Disseminated Stages Research Articles

P-1291. Racial disparities in Lyme disease among beneficiaries of US Medicaid and Medicare

Abstract Background Lyme disease (LD) is the most common vector-borne disease in the US. Manifestations range from a localized rash to neurologic, cardiac, and musculoskeletal conditions during disseminated stages. LD incidence is highest among White persons in the US, but evidence suggests that people from racial and ethnic minority groups experience more severe disease. Methods We used a claims-based algorithm (≥ 1 LD ICD-10 code and appropriate antibiotics within 30 days) to identify LD cases among Medicaid (age < 19 and ≥ 19 years) and Medicare fee-for-service (age < 65 [persons with disabilities] and ≥ 65 years old) beneficiaries living in 16 high incidence states ( > 10 cases/100,000 population for ≥ 3 years) during 2016-2021. We calculated prevalence ratios for disseminated disease and hospitalization by racial group using White persons as the reference. Results There were 62,055 LD cases identified among Medicaid beneficiaries and 90,882 among Medicare beneficiaries. In Medicaid, 85% of cases were in White persons, 6% in Hispanic, 4% in Black, 4% in Asian/Pacific Islander, and 1% in Native American persons. In Medicare, 96% of cases were in White persons, with 1% or less reported in other groups. Non-White persons were more likely to be hospitalized at diagnosis, diagnosed outside of primary care, diagnosed outside of the peak months for LD transmission, to be female, and to have disseminated disease (Table 1). Medicaid beneficiaries and Medicare beneficiaries ≥ 65 years old who identified as Black, Asian/Pacific Islander, or Hispanic had a higher likelihood of disseminated disease than White persons. Among Medicaid beneficiaries < 19 years old, those who identified as Black, Asian/Pacific Islander, or Hispanic had a higher likelihood of being hospitalized at diagnosis than those who identified as White. Black Medicaid beneficiaries ≥ 19 and Medicare beneficiaries < 65 also had a higher likelihood of hospitalization (Table 2). Conclusion These data illustrate disparities in LD by race and ethnicity and suggest possible disparities by other characteristics including sex and, given the high rates of disseminated disease in Medicare beneficiaries < 65 years old, disability. Equitable interventions are needed to reduce disparities in LD recognition and severity. Disclosures L. Hannah Gould, PhD, MS, MBA, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Sarah J. Willis, PhD, MPH, Pfizer, Inc.: Employment|Pfizer, Inc.: Stocks/Bonds (Private Company) Christopher G. Prener, PhD, Pfizer, Inc.: Employee|Pfizer, Inc.: Stocks/Bonds (Public Company) Stephanie A. Duench, PhD, Pfizer Inc.: Employee|Pfizer Inc.: Stocks/Bonds (Public Company) Holly Yu, MSPH, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) Jennifer Moisi, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company) James H. Stark, PhD, Pfizer: Employee|Pfizer: Stocks/Bonds (Public Company)

The Epigenetic Hallmarks of Cancer.

Cancer is a complex disease in which several molecular and cellular pathways converge to foster the tumoral phenotype. Notably, in the latest iteration of the cancer hallmarks, "nonmutational epigenetic reprogramming" was newly added. However, epigenetics, much like genetics, is a broad scientific area that deserves further attention due to its multiple roles in cancer initiation, progression, and adaptive nature. Herein, we present a detailed examination of the epigenetic hallmarks affected in human cancer, elucidating the pathways and genes involved, and dissecting the disrupted landscapes for DNA methylation, histone modifications, and chromatin architecture that define the disease. Significance: Cancer is a disease characterized by constant evolution, spanning from its initial premalignant stages to the advanced invasive and disseminated stages. It is a pathology that is able to adapt and survive amidst hostile cellular microenvironments and diverse treatments implemented by medical professionals. The more fixed setup of the genetic structure cannot fully provide transformed cells with the tools to survive but the rapid and plastic nature of epigenetic changes is ready for the task. This review summarizes the epigenetic hallmarks that define the ecological success of cancer cells in our bodies.

Approach to prediction and receiver operating characteristic analysis of a regression model for assessing the severity of the course Lyme borreliosis in children

IntroductionLyme borreliosis (LB) is a multisystemic zoonotic disease transmitted by the bite of infected tick vectors. The aim of the study is to develop a mathematical model for predicting the risk of severity of Lyme disease by the risk factor of the disseminated form of LB in children who have had a tick attack. To test the effectiveness of the formula for predicting the development of the disseminated stage of LB, we built a receiver operating characteristic (ROC) curve and determined the specificity and sensitivity of our model. The results of the examination of 122 patients with the confirmed local and disseminated stages of LB were taken as a basis.Material and methodsTo build a prognostic model for prediction of the risk of the developing of the stage in LB predicting the risk of severity of course in Lyme borreliosis (PRSCLB), 122 children (aged 13 ±3 years) with LB were examined using multivariate regression analysis, including 52 boys and 70 girls. Groups of patients: 79 children with erythema migrans, 16 with Lyme arthritis, and 27 with nervous system involvement by LB. The quality of the prognostic model was checked by the Nagelkerke R Square (Nagelkerke R2) and the acceptability of this model was assessed using ROC analysis.ResultsThe method of multivariate regression analysis for predicting severe course and organ and system damage in LB in children, taking into account the factors and variants of the disease itself, makes it possible to develop a mathematical model for predicting the relative response factors (RRF) of severe forms of Lyme disease and will improve the effectiveness of treatment. This will create all the prerequisites for high-quality preventive measures and reduce the relative response factors rate. The initial data for predicting the severity of LB were 28 factors. According to the results of regression analysis, 24 factors were included in the model for predicting the severity of LB.ConclusionsThe results of the study showed that the multifactorial model predicts the severity and organ and system damage in LB in children with an accuracy of 95%. The ROC curve, which was built on the basis of the results, has an area under the curve of 0.94, which indicates the high efficiency of the model.

Lyme Disease: An Overview.

Lyme disease, a tick-borne multisystem disease, is caused by spirochete Borrelia burgdorferi (sensu lato). It is a common illness in temperate countries, especially the United States, but the incidence is increasing across continents due to increasing reforestation, travel and adventure tourism, increased intrusion in the vector habitat, and changing habitat of the vector. Transmission primarily occurs via bite of an infected tick (Ixodes spp.). The appearance of an erythema migrans rash following a tick bite is diagnostic of early Lyme disease even without laboratory evidence. Borrelia lymphocytoma and acrodermatitis chronica atrophicans along with multisystem involvement occur in late disseminated and chronic stages. A two-step serologic testing protocol using an enzyme-linked immunosorbent assay (ELISA) followed by confirmation of positive and equivocal results by Western immunoblot is recommended for the diagnosis. Transplacental transmission to infant occurs in the first trimester with possible congenital Lyme disease making treatment imperative during antenatal period. The treatment is most effective in the early stages of the disease, whereas rheumatological, neurological, or other late manifestations remain difficult to treat with antibiotics alone. Treatment with oral doxycycline is preferred for its additional activity against other tick-borne illnesses which may occur concurrently in 10%-15% of cases. New-generation cephalosporins and azithromycin are alternative options in patients with doxycycline contraindications. No vaccine is available and one episode of the disease will not confer life-long immunity; thus, preventive measures remain a priority. The concept of post-Lyme disease syndrome versus chronic Lyme disease remains contested for want of robust evidence favoring benefits of prolonged antibiotic therapy.

Immunization with a tri-antigen syphilis vaccine significantly attenuates chancre development, reduces bacterial load, and inhibits dissemination of Treponema pallidum

Syphilis continues to be a significant public health concern worldwide. The disease is endemic in many low- and middle-income countries, and rates have risen sharply in high-income countries over the last decade. The continued prevalence of infectious and congenital syphilis worldwide highlights the need for the development of an effective syphilis vaccine to complement public health measures for syphilis control. The complex, multi-stage course of syphilis infection necessitates a holistic approach to the development of an effective vaccine, in which immunization prevents both the localized stage of infection (typified by the highly infectious chancre) and the disseminated stages of infection (typified by the secondary rash, neurosyphilis, and destructive tertiary lesions, as well as congenital syphilis). Inhibiting development of the infectious chancre would reduce transmission thus providing community- level protection, while preventing dissemination would provide individual-level protection by reducing serious sequelae and may also provide community level protection by reducing shedding during secondary syphilis. In the current study we build upon prior investigations which demonstrated that immunizations with individual, well characterized T. pallidum TprK, TprC, and Tp0751 peptides elicits partial protection against infection in the animal model. Specifically, we show here that immunization with a TprC/TprK/Tp0751 tri-antigen cocktail protects animals from progressive syphilis lesions and substantially inhibits dissemination of the infection.

Epidemiological impact of lung cancer screening by low dose CT scan in the French Department of the SOMME

ContextLung cancer is the leading cause of cancer death worldwide. In recent years, screening using low-dose CT scan has shown a reduction in lung cancer-related mortality and in all-cause mortality. The DEP KP80 study was implemented in the French department of the Somme with the aim of investigating lung cancer screening in practice. The results of the first round showed a prevalence of 2.7% for lung cancer, with the majority at localized stages (77%).The primary objective of our study was to compare the stage at diagnosis of patients with lung cancer screened as part of DEP KP80 and those who were not screened. The secondary objectives were to describe the epidemiological characteristics of lung cancer in the French department of the Somme for the period in question and to compare survival rates in screened and unscreened patients. MethodsThis retrospective cohort study compared from May 2016 to December 2017 the characteristics of patients with lung cancer screened as part of DEP KP80 and those who were not screened, using data from the Somme Cancer Registry. ResultsIn total, 644 patients with lung cancer were included (18 in the screened group and 626 in the unscreened group). There was a significant inversion in the stage distribution at diagnosis, with a predominance of metastatic or locally advanced stages (69%) and a minority of early stages (31%) in unscreened patients, and a majority of early stages (77.8%) and a lower proportion of locally advanced or disseminated stages (22.2%) in screened patients (p < 0.01). In the screened group, there was a significant improvement in survival, a higher rate of surgical resection, and a longer time interval between first contact and treatment initiation. ConclusionLung cancer screening by low-dose CT scan in the French department of the Somme showed an impact on stage at diagnosis, with a majority of early stages in screened patients, allowing for curative treatment with a significant improvement in survival.

Results of longstanding, single-center trial for pediatric Hodgkin lymphoma treatment

Background. Actually, treatment results of Hodgkin lymphoma (HL) are the most dramatic oncohematology achievements, therefore modern treatment protocols designed to toxicity reduction with the same high level of patients’ survival. Time of complete response occupies a central position in the prognostic factors for HL and helps to find a group of patients whose treatment could be de-escalated.Objective: to evaluate the efficacy of original domestic risk-adopted protocol RDC POG-HL 2003 with treatment de-escalation and refused radiation therapy (RT) for early-responded patients.Materials and methods. 192 patients were enrolled in prospective RDC POG-HL 2003 protocol from February 2003 to November 2020. Median age was 12.8 years (from 3 to 17). Local stages (IA–IIA) were diagnosed in 48 (25 %) patients, disseminated (IIB–IVB) – in 144 (75 %) cases. For local (IA–IIA) stages by RCD POG-HL 2003 treatment included DBVE + RT, for disseminated (IIB–IVB) – BEACOPP escalated (esc.) + RT. In case of 70 % and more tumor reduction after 4 induction courses of BEACOPP-esc., the following treatment included less intensive schemes (ABVD, COPP/ABV). Because of high risk of breast cancer in girls after mediastinal RT, it was possible to omit a RT in case of early response.Results. All patients with local stages are alive by the time of study end. Event- and relapse-free survivals in this group were 97.8 ± 2.5 % (median follow up 181.9 ± 4.8 months). Event-free survival for disseminated stages patients was 90.3 ± 3.3 % (median follow up 179.1 ± 4.2 months), relapse-free survival – 93.5 ± 2.1 % (median follow up 191.7 ± 2.3 months) and overall survival – 97.9 ± 1.2 % (median follow up 196.3 ± 2.6 months). In 48 (25 %) patients it was possible to omit RT without reducing survival rates.Conclusion. Differentiated HL treatment with respect to disease stage and time of complete response is a key to success of treatment. Such approach permits us to reduce cumulative therapy toxicity by its de-escalation and, in some cases, to omit RT.

Anxiety and depression disorders in relation to the quality of life of breast cancer patients with locally advanced or disseminated stage

ObjectiveTo evaluate patterns of association between anxiety and depression and the different elements of the construct of quality of life, in patients with locally advanced breast cancer or disseminated stages. MethodsWith a single measure over time, HADS and FACIT-B scales were applied in 107 women histologically confirmed to have breast cancer, in stages IIB, IIIA, IIIB, IIIC and IV. Factor analysis and multidimensional scaling methods were used to analyse patterns of association. ResultsIn 84.1% of the patients clinical anxiety was found (95%CI, 75.8–90.5%) and clinical depression in 25.2% (95%CI, 17.3–34.6%). Factor analysis groups items of the two scales in 4 domains which accounted for 59% of the total variance, where 2 items (H11 and B8) showed high values of uniqueness and low factor loadings. Multidimensional scaling suggests five groups, showing proximity between depressive symptoms and physical symptoms, as well as between anxious symptoms and related to functionality and social and family environment. ConclusionsThe HADS in patients with neoplastic disease detects a high frequency of depressive and especially anxious symptoms, which makes it advisable to reevaluate their psychometric properties in patients with cancer. The association between depressive symptoms of HADS and physical symptoms of quality of life construct is in favour of the difficulty of diagnosing depressive disorder in patients with cancer, so it may be necessary to develop instruments that allow locating symptoms or clinical characteristics that facilitate this diagnosis.

Trastornos de ansiedad y depresión en relación con la calidad de vida de pacientes con cáncer de mama en estadio localmente avanzado o diseminado

ObjectiveTo evaluate patterns of association between anxiety and depression and the different elements of the construct of quality of life, in patients with locally advanced breast cancer or disseminated stages MethodsWith a single measure over time, HADS and FACIT-B scales were applied in 107 women histologically confirmed to have breast cancer, in stages IIB, IIIA, IIIB, IIIC and IV. Factor analysis and multidimensional scaling methods were used to analyze patterns of association ResultsIn 84.1% of the patients clinical anxiety was found (95%CI, 75.8-90.5%) and clinical depression in 25.2% (95%CI, 17.3-34.6%). Factor analysis groups items of the two scales in 4 domains which accounted for 59% of the total variance, where 2 items (H11 and B8) showed high values of uniqueness and low factor loadings. Multidimensional scaling suggests five groups, showing proximity between depressive symptoms and physical symptoms, as well as between anxious symptoms and related to functionality and social and family environment ConclusionsThe HADS in patients with neoplastic disease detects a high frequency of depressive and especially anxious symptoms, which makes it advisable to reevaluate their psychometric properties in patients with cancer. The association between depressive symptoms of HADS and physical symptoms of quality of life construct is in favor of the difficulty of diagnosing depressive disorder in patients with cancer, so it may be necessary to develop instruments that allow locating symptoms or clinical characteristics that facilitate this diagnosis

S63 - Treatment of Kaposi's Sarcoma (KS) with nab-paclitaxel

Background: Kaposi's sarcoma (KS) is a potentially life-threatening multifocal neoplasm that may represent a difficult therapeutic challenge in disseminated stages. Liposomal anthracyclines, or combination chemotherapy are widely used to treat this kind of patients. The efficacy of taxanes (paclitaxel and docetaxel), as agents with antiangiogenic properties, has been described previously in the treatment of KS patients butthe length of the infusion, the need for pre-medication with steroids and toxicity caused by solvents - Cremophor EL (CrEL) and polysorbate 80 (Tween80) - can limit their utilization, especially in elderly patients.Nab-paclitaxel has efficacy comparable with solvent-based taxanes without need for steroid premedication which can make it easier to tolerate. At the moment there are no studies on its efficacy and safety in older KS patients. Methods: After written informed consent was obtained a phase II trial was conducted with nab-paclitaxel in 6 patients with advanced-stage KS to assess its safety and antitumor activity. The mean age of patients was 74,8 years( range 71-83). Nab-paclitaxel was administered at a fixed dose of 100 mg intravenously over 30 minutes administered weekly on days 1, 8, and 15 of each 4-week cycle for 4 cycles. No premedication to prevent hypersensitivity reactions was required before administration. Thereafter, if the patient experienced stable disease or better response, treatment doses were given every two weeks until complete disease remission, disease progression, or unacceptable toxicity occurred. Results: All patients improved dramatically after chemotherapy. Partial desinfiltration (n = 2) or complete desinfiltration (n = 4) of all papulonodular skin lesions was observed with marked improvement of lymphedema in 1 patient. Grade 3 neutropenia and thrombocytopenia were observed in three of six and one of six patients, respectively. It was not observed any grade 4 toxicity Conclusions: Classic KS predominantly affects elderly people over 60 years, many of whom do not tolerate aggressive chemotherapy regimens well due to frequent comorbidity and diminished cardiovascular and bone marrow reserves. Nab-paclitaxel has a good and rapid efficacy in our experience which involved a setting of patients difficult to manage.

Weekly nab-paclitaxel in elderly patients with classic Kaposi sarcoma.

e22539Background: Kaposi's sarcoma (KS) is a potentially life-threatening multifocal neoplasm that may represent a difficult therapeutic challenge in disseminated stages. Liposomal anthracyclines, or combination chemotherapy are widely used to treat this kind of patients.. The efficacy of taxanes (paclitaxel and docetaxel), as agents with antiangiogenic properties,has been described previously in the treatment of KS patients but the length of the infusion, the need for pre-medication with steroids and toxicity caused by solvents can limit their utilization , especially in elderly patients. Nab-paclitaxel has efficacy comparable with solvent-based taxanes without need for steroid premedication which can make it easier to tolerate .At the moment there are no studies on its efficacy and safety in older KS patients . Methods: After written informed consent was obtained a phase II trial was conducted with nab-paclitaxel in 6 patients with advanced-stage KS to assess its safety and antitumor activity. The mean ...

Chemotherapy of seminoma in disseminated stages of satisfactory and intermediate prognosis

Chemotherapy of seminoma in disseminated stages of satisfactory and intermediate prognosis

The Use of Multiplex Phosphorescence Analysis (PHOSPHAN&lt;sup&gt;TM&lt;/sup&gt;) and Polymerase Chain Reaction for Laboratory Diagnosis of Ixodid Tick-borne Borrelioses

In this report, we evaluated the performance of C6 peptide based multiplex Phosphorescence Analysis (PHOSPHANTM) and Polymerase Chain Reaction (nested PCR) for laboratory diagnosis of Ixodid Tick-borne Borrelioses (ITBB). The study was conducted on 155 patients with localized and disseminated stages of the disease, the cases of mixed infection with ITBB and human granulocytic anaplasmosis including. Positive PHOSPHAN reactions were observed in 78 ± 7.7% of patients with erythema migrans (EM) and 91 ± 11.7% of patients without cutaneous manifestations of the disease. The frequency of PCR positive samples was lower, 26 ± 8.2% and 72 ± 17.1% respectively. The maximum frequency of positive samples detected by both methods was mainly observed at 2 - 4 week from the onset of the disease (or 22 - 35 day after tick bite). In general, PHOSPHAN provided serologic confirmation of the disease in 52 of 55 (94.5 ± 6.2%) patients, whose blood contained Borrelia DNA. Only 3 patients tested positive in PCR (1 - with EM and 2 - without this skin manifestation) were seronegative. These data confirmed the high efficiency of PHOSPHAN method for serologic verification of ITBB both at localized and disseminated stages of the disease. The use of PCR (in addition to PHOSPHAN) is appropriate within a certain period of time (no later than 2 - 3 weeks from the onset of the disease) to clarify the diagnosis in seronegative patients having clinical signs of disseminated non-cutaneous form of ITBB, or atypical cutaneous manifestations of erythematous form of the disease.

Syndecan-1 in Cancer: Implications for Cell Signaling, Differentiation, and Prognostication.

Syndecan-1, a cell surface heparan sulfate proteoglycan, is critically involved in the differentiation and prognosis of various tumors. In this review, we highlight the synthesis, cellular interactions, and the signalling pathways regulated by syndecan-1. The basal syndecan-1 level is also crucial for understanding the sequential changes involving malignant transformation, tumor progression, and advanced or disseminated cancer stages. Moreover, we focus on the cellular localization of this proteoglycan as cell membrane anchored and/or shed, soluble syndecan-1 with stromal or nuclear accumulation and how this may carry different, highly tissue specific prognostic information for individual tumor types.

Genetic profile analysis of tumor stem cells in locally advanced breast cancer

Background Breast carcinoma is a highly prevalent and incident disease. About half the observed cases are diagnosed in later and/or disseminated disease stages. Treatment success in advanced disease stage occurs in about 20% of cases. The identification of patients who would most benefit from neoadjunvant therapy can reduce treatment costs and avoid adverse effects in patients with low probability of response. However, is not yet possible to make such a prediction. The cancer stem cells (CSCs) paradigm relates a cell population resistant to radiotherapy, chemotherapy and cells capable of tumor initiation and recurrence. The identification and characterization of CSCs in the primary tumor can be an effective method of predicting response to neoadjuvant chemotherapy in locally advanced breast cancer.

Cáncer de testículo

Testicular cancer is the most frequent tumor in 15–34 year old males. A total of 95% come from testicular germ cells. They are classified into seminomatous and non-seminomatous germ cells. Its initial treatment is orchiectomy, even in disseminated stages. They are highly sensitive to chemotherapy and radiotherapy. Their curation rate is elevated, even when diagnosed in the advanced phase. Thus, it is very important to distinguish different prognostic groups, which would allows us to individualize the therapy. The objective consists in administering adequate treatment to attempt to achieve cure, even when diagnosed in the metastatic phase, with the least possible sequels. Multidisciplinary treatment is essential. This includes surgery, radiotherapy, chemotherapy that are coordinated and combined adequately to obtain the best results.

Bacillus anthracis spore interactions with mammalian cells: Relationship between germination state and the outcome of in vitro

BackgroundDuring inhalational anthrax, internalization of Bacillus anthracis spores by host cells within the lung is believed to be a key step for initiating the transition from the localized to disseminated stages of infection. Despite compelling in vivo evidence that spores remain dormant within the bronchioalveolar spaces of the lungs, and germinate only after uptake into host cells, most in vitro studies of infection have been conducted under conditions that promote rapid germination of spores within the culture medium.ResultsUsing an in vitro model of infection, we evaluated the influence of the germination state of B. anthracis spores, as controlled by defined culture conditions, on the outcome of infection. Spores prepared from B. anthracis Sterne 7702 germinated in a variety of common cell culture media supplemented with fetal bovine serum (FBS) while, in the absence of FBS, germination was strictly dependent on medium composition. RAW264.7 macrophage-like cells internalized spores to the same extent in either germinating or non-germinating media. However, significantly more viable, intracellular B. anthracis were recovered from cells infected under non-germinating conditions compared to germinating conditions. At the same time, RAW264.7 cells demonstrated a significant loss in viability when infected under non-germinating conditions.ConclusionsThese results suggest that the outcome of host cell infection is sensitive to the germination state of spores at the time of uptake. Moreover, this study demonstrates the efficacy of studying B. anthracis spore infection of host cells within a defined, non-germinating, in vitro environment.

The Type of Enteropathy Is a Prognostic Factor in Enteropathy-Associated T-Cell Lymphoma.

Abstract 2937Poster Board II-913Enteropathy-associated T-cell Lymphoma (EATL) may complicate celiac disease (CD), refractory celiac disease type I (RCD I) characterized by normal intraepithelial lymphocytes (IEL) or refractory celiac disease type II (RCD II) defined by abnormal IEL (CD3s-,CD3i+ and CD8-) and a clonal rearrangement of the gamma or delta chain of the T cell receptor (TCRγ/δ). It remains unknown whether the type of the associated enteropathy, non clonal (CD or RCD I) or clonal (RCD II), may be a prognostic factor in EATL.We aimed to assess the prognosis of EATL according to the type of the associated enteropathy. Medical files of 29 patients with EATL were retrospectively studied. The type of associated enteropathy was confirmed by immunohistochemistry analysis in all cases and by flow cytometry phenotyping analysis of freshly isolated IEL and search for a TCR γ or δ clonal rearrangement by Multiplex PCR whenever possible. Kaplan-Meier curves and Logrank test were used to compare survival of EATL in the 2 groups of enteropathy (clonal or not).Mean age at EATL (13 women / 16 men) onset was 57 years. The associated enteropathy was CD (n=10) or RCD I (n=2) in 12 patients and RCD II in 17 patients. No statistical difference was found in lymphoma staging with localized (IE and IIE) versus disseminated stages (IV) found in 42% and 58% of patients with CD or RCD I and in 53% and 47% of patients with RCD II, respectively. Diagnostic or therapeutic surgery was practiced in 83% and 47% of patients with CD or RCD I and with RCD II, respectively and chemotherapy in 92% and 82% of the same groups of patients, respectively (n.s). Considering all the EATL, the two-year and five-year survival rates of EATL were 34.1% and 20.2%, respectively. In subgroup analysis, the two-year and five-year survival rates of EATL were 66.7% and 53.3% in case of CD and/or RCD I and 11.8% and 0% in case of RCD II, respectively (p=0.0007).In conclusion, the type of enteropathy significantly impacts the prognosis of EATL with a particular short survival in case of associated RCD II enteropathy. Disclosures:No relevant conflicts of interest to declare.

Pediatric liver tumors: Initial presentation, image finding and outcome

Few reports have been carried out on the characteristics of pediatric liver tumors. A retrospective study of 57 patients diagnosed with liver tumors from 1989 through 2004 was conducted. They were classified into groups; 10 benign, 33 primary malignant and 14 metastatic liver tumors. Their demographics, initial presentations, laboratory data, image findings and outcomes were investigated and compared. Hepatocellular carcinoma (HCC) with 91% hepatitis B virus-related, constituted 23 of 33 primary malignant liver tumors and had the poorest survival rate. Initially, 70% of patients with primary malignant liver tumors were at disseminated stages. All of HCC and 88% of hepatoblastoma had elevated serum levels of aphal-fetoprotein. However, abnormal liver function tests as alanine aminotransferase, total bilirubin, albumin and alkaline phosphatase were uncommon in patients with pediatric liver tumors. Metastatic liver tumors compared with primary malignant liver tumors showed hypo-echogenicity in abdominal ultrasound (US) exam and a lesser presence of vessel invasion and contrast enhancement in computed tomography studies (P < 0.01). It is important to diagnose primary malignant liver tumors before their clinical symptoms and signs develop. Children with chronic hepatitis B virus infection must be followed every 6 months by serum aphal-fetoprotein and abdominal US even when their liver function tests are normal. Image studies with abdominal US and computed tomography scan can differentiate between primary and metastatic liver tumors.

A LightCycler TaqMan assay for detection of Borrelia burgdorferi sensu lato in clinical samples

Lyme disease (LD) is an infection caused by an ixodid tick-borne spirochete, Borrelia burgdorferi sensu lato. LD manifests itself as a multisystem inflammatory disease that affects the skin in its early localized stage and spreads to the joints, nervous system, heart, and, to a lesser extent, other organ systems in its later disseminated stages. If diagnosed and treated early with appropriate antibiotics, LD is almost always readily cured. Developing a highly sensitive and specific real-time polymerase chain reaction assay could be very useful in improving the diagnostic accuracy and decreasing turnaround time for results. We report the development of a LightCycler TaqMan assay targeting the OspA gene for clinical detection of B. burgdorferi sensu lato in various types of biologic samples. This assay was validated by testing a variety of clinical samples including cerebrospinal fluid, synovial fluid, skin biopsies, and blood and culture isolates from skin biopsies. The TaqMan testing results were 100% concordant with previously reported results. Reference strains representing isolates from other geographic regions were also successfully amplified. The developed assay is robust, is highly sensitive and specific for B. burgdorferi sensu lato, and is suitable for clinical detection of the bacterium in biologic samples.