Therapeutic Reduction Mammoplasty: Experience of a Single Institute

INTRODUCTION

Breast cancer is the most common malignancy in women worldwide as reported by the World Health Organization. The concept of oncoplastic breast surgery appeared as an extension of breast-conserving surgery, applying breast reduction techniques with more acceptable aesthetic and functional outcomes. The purpose of the present study was to describe the breast cancer population of a single institute submitted to lumpectomy and bilateral immediate breast reduction or mastopexy and its complications.

MATERIAL AND METHODS

This is a retrospective observational study including patients submitted to lumpectomy and immediate bilateral breast reduction or mastopexy. Patients and tumour characteristics, surgical technique, complications, follow-up period, and recurrence data were obtained and analyzed.

RESULTS

A total of 49 patients were submitted to lumpectomy and bilateral breast therapeutic reduction/mastopexy, with a mean age of 56.47 ±8.58 years and a mean body mass index of 28.68kg/m² ±3.94 kg/m² between January 2019 and December 2021. Invasive tumours of no specific type, associated or not, with carcinoma intraductal in situ were the most common histological type corresponding to almost 80% of the cases with T1 stage corresponding to more than half of the cases. Sixteen percent of the patients had early minor complications with wound dehiscence associated with wound delayed healing, corresponding to 75% of the cases. Body mass index had a statistical difference between groups (p=0,006, t-test).

CONCLUSIONS

The low rates of minor and major complications show that immediate therapeutic breast reduction can be a suitable approach in selected cases.

Contrast-induced nephropathy following PCI: can we calculate a safe contrast volume?

Introduction

Acute kidney injury (AKI) due to contrast induced nephropathy (CIN) is a common complication after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS), and is associated with prolonged hospitalizations and elevated cardio and renovascular morbidity. Scientific evidence demonstrates that the mean volume of contrast (VolC) and ratio with creatinine clearance (CrCl) (VolC/CrCl) are independent predictors of CIN, but the accepted optimal value remains controversial.

Objective

Population characterization. To evaluate whether the calculation of VolC using the VolC/ClCr ratio <3.7 used in our Cath lab during PCI of ACS allows preventing the development of AKI by CIN, and whether the development of early vs late AKI influences outcomes.

Methods

Retrospective study between 2017/2020, composed of n=378 patients who suffered ACS. Descriptve analysis was carried out regarding the demographic and clinical characteristics of the patients. Chi-Square test was used for categorical variables and the T-Student test for numerical variables, with a significance level of 95%.

Results

A total of 378 patients were identified, with a mean age of 64.5±11.2 years, 78.6% were male. 60.1% had hypertension, 48.4% dyslipidemia, 24.3% diabetes, 2.6% chronic renal failure (CRF) and 1.6% heart failure. Of these, 12.7% developed AKI (<24h in 1.9% vs ≥24h in 10,8%). Indepedent prognostic factors for development of AKI were smokers (AKI ≥24h 7 (4.8%) vs AKI<24h 2 (1.4%), p=0.001), diabetes (AKI≥24h 17 (19%) vs AKI <24h 2 (2.2%), p=0.007), CRF (AKI ≥24h 6 (60%) vs AKI <24h 1 (10%), p=0.001), CrCl (AKI ≥24h 65.8±27.1, p=0.001), ratio VolC/CrCl (AKI ≥24h 3.3±2.5, p=0.001) and LVEF (AKI ≥24h 51.4±9.7, p=0.001). Mortality afected 4.2% of the patients, and was more frequente in AKI subjects (AKI ≥24h 7 (70%) vs AKI <24h 1 (10%), p=0.001). Using a ratio <3.7 allowed to prevent AK <24h but not AKI ≥24h (AKI <24h ratio <3.7 = 3 (1%) vs ratio ≥3.7 = 9 (4.1%), p=0.001) (AKI ≥24 ratio <3.7 = 30 (25%) vs ratio ≥3.7 = 11 (9.7%), p=0.001). A ratio <2.0 allowed to prevent both early and late AKI (AKI <24h ratio <2.0 = 0 (0%) vs ratio ≥2.0 = 7 (4.5%), p=0.001) (AKI ≥24 ratio <2.0 = 11 (5.6%) vs ratio ≥2.0 = 30 (19.1%), p=0.001).

Conclusion

In patients submitted to ACS PCI, the development of AKI increases mortality, especial if AKI emerge after 24h. We report a more suitable ratio VolC/ClCr <2.0, that allow us to calculate a safe VolC that will help to prevent both early and late AKI in selected patients wtih ACS.

Funding Acknowledgement

Type of funding sources: None.

ESPRAS Survey on Continuing Education in Plastic, Reconstructive and Aesthetic Surgery in Europe

BACKGROUND

Specialty training in plastic, reconstructive and aesthetic surgery is a prerequisite for safe and effective provision of care. The aim of this study was to assess and portray similarities and differences in the continuing education and specialization in plastic surgery in Europe.

MATERIAL AND METHODS

A detailed questionnaire was designed and distributed utilizing an online survey administration software. Questions addressed core items regarding continuing education and specialization in plastic surgery in Europe. Participants were addressed directly via the European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). All participants had detailed knowledge of the organization and management of plastic surgical training in their respective country.

RESULTS

The survey was completed by 29 participants from 23 European countries. During specialization, plastic surgeons in Europe are trained in advanced tissue transfer and repair and aesthetic principles in all parts of the human body and within several subspecialties. Moreover, rotations in intensive as well as emergency care are compulsory in most European countries. Board certification is only provided for surgeons who have had multiple years of training regulated by a national board, who provide evidence of individually performed operative procedures in several anatomical regions and subspecialties, and who pass a final oral and/or written examination.

CONCLUSION

Board certified plastic surgeons meet the highest degree of qualification, are trained in all parts of the body and in the management of complications. The standard of continuing education and qualification of European plastic surgeons is high, providing an excellent level of plastic surgical care throughout Europe.

HINTERGRUND

Die Facharzt-Weiterbildung für Plastische und Ästhetische Chirurgie ist eine Grundvoraussetzung für sichere und effektive Patientenversorgung. Ziel der vorliegenden Studie war die Darstellung von Gemeinsamkeiten und Unterschieden in der Weiterbildung für Plastische Chirurgie innerhalb von Europa.

MATERIALIEN UND METHODEN

Ein internetbasierter Fragebogen wurde mit Hilfe eines kostenlosen Formularerstellungstools erstellt und verteilt. Die Fragen betrafen Kernpunkte der Weiterbildung für Plastische Chirurgie in Europa. Die Teilnehmer wurden direkt über das European Leadership Forum (ELF) der European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) kontaktiert. Alle Teilnehmer hatten weitreichende Kenntnisse über die Organisation und Struktur der plastisch-chirurgischen Weiterbildung in ihrem jeweiligen Land.

ERGEBNISSE

29 Teilnehmer*innen aus 23 europäischen Ländern nahmen an der Umfrage teil. Die Weiterbildung für Plastische Chirurgie beinhaltet grundlegende Prinzipien und Techniken zur Wiederherstellung von Form und Funktion innerhalb der verschiedenen Säulen der Plastischen Chirurgie, sowie in allen Körperregionen. In den meisten europäischen Ländern ist eine Rotation in der Intensiv- und Notfallmedizin und die Behandlung kritisch kranker Patienten obligatorisch. Voraussetzung für die Facharztbezeichnung ist die mehrjährige, national organisierte Weiterbildung, der Nachweis einer festgelegten Anzahl selbstständig durchgeführter Operationen, sowie die mündliche und/oder schriftliche Abschlussprüfung.

SCHLUSSFOLGERUNG

Fachärzte für Plastische und Ästhetische Chirurgie sind hochqualifiziert und auch im Umgang mit Komplikationen geschult. Der Standard der Weiterbildung der europäischen Plastischen Chirurgen ist hoch, so dass innerhalb Europas eine hohe Qualität plastisch-chirurgischer Versorgung gewährleistet ist.

Climate change vulnerability of cetaceans in Macaronesia: Insights from a trait-based assessment

Over the last decades global warming has caused an increase in ocean temperature, acidification and oxygen loss which has led to changes in nutrient cycling and primary production affecting marine species at multiple trophic levels. While knowledge about the impacts of climate change in cetacean's species is still scarce, practitioners and policymakers need information about the species at risk to guide the implementation of conservation measures. To assess cetacean's vulnerability to climate change in the biogeographic region of Macaronesia, we adapted the Marine Mammal Climate Vulnerability Assessment (MMCVA) method and applied it to 21 species management units using an expert elicitation approach. Results showed that over half (62%) of the units assessed presented Very High (5 units) or High (8 units) vulnerability scores. Very High vulnerability scores were found in archipelago associated units of short-finned pilot whales (Globicephala macrorhynchus) and common bottlenose dolphins (Tursiops truncatus), namely in the Canary Islands and Madeira, as well as Risso's dolphins (Grampus griseus) in the Canary Islands. Overall, certainty scores ranged from Very High to Moderate for 67% of units. Over 50% of units showed a high potential for distribution, abundance and phenology changes as a response to climate change. With this study we target current and future information needs of conservation managers in the region, and guide research and monitoring efforts, while contributing to the improvement and validation of trait-based vulnerability approaches under a changing climate.

Therapeutic Breast Reduction in Upper Quadrant Breast Tumor

Introduction: Breast conserving surgery plus radiation therapy and mastectomy procedures has equal results in terms of survival. Oncoplastic surgery principles along with breast reduction techniques allow for very good aesthetic results in immediate breast reconstruction with local tissues in several well-defined clinical scenarios. Nevertheless, we still find several limitations to their use regarding the location of the tumor or the need for inconvenient skin resections out of the standard markings of breast reduction. We present a case where traditional breast reduction techniques were inadequate and technical modifications of standard markings and pedicle design were developed to avoid the need to undergo a mastectomy. Methods: We present a patient diagnosed with breast cancer where the clinical characteristics of the tumor (location, skin excision needed) precluded the use of traditional oncoplastic breast reduction techniques. Modifications to the traditional breast reduction techniques were used to cope with the oncological resections needed. Results: A good global symmetry and aesthetic result were achieved. Scar pattern obtained was considered relatively camouflaged and patient satisfaction was high. Conclusion: Breast reduction procedures can be the solution for the treatment of breast cancer. The location of the tumor in the superior quadrants outside standard markings and the need to include skin in the tumor resection can be sidetracked by using enlarged NAC pedicles with modifications to classic skin markings without compromising oncologic safety. The final aesthetic results obtained are considered very good and the patient is very satisfied.

ESPRAS Survey on Breast Reconstruction in Europe

BACKGROUND

 The European Leadership Forum (ELF) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS) previously identified the need for harmonisation of breast reconstruction standards in Europe, in order to strengthen the role of plastic surgeons. This study aims to survey the status, current trends and potential regional differences in the practice of breast reconstruction in Europe, with emphasis on equity and access.

MATERIALS AND METHODS

 A largescale web-based questionnaire was sent to consultant plastic and reconstructive surgeons, who are experienced in breast reconstruction and with understanding of the national situation in their country. Suitable participants were identified via the Executive Committee (ExCo) of ESPRAS and national delegates of ESPRAS. The results were evaluated and related to evidence-based literature.

RESULTS

 A total of 33 participants from 29 European countries participated in this study. Overall, the incidence of breast reconstruction was reported to be relatively low across Europe, comparable to other large geographic regions, such as North America. Equity of provision and access to breast reconstruction was distributed evenly within Europe, with geographic regions potentially affecting the type of reconstruction offered. Standard practices with regard to radiotherapy differed between countries and a clear demand for European guidelines on breast reconstruction was reported.

CONCLUSION

 This study identified distinct lack of consistency in international practice patterns across European countries and a strong demand for consistent European guidance. Large-scale and multi-centre European clinical trials are required to further elucidate the presented areas of interest and to define European standard operating procedures.

A three-decade survey of Brazilian Fusarium oxysporum f. sp. lycopersici races assessed by pathogenicity tests on differential tomato accessions and by molecular markers

AIM

Physiological race determination of 143 Fusarium oxysporum f. sp. lycopersici (FOL) isolates collected along 30 years in major tomato-producing regions of Brazil.

MATERIALS AND RESULTS

Physiological races were determined via root-dipping inoculation of differential tomato accessions and by the PCR-based marker system of Hirano and Arie (2006). According to pathogenicity/virulence assays, five race 1, 23 race 2 and 115 race 3 isolates were identified. FOL race 1 and 2 isolates prevailed up to early 2000s. Afterwards, the large majority of the isolates was classified as the invasive race 3. Novel reports of race 3 were done in five states, thus expanding its geographical distribution. Using this PCR-based marker system, a precise discrimination was observed for all race 3 isolates. However, all race 1 and 2 isolates displayed only the cosmopolitan race 1-specific amplicon pattern.

CONCLUSION

The development and/or validation of novel race-specific marker systems are necessary to allow a precise discrimination of the potentially endemic Brazilian FOL race 2.

SIGNIFICANCE AND IMPACT OF THE STUDY

The present characterization of isolates indicates that distinct evolutionary mechanisms are acting to select new FOL races and/or genetic variants across agroecosystems around the globe.

Strengthening Plastic Surgery in Europe – ESPRAS Survey at ESPRAS European Leadership Forum (ELF)

Hintergrund Das Exekutivkomitee (ExCo) der ESPRAS hat im Oktober 2020 das erste ESPRAS European Leadership Forum (ELF) initiiert, um den internationalen Austausch zwischen den verschiedenen nationalen plastisch-chirurgischen Gesellschaften zu fördern und eine Plattform für die Bewältigung gemeinsamer Herausforderung bereitzustellen. Das vorgelegte Manuskript präsentiert die wichtigsten Ergebnisse und Schlussfolgerungen dieses Treffens.

Materialien und Methoden Mitglieder des Vorstands (Präsidenten, Vize-Präsidenten, Generalsekretäre) und Delegierte der nationalen Gesellschaften für Plastische Chirurgie diskutierten aktuelle Themen der Plastischen Chirurgie über das virtuelle Konferenzsystem Zoom (Zoom Video Communications, Inc.). Über Zoom erfolgte zudem eine Umfrage zu verschiedenen international relevanten plastisch-chirurgischen Themen.

Ergebnisse Die Durchführung ästhetischer Eingriffe durch Ärzte ohne Facharztweiterbildung in der Plastischen Chirurgie, sowie das Brustimplantat-assoziierte anaplastische großzellige Lymphom (BIA-ALCL) wurden als die wichtigsten internationalen Herausforderungen der Plastischen Chirurgie erkannt, für deren Bewältigung auf europäischer Ebene ein standardisiertes Vorgehen diskutiert wurde. Weiterhin wurden aktuelle Entwicklungen in der Weiterbildung junger Plastischer Chirurgen eruiert, wobei die Etablierung eines europäischen Fellowship Programms von der Mehrheit der Befragten stark befürwortet wurde. Strategien zur Einführung von europäischen Registern für freie Lappenplastiken, Implantate und für die Brustrekonstruktion wurden erörtert.

Schlussfolgerung Das ESPRAS ELF stärkt den internationalen Austausch und die europäische Einheit in der Plastischen Chirurgie. Ein weiteres virtuelles Webinar mit dem Thema „Strategien zur Stärkung und Verteidigung der Plastischen Chirurgie gegenüber anderen“ wurde für das Frühjahr 2021 terminiert.

Recurrent syncope, which patient should we follow more closely

Introduction

The importance of education is well recognized in patients presenting with syncope, in order to reduce the recurrence rate.

Purpose

To determine a predictive score of recurrent syncopal episodes after the first medical assessment.

Methods

We conducted a retrospective study enrolling patients followed in our Syncope Consultation from January 2015 to November 2019. Clinical and episodes characteristics, as well as diagnostic studies were analysed. Correlation between variables was performed by the Chi-square and T-Student tests, with a significance level of 95%. Independent predictors of recurrent syncope were identified through a binary logistic regression analysis, considering p=0.05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analysed groups. SPSS 24.0 was used for statistical analysis.

Results

A total of 694 patients were included, and 420 (60.5%) had recurrent syncope at the first evaluation. After educational approach, 97 (14%) maintained recurrent episodes. In this subgroup, the mean age was 63.7±22.8 years-old and 88.7% already had previous recurrent syncope (vs 56.1%; p<0.001). The prodrome of malaise was common (40.2% vs 26.8%; p=0.008), but 32% of these patients had syncope without prodromes (vs 21.8%; p=0.032). They also had frequently first-degree atrioventricular (AV) block (22.5% vs 6.8%; p<0.001) and 51.7% had a final diagnosis of reflex syncope. No previous medication with calcium channel blockers (CCB) (p<0.001), malaise (p=0.011), not having Q-waves in the electrocardiogram (p=0.022) and the presence of first-degree AV block (p<0.001) were independent predictors of recurrent syncope. A predictive score of recurrence was determined using the formula: 0.108 − 1.556 x (medication with CCB) + 0.989 x (malaise) − 1.031 x (Q-waves) + 2.406 x (first degree AV block). Variables should be replaced by 1 or 0, depending on whether the condition is present or not. A cut-off of 0.283 was obtained with a specificity of 96.1% and a discriminative power of 81.2%.

Conclusion

In our patients presenting with syncope, recurrence rate reduced from 60,5% to 14% just with educational measures. To help identify patients who maintain recurrence, we determined a predictive score using clinical data from the first visit, with a good discriminative power and excellent specificity. It could be used to strengthen education, to direct diagnostic studies and to shorten follow-up visits, but it still needs validation to be used in clinical practice.

Funding Acknowledgement

Type of funding source: None

EASAPS/ESPRAS Considerations in getting back to work in Plastic Surgery with the COVID-19 Pandemic – A European point of view

The aim of this paper is to summarize the results of a consensus process and a European webinar of the two societies, European Association of Societies of Aesthetic Surgery (EASAPS) and the European Society of Plastic, Reconstructive and Aesthetic Societies (ESPRAS) on what is considered safe practice based on the scientific knowledge we have today. This review of the current situations gives considerations which have to be taken into account when getting back to work in plastic surgery with COVID-19 in Europe. At all times, one should be familiar the local and regional infection rates in the community, with particular emphasis on the emergence of second and third waves of the pandemic. Due to the fast-evolving nature of the COVID-19 pandemic the recommendations aim to be rather considerations than fixed guidelines and might need to be revised in near future.

The COVID-19 Pandemic and its Impact on Plastic Surgery in Europe - An ESPRAS Survey

The present article provides an overview of the current and expected effects of plastic surgery in Europe. It presents the experience of departments for plastic and reconstructive surgery, as evaluated by interviews with members of the Executive Committee (ExCo) of the European Society of Plastic, Reconstructive and Aesthetic Surgery (ESPRAS). The objective of this overview is to summmarise current information in our area of work and to make this accessible to a broad group of readers. As our knowledge is rapidly increasing during the current pandemic, it is evident that we can only provide a snapshot and this will inevitably be incomplete.

P871 Giant left ventricular (pseudo?)aneurysm complicating anterior myocardial infarction

Introduction

Clinical approach of cardiac aneurysms and pseudoaneurysms is significantly distinct. Therefore, it is crucial to accurately differentiate these two entities, which could be a real challenge.

Case report

We describe a case of a 55-year-old woman, with hypertension and previous smoking habits. She was admitted in our Cardiology Department with the diagnosis of anterior acute myocardial infarction, and was submitted to emergent coronariography, unveiling an occlusion of the middle segment of the anterior descending artery. She underwent successful primary percutaneous coronary intervention (PCI) 1h45 after the chest pain onset. Transthoracic echocardiogram (TTE) revealed depressed left ventricle ejection fraction (LVEF 30%), with akinesia of anterior and septal walls and all apical segments. She evolved in Killip-Kimbal class 2 and was discharged clinically stable. One week later, the patient performed a control TTE that showed an apical thrombus, with a small pericardial effusion, and she initiated warfarin. Three weeks later, a reevaluation TTE demonstrated a severe increase of the left ventricle dimensions, with LVEF 32%, and a small pericardial effusion. In apical 4-chambers incidence, it was visualized a linear structure (42 mm x 5 mm) attached to the endocardial border of the anterolateral apical segment and to the apical segment of the interventricular septum, of undefined nature. The apical segments were dyskinetic and had a very thin wall, which could correspond to aneurysm versus pseudoaneurysm. To clarify these findings, the patient performed a cardiac magnetic resonance revealing a large anterior myocardial infarction complicated with extensive myocardial necrosis, severe depression of LV systolic function (LVEF 25%) and septum rupture distal to the right ventricle apex (without connecting with it), compatible with a large apical pseudoaneurysm. The clinical case was discussed in the Heart Team and it was decided to perform cardiac surgery. However, surgical findings showed integrity of septal and free walls, and she underwent an aneurysmectomy, without further complications. Histological examination confirmed the presence of a thin myocardial wall with marked fibrosis and, consequently, the diagnosis of ventricular aneurysm. She was discharged clinically stable and maintains follow-up in Cardiology consultation of our Hospital.

Conclusion

In this patient, initially admitted with an anterior myocardial infarction submitted to primary PCI, follow-up with advanced imaging modalities pointed to the diagnosis of pseudoaneurysm. Despite the preoperative diagnosis, surgical findings were compatible with a giant left ventricular aneurysm. Even with high spatial resolution exams, postoperative evaluation of tissue layers remains the gold standard for this differential diagnosis.

Abstract P871 Figure. Apical pseudoaneurysm vs aneurysm

P918 Screening protocol of patent foramen ovale in cryptogenic stroke

Introduction

Cryptogenic stroke reaches a prevalence of 30% and entails a significant risk of recurrence. Transesophageal echocardiography is the gold standard in identifying potential proximal embolic sources, including patent foramen ovale (PFO). Based on recent evidence, PFO percutaneous closure is recommended in selected cases of cryptogenic stroke, especially if associated with high risk features. Since PFO is present in up to 27% of the general population, the real challenge is to define which patients have a pathogenic PFO.

Purpose

To develop a pathogenic PFO screening protocol in patients with cryptogenic stroke, aimed at secondary prevention.

Methods

We revised the literature, analysing published articles in PubMed in the last 5 years, with the keywords "patent foramen ovale and cryptogenic stroke". Subsequently, we produced a screening algorithm based on cryptogenic stroke definition, on RoPE (Risk of Paradoxical Embolism) Score and on the inclusion and exclusion criteria of the CLOSE, REDUCE and RESPECT studies, which showed promising results of PFO closure in this context.

Results

Our protocol establishes that patients who present with ischemic stroke should be evaluated for risk factors and undergo a detailed etiological study. When the study is inconclusive, the RoPE score is applied to determine the probability of finding a pathogenic or an incidental PFO. If equal or greater than 7 points, in the absence of predefined exclusion criteria, a transesophageal echocardiogram is performed. If the screening is positive, the patient will be referred to the Cardiology Department for therapeutic guidance. If negative, alternative complementary diagnostic methods may be considered.

Conclusion

Through the application of this protocol, patients with high probability of having a pathogenic PFO and, consequently, those who may benefit from percutaneous closure, will be selected to undergo a screening transesophageal echocardiogram. The implementation of a PFO screening protocol in patients who present with cryptogenic stroke is relevant, by proposing to reduce its recurrence rate through the early referral of young patients with indication for an invasive strategy.

A single mutation in cyclodextrin glycosyltransferase from Paenibacillus barengoltzii changes cyclodextrin and maltooligosaccharides production

Cyclodextrin glycosyltransferases (CGTases) are bacterial enzymes that catalyze starch conversion into cyclodextrins, which have several biotechnological applications including solubilization of hydrophobic compounds, masking of unpleasant odors and flavors in pharmaceutical preparations, and removal of cholesterol from food. Additionally, CGTases produce maltooligosaccharides, which are linear molecules with potential benefits for human health. Current research efforts are concentrated in the development of engineered enzymes with improved yield and/or particular product specificity. In this work, we analyzed the role of four residues of the CGTase from Paenibacillus barengoltzii as determinants of product specificity. Single mutations were introduced in the CGTase-encoding gene to obtain mutants A137V, A144V, L280A and M329I and the activity of recombinant proteins was evaluated. The residue at position 137 proved to be relevant for CGTase activity. Molecular dynamics studies demonstrated additionally that mutation A137V produces a perturbation in the catalytic site of the CGTase, which correlates with a 10-fold reduction in its catalytic efficiency. Moreover, this mutant showed increased production of maltooligosaccharides with a high degree of polymerization, mostly maltopentaose to maltoheptaose. Our results highlight the role of residue 137 as a determinant of product specificity in this CGTase and may be applied to the rational design of saccharide-producing enzymes.

Abstract P6-06-02: Low expression levels of hormone receptors (ER-α and PGR) in human breast cancer samples is significantly associated with high-grade human cytomegalovirus-IEA

Background: Breast cancer (BC) is the most common type of malignancy and second leading cause of cancer deaths in women worldwide. While contemporary breast cancer therapy allows many patients with localized breast cancer to be cured for their disease, subgroups experience non-curable distant metastasis. In addition, majority of BC cases are considered to be "sporadic", with unknown underlying mechanisms. Thus, it is of major importance to investigate alternative factors that may initiate or promote human breast cancer. Recently, human cytomegalovirus (HCMV) has been detected in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients. However, the oncomodulatory role of HCMV in BC is unknown. Accordingly, the purpose of this study was to elucidate possible correlations between expression of HCMV proteins and established histopathological markers (ER-α, PgR, HER2 etc.) in human breast cancer tissues. Material and Methods: Paraffin embedded breast cancer biopsies (n=62), ductal carcinoma in-situ (DCIS, n=18) and adjacent, benign breast tissue samples (n=42) were retrospectively examined for HCMV-immediate early (IE) and late (LA) proteins by using immunohistochemical techniques. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. The median age at time of surgery was 55 years. All patients received standard adjuvant treatment according to the Norwegian guidelines. Results: HCMV-IE was detected at different levels in all BC cases, DCIS and benign breast tissue samples. Interestingly, high grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 77% of infiltrating BC and in 39% of DCIS and merely in 7% benign breast tissue samples. High grade HCMV-IE was detected in 40%, 76% and 83% of BC patients with >50-90%, >10-50% and <10% tumor cells expressing PgR in their tumors, respectively (p=0.003). All BC samples with negative or low (0-10%) positive staining for estrogen receptors (ER-α) showed high-grade HCMV-IE staining. In subgroups of patients with increasingly positive staining for ER-α between 10-50% and >50-90% of tumor cells, high HCMV-IE was found in 86% and 74%, respectively (p=0.02). A trend but no significant correlation was found between high-grade HCMV-IE and HER2 negativity (p=0.09). In contrast, High grade HCMV-LA proteins were detected in 5%, 11% and 3% of adjacent benign breast samples, DCIS and infiltrating BC, only. Conclusion: Our findings demonstrate that HCMV- IE but not HCMV-LA proteins are frequently detected in samples obtained from infiltrating BC and DCIS. Although the role of HCMV in carcinogenesis of BC is not defined, our findings suggest a negative correlation between high grade HCMV-IE and hormone receptors in general. All in all, our findings may indicate a possible oncomodulatory role of HCMV-IE in human BC, hampering the expression of hormone receptors and forcing the BC cells to a more aggressive phenotype. The effects of HCMV-induced proteins in human breast cancer cells should be investigated further.Background: Breast cancer (BC) is the most common type of malignancy and second leading cause of cancer deaths in women worldwide. While contemporary breast cancer therapy allows many patients with localized breast cancer to be cured for their disease, subgroups experience non-curable distant metastasis. In addition, majority of BC cases are considered to be "sporadic", with unknown underlying mechanisms. Thus, it is of major importance to investigate alternative factors that may initiate or promote human breast cancer. Recently, human cytomegalovirus (HCMV) has been detected in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients. However, the oncomodulatory role of HCMV in BC is unknown. Accordingly, the purpose of this study was to elucidate possible correlations between expression of HCMV proteins and established histopathological markers (ER-α, PgR, HER2 etc.) in human breast cancer tissues. Material and Methods: Paraffin embedded breast cancer biopsies (n=62), ductal carcinoma in-situ (DCIS, n=18) and adjacent, benign breast tissue samples (n=42) were retrospectively examined for HCMV-immediate early (IE) and late (LA) proteins by using immunohistochemical techniques. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. The median age at time of surgery was 55 years. All patients received standard adjuvant treatment according to the Norwegian guidelines. Results: HCMV-IE was detected at different levels in all BC cases, DCIS and benign breast tissue samples. Interestingly, high grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 77% of infiltrating BC and in 39% of DCIS and merely in 7% benign breast tissue samples. High grade HCMV-IE was detected in 40%, 76% and 83% of BC patients with >50-90%, >10-50% and <10% tumor cells expressing PgR in their tumors, respectively (p=0.003). All BC samples with negative or low (0-10%) positive staining for estrogen receptors (ER-α) showed high-grade HCMV-IE staining. In subgroups of patients with increasingly positive staining for ER-α between 10-50% and >50-90% of tumor cells, high HCMV-IE was found in 86% and 74%, respectively (p=0.02). A trend but no significant correlation was found between high-grade HCMV-IE and HER2 negativity (p=0.09). In contrast, High grade HCMV-LA proteins were detected in 5%, 11% and 3% of adjacent benign breast samples, DCIS and infiltrating BC, only. Conclusion: Our findings demonstrate that HCMV- IE but not HCMV-LA proteins are frequently detected in samples obtained from infiltrating BC and DCIS. Although the role of HCMV in carcinogenesis of BC is not defined, our findings suggest a negative correlation between high grade HCMV-IE and hormone receptors in general. All in all, our findings may indicate a possible oncomodulatory role of HCMV-IE in human BC, hampering the expression of hormone receptors and forcing the BC cells to a more aggressive phenotype. The effects of HCMV-induced proteins in human breast cancer cells should be investigated further.

Citation Format: Rahbar A, Touma J, Costa H, Davoudi B, Vetvik K, Geisler J, Söderberg Naucler C. Low expression levels of hormone receptors (ER-α and PGR) in human breast cancer samples is significantly associated with high-grade human cytomegalovirus-IEA [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-06-02.

Abstract P6-06-01: High-grade human cytomegalovirus IEA is associated with expression of COX-2 and 5-LO in human breast cancer samples

Background: The role of cyclooxygenase-2 (COX-2) in breast cancer development and progression has been supported by an increasing number of studies that show the overexpression of COX-2 in all the stages of the disease but in particular, in the metastatic phase. Besides COX-2 and its derived metabolites, 5-lipoxygenase (5-LO) and leukotrienes have also been associated with cancer progression. Human Cytomegalovirus (HCMV) detection in samples from primary BC, sentinel lymph nodes and brain metastases obtained from breast cancer patients' suggests that viral infection may also have a critical role in the development of breast cancer metastasis. Interestingly, in vitro studies showed that HCMV infections induce COX-2 in human fibroblasts, which augments viral replication through a prostaglandin dependent pathway. Thus, our main objective was to investigate whether there is a correlation between HCMV infection and overexpression of COX-2 and 5-LO in breast cancer. If so, HCMV could be an important additional target for breast cancer treatment.

Material and Methods: Paraffin embedded breast cancer biopsies (n=48), ductal carcinoma in-situ (DCIS, n=14) and adjacent, benign breast tissue samples (n=29) were retrospectively examined for HCMV-immediate early (IE), HCMV-Late (LA) proteins, COX2 and 5LO by using immunohistochemical techniques established in our laboratory. Clinical data were available from the patients´ hospital files provided from the departments of oncology and pathology at Akershus University Hospital, Norway. All patients underwent direct surgery in 2011. All patients received standard adjuvant treatment according to the Norwegian guidelines. For in vitro studies, breast cancer cell lines (MCF-7, MB-MDA-231 and SKBR3) were infected with HCMV VR1814 strain and levels of COX-2 and 5-LO were determined by qPCR and western blot and immunofluorescence.

Results: High levels of COX-2, 5-LO and HCMV-IE were detected mainly in breast cancer samples. High grade HCMV-IE (defined as >50% positive cells in the tumor tissues) was detected in 72% of infiltrating BC and in 28% of DCIS, but it was detected only in 7% of benign, adjacent breast tissue samples. Similarly, high grade COX-2 and 5-LO were detected in 58% and 53% of BC, in 21% and 8% of DCIS, and in 4% and 7% of benign, adjacent breast tissue samples, respectively. We found a statistically significant positive correlation for the levels of HCMV-IE and COX-2 (p=0.001) as well as for HCMV-IE and5-LO (p=0.0002) in infiltrating breast cancer. Furthermore, induction of COX-2 and 5-LO was confirmed in breast cancer cell lines following infection with HCMV was shown at both mRNA and protein level.

Conclusion: Our findings confirm a positive correlation of HCMV-IE protein synthesis and overexpression of COX-2 and 5-LO in infiltrating breast cancer, DCIS and benign, adjacent breast tissue samples, which is consistent with the up-regulation of these enzymes in breast cancer cells infected with HCMV. These results suggest that the inflammation driven by COX-2 and 5-LO in human breast cancer might be induced by HCMV infections and lead to tumor progression. Thus, anti-viral therapy should be considered as an additional experimental treatment in selected breast cancer patients.

Citation Format: Costa H, Touma J, Davoudi B, Geisler J, Vetvik K, Söderberg Naucler C, Rahbar A. High-grade human cytomegalovirus IEA is associated with expression of COX-2 and 5-LO in human breast cancer samples [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-06-01.

First Report of Leaf Spot Caused by Myrothecium roridum on Coffea canephora in Brazil

Coffea canephora (conilon coffee) represents approximately 30% of the coffee marketed worldwide. The state of Espírito Santo is the largest conilon coffee-producing state in Brazil. In 2013 and 2014, leaves with a leaf spot were observed on most of the conilon coffee seedlings in a commercial nursery in Laranja da Terra, Espírito Santo, Brazil. The infected leaves were deposited in the VIC Herbarium (VIC 42482) and a pure single-spore culture of the pathogen was deposited in the culture collection of the Universidade Federal de Viçosa (Accession No. COAD 1729). The initial symptoms were circular, brown to dark brown lesions with yellow margins occurring on both leaf surfaces. In high humidity, concentric rings formed and the lesions expanded rapidly to reach up to 30 mm in diameter, and later became dark brown with a grayish center. Black sporodochia with white, and marginal mycelial tuffs bearing black spore masses were observed in the older lesions. These symptoms were consistent with those of Myrothecium leaf spot reported on Coffea spp. (3). Microscopic observation revealed aseptate, hyaline, and cylindrical conidia, rounded at both ends, greenish to black in mass, and 5 to 6 μm long and 1 to 2 μm wide. The symptoms and morphological characteristics described above matched the description of Myrothecium roridum Tode (4). To confirm this identification, DNA was extracted using a Wizard Genomic DNA Purification Kit and the sequence of an internal transcribed spacer (ITS) region was obtained and deposited in GenBank (Accession No. KJ815095). The sequence of the ITS region exhibited 100% identity over 561 bp with another M. roridum sequence in GenBank (JF343832). To verify the pathogenicity of the fungus, healthy leaves of the C. canephora clones 12v and 14 (four seedlings each) were wounded superficially with a sterilized needle and inoculated by spraying them with a suspension of M. roridum conidia (10⁶ conidia ml^-1). The seedlings were covered with plastic bags and incubated in a growth chamber at 25°C under a photoperiod of 12 h light/12 h dark for 5 days. The control seedlings were sprayed with distilled water and incubated similarly. Fifteen days after inoculation, symptoms in all inoculated seedlings were consistent with those initially observed on the naturally infected seedlings, whereas the controls remained healthy. Re-isolation and identification confirmed Koch's postulates. M. roridum has a wide host range, and symptoms were similar to those reported in other hosts of the pathogen in Brazil (2,3). There is only one report of M. roridum on C. canephora in Colombia (1); however, this pathogen was previously reported on C. arabica in Brazil, Colombia, Costa Rica, Guatemala, India, Indonesia, Puerto Rico, and the Virgin Islands (1,3). To our knowledge, this is the first report of a leaf spot caused by M. roridum on conilon coffee in Brazil. The cultivation of conilon coffee is increasing and the reported leaf spot disease affects the quality of the seedlings in nurseries. It is therefore important to conduct a thorough study of management strategies for this disease. References: (1) D. F. Farr and A. Y. Rossman. Fungal Databases. Syst. Mycol. Microbiol. Lab. ARS, USDA. Retrieved from http://nt.ars-grin.gov/fungaldatabases , 27 May 2014. (2) A. M. Quezado Duval et al. Braz. J. Microbiol. 41:246, 2010. (3) S. F. Silveira et al. Fitopatol. Bras. 32:440, 2007. (4) M. Tulloch. Mycol. Pap. No. 130. CMI, Wallingford, UK, 1972.

Virus manipulation of cell cycle

Viruses depend on host cell resources for replication and access to those resources may be limited to a particular phase of the cell cycle. Thus manipulation of cell cycle is a commonly employed strategy of viruses for achieving a favorable cellular environment. For example, viruses capable of infecting nondividing cells induce S phase in order to activate the host DNA replication machinery and provide the nucleotide triphosphates necessary for viral DNA replication (Flemington in J Virol 75:4475-4481, 2001; Sullivan and Pipas in Microbiol Mol Biol Rev 66:179-202, 2002). Viruses have developed several strategies to subvert the cell cycle by association with cyclin and cyclin-dependent kinase complexes and molecules that regulate their activity. Viruses tend to act on cellular proteins involved in a network of interactions in a way that minimal protein-protein interactions lead to a major effect. The complex and interactive nature of intracellular signaling pathways controlling cell division affords many opportunities for virus manipulation strategies. Taking the maxim "Set a thief to catch a thief" as a counter strategy, however, provides us with the very same virus evasion strategies as "ready-made tools" for the development of novel antivirus therapeutics. The most obvious are attenuated virus vaccines with critical evasion genes deleted. Similarly, vaccines against viruses causing cancer are now being successfully developed. Finally, as viruses have been playing chess with our cell biology and immune responses for millions of years, the study of their evasion strategies will also undoubtedly reveal new control mechanisms and their corresponding cellular intracellular signaling pathways.

MHV-68 Open Reading Frame 20 is a nonessential gene delaying lung viral clearance

Recently, it has been demonstrated that the MHV-68 ORF20-encoded gene product induces cell-cycle arrest at the G2/M phase, followed by apoptosis. To study the role of this conserved gene in vivo, two independent ORF20-deficient MHV-68 viruses and their revertants were constructed. As the replication in vitro of both mutants followed similar kinetics to that of the wild-type and revertant viruses, ORF20 is therefore a nonessential virus gene. No cell cycle arrest could be observed upon infection of cells with wild type MHV-68 or mutant viruses. In addition, no major differences were detected between mock- and virus-infected cells when protein and inactivation levels of the mitotic promoter factor cdc2/cyclinB were analyzed. Following intranasal infection, the recovery of mutant, revertant and wild-type viruses in the lungs was similar. With the ORF20-deficient viruses, however, there was a significant delay of four days in clearance of virus from the lungs. Surprisingly, the magnitude and cell population distribution in the exudates of the lung was essentially similar to mice infected with wild-type, revertant or ORF20-deleted viruses. Subsequent establishment of latency was normal for both mutants, demonstrating that ORF20 does not play a critical role in establishment of a persistent infection. These results indicate that while expression of ORF20 may impact on the pathogenicity of the infection, the observed induction of G2/M arrest in ORF20-expressing cells may not be the primary function of ORF20 in the context of viral infection.

First Report of Turnip mosaic virus on Watercress in Brazil

Watercress (Nasturtium officinale L.), a member of the family Brassicaceae, is consumed mainly as salad. Medicinal properties have also been attributed to this species. In Brazil, watercress is grown mainly by very small farmers. The crop is primarily seed propagated and growers can harvest several times per year in an established planting. Very few diseases have been reported in this crop worldwide. In Brazil, watercress infection by Cauliflower mosaic virus (CaMV) (3), Cucumber mosaic virus (CMV) (1), and an unidentified potyvirus (2) were previously reported. In January 2009, 80% of watercress plants, cv. Gigante Redondo, exhibiting severe mosaic, leaf size reduction, and plant stunting were observed in a crop in Marechal Floriano Municipality, State of Espírito Santo, Brazil. Preliminary leaf dip analysis by transmission electron microscopy revealed the presence of potyvirus-like particles. Sap from five infected plants reacted in plate-trapped antigen (PTA)-ELISA with polyclonal antiserum against Turnip mosaic virus (TuMV), but not with antiserum against CMV. Both antisera were produced in the Plant Virology Laboratory, ESALQ/USP. Mechanically inoculated watercress plants developed similar systemic mosaic symptoms. The virus was also transmitted to Nicotiana benthamiana, which exhibited severe mosaic and stunting. The presence of TuMV on these inoculated plants was confirmed by PTA-ELISA and reverse transcription (RT)-PCR. Total RNA extracted from infected and healthy watercress and infected N. benthamiana was analyzed by RT-PCR using specific pairs of primers flanking the coat protein gene of TuMV. Degenerated anti-sense (5'-t/caacccctt/gaacgcca/cagt/ca-3') and sense (5'-gcaggtgaa/gacg/acttgat/ca/gc-3') primers were designed after analysis to an alignment of the nucleotide sequences for five isolates of TuMV available in the GenBank (Accession Nos. NC_002509, D10927, EU680574, AB362513, and D88614). One fragment of 838 bp was amplified from samples in the infected plants, but not in the healthy controls. Two amplicons were purified and directly sequenced in both directions. Comparisons of the 731-bp consensus nucleotide sequence (Accession No. HM008961) to several other isolates of TuMV revealed 94 to 95% identity in the coat protein region. To our knowledge, this is the first report of TuMV in watercress in Brazil. Management of the disease should include propagation by seeds instead of vegetative parts of the plants and rouging of diseased plants to prevent mechanical transmission during successive harvestings. References: (1) A. J. Boari et al. Fitopatol. Bras. 25:438, 2000. (2) A. J. Boari et al. Fitopatol. Bras. 27:S200, 2002. (3) M. L. R. Z. C. Lima et al. Fitopatol. Bras. 9:403, 1984.

Fusarium Wilt Caused by Fusarium oxysporum on Lettuce in Espirito Santo, Brazil

Plants of lettuce cv. Salad Regina that showed symptoms of a wilt disease were observed in commercial fields in the Marechal Floriano and Caxixe production regions in the highlands of Espirito Santo State (ES), Brazil. Wilted plants were first observed during the 2000 cropping season (June to September) when temperatures were between 26 and 34°C. Outbreaks of wilt in the Caxixe Region also occurred in the last 2 years on cultivars of the Lisa type. Symptoms were observed on seedlings and adult plants. Affected plants appeared wilted, showed red-to-brown discoloration of vascular tissues, were stunted, and developed yellow leaves that had brown or black streaks in the vascular system. The vascular streaks in the yellow leaves were continuous from the red-brown vascular discoloration in the crown. A Fusarium sp. was consistently and readily isolated by plating surface-sterilized (with NaOCl) root and crown tissue segments from symptomatic plants onto lactic-acid-amended potato dextrose agar and a Fusarium-selective medium (4). To complete Koch's postulates, a single hyphal tip of the isolated fungi was transferred to carnation leaf agar. Micro- and macroconidia formed abundantly within 8 days and matched the description of Fusarium oxysporum Schlechtend. Fr. Two- to three-week-old lettuce seedlings of each of six cultivars (Monalisa AG-819, Grand Rapids Nacional, Regina, Carolina AG-576, Vitória, and Grandes Lagos), representing the range of lettuce genetic diversity typically planted in Espirito Santo, were inoculated with the isolated fungus by dipping the roots of each plant in a spore suspension (1 × 10⁵ CFU/ml) or planting the seedlings in a steam-sterilized soil infested with the fungus at 1 × 10⁵ conidia/ml potting medium. Ten inoculated seedlings of each cultivar were arranged in a completely randomized design and placed in a greenhouse (26 ± 2°C) to allow development of the infectious agent. Ten noninoculated plants of each cultivar served as control treatments. Wilt symptoms developed on all inoculated plants 20 to 30 days after inoculation, and infected plants showed the same symptoms as observed on the original plants from which the pathogen was isolated. Noninoculated plants remained symptomless. F. oxysporum was consistently reisolated from the inoculated seedlings. The pathogenicity test was conducted twice. A wilt of lettuce attributed to F. oxysporum f. sp. lactucae was previously reported in Japan (3) and later in the United States where the disease was attributed to F. oxysporum f. sp. lactucum (2). In 2002, a lettuce wilt caused by F. oxysporum f. sp. lactucae was reported in Italy (1). Studies are being carried out to determine the formae speciales of these Brazilian lettuce isolates of F. oxysporum. To our knowledge, this is the first report of F. oxysporum on cultivated lettuce in Brazil. References: (1) A. Garibaldi et al. Plant Dis. 86:1052, 2002. (2) J. C. Hubbard and J. S. Gerik. Plant Dis. 77:750, 1993. (3) T. Matuo and S. Motohashi. Trans. Mycol. Soc. Jpn. 8:13,1967. (4) J. A. Ventura. Rev. Ann. Patologia de Plantas 7:271, 1999.

Distribution of 125I-labeled crotamine in mice tissues

Crotamine is a strong basic polypeptide from Crotalus durissus terrificus (Cdt) venom composed of 42 amino acid residues tightly bound by three disulfide bonds. It causes skeletal muscle spasms leading to spastic paralysis of hind limbs in mice. The objective of this paper was to study the distribution of crotamine injected intraperitoneally (ip) in mice. Crotamine was purified from Cdt venom by gel filtration followed by ion exchange chromatography, using a fast-performance liquid chromatography (FPLC) system. Purified crotamine was irradiated at 2 kGy in order to detoxify. Both native and irradiated proteins were labeled with (125)I using chloramine T method, and separated by gel filtration. Male Swiss mice were injected ip with 0.1 mL (2 x 10(6)cpm/mouse) of (125)I native or irradiated crotamine. At various time intervals, the animals were killed by ether inhalation and blood, spleen, liver, kidneys, brain, lungs, heart, and skeletal muscle were collected in order to determine the radioactivity content. The highest levels of radioactivity were found in the kidneys and the liver, and the lowest in the brain.

Anaphylaxis to povidone in a child

Povidone is an allergic agent present in numerous substances, food and medicines. The authors present the clinical case of a 9-yr-old male child admitted in the emergency room with anaphylaxis, in two occasions separated by a 6-month period. The first episode occurred 5 min after the first oral administration of Fluvermal (flubendazole) and the second occurred 10 min after cutaneous application of Betadine (povidone iodine solution). Previous cutaneous application of this solution and ingestion of mebendazole occurred without apparent adverse reactions. The allergy study revealed eosinophilia, an elevated total IgE level and positive prick-by-prick test for both drugs. A cutaneous prick-by-prick test with povidone (the sole common constituent) was also positive. This is probably the first case described in the literature of anaphylaxis induced by povidone in a child.

Effects of (60)Co gamma radiation on crotamine

Ionizing radiation can change the molecular structure and affect the biological properties of biomolecules. This has been employed to attenuate animal toxins. Crotamine is a strongly basic polypeptide (pI 10.3) from Crotalus durissus terrificus venom composed of 42 amino acid residues. It induces skeletal muscle spasms leading to a spastic paralysis of hind limbs in mice. The objective of the present study was to carry out a biochemical study and a toxic activity assay on native and irradiated crotamine. Crotamine was purified from C.d. terrificus venom by Sephadex G-100 gel filtration followed by ion-exchange chromatography, and irradiated at 2 mg/ml in 0.15 M NaCl with 2.0 kGy gamma radiation emitted by a 60Co source. The native and irradiated toxins were evaluated in terms of structure and toxic activity (LD50). Irradiation did not change the protein concentration, the electrophoretic profile or the primary structure of the protein although differences were shown by spectroscopic techniques. Gamma radiation reduced crotamine toxicity by 48.3%, but did not eliminate it.