-1 may be involved in malignant progression. Objective: Evaluate the significance of Fra-1 expression in breast carcinogenesis and its possible help in sub typing and prognosis of breast carcinomas. Methods: Fra-1 expression was investigated by immunohistochemistry in a Tissue Microarray composed by neoplastic breast tissue from 85 in situ breast carcinomas lesions and 769 invasive ductal carcinomas NOS (IDC), ranging from early stage T1 N0M0 to very aggressive metastatic disease (TxN1-3M1). Positive and negative controls were present in each reaction. Nuclear staining were considered positive. Correlations of Fra-1 expression with other indicators of breast carcinoma prognosis (ER, PR TNM, survival) were analyzed. Results: IDC showed 22.8 % of positivity while in situ lesions maintained a 42.2% of reactive cases. In IDC samples, Fra-1 expression correlated with markers of invasiveness, as Node status, histological grade (P= 0.005 and 0.001, chi-square test) and marginally with presence of metastasis (P= 0.07). Fra-1 was also associated to Cytokeratin (CK) 14 (P= 0.043) and marginally to CK18 and her-2 status (P=0.063 and 0.05), and indirectly to estrogen receptor (P= 0.01). When we select basaloid (CK6 positive, ER negative) cases Fra-1 was associated to worse prognosis (P= 0. 013 - Log Rank test). Conclusions: The data shown here suggest that Fra-1 expression is progressively lost during cancer progression from DCIS to IDC. Fra-1 expression in IDC basaloid tumors confers a worse prognosis. Supported by FAPESP nº 04/04607-8.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2129.

Lunar and daily spawning rhythms of Senegal sole Solea senegalensis

A periodicity of 29 days was observed in spawning rhythms in Senegal sole Solea senegalensis, with an acrophase around the last quarter and the new moon. In both spring and autumn, a very marked nocturnal spawning rhythm was registered, with spawning beginning after dusk and the acrophase occurring around 2300 hours. When the photoperiod was artificially extended (from 10L:14D to 14L:10D), S. senegalensis synchronized to the new photoperiod: spawning took place after the new 'dusk', the beginning gradually shifting from 2100 to 2300 hours and the acrophase from 2325 to 0032 hours. Under continuous light conditions, fish sustained rhythmicity for 2 days, with an acrophase at 2249 hours, which suggested the existence of an endogenous pacemaker controlling the daily spawning rhythm. These findings provided new insights for better understanding the reproductive physiology of this species and for optimizing the timing protocols of egg collection and larvae production in S. senegalensis aquaculture.

Carcinoma ex pleomorphic adenoma (CXPA): immunoprofile of the cells involved in carcinomatous progression

AIMS

To characterize the cellular component in pleomorphic adenoma (PA) that undergoes malignant transformation in carcinoma ex pleomorphic adenoma (CXPA).

METHODS AND RESULTS

A panel of antibodies against cytoskeletal proteins was applied in 16 cases of CXPA: intracapsular carcinoma (five cases), minimally invasive (four cases) and frankly invasive (seven cases). The CXPAs were classified into two main groups according to their predominant cellular component as detected by the panel of antibodies: (i) carcinomas with only epithelial differentiation (75% of the cases), and (ii) carcinomas with a myoepithelial component (25%). CXPA with only epithelial differentiation showed two types of malignant areas in the part of the tumour that was confined by the PA capsule: (i) intraductal carcinoma areas characterized by ductal structures containing both benign myoepithelial cells positive for alpha-smooth muscle actin (alpha-SMA), vimentin and cytokeratin (CK)14 and proliferating atypical luminal cells reactive for CK7, CK8 and CK19, and (ii) carcinoma areas composed only of epithelial cells reactive for CK7, CK8 and CK19. In the latter, the cells presented morphological and immunohistochemical characteristics similar to those found in areas of invasive carcinoma outside the PA capsule. CXPAs with a myoepithelial component were composed mainly or exclusively of cells that expressed vimentin and alpha-SMA. In this group, ductal structures reminiscent of PA filled by malignant cells were not identified.

CONCLUSION

Most CXPAs consist only of epithelial cells that have an immunoprofile comparable to ductal luminal cells of PA. These malignant luminal cells arise in the duct-like structures as intraductal carcinoma and probably only at this early stage of development should the lesion be considered as a non-invasive carcinoma.

Correlation of p53 status with outcome of neoadjuvant chemotherapy using paclitaxel and doxorubicin in stage IIIB breast cancer

BACKGROUND

The role of p53 in modulating apoptosis has suggested that it may affect efficacy of anticancer agents. We prospectively evaluated p53 alterations in 73 patients with locally advanced breast cancer (IIIB) submitted to neoadjuvant chemotherapy.

PATIENTS AND METHODS

Patients received three cycles of paclitaxel (175 mg/m2) and doxorubicin (60 mg/m2) every 21 days. Tumor sections were analyzed before treatment for altered patterns of p53 expression using immunohistochemistry and DNA sequencing.

RESULTS

An overall response rate of 83.5% was obtained, including 15.1% complete pathological responses. The regimen was well tolerated with 17.7% grade 2/3 nausea and 12.8% grade 3/4 leukopenia. There was a statistically significant correlation between response and expression of p53. Of the 25 patients who obtained a complete clinical response, two were classified as positive (P = 0.004, chi-square). Of 11 patients who obtained a complete pathological remission, one was positive (P = 0.099, chi-square). Discussion The combination is highly effective in locally advanced breast cancer. A negative expression of p53 indicates a higher chance of responding to this regimen. The p53 status may be used as a biological marker to identify those patients who would benefit from more aggressive treatments.