RN Group Research Articles

Comparison of a Reduced Needle With a Thin Tip and a Standard Thin Needle (Same Width Overall) for Oocyte Retrieval.

At our facility, oocyte retrieval had previously been performed with a 20-gauge standard needle that is uniformly thin overall (tSN); but recently, we have instead started using reduced needles, with a 20-gauge tip and 17-gauge body (RN). Until now, there have been comparisons between RN and thick standard needles, but there have been no comparisons between RN and tSN. The purpose of this study was to compare oocyte retrieval outcomes using RN with tSN. Information on oocyte retrieval was extracted from the medical records of 304 cycles performed at our facility from January 2020 to December 2023. The oocyte retrieval outcomes of the two types of needles were compared retrospectively with respect to age, anti-Müllerian hormone (AMH), procedure time, additional sedatives, number of follicles punctured, number of oocytes retrieved, number of oocytes fertilized, oocyte recovery rate, and fertilization rate. When AMH ≥ 1.2 ng/mL, the procedure time was 9.3 ± 3.7 and 12.1 ± 4.6 minutes in the RN and tSN groups, respectively (P< 0.001), and the need for additional sedatives was also significantly different: 54.0% in the RN group and 78.5% in the tSN group (P= 0.002). The oocyte recovery rate was significantly different between the RN and tSN groups at 65.3% and 61.2%, respectively (P= 0.046), and the fertilization rate was significantly different between the RN and tSN groups at 56.8% and 66.8%, respectively (P< 0.001). There were no significant differences by age, AMH, number of follicles punctured, number of oocytes retrieved, or number of oocytes fertilized. Without diminished ovarian reserve, RN reduced procedure time and the need for additional sedatives compared to tSN. In addition, the number of oocytes fertilized per oocyte retrieval remained the same, indicating that oocyte retrieval performance was not affected.

Inhomogeneous Au2S for Photoacoustic Imaging and Photodynamic Tumor Therapy Based on Different Forms of Energy Dissipation.

Nanomaterials with unique structures and components play a crucial role in nanomedicine. In this study, we discovered that the inhomogeneous Au2S constructed by cation exchange and acid etching could dissipate energy in different forms after absorbing multichromatic light, which could be used to achieve the integrated diagnosis and treatment of tumors, respectively. Folic acid modified Au2S ringed nanoparticles (FA-Au2S RNs) with an assembly-like structure were demonstrated to result in better PA imaging performance and generate more reactive oxygen species (O2·-, ·OH, and 1O2) than folic acid modified Au2S triangular nanoparticles (FA-Au2S TNs). Finite element analyses determined the reason for the high absorbance properties and synergistic enhancement of plasma resonance in the assembly-like structure of Au2S RNs. Both FA-Au2S nanostructures were modified with folic acid and injected into 4T1 tumor-bearing mice via the tail vein. The best PA imaging contrast was obtained under 700 nm laser illumination, and the most effective PDT antitumor activity was achieved under 1064 nm laser illumination. The PA average of the tumor in the FA-Au2S RN group was approximately 2 times higher than that of the FA-Au2S TN group at 24 h of injection. The PA imaging results of intratumorally injected FA-Au2S RNs proved that they were still able to show better PA signal enhancement at 24 h postinjection. Our study demonstrates that FA-Au2S nanomaterials with unique structures and special properties can be reliably produced using strictly controlled chemical synthesis. It further provides a strategy for the construction of highly sensitive PA imaging platforms and efficient PDT antitumor agents that exploit wavelength-dependent energy dissipation mechanisms.

Partial Versus Radical Nephrectomy: Comparison of Postoperative Complications and Contribution to Mortality

Background: Partial nephrectomy is the preferred treatment method for certain kidney tumors owing to its nephron-preserving benefit. We aimed to compare the occurrence and importance of complications after radical (RN) or partial (PN) nephrectomy for localized renal cell carcinoma (RCC) and contribution to patient mortality. Methods: All RCC cases were extracted from the National Surgical Quality Improvement Program between 2005 and 2017. All-cause mortality was the primary endpoint that defined a failure to rescue (FTR) after the occurrences of complications. Propensity score matching (PSM) was performed to adjust for confounding variables between the 2 groups. The exclusion criteria included patients on dialysis, those with distant metastases, and those with concurrent procedures. Null hypotheses were rejected when P-values were &lt; .05. Results: The database included 24,830 patients, with 22,015 in the RN group and 2815 in the PN. After PSM, 2226 patients after PN were matched 1:1 to an equal number of patients who underwent RN. Overall, postoperative complications occurred in 20.5% after RN, more frequent than 15.9% after PN (P &lt; .001). While the mortality rates were similar, patients were more likely to experience blood transfusion and reintubation, as well as longer hospital stay after RN, while they were likely to have more infectious complications, including abdominal abscess, and more likely to return to the operating room after PN. In both groups, cardiac and respiratory complications were associated with FTR, leading to mortality. Excessive bleeding (requiring transfusion) was also a significant cause of death after RN but not after PN. Conclusion: When planning PN or RN, patients should be counseled on the risks of their selective procedure and the potential increased mortality risk with certain complications. These risks should be weighed against the benefit of those cancer surgeries.

Influence of paraspinal muscle degeneration and postoperative Roussouly classification restoration on mechanical complications in female patients with degenerative scoliosis after surgery

Objective: To investigate the impact of lumbar paraspinal muscle degeneration and postoperative failure to restore ideal Roussouly classification on the occurrence of mechanical complications (MC) following long-segment spinal correction surgery in female patients with degenerative scoliosis (DS). Methods: The clinical data of 72 female DS patients who underwent long-segment spinal correction surgery in Gulou Hospital from June 2017 to November 2021 were retrospectively analyzed. According to whether restoring the ideal Roussouly classification after surgery, the patients were divided into R group(recovery group) (n=51) and N group(non-recovery group) (n=21). According to whether mechanical complications occurred after operation within two years, the patients were divided into MC (mechanical complications)group (n=24) and NMC(non-mechanical complications) group (n=48). The RM group (n=14) experienced mechanical complications in the R group, while the RN group (n=37) did not. The NM group (n=10) experienced mechanical complications in the N group, while the NN group (n=11) did not.Radiographic assessment included Sagittal parameters of spine and pelvis, standardized cross-sectional area (SCSA) and fat infiltration rate (FI%) of paraspinal muscle at each lumbar disc level. Results: The age of DS patients in this study was (61.4±6.2) years.The incidence of MC was 33.33%(n=24)in all patients. The incidence of MC was 27.45%(n=14)in group R and 47.62%(n=10) in group N. The correction amount of pelvic tilt angle (PT) (-11.62°±10.06° vs -7.04°±8.45°, P=0.046) and T1 pelvic angle(TPA)(-12.88°±11.23° vs -7.31°±9.55°, P=0.031)during surgery were significantly higher in MC group compared to the NMC group. In group R, the FI% of paraspinal muscles in each lumbar segment of patients with postoperative MC was higher than that in patients without MC (P<0.05). In the R and N groups, there was no significant difference inthe SCSA of the lumbar paravertebral muscles between patients with postoperative MC and those without MC at each level (all P>0.05). Multivariate logistic regression analysis showed that the average FI% of lumbar PSM was correlated with the occurrence of MC after spinal fusion in DS patients.The average FI% of lumbar PSM≥22.63% was a risk factors for MC after spinal fusion (P=0.010,OR=1.088, 95%CI:1.020-1.160). Conclusions: Female DS patients with higher degree of preoperative paraspinal muscle degeneration have a higher incidence of postoperative mechanical complications. For these patients,.there is still a higher risk of mechanical complications after surgery even if the ideal Roussouly classification is restored after surgery.

953 Outcomes of Partial Nephrectomy for pT3a Renal Cell Cancer Over 20 Years at a Single Centre

Abstract Aim There is limited information on outcomes of pT3a RCC treated with PN. Retrospective studies of cT1/2 upstaged to pT3a treated with RN vs PN show contradictory results. Method Retrospective analysis of all pT3a renal tumours removed by either RN or PN between 2000-2020 at a single centre performed by 6 surgeons with a median follow up period of 4 years. Results 186 cases of pT3a RCC were treated with RN and 78 with PN. There was CT suspicion of T3a disease in 1 PN and 6 RN cases. The mean tumour size in PN vs RN was 4.5cm vs. 8cm. Preoperative and postoperative eGFR were similar between RN and PN groups with a smaller drop in eGFR from preop to post op in the PN vs RN group (16 vs 20ml/min) The number of patients who went on to have renal replacement therapy for end stage renal failure was 6 in the RN group and 2 in the PN group. At median 4 years follow up, 86% of PN patient were alive vs 93% who had RN. Of the patients who had died 5.6% were due to renal cancer in the PN group vs 8.6% in the RN group. The rate of any recurrence or spread of renal cancer detected at follow up was 21% in the PN group and 38% in the RN group. Conclusions This case series suggests PN for pT3a tumours is a reasonable option for patients who have strong indications for nephron sparing surgery.

Forgotten joint score is worse when the affected leg perceived longer than shorter after total hip arthroplasty

BackgroundOne of the causes of patient dissatisfaction after total hip arthroplasty (THA) is leg length discrepancy (LLD). Even when radiographic LLD (R-LLD) is within 5 mm, some people perceive the affected side to be longer, while others perceive it is shorter. The purpose of this study was to investigate the relationship between perceived LLD (P-LLD), R-LLD, and Forgotten Joint Score (FJS-12) after THA.MethodsA retrospective study of 164 patients with unilateral hip disease was conducted. Based on P-LLD after THA, they were classified into three categories: perceived short (PS 21 patients), no LLD (PN 121 patients), and perceived long (PL 22 patients). On the other hand, based on R-LLD after THA, they were divided into < − 5 mm (RS 36 patients), − 5 mm ≤ x < 5 mm (RN 99 patients), and 5 mm ≥ (RL 29 patients), respectively. The proportion of P-LLD in the RN group was also evaluated. In each group, the relationship between P-LLD, R-LLD and FJS-12 was investigated.ResultsAfter THA, the PL group had significantly worse FJS-12 (PS: 68.3 ± 26.2, PN: 75.0 ± 20.9, PL: 47.3 ± 25.2, P < .0001). In the R-LLD evaluation, there was no difference in FJS-12 among the three groups (RS: 73.7 ± 21.1, RN: 70.0 ± 24.5, RL: 67.7 ± 25.4, P < .53). The RN group perceived leg length to be longer (RN-PL) in 12.1% of cases, and the RN-PL groups had significantly worse FJS-12 (RN-PS: 65.4 ± 24.8, RN-PN: 73.8 ± 23.1, RN-PL: 41.8 ± 27.6, P < .0001).ConclusionOne year after THA, patients with longer P-LLD had worse FJS-12, even if the R-LLD was less than 5 mm.

Prophylactic Femoral Neck Fixation in an Osteoporosis Femur Model: A Novel Surgical Technique with Biomechanical Study.

Intramedullary nailing (IMN) is a popular treatment for elderly patients with femoral shaft fractures. Recently, prophylactic neck fixation has been increasingly used to prevent proximal femoral fractures during IMN. Therefore, this study aimed to investigate the biomechanical strength of prophylactic neck fixation in osteoporotic femoral fractures. An osteoporotic femur model was created to simulate the union of femoral shaft fractures with IMN. Two study groups comprising six specimens each were created for IMN with two standard proximal locking screws (SN group) and IMN with two reconstruction proximal locking screws (RN group). Axial loading was conducted to measure the stiffness, load-to-failure, and failure modes. There were no statistically significant differences in stiffness between the two groups. However, the load-to-failure in the RN group was significantly higher than that in the SN group (p < 0.05). Femoral neck fractures occurred in all specimens in the SN group. Five constructs in the RN group showed subtrochanteric fractures without femoral neck fractures. However, one construct was observed in both subtrochanteric and femoral neck fractures. Therefore, prophylactic neck fixation may be considered an alternative biomechanical solution to prevent proximal femoral fractures when performing IMN for osteoporotic femoral fractures.

A COMPARATIVE STUDY IN MANAGEMENT OF DISTAL FEMUR FRACTURES BY DISTAL FEMUR LOCKED COMPRESSION PLATE VERSUS RETROGRADE NAILING

Background : Distal femoral fractures comprise approximately 3%–6% of all femoral fractures. The associated mechanism of injury can be of high or low energy. Surgery is the standard mode of treatment aiding for early weight bearing and mobilization is required in order to prevent longterm complications due to prolonged bed rest. Open reduction and internal xation using extra-medullary implants have been the standard treatment for supracondylar fractures, irrespective of age group with high complication rates including delayed union; implant failure, and infection. Transmedullary nail offers a potential biomechanical advantage over side plates and screws because of intramedullary location; resulting in less stress over the implant and better stress distribution than with eccentric side plate and screws.6 While both techniques are considered standard , the merits and demerits of each technique may be different; leading to better results or alignment using one over the other. This study aims at comparing the two xation methods. A total of 70 patients who met the inc Materials and methods: lusion criteria were included in the study and were divided into 2 groups- Group A comprised those patients treated with Retrograde Nailing (n=35) while Group B patients were treated with Distal Femur Locking Compression Plate(n=35). All post-operative patients were evaluated at 2weeks, 4weeks, 3 months and 6months. Results and conclusion: It was found out that the mean Range of Motion (ROM) evaluated at 6 months was 119.85 (-+21.11) degrees for the RN group while it was 110.0(-+18.85) degrees in the DFLCP group and was statistically signicant with p=0.044 , also the functional outcome assessed by AKSS was statistically signicant (p=0.03) favoring the RN group over the DFLCP group. Similar signicant outcomes were obtained in terms of duration of surgery and amount of blood loss favoring RN group . The radiological union time for RN group was 12 weeks compared to 13.21 weeks in case of DFLCP group , but was not statistically signicant (p=0.100). Hence , distal femur fractures especially the extra articular type had good outcome when treated with RN compared to DFLCP , when intervened early and coupled with adequate post operative physiotherapy.

Prognostic value of tumour contour irregularity on surgical strategies for T1bN0M0 renal cell carcinoma: A multi-institutional study

PurposeTo determine the prognostic value of tumour contour irregularity degree (CID) in surgical strategy options for T1bN0M0 renal cell carcinoma (RCC). Materials and methodsWe performed a retrospective multi-institutional review of 489 patients with T1bN0M0 RCC treated between January 2009 and June 2019. Cox regression and Kaplan-Meier analyses were performed to analyse the impact of CID on disease-free survival (DFS). ResultsThe median follow-up time was 55 months (interquartile range, 40–81 months) for 55 (11.2 %) patients with metastasis or recurrence. Logistic analysis indicated that CID was associated with World Health Organization/International Society of Urological Pathology (WHO/ISUP) grades III–IV (odds ratio, 1.015; 95 % confidence interval [CI], 1.008–1.023; p < 0.001). After being classified into high CID (≥50 %) and low CID (<50 %) groups, those with a high CID showed a significantly higher ratio of WHO/IUSP grades III–IV (74/277 [26.7 %] vs 25/212 [11.8 %]) and shorter DFS than the low CID group (p < 0.001). Multivariable Cox regression showed that partial nephrectomy (PN; hazard ratio [HR], 1.889; 95 % CI, 1.020–3.499; p = 0.043), high CID (HR, 6.685; 95 % CI, 2.776–16.100; p < 0.001), and WHO/ISUP grade III–IV (HR, 1.950; 95 % CI, 1.100–3.458; p = 0.022) were independent prognostic factors for DFS. The Kaplan-Meier plot showed that PN had a DFS rate comparable to that of radical nephrectomy (RN; p = 0.994). In the low CID group, patients who underwent PN showed comparable DFS to those who underwent RN (p = 0.903). Furthermore, patients with a high CID tended to have worse DFS in the PN versus RN group (p = 0.044). Multivariable Cox regression showed that PN (HR, 2.049; 95 % CI, 1.065–3.942; p = 0.032) and WHO/ISUP grade III–IV (HR, 2.148; 95 % CI, 1.189–3.881; p = 0.011) were independent prognostic factors of DFS in the high CID group. ConclusionsCID is a reliable preoperative parameter which is positively correlated with WHO/ISUP grade and can help with surgical decision-making in patients with T1bN0M0 RCC.

Skin endothelial cell and microcirculation function study in recurred keloids patients after keloid surgery and radiotherapy.

Keloid is a type of benign tumor of the skin with abnormal proliferation of fibrous tissue. We sought to observe the changes in skin microcirculation and endothelial cell function around the recurred keloid and explore the skin microcirculation characters in recurred keloid patients. Six patients with recurred keloid were treated with keloid surgery and radiotherapy for the second time. Microcirculation of recurred keloids and their surrounding normal skin tissue was observed with laser Doppler flowmeter before operation. Expression of vascular endothelial growth factor (VEGF), CD31, and HIF-1α were identified by several assay. The local blood flow of group RN was enhanced. The average strength of group N is 0.87. The average strength of group RN is 2.08. The expression of VEGF, CD31, and hypoxia inducible factor-1α (HIF-1α) protein in the keloid-recurred skin (RN) group was higher than the normal skin group via immunohistochemistry (IHC) and Western blotting analysis. The relative expression of VEGF and CD31 mRNA was significantly increased in RN group samples (P < .05). There are significant differences in the expression of VEGF, CD31, and HIF-1α in the recurred keloid skin after radiotherapy and normal skin. They may be used as potential biomarkers and targets for future research on keloid recurrence.

A lipid metabolite lipidomics assay for prediction and severity evaluation of rotator cuff injury.

ObjectiveRotator cuff injury can be caused by local inflammation and fibrosis of musculotendinous cuff. Hypercholesterolemia can lead to physiological changes of rotator cuff that resemble rotator cuff injury. However, the relationship between lipid metabolism and rotator cuff injury and its potential pathological mechanism remain unclear. Herein, we aimed to investigate the correlation between the plasma lipidome, rotator cuff injury, and successive fatty infiltration pathology, and hoped to identify biomarkers for predicting higher risk or higher severity rotator cuff injury by assessing metabolic perturbations and dyslipidemia using lipidomics.MethodsWe quantitatively analyzed 60 lipids species of seven lipids classes and subclasses from 66 subjects using lipidomics. Subjects were divided into four groups: (1) normal rotator cuff with normal clinical routine serum lipid test results (NN group = 13); (2) normal rotator cuff with abnormal clinical routine serum lipid test results (NA group = 10); (3) rotator cuff tear with normal routine serum lipid test results (RN group = 30); (4) rotator cuff tear with abnormal routine serum lipid test results (RA group = 13). Independent-sample t-tests and Kruskal-Wallis tests were used to compare lipid metabolite levels in serum between different groups in patients with rotator cuff tears. The orthogonal partial least squares-discriminant analysis (OPLS-DA) model was used to verify the ability of five lysophosphatidylcholines (LPCs) to distinguish rotator cuff injuries. In the rotator cuff tear group, magnetic resonance imaging (MRI) was used to classify fatty infiltration according to Goutallier's classification. Kruskal-Wallis tests were used to analyze molecular differences between high-grade (grade 3–4) and low-grade (grade 0–2) fatty infiltration groups. Receiver operator characteristic (ROC) curves were drawn for each diagnostic method via different metabolites. The area under the curve (AUC), cutoff, specificity, sensitivity, and accuracy of each diagnostic criterion were calculated.ResultsOur results showed that some rotator cuff injury patients yielded unique lipidomic profiles. Based on Kruskal-Wallis tests, our results showed significant differences in three lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, and 18:3 (Cis) PC, among all four groups independent of clinical blood lipid levels. Also, independent of clinical blood lipid levels, two lipid molecules, 22:0 Lyso PC and 24:0 Lyso PC, were significantly different between the two groups based on Independent sample t-tests. Kruskal-Wallis test results showed that in the rotator cuff tear group, two metabolites (24:0 SM and 16:0 ceramide) differed between high-grade and low-grade fatty infiltration. The AUC values for 22:0 Lyso PC, 24:0 Lyso PC, 18:0–22:6 PE, 24:0 SM, and 16:0 ceramide were 0.6036, 0.6757, 0.6712, 0.8333, and 0.8981, respectively.ConclusionThe results provide insight into how the metabolic mechanisms associated with dyslipidemia impact rotator cuff diseases. Five lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, 18:3 (Cis) PC, 22:0 Lyso PC, and 24:0 Lyso PC, were closely related to rotator cuff tear based on two statistical analysis methods, independent of clinical routine serum lipid test results, which indicates that lipidomics assays are more sensitive than conventional lipid tests, and more suitable for studying rotator cuff lipid metabolism. In addition, two lipid metabolites, 24:0 SM and 16:0 ceramide, are potentially useful for predicting fatty infiltration severity. Further research with a larger number of samples is needed to verify whether these two metabolites can serve as potential markers of severe fatty infiltration. The findings illuminate how metabolic mechanisms associated with dyslipidemia affect rotator cuff disease.

Transcription and proteome changes involved in re-innervation muscle following nerve crush in rats

Severe peripheral nerve injury leads to the irreparable disruption of nerve fibers. This leads to disruption of synapses with the designated muscle, which consequently go through progressive atrophy and damage of muscle function. The molecular mechanism that underlies the re-innervation process has yet to be evaluated using proteomics or transcriptomics. In the present study, multi-dimensional data were therefore integrated with transcriptome and proteome profiles in order to investigate the mechanism of re-innervation in muscles. Two simulated nerve injury muscle models in the rat tibial nerve were compared: the nerve was either cut (denervated, DN group) or crushed but with the nerve sheath intact (re-innervated, RN group). The control group had a preserved and intact tibial nerve. At 4 weeks, the RN group showed better tibial nerve function and recovery of muscle atrophy compared to the DN group. As the high expression of Myh3, Postn, Col6a1 and Cfi, the RN group demonstrated superior re-innervation as well. Both differentially expressed genes (DEGs) and proteins (DEPs) were enriched in the peroxisome proliferator-activated receptors (PPARs) signaling pathway, as well as the energy metabolism. This study provides basic information regarding DEGs and DEPs during re-innervation-induced muscle atrophy. Furthermore, the crucial genes and proteins can be detected as possible treatment targets in the future.

Catch‐up fat in male adults induces low testosterone and consequently promotes metabolic abnormalities and cognitive impairment

Catch-up fat in adults (CUFA) caused by rapid nutrition promotion after undernutrition plays an important role in the epidemic of insulin resistance (IR)-related diseases in developing societies. Insulin resistance is considered to be closely associated with reduced testosterone levels and cognitive function. However, the effects of CUFA on testosterone levels and cognitive function are unclear in males. To investigate the changes in testosterone levels and cognitive function in CUFA in male humans and rats, and explore their probable relationship and mechanisms in rats. The blood testosterone levels, fasting glucose, and blood insulin (FINS) were measured in subpopulation 1 (27 CUFA individuals, 61 controls without CUFA) aged 40-50 years to show the characteristics of sex hormone levels and the metabolic status in CUFA men. Cognitive Flexibility Inventory was conducted in subpopulation 2 (54 CUFA individuals, 214 controls) over 20 years to investigate the associations between sex hormone levels, cognitive function, and CUFA. Male rats (n = 27) were randomly allocated to the NC group (normal chow controls), RN group (CUFA, refeeding after caloric restriction), and RT group (RN with testosterone intramuscular injected while refeeding). The blood testosterone levels, intraperitoneal insulin tolerance test (IPITT), and FINS were measured, and the attentional set-shifting task test (ASST) for the assessment of cognitive function was performed in these animals. Insulin signaling pathway, N-methyl-d-aspartate receptors subtype 2A (NR2A) and 2B (NR2B) expression levels were determined in the rat cerebral cortex. The total testosterone levels decreased (medium [inter-quartile ranges], 13.43 [9.87-18.96] vs. 15.58 [13.37-24.96], p = 0.036), and HOMA-IR (Homeostatic Model Assessment for Insulin Resistance) elevated (1.61 [1.08-2.33] vs. 1.24 [0.87-1.87], P = 0.037) in CUFA men in subpopulation 1. Additionally, cognitive impairment was observed in CUFA men in subpopulation 2. Moreover, our results indicated decreases in total and free testosterone levels, elevations in visceral lipid accumulation, FINS, HOMA-IR, blood glucose, and the area under the curve after IPITT, increases in the number of trials required to achieve the criterion of the first reversal of discrimination (R1) in ASST, and downregulation of IRS-1 mRNA expression, AKT phosphorylation, and the NR2A and NR2B expression in brain tissue in male CUFA rats. Notably, testosterone supplementation improved visceral lipid accumulation and IR-related metabolic disorders, cognitive dysfunction, decreases in IRS-1 mRNA expression, Akt phosphorylation, and NR2A and NR2B expression in brain tissue in male CUFA rodents. CUFA was characterized by reduced testosterone levels, metabolic abnormalities, and cognitive dysfunction in males, and testosterone supplementation attenuated these changes, as well as the alteration in insulin signaling and NR2A and NR2B expression in male CUFA rodents. Herein, we tentatively put forward that CUFA in males induces low testosterone, consequently promoting metabolic abnormalities and cognitive impairment probably mediated by defects in insulin signaling and NR2A, NR2B pathway in brain tissue.

Recurrence after radical and partial nephrectomy in high complex renal tumor using propensity score matched analysis

We evaluated the recurrence after radical and partial nephrectomy in patients with RENAL nephrometry score [RENAL] ≥ 10. A total of 474 patients (radical nephrectomy [RN, n = 236] & partial nephrectomy [PN, n = 238]) in a single tertiary referral institution from December 2003 to December 2019 were assessed. Functional outcomes, defined as estimated glomerular filtration rate changes, relapse pattern, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were evaluated using propensity score-matched analysis. The predictors of recurrence and survival were assessed by Cox-regression analysis. 44 patients in the RN group and 88 in the PN group were included without significant differences in preoperative clinical factors after matching. The PN patients achieved significantly higher renal function preservation rates (p < 0.001). There were five recurrences in RN and six in PN. The PN patients revealed 5-year RFS rate (86.8%), 5-year CSS rate (98.5%), and 5-year OS rate (98.5%) comparable to the RN patients (RFS: 88.7% [p = 0.780], CSS: 96.7% [p = 0.375], and OS: 94.3% [p = 0.248]). Patients with a body mass index (BMI) ≥ 23 had lower 5-year RFS rates (85.5%) and OS rates (95.6%) than those with BMI < 23 (RFS: 90.0% [p = 0.195], OS: 100% [p = 0.117]) without significance. The significant predictor of recurrence was the pathologic T stage (hazard ratio [HR] 3.99, 95% confidence [CI] 1.10–14.50, p = 0.036). The significant predictor of death was the R domain of the RENAL (HR 3.80, 95% CI 1.03–14.11, p = 0.046). PN, if technically feasible, could be considered to preserve renal function in patients with RENAL ≥ 10. Nonetheless, PN needs to be implemented with caution in some patients due to the higher potentiality for recurrence and poor survival.

Decrease in leptin mediates rat bone metabolism impairments during high-fat diet-induced catch-up growth by modulating the OPG/RANKL balance.

Due to catch-up growth (CUG), there are adverse effects on human health. However, there is little information about its influence on bone metabolism. This study aimed to investigate the effects of leptin on bone metabolism and formation during high-fat diet (HFD)-induced CUG. We randomly divided male Wistar rats (5weeks old) into four groups: control (CTL), caloric restriction and normal chow (RN), caloric restriction (4weeks), and HFD (RH), and RH + leptin antagonist (RH + LEPA). We monitored body weights, biochemical markers, and epididymal and perirenal fat in these rats. We then performed Hematoxylin and Eosin (H&E) staining to evaluate bone metabolism. We detected osteoprotegerin (OPG) and receptor activator of nuclear factor-kappa b ligand (RANKL) by qRT-PCR and immunohistochemistry (IHC). We found that HFD increased the body weights in rats. In RN, RH, and RH + LEPA groups, major biochemical markers of bone metabolism in rat serum were significantly altered. We found that epididymal and perirenal fat tissues of RH and RH + LEPA groups were higher than those in the RN group. Severe bone formation impairment in the distal diaphysis and metaphysis of the left femora and lumbar vertebra was seen in the RH group compared to RN, which was even aggravated by a leptin antagonist. OPG in the left femora and lumbar vertebra was lower in RH than the RN group. The leptin antagonist decreased OPG during CUG in the RH group, whereas RANKL expression showed an opposite alteration. During HFD-induced CUG, bone formation was mediated by OPG and RANKL and was affected by the leptin content.

Abstract 2338: Comparison of genomic alterations in lung cancer specimens from high and low radon zones: Search for a genomic fingerprint

Abstract Introduction: Radon-222 (Rn) is a radioactive gas found in rocks and soil. It emits alpha particles that cause dsDNA breaks and increases potential for carcinogenesis. Rn is the 2nd leading cause of lung cancer in the US after smoking, with EPA estimates of &amp;gt;15000 deaths. A significant portion of land in US has high Rn soil levels; ‘action level' for indoor Rn mitigation is &amp;gt;4pci/L. Rhode Island (RI) contains several high Rn areas. We hypothesize that specific cellular and molecular mechanisms play a role in the neoplastic potential of Rn, detectable as signature genetic profiles. Our aim is to identify molecular patterns in patients (pts) from high Rn zones, by evaluating next generation sequencing (NGS) based assays in advanced lung cancer pts. Methods: Using a commercially available NGS assay, we retrospectively analyzed genomic DNA alterations in 324 genes from FFPE specimens of 159 stage IV lung cancer pts treated at Lifespan Cancer Institute at Brown University from 2014- 2019. Based on EPA Rn maps, we identified counties in RI with high indoor Rn levels (&amp;gt;4 pci/L), and compared the gene mutation patterns with those residing in low Rn areas (&amp;lt;4 pci/L). Results: Of the 159 pts (median age= 58), 35 (22%) belonged to high Rn and 124 (78%) to low Rn zones. Both groups had predominantly adenocarcinoma histology and high smoking prevalence (75-80%). Most prevalent genomic alterations in both cohorts were TP53, KRAS and CDKN2A mutations. In the high Rn group, we identified more frequent recurrent mutations in two DNA repair genes: ATM (11% in high Rn vs 1% in low Rn areas, p=0.00086) and CHEK2 (6% vs 0%, respectively, p=0.047). We then classified all detected genomic alterations into major pathways implicated in lung carcinogenesis; DNA repair, cell cycle, tyrosine kinase, and apoptosis. The only observed statistically significant difference in the frequency of mutations was for the DNA repair pathway (29% in high Rn vs 13% in low Rn, p=0.038). Conclusion: To our knowledge, this is the first report of a novel and mechanistically unique insight into the pathobiology of Rn induced lung cancer. Our observations suggest that Rn induced dsDNA breaks may constitute an oncogenic hit in cells which are unable to efficiently repair them because of DNA repair pathway mutations (particularly ATM and CHEK2). We are further testing this “second hit” hypothesis in a larger nationwide dataset comparing NGS profiles of lung cancers from low and high Rn areas in the US. Top 10 mutated genes in High and Low Radon groups (rank; frequency, %)High RnLow RnP value1. TP53 (63)1. TP53 (70)0.422. KRAS (26)2. KRAS (28)0.833. CDKN2A (23)3. CDKN2A (24)0.994. RB1 (17)4. RB1 (20)0.815. EGFR (14)7. EGFR (10)0.546. CDKN2B (14)6. CDKN2B (15)0.997. STK11 (11)5. STK11 (19)0.338. RBM10 (11)-. RBM10 (3)0.07-. SMARCA4 (3)8. SMARCA4 (8)0.469. NF1 (11)9. NF1 (7)0.4910. ATM (11)-. ATM (1)0.008-. MYC (6)10. MYC (5)0.99 Citation Format: Hina Khan, Harish Saiganesh, Adam J. Olszewski, Christopher G. Azzoli, Howard Safran. Comparison of genomic alterations in lung cancer specimens from high and low radon zones: Search for a genomic fingerprint [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2338.

An Interdisciplinary Team Decreases Hospital Acquired Infections in HCT Patients

Topic Significance & Study Purpose/Background/Rationale Prevention of healthcare-associated infections (HAI) is a priority of regulatory and national agencies and CMS implemented payment reductions for HAIs as of 2015. Central Line Associated Blood Stream Infections (CLABSI) in hospitalized patients are challenging HAIs that are known to increase lengths of stay, financial burdens, and overall mortality. HAI definitions are based on non-immunocompromised patient populations and immunocompromised patients often have increased reporting for these infections. Our NCCN hospital sought to better describe CLABSIs in our hematopoietic cell transplant (HCT) population to assure appropriate reporting of HAIs and to identify opportunities for quality improvement. Methods, Intervention, & Analysis An interdisciplinary team including the Infection Prevention Medical Director, Infection Preventionists and Physicians, Pharmacist, inpatient Nurse Manager and a Clinical Nurse Specialist met monthly to perform intensive reviews of CLABSI events that occurred on an inpatient HCT unit. The review included patient risk factors for infection and the degree to which nurses followed the central line care bundle. As a result of these reviews, a Staff RN group was formed who were educated to became unit experts on CLABSI and central line care. Subsequently, CLABSI rates reduced by 30%. Findings & Interpretation CLABSI reviews found common organisms across cases, opportunities for improvement in nursing practice as well as trends in patient characteristics where gaps in care may exist. By expanding these reviews to other HAIs, situations where standard definitions may not directly apply were identified, particularly with Clostridium Difficile Infection (CDI). The interdisciplinary CDI review focused on common causes of diarrhea which were then categorized and shared with staff to aid in patient care decisions. Discussion & Implications Intensive review of HAI events and identification of trends in the immunocompromised patient population assures accurate reporting of these cases. Reviews also allow for development of internal classifications of causes and ongoing process improvement in patient care by identifying unique situations leading to those infections. While this process requires resources to perform data collection and to review cases, the subsequent potential improvement in patient care may offset those. Multidisciplinary case review can help to improve practice, decrease infections, and potentially decrease the cost of patient care.

Nephron Sparing Surgery: A Run after a Chimera?

NSS showed a significantly higher disease free survival (DFS) (70.2% vs. 93.5%, p < 0.001) and cancer specific survival (CSS) at 10 years (78.4% vs. 97.8%, p = 0.011), whereas the 10 years overall survival (OS) in both groups did not differ significantly (RN 65.3% vs. NSS 71.3%, p = 0.214). Renal function preservation was better in the NSS group and the new onset of chronic kidney diseases was significantly less in the NSS group. Total complication rate was significantly less in the RN group (5.6% vs. 8.9%) but became comparable in the last years of observation.

Health-related quality of life in localized renal masses: A matter of sparing nephrons or minimizing the incision?

PurposeLongitudinal assessment of health-related quality of life (HRQoL) differences in patients with localized renal masses according to treatment strategy. MethodsConsecutive patients ≥ 18 years with localized renal masses treated with different approaches (open [O], laparoscopic [L], and percutaneous [P]) and modalities (radical nephrectomy [RN], nephron sparing surgery [NSS] and cryoablation [CA]). The SF-36, Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 questionnaires and pain visual analog scale were completed pretreatment and at 1, 3, and 12 months posttreatment. Questionnaire results were stratified according to approach and treatment modality using a longitudinal multilevel linear regression model. Clinical patient and tumor characteristics, complications, and histopathology results were tested as confounders. ResultsNinety eight patients completed baseline and at least one follow-up questionnaires; 27.5%, 16.3%, 22.5%, 9.2%, 13.3%, and 11.2% patients received LNSS, ONSS, LRN, ORN, LCA, and PCA, respectively. Higher baseline SF-36 (3 domains) and Functional Assessment of Cancer Therapy-Kidney Symptom Index-15 scores were reported in L group compared with the O approach. Overall, HRQoL decreased at 1 month and gradually normalized to baseline level or higher at 1 year. For treatment modality at baseline, higher mean visual analog scale was observed in CA than RN group. A trend to decreased HRQoL was observed at 1 month for RN and NSS; thereafter, scores normalized to baseline levels or higher. Approach or treatment modality HRQoL did not change substantially when corrected for confounders. ConclusionAt short-term, HRQoL outcome favored minimally invasive treatment of RCC; at mid-term, these advantages were no longer apparent. This suggest that in selecting the best surgical treatment for the patient, oncological outcome should be the primary consideration as both approach and treatment modality result in similar HRQoL outcomes.

Improving the Pain Experience for Hospitalized Patients With Cancer

Purpose: To determine the effect of an evidence-based Pain Stoppers bundled intervention on pain management satisfaction scores and actual pain intensity scores of hospitalized patients with cancer, as well as nurses’ knowledge and attitudes on pain. Participants &amp; Setting: Participants and nurses took part in a preintervention group (n = 173 and 11, respectively) and a postintervention group (n = 157 and 9, respectively) at a National Cancer Institute–designated comprehensive cancer center. Methodologic Approach: A pre- and postintervention design was used. Evidence-based strategies included staff education, improved staff communication, adoption of caring behaviors and timely responses, improved patient education, and efforts to maintain patients’ analgesic levels. Findings: Patient satisfaction with staff improved from preintervention to postintervention. No statistically significant differences were noted in actual pain intensity scores between the groups; however, fewer patients in the postintervention group received chemotherapy within 30 days, and more were admitted for symptom management versus chemotherapy administration. In addition, no difference was noted between RN group scores, although there was statistically significant improvement on individual questions in the postintervention group. Implications for Nursing: Implementation of a Pain Stoppers bundled intervention may be effective in improving the pain experience for hospitalized patients with solid tumor cancers.