Biomechanical Characteristics of Labral Augmentation Versus Labral Reconstruction in a Hip Cadaver Model

Objectives: An integral component of hip stability is the negative pressure gradient created by the labral suction seal. No prior studies have quantitatively compared the integrity of the suction seal under normal, pathologic, and surgical conditions. The purpose of this study was to evaluate the biomechanical properties of the labral suction seal in the following four scenarios: intact labrum, labral tear, labral augmentation, and labral reconstruction. Methods: Eight fresh-frozen hemi-pelvises without osteoarthritis and with an intact labrum were dissected to the level of labrum and mounted for biomechanical testing. Each specimen was evaluated sequentially under four testing conditions: intact labrum, labral tear, labral augmentation, and labral reconstruction. Following testing of the intact labrum, the specimens were manipulated to create a labral tear from 12- to 3-o’clock. Labral augmentation was then performed with bone anchors and iliotibial band graft after debridement of only the peripheral half of the labral tear. Labral reconstruction was performed last with bone anchors and iliotibial band graft after removing the entire labral tear. In each condition the specimens were placed in the test machine to undergo pure distraction of the joint. First, the femur was compressed with 250 N of force and then distracted at 10 mm/s with force and displacement continuously recorded until the suction seal was disrupted. In each specimen, the tests were repeated for a total of three tests in each of the four conditions, and the average peak force was calculated. Data was normalized to the intact peak force for each specimen to account for gender and size differences. Statistical testing was performed via a repeated measures ANOVA with a post hoc Bonferroni correction for pairwise analysis. Results: Peak loads occurred early in displacement. The average peak force values (mean ± standard deviation) were as follows: intact (137.2 ± 40.7), labral tear (126.3 ± 43.5), labral augmentation (94.7 ± 59.7), labral reconstruction (78.9 ± 51.2). The average normalized peak force values relative to the intact condition were as follows: labral tear (91.1 ± 8.5), augmentation (66.1 ± 27.6), and reconstruction (55.6 ± 25.7). There was no statistically significant difference in peak force relative to the intact labrum for the labral tear (p = 0.34). Relative to the labral tear, there was no significant difference in peak force for the augmentation (p = 0.12), but there was a significant decrease in peak force for the reconstruction (p = 0.03). Conclusion: This model provides a new means of quantitatively evaluating the labral suction seal under various normal, pathologic, and surgical conditions. The results show that relative to the labral tear condition, labral augmentation may recreate the labral suction seal better than labral reconstruction. Clinically, these findings suggest augmentation may improve hip stability over labral reconstruction. [Figure: see text]

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Can ultrasound suffice for triaging patients requiring surgical correction of rotator cuff tears—a comparative evaluation of ultrasound and magnetic resonance imaging

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-021-00477-2 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Aniket Agarwal ◽

Kavita Vani ◽

Anurag Batta ◽

Kavita Verma ◽

Shishir Chumber

Keyword(s):

Rotator Cuff ◽

Biceps Tendon ◽

Surgical Correction ◽

Statistical Testing ◽

Rotator Cuff Tears ◽

Full Thickness ◽

Partial Thickness ◽

Linear Probe ◽

Significant Difference ◽

Sensitivity Specificity

Abstract Background Objectives: To comparatively evaluate the role of ultrasound and MRI in rotator cuff and biceps tendon pathologies and to establish ultrasound as a consistently reproducible, quick and accurate primary investigation modality sufficient to triage patients requiring surgical correction of full thickness rotator cuff tears. Methods: Fifty patients, clinically suspected to have rotator cuff and/or biceps tendon pathologies, with no contraindications to MRI, were evaluated by US and MRI, in a prospective cross-sectional observational study. US was done with high-frequency linear probe, and MRI was done on a 1.5-T scanner using T1 oblique sagittal, proton density (PD)/T2 fat-suppressed (FS) oblique sagittal, T1 axial, PD/T2 FS axial, T1 oblique coronal, T2 oblique coronal and PD FS oblique coronal sequences. Statistical testing was conducted with the statistical package for the social science system version SPSS 17.0. The sensitivity, specificity, PPV, NPV and accuracy were also calculated to analyze the diagnostic accuracy of US findings correlating with MRI findings. A p value less than 0.05 was taken to indicate a significant difference. Results Mean age was 45 years; 74% patients were males; 77% females and 60% males had tears. Majority of patients with rotator cuff tears were in the sixth decade of life. The frequency of tears was higher among older patients. Fourteen percent of patients had full thickness tears while 64% had partial thickness tears. US was comparable to MRI for detection of full thickness tears with overall sensitivity, specificity, PPV and accuracy of 93.8%, 100%, 100% and 98.2%, respectively (p value < 0.001). For partial thickness tears, US had overall sensitivity, specificity, PPV and accuracy of 75.6%, 82.6%, 89.5% and 78%, respectively (p value < 0.001), as compared to MRI. Subacromial-subdeltoid bursal effusion and long head of biceps tendon sheath effusion were common associated, though, non-specific findings. Conclusion Ultrasound findings in our study were found to be in significant correlation with findings on MRI in detection of rotator cuff tears. US was equivalent to MRI in detection of full thickness tears and fairly accurate for partial thickness tears. Therefore, US should be considered as the first line of investigation for rotator cuff pathologies.

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Effect of Yd:YAG laser irradiation on the shear bond strength of orthodontic metal brackets

Dental Press Journal of Orthodontics ◽

10.1590/2177-6709.25.1.028-035.oar ◽

2020 ◽

Vol 25 (1) ◽

pp. 28-35

Author(s):

Fernando César Moreira ◽

Helder Baldi Jacob ◽

Luis Geraldo Vaz ◽

Antonio Carlos Guastaldi

Keyword(s):

Bond Strength ◽

Laser Irradiation ◽

Shear Bond Strength ◽

Surface Characterization ◽

Test Machine ◽

Base Surface ◽

Bonding Failure ◽

Significant Difference ◽

Chi Square Analysis ◽

Bracket Base

ABSTRACT Objective: The purpose of this study was to evaluate the effect of the Yd:YAG laser irradiation on orthodontic bracket base surface. Shear bond strength (SBS) values and sites of the bonding failure interfaces were quantified. Methods: Brackets were divided into two groups: OP (One Piece - integral sandblast base) and OPL (One Piece - laser irradiation). The brackets were randomly bonded on an intact enamel surface of 40 bovine incisors. The SBS tests were carry out using a universal test machine. A stereomicroscopy was used to evaluate the adhesive remnant index (ARI), and surface characterization was performed by scanning electron microscopy (SEM). Student’s t-test was used to compare the SBS between the two groups (p< 0.05). Frequencies and chi-square analysis were applied to evaluate the ARI scores. Results: OPL group showed higher value (p< 0.001) of SBS than OP group (43.95 MPa and 34.81 MPa, respectively). ARI showed significant difference (p< 0.001) between OPL group (ARI 0 = 100%) and OP group (ARI 0 = 15%). SEM showed a higher affinity between the adhesive and the irradiated laser base surface. Conclusions: Yd:YAG laser irradiation on bracket base increased SBS values, showing that bonding failure occurs at the enamel/adhesive interface. Laser-etched bracket base may be used instead of conventional bases in cases where higher adhesion is required, reducing bracket-bonding failure.

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The Hip Suction Seal, Part I: The Role of Acetabular Labral Height on Hip Distractive Stability

The American Journal of Sports Medicine ◽

10.1177/0363546520941855 ◽

2020 ◽

Vol 48 (11) ◽

pp. 2726-2732 ◽

Cited By ~ 2

Author(s):

Hunter W. Storaci ◽

Hajime Utsunomiya ◽

Bryson R. Kemler ◽

Samuel I. Rosenberg ◽

Grant J. Dornan ◽

...

Keyword(s):

Negative Pressure ◽

Clinical Effects ◽

Acetabular Labrum ◽

Peak Negative Pressure ◽

Hip Stability ◽

New Strategy ◽

Fresh Frozen ◽

Articular Pathology ◽

Distraction Force ◽

Suction Seal

Background: The acetabular labrum has been found to provide a significant contribution to the distractive stability of the hip. However, the influence of labral height on hip suction seal biomechanics is not known. Hypothesis: The smaller height of acetabular labrum is associated with decreased distractive stability. Study Design: Descriptive laboratory study. Methods: A total of 23 fresh-frozen cadaveric hemipelvises were used in this study. Hips with acetabular dysplasia or femoroacetabular impingement–related bony morphologic features, intra-articular pathology, or no measurable suction seal were excluded. Before testing, each specimen’s hip capsule was removed, a pressure sensor was placed intra-articularly, and the hip was fixed in a heated saline bath. Labral size was measured by use of a digital caliper. Maximum distraction force, distance to suction seal rupture, and peak negative pressure were recorded while the hip underwent distraction at a rate of 0.5 mm/s. Correlations between factors were analyzed using the Spearman rho, and differences between groups were detected using Mann-Whitney U test. Results: Of 23 hips, 12 satisfied inclusion criteria. The maximum distraction force and peak negative pressure were significantly correlated ( R = −0.83; P = .001). Labral height was largely correlated with all suction seal parameters (maximum distraction force, R = 0.69, P = .013; distance to suction seal rupture, R = 0.55, P = .063; peak negative pressure, R = −0.62, P = .031). Labral height less than 6 mm was observed in 5 hips, with a mean height of 6.48 mm (SD, 2.65 mm; range, 2.62-11.90 mm; 95% CI, 4.80-8.17 mm). Compared with the 7 hips with larger labra (>6 mm), the hips with smaller labra had significantly shorter distance to suction seal rupture (median, 2.3 vs 7.2 mm; P = .010) and significantly decreased peak negative pressure (median, −59.3 vs −66.9 kPa; P = .048). Conclusion: Smaller height (<6 mm) of the acetabular labrum was significantly associated with decreased distance to suction seal rupture and decreased peak negative pressure. A new strategy to increase the size of the labrum, such as labral augmentation, could be justified for patients with smaller labra in order to optimize the hip suction seal. Clinical Relevance: The height of the acetabular labrum is correlated with hip suction seal biomechanics. Further studies are required to identify the clinical effects of labral height on hip stability.

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Sonoarthrographic examination of posterior labrocapsular structures of the shoulder joint

British Journal of Radiology ◽

10.1259/bjr.20190886 ◽

2020 ◽

Vol 93 (1106) ◽

pp. 20190886

Author(s):

Hayri Ogul ◽

Nurmuhammet Tas ◽

Mutlu Ay ◽

Mehmet Kose ◽

Mecit Kantarci

Keyword(s):

Shoulder Joint ◽

Glenohumeral Joint ◽

Imaging Modality ◽

Mr Arthrography ◽

Labral Tear ◽

Labral Tears ◽

Significant Difference ◽

Arthroscopic Examination ◽

Synovial Folds ◽

Direct Mr Arthrography

Objective: To describe the posterior labral lesions and labrocapsular abnormalities of the shoulder on sonoarthrography and to compare these findings with MR arthrography results. Methods: 82 shoulders were initially evaluated with ultrasonography and MRI and then were examined with sonoarthrography and MR arthrography following intraarticular injection of diluted gadolinium solution. The ultrasonography images were prospectively evaluated for the presence of posterior labral tear, sublabral cleft, and posterior capsular abnormalities by two radiologists. The diagnostic accuracy of sonoarthrography in the detection of posterior labral tears and posterior labrocapsular variants was compared with that of MR arthrography. Results: In sonoarthrographic examinations of 82 shoulders, 5 and 6 posterior labral tears were identified by Observer 1 and 2, respectively. Moreover, 6 and 7 posterior sublabral clefts, and 2 and 3 posterior synovial folds were identified by Observer 1 and 2, respectively. All the 82 patients were examined with MR arthrography; however, only 14 patients underwent arthroscopic examination. No significant difference was found among the 82 patients with regard to age, gender, and the prevalence of posterior labral tear, posterior labral cleft, and posterior synovial fold (p > 0.05). Interobserver variability showed substantial agreement between the sonoarthrographic and MR arthrographic results of the posterior labrocapsular structures (κ = 0.71, p < 0.05). Conclusion: Posterior labral tears and posterior synovial folds of the shoulder joint can be evaluated non-invasively by sonoarthrography. Advances in knowledge: Variations and pathologies of posterior labrocapsular structures of the glenohumeral joint are relatively uncommon. Direct (MR) arthrography is the gold-standard imaging modality to evaluate of posterior labrocapsular abnormalities of the glenohumeral joint. Sonoarthrography of the glenohumeral joint may be utilized in clinical practice in patients with contraindications to (MRI).

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Exploring Active and Passive Contributors to Turnout in Dancers and Non-Dancers

Medical Problems of Performing Artists ◽

10.21091/mppa.2015.2013 ◽

2015 ◽

Vol 30 (2) ◽

pp. 78-83 ◽

Cited By ~ 9

Author(s):

Kristen Sutton-Traina ◽

Jo A Smith ◽

Danielle N Jarvis ◽

Szu-Ping Lee ◽

Kornelia Kulig

Keyword(s):

External Rotation ◽

Peak Force ◽

Ultrasound Images ◽

Cross Sectional ◽

Dance Training ◽

Femoral Version ◽

Significant Difference ◽

Hip Abductor ◽

The Difference ◽

Bony Morphology

OBJECTIVE: Lower-extremity external rotation, or turnout, is a fundamental skill in dance. Active standing turnout has previously been measured using low-friction turnout disks. Turnout is influenced by passive range of motion (ROM) and strength, with passive ROM a function of bony morphology and ligamentous/capsular restraints. PURPOSE: Our study explored the relationship between standing active turnout and femoral bony morphology, hip passive ROM, and strength among dancers and non-dancers. METHODS: Cross-sectional cohort study. Twenty-three female dancers and 13 female non-dancers aged 18 to 30 yrs were recruited. Standing active turnout on reduced-friction disks, ultrasound images of femoral version, supine passive turnout, and hip abductor and external rotator strength were collected. RESULTS: Dancers demonstrated greater standing turnout (107º±18º) than non-dancers (92º±28º), but the difference was not statistically significant (p=0.054). A significant difference was found for femoral version (p<0.001), 4.7º (±2.8º) for dancers vs 12.1º (±4.6º) for non-dancers. Dancers demonstrated greater supine turnout, 102.7º±18.8º, compared to non-dancers, 84.3º±30.4º (p=0.031). Dancers were able to achieve greater peak force in turnout compared to non-dancers: 2.44±0.44 N/kg and 1.72±0.59 N/kg, respectively (p<0.0001). Supine total turnout was the best predictor of active turnout, contributing 48% of the variance (r=0.696, p<0.001). CONCLUSION: Our findings suggest supine turnout is the largest predictor for standing turnout. Investigating dancers and non-dancers independently, our finding were similar to previous studies suggesting the femoro-acetabular complex may be influenced by dance training, contributing to differences in bony morphology between dancers and non-dancers. Although strength did not significantly contribute to active standing turnout, dancers demonstrated greater peak force compared to non-dancers.

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A Non-inferiority Trial: Safety and Efficacy of Topical 1:1000 versus 1:10 000 Epinephrine in Sino-nasal Surgeries

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489420962825 ◽

2020 ◽

pp. 000348942096282

Author(s):

Cassie L. Dow ◽

Anders W. Sideris ◽

Ravjit Singh ◽

Mitchell H. Giles ◽

Catherine Banks ◽

...

Keyword(s):

Heart Rate ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Nasal Passage ◽

Hemodynamic Parameters ◽

Hemodynamic Stability ◽

Absolute Change ◽

Significant Difference ◽

Blood Pressures ◽

Surgical Conditions

Objective: This study aimed to test the non-inferiority of topical 1:1000 epinephrine compared to topical 1:10 000 with regard to intraoperative hemodynamic stability, and to determine whether it produced superior visibility conditions. Methods: A single-blinded, prospective, cross-over non-inferiority trial was performed. Topical 1:1000 or topical 1:10 000 was placed in 1 nasal passage. Hemodynamic parameters (heart rate, systolic and diastolic blood pressures, and mean arterial pressure) were measured prior to insertion then every minute for 10 minutes. This was repeated in the contralateral nasal passage of the same patient with the alternate concentration. The surgeon graded the visualization of each passage using the Boezaart Scale. The medians of the greatest absolute change in parameters were compared using a Wilcoxon Rank-Signed test and confidence intervals were calculated using a Hodges-Lehman test. The non-inferiority margin was pre-determined at 10 bpm for heart rate and 10 mmHg for blood pressures. A Wilcoxon Rank-Signed test was used to assess superiority in visualization. Results: Thirty-two patients were enrolled and after exclusions, nineteen were assessed (mean age = 35.63 ± 12.49). Differences in means of greatest absolute change between the 2 concentrations were calculated (heart rate = 2.49 ± 1.20; systolic = −1.51 ± 2.16; diastolic = 2.47 ± 1.47; mean arterial pressure = 0.07 ± 1.83). In analyses of medians, 1:1000 was non-inferior to the 1:10 000. There was a significant difference (–0.58 ± 0.84; P = .012) in visualization in favor of topical 1:1000. Conclusion: Topical 1:1000 epinephrine provides no worse intraoperative hemodynamic stability compared to topical 1:10 000 but affords superior visualization and should be used to optimize surgical conditions.

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Management of appendicitis during COVID-19 pandemic; short-term outcomes

Scottish Medical Journal ◽

10.1177/0036933020956316 ◽

2020 ◽

Vol 65 (4) ◽

pp. 144-148

Author(s):

Radhakrishnan Ganesh ◽

James Lucocq ◽

Neville Ogbonnia Ekpete ◽

Noor Ul Ain ◽

Su Kwan Lim ◽

...

Keyword(s):

Conservative Management ◽

Short Term ◽

Mri Scan ◽

Operative Outcomes ◽

Uncomplicated Appendicitis ◽

Significant Difference ◽

Long Term Follow Up ◽

Surgical Conditions

Background and aim COVID-19 pandemic has predisposed patients undergoing surgery to post-operative infection and resultant complications. Appendicitis is frequently managed by appendicectomy. After the onset of the pandemic, selected cases of appendicitis were managed with antibiotics which is a recognised treatment option. Our objective was to compare the management of appendicitis and post-operative outcomes between pre- and post-COVID-19. Methods Ninety-six patients were identified from before the onset of the pandemic (November 2019) to after the onset of the pandemic (May 2020). Data were collected retrospectively from electronic records including demographics, investigations, treatment, duration of inpatient stay, complications, readmissions and compared between pre- and post-COVID-19 groups. Results One hundred percent underwent surgical treatment before the onset of pandemic, compared with 56.3% from the onset of the pandemic. A greater percentage of patients were investigated with imaging post-COVID-19 (100% versus 60.9%; p < 0.00001). There was no significant difference in the outcomes between the two groups. Conclusion CT/MRI scan was preferred to laparoscopy in diagnosing appendicitis and conservative management of uncomplicated appendicitis was common practice after the onset of pandemic. Health boards can adapt their management of surgical conditions during pandemics without adverse short-term consequences. Long term follow-up of this cohort will identify patients suitable for conservative management.

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The Hip Suction Seal, Part II: The Effect of Rim Trimming, Chondrolabral Junction Separation, and Labral Repair/Refixation on Hip Distractive Stability

The American Journal of Sports Medicine ◽

10.1177/0363546520941859 ◽

2020 ◽

Vol 48 (11) ◽

pp. 2733-2739 ◽

Cited By ~ 1

Author(s):

Hajime Utsunomiya ◽

Hunter W. Storaci ◽

Samuel I. Rosenberg ◽

Bryson R. Kemler ◽

Grant J. Dornan ◽

...

Keyword(s):

Pain Relief ◽

Femoroacetabular Impingement ◽

Labral Repair ◽

Neutral Position ◽

Native State ◽

Intact Group ◽

Significant Difference ◽

Labral Refixation ◽

Biomechanical Parameters ◽

Suction Seal

Background: The acetabular labrum contains free nerve endings, and an unstable labrum can result in increased femoral head movement during hip motion. This can be caused by chondrolabral junction (CLJ) separation, especially in association with pincer-type femoroacetabular impingement, and may contribute to hip pain. Hypothesis: Rim resection alone has no effect on suction seal biomechanics. Further, separation of the CLJ changes hip suction seal biomechanics when compared with those of the native state, whereas repair and refixation with suture anchors restore these biomechanical parameters. Study Design: Controlled laboratory study. Methods: A total of 12 fresh-frozen human cadaveric hips were used in this study. Hips were mounted in a saline bath on a dynamic tensile testing machine and were distracted at a rate of 0.5 mm/s from neutral position. A total of 3 parameters (force, displacement, and intra-articular pressure) were measured throughout testing. Before testing, hips were randomly allocated to 1 of 2 groups: 1 that included the CLJ separation (CLJ Cut group) and 1 that did not (CLJ Intact group). Hips were tested in the following states: (1) native, (2) rim trimming, (3) separated CLJ (CLJ Cut group only), and (4) labral repair/refixation. For each group a linear mixed-effects model was used to compare biomechanical parameters between states. Results: Rim trimming did not affect any suction seal parameters relative to those of the native state. In the CLJ Cut group, no significant difference in distance to break the suction seal was observed for any states compared with that of the native state. In the CLJ Intact group, the distance to break the suction seal was significantly shorter in the labral refixation state (1.8 mm) than the native state (5.6 mm; P = .002). The maximum distraction force (62.1 ± 54.1 N) and the peak negative pressure (−36.6 ± 24.2 kPa) of the labral repair/refixation state were significantly lower than those of the native state in both groups (93.4 ± 41.7 N, P = .01; –60.7 ± 20.4 kPa, P = .02). Conclusion: Rim trimming did not change the biomechanical properties of the labral suction seal. Labral refixation resulted in a shorter distance to break the labral suction seal. This indicates that labral mobility is reduced by the labral refixation procedure, which could be beneficial in postoperative pain relief and labral healing. Clinical Relevance: The labral refixation reduced labral mobility, which could be beneficial for both pain relief and labral healing to the acetabulum after pincer-type femoroacetabular impingement resection.

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Hodgkin Lymphoma Outcomes: Can We Expect Ethnic Parity in a Hispanic Prevalent Population?

Blood ◽

10.1182/blood-2019-129058 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 4056-4056

Author(s):

Michelle Janania Martinez ◽

Prathibha Surapaneni ◽

Juan F Garza ◽

Tyler W Snedden ◽

Snegha Ananth ◽

...

Keyword(s):

Hodgkin Lymphoma ◽

Conflicts Of Interest ◽

Relative Survival ◽

Complete Response ◽

Statistical Testing ◽

P Value ◽

Hispanic Population ◽

Significant Difference ◽

The Mean

BACKGROUND It is estimated that 8110 persons will be diagnosed with Hodgkin Lymphoma (HL) in the US during 2019, but the advent of new treatment options has increased the cure rate to at least 80%. It has been reported that the rates of HL are lower in the adolescent and young adult (AYA) Hispanic population but significantly higher in the Hispanic population older than 65. The relative survival estimates are stated to be similar between AYA Hispanics (HI) and non-Hispanics (NH) but for ages 65-84, HI have a significantly higher mortality rate. Pediatric studies have suggested that ethnicity plays a role in outcomes in patients with HL but there is limited data in the adult population. There is an unmet need in the field, where dossiers on underrepresented ethnic minorities need to be carefully considered and compared to existing data. Therefore, our study aims to compare survival outcomes in Hispanics vs Non-Hispanics with HL, who were treated at the only NCI designated cancer center of South Texas. To our knowledge this is the largest cohort of HL patients from a single academic institution that serves primarily Hispanics. METHODS We located and retrospectively analyzed a total of 616 patients with diagnosis of Lymphoma (HL and NHL) by International Classification of Diseases (ICD) codes and identified 116 cases of HL; all the patients received care at UT Health San Antonio, between 2008-2018. Key variables for each patient included age, gender, race/ethnicity, comorbidities, insurance status, stage, BM and extranodal involvement, treatment received, outcome at 3 and 5 years and vitality status in 2018. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. The study was approved by the local Institutional Review Board. The findings will be available to patients, funders and medical community through traditional publishing and social media. RESULTS We identified 116 patients with HL, of which 73 were HI (63%), 43 NH (36%) and 1 not specified (1%). In regard to race, 92% identified as Caucasian, 4% as African American, 3% other and 1% Asian. The median age at diagnosis was 37.4, (SD 15.13). There were 49 females (42%) and 67 males (58%). The most common funding source was commercial insurance N=54 (47%), followed by a hospital payment plan N=30 (26%), Medicare N=16 (14%), unfunded N=13 (11%) and Medicaid N=3 (2%). Most prevalent co-morbidities were HTN N=28 (24%) and diabetes mellitus N= 23(20%); 50% of patients had no co-morbidities (N=63).At diagnosis ECOG of 0-1 was seen in 108 patients (93%); 8 were Stage I (7%), 39 stage II (33%), 32 stage III (28%), and 37 stage IV (32%). EBV was positive in 26 patients (22%). There were 15 patients that were HIV positive (13%), 54% with CD4 count <200, and 12 (75%) on antiretroviral therapy at diagnosis. Median PFS was 853.85 days (SD 912.92). We excluded patients who were lost to follow up or had not reached 3/5 years. At 3 year follow up there was: complete response in 37 HI (74%) vs 22 NH (92%); disease progression in 8 (16%) vs 0 (0%); death in 5 (10%) vs 2 (8%), respectively (p-value= 0.094). At 5 year follow up there was: complete response in 30 HI (77%) vs 17 NH (90%); progressive disease in 2 (5%) vs 0 (0); death 7 (18%) vs 2 (11%), respectively (p-value = 0.619). At the end of 2018, 41 HI (84%) were alive compared to 22 NH (88%) [p-value 0.74]. CONCLUSION Within the limitations of sample size, our study demonstrates that in the prevalently Hispanic population of our institution, HI patients with HL have no statistically significant difference in outcome when compared to NH patients. Disclosures No relevant conflicts of interest to declare.

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Effect of bevacizumab (BV) and chemotherapy (CT) on serum levels of vascular endothelial growth factor receptor-2 (sVEGFR-2) in patients with inflammatory and locally advanced breast cancer

Journal of Clinical Oncology ◽

10.1200/jco.2006.24.18_suppl.13003 ◽

2006 ◽

Vol 24 (18_suppl) ◽

pp. 13003-13003

Author(s):

J. M. Walshe ◽

N. Denduluri ◽

A. W. Berman ◽

D. Nguyen ◽

S. Y. Yang ◽

...

Keyword(s):

Breast Cancer ◽

Wound Healing ◽

Locally Advanced Breast Cancer ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Statistical Testing ◽

Reference Sequence ◽

Tissue Samples ◽

Significant Difference ◽

Wound Healing Problems

13003 Background: VEGFR-2 is a principal mediator of angiogenesis. The effects on sVEGFR-2 after anti-angiogenesis therapy are unknown. Methods: Twenty-one patients (pts) with breast cancer underwent neoadjuvant treatment with BV for 1 cycle (C1) followed by 6 cycles of BV, CT and filgrastim. Blood was collected at baseline (BL), post-cycles 1, 4 and 7. Objectives were to correlate sVEGFR-2 changes after treatment with response, assess wound healing complications, and evaluate for tumor VEGFR-2 mutations. sVEGFR-2 levels were measured by ELISA. Exons 17–26 were sequenced on tissue samples from 20 pts at BL and post C1 to evaluate for VEGFR-2 mutations. Statistical testing is non-parametric. All p-values are two-tailed, with a p < 0.01 interpreted as a statistically significant difference. Results: Thirteen pts had a partial response (PR), 1 unconfirmed PR, 5 stable disease (SD), and 2 progressive disease (PD). Median sVEGFR-2 levels increased by 16% from BL to post C1 (p = 0.0003) and decreased by 19% post C1 to post C4 (p = 0.048). sVEGFR-2 levels were not associated with clinical response. sVEGFR-2 levels at BL did not correlate with other BL parameters: Ki67, microvessel density, VEGF-A, pVEGFR-2, VEGFR-2 or TUNEL (apoptosis). A moderate-weak correlation was seen between post C1 levels of sVEGFR-2 and pVEGFR-2 (r = 0.43). A moderate inverse correlation was seen in the relative difference of sVEGFR-2 and TUNEL from BL to post C1 (r = −0.59). Comparing pts with (n = 5) and without (n = 16) wound healing problems, median sVEGFR-2 levels were 11322 ng/ml and 7524 ng/ml at BL (p = 0.019), 13928 ng/ml and 10148 ng/ml post C1 (p = 0.029), and 10965 ng/ml and 7932 ng/ml post C4 (p = 0.042). In 40 samples where tumor VEGFR-2 sequencing was obtained, no mutations were seen compared to the reference sequence. Conclusion: sVEGFR-2 levels rose significantly following BV alone but were not associated with response. There is a suggestion that sVEGFR-2 may correlate with activated VEGFR2 and a decrease in apoptosis. sVEGFR-2 levels were higher in pts with wound healing problems and may predict pts at higher risk of this complication. There were no mutations of VEGFR2. [Table: see text]

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