Comparative efficacy of vericiguat to sacubitril/valsartan for patients with heart failure reduced ejection fraction: Systematic review and network meta-analysis

BACKGROUND

Despite the established efficacy of vericiguat compared to placebo, uncertainties remain regarding its comparative efficacy to sacubitril/valsartan for patients with heart failure reduced ejection fraction (HFrEF). This study aimed to assess the relative efficacy of vericiguat and sacubitril/valsartan through a systematic review, network meta-analysis, and non-inferiority tests.

METHODS

A systematic review was conducted to identify the randomized phase 3 clinical trials involving vericiguat and sacubitril/valsartan. The hazard ratios (HRs) with 95% confidence intervals (CI) for cardiovascular death (CVD) and hospitalization due to HF (hHF) were extracted from these trials and synthesized via network meta-analysis. Non-inferiority testing of vericiguat was performed using a fixed-margin method with a predefined non-inferiority margin (1.24). Sensitivity analyses explored the impact of the time from hHF to screening.

RESULTS

Among the 1366 studies, two trials (VICTORIA and PARADIGM-HF) met the inclusion criteria. Network meta-analysis demonstrated that the HR for CVD or hHF with vericiguat did not significantly differ from that for sacubitril/valsartan (HR: 0.88, 95% CI:0.62-1.23). The upper limit of the 95% CI was less than the predefined margin of 1.24, confirming vericiguat's non-inferiority to sacubitril/valsartan. Sensitivity analyses affirmed the robustness of the base-case results.

CONCLUSION

Vericiguat exhibited a comparable risk of CVD or hHF when contrasted with sacubitril/valsartan. Importantly, in patients with HFrEF, vericiguat's efficacy was not statistically inferior to that of sacubitril/valsartan. These findings reinforce the potential of vericiguat as a viable treatment option for this patient population.

Short-Term Impact of Low-Intensity Exercise with Blood Flow Restriction on Mild Knee Osteoarthritis in Older Adults: A Pilot Study

This pilot study aimed to investigate the immediate impact of low-intensity exercises with blood flow restriction (BFR) on older adults with knee osteoarthritis (KOA). Fifteen patients with KOA who were over 50 years old, participated and underwent low-intensity resistance knee exercises at 30% of their one-repetition maximum with BFR three times/week for two weeks. Pre- and post-exercise assessments included pain levels, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, isokinetic knee strength, lower extremity muscle volume (via leg circumference and muscle thickness), functional performance tests (timed up-and-go [TUG] and sit-to-stand [STS]), skeletal muscle index (SMI) using bioelectrical impedance analysis, and handgrip strength (HGS). Post-exercise, there was a significant reduction in pain. WOMAC scores showed significant improvements across all three domains: pain, stiffness, and physical function. In the TUG and STS tests, completion times were significantly reduced. Thigh and calf circumferences, as well as thigh muscle thickness significantly increased after exercise. Post-exercise SMI and HGS also significantly increased. However, isokinetic knee strength did not show significant changes. In conclusion, low-intensity BFR exercises provide immediate benefits in symptoms and physical performance for patients with KOA, potentially inducing local and systemic muscle mass increase, even after a short-term intervention.

Random intercept hierarchical linear model for multi-regional clinical trials

In multi-regional clinical trials, hierarchical linear models have been actively studied because they can reflect that patients in the same region share common intrinsic and extrinsic factors. In this paper, we investigate the statistical properties of the hierarchical linear model including a random effect in the intercept. The big advantage of the random intercept hierarchical linear model is that it can control the type I error rates of testing the overall treatment effect when there are no or clinically negligible regional differences in the treatment effect. Moreover, we compare the pros and cons with the hierarchical linear model in which the random effect is included in the slope. For the two hierarchical linear models, the model selection criteria are determined according to the magnitude of the difference in treatment effect across the regions, and we provide the criteria through simulation studies.

[The implementation and management of disease risk reduction claims in the European Union and the United States]

The improvement of food labeling can improve consumers' health awareness, reduce the burden of chronic diseases on the health and economy, and promote the development of the healthy food industry. Disease Risk Reduction Claim has been developed in European Union and the U.S. for over 20 years, with mature management methods and experience, but it is still lacking in China. Learning and drawing on the international management experience of food disease risk reduction claims can assist China to establish food disease risk reduction claims and improve the food health claims and labeling system.

Regional inequality of socioeconomic status and the prevalence of hypertension between rural and urban areas

Background

Lower socioeconomic status (SES) is associated with greater burdens of cardiovascular disease in a community. The regional disparity of SES may result in an uneven distribution of hypertension (HTN) by a region. This study aims to analyze the regional disparity in the SES and HTN burden between rural and urban areas of the Korea.

Methods

We used data from the Korea National Health and Nutrition Examination Survey (KNHANES) V (2010–2012), VI (2013–2015), and VII (201–2018). We analyzed 11,206 and 1739 subjects from Seoul metropolitan and rural area (Gangwon province), respectively. We compared socioeconomic characteristics, the distribution of HTN between two regions. Finally, we performed a multivariate logistic regression adjusting for traditional CV risk factors and SES status to examine differences in the prevalence of HTN.

Results

Subjects in Gangwon province were older than Seoul (54.6±0.4 vs 49.4±0.2 years old, p<0.001). The proportions of subjects with low economic status and low education level were significantly higher in Gangwon province compared to Seoul (low economic status; 25.6 vs 14.4%, p<0.001, low education level; 35.3 vs 16.5%, p<0.001). Mean systolic blood pressure (SBP) was higher in Gangwon compared to Seoul (121.6±0.4 vs 118.1±0.2 mmHg, p<0.001). In the longitudinal trend from KNHANES V to VII, the difference of SBP between the two regions increased (Figure). The age-matched prevalence of HTN was significantly higher in Gangwon compared to Seoul (23.8 vs 21.6%, p<0.05), and the difference of prevalence of HTN by regions longitudinally increased (Figure). In the univariate analysis, the residency in Gangwon was associated with the presence of HTN (reference: Seoul, OR=1.63; 95% CI: 1.45–1.83). In the multivariate logistic regression model, the residency in Gangwon was not associated, however, low economic status and low education level were significantly associated with the presence of HTN (economic status, OR=1.39; 95% CI: 1.17–1.67, education level, OR=1.88; 95% CI: 1.57–2.24).

Conclusion

The SES status was lower and the prevalence of HTN was higher in Gangwon compared to Seoul. The burden of HTN longitudinally increased in Gangwon, but not in Seoul. The poor SES was significantly associated with HTN. It suggests that the inequalities of SES in Gangwon may contribute to the increasing prevalence of HTN. The regional and individual disparity of SES should be considered in the establishment of public health strategies for HTN.

Funding Acknowledgement

Type of funding sources: None.

Impact of dementia and drug compliance on patients with acute myocardial infarction

Background

There has been a worrying rise in the number of people with dementia, especially with many of them also suffering from acute myocardial infarction (AMI), a disease with a high mortality rate.

Purpose

We evaluated the impact of dementia on the mortality of patients with AMI and how drug compliance affects this relationship.

Methods

The data were derived from National Health Insurance Service-Senior. The total number of patients diagnosed with AMI for the first time between 2007 and 2013 was 16,835, among whom 2,021 had dementia. Medication possession ratio (MPR) was used to assess medication adherence.

Results

AMI patients with dementia had unfavorable baseline characteristics; they had significantly higher risk of all-cause mortality (Hazard ratio [HR]: 2.49; 95% confidence interval (CI): 2.34–2.66; P<0.001) and lower MPR (aspirin: 21.9% vs. 42.8%; P<0.001). AMI patients were stratified by presence of dementia and medication adherence, and the survival rate was the highest among those with no dementia and good adherence. followed by those with no dementia and poor adherence, those with dementia and good adherence, and those with dementia and poor adherence. The multivariable analysis revealed that dementia (HR: 1.64; 95% CI: 1.53–1.75; P<0.001) and poor adherence to medication (HR: 1.60; 95% CI: 1.49–1.71; P<0.001) had a significant association with all-cause mortality in AMI patients.

Conclusions

AMI patients with dementia have a higher mortality rate. Patients with dementia have poorer medication adherence than those without, negatively affecting their prognosis.

Funding Acknowledgement

Type of funding sources: None.

Development of a low-melting-point eutectic salt and evaluation of its discharge performance for light weight thermal batteries

This paper proposes low-melting-point eutectic salts containing RbCl as electrolytes for light weight thermal batteries. The handleability of the eutectic salts was remarkably improved for commercialisation. Their performance as thermal battery molten-salt electrolytes was verified using tests on a single cell and a 12-cell stacked battery.

ACGCN: Graph Convolutional Networks for Activity Cliff Prediction between Matched Molecular Pairs

One of the interesting issues in drug-target interaction studies is the activity cliff (AC), which is usually defined as structurally similar compounds with large differences in activity toward a common target. The AC is of great interest in medicinal chemistry as it may provide clues to understanding the complex properties of the target proteins, paving the way for practical applications aimed at the discovery of more potent drugs. In this paper, we propose graph convolutional networks for the prediction of AC and designate the proposed models as Activity Cliff prediction using Graph Convolutional Networks (ACGCNs). The results show that ACGCNs outperform several off-the-shelf methods when predicting ACs of three popular target data sets for thrombin, Mu opioid receptor, and melanocortin receptor. Finally, we utilize gradient-weighted class activation mapping to visualize activation weights at nodes in the molecular graphs, demonstrating its potential to contribute to the ability to identify important substructures for molecular docking.

Efficacy and Tolerability of Pitavastatin Versus Pitavastatin/Fenofibrate in High-risk Korean Patients with Mixed Dyslipidemia: A Multicenter, Randomized, Double-blinded, Parallel, Therapeutic Confirmatory Clinical Trial

PURPOSE

Dyslipidemia is an important risk factor for cardiovascular disease (CVD). Statins are known to effectively reduce not only low-density lipoprotein cholesterol (LDL-C) level but also death and nonfatal myocardial infarction due to coronary heart disease. The risk for CVD from atherogenic dyslipidemia persists when elevated triglyceride (TG) and reduced high-density lipoprotein cholesterol (HDL-C) levels are not controlled with statin therapy. Therefore, statin/fenofibrate combination therapy is more effective in reducing CVD risk. Here, we assessed the efficacy and tolerability of pitavastatin/fenofibrate combination therapy in patients with mixed dyslipidemia and a high risk for CVD.

METHODS

This multicenter, randomized, double-blind, parallel-group, therapeutic-confirmatory clinical trial evaluated the efficacy and tolerability of fixed-dose combination therapy with pitavastatin/fenofibrate 2/160 mg in Korean patients with a high risk for CVD and a controlled LDL-C level (<100 mg/dL) and a TG level of 150-500 mg/dL after a run-in period with pitavastatin 2 mg alone. In the 8-week main study, 347 eligible patients were randomly assigned to receive pitavastatin 2 mg with or without fenofibrate 160 mg after a run-in period. In the extension study, patients with controlled LDL-C and non-HDL-C (<130 mg/dL) levels were included after the completion of the main study. All participants in the extension study received the pitavastatin/fenofibrate combination therapy for 16 weeks for the assessment of the tolerability of long-term treatment.

FINDINGS

The difference in the mean percentage change in non-HDL-C from baseline to week 8 between the combination therapy and monotherapy groups was -12.45% (95% CI, -17.18 to -7.72), and the combination therapy was associated with a greater reduction in non-HDL-C. The changes in lipid profile, including apolipoproteins, fibrinogen, and high-sensitivity C-reactive protein from baseline to weeks 4 and 8 were statistically significant with combination therapy compared to monotherapy at all time points. Furthermore, the rates of achievement of non-HDL-C and apolipoprotein B targets at week 8 in the combination therapy and monotherapy groups were 88.30% versus 77.98% (P = 0.0110) and 78.94% versus 68.45% (P = 0.0021), respectively. The combination therapy was well tolerated, with a safety profile similar to that of statin monotherapy.

IMPLICATIONS

In these Korean patients with mixed dyslipidemia and a high risk for CVD, combination therapy with pitavastatin/fenofibrate was associated with a greater reduction in non-HDL-C compared with that with pitavastatin monotherapy, and a significantly improvement in other lipid levels. Moreover, the combination therapy was well tolerated, with a safety profile similar to that of statin monotherapy. Therefore, pitavastatin/fenofibrate combination therapy could be effective and well tolerated in patients with mixed dyslipidemia. ClinicalTrials.gov identifier: NCT03618797.

Evolution of structural and magnetic properties in iron oxide nanoparticles synthesized using Azadirachta indica leaf extract

The novel superparamagnetic nature of magnetic nanoparticles (MNPs) has received significant attention in the wide variety of fields. However, the prerequisites to use these MNPs, particularly in biomedical applications are biocompatibility and high saturation magnetization (Ms). Thus, the development of a sustainable approach for the synthesis of biocompatible MNPs, which utilizes the redox properties of natural compounds from plant extracts, is highly desired. Herein, we have examined the growth of phase selective MNPs synthesized using Azadirachta indica (Neem) extract as a reducing and capping agent. The physical and biological properties of MNPs synthesized with the modified green hydrothermal method at different reaction times and temperatures were investigated. It was observed that the reaction time and temperature strongly modulated the magnetic and structural characteristics of MNPs. At lower reaction time and temperature of 200 °C for 2 h, primarily iron oxalate hydrate (Fe(C2O4).2(H2O)) was formed. Further, with increasing reaction temperature, the phase transformation from iron oxalate hydrate to pure magnetite (Fe3O4) phase was observed. The MNPs prepared with optimum conditions of 220 °C for 4 h show superparamagnetic nature with improved Ms value of 58 emu g−1. The antibacterial study of MNPs against gram-positive bacteria Staphylococcus aureus showed that the MNPs inhibits the growth of bacteria with the least inhibitory MNPs concentration of 6 μl. Thus, the MNPs obtained by this modified biogenic approach will widen the scope and their applicability in future biomedical applications.

Association of exposure to secondhand smoke at home with early age at menarche in South Korea

OBJECTIVES

The secular trend in age at menarche (AAM) has declined both worldwide and in Korea. Early AAM is associated with the risk of several diseases, reproductive capacity, and psychological problems. We aimed to investigate the relationship between secondhand smoke (SHS) exposure at home and early puberty onset using AAM in Korean adolescents.

STUDY DESIGN

This is a retrospective cross-sectional study.

METHODS

This study used data from the Korea Youth Risk Behavior Web-based Survey 2014-2015. We used the mean AAM (12.2 years) as a determinant of early AAM. After the exclusion of girls without menarche or who did not respond, the total population comprised 63,618 participants. We categorized AAM as 'early' and 'average or late.' Adolescents with SHS exposure were assigned to the 'never exposed,' 'light exposure,' and 'heavy exposure' groups. Multiple logistic regression analyses were performed.

RESULTS

We observed a positive association, approximately 1.12 times, between early AAM and high SHS exposure (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.05-1.19). Girls who started smoking before the age of 12 years (OR, 1.68; 95% CI, 1.41-1.99) showed a stronger association with early AAM than non-smokers. Active smoking showed a stronger association with early AAM. Never smokers with high SHS exposure at home were 1.13 times likelier to have an early AAM (OR, 1.13; 95% CI, 1.05-1.22) than those without SHS exposure.

CONCLUSIONS

In addition to active smoking, SHS may also be a risk factor for early AAM. Education aimed at active and secondhand smoking prevention is needed to protect children against early AAM.

Binder-Free Cathode for Thermal Batteries Fabricated Using FeS2 Treated Metal Foam

In this study, we fabricated a cathode with lower amounts of additive materials and higher amounts of active materials than those of a conventional cathode. A thermal battery was fabricated using FeS₂ treated foam as the cathode frame, and its feasibility was verified. X-ray diffraction, transmission electron microscopy, and scanning electron microscopy were used to analyze the effects of thermal sulfidation temperature (400 and 500°C) on the structure and surface morphology of the FeS₂ foam. The optimal temperature for the fabrication of the FeS_x treated foam was determined to be 500°C. The FeS₂ treated foam reduced the interfacial resistance and improved the mechanical strength of the cathode. The discharge capacity of the thermal battery using the FeS₂ treated foam was about 1.3 times higher than that of a thermal battery using pure Fe metal foam.

Effect of Sedentary Time on the Risk of Orthopaedic Problems in People Aged 50 Years and Older

OBJECTIVE

Many people experience orthopaedic problems (OPPs), such as knee joint pain, hip joint pain, low back pain, and knee stiffness in their lifetimes. OPPs can impair lower extremity function, cause depression, and worsen quality of life. The aim of this study was to investigate the association between sedentary time (SDT) and OPPs.

DESIGN

Retrospective cross-sectional study.

SETTING

This study used data from the 2014-2015 Korea National Health and Nutrition Examination Survey. Survey participants with previous or current osteoarthritis or rheumatoid arthritis, as diagnosed by a doctor, were excluded. OPPs were defined as knee joint pain, hip joint pain, low back pain, and knee stiffness. The cut-off value for SDT was 7.5 hours/day. The study population comprised 3,671 people (1,856 men and 1,815 women), all of whom were ≥50 years-old. Multiple logistic regression analyses were performed.

RESULTS

A total of 328 men (17.7%) and 519 women (28.6%) had OPPs. Men with SDTs ≥7.5 hours had a greater risk of OPPs than did men with SDTs <7.5 hours (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.08-1.93). A pink-collar job, physical inactivity during leisure time, and passive (e.g. riding in a car or train) versus active (e.g. walking or riding a bicycle) transportation predicted OPPs in men with SDTs ≥7.5 hours. SDT was a risk factor for knee joint pain in men (OR, 1.80; 95% CI, 1.11-2.92) and hip joint pain in women (OR, 2.05; 95% CI, 1.35-3.11).

CONCLUSIONS

In men, prolonged SDT is a risk factor for OPPs. More physical activity programmes should be launched at the community level for people ≥50 years-old to reduce the occurrence of OPPs.

1272Physical activity and mortality with and without cardiovascular disease

Background/Introduction

Physical activity has been shown to reduce mortality in a dose-response fashion. Current guidelines recommend 500 to 1,000 MET-min per week of regular physical activity. However, evidence is limited regarding the specific dose-response relationship in patients with cardiovascular disease.

Purpose

Our aim was to compare the impact of physical activity on mortality in primary versus secondary cardiovascular prevention.

Methods

We analyzed 441,798 individuals with complete information on physical activity levels between 2009 and 2015 were extracted from a population-based cohort (National Health Insurance Service-National Health Screening cohort). Physical activity measured by self-report questionnaires. A rating of 2.9, 4.0, and 7.0 METs were assigned for light-intensity, moderate-intensity, and vigorous-intensity activities, respectively. Physical activity-related energy expenditure (MET-min/week) was calculated by summing the product of frequency, intensity, and duration. The level of physical activity was classified into 0, 0 to 499, 500 to 999, 1,000 to 1,499, and ≥1,500 MET-min/week. Study participants were stratified by the presence of cardiovascular disease, defined as prior myocardial infarction, ischemic heart disease, prior stroke, and/or chronic heart failure. The main study outcome was all-cause mortality. The median follow-up duration was 5.9 years.

Results

Individuals with cardiovascular disease had lower physical activity levels and a higher risk of mortality than those without cardiovascular disease. There was an inverse relationship between the physical activity level and the mortality risk in both groups. The benefit in the secondary prevention group was shown to be greater than that in the primary prevention group: every 500 MET-min/week increase in physical activity resulted in a 14% and 7% risk reduction in mortality in the secondary and primary prevention groups, respectively (interaction P<0.001). In addition, while individuals without cardiovascular disease benefited the most between 0 and 500 MET-min/week of physical activity, the benefit in those with cardiovascular disease continued above 500 to 1,000 MET-min/week. The adjusted mortality risk of individuals with cardiovascular disease who performed a high level of physical activity (≥1,000 MET-min/week) was shown to be comparable to or lower than that of their counterparts without cardiovascular disease.

Adjusted risk of mortality

Conclusion

Individuals with cardiovascular disease may benefit from physical activity to a greater extent than do healthy subjects without cardiovascular disease. Clinicians should encourage patients with cardiovascular disease to maintain a physically active lifestyle as much as possible.

[Magnetic resonance imaging findings and differential diagnosis of renal epithelioid angiomyolipoma comparing with renal no-epithelioid angiomyolipoma]

Objective: To investigate whether MRI findings can differentiate renal epithelioid angiomyolipoma (EAML) from renal no-epithelioid (typical) angiomyolipoma. Methods: A total of 44 patients were collected from General Hospital of PLA.These cases were obtained from January 2009 to June 2015.To retrospectively analyze these mainly MRI findings among 12 cases of EAML (age from 27 to 61 years, male 2 cases, female 10 cases, mean age was 46.7 years); 32 cases of renal no-epithelioid AML (age from 34 to 70 years old, male 9 cases, female 23 cases, mean age was 53.4 years old) as case control study. MRI findings included gender, T(2)WI, the signal on gross fat, pseudocapsle, necrosis or cystic degeneration, DWI, hemorrhage and the peak in three phases of dynamic enhancement.All data were analyzed statistically using SPSS version 19.0 (IBM, Armonk, NY, USA). χ(2) test and a single order chart were used to analyze the enumeration data. Results: Comparing with renal no-epithelioid angiomyolipoma, minimal fat, necrosis or cystic degeneration and hemorrhage were statistical significance. P values were 0.002, 0.007, 0.025, respectively.Gender, solid components of tumors on T(2)WI, the signal of DWI, pesudocapsule and the peak of enhancement had no statistical significance. P values were 0.863, 0.053, 0.479, 0.460, respectively. Conclusion: Comparing with renal no-epithelioid AML, necrosis or cystic degeneration and hemorrhage with minimal fat are characteristic MRI findings of EAML.

Delayed viral suppression during antiviral therapy is associated with increased hepatocellular carcinoma rates in HBeAg-positive high viral load chronic hepatitis B

The treatment option in chronic hepatitis B (CHB) patients with persistent low-level viremia despite entecavir or tenofovir monotherapy is unclear. This study investigated the development of hepatocellular carcinoma (HCC) or cirrhosis in hepatitis B e antigen (HBeAg)-positive high viral load CHB patients, according to the time needed to achieve complete viral suppression. A total of 325 HBeAg-positive CHB patients with high viral load who were recently started on antiviral therapy with entecavir or tenofovir were included. The enrolled patients were divided into 2 groups with 4 separate criteria based on the time needed to achieve complete viral suppression: within 1, 2, 3 or 4 years of therapy initiation. The outcomes were development of HCC and cirrhosis. The cumulative incidence of HCC was significantly higher in patients failing complete viral suppression within 1 year (hazard ratio (HR), 4.54; 95% confidence interval (CI), 1.03-19.93; P = .045) or 2 years (HR, 3.38; 95% CI, 1.24-9.23; P = .018), than patients who achieved complete viral suppression within 1 or 2 years, respectively. Cumulative incidence of cirrhosis was also significantly higher in patients failing suppression within 1 year (HR, 1.95; 95% CI, 1.04-3.66; P = .037) or 2 years (HR, 2.44; 95% CI, 1.41-4.22; P = .001). When the time for achieving viral suppression exceeded 2 years, the cumulative incidence of HCC or cirrhosis was not different regardless of viral suppression. Complete hepatitis B virus suppression within 2 years of antiviral therapy initiation is associated with risk reduction in HCC or cirrhosis development.

Abstract P3-01-16: How hot is enough for accurate sentinel lymph node axillary staging in breast cancer?

Purpose:

Sentinel lymph node (SLN) biopsy is a well-established procedure for staging of the axilla in early-stage breast cancer and has replaced axillary lymph node dissection as the standard of care in patients with clinically lymph node–negative axilla. No consensus exists about the number of sentinel lymph nodes (SLNs) that should be removed based on radioactivity counts in breast cancer, although the “10% rule” is often used. In order to determine the frequency with which the hottest SLN 'fails' to be pathologically positive, and to determine which criteria best define the radioactive lymph node to be removed, we reviewed and analyzed our cases in which more than one SLN was detected and where there was also at least one pathologically positive node.

Methods:

We retrospectively studied 1062 breast cancer patients who underwent lymphoscintigraphy by injection of radioactive colloid and SLN biopsy between 2006 and 2015, with intraoperative determination of radioactive counts of nodes by a gamma probe.

Results:

A total of 247 patients (23.3%) had more than 1 SLN removed (mean 2.29); 53 patients (21.5%) had nodal metastases. Of the node-positive patients, the hottest SLN was positive in 90.6% (48 of 53). The lowest radioactive count of a positive SLN was 32% of that of the hottest node.

Conclusions:

In our study, most positive SLNs had the highest radioactivity and the hottest lymph node was not the pathologically positive node only in 9.4 %. Our institutional experience indicates that to obtain an acceptable false-negative rate, nodes should be removed until the 10% rule is met.

Citation Format: Lee MH, Kang SH, Cho J. How hot is enough for accurate sentinel lymph node axillary staging in breast cancer? [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-01-16.

Rifaximin treatment is associated with reduced risk of cirrhotic complications and prolonged overall survival in patients experiencing hepatic encephalopathy

BACKGROUND

Rifaximin might decrease the risk of portal hypertension-related complications by controlling small intestinal bacterial overgrowth.

AIM

To evaluate whether rifaximin was associated with the risk of death and cirrhotic complications.

METHODS

We conducted a retrospective study that included 1042 patients experiencing hepatic encephalopathy (HE): 421 patients without hepatocellular carcinoma (HCC; the non-HCC cohort) and 621 patients with HCC (the HCC cohort). The primary endpoint was overall survival and secondary endpoints were recurrence of HE and the development of spontaneous bacterial peritonitis (SBP), hepatorenal syndrome (HRS) and variceal bleeding.

RESULTS

In the non-HCC cohort, 145 patients received rifaximin plus lactulose (the rifaximin group) and 276 patients received lactulose alone (the control group). The multivariate analysis revealed that rifaximin was significantly associated with lower risk of death (adjusted hazard ratio [aHR], 0.697; P = .024) and reduced the risk of recurrent HE (aHR, 0.452; P < .001), SBP (aHR, 0.210; P < .001) and variceal bleeding (aHR, 0.425; P = .011) but not HRS (aHR, 0.598; P = .08). In the HCC cohort, 173 patients received rifaximin plus lactulose and 448 patients received lactulose. Rifaximin was not associated with the risk of death (aHR, 1.177; P = .121). Rifaximin was associated with lower risk of SBP (aHR, 0.323; P < .001) but not with variceal bleeding (aHR, 0.660; P = .104) or recurrent HE (aHR, 0.689; P = .057). The risk of Clostridium difficile-associated diarrhoea was not different between the groups (aHR, 0.028; P = .338).

CONCLUSIONS

In patients without HCC, rifaximin treatment was significantly associated with prolonged overall survival and reduced risks of spontaneous bacterial peritonitis, variceal bleeding and recurrent hepatic encephalopathy.

Low appendicular muscle mass is associated with mortality in peritoneal dialysis patients: a single-center cohort study

BACKGROUND/OBJECTIVES

There are few studies of the association between low appendicular muscle mass (LAM) and clinical outcomes in peritoneal dialysis (PD) patients. We aimed to determine the clinical association between LAM and clinical outcomes in PD patients.

SUBJECT/METHODS

We reviewed all PD patients who underwent PD between January 2001 and April 2014. Each patient's appendicular lean mass was estimated using dual-energy X-ray absorptiometry. The appendicular muscle mass index (AMI) was calculated using total appendicular lean mass (kg) over body mass index (kg/m²). The cut-off AMI value for LAM was <0.789 for men and <0.512 for women.

RESULTS

The number of patients in the Non-LAM and LAM groups was 328 and 303, respectively. The median follow-up durations in the Non-LAM and LAM groups were 47 and 49 months, respectively. The numbers of deaths in the Non-LAM and LAM groups were 96 (29.3%) and 160 (52.8%), respectively. In a comparison with the Non-LAM group, the hazard ratio in the LAM group was 1.74 (95% confidence interval (CI), 1.35-2.24) in univariate and 1.71 (95% CI, 1.28-2.26) in multivariate Cox regression analysis. In addition, the hazard ratio for a 0.1 increase in baseline AMI was 0.89 (95% CI, 0.84-0.95) in univariate analysis and 0.84 (95% CI, 0.76-0.91) in multivariate analysis. Analyses using the 1-year AMI showed trends similar to those for the initial AMI.

CONCLUSIONS

Our study showed the association of LAM with mortality in the incident PD patients.

Bioequivalence data analysis for the case of separate hospitalization

A bioequivalence study is usually conducted with the same-day drug administration. However, hospitalization is occasionally separated for logistical, operational, or other reasons. Recently, there was a case of separate hospitalization because of difficulties in subject recruitment. This article suggests a better way of bioequivalence data analysis for the case of separate hospitalization. The key features are (1) considering the hospitalization date as a random effect than a fixed effect and 2) using "PROC MIXED" instead of "PROC GLM" to include incomplete subject data.

Drip, Ship, and On-Demand Endovascular Therapy for Acute Ischemic Stroke

BACKGROUND

The "drip and ship" approach can facilitate an early initiation of intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) at community hospitals. New endovascular treatment modalities, such as stent retrieval, have further improved the rate of safe and successful recanalization. We assessed the clinical outcomes of on-demand endovascular therapy in patients with AIS who were transported to a comprehensive stroke center under the "drip and ship" paradigm.

METHODS

This retrospective study evaluated prospectively registered patients with acute large vessel occlusions in the anterior circulation who underwent endovascular recanalization after IVT at our regional comprehensive stroke center between January 2011 and April 2014. Clinical outcomes and neuroradiological findings were compared between patients who received IVT at the center (direct visit, DV) and at a community hospital (drip and ship, DS).

RESULTS

Baseline characteristics such as age, initial National Institutes of Health Stroke Scale (NIHSS) score, and risk factors for stroke were similar, and most patients underwent endovascular therapy with a Solitaire stent (81.9% vs. 89.3% for DV and DS, respectively, P = 0.55). The average initial NIHSS score was 12.15 ± 4.1 (12.06 vs. 12.39 for DV and DS, respectively, P = 0.719). The proportions of long-term favorable outcomes (modified Rankin Scale score ≤ 2 at 90 days) and successful recanalization (Thrombolysis in Cerebral Ischemia score ≥ 2b) were not significantly different (P = 0.828 and 0.158, respectively). The mortality rates and occurrences of symptomatic intracerebral hemorrhage were not significantly different (P = 0.999 and 0.267, respectively).

CONCLUSIONS

The "drip and ship" approach with subsequent endovascular therapy is a feasible treatment concept for patients with acute large vessel occlusion in the anterior circulation that could help improve clinical outcomes in patients with AIS.

Abstract P1-10-25: Intrathoracic paclitaxel chemotherapy for malignant pleural effusion in breast cancer

Background: Malignant pleural effusion in breast cancer has been associated with poor prognosis which median survival rate is 5–16 months. The response rate of local treatment has been very low and in some case, complications have resulted in death.

Patients and methods: We investigated the efficacy and safety of paclitaxel, as an intrapleural chemotherapeutic agent. From January 2006 to June 2015, total 35 times of intrapleural chemothepapy were performed in 26 breast cancer patients who had developed malignant pleural effusion. They were infused 120mg/m2 of paclitaxel through a chest tube, which was clamped for 48 hours. The chest tube was maintained until drainage was reduced to less than 50-100 mL/day.

Results: Mean follow up period after intrapleural chemotherapy was 11 months.The average time of indwelling with a chest tube after intrapleural chemotherapy was 9.7 days.

Mean progression free survival was 7.8 Months. During the follow-up period, 5 patients had no progression of pleural effusion and 2 of them were free from progression for more than 36 months. In 26 attempts, there were effective and could remove chest tube otherwise In 9 attempts, there were no improvement after intrapleural chemotherapy. 1 patients received a second round of ipsilateral intrapleural chemotherapy and had no response unlike earlier attempts. There were 3 severe adverse effect related death caused by respiratory failure with or without G4 neutropenia.

Conclusion: Intrapleural paclitaxel chemotherapy is helpful for some cases of uncontrolled pleural effusion in that reduce the duration of hospital stay and improve quality of life. But it will be determined carefully, considering the side effects and response rate of treatment.

Citation Format: Yeu KJ, Park J, Choi JE, Kang SH, Lee SJ. Intrathoracic paclitaxel chemotherapy for malignant pleural effusion in breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-10-25.

Abstract P5-01-10: Correlation of apparent diffusion coefficient with standardized uptake value in invasive lobular carcinoma of breast using in hybrid 18F-FDG PET/MR

Purpose: To compare the apparent diffusion coefficient (ADC) with maximum standardized uptake values (SUV) derived from combined 18F-FDG PET/MRI in invasive lobular carcinoma (ILC) patients.

Methods: From 2012 Aug to 2015 Feb, 53 women with histologically proven ILC (mean age, 50.3 ± 7.7 y-o) underwent hybrid 18F-FDG PET/MR (Siemens Biograph mMR) scan for preoperative assessment. During PET acquisition, simultaneous diffusion-weighted imaging (DWI, b values: 0, 400, 800 s/mm2) was performed using breast coil. ILC over than 2 Cm in size were analyzed. Regions of interest (ROI) were drawn covering the entire ILC on the attenuation-corrected PET-image and the monoexponential ADC-map on PET/MR workstation. All the patients were received surgical treatment within 3 weeks after scan. Spearman rank correlation coefficient (ρ) was calculated to examine the correlation between SUVmax and ADC value.

Results: Total 25 ILC (5.4±1.3 cm; 2.1-6.3 cm) of 22 women were enrolled. 24 ILC showed ER (+)/PR (+) and all ILC showed HER2 (-). 15 patients were confirmed metastatic axillary lymph nodes. The mean of SUVmax was 2.14 ± 2.2 (0.91-11.9) and mean of ADC was 1.02 ×10-3 (0.82 -1.31 ×10-3) mm2/s. Higher histologic grade was correlated with higher SUV (ρ = -0.6, p=0.001). And SUV showed inverse correlation with ADC (ρ = -0.48, p=0.016).

Conclusion: The present data show inverse correlation between increased glucose-metabolism and cellularity in ILC patients. 18F-FDG PET and DWI thus may offer complementary information for the evaluation of treatment response in ILC.

Citation Format: Choi JE, Kang SH, Lee SJ, Kong EJ. Correlation of apparent diffusion coefficient with standardized uptake value in invasive lobular carcinoma of breast using in hybrid 18F-FDG PET/MR. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-01-10.

Abstract P3-13-06: The efficacy and long term results of intraoperative frozen section analysis to access resection margin in ductal carcinoma in situ

Introduction

Breast conserving surgery (BCS) is a standard procedure for early breast cancer and resection margin state is the most important risk factor of local recurrence. Re-operation is generally conducted in 20∼40% after initial BCS to achieve negative margins, especially in breast cancer with carcinoma in situ components. In this study, we analyzed the long-term follow up results and efficacy of BCS using intraoperative frozen section analysis to access resection margin in ductal carcinoma in situ (DCIS) patients.

Methods

Between 2004 and 2006, 1016 patients were diagnosed with primary breast cancer and received breast cancer surgery. Among them, BCS was attempted as an initial operation for 523 patients. Superior, inferior, medial and lateral margin of resected specimen were evaluated according to the intraoperative frozen section analysis. If tumor cells existed less than 2mm from resected specimen margin, intraoperative further resection was done and if the further resection was impossible, initial BCS was converted to mastectomy. All medical records and pathologic reports were reviewed retrospectively.

Results

Of the 523 patients who had to undergo BCS, 13.3% (70/523) were converted to mastectomy during initial BCS. The number of the patients who had either only DCIS or invasive carcinoma c carcinoma in situ component was 372 (71.1%, 372/523) and 17.2% (64/372) were converted to mastectomy. One hundred fifty one (28.9%, 151/523) patients had only invasive carcinoma and 3.97% (6/151) were converted to mastectomy. In this study, we analyzed 94 patients who had to undergo BCS with DCIS. The rate of intraoperative conversion to mastectomy was 13.8% (13/94) and 81 patients had successful BCS with 0∼3 times of intraoperative frozen section analysis. There were no differences between patients who had BCS and final mastectomy in clinicopathologic characteristics such as physical examination of tumor, age of patients, DCIS subtypes, nuclear polymorphism, presence of necrosis, ER, PR, HER2 and Ki67. After permanent biopsy was reported, in 5 patients, resected specimen had tumor cells within less than 2mm from resected margin, not inked margin. They had no reoperations and no recurrences. Mean follow up period was 76.6 months. One locoregional and 3 local recurrences in BCS patients and 1 local recurrence in mastectomy patients were found. There was no difference in disease free survival between two groups (95.1% vs 92.3%, p=0.659). In these DCIS patients, reoperation rate was 0%.

Conclusion

Intraoperative frozen section analysis during BCS to access resection margin helps to avoid reoperations and increase intraoperative success rate of BCS in DCIS. It also shows oncological safe long term results. Further studies are needed to resolve the problem with cost-effectiveness of intraoperative frozen section analysis.

Citation Format: Choi JE, Yeu KJ, Park JY, Kang SH, Lee SJ, Bae YK. The efficacy and long term results of intraoperative frozen section analysis to access resection margin in ductal carcinoma in situ. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-13-06.

Creutzfeldt-Jakob Disease Presenting With Dizziness and Gaze-Evoked Nystagmus: A Case Report

Sporadic Creutzfeldt-Jakob disease (CJD) is clinically characterized by rapidly progressive dementia combined with other cardinal symptoms, such as myoclonus, visual or cerebellar disturbances, extrapyramidal or pyramidal disturbance, and akinetic mutism. However, as an initial manifestation, focal neurologic deficits other than the aforementioned or nonspecific generalized symptoms may lead to a misdiagnosis or a delayed diagnosis. The authors report a case of 66-year-old male patient with sporadic CJD who had dizziness, gaze-evoked nystagmus (GEN), and other central eye signs (impaired smooth pursuit, saccadic dysmetria) as an initial manifestation without dementia. The central eye signs led us to perform brain magnetic resonance images, which showed abnormal cortical high-signal intensity in both the cerebral and cerebellar hemispheres including the vestibulocerebellum. We reached a presumptive diagnosis of CJD, but the findings did not meet diagnostic criteria for probable CJD at that time. Three weeks after the initial work-ups, the patient presented with typical neurological findings of CJD: rapidly progressive dementia, akinetic mutism, and myoclonus of the left arm. Cerebrospinal fluid was positive for 14-3-3 protein, and electroencephalography showed periodic sharp wave complexes. In this patient, GEN and other central eye signs provided diagnostic clues for CJD. These unusual neurological manifestations may help physicians have a thorough knowledge of early deficits of CJD.

Avoiding ambiguity with the Type I error rate in noninferiority trials

This review article sets out to examine the Type I error rates used in noninferiority trials. Most papers regarding noninferiority trials only state Type I error rate without mentioning clearly which Type I error rate is evaluated. Therefore, the Type I error rate in one paper is often different from the Type I error rate in another paper, which can confuse readers and makes it difficult to understand papers. Which Type I error rate should be evaluated is related directly to which paradigm is employed in the analysis of noninferiority trial, and to how the historical data are treated. This article reviews the characteristics of the within-trial Type I error rate and the unconditional across-trial Type I error rate which have frequently been examined in noninferiority trials. The conditional across-trial Type I error rate is also briefly discussed. In noninferiority trials comparing a new treatment with an active control without a placebo arm, it is argued that the within-trial Type I error rate should be controlled in order to obtain approval of the new treatment from the regulatory agencies. I hope that this article can help readers understand the difference between two paradigms employed in noninferiority trials.

Clinical results of treatment of garden type 1 and 2 femoral neck fractures in patients over 70-year old

INTRODUCTION

We retrospectively analyzed the clinical results of treatment of impacted or undisplaced femoral neck fractures (Garden types 1 and 2) by osteosynthesis in elderly patients >70-year old.

MATERIALS AND METHODS

We retrospectively reviewed the radiological results of 52 patients who were followed up for at least 6 months from April 2002 to December 2008. The average age of the patients was 77.6 years (range 70-97 years), and 38 patients were females. The mean follow-up period was 11.7 months (range 6-19 months). Thirteen cases were Garden type 1 fractures, and 39 were Garden type 2 fractures. We assessed the relationships between the occurrence of complications and age, sex, Garden stage, bone mineral density (BMD), history of contralateral hip fracture, and any additional hip injury.

RESULTS

Major complications occurred in 18 cases (34.6 %), including nonunion (8 cases), osteonecrosis (6 cases), stress fracture of the subtrochanter (2 cases), excessive pull-out of a screw (1 case), and deep infection (1 case). The development of complications was associated with Garden stage 2, BMD, and additional hip injury. However, other factors were not associated with complications. Reoperations were performed in 16 cases (30.1 %), and 2 of the patients died during follow-up.

CONCLUSION

A relatively high rate of complications or reoperations developed after treatment of Garden 2 femoral neck fractures in senile patients >70 years of age with osteoporosis. Although internal fixation has been recommended in the literature for undisplaced femoral neck fractures, primary arthroplasty may be a better option for treatment of Garden type 2 fractures in elderly patients.

Using hidden Markov models to characterize termite traveling behavior in tunnels with different curvatures

Subterranean termites live underground and build tunnel networks to obtain food and nesting space. After obtaining food, termites return to their nests to transfer it. The efficiency of termite movement through the tunnels is directly connected to their survival. Tunnels should therefore be optimized to ensure highly efficient returns. An optimization factor that strongly affects movement efficiency is tunnel curvature. In the present study, we investigated traveling behavior in tunnels with different curvatures. We then characterized traveling behavior at the level of the individual using hidden Markov models (HMMs) constructed from the experimental data. To observe traveling behavior, we designed 5-cm long artificial tunnels that had different curvatures. The tunnels had widths (W) of 2, 3, or 4mm, and the linear distances between the two ends of the tunnels were (D) 20, 30, 40, or 50mm. High values of D indicate low curvature. We systematically observed the traveling behavior of Coptotermes formosanus shiraki and Reticulitermes speratus kyushuensis and measured the time (τ) required for a termite to pass through the tunnel. Using HMM models, we calculated τ for different tunnels and compared the results with the τ of real termites. We characterized the traveling behavior in terms of transition probability matrices (TPM) and emission probability matrices (EPM) of HMMs. We briefly discussed the construction of a sinusoidal-like tunnels in relation to the energy required for termites to pass through tunnels and provided suggestions for the development of more sophisticated HMMs to better understand termite foraging behavior.

Statistical assessment of biosimilarity based on the relative distance between follow-on biologics for binary endpoints

A new three-arm parallel design was recently proposed to investigate the biosimilarity between a biological product and a reference product by using the relative distance. The purpose of this article is to extend their results to binary endpoints for three popular metrics: the risk difference, the log relative risk, and the log odds ratio. The relative distances based on the three metrics are defined, and corresponding test procedures are developed. The type I error rates and powers are investigated theoretically and empirically.

An improved preprocessing algorithm for haplotype inference by pure parsimony

The identification of haplotypes, which encode SNPs in a single chromosome, makes it possible to perform a haplotype-based association test with disease. Given a set of genotypes from a population, the process of recovering the haplotypes, which explain the genotypes, is called haplotype inference (HI). We propose an improved preprocessing method for solving the haplotype inference by pure parsimony (HIPP), which excludes a large amount of redundant haplotypes by detecting some groups of haplotypes that are dispensable for optimal solutions. The method uses only inclusion relations between groups of haplotypes but dramatically reduces the number of candidate haplotypes; therefore, it causes the computational time and memory reduction of real HIPP solvers. The proposed method can be easily coupled with a wide range of optimization methods which consider a set of candidate haplotypes explicitly. For the simulated and well-known benchmark datasets, the experimental results show that our method coupled with a classical exact HIPP solver run much faster than the state-of-the-art solver and can solve a large number of instances that were so far unaffordable in a reasonable time.

Sample size calculations for the development of biosimilar products

The most widely used design for a Phase III comparative study for demonstrating the biosimilarity between a biosimilar product and a renovator biological product is the equivalence trial, whose aim is to show that the difference between two population means of a primary endpoint is less than a prespecified equivalence margin. A well-known sample size formula for the equivalence trial is given by [Formula: see text] Since this formula is obtained based on the approximate power rather than the exact power, we investigate in this article the accuracy of the sample size formula. We conclude that the sample size formula is very conservative. Specifically, we show that the exact power based on the sample size calculated from the formula to have power [Formula: see text] is actually [Formula: see text] under some conditions. Therefore, the use of the sample size formula may cause a huge extra cost to biotechnology companies. We propose that the sample size should be calculated based on the exact power precisely and numerically. The R code to calculate the sample size numerically is provided in this article.

A pilot study on the safety and efficacy of generic mycophenolate agent as conversion maintenance therapy in stable liver transplant recipients

PURPOSE

The patent covering mycophenolate mofetil (MMF) in Korea has expired and, thus, several generic MMF agents are now commercially available. The supply of Cellcept (Roche Korea) was interrupted at the end of 2011, so it was inevitable that a generic MMF would be used instead. During this period, we performed a prospective pilot study to examine the safety and efficacy of a generic mycophenolate agent (Myconol: Hanmi Pharmaceutical, Seoul Korea) for use as conversion maintenance therapy in stable liver transplantation (OLT) recipients.

METHODS

OLT recipients, who were treated with MMF on an outpatient basis from January 2012 to March 2012, attended follow-up interviews conducted. The patients had undergone OLT ≥ 2 years before the study, had tolerated Cellcept, and showed stable liver function. Fifty-three patients were followed up for more than 3 months after conversion to the same dose of Myconol.

RESULTS

After conversion to Myconol, 6 patients (11.3%) experienced new side effects, which disappeared when they reverted to Cellcept (n = 5) or stopped taking Myconol medication (n = 1). The side effects associated with Myconol included gastrointestinal symptoms (indigestion and diarrhea; n = 3), skin eruptions (n = 1), pruritus (n = 1), and insomnia (n = 1). The mean mycophenolic acid levels were 1.71 ± 0.88 μg/mL for Cellcept and 1.83 ± 0.91 μg/mL for Myconol, which showed a strong correlation (r(2) = 0.92, P < .001).

CONCLUSIONS

Myconol showed similar pharmacokinetics to those of Celcept, but a small proportion of patients experienced agent-specific side effects; therefore, patients should be closely monitored when taking Myconol. Also, further studies, with a greater number of patients, are required to identify the full spectrum of drug-associated side effects.

First report: Robotic pelvic exenteration for locally advanced rectal cancer

AIM

The aim of this study was to present the feasibility and surgical outcome of robotic en bloc resection of the rectum and with prostate and seminal vesicle invaded by rectal cancer.

METHOD

The details of three consecutive cases involving male patients in their forties, with locally invasive low rectal cancers are presented. The da Vinci robotic system was used by experienced colorectal and urological surgeons to perform en bloc resection of the rectum, prostate and seminal vesicles.

RESULTS

In the first case, coloanal and vesico-urethral anastomoses were performed, and the second included an end colostomy and vesico-urethral anastomosis. The bladder and bulbar urethra were also removed en bloc in the third case, with robotic intracorporeal ileal conduit formation and end colostomy. There was no major complication postoperatively. In the second patient there was a minor leakage at the vesico-urethral anastomosis. The third was readmitted the following week with a urinary infection which settled with intravenous antibiotics. In the first case, the circumferential resection margin was microscopically positive but the patient is currently free of recurrence after 14 months. In the second and third cases, all margins were clear.

CONCLUSION

This the first report of the use of the da Vinci robotic system for pelvic exenteration in patients with locally advanced rectal cancer invading the prostate and seminal vesicles. The robot may have a potential role in selected patients requiring exenterative pelvic surgery particularly in men.

Geographic information system-coupling sediment delivery distributed modeling based on observed data

Spatially distributed sediment delivery (SEDD) models are of great interest in estimating the expected effect of changes on soil erosion and sediment yield. However, they can only be applied if the model can be calibrated using observed data. This paper presents a geographic information system (GIS)-based method to calculate the sediment discharge from basins to coastal areas. For this, an SEDD model, with a sediment rating curve method based on observed data, is proposed and validated. The model proposed here has been developed using the combined application of the revised universal soil loss equation (RUSLE) and a spatially distributed sediment delivery ratio, within Model Builder of ArcGIS's software. The model focuses on spatial variability and is useful for estimating the spatial patterns of soil loss and sediment discharge. The model consists of two modules, a soil erosion prediction component and a sediment delivery model. The integrated approach allows for relatively practical and cost-effective estimation of spatially distributed soil erosion and sediment delivery, for gauged or ungauged basins. This paper provides the first attempt at estimating sediment delivery ratio based on observed data in the monsoon region of Korea.

Abstract P5-07-07: Prognostic value of mutant TP53 in basal breast cancer

Backgrounds; p53 is a tumor suppressor gene that plays an important role in cell cycle control and apoptosis. In the breast cancer, mutant tumor protein (TP53) is expressed in approximately 30% and patients with mutant TP53 often tend to have poor response to chemotherapy and poor prognosis than those with normal TP53. But, according to a recent study, TP53 inactivation could cause to significant DNA damage and to eventual cell death by mitotic catastrophe. We investigated the expression frequency and prognostic value of mutant TP53 using tissue microarrays of 898 invasive breast cancers.

Patients and methods; From January 1995 to December 2005 at Yeungnam university hospital, patients who diagnosed with the primary invasive breast cancer and received operation were included in this study. Patients with bilateral breast cancer or distant metastasis at the time of diagnosis were excluded. According to the immunohistochemical results of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 (HER2), Ki67, epidermal growth factor (EGFR) and cytokeratin (CK) 5/6, we classified patients into 6 subgroups, luminal A, luminal B1, B2, HER2-enriched, normal breast-like (triple negative nonbasal) and basal-like breast cancers. Immunohistochemical staining for TP53 was performed and we defined more than 10% stain of tumor cell as mutant TP53-positive. Distribution and prognostic significance of mutant TP53 in each subgroup was investigated.

Results; In 898 invasive breast cancers, mutant TP53 was identified in 33.5% (301/898). Each expression frequency of mutant TP53 was 10.9% (42/385) in luminal A, 32.1% (45/140) in luminal B1, 50.0% (34/68) in luminal B2, 63.7% (72/113) in HER2-enriched, 54.7% (35/64) in normal breast-like and 57.0% (73/128) in basal-like subtype, respectively. In whole breast cancer patients, patients with mutant TP53 tended to have poor overall survival (OS) and disease free survival (DFS). However, there was no statistical significance (p = 0.187 and p = 0.651). But, in 128 patients with basal-like breast cancer, mutant TP53 showed good prognosis in both OS and DFS (p = 0.003 and p = 0.021). In basal-like breast cancer, the expression of mutant TP53 had no association with other clinicopathologic factors such as tumor size, lymph node metastasis, histological grade, lymphovascular invasion etc. and 98.4% (126/128) patients received adjuvant chemotherapy. In multivariate anaylsis, expression of mutant TP53 was an independent prognostic factor for OS and DFS in basal-like breast cancers (p = 0.008 and p = 0.012).

Conclusions: This study showed that basal-like breast cancer with mutant TP53 has a good outcome in both OS and DFS. Further studies are needed to identify the action mechanism of mutant TP53.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-07-07.