Differential impact of target vessel on the diagnostic performance of resting full-cycle ratio as non-hyperemic physiological assessment

Background

Recently, wire-based resting indices have been recognized as gold standard for evaluating physiological lesion assessment. The resting full-cycle ratio (RFR) is a unique resting index which is calculated as the point of absolutely lowest distal pressure to aortic pressure during entire cardiac cycle. It is unclear whether the diagnostic performance of RFR for detecting functional coronary artery stenosis is similar in each coronary artery. The aim of this study is to compare the diagnostic performance of RFR based on target coronary vessel.

Method

This study was a prospectively enrolled observational study. A total of 156 consecutive patients with 220 intermediate lesions were enrolled in this study. The RFR was measured after adequately waiting for stable condition, while FFR was measured after intravenous administration of ATP (180mcg/kg/min). Lesions with FFR ≤0.80 were considered functionally significant coronary artery stenosis.

Results

In all lesions, reference diameter, diameter stenosis, lesion length, RFR, and FFR were 3.0±0.7mm, 45±13%, 13.0±8.8mm, 0.90±0.09, and 0.82±0.10, respectively. Functional significance was observed in 88 lesions (40%) of all lesions. RFR showed a significant correlation with FFR in overall lesions (r=0.774, p<0.001). The ROC curve analysis of RFR showed good accuracy for predicting functional significance (AUC 0.87, diagnostic accuracy 81%) in all subjects. Regarding each target vessel, there were similar and significant positive correlation between RFR and FFR (LAD; r=0.733, p<0.001, LCX; r=0.771, p<0.001, RCA; r=0.769, p<0.001, respectively). The prevalence of discordant between RFR and FFR was significantly different among 3 vessels (LAD 26%, LCX 12%, RCA 13%, respectively, p<0.05 for among 3 groups). Regarding the comparison of ROC curves according to lesion location, AUC was significantly lower in LAD than in LCX and RCA (LAD 0.780, LCX 0.947, RCA 0.926, p<0.01 for LAD compared to LCX, p<0.01 for LAD compared to RCA, respectively). Furthermore, the diagnostic accuracy was significantly different according to target vessel (LAD 74%, LCX 88%, RCA 87%, respectively, p<0.05 for among 3 vessels).

Conclusion

RFR demonstrated better diagnostic accuracy for evaluating functional lesion severity. The diagnostic performance of RFR was different based on target vessel. RFR is a unique and useful resting index, and it may detect functionally significant coronary stenosis that cannot be detected with other resting indices in daily practice.

Funding Acknowledgement

Type of funding source: None

EAACI Position paper on the standardization of nasal allergen challenges

Nasal allergen challenge (NAC) is an important tool to diagnose allergic rhinitis. In daily clinical routine, experimentally, or when measuring therapeutic success clinically, nasal allergen challenge is fundamental. It is further one of the key diagnostic tools when initiating specific allergen immunotherapy. So far, national recommendations offered guidance on its execution; however, international divergence left many questions unanswered. These differences in the literature caused EAACI to initiate a task force to answer unmet needs and find a consensus in executing nasal allergen challenge. On the basis of a systematic review containing nasal allergen challenges of the past years, task force members reviewed evidence, discussed open issues, and studied variations of several subjective and objective assessment parameters to propose a standardized way of a nasal allergen challenge procedure in clinical practice. Besides an update on indications, contraindications, and preparations for the test procedure, main recommendations are a bilaterally challenge with standardized allergens, with a spray device offering 0.1 mL per nostril. A systematic catalogue for positivity criteria is given for the variety of established subjective and objective assessment methods as well as a schedule for the challenge procedure. The task force recommends a unified protocol for NAC for daily clinical practice, aiming at eliminating the previous difficulty of comparing NAC results due to unmet needs.

Distal radius fracture fixation with a volar locking plate and endoscopic carpal tunnel release using a single 15mm approach: Feasibility study

Distal radius fractures (DRF) may trigger, reveal or decompensate acute carpal tunnel syndrome (CTS) in 0.5-21% of cases. Internal fixation and median nerve release must then be carried out urgently. Less invasive approaches have been described for both the median nerve release using an endoscopic device and for the DRF fixation using a volar locking plate. We assessed the feasibility of DRF fixation and median nerve release through a single, minimally-invasive 15mm approach on a series of 10 cases. We reviewed retrospectively 10 consecutive cases of DRF associated with symptomatic CTS in 8 women and 2 men, aged 57 years on average. CTS was diagnosed clinically. All patients were treated during outpatient surgery with a volar locking plate and endoscopic carpal tunnel release using a single 15mm minimally-invasive approach. In one case, arthroscopic scapholunate repair was also required. Six months after the procedure, all patients were reviewed with a clinical examination and a radiological evaluation. The average values for the clinical and radiological outcomes were as follows: pain on VAS 1.5/10; QuickDASH 14.3/100; flexion 90%; extension 90.6%; pronation 95.6%; supination 87.9%; grip strength 90.1%; 2PD test 5.2mm (4-8mm). Five complications occurred: two cases of temporary dysesthesia in the territory of the median nerve and one case of temporary hypoesthesia of the palmar branch of the median nerve, which had all completely recovered; two cases of complex regional pain syndrome type I, which were still active at 6 months. Despite its methodological weaknesses, our study is the only one to describe the technical feasibility of a single 15mm minimally-invasive approach for both internal fixation using a volar locking plate and endoscopic nerve release, with no serious complications. This technique should be added to the surgical toolbox of minimally-invasive procedures for the hand and wrist.

Proximodistal interphalangeal arthrodesis of the little finger: A series of 7 cases

As an alternative to amputation of the little finger, we report here seven cases of shortening arthrodesis carried out by resecting the middle phalanx and proximodistal interphalangeal (PDIP) arthrodesis. Our cohort consisted of 6 males and 1 female (58years average age), with a stiff little finger secondary to Dupuytren's disease or trauma. All fingers were approached dorsally; after resection of the middle phalanx and decortication of the subchondral bone, fusion of the remaining phalanges was performed using an intramedullary self-breaking screw-pin. At a mean follow-up of 34.9months, pain decreased significantly (1.4/10 versus 5.4/100 preoperatively), the QuickDASH score improved significantly (33/100 versus 51/100 preoperatively) and all the joints had fused. One patient suffered from cold intolerance. PDIP arthrodesis is an alternative salvage procedure to amputation for multioperated stiff little fingers that does not burn any bridges if it fails.

Thorough debridement and immediate primary wound closure for animal bite injuries of the upper limbs

PURPOSE

Animal bite injuries are often encountered in daily practice. In particular, these injuries of the upper limbs can result in severe functional impairment. We have performed early debridement of contaminated tissue and primary closure for these injuries.

METHODS

The subjects consisted of 15 patients (6 males and 9 females) aged 1-91 years (mean 53.6 years) who visited our hospital due to animal bite injuries (dog in 9 patients, cat in 6). The bite site was the forearm in 5 patients and the hand in 10. In the operating room, contaminated tissue was removed, and primary wound closure was performed after irrigation.

RESULTS

The bite penetrated to the muscle layer in 6 patients, tendon sheath in 5, joint in 1, bone in 1, and involved only the subcutaneous tissue in 3 patients. The mean period until the completion of wound treatment was 19.8 ± 8.4 days. As complications, numbness of finger, metaphalangeal joint contracture and superficial radial nerve injury were observed in each one case. In a patient with bite injury of the palmar and dorsal sides of the thumb reaching the bone, additional debridement was necessary. At the final observation, the visual analog scale was 1.2 ± 1.4, and the Quick Disabilities of the Arm, Shoulder, and Hand score was 9.7 ± 12.2.

CONCLUSIONS

Debridement to achieve wound closure is indispensable in patients with animal bite injuries of the upper limbs. The results of our study suggest that thorough debridement allows primary closure, even for animal bite injuries.

Graner's procedure in Kienböck disease: a series of four cases with 25years of follow-up

Advanced stages of Kienböck's disease are treated by several techniques, one of which is Graner's procedure, nearly abandoned nowadays. The results of long-term follow-up of a series of four cases Graner's procedure are presented. Four patients were reviewed with a follow-up of 25years. There were two women and two men mean aged 37years at the time of surgery. Two of them were manual workers. Graner's procedure was the first surgery in three cases and secondary to failure of radius shortening in one case of Stage IIIa. Three patients underwent bone healing and the fourth benefited secondarily from radiocarpal arthrodesis. At maximal follow-up, the mean DASH score was 36.6 and pain assessed by visual analogic scale was 3.25 out of 10; the range of movement was half of the opposite side; the wrist strength was 80.9% of the opposite side. In the three consolidated cases, a spontaneous remodeling of the radiocarpal articular surfaces was noted. Graner's procedure is logical as it aims at creating a new radiocarpal articulation, either by the fusion of the lunate with the capitate (Graner I) or by replacing the lunate with the head of the capitate (Graner II and III). However, this old procedure should no longer be one of the surgical procedures for Kienböck disease due to its drawbacks: necrosis or non-union of the head of the capitate, necessity to perform a wrist fusion in the long-term and side effects of bone graft harvesting.

LEVEL OF EVIDENCE

II. Retrospective study.

Ulnar nerve transposition using a mini-invasive approach: case series of 30 patients

The treatment of ulnar nerve compression at the elbow remains controversial. No single technique has yet proven its superiority. We describe a technique combining the advantages of the mini-invasive approach with those of transposition. We present the results of 30 patients, of mean age 52 years, who underwent anterior subcutaneous transposition of the ulnar nerve using a mini-invasive approach with a follow-up of more than six months. The incision measures 3 cm. The results were evaluated by measuring pain intensity, quick disabilities of the arm shoulder and hand (DASH), grip strength and pinch, and McGowan score, pre- and post-operatively. All parameters were improved post-operative. The mean pain score went from 5.5 to 4, the quick DASH from 48 to 38, mean grip strength from 28 to 31 kg, and mean pinch strength from 4.7 to 6.4 kg. The McGowan score was also improved; pre-operatively, there were 16 patients at stage III, seven patients stage II, seven patients stage I, and post-operatively there was one patient stage III, three patients stage II, 16 patients stage I, and 10 patients stage 0. Analysis of our series shows that a 3 cm incision without endoscopy allows subcutanous transposition, with results at least as good as those with other techniques. The advantages of our technique are that it is easy, has a limited approach, preserves blood supply, allows placement of the nerve in a favourable environment, and decreases nerve stretching during elbow flexion.

333 ESTABLISHMENT OF NOVEL METHOD FOR REPEATED CONSTRUCTION OF ENGINEERED ZINC FINGER NUCLEASE

Zinc finger nucleases (ZFN), which are artificial restriction enzymes consisting of an engineered zinc-finger domain (ZF) and an endonuclease domain, can be used for the induction of site-directed mutation and the efficient generation of gene knockout animals. However, the repeated construction of various ZFN sequences is both expensive and time consuming. In this study, we attempted to establish a novel method for inexpensive and rapid ZFN construction. First, we constructed ZFN against mouse Rosa26 and original mouse Gli3 gene loci using short PCR primer sets (>30 bp), which contained 21 bp of the ZF recognition helix for a specific DNA triplet. We prepared 18 sets of such primers and PCR was performed using one of these primer sets and the partial ZF sequence as a template, which was obtained from the first to second DNA recognition helix of mouse Zif268. The PCR products were joined by overlap-PCR and nested PCR, and then inserted into a vector coding the endonuclease domain of FokI nuclease. By these steps, we successfully synthesised intended ZFN vectors containing 4 to 6 fingers. Next, we evaluated the functions of constructed ZFN. The mRNA of constructed ZFN were transcribed in vitro and injected into the cytoplasm of C57BL/6N zygotes. After 24 h of culture, 2-cell stage embryos were subjected to genomic PCR of the target locus, and the PCR products were directly sequenced. When ZFN mRNA for mouse Rosa26 was injected, 3- to 146-bp deletions were detected in 92.8% of injected embryos. This result was almost the same as previously reported for ZFN, indicating that our novel construction method can synthesise functional ZFN, which work as a site-directed nuclease, and that efficiency was comparable with those constructed by conventional PCR methods using long oligonucleotide sets (60 bp).

187 EXPRESSION AND REGULATION OF THE FIBROBLAST GROWTH FACTOR GENE FAMILY DURING MOUSE FOLLICULAR DEVELOPMENT

Recent studies have shown the critical roles of fibroblast growth factors (FGFs), including FGF8 produced by oocytes, in regulating follicular development. However, the expression and regulation of the FGF gene family, which consists of 22 ligands and 4 receptors, in the mouse ovary have not been well understood. The aim of the present study was to assess the expression and regulation of FGF ligands and receptors in the mouse ovary. Transcript levels of FGF ligands and receptors in immature (3-week-old) and adult (7- to 8-week-old) ovaries as well as other tissues of B6/DBA2F1 mice were analysed with RT-PCR. Furthermore, expression levels of FGF receptors in cumulus cells (CC) and mural granulosa cells (MG) before and after equine chorionic gonadotropin (eCG) treatment were determined with RT-quantitative PCR. Among 21 FGF ligands examined, 12 and 9 transcripts were detectable in immature and adult ovaries, respectively. More FGF ligands were detected in ovary, testis, heart, and brain compared to other tissues, including liver and spleen. Transcripts of all 4 FGF receptors (Fgfr1–4) were detectable in both immature and adult ovaries. Expression levels of Fgfr1 and Fgfr2 were significantly higher in MG compared with CC before and after the eCG treatment. Levels of Fgfr4 were comparable between MG and CC before the eCG treatment, but became significantly different with higher expression levels in MG after the eCG treatment. Fgfr3 transcripts were barely detectable in CC and MG. Overall levels of Fgfr1 in granulosa cells (CC and MG) were downregulated by eCG treatment, whereas those of Fgfr2 and Fgfr4 were upregulated. In summary, many FGF ligands are expressed, at least in mRNA levels, in mouse ovaries. Moreover, the expression levels of Fgfr transcripts in granulosa cells are dynamically regulated during follicular development.

Significant relationship between local angle at fused segments and C2-7 angle: Average duration of longer than 20 years after anterior cervical discectomy and fusion

Background:

The authors have focused their attention to the radiological durability of cervical sagittal alignment after anterior cervical discectomy and fusion (ACDF) using autologous bone grafting.

Materials and Methods:

Among the patients who underwent ACDF with trans-unco-discal (TUD) approach between 1976 and 1997, 22 patients (16 males and 6 females) made return visits for a clinical evaluation. Patients with trauma or previously treated by anterior cervical fusion or by posterior decompression were excluded from the present study. Clinical evaluation included adjacent segment degeneration (ASD), osseous fusion, local angle at the fused segments and C2-7 angle of cervical spine.

Results:

The duration after ACDF ranged from 13 to 34 years with an average of 21.3 ± 7.0 years. A single level fusion was done on 8 patients, 2 levels on 11 patients, 3 levels on 2 patients, and 4 levels on 1 patient. Imaging studies indicated that 12 of the 22 patients (54.5%) were graded as having symptomatic ASD. Osseous bony fusion at ACDF was recognized in all cases. None of the patients demonstrated kyphotic malalignment of the cervical spine. Average degrees of local angle at the fused segments and the C2-7 angle were 7.06 and 17.6, respectively. Statistical analysis indicated a significant relationship between the local at the fused segments and C2-7 angles.

Conclusions:

Sagittal alignment of the cervical spine was durable long after ACDF when the local angle at the fused segments was well stabilized.

Should we stop oral anticoagulants in the surgical treatment of carpal tunnel syndrome?

INTRODUCTION

It is usual to stop the intake of oral anticoagulants (anti-vitamin K) before surgery. Some authors have shown that during minimal surgery, the relay with low molecular weight heparin (LMWH) may lead to more thromboembolic complications. We present a prospective comparative study while evaluating the results of stopping or continuing anticoagulants in the surgery for carpal tunnel syndrome.

MATERIAL AND METHODS

Our series included 21 patients (24 hands) taking anticoagulants on a long-term basis. For the first nine patients (group I), treatment with anticoagulants was stopped before the surgery. For the following 12 patients (group II), treatment with anticoagulants was not interrupted. The evaluation was based on the measurement of pain (VAS), functional score of the Quick D.A.S.H. and grip strength (Jamar®) and search for a haematoma or thromboembolism).

RESULTS

The pain decreased by 3.5 points in both groups. The Quick D.A.S.H. decreased by 19.9 and 27.7 points in groups I and II, respectively. The average grip strength decreased by 2.5 kg in group I and increased by 3.8 kg in group II. A subcutaneous haematoma that got healed by itself was observed in group II. We did not observe any thromboembolic complications.

DISCUSSION

In conclusion, it seems pointless to stop anticoagulants before surgical treatment of carpal tunnel. The first reason is that continuing anticoagulants does not result in a bleeding risk. The second reason is that this approach removes the theoretical risk of thromboembolic complications during a poorly monitored relay.

Development of a pattern to measure multiscale deformation and strain distribution via in situ FE-SEM observations

We investigated a method for measuring deformation and strain distribution in a multiscale range from nanometers to millimeters via in situ FE-SEM observations. A multiscale pattern composed of a grid as well as random and nanocluster patterns was developed to measure the localized deformation at the specimen surface. Our in situ observations of a carbon fiber-reinforced polymer matrix composite with a hierarchical microstructure subjected to loading were conducted to identify local deformation behaviors at various boundaries. We measured and analyzed the multiscale deformation and strain localizations during various stages of loading.

259 Cdk7 AND CYCLIN H, BUT NOT Mat1, ARE INVOLVED IN MEIOTIC RESUMPTION OF PORCINE IMMATURE OOCYTE

The complex kinase Cdk-activating kinase (CAK) consists of the catalytic subunit Cdk7, regulatory subunit Cyclin H, and assembly factor Mat1. The CAK is essential for maturation-promoting factor (MPF) activation by phosphorylating threonine 161 (T161) of Cdc2 in mitosis. Although it is known that meiotic resumption of oocytes is regulated by MPF activity, the role of CAK in meiosis is still unclear. In the present study, we attempted to confirm the involvement of CAK in meiotic resumption of porcine immature oocyte. Cumulus–oocyte complexes (COC) were collected from antral follicles of gilts and cultured up to 48 h in TYH medium containing 20% porcine follicular fluid, 3.2 mg/mL of BSA, and 1.0 IU mL–1 of pregnant mare serum gonadotropin. The T161 phosphorylation level of Cdc2 in cultured oocytes was analysed by Western blot analysis. The transcripts were collected from noncultured or cultured oocytes, and Cdk7, Cyclin H, and Mat1 expression were detected by RT-PCR. Overexpression of Cdc2 or inhibition of Cdk7, Cyclin H, and Mat1 during oocyte maturation was performed by microinjection of mRNA or antisense RNA into ooplasm of immature COC and verified by Western blot or semiquantitative RT-PCR. Maturation-promoting factor kinase activity was assayed by Histone H1 kinase activity assay. Statistical analyses in this study were carried out by Student’s t-test. The T161 phosphorylation of Cdc2 was found during the culture period from 18 h to 48h, which was after germinal vesicle breakdown (GVB). Overexpression of Cdc2 increased the incidence of GVB at 18 h, but overexpression of mutant Cdc2 (replaced T161 by alanine) had no influence on GVB. These results indicate that T161 phosphorylation of Cdc2 is important for meiotic resumption. Next, we attempted to confirm the CAK function during oocyte maturation. Transcripts of Cdk7, Cyclin H, and Mat1 were detectable throughout the culture period. Inhibition of Cdk7 and Cyclin H caused a decrease in T161 phosphorylation and MPF activity, and the incidence of GVB was significantly lower than in nontreated oocytes. In contrast, Mat1-inhibited oocytes resumed meiosis and developed to the metaphase II stage, and the incidence was not different between Mat1-inhibited oocytes and nontreated oocytes. These results suggest that Cdk7 and Cyclin H are working as CAK and activate Cdc2 by T161 phosphorylation, although Mat1 is dispensable during oocyte maturation.

Abstract P2-02-01: Characterization of the Breast Lesions by Biexponential Signal Attenuation Analysis of Diffusion-Weighted Magnetic Resonance Images

Purpose: Signal attenuation of diffusion-weighted magnetic resonance images (DWI) in vivo with high b-values is sometimes non-linear when plotted with a semilogarithmic function, but it fits well with the biexponential equation, Sb/S0=f1exp(bD1) + (1-f1)(bD2). Others have indicated that the fast and slow component fractions (f1, 1-f1) of the apparent diffusion coefficients (D1, D2) can be derived by biexponential fitting, and that these fractions correspond to actual diffusion components in the extra-and intracellular space. Here, we investigated the clinical value of DWI for breast screening by performing multi b-factor DWI on healthy volunteers and patients. We then analyzed signals by fitting them with the biexponential equation and compared the fitting parameters of breast lesions.

Patients and methods: This study was approved by our center's institutional review board and all patients and volunteers gave their informed consent. We analyzed data from eight healthy females (controls) and 80 female patients with a total of 100 breast tumors (42 benign and 58 malignant). We performed DWI using 12 and 6 b-values for the controls and patients up to a maximum b-value of 3500 sec/mm2.

Results: We identified the DWI signal attenuation features of the normal mammary gland, and of benign and malignant tumors [Figure1]. The DWI signal attenuation was similar between some proliferative benign tumors and malignancies. A comparison of the parameters derived from biexponential fitting revealed a significant difference in f1 between noninvasive and invasive ductal carcinoma [Figure 2]. Conclusion: The biexponential fitting parameters might reflect the features of tumor cellularity. Thus, to distinguish malignant from benign breast tumors only by DWI is difficult due to the pathological diagnosis that rather emphasizes cell configuration or shape rather than cellularity. Nevertheless, our findings will help to understand why malignant tumors present as high signal intensity in DWI.

[Combined aortic root replacement and pectus excavatum correction in Marfan's syndrome]

A 53-year-old man with Marfan's syndrome was admitted for repair of annulo-aortic ectasia (58 mm). He had also severe pectus excavatum. The skin was incised along the sternal midline. The pectoral muscles were detached laterally. After the perichondrium and costal cartilages were resected bilaterally. the left-sided intercostal muscles and perichondrial sheaths were divided 3 cm lateral to the sternum. To place the retractor in parasternal position, excellent exposure of the heart and aortic root was enabled. The aortic root was replaced with a Carboseal graft. Chest wall reconstructions was completed by modified Ravitch procedure with Gore-tex sheet The patient was discharged after an uneventful recovery on postoperative day 14.

Surgical repair of pelvic-floor prolapse: lessons learned from longitudinal follow-up of quality-of-life survey

BACKGROUND

Scant evidence has been reported on the evaluation of quality-of-life (QOL) in patients who had undergone surgical treatment due to pelvic floor prolapse including cystocele. The aim of this study is to evaluate the impact of surgical intervention on patients' QOL before and after surgery.

METHODS

Between 1997 and 2007, 135 patients (median age: 66.6 years) with pelvic floor prolapse including cystocele underwent bladder neck suspension with anterior/posterior colporrhaphy. The follow-up period was 39.6 months. Seventy-two patients (53 %) had urinary incontinence. The cystocele was graded as mild (grade 2), moderate (grade 3), and severe (grade 4) in 35, 60, and 40, respectively, according to the Baden-Walker classification. A urodynamic study was performed in 69 patients (51 %) who had obstructive symptoms with 100 ml or more of postvoid residual urine. Postoperative QOL was longitudinally assessed in 114 patients by scoring three disease-specific items (sensation of vaginal bulging, obstructive symptoms, urinary incontinence), and one overall health-related QOL (HR-QOL), and compared with corresponding baseline scores.

RESULTS

A longitudinal study demonstrated that a significant improvement in these symptoms was sustained at a median follow-up of 62.2 months. HR-QOL was significantly associated with vitality assessed by SF 36 (p = 0.036). Multivariate analysis revealed that update urinary incontinence, pre-operative HR-QOL was independent prognostic factors for predicting postoperative patient's satisfaction.

CONCLUSIONS

Although surgical repair of pelvic floor prolapse can achieve acceptable results with intermediate-term durability as well as improving the QOL, preoperative patients' HR-QOL may be considered in the decision making process for treatment.

Methylation level of the RASSF1A promoter is an independent prognostic factor for clear-cell renal cell carcinoma

BACKGROUND

Ras association domain family 1A (RASSF1A) is a tumor suppressor that regulates the cell cycle, apoptosis, and microtubule stability. The association between the methylation levels of RASSF1A and the prognosis of clear-cell renal cell carcinoma (CCRCC) remains unclear. Therefore, we investigated this relationship to determine the prognostic value of RASSF1A methylation levels for CCRCC.

PATIENTS AND METHODS

The study comprised 179 Japanese patients who underwent radical or partial nephrectomy for CCRCC. The methylation level of 5' CpG islands in the RASSF1A was evaluated using combined bisulfite restriction analysis and bisulfite sequencing.

RESULTS

High levels of methylation in the RASSF1A promoter were significantly more frequent in grade 3 compared with grade 1 or 2 tumors (P = 0.028) and in patients with stage III or IV compared with patients with stage I or II (P = 0.043). Patients with high methylation levels had a significantly less favorable prognosis compared with those with low methylation levels (P = 0.040). Higher methylation levels were independently associated with a poor prognosis following multivariate analysis (P = 0.0053).

CONCLUSION

These results indicate that quantitative promoter methylation levels of the RASSF1A gene may be a useful marker to predict the prognosis of CCRCC.

INDICATION OF VARICOCELECTOMY IN THE ERA OF ASSISTED REPRODUCTIVE TECHNOLOGY: PREDICTION OF TREATMENT OUTCOME BY NONINVASIVE DIAGNOSTIC METHODS

Of 103 patients who underwent varicocelectomies, 87 underwent all the diagnostic methods: color Doppler ultrasonography (DOP), scrotal deep body temperature (DBT), and scrotal scintigraphy (SSG). Total motile sperm (TM) was calculated. The positivities of DOP, DBT, and SSG were 67, 51, and 90%, respectively. In the patients <30 years old, TM increased in the DBT-positive group. In older patients, positive for DBT indicated poor improvement of TM, whereas positive for DOP indicated better response in the group. Patients older than 30 years and positive for DBT, but not DOP, should be counseled directly to receive intrauterine insemination or in vitro fertilization/intracytoplasmic sperm injection.

Radiofrequency ablation therapy: results in 100 patients with breast cancer

Abstract #5153

Background: Radiofrequency ablation therapy (RFA) is one of the most minimally invasive approaches for the treatment of hepatic cancers and other solid malignancies. The aim of this study is to assess the safety and local controllability of RFA against breast cancer.&#x2028; Patients and Methods: A total of 100 pts with localized early breast cancer were enrolled. Ductal spreading and/or daughter nodules were preoperatively checked with mammography, ultrasound and MRI. Tumor size was 0.5-2.0cm (median 1.5cm). LeVeen system and Cool-tip RF system was used in 5 pts and 95 pts respectively. One session of RFA was applied to 96 pts, 2 sessions to 4 pts. To avoid skin burn, 5% glucose was injected subcutaneously just above the tumor and the skin was cooled during RFA. After completing RFA, temperatures along the needle tract were measured at 1 cm intervals in 89 pts. All pts underwent cytological and MR-imaging study 3-4 weeks after operation, and received adjuvant radiotherapy (50Gy) to the breast.&#x2028; Results: RFA heated the tumors up to over 60° in 1 pt, 70° in 4 pts, 80° in 21 pts, 90° in 51 pts, and 100° in 13 pts. Skin burn was found in 2 pts over the tumor, and 1 pt at the grounding pads. No major side effects except for skin burn were found. Postoperative cytological and imaging study showed complete ablation of all the target tumors. No pts developed local and distant recurrence for 16-54 months (median 31 months).&#x2028; Discussion: Our RFA procedures can offer good local control without serious adverse events to breast cancer patients.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5153.

[Histoculture drug response assay guided concurrent chemoradiotherapy for non-small cell lung cancer]

Retrospective analysis was done to evaluate concurrent chemoradiotherapy (CCRT) using chemotherapeutic agents judged to be sensitive by histoculture drug response assay (HDRA) for non-small cell lung cancer (NSCLC). We treated 21 NSCLC patients with CCRT using senstivie agents judged by HDRA from 1999 to 2004. Objective response was evaluated in 20 patients. They were consisted of 1 complete response (CR) case, 18 partial response (PR) cases, and 1 stable disease (SD) case. The response rate was 95%. Ten cancer related deaths were observed during 816 +/- 861 (60-2,780) days follow-up. Median survival time was 604 days. One- and 5-year survival rates were 73.9% and 40.3%, respectively. In conclusion, HDRA may improve efficacy of CCRT for NSCLC.

An intensive group therapy programme for smoking cessation using nicotine patch and internet mailing supports in a university setting

AIMS

Despite the growing literature on workplace tobacco control policies, very few studies have evaluated the role of smoking cessation programme as one of these policies in a university setting. We aimed to investigate the efficacy of intensive cessation programme delivered in a group format using nicotine patch therapy and internet mailing supports for our university employees.

METHODS

From January 2003, we conducted the group therapy programme for smoking cession seven times in Okayama University, Japan. This programme consisted of nicotine patch therapy and on-line supporting system. Smoking status was regularly assessed by direct interviews.

RESULTS

A total of 102 employees were enrolled in this programme, of whom 101 initiated their smoking cessation. One hundred participants (99%) received nicotine patch therapy, and its toxicities were generally mild. Of the 94 employees who could be follow-up for a year after the cessation, 50 (53%) sustained abstinence for a year. Multivariate analysis revealed that writing and sending e-mail messages within the first 1 week were significant factors affecting long-term cessation. The type of position also affected the cessation rate.

CONCLUSION

This study suggests that our programme in a university setting seems to be effective mainly because of peer-supports among the participants through regular face-to-face meetings and their own mailing supports.

The association of DNA repair gene polymorphisms with the development and progression of renal cell carcinoma

BACKGROUND

DNA repair enzymes repair some of the DNA damage associated with risk factors for renal cell carcinoma (RCC), including smoking. DNA repair gene polymorphisms modulate the repair capacity and might influence individual risk and progression of RCC. We examined associations between functional polymorphisms and risk, clinicopathologic characteristics and survival of RCC.

PATIENTS AND METHODS

The study groups comprised 215 RCC patients and 215 age- and gender-matched healthy controls. Polymorphisms in xeroderma pigmentosum complementation groups C, D and G and X-ray repair cross-complementing groups 1 and 3 genes were genotyped.

RESULTS

No significant differences in DNA repair genotype were observed between RCC cases and controls. In all patients, however, greater numbers (> or =3) of total variant alleles in all DNA repair genes studied were associated with less frequent venous extension (P = 0.0079). In smokers, some genotypes were associated with characteristics of RCC (Ps < or = 0.0067) and smokers with greater numbers of total variant alleles had improved overall survival (P = 0.040).

CONCLUSION

These results suggest that DNA repair gene polymorphisms may not influence RCC susceptibility, but that some of them may influence RCC progression, especially in smokers, possibly due to altered DNA repair capacity by these polymorphisms.

Identification of post-menopausal women at risk of osteoporosis by trained general dental practitioners using panoramic radiographs

BACKGROUND

An eroded inferior cortex of the mandible on panoramic radiographs may be useful for identifying post-menopausal women with low bone mineral density (BMD), or osteoporosis. The purpose of this study was to assess whether trained general dental practitioners (GDPs) can identify post-menopausal women with undetected low skeletal BMD as well as spinal fractures by panoramic radiographs in their clinics.

METHODS

Out of 455 women aged 50 years and older who visited the dental clinics of 22 trained GDPs and had panoramic radiographic assessment for the examination of dental diseases between June and December 2004, 168 post-menopausal women were diagnosed as having low skeletal BMD based on cortical erosion findings. Of these women, 39 women aged 50-84 years (mean age (SD, standard deviation), 64.8 (7.4) years) with no previous diagnosis of osteoporosis participated in this study. BMD at the lumbar spine and femoral neck was measured using dual energy X-ray absorptiometry (DXA). Spine fractures were assessed on lateral radiographs obtained at the time of the DXA assessment.

RESULTS

Two women (5.1%) had normal BMD (BMD T-score>-1.0), 21 women (53.9%) had osteopenia (BMD T-score of -2.5 to -1.0) and 16 women (41.0%) had osteoporosis (BMD T-score<-2.5). Eight women (20.5%) had fractures at the thoracic spine, lumbar spine, or both.

CONCLUSIONS

Our results suggest that a high percentage of post-menopausal women with undetected low skeletal BMD as well as spinal fractures may be identified based on trained GDPs' analyses of their panoramic radiographs.

Four cases of thrombotic events associated with neuro-endovascular therapy: heparin resistance and aspirin resistance

SUMMARY

Thrombotic events are caused by insufficient antithrombotic treatment in endovascular surgery. We experienced four cases of thrombotic events and consider the factors from the point of view of heparin resistance and aspirin resistance. The proportion of these features is quite high and appropriate management is important.

Detection of new anti-neutral glycosphingolipids antibodies and their effects on Trk neurotrophin receptors

We screened sera from patients with various neurological disorders for the presence of anti-neutral glycosphingolipids antibodies and only found them in sera from relapsing polychondritis with limbic encephalitis patients. Neutral glycosphingolipids are resident in membrane lipid rafts where high affinity nerve growth factor (NGF) receptor, Trk is co-localized. Therefore, we examined whether these antibodies influence the action of NGF in NGF-responsive cells. The results strongly suggest that these antibodies enhance NGF-induced Trk autophosphorylation and neurite outgrowth as well as neurofilament M expression. These data strongly indicate that these anti-neutral glycosphingolipids antibodies have a functional impact on NGF-Trk-mediated intracellular signal transduction pathway.

Single nucleotide polymorphisms in DNA repair genes might be prognostic factors in muscle-invasive bladder cancer patients treated with chemoradiotherapy

DNA repair enzymes repair DNA damaged by platinum agents and ionising radiation. Single nucleotide polymorphisms (SNPs) in DNA repair genes modulate the repair capacity and might affect response and prognosis following platinum-based chemoradiotherapy (CRT). We investigated associations between the functional SNPs in DNA repair genes and response and survival in muscle-invasive bladder cancer patients treated with CRT to determine the predictive value of the SNPs in patient selection for bladder conservation therapy. The study group comprised 78 patients who underwent CRT for transitional cell carcinoma of the bladder. Single nucleotide polymorphisms in xeroderma pigmentosum complementation groups C (Lys939Gln, A/C), D (XPD; Lys751Gln, A/C), and G (Asp1104His, G/C), and X-ray repair cross-complementing groups 1 (XRCC1; Arg399Gln, G/A) and 3 (Thr241Met, T/C) genes were genotyped. Combined genotypes with at least one variant allele in XPD or XRCC1 were significantly associated with improved cancer-specific survival compared with remaining groups (P=0.009). In multivariate analysis, only the combined XPD and XRCC1 genotypes were independently associated with cancer-specific survival (P=0.04). The association was stronger in stage T3/T4 patients (P=0.0008). These results suggest that combined XPD and XRCC1 genotypes might be prognostic factors in muscle-invasive bladder cancer patients treated with CRT.

Salvage chemotherapy with paclitaxel, ifosfamide, and nedaplatin in patients with urothelial cancer who had received prior cisplatin-based therapy

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Background: The combination chemotherapy of paclitaxel, ifosfamide, and nedaplatin (PIN regimen) has been shown to be effective in patients with advanced urothelial cancer. The aim of this presentation is to evaluate long-term followup outcomes in patients who had treated with standard cisplatin-based chemotherapy. Methods: The PIN regimen consisted of paclitaxel 175 mg/m2 on day 1, ifosfamide 4.5 g/m2 divided over days 1, 2 and 3, and nedaplatin 70 mg/m2 on day 1; PIN was given every 28 days. The doses of nedaplatin and ifosfamide were reduced according to the impairment of renal function (24h CCr) just before starting each cycle of PIN therapy Results: Thirty two patients who had previously undergone cisplatin-based chemotherapy were entered onto the study (median age, 66 years; median performance status, 1, median 24h CCr, 62ml/min [29–119ml/min] ). Metastatic sites at study entry included the lymph nodes (24), lung (6), bone (5), primary (5), soft tissue (3), and liver (2). Among the 32 assessable patients, there were 5 CRs (16%) and 19 PRs (59%) for an overall RR of 75 % (95% confidence interval [CI], 59–91 %). The median time to progression was 8 months (range, 0–50+ months) and the median survival was 22 months (range, 4–52+ months). Twelve patients received the full dose of PIN combination (median 5 cycles) and 20 patients required dose reduction (median 3 cycles). Nine of 12 (75%) patients who were treated with the full-dose PIN combination obtained a CR or PR, as did 15 of 20 (75%) patients who required dose reduction. Grades 3 and 4 neutropenia occurred in all patients. Febrile neutropenia occurred in 8 (25%) patients. Grades 3 and 4 thrombocytopenia occurred in 8 (25%) patients. Grades 3 and 4 anemia was observed in 6 (19%) patients. Grade 3 neuropathy occurred in 1 (3%) patient, who could not continue to receive additional cycles of PIN combination after 3 cycles. No patient experienced renal failure. There were no treatment-related deaths. Conclusions: The PIN combination was highly active and tolerable in patients who had previously treated with cisplatin-based chemotherapy, and might be suitable for those with mild to moderate renal insufficiency.

No significant financial relationships to disclose.