Enhancing routine HIV and STI testing among young men who have sex with men: primary outcomes of the get connected clinical randomized trial (ATN 139)

BACKGROUND

Regular HIV and STI testing remain a cornerstone of comprehensive sexual health care. In this study, we examine the efficacy of Get Connected, a WebApp that combines test locators with personalized educational resources, in motivating young men who have sex with men (YMSM) to undergo regular HIV and STI testing.

METHODS

Participants were randomly placed in one of two conditions. The first condition included the full version of GC (GC-PLUS), which included content tailored to users' psychosocial characteristics (e.g., age, race/ethnicity, relationship status, HIV/STI testing history). The second condition served as our attention-control and only included the testing locator (GC-TLO) for HIV/STI testing services. Participants were recruited from three cities (Houston, Philadelphia, and Atlanta) characterized by high HIV incidence. Assessments were collected at 1, 3-, 6-, 9- and 12-month follow-ups.

RESULTS

Both versions of GC were acceptable and efficacious in increasing routine HIV and STI testing over a 12-month period. 40% of the sample reported testing at least twice, with no main effects observed across the two intervention arms (OR = 1.11; 95% CI: 0.69, 1.80), p =.66). Greater intervention effects were observed among YMSM who engaged more frequently with the intervention, with regional differences observed.

CONCLUSIONS

Our findings underscore the need to cater to the diverse needs of YMSM through multilevel approaches. Broadly, mHealth HIV/STI testing interventions, such as Get Connected, would benefit from matching technologies to the local context to have the greatest impact.

TRIAL REGISTRATION

This study is registered on ClinicalTrials.gov (NCT03132415).

The Atacama Rover Astrobiology Drilling Studies (ARADS) Project

With advances in commercial space launch capabilities and reduced costs to orbit, humans may arrive on Mars within a decade. Both to preserve any signs of past (and extant) martian life and to protect the health of human crews (and Earth's biosphere), it will be necessary to assess the risk of cross-contamination on the surface, in blown dust, and into the near-subsurface (where exploration and resource-harvesting can be reasonably anticipated). Thus, evaluating for the presence of life and biosignatures may become a critical-path Mars exploration precursor in the not-so-far future, circa 2030. This Special Collection of papers from the Atacama Rover Astrobiology Drilling Studies (ARADS) project describes many of the scientific, technological, and operational issues associated with searching for and identifying biosignatures in an extreme hyperarid region in Chile's Atacama Desert, a well-studied terrestrial Mars analog environment. This paper provides an overview of the ARADS project and discusses in context the five other papers in the ARADS Special Collection, as well as prior ARADS project results.

Primary ciliary dyskinesia diagnosis and management and its implications in America: a mini review

Introduction

Primary ciliary dyskinesia (PCD) is a rare genetic disorder that can result in significant morbidity and mortality if left untreated. Clinical manifestations of PCD include recurrent respiratory infections, laterality defects, and infertility, all of which arise from impaired or absent ciliary motility. Diagnostic approaches for PCD may include high-speed video microscopy, measurement of nasal nitric oxide levels, and genetic testing; however, no single definitive diagnostic test exists. The present study aims to highlight the lack of standardized diagnostic and treatment guidelines for PCD in Latin America (Central and South America, and the Caribbean). To this effect, we compared North American and European recommendations for the diagnosis and management of PCD and found that certain diagnostic tools and treatment options mentioned in these guidelines are not readily accessible in many Latin American countries.

Methods & Results

This review gathers disease information in North America, Europe, and Latin America organizing guideline results into tables for clarity and potential interventions. Management information for Latin America is inferred from case reports, as most findings are from North American recommendations and studies on PubMed, Google Scholar, and Scopus. Treatment and management information is based on North American and European standards.Among 5,774 publications reviewed, only 15 articles met the inclusion criteria (focused on PCD management, peer-reviewed, and located in America). No clinical guideline for PCD in Latin America was found, but recommendations on respiratory management from Colombia and Chile were discovered. The lack of guidelines in Latin America may originate from limited resources and research on the disease in those countries.

Discussion

PCD lacks documentation, research, and recommendations regarding its prevalence in Latin America, likely due to unfavorable economic conditions. This disadvantage results in limited access to diagnostic tests available in North America and Europe. The PICADAR score, discussed in this review, can be used in low-income nations as a screening tool for the disorder.

Prevalence of Plasmid-Associated Tetracycline Resistance Genes in Multidrug-Resistant Escherichia coli Strains Isolated from Environmental, Animal and Human Samples in Panama

Antimicrobial resistance bacteria are nowadays ubiquitous. Its presence has been reported in almost every type of source, from water for agricultural and recreative use, water distribution pipes, and wastewater, to food, fomites, and clinical samples. Enterobacteriaceae, especially Escherichia coli, are not the exception, showing an increased resistance to several antibiotics, causing a global health and economic burden. Therefore, the monitoring of fecal microbiota is important because it is present in numerous reservoirs where gene transfer between commensal and virulent bacteria can take place, representing a potential source of resistant E. coli. In this work, antibiotic resistance profiles of 150 E. coli isolates from environmental, animal, and human samples, collected in three rural areas in Panama, were analyzed. A total of 116 isolates were resistant to at least one of the nine antibiotics tested. Remarkably, almost 100% of these exhibited resistance to tetracycline. Plasmid-associated tetA and tetB genes were detected in 42.86% of the isolates analyzed, tetA being the most prevalent. These results suggest that tetracycline resistance would be used as a convenient indicator of genetic horizontal transfer within a community.

Association between PIK3CA Mutations in Blood and Tumor-Infiltrating Lymphocytes in Peruvian Breast Cancer Patients

OBJECTIVE

To evaluate the relationship between circulating tumor DNA (ctDNA) presence and tumor features including tumor-infiltrating lymphocyte (TIL) levels in Peruvian breast cancer patients.

MATERIALS AND METHODS

This was a prospective study conducted at the Instituto Nacional de Enfemedades Neoplasicas, Peru. We evaluated level of TIL and PIK3CA mutations in ctDNA. Clinical characteristics, including outcome data, were collected from the patient file. Survival was calculated from the date of blood sample drawn to the event time. Data collected were analyzed using SPSS software version 25.

RESULTS

We analyzed plasma samples from 183 breast cancer patients. most cases were of Luminal-B (44.8%) phenotype and stage II (41.5%), and median stromal TIL was 30%. PIK3CA mutation in ctDNA was detected in 35% cases (most with E545K) and was associated with lower TIL level (p=0.04). PIK3CA in ctDNA tended to be associated with advanced stages (p=0.09) in the whole series and with higher recurrence rates (p=0.053) in the non-metastatic setting. Patients with presence of PIK3CA in ctDNA tended to have shorter survival (p=0.083).

CONCLUSION

Presence of PIK3CA mutation in ctDNA was frequently found in our Peruvian breast cancer series, was associated with lower TIL levels and tended to predict poor outcomes.

Abstract 509: Tumor inflammation signature (TIS) in residual disease is associated with survival in breast cancer patients with high risk of recurrence

Background: The assessment of tumor inflammation signature (TIS) quantifies the adaptive immune response in the tumor microenvironment and is emerging as a predictor of clinical benefit in breast cancer. In this study we evaluated the ability of TIS to be a prognostic biomarker of survival benefit in patients with moderated and high residual disease after neoadjuvant chemotherapy (NAC) in breast cancer patients and its correlation with residual TILS after NAC.

Methods: We analyzed 46 samples of residual disease of breast cancer patients who received NAC and were under surgery between 2013 - 2018, with high risk of recurrence defined as Residual Cancer Burden (RCB) group II and III. TIS signature was evaluated using the Research Use Only version of 18-gen signature algorithm. Median of TIS score was 5.88, TIS score were categorized in four groups by quartiles and defined as low TIS score (lower quartile, score ≤ 4.82) and high TIS score (score > 4.82). In addition, we quantified the percentage of stromal TILS in residual disease, categorizing level of TILS in high and low level using median (20%) as a cut-off. Survival analysis was performed with Kaplan-Meier method and the associations with Cox regression model. Correlation between TIS and TILS was performed whit Pearson coefficient. Clinical data was collected of medical records.

Results: The median age at diagnosis was 50 years (26y - 78y), 65.2% of patients were Luminal B subtype, 63% were clinical stage IIIB, 26.2% were RCB II and 73.9% RCB III. No correlation between TIS score and percentage of stromal TILS was founded (p = 0.264). After median follow-up of 60 months, estimated median PFS for high TIS score was 71.7 vs 18.2 months for low score (HR = 0.28, 95% CI [0.13-0.64], p = 0.002), and estimated median OS for high TIS score was non-reached vs 40.9 months for low score (HR = 0.28, 95% CI [0.11-0.68], p = 0.005). Did not found differences in PFS (p = 0.408) and OS (p = 0.773) by level of TILS.

Conclusions: High TIS score in moderated/high residual disease after neoadjuvant chemotherapy is associated with survival benefit expressed in prolonged PFS and OS. Level of TILS in residual disease did not show differences in survival and its percentage did not have correlation with TIS score.

Funding: FONDECYT-198-2015/280-INNOVATEPERU-EC-2017.

Citation Format: Marco Galvez-Nino, Miluska Castillo, Luis Bernabe, Nancy Suarez, Joselyn Sanchez, Katia Roque, Silvia Neciosup, Henry Gomez, Carlos Castaneda. Tumor inflammation signature (TIS) in residual disease is associated with survival in breast cancer patients with high risk of recurrence [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 509.

Human Papillomavirus, Cytomegalovirus Infection and P16 Staining in Breast Tumors from Peruvian Women

Objective:

To evaluate the frequency distribution of viral infections in Peruvian Breast Cancer (BC) lesions and its association with clinicopathological features. Additionally, a prospective evaluation of p16 and Tumor-infiltrating lymphocytes (TIL) levels were performed for developing a comprehensive analysis.

Methods:

Detection of high risk- human papillomavirus (HR- HPV) through qPCR was performed in 447 BC and 79 non-cancer frozen samples. Paired paraffin samples from 238 BC were stained with Human cytomegalovirus (HCMV) and p16 immunohistochemistry. TIL was calculated in 397 BC cases.

Results:

HCMV was positive in 72.5%. HR- HPV was detected in 2.9% of BC and 1.3% of non-malignant samples. P16+ was found in 28.15% and median TIL percentage was 30. HR- HPV infection was associated with non-ductal histology (p=0.003) and p16+ (p=0.017). Positive P16+ was associated with higher T stage (p=0.022), grade (p=0.009), TIL level (p=0.002), and triple-negative phenotype (p=0.021).

Conclusion:

HCMV is frequent, but HR- HPV infection is unusual in Peruvian BC. P16+ is associated with HR- PVH infection, high TIL and aggressive features.

The relationship between tumour infiltrating lymphocytes, Epstein–Barr virus and Helicobacter pylori infection in gastric cancer

Objective

Epstein–Barr virus (EBV) and Helicobacter pylori (HP) infections have been extensively recognised as gastric cancer (GC) triggers, and recent publications suggest they could behave as predictive markers for immune-modulating therapies. Tumour-infiltrating lymphocytes (TILs) have also been identified as a predictive biomarker for immunotherapy in different malignancies. This study aimed to investigate the association between EBV and HP infection with TIL levels in GC.

Methods

TIL evaluation in haematoxylin-eosin was performed by a pathologist and density of CD3, CD8 and CD163 positive (immunohistochemistry staining) immune cells was calculated with the use of digital pathology software. EBV infection was detected by in situ hybridisation (ISH) and by quantitative polymerase chain reaction (qPCR). Methylation status of EBV-related genes was detected by PCR and a methylome analysis was performed by the Illumina Infinium MethylationEPIC BeadChip. HP status was detected by qPCR.

Results

We included 98 resected GC Peruvian cases in our evaluation. Median TIL percentage was 30. The proportion of EBV+ detected by ISH was 24.1%, of EBV+ detected by qPCR was 41.8%, while 70% showed methylation of EBV-related genes, and 58.21% of cases were HP+. Younger age (p = 0.024), early stages (p = 0.001), HP+ (p = 0.036) and low CD8 density (p = 0.046) were associated with longer overall survival (OS). High TIL level was associated with intestinal subtype (p < 0.001), with grade 2 (p < 0.001), with EBV qPCR+ (p = 0.001), and with methylation of EBV-related genes (p = 0.007). Cases with high TIL level and cases that are EBV positive share eight genes with similarly methylated status in the metabolomic analysis. High CD8 density was associated with EBV PCR+ (p = 0.012) and HP− (0.005).

Conclusion

Lower CD8 density and HP+ predict longer OS. High TIL level is associated with EBV+ and methylation of EBV-related genes, while lower CD8 density is associated with HP+ GC.

Biomarkers of human papillomavirus (HPV)-driven head and neck cancer in Latin America and Europe study: Study design and HPV DNA/p16INK4a status

BACKGROUND

Human papillomavirus (HPV)-driven head/neck squamous cell carcinomas (HNSCC) prevalence varies globally. We evaluated HPV DNA and p16INK4a in formalin fixed paraffin embedded (FFPE) HNSCC from Argentina, Brazil, Colombia, and Peru.

METHODS

HPV was genotyped by PCR-hybridization. All HPV DNA positive and some HPV DNA negative cases underwent p16INK4a immunohistochemistry.

RESULTS

HPV DNA was detected in 32.8%, 11.1%, and 17.8% of oropharyngeal (OPC), oral cavity (OCC) and laryngeal (LC) cancers, respectively. OPC HPV prevalence was higher in Colombia (94.7%), and Argentina (42.6%) compared to Brazil (10.6%) and Peru (0.0%). HPV-16 was the most detected. Other HPVs were found in LC. Higher rates of p16INK4a positivity were observed among HPV positive OPC/OCC cases compared to LC cases.

CONCLUSIONS

Our results support a role for HPV-16 in a subset of HNSCC, corroborate the heterogeneity observed in samples from different countries, and contribute additional etiological and biomarkers information in tumors of significant impact worldwide.

The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group

The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.

Concurrent Detection of Circulating Tumor Cells and Circulating Tumor DNA in Triple-negative Breast Cancer

Objective: Circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) provide tumor information in breast cancer. Our objective was to characterize CTCs, and contrasted them with ctDNA PIK3CA mutation in 24 triple-negative breast cancer (TNBC). Methods: CTCs genes were characterized by AdnaTest protocol and ctDNA by digital PCR. Results:  We found CTCs genes in 37.5% and ctDNA PIK3CA mutations in 29.16%. Three cases with CTCs genes had concurrent ctDNA PIK3CA mutations. MUC1 or GA733-2 were found in 4 cases, and 3 of them had concurrent ctDNA PIK3CA. CTCs ALDH1/TWIST1 were found in 2 cases, AKT2 in one and PI3Kα in another, and none had concurrent ctDNA PIK3CA mutations. There was no correlation between CTCs and ctDNA detection. All 3 cases with CTC & cDNA concurrent finding underwent death during follow-up. Conclusion: Infrequent concurrent detection of CTC and ctDNA presence suggests that both represent independent processes in TNBC patients, and could identify worst prognosis cases.

A biomarker study in Peruvian males with breast cancer

BACKGROUND

Breast cancer (BC) frequency in males is extremely low and tumor features vary from its female counterpart. Breast cancer clinical and pathological features differ by race in women. Tumor infiltrating lymphocyte (TIL) levels, mismatch repair (MMR) protein loss, androgen receptor (AR) expression, and PIK3CA gene mutations are predictive biomarkers of response to biological therapy in female BC. There is limited information about clinical and pathological features as well as predictive biomarkers in males of non-Caucasian races with BC.

AIM

To investigate clinicopathological features and biomarkers of BC tumors in males and their prognostic value in Peruvian population.

METHODS

This study looked at a single-institution series of 54 Peruvian males with invasive BC who were diagnosed from Jan 2004 to June 2018. Standard pathological features, TIL levels, MMR proteins, AR immunohistochemistry staining, and PIK3CA gene mutations were prospectively evaluated in cases with available paraffin material. Percentage of AR and estrogen receptor (ER) positive cells was additionally calculated by software after slide scanning. Statistical analyses included association tests, intraclass correlation test and Kaplan Meier overall survival curves.

RESULTS

The median age was 63 years and most cases were ER-positive (85.7%), HER2 negative (87.2%), Luminal-A phenotype (60%) and clinical stage II (41.5%) among our male breast tumors. Median TIL was 10% and higher levels tended to be associated with Luminal-B phenotype and higher grade. AR-positive was found in 85.3% and was correlated with ER (intraclass index of 0.835, P < 0.001). Loss of MMR proteins was found in 15.4% and PIK3CA mutation (H1047R) in 14.3% (belonged to the Luminal-A phenotype). Loss of MMR proteins was associated with AR-negative (P = 0.018) but not with ER (P = 0.43) or TIL (P = 0.84). Early stages (P < 0.001) and lower grade (P = 0.006) were associated with longer overall survival. ER status, phenotype, AR status, TIL level, MMR protein loss nor PIK3CA mutation was not associated with survival (P > 0.05).

CONCLUSION

Male BC is usually ER and AR positive, and Luminal-A. MMR loss and PIK3CA mutations are infrequent. Stage and grade predicted overall survival in our South American country population.

Roadmap Consensus on Carotid Artery Plaque Imaging and Impact on Therapy Strategies and Guidelines: An International, Multispecialty, Expert Review and Position Statement

Current guidelines for primary and secondary prevention of stroke in patients with carotid atherosclerosis are based on the quantification of the degree of stenosis and symptom status. Recent publications have demonstrated that plaque morphology and composition, independent of the degree of stenosis, are important in the risk stratification of carotid atherosclerotic disease. This finding raises the question as to whether current guidelines are adequate or if they should be updated with new evidence, including imaging for plaque phenotyping, risk stratification, and clinical decision-making in addition to the degree of stenosis. To further this discussion, this roadmap consensus article defines the limits of luminal imaging and highlights the current evidence supporting the role of plaque imaging. Furthermore, we identify gaps in current knowledge and suggest steps to generate high-quality evidence, to add relevant information to guidelines currently based on the quantification of stenosis.

Statistical analysis of thermal conductivity experimentally measured in water-based nanofluids

Nanofluids are suspensions of nanoparticles in a base heat-transfer liquid. They have been widely investigated to boost heat transfer since they were proposed in the 1990s. We present a statistical correlation analysis of experimentally measured thermal conductivity of water-based nanofluids available in the literature. The influences of particle concentration, particle size, temperature and surfactants are investigated. For specific particle materials (alumina, titania, copper oxide, copper, silica and silicon carbide), separate analyses are performed. The conductivity increases with the concentration in qualitative agreement with Maxwell’s theory of homogeneous media. The conductivity also increases with the temperature (in addition to the improvement due to the increased conductivity of water). Surprisingly, only silica nanofluids exhibit a statistically significant effect of the particle size, whereby smaller particles lead to faster heat transfer. Overall, the large scatter in the experimental data prevents a compelling, unambiguous assessment of these effects. Taken together, the results of our analysis suggest that more comprehensive experimental characterizations of nanofluids are necessary to estimate their practical potential.

Biological characteristics of a sub-population of cancer stem cells from two triple-negative breast tumour cell lines

Triple-negative breast tumours (TNBTs) make up 15-20% of all breast tumours. There is no treatment for them, and the role that cancer stem cells (CSCs) have in carcinogenesis is still unclear, so finding markers and therapeutic targets in CSC exosomes requires these cells to exist as a homogeneous cell population. The objective of this work was to determine differences in ultrastructural morphology, proliferative capacity, and mouse-xenotransplantation characteristics of the MDA-MB-231 and MDA-MB-436 TNBT cell lines with the CD44 high /CD24 low phenotype in order to study their exosomes. The results show that the CD44 high /CD24 low MBA-MB-231 cells had a population doubling time of 41.56 h, compared to 44.79 h in the MDA-MB-436 cell line. After magnetic immunoseparation, 18.75% and 14.56% of the stem cell population of the MDA-MB-231 and MDA-MB-436 cell lines, respectively, were of the CD44 high /CD24 low phenotype, which were expanded to reach purities of 80.4% and 87.6%. The same expanded lineage in both cell lines was shown to possess the pluripotency markers Nanog and Oct4. Under a scanning electron microscope, the CD44 high /CD24 low lineage of the MBA-MD-231 cell line formed groups of more interconnected cells than this lineage of the MBA-MD-436 line. A total of 16% of the mice inoculated with the CD44 high /CD24 low lineage of either cell line presented tumours of the breast, lung, and submandibular ganglia, in whose tissues variable numbers of inoculated cells were found 30 days post-inoculation. By magnetic immunoselection, it was possible to isolate in similar quantities and characterize, expand, and xenotransplant the CD44 high /CD24 low lineage of the MDA-MB-231 and MDA-MB-436 cell lines. The former cell line has greater proliferative capacity, the two lines differ under scanning electron microscopy in how they intercommunicate, and both cell lines induce new tumours in mice and persist at least 30 days post-inoculation in the transplanted animal so their exosomes would also be different.

Prevalence of H. pylori Infection in Relatives of Peruvian Patients with Gastric Cancer

Objective: The aim of this study was to determine the relationship between Helicobacter pylori (H. pylori) infection in relatives and patients with gastric cancer (GC).Methods: H. pylori infection was evaluated by the breath urease test in 171 relatives and by qPCR technique in gastric tissue of 61 patients (n=45 for GC and n=16 for non-GC). Results: There were included 137 relatives of GC patients and 34 of non-GC. The median age of the relatives of patients with a gastric tissue sample was 39 years (10-86). Infection was found in 60.2% (n=103) relatives. There were no higher H. pylori infection rates in relatives of patients with gastric cancer (62% vs 62.9%, p=0.33), H. pylori infection (60% vs 60%, p=0.96), or metaplasia (58.8% vs 61.8%, p=0.71). Conclusion: The prevalence of infection in relatives of GC patients is high in our population but not associated with H. pylori presence in the paired case.

COVID-19 in cancer patients: a systematic review

OBJECTIVE

Development of severe disease and death from COVID-19 is more frequent in patients with comorbidities. Some studies report an increased frequency of severe COVID-19 in cancer patients. This review aims to describe the risk of infection and developing severe COVID-19 in cancer patients.

MATERIALS AND METHODS

A systematic review was carried out through an exhaustive search of literature in PubMed and Scopus until May 2020. A secondary search was performed to include more studies.

RESULTS

The initial search identified 2,192 records, which included 17 publications with at least 10 infected cancer patients. Also, 5 articles were added from the additional search of the references cited by those 17 publications. Ten publications were from Chinese authors. Data analysis showed that COVID-19 infection is more frequent in cancer patients, and frequent therapeutic visits to the healthcare facility may be the cause. The presence of neoplasia predisposed patients to develop severe disease. Advanced age, associated comorbidities, advanced malignancy, and the presence of serum inflammatory markers increased the risk of developing severe disease. Initial studies indicate that the use of systemic treatment may also be a predisposing factor.

CONCLUSIONS

The risk of becoming infected by COVID-19 and developing severe disease is higher in the oncological population.

Acute coronary syndromes in nonagenarians: do we have reliable risk scores?

Introduction

GRACE score is strongly validated to determine the probability of death in acute coronary syndrome (ACS), nevertheless its usefulness in nonagenarians, a population with frequently associated comorbidities, is less stablished. BARTHEL and CHARLSON scores might be useful tools to predict outcomes in this population.

Objective

The aim of this study was to evaluate the potential applicability of GRACE score and two comorbidity scores (CHARLSON and BARTHEL) to estimate prognosis in nonagenarians with ACS.

Material and methods

We retrospectively included all consecutive patients equal to or older than 90 years old admitted with non-ST (NSTEMI) or ST segment elevation myocardial infarction (STEMI) in four tertiary care centers between 2005 and 2018. Patients with type 2 myocardial infarction were excluded. We collected patients' baseline characteristics and procedural data. In-hospital and at 1-year follow-up all-cause and cardiovascular mortality were assessed. Risk score accuracy was evaluated by area under the curve ROC (AUC).

Results

A total of 444 patients (mean age 92.6±2.4 years, 60% females) were analyzed.

Approximately half of them (n=241, 54%) with STEMI and the remainder (n=203, 46%) with NSTEMI. Global GRACE-AUC for in-hospital and 1-year all-cause mortality were moderate (0.64; 95% CI: 0.59–0.69 and 0.62; 95% CI: 0.57–0.67, respectively). Only in the NSTEMI group, the GRACE-AUC was better to predict in-hospital mortality, 0.70 (95% CI: 0.63–0.77). Neither CHARLSON nor BARTHEL showed better predictive results than GRACE score (AUC ≤0.60).

Conclusion

GRACE score has moderate accuracy to estimate mortality in nonagenarian patients with ACS. BARTHEL and CHARLSON scores do not improve the predictive value of GRACE score. An individualized approach is required to make therapeutic decisions in this special population.

Figure 1. ROC-GRACE curves

Funding Acknowledgement

Type of funding source: None

Detection of Helicobacter pylori in gastric cancer tissue through histopathology, immunohistochemistry and real-time reverse transcription-PCR

Aim: Helicobacter pylori is usually detected based on hematoxylin-eosin (H-E) features, but, immunohistochemistry (IHC) and real-time PCR (RT-PCR) are more precise in chronic-gastritis. We evaluated the relevance of these tests in Peruvian gastric cancer samples. Materials & methods: We performed and evaluated H-E, IHC staining and RT-PCR in 288 gastric tumors. Slides were independently evaluated by three pathologists. Results: H. pylori was detected in 167/287 through H-E, 140/288 through IHC and 175/288 through RT-PCR, and positive-status were associated (p < 0.001). H. pylori detection by H-E had a good concordance with IHC (kappa index = 0.632) but poor with RT-PCR (kappa index = 0.317). Higher median gene-copies were found in high H. pylori density through H-E or IHC (p < 0.001). Conclusion: H-E evaluation is accurate in gastric cancer, and IHC and RT-PCR can complement its results.

Neurovascular Complications in COVID-19 Infection: Case Series

We present a series of 10 hospitalized patients with confirmed coronavirus 2019 infections who developed severe neurovascular complications and discuss the possible reasons for these findings and their relationship to the novel Severe Acute Respiratory Syndrome coronavirus 2 infection.

MRS as an Aid to Diagnose Malignant Transformation in Low-Grade Gliomas with Increasing Contrast Enhancement

BACKGROUND AND PURPOSE

Increased contrast enhancement has been used as a marker of malignant transformation in low-grade gliomas. This marker has been found to have limited accuracy because many low-grade gliomas with increased contrast enhancement remain grade II. We aimed to investigate whether MR spectroscopy can contribute to the diagnosis of malignant transformation in low-grade gliomas with increased contrast enhancement.

MATERIALS AND METHODS

Patients with low-grade gliomas who had contemporaneous MR spectroscopy and histopathology for tumor regions with increased contrast enhancement between 2004 and 2015 were retrospectively reviewed. Clinical data collected were sex and age, Karnofsky Performance Scale, histologic subtypes, isocitrate dehydrogenase 1 mutation status, disease duration, adjuvant therapy, and post-radiation therapy duration. Imaging data collected were contrast-enhancement size, whole-tumor size, MR spectroscopy metabolite ratios, and tumor grades of regions with increased contrast enhancement. Diagnostic values of these factors on malignant transformation of low-grade gliomas were statistically analyzed.

RESULTS

A total of 86 patients with 96 MR spectroscopy studies were included. Tumor grades associated with increased contrast enhancement were grade II (n = 42), grade III (n = 27), and grade IV (n = 27). On multivariate analysis, the NAA/Cho ratio was the only significant factor (P < .001; OR, 7.1; 95% CI, 3.2-16.1) diagnostic of malignant transformation. With 0.222 as the cutoff value, the sensitivity, specificity, and accuracy of NAA/Cho for diagnosing malignant transformation were 94.4%, 83.3%, and 89.6%, respectively.

CONCLUSIONS

MR spectroscopy complements conventional MR imaging in the diagnosis of malignant transformation in a subgroup of low-grade gliomas with increased contrast enhancement.

Molecular epidemiology of methicillin-resistant Staphylococcus aureus from different population groups in Argentina

OBJECTIVES

In Latin America, methicillin-resistantStaphylococcus aureus (MRSA) is a leading cause of nosocomial infections. Limited studies have addressed the molecular epidemiology of MRSA clones in Argentina, characterised by continuous human migratory movements. The aim of this study was to describe the MRSA epidemiology, including distinct patient populations from different regions of the country.

METHODS

MRSA strains were collected in epidemiological studies conducted from 2009 to 2015 in three cities (Formosa, Córdoba and Tucumán) and involving four population groups: community adult patients; hospitalised adults; hospitalised children; and healthy children (nasal colonisation). Antimicrobial susceptibility testing, SCCmec and Panton-Valentine leukocidin (PVL) typing, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were performed.

RESULTS

A total of 120 MRSA isolates were recovered with an important population diversity in the groups studied; in community adult patients, MRSA isolates corresponded to ST5, ST267 and ST1619; from hospitalised adults they were ST97, ST5, ST72, ST125, ST200, ST647, ST747, ST935 and ST2941; from hospitalised children they were ST5, ST30, ST34, ST1163 and ST1619; and from colonised children they were ST5, ST125, ST34, ST100, ST1619, ST207 and ST1163. Results of SCCmec typing showed SCCmec I, SCCmec IIIA, SCCmec IV and SCCmec ND associated or not with PVL genes.

CONCLUSIONS

MRSA genetic lineages have differing distribution in the three regions. The most prevalent was ST5 in colonisation, community and invasive settings. Here we describe ST34-SCCmec IV clone for the first time in the hospitalised paediatric population. These findings contribute to the understanding of epidemiological changes in recent years.

Hemorrhagic Posterior Reversible Encephalopathy Syndrome as a Manifestation of COVID-19 Infection

We describe 2 hospitalized patients with confirmed coronavirus 19 (COVID-19) infection in whom brain imaging showed hemorrhagic posterior reversible encephalopathy syndrome, and we discuss the possible reasons for these findings and their relationship to the infection.

Pitfalls in assessing stromal tumor infiltrating lymphocytes (sTILs) in breast cancer

Stromal tumor-infiltrating lymphocytes (sTILs) are important prognostic and predictive biomarkers in triple-negative (TNBC) and HER2-positive breast cancer. Incorporating sTILs into clinical practice necessitates reproducible assessment. Previously developed standardized scoring guidelines have been widely embraced by the clinical and research communities. We evaluated sources of variability in sTIL assessment by pathologists in three previous sTIL ring studies. We identify common challenges and evaluate impact of discrepancies on outcome estimates in early TNBC using a newly-developed prognostic tool. Discordant sTIL assessment is driven by heterogeneity in lymphocyte distribution. Additional factors include: technical slide-related issues; scoring outside the tumor boundary; tumors with minimal assessable stroma; including lymphocytes associated with other structures; and including other inflammatory cells. Small variations in sTIL assessment modestly alter risk estimation in early TNBC but have the potential to affect treatment selection if cutpoints are employed. Scoring and averaging multiple areas, as well as use of reference images, improve consistency of sTIL evaluation. Moreover, to assist in avoiding the pitfalls identified in this analysis, we developed an educational resource available at www.tilsinbreastcancer.org/pitfalls.

Scientific Collaboration across Time and Space: Bibliometric Analysis of the American Journal of Neuroradiology, 1980-2018

BACKGROUND AND PURPOSE

Scientific collaboration is traditionally acknowledged through coauthorship. Studies on this topic are few in the neuroimaging literature. This study is a bibliometric analysis of the American Journal of Neuroradiology (AJNR) between 1980 and 2018, with the primary aim of evaluating changes in article collaboration.

MATERIALS AND METHODS

Full bibliographic records from 1980 to 2018 were retrieved. Yearly metrics calculated included the number of articles published, the average number of authors, and the average number of affiliations per article. The levels of evidence of 160 random articles were determined. Geographic characteristics of author affiliations were analyzed. Changes across time were evaluated using linear regression, while Spearman rank-order correlation was used to determine relationships between level of evidence and time, number of authors, and number of affiliations.

RESULTS

There was a steady linear growth in the number of articles (R ² = 0.70, P < 1e-10) from 1980 to 2018. There were clear linear increases in the average number of authors (R ² = 0.91, P < 1e-15) and affiliations (R ² = 0.90, P < 1e-15) per article. There was a significant correlation between level of evidence and time period (Spearman ρ = -0.42, P < 1e-7), indicating that articles trended toward better methodologic quality or strength of results over time. A significant correlation existed between the level of evidence and the number of authors (Spearman ρ = -0.39, P < 1e-6). There were linear increases in the average number of different geographic locales of authors per article by country/region (R ² = 0.80, P < 1e-13), state/province (R ² = 0.88, P < 1e-15), and locality/city/town (R ² = 0.86, P < 1e-15).

CONCLUSIONS

From 1980 to 2018, as the quantity of articles published in the AJNR increased, their level of evidence improved, while an increasing number of authors with different affiliations and from different geographic locales collaborated on these articles.

Prevalence of Helicobacter pylori Infection, Its Virulent Genotypes, and Epstein-Barr Virus in Peruvian Patients With Chronic Gastritis and Gastric Cancer

PURPOSE

Helicobacter pylori (HP) and Epstein Barr virus (EBV) infections induce chronic gastritis (CG) and are accepted carcinogenics of gastric cancer (GC). Our objective for this study was to determine the prevalence of these agents and clinicopathological features of GC and CG associated with the infection.

PATIENTS AND METHODS

A single-center cohort of 375 Peruvian patients with GC and 165 control subjects with CG were analyzed. Evaluation of HP and EBV genes was performed through quantitative polymerase chain reaction.

RESULTS

Prevalence of HP was 62.9% in the whole population and 60.8% in the GC subset. The cagA gene was detected in 79.9%; vacAs1 and vacAm1 alleles in 41.6% and 60.7%, respectively; and concurrent expression of vacAs1 and vacAm1 in 30.4% of infected patients in the whole series. The prevalence of EBV was 14.1% in the whole population and was higher in GC (P < .001). Coinfection of HP and EBV was found in 7.8% and was also higher in GC in univariate (P < .001) and multivariate (P = .011) analyses. Infection rates of HP and EBV were not associated with a geographic location in the whole series. Few clinicopathological features have been associated with infectious status.

CONCLUSION

Prevalence of HP infection and virulent strains are high in the Peruvian population. Infection by EBV was more frequent in patients with GC.

New approach for the removal of mature biofilms formed by wild strains of Listeria monocytogenes isolated from food contact surfaces in an Iberian pig processing plant

One of the main objectives of the food industry is to guarantee food safety by providing innocuous food products. Therefore, this sector must consider all the possible biotic or abiotic contamination routes from the entry of raw materials to the release of the final product. Currently, one important problem in this regard is the presence of biofilms on food contact surfaces which can transmit pathogens such as L. monocytogenes. In industrial conditions biofilms are found in a mature state, so it is essential that when carrying out removal effectiveness studies in vitro the tests are realized with models that produce these structures in a similarly mature state. The main objective of this study was to evaluate the effectiveness of an alternative treatment (i.e. enzymatic detergent that include natural antimicrobial agents) and a conventional treatment (i.e. chlorinated alkaline) for the elimination of mature L. monocytogenes biofilms. The results showed a cell detachment from the formed mature biofilms with an effectivity of between 74.75%-97.73% and 53.94%-94.02% for the enzymatic treatment and the chlorinated alkaline detergent, respectively. On a qualitative level, it was observed that the dispersion in the structure was much higher for the enzymatic treatment than for the chlorinated alkaline, which continued to show obvious structure integrity. All this leads to the conclusion that treatments with an enzymatic detergent have a significantly greater impact on the removal of mature L. monocytogenes biofilms, although a further disinfection process would be needed, enhancing even more the treatment effectivity. This may imply that the industrial approach to addressing this problem should be modified to include new perspectives that are more effective than traditional ones.

Abstract P1-10-22: Predictive biomarkers of survival after neoadjuvant chemotherapy for breast cancer

Introduction: The use of neoadjuvant chemotherapy (NAC) has become the standard of care in non-metastatic breast cancer patients meaning an improvement of tumor regression rates with a high impact on survival especially in patients who achieve pathological complete response (pCR). Predictive biomarkers of survival acquire more relevance in the setting of patients who don’t achieve complete response allowing us to design strategies based on the response evaluation. This study aimed to evaluate the predictive value of the NAC response represented by residual cancer burden (RCB) and tumor-infiltrating lymphocytes in residual disease (RD TILs). Methods: We analyze non-metastatic breast cancer patients diagnosed at Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima-Peru who received NAC and were under surgery from 2016 to 2019, we performed a prospective evaluation of RCB and the level of stromal RD TILS by hematoxylin and eosin (H&E), CD-3 and CD-8 by immunohistochemistry in a subgroup of patients, we choose the median of percentage as a cut-off. Epidemiologic and clinic-pathological data were collected from clinical files. Survival analysis was calculated by using Kaplan-Meier method. Results: During the study period, we analyzed 271 NAC cases, median of age of diagnosis was 51 years, most common molecular subtype was Luminal B (56.5%) followed by Triple Negative (24.4%), 124 (45.8%) patients were at clinical stage IIIB followed by 54 (19.9%) IIB. 226 (83.4%) patients didn’t achieve pCR, most of them achieved RCB class III (40.6%) followed by RCB class II (37.6%). Among these we evaluated RD TILs in 42 patients. 54.8% of patients had RD TILs level greater than 30%, 53.3% had CD-3 level greater than 60% and 51.2% a level of CD-8 greater than 40%. Median PFS was 42 months (range 15.6 - 68) and estimated 3-years OS was 95.5%. We found significative difference between the RCB class and PFS (p=0.001) and OS (p=0.035), no differences between the level of stromal RD TILs, CD-3 or CD-8 with PFS or OS was found. Conclusion: Results from this cohort provide evidence for the benefit of NAC, in this setting RCB had a significative predictive value for breast cancer recurrence and survival, however, the level of RD TILs, CD-3 and CD-8 didn’t show differences on survival maybe by the number of cases. This work was supported by CONCYTEC (contract No. 198-2015-CONCYTEC) Keywords: Breast cancer, Neoadjuvant, Residual cancer burden, TILs, progression-free survival.

Citation Format: Marco Galvez-Nino, Katia Roque, Luis Angel Bernabe, Miluska Castillo, Joselyn Sanchez, Maria Landa Baella, Gabriela Calderon, Miguel De la Cruz, Jorge Dunstan, Julio Abugatas, Jose Cotrina, Carlos Castaneda, Henry Gomez. Predictive biomarkers of survival after neoadjuvant chemotherapy for breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-10-22.

Latin American Study of Hereditary Breast and Ovarian Cancer LACAM: A Genomic Epidemiology Approach

Purpose: Hereditary Breast and Ovarian Cancer (HBOC) syndrome is responsible for ~5-10% of all diagnosed breast and ovarian cancers. Breast cancer is the most common malignancy and the leading cause of cancer-related mortality among women in Latin America (LA). The main objective of this study was to develop a comprehensive understanding of the genomic epidemiology of HBOC throughout the establishment of The Latin American consortium for HBOC-LACAM, consisting of specialists from 5 countries in LA and the description of the genomic results from the first phase of the study. Methods: We have recruited 403 individuals that fulfilled the criteria for HBOC from 11 health institutions of Argentina, Colombia, Guatemala, Mexico and Peru. A pilot cohort of 222 individuals was analyzed by NGS gene panels. One hundred forty-three genes were selected on the basis of their putative role in susceptibility to different hereditary cancers. Libraries were sequenced in MiSeq (Illumina, Inc.) and PGM (Ion Torrent-Thermo Fisher Scientific) platforms. Results: The overall prevalence of pathogenic variants was 17% (38/222); the distribution spanned 14 genes and varied by country. The highest relative prevalence of pathogenic variants was found in patients from Argentina (25%, 14/57), followed by Mexico (18%, 12/68), Guatemala (16%, 3/19), and Colombia (13%, 10/78). Pathogenic variants were found in BRCA1 (20%) and BRCA2 (29%) genes. Pathogenic variants were found in other 12 genes, including high and moderate risk genes such as MSH2, MSH6, MUTYH, and PALB2. Additional pathogenic variants were found in HBOC unrelated genes such as DCLRE1C, WRN, PDE11A, and PDGFB. Conclusion: In this first phase of the project, we recruited 403 individuals and evaluated the germline genetic alterations in an initial cohort of 222 patients among 4 countries. Our data show for the first time in LA the distribution of pathogenic variants in a broad set of cancer susceptibility genes in HBOC. Even though we used extended gene panels, there was still a high proportion of patients without any detectable pathogenic variant, which emphasizes the larger, unexplored genetic nature of the disease in these populations.

Level of tumor-infiltrating lymphocytes and density of infiltrating immune cells in different malignancies

Aim: To correlate levels of tumor-infiltrating lymphocytes (TIL) evaluated using the International Immuno-Oncology Biomarker Working Group methodology, and both density of tumor-infiltrating immune cell and clinicopathological features in different malignancies. Methods: 209 pathological samples from gastric cancer, cervical cancer (CC), non-small-lung cancer, cutaneous melanoma (CM) and glioblastoma were tested for TIL in hematoxylin eosin, and density of CD3+, CD4+, CD8+, CD20+, CD68+ and CD163+ cells by digital analysis. Results: TIL levels were higher in invasive margin compartments (IMC). TIL in IMC, intratumoral and stromal compartments predicted survival. CC and gastric cancer had higher TIL in intratumoral; CC and CM had higher TIL in stromal compartment and IMC. CM had the highest density of lymphocyte and macrophage populations. CD20 density was associated with survival in the whole series. Conclusion: Standardized evaluation of TIL levels may provide valuable prognostic information in a spectrum of different malignancies.

Liquid Chromatographic Method for Quantitation of Patulin at 10 ng/mL in Apple-Based Products Intended for Infants: Interlaboratory Study

An interlaboratory trial for the determination of patulin in apple juice and fruit puree was conducted, involving 17 participants representing a cross section of industry, official food control, and research facilities. Mean recoveries reported ranged from 74 (10 ng/g) to 62% (25 ng/g) for apple juice and from 72 (25 ng/g) to 74% (10 ng/g) for fruit puree. Based on results for spiked samples (blind pairs at 2 levels), as well as naturally contaminated samples (blind pairs at 3 levels), the relative standard deviation for repeatability (RSDr) in juice ranged from 8.0 to 14.3% and in puree from 3.5 to 9.3%. The relative standard deviation for reproducibility (RSDR) in juice ranged from 19.8 to 39.5% and in puree from 12.5 to 35.2%, reflecting HORRAT values from 0.6 to 1.0 for juice and 0.4 to 0.9 for puree. The method showed acceptable within-laboratory and between-laboratory precision for each matrix, as required by current European legislation.

Helicobacter Pylori Detected in Tap Water of Peruvian Patients with Gastric Cancer

OBJECTIVE

To evaluate the correlation between the presence of H. pylori in paired samples of tap water and gastric cancer (GC) lesion in Lima city (Peru).

MATERIAL AND METHODS

Gastric tissue and tap-water samples were prospectively collected from 82 Gastric Cancer who lived in Lima. HspA and ureA genes were evaluated by qPCR in the samples.  Results: The median age of patients with GC was 63 years, 52.4% were men and stage-II in 36.6%. A home-living time> 10 years was reported in 84.1% of patients. Boiling water treatment was indicated in 85.4% of cases. H. pylori was detected in 69.5% of gastric tissues and in 12.2% of analyzed tap-water. There was no differences in gastric infection rates among those with or without water contamination (70% vs. 69.4%, p=0.971). Conclusion & Impact: H. pylori was found in tap-water samples, however, detection rates were lower than in gastric cancer samples. Other sources of infection transmission should be investigated.

Molecular Allergen Profiling of Dual Mite Sensitization in Severe Allergic Rhinitis

BACKGROUND

Mites are the most prevalent source of indoor allergens. The present study used a component-resolved diagnosis (CRD) approach to investigate the mite-specific IgE sensitization profile for Dermatophagoides pteronyssinus and Blomia tropicalis. We also assessed the performance of a commercially available CRD approach in patients with severe allergic rhinitis.

METHODS

We selected 63 consecutive patients with dual sensitization to D pteronyssinus and B tropicalis and persistent severe rhinitis according to the ARIA guidelines. We performed skin prick tests with standardized extracts and determined specific serum IgE to both mites, along with serum specific IgE to Der p 1, Der p 2, Der p 23, Der p 10, and Blo t 5.

RESULTS

Fifty-eight and 59 patients had positive sIgE to the whole extracts of D pteronyssinus and B tropicalis, respectively. While 91.67% of patients were sensitized to specific IgE to Der p 1, Der p 2, and/or Der p 23, specific IgE to Blo t 5 (≥0.3 ISU-E) was not detected in most of the serum samples (55%).

CONCLUSIONS

Although the combination panel of the commercially available major allergens Der p 1, Der p 2, and Der p 23 identified more than 90% of the D pteronyssinus-allergic patients, Blo t 5 performed somewhat poorly in those sensitized to B tropicalis. Improvements in CRD and further research concerning the prevalence and clinical relevance of serodominant allergens are needed to achieve a genuine molecular diagnosis, as well as patient-centered mite allergy-specific immunotherapy.

Relationship between tumor-associated immune infiltrate and p16 staining over clinicopathological features in acral lentiginous melanoma

PURPOSE

This study aims to evaluate the association between composition of tumor-infiltrating lymphocytes (TIL) and expression of p16 in acral lentiginous melanoma (ALM), and their impact on prognosis.

MATERIALS AND METHODS

A cohort of 148 surgical pathology specimens of ALM was studied. TIL were evaluated by immunohistochemical detection of CD3 and CD8, along with CD20, CD4, CD68, and CD163 in a subset of 43 cases. p16 protein expression was also investigated in all the cases.

RESULTS

The median age was 66 years, median Breslow thickness was 6.0 mm, grade III TIL was found in 28.4% and lymph nodes were involved in 54.2%. Breslow thickness (p < 0.001), stage I-II (p < 0.001), negative lymph nodes (p < 0.001) and < 10% p16 (p = 0.01) were associated with longer survival. Grade III of TIL was associated with thinner Breslow thickness (p = 0.008) and lower mitosis (p = 0.047). A higher density of CD3 TIL was associated with male gender (p = 0.008), thinner Breslow thickness (p = 0.047), negative lymph node (p = 0.031), early stage (p = 0.046), and p16 nuclear expression of > 10% (p = 0.045). Higher CD8 TIL was associated with > p16 (p = 0.03). Survival analysis found that longer survival had a trend to be associated with high TIL (p = 0.090). Levels of CD3+ and CD8+ cells were correlated with those of CD4+, CD20+, CD68+ and CD163+ immune cells.

CONCLUSIONS

Higher levels of TIL tend to be associated with better overall survival in ALM. Loss of expression of p16 is associated with lower levels of CD3+ and CD8+ TIL, indicating a probable relationship between p16 and TIL immune response in ALM .

Abstract 4564: Tumor infiltrating lymphocytes are associated with p16 protein expression in acral lentiginous melanoma

Background: The loss of function of gene p16(INK4a)/CDKN2 is associated with the development of several neoplasm and tumor progression, likewise, the level of tumor infiltrating lymphocytes is a predictive and prognostic biomarker of survival. This study aims to evaluate the association between composition of tumor infiltrating lymphocytes (TILs) and expression of p16 in acral lentiginous melanoma (ALM), and their impact on prognosis.

Materials and methods: A cohort of 148 surgical pathology specimens of ALM was studied. TILs were evaluated by immunohistochemical detection of CD3 and CD8, along with CD20, CD4, CD68, and CD163 in a subset of 43 cases, likewise, we classify the level of TILs in grades by combining density and distribution. p16 protein expression by immunohistochemistry was also investigated in all cases.

Results: The median age was 66 years, median Breslow thickness was 6.0 mm, Grade III of TILs was found in 28.4% and lymph nodes were involved in 44.6%. Breslow thickness (p&lt;0.001), stage I-II (p&lt;0.001), negative lymph nodes (p&lt;0.001) and &lt;10% p16 (p&lt;0.001) were associated with longer survival. Grade III of TILs was associated with thinner Breslow thickness (p=0.008) and lower mitosis (p=0.047). A higher density of CD3 TILs was associated with male gender (p=0.008), thinner Breslow thickness (p=0.047), negative lymph node (p=0.031), early stage (p=0.046), and p16 nuclear expression of &gt;10% (p=0.045). Higher CD8 TIL was associated with &gt;p16 (p=0.03). Survival analysis found that longer survival doesn’t associated with high grade of TILs (p=0.094). Levels of CD3+ and CD8+ cells were correlated with those of CD4+, CD20+, CD68+ and CD163+ immune cells.

Conclusions: Loss of expression of p16 is associated with lower levels of CD3+ and CD8+ TIL, indicating a probable relationship between p16 and TILs immune response in ALM.

Citation Format: Marco A. Galvez Nino, Miluska Castillo, Luis A. Bernabe, sandro Casavilca, Valeria Villegas, Joselyn Sanchez, Jorge Dunstan, Julio Abugatas, Carlos Castaneda, Henry Gomez. Tumor infiltrating lymphocytes are associated with p16 protein expression in acral lentiginous melanoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 4564.

Neuroimaging Findings in Moebius Sequence

BACKGROUND AND PURPOSE

Moebius sequence comprises a spectrum of brain congenital malformations predominantly affecting the function of multiple cranial nerves. Reported neuroimaging findings are heterogeneous and based on case reports or small case series. Our goal was to describe the neuroimaging findings of Moebius sequence in a large population of patients scanned with MR imaging.

MATERIALS AND METHODS

An observational cross-sectional study was performed to assess brain MR imaging findings in 38 patients with Moebius syndrome studied between 2013 and 2016.

RESULTS

Retrospective analysis of MR imaging studies showed flattening of the floor of the fourth ventricle floor secondary to a bilateral absent facial colliculus in 38 patients (100%) and unilateral absence in 1. A hypoplastic pons was found in 23 patients (60.5%). Mesencephalic malformations consisted of tectal beaking in 15 patients (39.5%) and increased anteroposterior midbrain diameter with a shallow interpeduncular cistern in 12 (31.6%). Infratentorial arachnoid cysts were found in 5 patients (13.2%), and cerebellar vermis hypoplasia, in 2 (5.3%). Supratentorial findings included the following: thalamic fusion (26.3%), periventricular nodular heterotopias (26.3%), ventriculomegaly (26.3%), callosal abnormalities (23.7%), and hippocampal malrotations (23.7%).

CONCLUSIONS

Findings seen in this large patient cohort agreed with previously published reports. Flattening of the fourth ventricle floor secondary to a bilaterally absent facial colliculus was the most frequent MR imaging finding. The presence of other brain stem and cerebellar malformations as well as supratentorial abnormalities may help explain clinical symptoms and achieve a correct diagnosis.

Abstract P2-14-12: Impact of the time interval between neoadjuvant chemotherapy and surgery in Latin-Americans breast cancer patients

Background: Few studies have evaluated the impact of the time interval between neoadjuvant chemotherapy (NAC) and surgery in breast cancer. In Latin America, where the vast majority of hospitals are oversaturated, it is important to define which patients to give priority and to be clear about ideal time or maximum to schedule surgery after NAC without altering the prognosis. The objective of this work is to establish the ideal time interval for post-neoadjuvant surgery and evaluate the impact on patient survival.

Methods: We reviewed the clinical histories of breast cancer with clinical stage II and III who received NAC between 2005 and 2014. Patients were divided into 3 groups according to the time interval to surgery: &lt;4, 4-8 and &gt;8 weeks. Overall survival (OS) and recurrence-free survival (RFS) were estimated using the Kaplan-Meier method, and comparisons of survival curves using the logrank or Breslow test, both globally and by molecular subtypes. The optimal time to surgery has been determined by the Cox model.

Results: During the study period, 583 patients who had post NA surgery before six months were registered. The median age was 49 years (range: 24-85), 82% had clinical stage III, 53% histological grade III, 32.7% were luminal A, 15.6% luminal B, 24.4% Her2 and 27.3% TN. According to the time interval to surgery, 67 (11.5%) patients had surgery before 4 weeks, 204 (35.0%) between 4 to 8 weeks, and 312 (53.5%) after 8 weeks. The groups do not present differences in relation to the clinical characteristics (p&gt; 0.05). The median follow-up time was 4.8 years. The 5-year OS rate according to the time interval was 57.9, 61.5, and 62.7% (p = 0.581) and the RFS rate was 40.6, 52.3, and 51.1% (p = 0.411). No differences were found in the survival curves by molecular subtypes , except for luminal b like . In the multivariate analysis, the effect of the time interval to surgery was not significant in OS and RFS; however, the HR curve suggests that the appropriate cut-off point for surgical time would be 8 weeks.

Table 1:Time Interval :OS - RFS  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPWeeks for NAC to Surgery      &lt;4 weeks3.240.6 6.157.9 4-8 weeks6.352.3 9.161.5 &gt;8 weeks5.151.10.416.762.70.581       Weeks for NAC to Surgery      &lt;8 weeks549.5 9.160.7 &gt;8 weeks5.151.10.5856.762.70.414

Table 2 :Time Interval - Molecular Subtype  RFS  OS  MEDIAN5 - yearsPMEDIAN5 - yearsPLUMINAL A LIKE      &lt; 8 weeks----74.1 ----84 &gt;8 weeks7.163.80.719.973.90.236       *LUMINAL B LIKE      &lt; 8 weeks2.336.8 5.460.5 &gt;8 weeks5.857.60.46----820.08       HER2      &lt;8 weeks2.228.7 3.938.4 &gt;8weeks3.645.90.57.26.261.30.616       TRIPLE NEGATIVE      &lt;8 weeks3.144.2 3.448.4 &gt;8 weeks2.041.80.9143.743.90.516* ER + PR &gt;20% KI67&gt;14% , HER2 NEGATIVE

Conclusion: The time interval between the end of neoadjuvant period and surgery has no impact on recurrence-free survival or on overall survival, despite this we suggest that the period of time between neoadjuvant and surgery not be greater than 8 weeks. More studies will be required to determine the ideal time interval and which cases should be prioritized according to the characteristics of our patients.

Citation Format: Rebaza LP, Galarreta JA, Castañeda C, Cotrina JM, Vilchez S, de la Cruz M, Ponce J, Aguilar A, Flores C, Castillo M, Galvez M, Vigil C. Impact of the time interval between neoadjuvant chemotherapy and surgery in Latin-Americans breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-14-12.