Abstract 3700: Prepubertal dietary genistein intake reduces ovarian cancer risk in BRCA+/- mice

Genistein, a soy-derived isoflavone, is thought to play a key role in the cancer-preventive activity of soy consumption. Germline mutations in BRCA1 and BRCA2 genes are known risk factors for both ovarian and breast cancers. Previously, our lab has discovered that prepubertal dietary exposure to genistein reduced 7,12-dimethylbenz(a)anthracene (DMBA)-induced mammary incidence (P = 0.029) and aggressiveness of the tumors (P < 0.001) in the WT mice, and upregulated the expression of BRCA1 in their mammary glands (P = 0.04). In this study, we investigated whether prepubertal dietary exposure to genistein reduces ovarian tumors in heterozygous BRCA+/- mice and their wild type littermates. Mice were fed a control diet AIN93G or 500 ppm genistein-supplemented diet from postnatal day (PND) 15 to PND 30, and thereafter mice received the control AIN93G diet. On PND42, control and genistein mice were primed with medroxyprogesterone acetate and, starting at PND50, administered 7,12-dimethylbenz(a)anthracene (DMBA) once a week for four weeks. Ovarian tissues were harvested at 5 months of age. Histopathology assessment shows that mice developed granulosa cell tumors. Ovarian tumor incidence in control diet fed wildtype mice was 80% and in the BRCA+/- mice 100%. The incidence dropped to 33% in the wildtype and to 50% in the BRCA+/- mice following prepubertal genistein intake. Thus, the exposure to prepubertal genistein in both BRCA+/- and WT mice significantly reduced ovarian tumor incidence, compared with their control diet fed littermates (P=0.001). The mechanisms mediating the protective effect of prepubertal genistein intake on ovarian cancer risk are being investigated.

Citation Format: E Carney, L. Hilakivi-Clarke, A. Warri, S. de Assis. Prepubertal dietary genistein intake reduces ovarian cancer risk in BRCA+/- mice. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3700. doi:10.1158/1538-7445.AM2013-3700

The association of lactate and vasopressor need for mortality prediction in survivors of cardiac arrest

BACKGROUND

Currently there are few tools available for clinicians to predict outcomes in cardiac arrest survivors. Our objective was to determine if the combination of simple clinical parameters (initial blood lactate and vasopressor use) can predict outcome in post-cardiac arrest patients.

METHODS

The design was a retrospective medical record review. The study was carried on in two urban, tertiary-care, university teaching hospitals. As for patients, inclusion criteria were: 1) age ≥18 years; 2) non-traumatic out-of-hospital cardiac arrest with return of spontaneous circulation; 3) lactic acid measured within one hour of return of circulation. No interventions was performed.

RESULTS

Patients were divided into groups based on two variables: 1) vasopressor status (receipt of vasopressors vs. no vasopressors); and 2) initial blood lactate (categories defined as lactate <5 mmol/L, lactate 5 to 10 mmol/L, lactate ≥10 mmol/L); 128 out-of-hospital cardiac arrest patients met study inclusion criteria. Overall mortality was 71% (95%CI 63-79%). Patients who received vasopressors had significantly higher mortality rates compared to patients who did not receive vasopressors (80% vs. 52%; P=0.002). A stepwise increase in mortality is associated with increasing lactate levels (39% lactate <5 mmol/L, 67% lactate 5 mmol/L to10 mmol/L, and 92% lactate ≥10 mmol/L; P<0.001). The AUC for our model was 0.82.

CONCLUSION

The combination of two clinical parameters, vasopressor need and lactic acid levels, is an accurate severity of illness classification system and can predict mortality in patients following out-of-hospital cardiac arrest. Prospective validation of these variables in post-cardiac arrest is needed.

Prediction of late recurrences by breast cancer index in the NCIC CTG MA.17 cohort

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Background: The MA.17 trial demonstrated that extended adjuvant endocrine therapy with letrozole after 5-y of tamoxifen markedly reduced the risk of recurrence in women with ER+ early stage breast cancer. This trial provides an opportunity to assess the ability of biomarkers to predict late recurrences in ER+ breast cancer. The Breast Cancer Index (BCI), a continuous risk index based on the combination of HOXB13:IL17BR (H:I) and the molecular grade index (MGI), estimates the individual risk of recurrence in ER+ breast cancer patients. In this study, the prognostic utility of BCI to predict late recurrences was examined.

Methods: FFPE tumor blocks were collected from patients who experienced a breast cancer recurrence up to unblinding of MA.17. Controls were matched 2:1 for age, tumor size, nodal status and prior chemotherapy, and were disease free for longer than cases. All cases were reviewed for standard histopathology and evaluated using the real-time RT-PCR BCI assay.

Results: Patient characteristics for the case-control study were similar to that from the overall study. Characteristics for cases (N=83) and controls (N=166) were not significantly different except for treatment. A higher percentage of controls compared to cases tended to be categorized as low risk by BCI (58% vs 43%), while a lower percentage of controls than cases tended to be categorized as high risk by BCI (34% vs 24%). In univariate analysis, treatment, BCI, H:I and HOXB13, but not tumor grade or MGI, were significant predictors of late recurrence. After adjusting for standard variables (age, tumor grade and treatment), BCI (OR 2.37; P=0.03), H:I (OR 2.55; P=0.04) and HOXB13 (OR 1.35; P=0.02) remained significant predictors of recurrence. HOXB13 expression at diagnosis predicted patient benefit from extended endocrine therapy with letrozole.

Conclusions: In this case-controlled study, the data demonstrate that BCI is a significant predictor of late recurrences in ER+ patients following 5-y of tamoxifen. The prognostic performance of BCI to predict late recurrences was largely dependent on HOXB13 expression. The integration of H:I and MGI within BCI provides prognostic utility for both early and late recurrences.

A modified technique improved histology similarity to human intracranial aneurysm in rabbit aneurysm model

Persistent undigested elastic membranes and collagen in the tunic media of rabbit elastase-induced aneurysm models lowered their histology similarity to human intracranial aneurysm. Our purpose was to make good the deficiency. Ten New Zealand white rabbits were divided into three groups: six rabbit in two groups for evaluating the difference in various treatments, and four rabbits for long-term observation. We inflated and occluded the right common carotid artery (CCA) by an endovascular technique. The first group of three rabbits was only given 200u elastase in the proximal segment of right CCA; the second group was given 100u elastase and 1.5mg collagenase, then the right CCA was ligated. The first and second groups were studied by magnetic resonance angiography (MRA), sacrificed at three weeks after aneurysm creation, their histology results were obtained and compared with human aneurysm. The third group underwent the same procedure as the second group only for three months of observation with enhanced MRA. Saccular aneurysms formed in all rabbits. Degeneration of the extracellular matrix and atrophy of smooth muscular cells in tunic media were more apparent in the second group. The third group remained stable for more three months. Two modifications included inflating the right CCA with a balloon and adding collagenase incubation can promote an aneurysm model more histologically similar to human aneurysm. In addition the improved aneurysm model remains stability for a long time.

Prevalence and level of Escherichia coli O157 on beef trimmings, carcasses and boned head meat at a beef slaughter plant

This study investigated the prevalence and level of Escherichia coli O157 on samples of beef trimmings (n=1351), beef carcasses (n=132) and bovine head meat (n=132) in a beef slaughter plant in Ireland. The survey also included an assessment of the prevalence of virulence genes in the E. coli O157 isolates obtained. Samples were examined for the presence of E. coli O157 by direct plating on SMAC-CT and by enrichment/immunomagnetic separation (IMS) with plating of recovered immunobeads onto SMAC-CT agar. Presumptive E. coli O157 isolates were confirmed by PCR targeting a range of genes i.e. vt1, vt2, eaeA, hlyA, fliC(h7) and portions of the rfb (O-antigen encoding) region of E. coli O157. Enterobacteriaceae on head meat samples were estimated by direct plating onto Violet Red Bile Glucose agar. E. coli O157 was recovered from 2.4% (32/1351) of beef trimmings samples, at concentrations ranging from<0.70-1.61 log10 cfu g(-1). Of the 32 positive isolates, 31 contained the eaeA and hylA genes while 30/32 contained the fliC(h7) gene and 31/32 contained vt1 or vt2, or both vt genes. E. coli O157 was recovered from 3.0% (4/132) of carcass samples, at concentrations ranging from <0.70-1.41 log10 cfu g(-1). All of the carcass isolates contained the eaeA, hylA and fliC(h7) genes. E. coli O157 was recovered from 3.0% (3/100) of head meat samples, at concentrations of 0.7-1.0 log10 cfu g(-1). All of the head meat isolates contained the eaeA, hylA, fliC(h7) and vt2 genes. No head meat isolates contained the vt1 gene. Head meat samples (n=100) contained Enterobacteriaceae, at concentrations ranging from 0.70-3.0 log10 cfu g(-1). Overall, the qualitative and quantitative data obtained for E. coli O157 on beef trimming samples in this study could be employed as part of a quantitative risk assessment model.

Prevalence and numbers of Escherichia coli O157 on bovine hides at a beef slaughter plant

In this study, we investigated the prevalence and numbers of Escherichia coli O157 on bovine hides. Samples (n = 1,500) were collected over a 17-month period (30 samples per week) by sponge swabbing approximately 122-cm2 areas of the bovine rump of slaughtered cattle at an early stage of carcass processing (first legging). Sponge samples (n = 1,500) were stomached in buffered peptone water supplemented with novobiocin, directly plated on sorbitol MacConkey with Cefixime tellurite (SMAC-CT), enriched for 24 h, extracted by immunomagnetic separation, and plated onto SMAC-CT agar. Presumptive E. coli O157 colonies from SMAC-CT plates were confirmed by PCR for the presence of eaeA, hlyA, fliCh7, vt1, vt2, and portions of the rfb (O-antigen encoding) region of E. coli O157. Overall, E. coli O157 was recovered from 109 samples (7.3%) at concentrations ranging from less than 0.13 to 4.24 log CFU/100 cm2. PCR analysis revealed a wide diversity of genetic profiles among recovered isolates of verocytotoxigenic E. coli. Of the isolates recovered, 99 of 109 contained the attaching and effacing gene (eaeA) and the hemolysin gene (hlyA), and 78 of 109 had the flagellar H7 antigen-encoding gene (fliCh7). Only 6 of 109 isolates contained both verotoxin-producing genes (vt1 and vt2); 91 of 109 contained the vt2 gene only, whereas 1 of 109 contained the vt1 gene only. The remaining 11 of 109 contained neither vt1 nor vt2.

Characterisation of E. coli O157 isolates from bovine hide and beef trimming in Irish abattoirs by pulsed field gel electrophoresis

Escherichia coli O157 isolates from bovine hide (n=117) and beef trimmings (n=32) from a single abattoir were examined by pulsed field gel electrophoresis (PFGE). Using BioNumerics software, dendrograms of isolates from each sample type (i.e. hide and beef trimming) were produced. In assessing the genetic relatedness of isolates, a similarity criterion of 80% was applied. The 117 E. coli O157 hide isolates were grouped into 14 clusters, comprising of 109 different PFGE profiles. Of the 109 different PFGE profiles, 8 were common to multiple isolates (i.e. shared 100% similarity by PFGE). The 32 E. coli O157 beef trimming isolates produced 28 different PFGE profiles and 2 clusters. Of the 28 PFGE profiles, 2 were common to multiple isolates and the remaining 26 were distinct. On a number of sampling occasions, isolates displaying identical PFGE patterns were recovered from multiple isolates collected from a single sample type (i.e. hides or trimmings), suggesting cross contamination from contaminated hides/animals to uncontaminated hides/animals and from contaminated beef trimmings to uncontaminated beef trimmings during abattoir operations.

Anatomical bases for paravertebral anesthetic block: fluid communication between the thoracic and lumbar paravertebral regions

An injection of a local anesthetics in the paravertebral region produces an analgesic field on the same side of the body, a paravertebral block. One point in question about this block is whether the local anesthetic spreads from the thoracic to the lumbar level of the paravertebral region. The purpose of this study was to find how the anesthetic fluid traveled to the lumbar paravertebral region, if at all. Twelve cadavers were used in this study. 15 ml of crimson dye was injected into the paravertebral region at the 11th thoracic level. The viscerae were removed so that we could examine the dye spread. While the crimson dye spread in the endothoracic fascia posterior to the parietal pleura, it also spread downward in the fascia mostly along the splanchnic nerves. At the upper surface of the diaphragm the dye spread laterally in the fascia, and entered the abdominal cavity through the medial and lateral arcuate ligaments. In the abdominal cavity, the dye was found to have spread so widely in the transversalis fascia that the subcostal, iliohypogastric, ilioinguinal, genitofemoral, lateral femoral cutaneous and femoral nerves were involved. We concluded that the dye in the thoracic paravertebral region can enter the abdominal cavity through the medial and lateral arcuate ligaments. This study explained possible fluid communication between the thoracic and lumbar paravertebral regions and confirmed our former clinical observations. The result is important for the future clinical application of paravertebral anesthesia.

A single-injection, multi-segmental paravertebral block-extension of somatosensory and sympathetic block in volunteers

BACKGROUND

It is our experience that a deposition of an anesthetic solution in the ventral area of the paravertebral space near the parietal pleura and the sympathetic trunk produces extended unilateral block. Because sympathetic block effects in this extended paravertebral block are not reported yet, we undertook this singly blinded, controlled study on the sympathetic change in volunteers.

METHODS

A total of 22 ml 1% lidocaine was injected at the T11 level into the ventral area of the right-sided paravertebral space in 16 volunteers. The distribution of analgesia, heart rate, blood pressure and body temperature (measured by 12 skin sensors) was monitored. On a later occasion the volunteers underwent a control injection of saline.

RESULTS

Unilateral analgesia (with no contralateral element) was induced in every subject injected with lidocaine, contrasted with no block induction with saline. Loss of pin-prick sensation was observed within 10 min after injection and involved a mean of 12 (range 8-13) dermatomes. A sympathetic block was indicated by cutaneous temperature increase within at least 6 dermatomes. Increase of arterial blood pressure was obtained in all volunteers with no change in pulse rate. No side effects or complications occurred. Epidural spread of the local anesthetic was unlikely because of the absence of contralateral cutaneous analgesia and temperature increase.

CONCLUSION

One-sided extended analgesia (sensory loss) follows the paravertebral injection of lidocaine. A large ipsilateral sympathetic block is observed without change in pulse rate and with no hypotension. These are all characteristics of an optimal regional block.

Difficult tracheal intubation in patients with retinoblastoma caused by 13q deficiency

Anesthetic management of retinoblastoma patients is unremarkable in most cases. Patients are most often babies and laryngoscopic procedures for intubation are usually easy. However, we recently experienced two cases with retinoblastoma with whom tracheal intubation was accomplished with difficulty. We report the two cases with a review of all 5-year records of retinoblastoma (rbl) in our institution. The cases we experienced recently were all patients with rbl with deletion of the long arm of thirteenth chromosome (13q-). In the 5-year review, the incidence of the difficult intubation was significantly higher (P < 0.05) in rbl with 13q- (4/11) than in rbl without 13q- (0/147). In our experience macroglossia was noted for the difficulty in the intubation. We assume that some patients with rbl will be cases of difficult intubation even to cannot ventilate-cannot intubate level when the results of their chromosomal analysis show a deletion on the thirteenth chromosome.

Multi-unit mapping of acoustic stimuli in gerbil inferior colliculus

Multi-unit peristimulus time (MU-PST) histograms were recorded in the gerbil inferior colliculus (IC) in response to tone burst stimuli. Histograms were collected every 100 microns as the recording electrode was advanced along the tonotopic axis of the central nucleus of the IC. Space/time maps of neural activity were constructed from these data. In most of our sample the pattern of response changed systematically as the stimulating frequency was increased in octave steps. At low frequencies (< 500 Hz) the pattern of response was broadly distributed spatially and phase-locked to the stimulus frequency. At higher frequencies (> 1 kHz) the pattern of response was more localized and showed no evidence of phase locking. The location of the maximum response to tones from 1 to 32 kHz moved ventrally along the tonotopic axis at an approximate rate of 230 microns/stimulus octave. The patterns of response were localized near stimulus threshold and spread over a larger region as level increased. This method of collecting and displaying multi-unit response maps provides an overview of ensemble activity that allows concurrent observation of spatial and temporal variations in activity patterns. The quantitative analysis of components of MU-PST Maps are consistent with trends illustrated with single-unit tuning and level functions. This perspective of IC activity suggests potential processing mechanisms that are congruent with single-unit reconstructions.

The effect of methylprednisolone on myocardial beta-adrenergic receptors and cardiovascular function in shock patients

The effect of methylprednisolone on the myocardial beta-adrenergic receptors after long term ( > 72 h) catecholamine infusion was studied. In 56 patients with pulmonary arterial catheter, 10 mg/kg of methylprednisolone was given as an intravenous bolus. Significant increases could be seen in cardiac output and blood pressure in patients who were simultaneously treated with vasopressors like dopamine and/or dobutamine. In patients who were on dopamine infusion higher than 10 micrograms/kg/min methylprednisolone there was an increase in the systemic vascular resistance. Patients who were not on vasopressors but received methylprednisolone, had no similar changes in hemodynamic parameters. In an in vitro analysis of tissue from the myocardium in 12/56 patients who succumbed and in four additional patients who expired after multiple trauma, a beta-adrenergic receptor assay was performed. It was found that the long term infusion of catecholamines decreased the receptor number and the methylprednisolone abolished or caused the decrease to be less pronounced. In this study we could not control the selection of the patients; a randomized study needs to be conducted in the future.

Preferred hearing-aid frequency responses in simulated listening environments

This study was designed to determine if an adaptive strategy could be used to select frequency/gain characteristics that would be considered appropriate across a variety of listening environments. In Experiment I, the test-retest reliability of the paired comparison procedure used in Experiment II was assessed in quiet for nine subjects and in speech noise for six subjects. For both conditions, results revealed mean standard deviations of < 3 dB from 200 through 4000 Hz. In Experiment II, four subjects selected frequency/gain characteristics for five different listening environments (quiet, speech noise, quiet conference room, reverberant lecture hall, and reverberant lecture hall in noise). In general, subjects did not tend to select different frequency/gain characteristics across the five simulated environments used in this study. When differences in frequency responses were observed, they tended to be alterations in overall gain rather than changes in relative frequency response. Findings support additional evaluation in more diverse listening environments, possibly with systems that incorporate nonlinear signal processing.

A comparison of speech discrimination with cochlear implants and tactile aids

This study investigates patterns of speech discrimination in profoundly hearing-impaired children who have received cochlear implants or tactile aids. The change/no change procedure was used to assess speech discrimination in these children. Three groups of subjects were tested: the first group used 3M/House single-channel cochlear implants; the second group used Nucleus 22-channel cochlear implants; and the third group used two-channel Tactaid II+ vibrotactile aids. Nine contrasts were constructed that assessed discrimination of suprasegmental and segmental speech features. Subjects were presented with stimulus trials in which stimuli changed during the trial or in which stimuli remained the same. Hits, misses, false alarms, and correct rejections were tallied and d' values were calculated for individual subjects for each contrast. Results indicated that different patterns of speech discrimination are provided by the three sensory prosthetic devices. For all contrasts, mean discrimination performance with the Nucleus device was better than that observed for the other two devices, despite the shorter duration of subject experience with this cochlear implant. In addition, interactions between device and speech contrast were not observed. Examination of individual subject performance revealed that each device group had a distribution of good to poor performers. The results suggest that the change/no change procedure is able to provide information regarding speech perception through sensory prosthetic devices despite existing differences in vocabulary and language skills of subjects.

Long-term and short-term characteristics of speech: implications for hearing aid selection for young children

This study examined the effects of distance and postural position of both parents and children on the long-term and short-term spectral characteristics of speech produced by the parents. Thirty children (ages 2 months to 3 1/2 years) and their parents (30 mothers and 15 fathers) participated. Third-octave band and overall levels of the long-term average speech spectrum (LTASS) for each speech sample were analyzed in three postural positions and a 1-meter reference condition for each age category. Short-term spectral characteristics of three phonemes (/s/, /integral of/, /t integral of/) also were analyzed. Results show that typical levels at the input to a child's hearing aid microphone may be as much as 20 dB higher than those found in face-to-face adult conversation. Furthermore, the spectral shape may deviate substantially from an idealized version of the LTASS. Results of the short-term analysis reveal that the peak levels of the three selected phonemes often exceed the LTASS by more than the 12 dB that is often quoted to represent the 1% rms levels of speech in relation to the long-term average. Implications of these results for specific hearing losses are discussed.

Comparison of media for isolation of Ureaplasma urealyticum and genital Mycoplasma species

A total of 484 frozen patient specimens originally positive for Ureaplasma urealyticum or Mycoplasma spp. or both were recultured, and the results were compared on the following media: Shepard's A7 agar, modified phenol red-urea, SP-4-urea, modified phenol red-arginine, and SP-4-arginine broths. Of 351 specimens positive for U. urealyticum, 30 (8.5%) were detected only in one or more of the broth media, whereas 117 (33%) were positive only on A7 agar. Separate use of the SP-4-urea broth or modified phenol red-urea broth isolated all but 1 and 2, respectively, of the negative A7 agar cultures. Of the 76 specimens positive for large colony Mycoplasma spp., 58 (76.3%) were not grown on the primary plating (A7) agar. Of 73 broth isolates, 73 (100%) grew in SP-4-arginine broth, and 64 (87.7%) grew in modified phenol red-arginine broth. Modified SP-4 broth appears to be a useful supplement to the A7 plating medium commonly used in the diagnostic laboratory for the isolation of U. urealyticum and Mycoplasma spp.

Statistical properties of responses to dichotic listening with CV nonsense syllables

Twenty-four listeners received 20 dichotic listening runs of 30 pairs of natural CV nonsense syllables per run. Left- and eight-ear responses are represented by two partially overlapping normal distributions with equal variance. Observed ear advantages across listening runs are also distributed normally. The means of the distribution of ear advantage are listener specific, but the standard deviations are 10.8% +/- 2.5. The origin of reversals in direction of ear advantage among listening runs is statistical--a small mean/sigma ratio--and approximately six listening runs (180 listening trials) are required to achieve a split-half reliability coefficient of + 0.90.

HLA antigens and HBV infection: evaluation in the chronic carrier state and in a large family

HLA antigens were determined in 65 apparently well chronic carriers of HBsAg, in race-matched controls and in 42 members of a family with a high frequency of hepatitis B virus infection. The only apparent significant association in the chronic carriers was negative, i.e., no HLA-B7 specificities were found among whites. B7 may confer resistance for whites to chronic infection with hepatitis B. In the family neither active (HBsAg) nor prior (anti-HBs) hepatitis B infection was associated with HLA specificities. HLA antigens in this family failed to provide a clue to the genetics of hepatitis B infection.

Stimulus dominance in dichotic listening

Twenty-four listeners received 20 dichotic-listening runs of natural stop-vowel syllables. Listeners marked two responses for each of 30 pairs of syllables per run, which yielded 480 pairs of responses for each of the 30 pairs of syllables. The principal analysis focused on "stimulus dominance" wherein a significantly higher score occurs for one of the competing syllables in a pair regardless of the ear to which that syllable is presented. With 30 pairs of syllables, there were 15 possible instances of stimulus dominance; 11 were observed. The voicing feature was contrasted for 9 of the 15 pairs. Seven of those pairs resulted in significantly higher scores (dominance) for the voiceless stop than for the voiced, one resulted in a higher score for the voiced member of the pair, and for one pair the scores for the two members were essentially the same. Stimulus dominance cannot, however, be characterized sufficiently as a dominance of voiceless over voiced stops; three of the six pairs in which voicing was shared also produced significant stimulus dominance. Stimulus dominance for a given pair of syllables may interact with, and in some cases override, the ear advantage. Of the 30 pairs of syllables, 11 produced a significant right ear advantage (REA), 9 produced a significant left ear advantage (LEA), and for 10 pairs the ear advantage was not significantly different from zero. For a specific pair of syllables, the direction of ear with, and in some cases override, the ear advantage. Of the 30 pairs of syllables, 11 produced a significant right ear advantage (REA), 9 produced a significant left ear advantage (LEA), and for 10 pairs the ear advantage was not significantly different from zero. For a specific pair of syllables, the direction of ear with, and in some cases override, the ear advantage. Of the 30 pairs of syllables, 11 produced a significant right ear advantage (REA), 9 produced a significant left ear advantage (LEA), and for 10 pairs the ear advantage was not significantly different from zero. For a specific pair of syllables, the direction of ear advantage usually corresponded to the ear that received the dominant syllable.