Prevalence of rectus diastasis is higher in patients with inguinal hernia

PURPOSE

To determine the prevalence of rectus diastasis (RD) in patients with inguinal hernia.

MATERIAL AND METHODS

Multicenter, cross-sectional study. Patients with inguinal hernia were included in the study group (IH) and those with benign proctologic complaints created the control group (CG). Age, gender, BMI, family history for inguinal hernias, comorbid diseases, alcohol use, smoking, constipation, malignancy, chemotherapy, number of births, multiple pregnancies and prostate hypertrophy history of all patients in both groups were recorded. All patients were evaluated for RD and umbilical hernias by physical examination.

RESULTS

A total of 528 consecutive patients were included in the study (292 IH / 236 CG). Overall prevalence of RD was 35.6% and it was significantly higher in IH than in CG (46.9% vs 21.6%, p < 0.001). Also, umbilical hernia was more frequently detected in the patients with inguinal hernia. Other risk factors for RD were age, BMI, DM, BPH and smoking. The mean inter-rectus distance for 528 patients was 18.1 mm; it was 20.71 ± 10.68 mm in IH and 14.88 ± 8.82 in CG (p < 0.001). It was determined that the increase in age and BMI caused an increase in the inter-rectus distance, and that the presence of DM, inguinal hernia and umbilical hernia increased the inter-rectus distance quantitatively.

CONCLUSIONS

The prevalence of RD seems to be higher in patients with inguinal hernia comparing to that in general population. Increased age, high BMI and DM were found to be independent risk factors for RD development.

Comparing the effectiveness of prolotherapy and percutaneous dry needling in the treatment of lateral epicondylitis: a retrospective cohort study

OBJECTIVE

Lateral epicondylitis (LE) can result in a functional loss in patients because of pain and has recently become more prevalent. This study compared the effects of minimally invasive prolotherapy (PRO) and percutaneous dry needling (PDN) on LE treatment.

PATIENTS AND METHODS

Patients were divided into three groups; Group 1 included patients undergoing PDN, Group 2 included those undergoing PRO, and Group 3 included those undergoing PDN+PRO. All these treatments were administered three times and at a 3-week interval in each patient. Data on the visual analog scale (VAS) and patient-rated tennis elbow evaluation (PRTEE) scale scores of the patients were collected at weeks 0, 3, and 6 and month 6 and retrospectively analyzed.

RESULTS

The VAS and PRTEE scores decreased in all groups. The decrease in Group 3 was higher than that in the other groups (p<0.001). Upon evaluating within-group differences in VAS and PRTEE scores, the scores at week 3, week 6, and month 6 gradually decreased compared with the baseline in all groups (p<0.001).

CONCLUSIONS

PDN and PRO are minimally invasive and can successfully treat LE. A combination of PDN+PRO provides better results than PDN or PRO alone. As the materials we used in these treatments are relatively inexpensive and readily available, we believe our study will help reduce the national healthcare costs allocated for the treatment of LE.

Does onlay mesh placement in emergency laparotomy prevent incisional hernia? A prospective randomized double-blind study

PURPOSE

The objective of this study is to assess the effectiveness and safety of onlay mesh closure of emergency midline laparotomy to prevent incisional hernia.

METHODS

This is a prospective randomized double-blind study and was carried out in the General Surgery Clinic, Konya City Hospital, from August 1, 2020 to August, 1, 2021. The study included 108 patients who were randomly grouped in 2 groups: patients with conventional abdominal closure and closure using additional onlay mesh (1:1). The follow-up period was for a year. The primary outcome was the incidence of incisional hernia and secondary outcomes were clinical data like complications, hospital length of stay, re-operations.

RESULTS

It was observed that incisional hernia was present in 14 patients (27.4%) in conventional abdominal closure group and was in 2 patients using mesh (4%), (p = 0.001). Clavien-Dindo 3B complications were in rise in conventional closure group (p = 0.02). Of all complications, burst abdomen was significantly more common in conventional closure group (p = 0.04). The rate of surgically treated complications were higher in conventional closure group (p = 0.02). Clavien-Dindo 3A complications were more common in patients with contaminated wound in mesh group (p = 0.02).

CONCLUSION

The use of mesh while closing the abdomen in emergency midline laparotomy reduces the risk of incisional hernia. Thus, to lower the risks of incisional hernia and its complications, prophylactic mesh can be used in high-risk patients.

P-125 INCIDENCE OF DIASTASIS RECTI ABDOMINIS SEEMS TO BE HIGHER IN PATIENTS WITH INGUINAL HERNIAS

Aim

To find the incidence of Diastasis Recti Abdominis (DRA) in patients with inguinal hernias.

Materials and Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients with proctological disorders in the control group (PC). Investigated parameters: age, gender, BMI, family history, systemic comorbidities, alcohol consumption, tobacco use, constipation, malignancies, chemotherapy, number of births, multiple pregnancies, prostate hypertrophy. The measurements were done at 3 cm above the umbilicus. Any separation ≥20 mm was accepted as DRA. The existence of paraumbilical hernia (PUH)was also recorded.

Results

36 female and 212 male patients with a mean age of 51.3± 1.4 in IH, whereas 137 women and 305 men with a mean age of 44.5±15.9 in PC. 48.0% of IH and 21.1% of PC were diagnosed with DRA (p=0.001). Incidences of PU were 16.5% and %5.2 respectively (p=0.01). BMI ≥25, chronic pulmonary disease, multiple pregnancies and prostatic enlargement were associated with DRA. Multivariate analysis revealed that inguinal hernia and multiple pregnancies were independent factors for DRA.

Conclusions

Incidences of DRA and PUH seem to be higher in patients with inguinal hernias in comparison with control subjects.

P-019 BIOELECTRIC IMPEDANCE ANALYSIS TO DETERMINE THE RISK FACTORS FOR INGUINAL HERNIA

Aim

To search the risk factors for inguinal hernia development by performing bioelectrical impedance analysis.

Material & Methods

Prospective, multicenter, cross-sectional study. Patients with inguinal hernias constitues the study group (IH), and patients who admitted with other surgical problems in the control group (SC). Age, gender, and BMI of the patients were recorded. Body composition measurements were done by bioelectrical impedance analysis. The relations between the obtained parameters and inguinal hernia were evaluated.

Results

9 female and 125 male patients with a mean age of 53.4± 15.4 in IH, whereas 44 women and 24 men with a mean age of 44.5±15.9 in (SC). There were statistically significant differences between two groups regarding BMI, total body fat, lean abdominal muscle mass, abdominal fat amount, and visceral fat rates. Male gender, low total body fat rate, low total body fat amount, low lean body mass rate, and low visceral fat rate were determined as risk factors for inguinal hernia in univariate analysis. Only low total body fat rate was found to be an independent risk factor.

Conclusions

Low total body fat rate is an independent risk factor for inguinal hernia development.

AB1387 THE EFFECTS OF PREGNANCY AND FERTILITY ON DRUG USAGE AND PREFERENCES IN RHEUMATOLOGICAL DISEASES: A SINGLE CENTER EXPERIENCE

Background

Rheumatological diseases usually affect women of reproductive age. Although the effects of these diseases on pregnancy vary; Joint and organ damage that may occur should be prevented, maternal and fetal effects of the treatment should be evaluated (1).

Objectives

The aim of this study to determine the effects of rheumatological diseases and drugs used on pregnancy and fertility.

Methods

Between January 2014 and January 2021, women between the ages of 18-45 who were diagnosed and treated at Cumhuriyet University Medical Faculty Rheumatology-Internal Medicine Department were retrospectively analyzed.

Results

The median age of the patients is 37 (min 19-max 45) years. 517 patients (51,7%) were pregnant after diagnosis, 39 patients (3,9%) had abortion after diagnosis, 957 patients (95,7%) had live birth, 69 patients (6,9%) had curettage, 43 patients (4,3%) could not have children. The median of pregnancies before diagnosis is 2 (min 1-max 11) the median of pregnancies after diagnosis is 1 (min 1-max 6) the median of abortions before diagnosis is 2 (min 1-max 7) the median of abortions after diagnosis is 1 (min. 1-max 4) the median of curettage is 1 (min 1-max 3) the median of live births is 2 (min 1-max 5). The distribution of patients according to drug use and drug used during pregnancy is shown in Figure 1. The distribution of the patients according to the diagnosis and the factors affecting pregnancies after diagnosis, abortions after diagnosis, curettage and live birth is shown in Table 1.

Table 1.

The distribution of the patients according to the diagnosis and the factors affecting pregnancies after diagnosis, abortions after diagnosis, curettage and live birth.

†FMF‡RA¶AS§PSASarcoidosisGranulomatous MastitisMyositisVasculitisBehçet’s DiseaseStill’s SyndromeGoutFibromyalgia††SLESjögren’s SyndromeSystemic Sclerosis‡‡APSAvaliable (%n)224 %22.4197 %19.7274 %27,459 %5,91 %0,1117 %0,7169 %16,93 %0,32146 %14,6105 %10,56037 %3,729 %2,9%0,1%0,1%0,2%6Not Avaliable (%n)776803 %80,3726 %72,6941 %94,1999 %99,9999 %99,9999 %99,9993 %99,3831 %83,1997 %99,7998 %99,8854 %99,9895 %89,5940 %94963 %96,3971 %97,1%77,6Total (%n)1000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %1001000 %100Use of colchicineUse of anakinraUse of methorexateUse of leflunomide(*OR %95 confidence range)(*OR %95 confidence range)(*OR %95 confidence range)(*OR %95 confidence range)**p value**p value**p value**p valueNumber of pregnancy after diagnosis*OR:1,58 (1,22-2,034)*OR:6,69 (1,51-29,60)*OR: - 0,73 (0,51-0,93)*OR: - 0,53 (0,30-0,93)**p: ‹0,001**p: ‹0,004**p: 0,05**p: 0,035‡‡APS (*OR %95 confidence range)††SLE (*OR %95 confidence range)**p value**p valueNumber of abortion*OR: 3,7 (1,68-8,43)*OR: 7,5 (2,78-20,25)after diagnosis**p: ‹0,001**p: 0,001‡‡APS (*OR %95 confidence range)**p valueNumber of curettage*OR: 5,5 (1,94-15,84) **p: 0,001Number of live birth*OR: - 0,20 (0,05-0,75) **p: 0,017

*OR: Odds Ratio

**p‹0,05 significant

†FMF: Family Mediterranean Fever

‡RA: Rheumatoid Arthritis

¶AS: Ankylosing Spondylitis

§PSA: Psoriatic Arthritis

††SLE: Systemic Lupus Erythematosus

‡‡APS: Anti Phospholipid Syndrome

Figure 1.

Distribution of patients according to drug use and drugs used during pregnancy

Conclusion

Women with rheumatic diseases should be in remission before pregnancy and should be followed closely throughout their pregnancy and treated with pregnancy-safe drugs. Preparations that can cause infertility in women during the reproductive period should not be used as much as possible. Patients should be informed in detail about the effects of their disease and the drugs used on pregnancy.

References

[1]Peterson E. A., Lynton J., Bernard A., Santillan M. K., Bettendorf B., Rheumatologic Medication Use During Pregnancy, Obstetrics & Gynecology: May 2020 - Volume 135 - Issue 5 - p 1161-1176doi: 10.1097/AOG.0000000000003755.

Acknowledgements

We would like to thank to Biostatistics Faculty Member Dr. Ziynet Çinar.

Disclosure of Interests

None declared

The role of three dimensional transesophageal echocardiography novel score in the success of redo percutaneous mitral balloon valvuloplasty

Funding Acknowledgements

Type of funding sources: None.

Background

Mitral valve morphology is traditionally evaluated according to the images of two-dimensional transthoracic echocardiography and Wilkins score (WS) criteria in the selection of suitable patients for Percutaneous balloon mitral valvuloplasty (PBMV).  However, WS does not include mitral commissural morphology, it is known that not only WS but mitral valve commissure morphology is also important in the success of PBMV. It is known that mitral stenosis might develop secondary to the progression of the disease in the follow-up of the patients after first PBMV, and there are a limited knowledge about outcome and success in terms of redo PBMV.

Purpose

We aimed to determine whether WS in redo PMBV is sufficient in the success of procedure and additionally we have evaluated a novel scoring system including three dimensional (3D) transesophageal echocardiography (TEE) of the mitral valve structure before redo PBMV in terms of success of the procedure.

Methods

Our study designed as a retrospective, single center study. Fifty patients who underwent redo PMBV were included in the study. The patients were divided into two groups according to the success of the Redo PMBV procedure which was defined as post-procedural Mitral valve area (MVA) ≥ 1.5 cm2 and post-procedural mitral regurgitation less than moderate by echocardiographic evaluation immediately after Redo PMBV. A novel score based on 3D TEE findings was created by analyzing the images recorded before Redo PMBV and by evaluating the mitral commissure and calcification. The role of traditional WS and novel score in the success of the procedure were investigated.

Results

In the study group, 36 patients (72%) had successful redo PMBV procedure. WS was 8 (IQR 7 - 9) and novel 3D TEE score was found 4 (IQR 3 - 4) in the whole study group. While no statistically significant relationship was found between WS and procedural success (p = 0.187), a statistically significant relationship was found between novel 3D TEE score and procedural success (p = 0.042). According to these findings; when both models were compared, the predictive accuracy and performance of the model developed with novel 3D TEE score to predict procedural success was found to be more favorable than the model developed with WS. When the probability of procedural success was calculated according to novel 3D TEE score using univariable logistic regression analysis, the probability of procedural successes was calculated &gt; 90%, especially when novel 3D TEE score was &lt;4. 

Conclusion

The novel 3D TEE score might be an informative scoring system in the selection of suitable patients for successful redo PMBV, especially in patients who are considered for surgery due to the high WS. Abstract Figure. Definition of novel 3D TEE scoring  Abstract Figure. Information about novel 3D TEE scoring

Study of Aqueous Ecballium Elaterium as Fibrinolytic in The Rabbit Model of Intrapleural Empyema

Aims

We aimed to investigate of intrapleural use of ecballium elaterium (EE) in a rabbit model empyema.

Methods

An empyema was induced in 21 rabbits after inoculation of Staphylococcus aureus. Glucose levels, pH, lactate dehydrogenase levels, and amounts of pleural drainage were evaluated in addition to pleural and empyema scores. The rabbits were divided into three groups, each 7, the isotonic solution, the streptokinase, and the ecballium group.

Results

At autopsy, there was no difference in pH, glucose, and LDH levels in three groups. The mean pleural drainage was greater in the ecballium group. A significant difference was detected between groups in terms of drainage amounts and pleural and empyema scores (P < 0.05). A significant difference in pleural and empyema scores was detected in the ecballium and streptokinase groups (P < 0.05). EE group had significant differences in drainage amounts and plural and empyema scores regard to the control group (P < 0.05). No significance was found between streptokinase and EE groups.

Conclusion

We conclude that intrapleural use of EE is at least as effective as streptokinase for the treatment of empyema.

The opioid peptide biphalin modulates human corneal epithelial wound healing in vitro

PURPOSE

Analgesic drugs, including nonselective opioids and non-steroidal anti-inflammatory drugs, should be used with great precautions to relieve pain after trauma to the corneal epithelium because of their unfavorable effects on wound healing. Biphalin is a synthetic opioid peptide that has been demonstrated to possess a strong analgesic effect on rodents. The purpose of this study is to investigate the effects of biphalin on human corneal epithelial wound healing.

METHODS

An immortalized human corneal epithelial cell (HCEC) culture was used to analyze the effects of biphalin on wound healing. The toxicity of biphalin at various concentrations was measured by the MTT assay. The effects of 1μM and 10μM biphalin on wound closure, cell migration and proliferation were tested in an in vitro scratch assay of HCECs. Naloxone, a non-selective competitive opioid receptor antagonist, was also used to inhibit the effects of biphalin in all experiments.

RESULTS

Biphalin did not cause any toxic effect on HCECs at concentrations lower than 100μM at various incubation time points. Biphalin significantly increased wound healing at 1μM concentration in an in vitro scratch assay of HCECs (P<0.05). It also significantly increased migration of HCECs (P<0.01). There was no significant difference between the biphalin and control groups of HCECs in the Ki67 proliferation assay.

CONCLUSION

Biphalin, which is a synthetic opioid peptide, promotes corneal epithelial wound healing by increasing cell migration. This role should be evaluated in further in vivo and clinical studies.

AB0893-HPR TREATMENT SATISFACTION, EXPECTATIONS, PATIENT PREFERENCES, AND CHARACTERISTICS IN PATIENTS WITH RHEUMATOID ARTHRITIS (RA): TURKISH COHORT RESULTS OF THE SENSE STUDY

Background:

Suboptimal control of RA may lead to severe and progressive articular damage, loss of function, and deterioration of the quality of life (QoL).

Objectives:

To assess treatment satisfaction, sociodemographic, clinical, health care resource utilization, and QoL characteristics of patients with sub-optimally controlled RA and treated with conventional synthetic and/or biologic DMARDs.

Methods:

This study was an international, multicenter, cross-sectional, non-interventional study. Adult RA patients with moderate to severe disease activity (DAS28>3.2) were enrolled. Patient satisfaction was evaluated with Treatment Satisfaction Questionnaire for Medication (TSQM, version 1.4) with a scale ranging from 0 (indicating poor satisfaction) to 100 (indicating perfect satisfaction). Patients were questioned regarding treatment adherence, patient preferences, and expectations. Workability was evaluated using Work Productivity and Activity Impairment Questionnaire-Rheumatoid Arthritis (WPAI-RA, version 2.0). Short Form 36 (V2) survey were performed to all patients.

Results:

One hundred sixty-four patients were included in the study and most (78.0%) were female. The median age was 57.0 years, ranging between 22.0 and 84.0 years. Half of the patients (50.6%) were primary school graduates and 6.1% were unemployed due to RA and seeking work. Median time since RA diagnosis was 8.0 years and mean (±SD) DAS28-CRP score was 4.8 (±1.0). Mean total activity impairment was 54.9% (±27.4). In the past 3 months from enrollment, the mean number of healthcare professional and emergency room visits were 1.8 (±1.1) and 1.8 (±1.3), respectively. Mean number and length of hospitalizations in the previous 3 months were 1.1 (±0.3) times and 8.3 (±7.2) days, respectively. Mean TSQM scores were 53.5 (±21.4) for effectiveness, 86.0 (±26.7) for side effects, 67.8 (±16.5) for convenience, and 57.7 (±22.0) for global satisfaction. The leading expectation was ‘lasting relief of RA symptoms’ (mean score: 5.8). Preferred time until the effect of onset was ‘up to 1 week’ for 76.2% of the patients. Most of the patients (57.9%) preferred oral administrations and the most preferred frequency of administration was ‘once per day’ (46.3%). Mean physical and mental component summary scores for Short Form 36 (V2) survey were 37.9 (±8.3) and 40.1 (±10.7).

Conclusion:

Two-thirds of the patients with RA who have suboptimal responses are not satisfied with their treatments. Moreover, oral and once-daily treatment approaches stand out in patient preferences. Finally, suboptimal control leads to deterioration in clinical characteristics, workability, and QoL of patients with RA.

Acknowledgements:

The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie participated in the interpretation of data, review, and approval of the publication. All authors have received research funding for this study. The authors wish to thank B. Murat Ozdemir of Monitor CRO for medical editing and reviewing services of this manuscript. AbbVie provided funding to Monitor CRO for this work.

Disclosure of Interests:

Umut Kalyoncu Speakers bureau: AbbVie, Pfizer, UCB, Novartis, and Janssen, Consultant of: AbbVie, Pfizer, UCB, Novartis, and Lilly, Grant/research support from: AbbVie, Pfizer, and Janssen, Adem Kucuk Speakers bureau: AbbVie, Gokhan Sargin: None declared, Fatih Ozdener Speakers bureau: UCB, Nutricia Advanced Medical Nutrition, Grant/research support from: Nutricia Advanced Medical Nutrition, Servet Yolbaş Speakers bureau: AbbVie, UCB, Pfizer, and MSD, Berna Yurttas: None declared, Sezin Turan: None declared, Gezmiş Kimyon Speakers bureau: AbbVie, Amgen, Pfizer, Novartis, UCB, MSD, Johnson and Johnson, and Celltrion, Consultant of: Amgen, and Pfizer, ALI SAHIN Speakers bureau: Roche, Pfizer, and AbbVie, Consultant of: Roche and Pfizer, Sedat Yilmaz Speakers bureau: UCB, Pfizer, AbbVie, MSD, Novartis, and Celltrion, Consultant of: Pfizer and Novartis, Ridvan Mercan Speakers bureau: AbbVie, Novartis, MSD, Pfizer, UCB, Roche, Amgen, and Celltrion, Consultant of: Novartis, MSD, Pfizer, and Celltrion, Hakan Emmungil Speakers bureau: AbbVie, Pfizer, Novartis, and MSD, Muhammet Çinar Speakers bureau: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, Grant/research support from: AbbVie, Pfizer, Celltrion, UCB, Amgen, Novartis, and MSD, İlhan Sezer Speakers bureau: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Consultant of: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Grant/research support from: AbbVie, Pfizer, MSD, Novartis, Celltrion, UCB, Amgen, and Abdi Ibrahim, Timuçin Kaşifoğlu Speakers bureau: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Consultant of: AbbVie, Amgen, Roche, MSD, Novartis, Pfizer, and UCB, Fulya Cosan Speakers bureau: AbbVie, Pfizer, Novartis, UCB, and MSD, Taskin Senturk: None declared, Nevsun Inanc Speakers bureau: AbbVie, UCB, Novartis, Pfizer, Roche, Lilly and MSD, Consultant of: Roche and Pfizer, Grant/research support from: Roche and Pfizer

Crossing mesh tails in the Lichtenstein repair method for medial (direct) inguinal hernia: recurrence and chronic pain rates after five years

PURPOSE

This study aimed to determine whether crossing of the mesh's lateral tails is beneficial in Lichtenstein repairs for medial (direct) inguinal hernias.

METHODS

We allocated 116 patients with unilateral medial (direct) inguinal hernias into two groups: mesh tail crossing (group C) or no mesh tail crossing (group N). In group C, the lateral tails were sutured together at the inguinal ligament, whereas the lateral tails were sutured in a parallel position in group N. Visual analog scale (VAS) scores were postoperatively recorded in person at the 1st, 7th, 30th, and 90th days and at the 1st year. The Short-Form Health Survey (SF-36) scores were calculated postoperatively at one month and one year. Examinations to detect hernia recurrence were performed at the end of the 1st year. Follow-ups at the 5th year were performed via phone calls to obtain the Sheffield pain scale and VAS values and to determine the possibility of hernia recurrence.

RESULTS

VAS and SF-36 scores at the 1st, 7th, 30th, and 90th days and 1st year were all higher in group C than in group N. In group C, one patient experienced moderate pain, and one experienced severe pain. In the 5th year, VAS and Sheffield pain scores were significantly higher in group C than in group N.

CONCLUSIONS

During Lichtenstein repair for medial (direct) inguinal hernias, crossing of the mesh tails may increase the frequency of postoperative chronic inguinal pain.

Effects of resveratrol on alpha-amanitin-induced nephrotoxicity in BALB/c mice

Alpha-amanitin (α-AMA), the primary toxin of Amanita phalloides, is known to cause nephrotoxicity and hepatotoxicity. Resveratrol is an antioxidant that has shown efficacy in many nephrotoxicity models. The aim of this study was to investigate the effects of resveratrol against the early and late stages of α-AMA-induced nephrotoxicity, compared to those of silibinin, a well-known antidote for poisoning by α-AMA-containing mushrooms. Mice kidney tissues were obtained from five groups: (1) α-AMA + NS (simultaneous administration of α-AMA and normal saline), (2) α-AMA + SR (simultaneous administration of α-AMA and resveratrol), (3) α-AMA + 12R (resveratrol administration 12 h after α-AMA administration), (4) α-AMA + 24R (resveratrol administration 24 h after α-AMA administration), and (5) α-AMA + Sil (simultaneous administration of α-AMA and silibinin). Histomorphological and biochemical analyses were performed to evaluate kidney damage and oxidant-antioxidant status in the kidney. Scores of renal histomorphological damage decreased significantly in the early resveratrol treatment groups (α-AMA + SR and α-AMA + 12R), compared to those in the α-AMA + NS group (p < 0.05). Catalase levels increased significantly in the α-AMA + SR group, compared to those in the α-AMA + NS group (p < 0.001). Early resveratrol administration within 12 h after α-AMA ingestion may reverse the effects of α-AMA-induced nephrotoxicity, partly through its antioxidant action, thereby suggesting its potential as a treatment for poisoning by α-AMA-containing mushrooms.

Abstract P1-05-05: eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer

The AURKA gene, encoding Aurora kinase-A (Aurora-A), is frequently amplified and overexpressed across multiple cancer types correlating with poor prognosis. Although the AURKA gene is frequently amplified in human cancers, underlying mechanism(s) for Aurora-A protein stability through different phases of cell cycle are not well elucidated. Inhibiting the kinase activity and promoting protein degradation are two well-validated conceptual strategies for targeting protein kinases in cancers. Here, we demonstrate that Eukaryotic Elongation Factor 1 Alpha 2 (eEF1A2) facilitates PTEN-GSK3β mediated Aurora-A protein degradation through the SCF complex (SKP1-Cul1-FBXW7) during the S/G2 phase of proliferating cells. In contrast, this mechanism is inactivated in cancer cells accompanying PTEN-GSK3β pathway deficiency. Mechanistically, eEF1A2 interacts with Aurora-A, GSK3β, FBXW7 and Cul1-E3 ligase, as the SCF complex, to facilitate Aurora-A polyubiquitination for 26S proteasomal degradation. eEF1A2 promotes PTEN phosphorylation at T366 and stability, inactivates AKT and activates GSK3β which in turn phosphorylates Aurora-A at S283, S284 and S342. The phosphorylation of Aurora-A at S342 is detected during S/G2 phase of cell mitosis in parallel with eEF1A2-SCF complex formation with active form of GSK3β and neddylated Cul1. Conversely, genetic ablation of EEF1A2 and PTEN, activation of AKT, inhibition of GSK3β, expression of Aurora-A phosphodeficient-mutant attenuates the Aurora-A protein degradation which is corroborated in Aurora-A overexpressing mouse mammary carcinomas and human breast carcinomas. This study identifies a novel mechanism of Aurora-A protein degradation mediated eEF1A2-PTEN-GSK3β pathway and provides a framework for the discovery of Aurora-A therapeutic targets in breast cancer that harbors deficiency of PTEN tumor suppressor pathway.

Citation Format: Treekitkarnmongkol W, Solis LM, Kai K, Thompson AM, Tian W, Wistuba II, Sasai K, Jltsumori Y, Sahin AA, Hawke DH, Lee JM, Qin L, Bawa-Khalfe T, Rad R, Wong KK, Abbott CM, Katayama H, Sen S. eEF1A2 facilitates PTEN-GSK3β mediated Aurora-A protein degradation during S-G2 phase inactivated in PTEN-deficient breast cancer [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 P1-05-05.

Abstract P6-17-38: Clinical and pathological features of breast cancer with 'polysomy' of Chromosome 17

Background: Anti-HER2 therapy is a standard of care for patients with HER2+ breast cancer. HER2 status is routinely evaluated using immunohistochemical stain and/or florescence in situ hybridization (FISH). Interpretation of FISH results may be challenging in tumors with 'polysomy' of chromosome 17 ('polysomy'17), which is defined by increased chromosome enumeration probe 17 (CEP17) signal number. There is evident that 'polysomy'17 might account for anti-HER2 therapy response in breast cancer (BC) with normal HER2/CEP17 ratio. This study aims to study the clinical and pathological features of BC with 'polysomy'17. Method: Primary BC were selected based on elevated CEP17 count (≥3.0) in HER2 FISH performed at MD Anderson Cancer Center between April 2014 and March 2018 (n=385). Patient charts were reviewed for detailed clinical and pathological features. These cases were further divided into four groups according to HER2/CEP17 and HER2 copy number, based on ASCO-CAP guidelines: group 1 (HER2+) – HER2/CEP17≥2.0, HER2 copies≥4.0; group 3 (HER2+) – ratio&lt;2.0, HER2 copies≥ 6.0; group 4 (HER2 equivocal) – ratio &lt;2.0, HER2 copies ≥4.0 and &lt;6.0; group 5 (HER2-) – ratio&lt;2.0, HER2 copies&lt;4.0. Chi-square tests were performed to study the difference of these characters. Results: In comparison with groups 1 and 3, BC in groups 4 and 5 are more commonly seen in elder patients (p=0.001). Also, these tumors show higher pathological category (p&lt;0.001) and higher rate of lymph nodes metastasis (p&lt;0.05). The clinical and pathological features are summarized in [Table 1]. Conclusion: Understanding the clinical and pathological features of BC with 'polysomy'17 may help clinically to choose patients who might be benefit from anti-HER2 therapy. Further study is to follow up the therapy response of those who received anti-HER2 treatment in this cohort of patients.

Clinical and pathological characteristics of breast cancer with 'polysomy' of chromosome 17  Total (N=385)Group 1 ( N=131)Group 3 (N=25)Group 4 (N=69)Group 5 (N=160)P valueAge (year)Mean (range)56.8 (25-94)53.9 (25-83)52.8 (26-75)58 (33-92)59.3 (29-94)0.001Race RaceBlack (%)37 (9.6)14 (10.7)4 (16)5 (7.2)14 (8.8)0.873 Hispanic (%)61 (15.8)23 (17.6)3 (12)12 (17.4)23 (14.4)  White (%)251 (65.2)82 (62.6)14 (56)44 (63.8)111 (69.4)  Other (%)36 (9.4)12 (9.1)4 (16)8 (11.6)12 (7.4) GenderFemale (%)383 (99.5)131 (100)25 (100)68 (98.6)159 (99.4)0.478 Male (%)2 (0.5)0 (0)0 (0)1 (1.4)1 (0.6) Histology typeIDC, NOS (%)350 (90.9)121 (92.4)20 (80)66 (95.7)143 (89.4)0.471 ILC (%)9 (2.3)3 (2.3)1 (4)0 (0)5 (3.1)  Others (%)26 (6.8)7 (5.3)4 (16)3 (4.3)12 (7.5) Nuclear gradeI (%)4 (1.2)2 (1.8)0 (0)1 (1.8)1 (0.7)0.044 II (%)122 (37)30 (26.3)12 (50)19 (33.3)61 (45.5)  III (%)203 (61.8)82 (71.9)12 (50)37 (64.9)72 (53.8)  NA561711226 Pathological tumor categorypT0+Tis (%)61 (21)36 (36.3)3 (20)5 (10.9)17 (13.1)&lt;0.001 pT1 (%)125 (43.2)39 (39.4)7 (46.7)20 (43.5)59 (45.4)  pT2+T3+T4 (%)104 (35.8)24 (24.3)5 (33.3)21 (45.6)54 (41.5)  NA9532102330 Pathological lymph node categorypN0 (%)187 (65.4)81 (82.7)11 (73.3)22 (47.8)73 (57.5)0.048 pN1+N2+N3 (%)99 (34.6)17 (17.3)4 (26.7)24 (52.2)54 (42.5)  pNx (%)9933102333 

Citation Format: Sun H, Chen H, Lim B, Sahin AA. Clinical and pathological features of breast cancer with 'polysomy' of Chromosome 17 [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 P6-17-38.

Abstract P3-10-23: Changes in the expression of HER2 and other genes in HER2-positive metastatic breast cancer induced by treatment with ado-trastuzumab emtansine and/or pertuzumab/trastuzumab

Background: Although tremendous progress has been achieved with targeted therapy for HER2-positive (HER2+) metastatic breast cancer, most advanced tumors eventually develop resistance. Improving our understanding of mechanisms of resistance to anti-HER2 therapy is needed to develop new therapeutic approaches. The purpose of this study was to identify the mechanisms of resistance to treatment with ado-trastuzumab emtansine (T-DM1) and/or taxane/pertuzumab/trastuzumab (TPH).

Methods: In our preclinical analysis, HER2+ cell lines resistant to treatment with T-DM1 (n=5), and pertuzumab/trastuzumab (n=3) were generated. HER2 expression in the original and resistant cell lines was compared using Western blot, and HER2 gene amplification was compared in them using fluorescence in situ hybridization (FISH) and a Droplet Digital Polymerase Chain Reaction HER2 copy-number-validation assay. In our clinical analysis, nine patients with HER2+ metastatic breast cancer who had progressed on T-DM1 and/or TPH were enrolled. Patients underwent biopsies following treatment with T-DM1 and/or TPH. Targeted next-generation sequencing was performed using the FoundationOne® assay (Foundation Medicine, Inc.) to identify gene alterations. Also, the HER2 expression before and after the therapy was compared using immunohistochemistry and/or FISH.

Results: In preclinical analysis, HER2 expression/amplification by Western blot and gene copy-number analysis was significantly decreased in T-DM1–resistant cell lines (four of five cell lines; P &lt; 0.01) but not in pertuzumab/trastuzumab-resistant cell lines (none of three cell lines). In clinical analysis, the patients' median age was 54 years (range, 45-77 years), and five patients (56%) were ER+. Five patients (56%) received first-line anti-HER2 therapy, and four patients (44%) received two lines of anti-HER2 therapy prior to enrollment. We observed loss of HER2 expression in four of nine patients (44%) after undergoing anti-HER2 therapy. After receiving TPH, one of eight patients (13%) lost HER2 positivity according to FISH. In contrast, after T-DM1, three of four tested patients (75%) lost HER2 amplification by FISH. As for next-generation sequencing, we analyzed seven samples: three after treatment with TPH and four after treatment with T-DM1. In four of these samples (57%), we observed loss of HER2 amplification: one after treatment with TPH and three after treatment with T-DM1. TP53 mutations were seen in all patients. Additionally, we observed TOP2A and MCL1 amplification in two patients with ERBB2 amplificationand AKT1 amplification in one patient with ERBB2 amplification loss.

Conclusions: We show for the first time that T-DM1–resistant breast cancer cells lose HER2 expression and amplification. Additionally, we observed loss of HER2 expression in patient samples following treatment with HER2 targeted therapy. Further study of resistant tumor samples is required to understand the impact of HER2 loss on outcomes. For the time being, repeating biopsy analysis of a metastatic site after treatment with T-DM1 to determine the HER2 expression status is reasonable, and it may increase the efficacy of future anti-HER2 therapy.

Citation Format: Kida K, Lee J, Liu H, Lim B, Murthy RK, Sahin AA, Tripathy D, Ueno NT. Changes in the expression of HER2 and other genes in HER2-positive metastatic breast cancer induced by treatment with ado-trastuzumab emtansine and/or pertuzumab/trastuzumab [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 P3-10-23.

Characterization of bevacizumab by dynamic light scattering while maintaining its native structure

Bevacizumab, is a humanized monoclonal antibody and patents on Avastin® (Bevacizumab, Roche) will expire in the US in 2019 and in Europe in 2022. Therefore, bevacizumab is a popular target for biosimilar developers. One of the most common problems in the formulation of antibody drugs is protein aggregation. Dynamic light scattering (DLS) is a well-established method for the determination of hydrodynamic dimensions, aggregates, and aggregation points of proteins. In contradistinction to other techniques that require diluted samples or specific conditions, proteins and aggregates can maintain their native structure during DLS measurements. In recent studies, bevacizumab was characterized by DLS using diluted samples. In this study, we aimed at investigating the hydrodynamic dimensions, aggregates, and aggregation onset of bevacizumab (Altuzan®, Turkey, Roche) by DLS, while maintaining its native structure. The intensity, volume, and number-based particle size distribution profiles of the test samples were evaluated and the aggregation onset of the formulation was successfully determined against increasing temperature. It is shown that the preservation of the native structure of commercial formulations in DLS measurements provides an opportunity to the characterization of commercial products and development of biosimilars.

The diagnostic value of the serum irisin level in patients with acute pericarditis and acute myopericarditis

OBJECTIVE

This preliminary study aims to examine a change in the blood levels of irisin in patients with acute pericarditis (AP) and acute myopericarditis (AMP) and examine the diagnostic value of the serum irisin level in AP and AMP.

METHODS

10 patients, who applied to the emergency service and cardiology clinic with chest pain and who were diagnosed with AP and 5 patients, who were diagnosed with AMP as a result of routine examinations, were included in the study. The basal laboratory parameters, echocardiography findings and serum irisin levels of the patients and during check one month later were examined.

RESULTS

While the basal irisin levels were found to be significantly low in the AMP group and high during the check (6.6 ± 1.58, 8.19 ± 1.43, respectively), no statistically significant difference was determined (p = 0.23). It was observed that the basal and control irisin levels did not vary significantly in the AP group (8.03 ± 1.6, 8.19 ± 1.43, respectively) (p = 0.84).

CONCLUSION

In this preliminary study, the basal irisin levels were found to be significantly low in the AMP group, while there was no statistically significant difference between the basal irisin levels and control irisin levels in the AP and AMP groups (Tab. 5, Ref. 17).

Using PVA and TPGS as combined emulsifier in nanoprecipitation method improves characteristics and anticancer activity of ibuprofen loaded PLGA nanoparticles

In the preparation of nanoparticles (NPs) by the nanoprecipitation method, emulsifiers play a key role for NPs' characteristics. The present study aimed to investigate the combined emulsifier effect on ibuprofen loaded poly(lactic-co-glycolic acid) (PLGA) NPs' characteristics and anticancer activity. Ibuprofen loaded PLGA NPs were prepared by nanoprecipitation using different concentrations of PVA (poly(vinyl alcohol)) or PVA-TPGS (d-α-tocopherol polyethylene glycol 1000 succinate) combination as emulsifier. It was found that encapsulation efficiencies of NPs varied between 17.9 and 41.9 % and the highest encapsulation efficiency was obtained with 0.5% PVA + 0.1% TPGS (coded as PLGA PVA/TPGS NPs). PLGA PVA/TPGS NPs were characterized and compared with PLGA PVA NPs, which was obtained by 0.5% PVA alone. Polydispersity index of PLGA PVA/TPGS and PLGA PVA NPs were found to be 0.08 and 0.15, respectively. Incorporation of TPGS with PVA slightly decreased the initial ibuprofen release. Transmission electron microscopy analyses demonstrated a nearly uniform particle size distribution and spherical particle shape of the PLGA PVA/TPGS NPs. Additionally, PLGA PVA/TPGS NPs were significantly more cytotoxic than PLGA PVA NPs on the MCF-7 (human breast adenocarcinoma cells) and Caco-2 (human epithelial colorectal adenocarcinoma) cells (p<0.05). Also PLGA PVA/TPGS NPs were not cytotoxic on normal cells (L929, mouse healthy fibroblast cells) (p>0.05). In conclusion, these results indicated that using a combination of TPGS and PVA as an emulsifier in nanoprecipitation could be a promising approach for preparing ibuprofen loaded PLGA NPs because of their improved characteristics and anticancer activity.

Multidisciplinary Intraoperative Assessment of Breast Specimens Reduces Number of Positive Margins

BACKGROUND

Successful breast-conserving surgery requires achieving negative margins. At our institution, the whole surgical specimen is imaged and then serially sectioned with repeat imaging. A multidisciplinary discussion then determines need for excision of additional margins. The goal of this study was to determine the benefit of each component of this approach in reducing the number of positive margin.

METHODS

This single-institution, prospective study included ten breast surgical oncologists who were surveyed to ascertain whether they would have taken additional margins based their review of whole specimen images (WSI) and review of serially sectioned images (SSI). These results were compared with the multidisciplinary decisions (MDD) and pathology results. Margin status was defined using consensus guidelines.

RESULTS

One hundred surveys were completed. Margins on the original specimen were positive or close in 21%. After WSI, surgeons reported that they would have taken additional margins in 26 cases, reducing the number of positive/close margins from 21 to 13% (p < 0.001). After SSI, 52 would have taken additional margins; however, the number of positive/close margins remained 13%. MDD resulted in additional margins taken in 56 cases, reducing the number of positive/close margins to 7% (p < 0.001 compared with SSI).

CONCLUSIONS

While surgeon review of specimen radiographs can decrease the number of positive or close margins from 21 to 13%, more rigorous multidisciplinary, intraoperative margin assessment reduces the number of close or positive margins to 7%.

Revisiting the definition of estrogen receptor positivity in HER2-negative primary breast cancer

Background

Although 1% has been used as cut-off for estrogen receptor (ER) positivity, several studies have reported that tumors with ER < 1% have characteristics similar to those with 1% ≤ ER < 10%. We hypothesized that in patients with human epidermal growth factor 2 (HER2)-negative breast cancer, a cut-off of 10% is more useful than one of 1% in discriminating for both a better pathological complete response (pCR) rate to neoadjuvant chemotherapy and a better long-term outcome with adjuvant hormonal therapy. Our objectives were to identify a percentage of ER expression below which pCR was likely and to determine whether this cut-off value can identify patients who would benefit from adjuvant hormonal therapy.

Patients and methods

Patients with stage II or III HER2-negative primary breast cancer who received neoadjuvant chemotherapy followed by definitive surgery between June 1982 and June 2013 were included. Logistic regression models were used to assess the association between each variable and pCR. Cox models were used to analyze time to recurrence and overall survival. The recursive partitioning and regression trees method was used to calculate the cut-off value of ER expression.

Results

A total of 3055 patients were analyzed. Low percentage of ER was significantly associated with high pCR rate (OR = 0.99, 95% CI = 0.986-0.994, P < 0.001). The recommended cut-off of ER expression below which pCR was likely was 9.5%. Among patients with ER ≥ 10% tumors, but not those with 1%≤ER < 10% tumors, adjuvant hormonal therapy was significantly associated with long time to recurrence (HR = 0.24, 95% CI = 0.16-0.36, P < 0.001) and overall survival (HR = 0.32, 95% CI = 0.2-0.5, P < 0.001).

Conclusion

Stage II or III HER2-negative primary breast cancer with ER < 10% behaves clinically like triple-negative breast cancer in terms of pCR and survival outcomes and patients with such tumors may have a limited benefit from adjuvant hormonal therapy. It may be more clinically relevant to define triple-negative breast cancer as HER2-negative breast cancer with <10%, rather than <1%, of ER and/or progesterone receptor expression.

Development and validation of a LC-FL method for the simultaneous determination of doxorubicin and celecoxib in nanoparticulate fixed dose combination (NanoFDC)

An isocratic reversed phase HPLC method for the simultaneous determination of doxorubicine (DOX) and celecoxib (CXB) out of a nanoparticulate fixed dose combination (NanoFDC) was developed and validated. Linearity of the results was demonstrated from 1-11 μg/mL for both components. Lower limits of detection were determined as 7 ng/mL for DOX and 13 ng/mL for CXB. Total run time was approximately 15 min.

The effect of mad honey on testosterone levels of male rats

OBJECTIVE

We aimed to investigate the effect of mad honey on sexual performance.

BACKGROUND

In traditional medicine in Turkey, mad honey is used to improve appetite, to heighten mental alertness, to reduce joint pain, to eliminate gastrointestinal system pains and to increase sexual performance.

METHODS

In this experimental animal study eighteen Sprague Dawley male rats were randomized into three groups, a control group, a normal honey group and a mad honey group. Rats in the treatment groups were given a daily dose of 80 mg/kg normal honey or mad honey throughout the 30-day study period. Total testosterone, free testosterone, FSH, LH, estradiol, and progesterone levels were subsequently investigated from blood sera on day 30.

RESULTS

Comparison of blood total testosterone levels among the groups revealed significantly higher levels in the mad honey group compared to the normal honey and control groups (p = 0.006, p = 0.00). Free testosterone levels were also significantly higher in the mad honey group than in the normal honey and control groups (p = 0.023, p = 0.01). No statistically significant differences were determined for other hormonal measurements.

CONCLUSIONS

This study revealed a significant increase in both total and free testosterone levels in mad-honey group (Tab. 1, Fig. 2, Ref. 16).

Abstract P1-08-09: Aurora kinase-A protein stability is negatively regulated by eEF1α2 and PTEN in breast cancer: Prognostic and therapeutic implications

Background: The AURKA gene encoding Aurora kinase-A (Aurora-A) protein is localized on chromosome 20q13 that is frequently amplified and overexpressed across multiple cancer types correlating with patient prognosis. Aurora-A plays a pivotal role in faithful segregation of chromosomes and normal progression of mitosis, peaking at G2/M followed by degradation at the end of mitosis by APC/C (Cdh1). However, regulation of Aurora-A protein stability in human cancer cells is not well elucidated. Here, we show that Aurora-A is targeted for ubiquitination and degradation by SCF complex involving eEF1α2 and PTEN in human breast cancer cells. Methods: Using a panel of breast cancer cell lines, as in vitro models, the eEF1α2 was knocked down or ectopically expressed to test the stability of Aurora-A protein. For in vivo models, tissue micro arrays of human breast cancer were immunostained for Aurora-A and eEF1α2 expression and categorized values were statistically tested by Chi-squared test. In addition, the public breast cancer dataset (Transbig) was used to predict breast cancer prognosis by Kaplan-Meier survival analysis. Results: In breast cancer cell lines and patient samples, an eEF1α2 non-expressing group showed a trend of higher Aurora-A expression than eEF1α2 expressing group, whose trend was significant in patient samples (P&lt;0.05). Knocking down of eEF1α2 enhanced Aurora-A protein stability. In contrast, ectopic expression of eEF1α2 dramatically decreased Aurora-A protein stability. Inhibition of proteasome activity by MG132 could restore the Aurora-A protein in eEF1α2 expressing cells. Biochemical assays showed the direct binding between eEF1α2 and Aurora-A, and eEF1α2 dependent ubiquitination of Aurora-A. Inverse correlation of the expression levels of the two proteins was also observed throug the cell cycle, with eEF1α2 levels being high from G1 through G2 phases while Aurora-A expression peaked from G2/M phase through cytokinesis. Taken together, these findings highlight eEF1α2 as a novel negative regulator destabilizing Aurora-A through ubiquitin-proteasome proteolytic pathway. Further, mechanistic studies revealed that eEF1α2 enhanced the interaction of SCF E3 ubiquitin ligase complex protein; FBXW7 and Cul1, with Aurora-A. In line with this scenario, knocking down of Cul1 increased Aurora-A level. Since PTEN loss was reported to stabilize Aurora-A through inhibiting SCF complex, we tested the significance of PTEN loss in our model. Knocking down of PTEN further stabilized Aurora-A suggesting an independent role of PTEN from eEF1α2 in destabilizing Aurora-A. When eEF1α2 expressing cells were treated with AKT inhibitor, Aurora-A was destabilized with enhanced bindings between Aurora-A and FBXW7/Cul1. Lastly, low PTEN expression correlated with poor prognosis of Aurora-A over expressing breast cancer patients (P&lt;0.01). Conclusions: Aurora-A overexpression in human breast cancer cells may be associated with loss of eEF1α2 and PTEN due to reduced interaction of SCF with Aurora-A. Findings indicate significant prognostic and therapeutic implications of altered expression of eEF1α2/PTEN/Aurora-A pathways among Aurora-A subset of breast cancer patients.

Citation Format: Treekitkarnmongkol W, Kai K, Katayama H, Tian W, Rodriguez-Canales J, Sahin AA, Sen S. Aurora kinase-A protein stability is negatively regulated by eEF1α2 and PTEN in breast cancer: Prognostic and therapeutic implications [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-08-09.

Dissection of Signaling Pathways in Fourteen Breast Cancer Cell Lines Using Reverse-Phase Protein Lysate Microarray

Signal transduction pathways play a crucial role in breast cancer development, progression, and response to different therapies. A major problem in breast cancer therapy is the heterogeneity among different tumor types and cell lines commonly used in preclinical studies. To characterize the signaling pathways of some of the commonly used breast cancer cell lines and dissect the relationship among a number of pathways and some key genetic and molecular events in breast cancer development, such as p53 mutation, ErbB2 expression, and estrogen receptor (ER)/progesterone receptor (PR) status, we performed pathway profiling of 14 breast cancer cell lines by measuring the expression and phosphorylation status of 40 different cell signaling proteins with 53 specific antibodies using a protein lysate array. Cluster analysis of the expression data showed that there was close clustering of phosphatidylinositol 3-kinase, Akt, mammalian target of rapamycin (mTOR), Src, and platelet-derived growth factor receptor β (PDGFRβ) in all of the cell lines. The most differentially expressed proteins between ER- and PR-positive and ER- and PR-negative breast cells were mTOR, Akt (pThr308), PDGFRβ, PDGFRβ (pTyr751), panSrc, Akt (pSer473), insulin-like growth factor-binding protein 5 (IGFBP5), Src (pTyr418), mTOR (pSer2448), and IGFBP2. Many apoptotic proteins, such as apoptosis-inducing factor, IGFBP3, bad, bax, and cleaved caspase 9, were overexpressed in mutant p53-carrying breast cancer cells. Hexokinase isoenzyme 1, ND2, and c-kit were the most differentially expressed proteins in high and low ErbB2-expressing breast cancer cells. This study demonstrated that ER/PR status, ErbB2 expression, and p53 status are major molecules that impact downstream signaling pathways.

Abstract P5-08-04: Bioscore: A novel staging system for breast cancer patients receiving neoadjuvant chemotherapy

Background: We previously described a novel breast cancer staging system, the CPS+EG score, which incorporates pretreatment clinical stage, post-treatment pathologic stage, estrogen receptor (ER) status and nuclear grade to create an ordinal scale that is predictive of disease-specific survival (DSS) after receipt of neoadjuvant chemotherapy. The prior work predated (1997-2005) routine use of trastuzumab for patients with HER2+ disease. The current study was undertaken to update the staging system with a more contemporary cohort of patients to include patients with HER2+ disease receiving trastuzumab. The impact of using 1% as the cutoff for ER-positivity was also assessed.

Methods: A cohort of 2377 patients treated with neoadjuvant chemotherapy from 2005-2012 was identified. Clinicopathologic characteristics, treatment regimens and patient outcomes were recorded. Patient scores were computed using two versions of the CPS+EG staging system with ER status categorized as positive if &gt;10% or if &gt;1%. Fits of the Cox proportional hazards (PH) model for the two sets of prognostic scores were compared using the Akaike Information Criterion (AIC). HER2 status was then added to the model and the likelihood ratio test was used to determine the improvement in fit.

Results: Median follow-up time was 4.2 years (range, 0.5 to 11.7). Five year DSS was 89% (95% CI: 87%-90%). This cohort validated our previous finding that the CPS+EG score facilitates more refined categorization into prognostic subgroups than initial clinical or final pathologic stage alone (table). The AIC demonstrated that the CPS+EG model fits were nearly identical for ER status categorized using either cutoff, though the fit was slightly better for the &gt;1% cutoff. There were 591 HER2+ patients included; all of them received trastuzumab-based chemotherapy. The improvement in the fit of the model when HER2 status was added was highly significant (p=0.00005) and incorporation of HER2 into the CPS+EG staging system by adding one additional point for HER2-negative status defined the bioscore (table) which again stratified patients with respect to prognosis.

Conclusion: The current study demonstrates a novel bioscore that significantly improves a previously validated prognostic score in patients receiving neoadjuvant chemotherapy and allows the staging system to be applied to patients with HER2+ disease. We recommend that biologic markers and response to treatment be incorporated into the forthcoming revision of the AJCC staging system.

Clinical Stage5-yr DSS (95%CI)Pathologic Stage5-yr DSS (95%CI)CPS+EG Score (1% cutoff for ER+)5-yr DSS (95%CI)Bioscore5-yr DSS (95%CI)0 097% (95-98%)098% (92-100%)097% (78-10)%)IA96% (75-99%)IA95% (92-97%)198% (96-99%)199% (95-100%)IIA96% (94-97%)IB90% (76-98%)294% (91-95%)297% (95-98%)IIB90% (87-92%)IIA91% (87-94%)387% (84-90%)393% (90-95%)IIIA85% (80-89%)IIB86% (81-90%)475% (69-80%)486% (82-89%)IIIB78% (70-85%)IIIA80% (75-84%)552% (40-63%)571% (64-77%)IIIC76% (70-81%)IIIB64% (42-80%)60648% (35-60%) IIIC64% (55-72%)   70

Citation Format: Mittendorf EA, Vila J, Tucker SL, Chavez-MacGregor M, Smith BD, Symmans WF, Sahin AA, Hortobagyi GN, Hunt KK. Bioscore: A novel staging system for breast cancer patients receiving neoadjuvant chemotherapy. [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 P5-08-04.

Neutrophil-to-lymphocyte ratio is involved in the severity of ankylosing spondylitis

OBJECTIVE

Ankylosing spondylitis (AS) is a progressive chronic inflammatory disease mainly characterized by axial skeleton and sacroiliac joint involvement. We aimed to investigate the relation between neutrophil-to-lymphocyte ratio (NLR) and disease severity of AS and to explore its availability in clinical practice.

METHODS

A total of 102 AS patients and 60 individuals who were age- and gender-compatible with the control group were included into the study. Patients were divided into 2 groups according to Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores. Patients with BASDAI scores < 4 were considered to be having mild disease activity, whereas those with scores ≥ 4 were considered to be displaying severe disease activity. Hemogram test during the diagnosis, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) and other laboratory values of the control group were recorded.

RESULTS

NLR was observed to be higher in AS patients compared to the controls (2.47 ± 1.33 and 1.72 ± 0.47; respectively; p<0.0001). NLR was observed to be significantly higher in severe AS disease activity compared to the mild AS disease activity (2.72 ± 1.41, 2.20 ± 1.19; respectively; p = 0.001). NLR had statistical significant differences between mild disease activity compared to the controls (2.20 ± 1.19 and 1.72 ± 0.47, respectively; p = 0.263). There was a positive correlation between NLR and BASDAI (r = 0.193, p = 0.041). The performance of NLR evaluating the disease severity by Roc analysis had sensitivity of 69%, specificity of 54% (cut-off value 1.91), and AUC of 0.652 (95% Cl, 0.549-0.755) (p = 0.006).

CONCLUSIONS

NLR may be a simple and inexpensive marker to indicate disease activity in patients with AS in daily clinical practice (Tab. 3, Fig. 3, Ref. 25).

Evaluation of human chaperonin 10 and high-sensitivity C-reactive protein levels of infertile women who underwent ovulation induction and intra-uterine insemination

INTRODUCTION

The implantation of embryo is one of the crucial steps of a successful pregnancy. The foetus should be protected from maternal immune system, for the appropriate implantation and modification in maternal immunity is crucial. We investigated high-sensitivity C-reactive protein (hs CRP), which is an indicator of low-grade inflammation and Cp10 that has immunosuppressant and growth-promoting capabilities at embryo levels in ovulation induction and intra-uterine insemination (IUI)applied in infertile women. The ovulation induction was maintained by clomiphene citrate or gonadotropins for 42 infertile patients. After successful ovulation induction, IUI was carried out. The blood samples were taken 2 and 8 days after IUI to evaluate Cp10 and hs CRP levels. The pregnant and non-pregnant groups' results were analyzed. The Cp10 levels 8 days after IUI were higher in pregnant group, whereas there was no difference for the 2 days after levels between pregnant and non-pregnant group. The hs CRP levels were similar for both 2nd and 8th days when we compared pregnant and non-pregnant groups. The Cp10 levels increased from day 2 to day 8 in pregnant group. In contrast, the Cp10 levels decreased in non-pregnant group. The change in hs CRP levels from day 2 to day 8 was not significant in pregnant and non-pregnant groups. The Cp10 levels were higher in early phases of fertilisation and elevated through the preceding days of conception in pregnant patients, while it decreased in non-pregnant patients with failed cycles.

Surgical outcome of bronchiectasis in children: long term results of 60 cases

BACKGROUND

Bronchiectasis is described as destruction and the irreversible dilatation of bronchial structure. We wanted to demonstrate our surgical practice and outcome of surgical treatment in bronchiectasis.

METHODS

We studied records of 60 pediatric patients who underwent surgical resection in our clinic between January 2000 and January 2013. The results were analyzed regarding factors influencing the outcome.

RESULTS

There were 32 boys and 28 girls with a mean age of 9.45 years (range 2-15). The most common cause was childhood infection in 25 (41.66%). The mean duration of the symptoms was 42.93 months. Patients underwent 64 operations including 2 staged thoracotomies and 2 re-thoracotomies. Atelectasis was the most frequent complication. Longer duration of symptoms related to postoperative complication. The morbidity and mortality rates were 20% and 3.33%, respectively. The outcome was optimal in 92%. Forced expiratory volume in 1 s less than 60% of the predicted value, hemoptysis and duration of symptoms were found prognostic variables for postoperative morbidity with high ratios of odds coefficients by using Binary Logistic Regression Method.

CONCLUSIONS

Complete and early resection of bronchiectasis provides a successful outcome. Duration of symptoms and timely intervention have a major impact on the management and prognosis.

Open-label randomized clinical trial of standard neoadjuvant chemotherapy with paclitaxel followed by FEC versus the combination of paclitaxel and everolimus followed by FEC in women with triple receptor-negative breast cancer†

BACKGROUND

Everolimus synergistically enhances taxane-induced cytotoxicity in breast cancer cells in vitro and in vivo in addition to demonstrating a direct antiproliferative activity. We aim to determine pharmacodynamics changes and response of adding everolimus to standard neoadjuvant chemotherapy in triple-negative breast cancer (TNBC).

PATIENTS AND METHODS

Phase II study in patients with primary TNBC randomized to T-FEC (paclitaxel 80 mg/m(2) i.v. weekly for 12 weeks, followed by 5-fluorouracil 500 mg/m(2), epirubicin 100 mg/m(2), and cyclophosphamide 500 mg/m(2) every 3 weeks for four cycles) versus TR-FEC (paclitaxel 80 mg/m(2) i.v. and everolimus 30 mg PO weekly for 12 weeks, followed by FEC). Tumor samples were collected to assess molecular changes in the PI3K/AKT/mTOR pathway, at baseline, 48 h, 12 weeks, and at surgery by reverse phase protein arrays (RPPA). Clinical end points included 12-week clinical response rate (12-week RR), pathological complete response (pCR), and toxicity.

RESULTS

Sixty-two patients were registered, and 50 were randomized, 27 received T-FEC, and 23 received TR-FEC. Median age was 48 (range 31-75). There was downregulation of the mTOR pathway at 48 h in the TR-FEC arm. Twelve-week RR by ultrasound were 29.6% versus 47.8%, (P = 0.075), and pCR were 25.9% versus 30.4% (P = 0.76) for T-FEC and TR-FEC, respectively. mTOR downregulation at 48 h did not correlate with 12-week RR in the TR-FEC group (P = 0.58). Main NCI grade 3/4 toxicities included anemia, neutropenia, rash/desquamation, and vomiting in both arms. There was one case of grade 3 pneumonitis in the TR-FEC arm. No grade 3/4 stomatitis occurred.

CONCLUSION

The addition of everolimus to paclitaxel was well tolerated. Everolimus downregulated mTOR signaling but downregulation of mTOR at 48 h did not correlate with 12-week RR in the TR-FEC group.

CLINICAL TRIAL NUMBER

NCT00499603.

Prevalence of sleep disturbance in chronic pain

OBJECTIVE

Sleep is a vital function for human beings, which can be affected by several factors. Chronic pain is one of these factors where it is the most frequent cause for seeking medical care in combination with insomnia. The aim of this study is to examine the prevalence and relationship between sleep disturbance and chronic pain.

PATIENTS AND METHODS

After approval, a total of 85 Family Medicine Units from over 170 in Tokat were randomly selected using a 50% sampling. A sample of 2635 subjects, over the age of 19 years, who were registered with the selected Family Medicine Units, were assessed due to gender, age group, and the urban/rural population size of Tokat using the stratified sampling method. The sample size distribution was calculated as 1515 urban subjects, 1120 rural subjects; 1345 female subjects, 1290 male subjects; 1123 subjects between 20-39 years of age, 1103 subjects between the ages of 40-64, and 409 subjects over 64 years of age. After sampling, subjects were invited to participate in the study via an invitation letter, and agreeing individuals were taken to the Family Medicine Unit for face-to-face meetings. Written, informed consent was obtained, along with demographic data. The presence of chronic pain was recorded. According to the presence of chronic pain, all subjects were separated into two groups as Group Chronic Pain and Group Non-Chronic Pain. The visual analog scale for pain intensity, and Pittsburgh Sleep Quality Index for sleep quality, were performed with all subjects. A multiple linear regression model was used to assess the predictors of sleep quality. Analyses were conducted using the Statistical Package for Social Sciences program (SPSS Inc., Chicago, IL, USA), version 20.0. The statistical significance for all analyses was set at p < 0.05.

RESULTS

The mean global Pittsburgh Sleep Quality Index score of Group Chronic Pain (5.30 ± 4.29) was significantly higher than in Group Non-Chronic Pain (3.22 ± 3.30; p < 0.01). The mean Pittsburgh Sleep Quality Index scores of females (5.69 ± 4.40) were significantly higher than males (4.54 ± 3.96) in Group Chronic Pain (p = 0.000045). A total of 40.7% of patients in Group Chronic Pain, and 21.9% in Group Non-Chronic Pain demonstrated poorer sleep quality according to the Pittsburgh Sleep Quality Index scores, with a cut-off level > 5. A moderate positive correlation was found between the global Pittsburgh Sleep Quality Index and Visual Analog Scale scores (r = 0.310, p < 0.01). A multiple linear regression analysis showed that age, gender, income, Visual Analog Scale, and presence of depression were the significant predictors for Pittsburgh Sleep Quality Index score.

CONCLUSIONS

The current study revealed that chronic pain and pain intensity are important predictors of sleep quality.

Prognostic value of the trichorhinophalangeal syndrome-1 (TRPS-1), a GATA family transcription factor, in early-stage breast cancer

BACKGROUND

TRPS-1 is a new GATA transcription factor that is differentially expressed in breast cancer (BC) where it been found recently to regulate epithelial-to-mesenchymal transition (EMT).

PATIENTS AND METHODS

We carried out a quantitative immunohistochemistry (qIHC) analysis of TRPS-1 expression in 341 primary-stage I-III BC samples in relation to patient clinical characteristics as well as its prognostic value, especially in an estrogen receptor-positive (ER+) subgroup.

RESULTS

Higher TRPS-1 expression was significantly associated with a number of clinical and pathological characteristics as well as with improved overall survival (OS) and disease-free survival (DFS). Among stage I/II ER+ BC patients who received endocrine therapy alone, those with high TRPS-1 expression had significantly longer OS and DFS. There was also a strong association between TRPS-1 levels and the EMT marker E-cadherin in the ER+ invasive ductal carcinoma cases. Analysis of gene expression data on a panel of BC lines found that TRPS-1 expression was low or absent in BC lines having enriched mesenchymal features.

CONCLUSIONS

Our data indicated that TRPS-1 is an independent prognostic marker in early-stage BC and a new EMT marker that can distinguish patients with ER+ BC who will respond longer to adjuvant endocrine therapy.

Malaria epidemiology in mersin province, Turkey from 2002 to 2011

BACKGROUND

Malaria is an infectious disease caused by Plasmodium spp. with high morbidity and mortality in human in tropical and subtropical regions. In recent years, number of malaria cases has been significantly reduced because of fight with the disease in Turkey. This study intended to investigate the malaria epidemiology in Mersin Province from 2002 to 2011 using data from the provincial Public Health Directorate.

METHODS

Over ten years, 303573 blood samples were taken from the people by active and passive surveillance methods and blood smears were prepared. Smears were stained with Giemsa and examined under the microscope.

RESULTS

Totally, 73 people including 44 male and 29 female were positive in terms of Plasmodium spp. It was determined that P. vivax observed in 67 cases while P. falciparum in 6 cases. Cases were mainly observed in 15 to 44 years old range, showed an increase between June-September periods and a significant decrease after 2006. Out of the 73 malaria cases, 54 cases were from Mersin Province and 13 cases were imported from another province of Turkey. Six cases were transmitted from abroad.

CONCLUSION

These results provide information about malaria epidemiology in an endemic area in Turkey and contribute its prevention in Mersin Province.

Abstract P1-07-06: Effect of biospecimen variables on proteomic biomarker assessment in breast cancer

Background: PI3K/Akt/mTOR signaling is being actively pursued as a therapeutic target. We sought to determine how tumor heterogeneity and biospecimen variables affect assessment of PI3K/Akt/mTOR pathway activation.

Methods: Intraoperative image-guided core-needle biopsies (CNB) of primary breast tumors were prospectively collected in 53 patients with invasive breast cancer. After surgery, specimens were collected from the center and periphery of the excised tumor. CNB, central and peripheral surgical specimens were assessed with reverse phase proteomic arrays (RPPA), H&E and immunohistochemistry (IHC).

Results: The expression of standard of care markers ER, PR, and HER2 by RPPA correlated well between biospecimen types. Overall, there was a significant correlation between the expression of 132 (86%) of 154 different markers in the center and periphery; the correlation was significantly higher for smaller tumors, and with shorter cold ischemia time. Expression of many investigational prognostic markers and druggable targets on CNB correlated with expression in the surgical specimen (average of center and periphery), while others, such as EGFR and c-MET, had a weak correlation. Of 154 RPPA markers, 132 (86%) were not statistically different between the center and periphery, and 97 (67%) were not different between the CNB and the surgical specimen. On analysis of the PI3K/AKT/mTOR pathway, pAkt S473 and PTEN had a significant correlation between central and peripheral specimens, and between CNB and surgical specimens. However, pAkt S473, pS6 S235/236 and pS6 240/244 levels were higher in CNB than the central specimens both by RPPA and by IHC. When patients were classified by RPPA PI3K pathway activation score, there was a moderate agreement between classification on the CNB and central specimens (Cohen's Kappa 0.539). However 9 of 20 tumors classified as having PI3K activation on CNB were classified as not having pathway activation on central specimens.

Conclusions: There is remarkable homogeneity in expression of biomarkers within a tumor. However, proteomic markers are differentially expressed by biospecimen type and other preanalytic variables. PI3K pathway activation is greater in CNB compared to surgical samples.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-07-06.

Functional proteomics characterization of residual breast cancer after neoadjuvant systemic chemotherapy

BACKGROUND

The purpose of this study was to determine the functional proteomic characteristics of residual breast cancer and hormone receptor (HR)-positive breast cancer after neoadjuvant systemic chemotherapy, and their relationship with patient outcomes.

METHODS

Reverse phase protein arrays of 76 proteins were carried out. A boosting approach in conjunction with a Cox proportional hazard model defined relapse predictors. A risk score (RS) was calculated with the sum of the coefficients from the final model. Survival outcomes and associations of the RS with relapse were estimated. An independent test set was used to validate the results.

RESULTS

Test (n = 99) and validation sets (n = 79) were comparable. CoxBoost revealed a three-biomarker (CHK1pS345, Caveolin1, and RAB25) and a two-biomarker (CD31 and Cyclin E1) model that correlated with recurrence-free survival (RFS) in all residual breast cancers and in HR-positive disease, respectively. Unsupervised clustering split patients into high- and low risk of relapse groups with different 3-year RFS (P ≤ 0.001 both). RS was a substantial predictor of RFS (P = 0.0008 and 0.0083) after adjustment for other substantial characteristics. Similar results were found in validation sets.

CONCLUSIONS

We found models that independently predicted RFS in all residual breast cancer and in residual HR-positive disease that may represent potential targets of therapy in this resistant disease.

Estimates of phenotypic and genetic parameters for birth weight of Brown Swiss calves in Turkey using an animal model

A study was conducted to assess the influence of genetic and environmental factors on Brown Swiss calf birth weight, and to estimate variance components, genetic parameters, and breeding values. Data were collected on 1,761 Brown Swiss calves born from 1990 to 2005 in the Konuklar State Farm in Turkey. Mean birth weight for all calves was 39.3 ± 0.09 kg. Least squares mean birth weights for male and female Brown Swiss calves were 40.3 ± 0.02 and 39.0 ± 0.02 kg, respectively. Variance components, genetic parameters, and breeding values for birth weight in Brown Swiss calves were estimated by restricted error maximum likelihood (REML)-best linear unbiased prediction(BLUP) procedures using an MTDFREML (multiple trait derivative free restricted maximum likelihood) program employing an animal model. Direct heritability (h(d)(2)), maternal heritability (h(m)(2)), total heritability (h(T)(2)), r(am) and c(am) estimates were 0.12, 0.09, 0.23, -0.58, and -0.06, respectively. The estimated maternal permanent environmental variance expressed as a proportion of the phenotypic variance (c(2)) was 0.05. Breeding values were estimated for the trait and used to evaluate genetic trends across the time period investigated. The genetic trend linear regression was not different from zero. No genetic trend for birth weight was expected, since there had been no direct selection pressure on the trait. Absence of a trend confirms that there was no change due to selection pressure on correlated traits. Genetic and environmental parameter estimates were similar to literature values indicating that effective selection methods used in more developed improvement programs would be effective in Turkey as well.