BACKGROUND AND PURPOSE:Recent studies of intracerebral hemorrhage (ICH) treatments have highlighted the need to identify reliable predictors of hematoma expansion. The goal of this study was to determine whether contrast extravasation on multisection CT angiography (CTA) and/or contrastenhanced CT (CECT) of the brain is associated with hematoma expansion and increased mortality in patients with primary ICH.

Voriconazole is a triazole antifungal used to prevent and treat invasive fungal infections after lung transplantation, but has been associated with an increased risk for developing cutaneous squamous cell carcinoma (SCC). Despite widespread use, there are no clear guidelines for optimal prophylactic regimens that balance its competing risks and benefits. We conducted a retrospective cohort study of all lung transplant recipients at the University of California, San Francisco transplanted between October 1991 and December 2012 (n=455) to investigate whether voriconazole exposure impacted development of SCC, Aspergillus colonization, invasive aspergillosis, and all-cause mortality. Voriconazole exposure was associated with a 73% increased risk for developing SCC (HR=1.73; 95% CI: 1.04–2.88; p=0.03), with each additional 30-day exposure at the standard dose increasing the risk by 3.0% (HR=1.03; 95% CI: 1.02–1.04; p<0.001). Voriconazole exposure reduced risk of Aspergillus colonization by 50% (HR=0.50; 95% CI: 0.34–0.72; p<0.001), but we were underpowered to detect risk reduction for invasive aspergillosis. Voriconazole exposure significantly reduced all-cause mortality among subjects who developed Aspergillus colonization (HR=0.34; 95% CI: 0.13–0.91; p=0.03), but had no significant impact on those without colonization. Physicians should consider patient-specific factors that modify the potential risks and benefits of voriconazole in the care of lung transplant recipients.

Background-Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (<5 years) mortality in this population. This study was designed to test the hypothesis that baseline biochemical parameters would add clinically meaningful predictive information in patients undergoing lower extremity bypass.

To investigate the genetic contribution to phenotypic variability in aneuploidy, we generated mice with trisomy 16 (Ts16) by mating [Rb(6.16)24Lub ؋ Rb(16.17)7Bnr]F1 males with females from four inbred strains, BALB/cJ, C3H/HeJ, C57BL/6J, and DBA/2J. Among the four Ts16 strains that were generated, there were no significant differences in survival, weight, or length relative to euploid control littermates at either embryonic day (E) 14.5 or E17.5. All Ts16 fetuses at E14.5 had edema that ranged from mild to severe, increased amniotic fluid volume, and a thickened neck. At E17.5, Ts16 fetuses exhibited two distinct phenotypes, one with an edematous morphology and the other runt-like. None of these gross morphological abnormalities was strain-specific either in occurrence or frequency. At E10.5, there were pharyngeal arch artery (PAA) anomalies in all Ts16 embryos on the C3H/HeJ background, but none in trisomics on the other three backgrounds. However, at E17.5, there was in addition to ventricular and atrioventricular septal defects, a high frequency of aortic arch defects in Ts16 fetuses, irrespective of genetic background. Taken together, these findings indicate that there are at least two mechanistic responses to the presence of three copies of mouse chromosome 16 in the modeling of the cardiovascular system: one, development of PAA defects, is strongly influenced by genetic background; but the second, development of aortic arch anomalies in the absence of preexisting PAA anomalies, is not. INTRODUCTIONAlthough the overall patterns of anomalies and minor variations in development that are characteristic of chromosomal disorders are quite distinct, these conditions are notable for the variability of their phenotypes. For example, in Down syndrome (DS), which results from trisomy 21, none of the typical physical features is present in all affected individuals, and it is very unlikely that two persons would be phenotypically identical. In the case of the major congenital malformations known to be associated with DS, congenital heart disease occurs only half of the time, and duodenal atresia or stenosis in only 2.5% (Epstein, 2001).Several possible explanations for this phenotypic variability in aneuploidy have been suggested (Epstein, 1988). One is that allelic differences in the genes that are triplicated might have different effects when present in three copies. For example, heterotrisomy for a gene (or genes) within a 9.6 cM minimal region (D21S167) on human chromosome 21 has been postulated to be a contributing factor to the pathogenesis of ventricular septal defects (VSDs) in DS, either through the presence of three different specific alleles or through the presence of specific combinations of alleles (Baptista et al., 2000). Second, the overall genetic background of the individual in whom the aneuploidy occurs could affect the penetrance and expression of different phenotypic features. Precedents for such background effects, often attributable to the existence of modifier loci, exist for many genetic trait...

5064 Background: Abiraterone acetate (Ab) is an oral inhibitor of 17 alpha hydroxylase and C17,20-Lyase, which are important in adrenal androgen synthesis. A phase I study was undertaken to define the maximum tolerated dose (MTD) of Ab in patients (pts) with AIPC, the need for corticosteroid replacement (CSR) and the effects of Ab on hormone levels. Methods: Eligible pts had progressive AIPC by consensus criteria and normal organ and adrenal function. Dose escalations both while fasting and with food range from 250 mg to a maximum planned dose of 2,000 mg per day. Single dose pharmacokinetic (pK) analysis was performed prior to the onset of continuous daily dosing. Results: Sixteen pts have been enrolled, 3 with non-metastatic AIPC and 13 with bone/soft tissue metastases. Median PSA and testosterone levels are 26.7 and 7.7 ng/dL, respectively. Fourteen of 16 received prior ketoconazole. CSR has been required during the first month in 1 pt at a dose level of 500 and in 1 pt in month 3. Two pts experienced syncopal events (grade 3) on Ab, one at 250 mg and one at 500 mg, both after starting CSR. Mineralocorticoid-induced hypertension (grade 2) developed in 4 pts and was treated with aldosterone antagonists. Grade 1 edema has occurred in 3 pts. Testosterone became undetectable in 4/9 pts with available data, the mineralocorticoid deoxycorticosterone rose by a median 6.7 fold on therapy (range 1.5–67 fold). PK suggest maximum concentrations of Ab are achieved within 2 hr post dose with a mean t 1/2 of 7.8 hr, and interpatient variability in AUC and Cmax of approximately 2.5 fold. A decline in PSA by >50% occurred in 7 of 14 patients (50%) completing the initial 28 days of treatment. Five of 9 pts with ketoconazole refractory disease experienced a >50% reduction in PSA. Conclusions: Abiraterone appears to have moderate activity in AIPC pts (including significant activity in pts treated previously with ketoconazole) and an acceptable toxicity profile. CSR has not been consistently required. No significant financial relationships to disclose.