To assess the effects that the physical and chemical properties of lignin might have on the enzymatic hydrolysis of pretreated lignocellulosic substrates, protease treated lignin (PTL) and cellulolytic enzyme lignin (CEL) fractions, isolated from steam and organosolv pretreated corn stover, poplar, and lodgepole pine, were prepared and characterized. The adsorption of cellulases to the isolated lignin preparations corresponded to a Langmuir adsorption isotherm. It was apparent that, rather than the physical properties of the isolated lignin, the carboxylic acid functionality of the isolated lignin, as determined by FTIR and NMR spectroscopy, had much more of an influence when lignin was added to typical hydrolysis of pure cellulose (Avicel). An increase in the carboxylic content of the lignin preparation resulted in an increased hydrolysis yield. These results suggested that the carboxylic acids within the lignin partially alleviate non‐productive binding of cellulases to lignin. To try to confirm this possible mechanism, dehydrogenative polymers (DHP) of monolignols were synthesized from coniferyl alcohol (CA) and ferulic acid (FA), and these model compounds were added to a typical enzymatic hydrolysis of Avicel. The DHP from FA, which was enriched in carboxylic acid groups compared with the DHP from CA, adsorbed a lower mount of cellulases and did not decrease hydrolysis yields when compared to the DHP from CA, which decreased the hydrolysis of Avicel by 8.4%. Thus, increasing the carboxylic acid content of the lignin seemed to significantly decrease the non‐productive binding of cellulases and consequently increased the enzymatic hydrolysis of the cellulose. Biotechnol. Bioeng. 2011; 108:538–548. © 2010 Wiley Periodicals, Inc.

INTRODUCTION: The optimal structure for survivorship care plan (SCP) programs and methodology for generating treatment summaries (TSs) has not yet been defined, but the Commission on Cancer and the National Accreditation Program for Breast Centers both mandate that participating oncology programs implement SCP-TS processes for patients that have completed treatment. METHODS: We used the Institute for Healthcare Improvement’s Plan-Do-Study-Act model for conducting a quality improvement project evaluating two different SCP-TS programs implemented at the Henry Ford Health System/Henry Ford Cancer Institute’s Breast Oncology Program in Detroit, Michigan. System I involved TSs drafted by nonspecialist breast clinic staff; System II involved TSs vetted through a multidisciplinary breast specialist conference approach. Accuracy of basic documentation entries related to dates and components of treatment were compared for the two approaches. RESULTS: Seventy-one System I and 93 System II documents were reviewed. Documentation was accurate in at least 90% of documents for both systems regarding delivery of chemotherapy and/or endocrine therapy and for documenting the identity of the various members of the cancer treatment team. Both systems had notable inaccuracies in documenting type of surgery performed, but System II had fewer inaccuracies than System I (33.78% v 51.67%, respectively; P = .05). System II, compared with System I, had fewer inaccuracies in documenting date of diagnosis (9.68% v 25.35%, respectively; P = .01) and had less missing information for dose of radiation delivered (9.33% v 33.9%, respectively; P < .01). CONCLUSION: A multidisciplinary team approach to drafting and reviewing SCP-TS documents improved content accuracy for our program, but ongoing education regarding documentation of various surgical procedures is warranted.

249 Background: In patients with metastatic breast cancer, clinical practice guidelines include obtaining histologic confirmation of metastases when possible. The purpose of this study was to investigate patterns and correlates of receipt of a confirmatory biopsy. Methods: Data were abstracted from the records of patients diagnosed with metastatic breast cancer in the Michigan Breast Oncology Quality Initiative (MiBOQI), a statewide registry of 25 health systems. Patients with Stage IV disease at diagnosis were excluded. Analyses investigated associations between receipt of a confirmatory biopsy and disease, clinical and non-clinical factors, and treating health system. Results: Data were available for 1,231 (96%) of eligible patients between 2006 and 2015. Of these, 66% had a confirmatory biopsy; the proportion of patients having a biopsy varied between the 25 sites from 41% to 100% (p = 0.03). In bivariate analyses, younger age (p = 0.02), lower comorbidity (p = 0.007), longer time between the primary and recurrence (p < 0.001), more recent year of recurrence (p = 0.01), having liver, skin, soft tissue, or multiple metastases (p < 0.001), and private or government insurance (p = 0.002) were associated with biopsy. In multivariate analyses, longer time since the primary diagnosis (p < 0.001), more recent year of recurrence (p = 0.03), initial site(s) of recurrence (p < 0.001), and private or government insurance (p = 0.004) remained significant predictors of biopsy. Treatment site was no longer significant (p = 0.14). Minority status, obesity status, and disease characteristics (stage, estrogen receptor, progesterone receptor, HER2, grade) of the primary were not significant in either bivariate or multivariate analyses. Analyses were repeated without insurance with no change in the other findings. Conclusions: In a statewide collaborative, the proportion of patients having a confirmatory biopsy increased over the study period and was associated with several clinical factors. Insurance was an independent and significant predictor of receipt of what is considered standard care.

16024 Background: Tumor lysis syndrome (TLS) is a life threatening complication occurring in highly proliferative malignancies. Chemotherapy often causes rapid tumor breakdown resulting in metabolic derangement, abnormal electrolytes and hyperuricemia. Untreated TLS can lead to renal failure and death. Rasburicase (recombinant urate oxidase) is a novel agent that reduces serum uric acid (SUA) levels in pediatric patients. Here we report on 18 adult patients treated with Rasburicase with highly proliferative malignancies. Methods: We retrospectively identified all adult TLS patients treated with Rasburicase at William Beaumont Hospital, Royal Oak, Michigan. We evaluated pre and post treatment SUA, electrolytes and renal function to determine the effect of a single dose of Rasburicase. Results: Twelve men and 6 women (mean age 56.5 years) received Rasburicase between July 2004 and November 2005. Thirteen patients had a diagnosis of TLS prior to treatment, 5 were treated prophylactically and did not develop TLS, 1 patient died of sepsis within 48 h of treatment and 1 patient died from cerebral hemorrhage within 72 h of treatment. Of the 12 assessable patients with TLS, the mean pretreatment SUA was 11.2 mg/dL and the mean 48 h post treatment SUA was 0.68 mg/dL. All SUA levels returned to normal (2.5–8 mg/dL) within 48 h. Ten patients had elevated pretreatment serum creatinine (Scr) levels (mean 2.5 mg/dL) and 2 patients had normal (0.7–1.5 mg/dL) levels. Within 72 h of treatment 7 of the 10 assessable patients showed improvement (mean reduction 0.6 mg/dL) in Scr. Conclusions: It is notable that while almost all patients had hematologic malignancies, 1 patient was diagnosed with an ovarian malignancy and showed great improvement in both SUA and Scr. Rasburicase reduced SUA levels in this patient group. Further studies on larger adult populations in or at high risk for TLS are necessary to determine statistical significance. No significant financial relationships to disclose.