Showing papers by "Lankenau Medical Center published in 2015"

Neuroprotection in acute brain injury: an up-to-date review

Abstract: Neuroprotective strategies that limit secondary tissue loss and/or improve functional outcomes have been identified in multiple animal models of ischemic, hemorrhagic, traumatic and nontraumatic cerebral lesions. However, use of these potential interventions in human randomized controlled studies has generally given disappointing results. In this paper, we summarize the current status in terms of neuroprotective strategies, both in the immediate and later stages of acute brain injury in adults. We also review potential new strategies and highlight areas for future research.

Web-Based Access to Positive Airway Pressure Usage with or without an Initial Financial Incentive Improves Treatment Use in Patients with Obstructive Sleep Apnea.

Abstract: Study objectives We tested whether providing adults with obstructive sleep apnea (OSA) with daily Web-based access to their positive airway pressure (PAP) usage over 3 mo with or without a financial incentive in the first week improves adherence and functional outcomes. Setting Academic- and community-based sleep centers. Participants One hundred thirty-eight adults with newly diagnosed OSA starting PAP treatment. Interventions Participants were randomized to: usual care, usual care with access to PAP usage, or usual care with access to PAP usage and a financial incentive. PAP data were transmitted daily by wireless modem from the participants' PAP unit to a website where hours of usage were displayed. Participants in the financial incentive group could earn up to $30/day in the first week for objective PAP use ≥ 4 h/day. Measurements and results Mean hours of daily PAP use in the two groups with access to PAP usage data did not differ from each other but was significantly greater than that in the usual care group in the first week and over 3 mo (P 0.124). Conclusions Positive airway pressure adherence is significantly improved by giving patients Web access to information about their use of the treatment. Inclusion of a financial incentive in the first week had no additive effect in improving adherence.

Comparison of Characteristics and Outcomes of Dabigatran Versus Warfarin in Hypertensive Patients With Atrial Fibrillation (from the RE-LY Trial).

Abstract: Hypertension is frequent in patients with atrial fibrillation (AF) and is an independent risk factor for stroke. The Randomized Evaluation of Long Term Anticoagulant TherapY (RE-LY) trial found dabigatran 110 mg (D110) and 150 mg twice daily (D150) noninferior or superior to warfarin for stroke reduction in patients with AF, with either a reduction (D110) or similar rates (D150) of major bleeding. Baseline characteristics and outcomes were compared in patients with and without hypertension. The quality of blood pressure control was also assessed. In RE-LY, 14,283 patients (78.9%) had hypertension. The mean blood pressure at baseline was 132.6 ± 17.6/77.7 ± 10.6 and 124.8 ± 16.7/74.6 ± 10.0 mm Hg for patients with and without hypertension, respectively. More patients with hypertension were diabetic (25.6% vs 14.8%, p 2 (2.3 vs 1.4, p 2 DS 2 -VASc scores (3.8 vs 2.8, p 2 and CHA 2 DS 2 -VASc scores. Blood pressure control in RE-LY was excellent. The benefits of dabigatran over warfarin, including a substantial reduction of intracranial hemorrhage, were similar in both hypertensive and non-hypertensive patients.

Are the novel anticoagulants better than warfarin for patients with atrial fibrillation

Abstract: Atrial fibrillation (AF) is associated with significant morbidity and mortality related to stroke due to thromboembolism. Several novel oral anticoagulants (NOACs) have been developed that dosedependently inhibit thrombin or activated factor X (factor Xa). These new agents offer potential advantages over vitamin K antagonists, however, several limitations exist. We will review the four large randomized trials comparing the efficacy and safety of new oral anticoagulants with warfarin for stroke prevention in patients with AF as well as assess “real world” data and discuss the limitations of the new agents.

Tyrosine kinase inhibitors directed against the vascular endothelial growth factor receptor (VEGFR) have distinct cutaneous toxicity profiles: A meta-analysis and review of the literature

Abstract: Purpose Inhibition of the vascular endothelial growth factor receptor (VEGFR) with tyrosine kinase inhibitors (TKIs) is associated with cutaneous adverse effects that increase patient morbidity. Our objective was to examine the skin toxicity profile of anti-VEGFR TKIs and determine the changing incidence in clinical trials.

Kidney Transplant Outcomes for Prior Living Organ Donors

Abstract: The Organ Procurement and Transplantation Network gives priority in kidney allocation to prior live organ donors who require a kidney transplant. In this study, we analyzed the effect of this policy on facilitating access to transplantation for prior donors who were wait-listed for kidney transplantation in the United States. Using 1:1 propensity score–matching methods, we assembled two matched cohorts. The first cohort consisted of prior organ donors and matched nondonors who were wait-listed during the years 1996–2010. The second cohort consisted of prior organ donors and matched nondonors who underwent deceased donor kidney transplantation. During the study period, there were 385,498 listings for kidney transplantation, 252 of which were prior donors. Most prior donors required dialysis by the time of listing (64% versus 69% among matched candidates; P=0.24). Compared with matched nondonors, prior donors had a higher rate of deceased donor transplant (85% versus 33%; P<0.001) and a lower median time to transplantation (145 versus 1607 days; P<0.001). Prior donors received higher-quality allografts (median kidney donor risk index 0.67 versus 0.90 for nondonors; P<0.001) and experienced lower post-transplant mortality (hazard ratio, 0.19; 95% confidence interval, 0.08 to 0.46; P<0.001) than matched nondonors. In conclusion, these data suggest that prior organ donors experience brief waiting time for kidney transplant and receive excellent-quality kidneys, but most need pretransplant dialysis. Individuals who are considering live organ donation should be provided with this information because this allocation priority will remain in place under the new US kidney allocation system.

Cardiac‐Specific Disruption of Bin1 in Mice Enables a Model of Stress‐ and Age‐Associated Dilated Cardiomyopathy

Abstract: Non-compensated dilated cardiomyopathy (DCM) leading to death from heart failure is rising rapidly in developed countries due to aging demographics, and there is a need for informative preclinical models to guide the development of effective therapeutic strategies to prevent or delay disease onset. In this study, we describe a novel model of heart failure based on cardiac-specific deletion of the prototypical mammalian BAR adapter-encoding gene Bin1, a modifier of age-associated disease. Bin1 deletion during embryonic development causes hypertrophic cardiomyopathy and neonatal lethality, but there is little information on how Bin1 affects cardiac function in adult animals. Here we report that cardiomyocyte-specific loss of Bin1 causes age-associated dilated cardiomyopathy (DCM) beginning by 8-10 months of age. Echocardiographic analysis showed that Bin1 loss caused a 45% reduction in ejection fraction during aging. Younger animals rapidly developed DCM if cardiac pressure overload was created by transverse aortic constriction. Heterozygotes exhibited an intermediate phenotype indicating Bin1 is haplo-insufficient to sustain normal heart function. Bin1 loss increased left ventricle (LV) volume and diameter during aging, but it did not alter LV volume or diameter in hearts from heterozygous mice nor did it affect LV mass. Bin1 loss increased interstitial fibrosis and mislocalization of the voltage-dependent calcium channel Cav 1.2, and the lipid raft scaffold protein caveolin-3, which normally complexes with Bin1 and Cav 1.2 in cardiomyocyte membranes. Our findings show how cardiac deficiency in Bin1 function causes age- and stress-associated heart failure, and they establish a new preclinical model of this terminal cardiac disease.

Intraoperative perfusion management impacts postoperative outcomes: an analysis of 682 autologous breast reconstruction patients.

Abstract: Summary Introduction Anesthetic management remains an understudied aspect of free autologous breast reconstruction. This study aims to critically examine intraoperative anesthetic management as it relates to free flap perfusion and its effect on major complications. Methods A retrospective cohort study was performed examining all abdominally based free autologous breast reconstructions from 2005 to 2011 at a single institution. Analysis focused on perioperative care and specifically fluid administration, urine output (UOP), vasopressor administration, and case duration. Outcomes included major intraoperative and postoperative complications. A post-hoc analysis was performed to determine anesthetic factors associated with thrombotic events. Results Overall, 682 patients (1033 flaps) were included. Patients with low UOP had lower rates of intraoperative fluid infusion rates/kg ( p = 0.0001), Estimated Blood Loss (EBL) ( p = 0.006) and pressor administration ( p = 0.03), but no significant differences were noted in intraoperative thrombotic events according to UOP. However, the below normal UOP cohort demonstrated a significant increased rate of delayed postoperative thromboses ( p = 0.03). A post hoc analysis of postoperative thrombotic events revealed that low rates of fluid resuscitation (OR = 3.01, p = 0.04) and low intraoperative UOP (OR = 3.67, p = 0.04) were independently associated with delayed thrombosis. A sub-analysis demonstrated that patients with ≥2 comorbidities and below normal UOP were at particular risk (any delayed thrombotic event OR = 4.3, p = 0.03; any delayed venous thrombosis OR = 9.1, p = 0.03). Conclusions This study demonstrates that intraoperative fluid under-resuscitation may place patients at increased risk for postoperative flap thrombosis, and low UOP is an important metric whereby intraoperative resuscitation should be gauged. Patients with comorbid conditions and below normal intraoperative UOP should be monitored particularly closely for delayed thrombotic events. Level of evidence : Prognostic/risk category, level II.

The ability of renal ultrasound and ureteral jet evaluation to predict 30-day outcomes in patients with suspected nephrolithiasis

Abstract: Study objective We sought to identify findings on bedside renal ultrasound that predicted need for hospitalization in patients with suspected nephrolithiasis. Methods A convenience sample of patients with suspected nephrolithiasis was prospectively enrolled and underwent bedside ultrasound of the kidneys and bladder to determine the presence and degree of hydronephrosis and ureteral jets. Sonologists were blinded to any other laboratory and imaging data. Patients were followed up at 30 days by phone call and review of medical records. Results Seventy-seven patients with suspected renal colic were included in the analysis. Thirteen patients were admitted. Reasons for admission included intractable pain, infection, or emergent urologic intervention. All 13 patients requiring admission had hydronephrosis present on initial bedside ultrasound. Patients with moderate hydronephrosis had a higher admission rate (36%) than those with mild hydronephrosis (24%), P Conclusions No patients with suspected renal colic and absence of hydronephrosis on bedside ultrasound required admission within 30 days. Ureteral jet evaluation did not help in prediction of 30-day outcomes and may not be useful in the emergency department management of renal colic.

Single-port laparoscopic colorectal surgery shows equivalent or better outcomes to standard laparoscopic surgery: results of a 190-patient, 7-criterion case-match study

Abstract: Single-port (SP) surgery has been characterized as having limited applicability regarding procedure, disease, and patient characteristics. There is a question if SP procedures offer disadvantages or advantages to multiport (MP) colorectal surgery. We hypothesize that SP is equivalent to MP and is a safe alternative in the full spectrum of colorectal disease and procedures. A case-matched analysis of a prospectively maintained database to compare perioperative outcomes in SP versus MP was performed. Criteria included age, gender, BMI, previous abdominal surgery, previous XRT, disease process, and procedure. 95 exact matches for all 7 criteria were found between 159 SP and 1,617 MP cases. Perioperative outcomes, surgical technique, morbidity, mortality, local recurrence, and 5-year survival were analyzed. There was lower mean EBL in SP but no difference in transfusion requirement. OR time for SP left colectomy was shorter, with a trend to shorter OR times found in all procedures. 99 % SP and 98 % MP had no intra-operative complications. Conversion to open was equivalent (0/1). Mean largest incision was smaller for SP. There were no differences in return of bowel function or length of hospital stay. There were no mortalities. There were no differences in perioperative morbidity, local recurrence, distant metastasis, or overall 5-year survival. SP is a safe alternative to MP colorectal surgery across the full array of procedures in equivalent patients. This study demonstrates SP has less blood loss, smaller incisions, is quicker in left colectomy, and tends to be quicker across all procedures. Conversion and morbidity rates are equivalent to MP, without compromise in quality of surgical technique. While proper training is essential, concerns regarding the inability to use SP laparoscopic colorectal surgery safely are unfounded in nearly exactly matched patients. These issues will require further study as SP laparoscopic colorectal surgery is practiced more widely.

Data Collection and Interpretation

Abstract: Patient monitoring is routinely performed in all patients who receive neurocritical care. The combined use of monitors, including the neurologic examination, laboratory analysis, imaging studies, and physiological parameters, is common in a platform called multi-modality monitoring (MMM). However, the full potential of MMM is only beginning to be realized since for the most part, decision making historically has focused on individual aspects of physiology in a largely threshold-based manner. The use of MMM now is being facilitated by the evolution of bio-informatics in critical care including developing techniques to acquire, store, retrieve, and display integrated data and new analytic techniques for optimal clinical decision making. In this review, we will discuss the crucial initial steps toward data and information management, which in this emerging era of data-intensive science is already shifting concepts of care for acute brain injury and has the potential to both reshape how we do research and enhance cost-effective clinical care.

Fast, Stable Induction of P-Glycoprotein-mediated Drug Resistance in BT-474 Breast Cancer Cells by Stable Transfection of ABCB1 Gene.

Abstract: BACKGROUND Patients with P-glycoprotein and HER2/neu (HER2) receptor-overexpressing breast cancer usually have poor clinical outcomes. However, there exist no commercially available breast cancer cell lines that are HER2/P-glycoprotein double-positive, which limits research in this field. MATERIALS AND METHODS We report on the development and characterization of a drug-resistant sub-line from an HER2-positive breast cancer cell line by stable transfection of the ATP-binding cassette (ABC) subfamily B member 1 (ABCB1) gene which encodes P-glycoprotein. RESULTS ABCB1 gene expression levels were higher after transfection, which led to a 40-fold increase in P-glycoprotein expression. Interestingly, the transfection of ABCB1 also led to a slight increase in HER2 gene and protein expression levels. The transfection of ABCB1 increased the P-glycoprotein expression levels significantly. CONCLUSION The method used herein for developing this cell line is appropriate for fast, stable induction of P-glycoprotein-mediated drug resistance compared to traditional methods. The in vitro cytotoxicity test suggests this cell line has cross-resistance to a wide range of chemotherapeutic agents.

Quality drives innovation.

Abstract: I [International Society for Minimally Invasive Cardiothoracic Surgery] really is a dynamic group, and I think it is the future of cardiothoracic surgery.What I want to talk about today are some ideas. There’s not much I can tell anyone in this room about innovation but I want to try and, if I have your patience, to put together some thoughts about quality and how quality can lead to successful innovation. So just a little recap or commercial for ISMICSVI can’t help it. As we know, we were formed in 1997, and it was really by people who are the innovators. It’s easy to be an innovator when everyone’s going in your direction, but at the time, most of your professional colleagues may look at you as crazy or just out of your mind, and that you don’t know what you’re talking about. And individuals, outliers if you will, like that to get together and form a group is an impressive accomplishment. Because you know you’re worried about your peers, you’re worried about your professional standing and then to take a radical departureVthat’s been a hallmark for the leaders of ISMICS. Aswe continue to grow, most importantly, we have lots of residents and fellows increasingly joining. We have recently created an affiliate membership to collaborate with and make a strategic outreach to the physicians’ assistants group; whose representatives are here with us today, to help them grow because the professional physician assistant is not widely recognized or accepted in most of the world. Next year at our meeting in Berlin, we will have made an alliance with our perfusionists as well, which was initiated at our last meeting in Prague. When I was working as the senior registrar in the Academic Department of Cardiac Surgery at the Royal Brompton Hospital in London, the EACTS [European Association for Cardio-Thoracic Surgery] meeting that year was in Prague. I was a foolish American, I guess, who wanted to work, work, work and do all the cases and stay behind. Everyone else went to Prague. They all came back and said how great it was. I always regretted never going to Prague at the time and so I was thrilled that I had the opportunity to go there for an excellent ISMICS 2013. This is some of our faculty after the meeting (Fig. 1), and although we don’t have the Charles Bridge here in Boston, we do have the Charles RiverVand an awesome ISMICS 2014. It’s important that ISMICS reaches out internationallyVit’s in our DNAVand we’ve been well received in partnering with colleagues around the world. This has been very beneficial to our group, and it’s also very educational to understand how people train in different countries. If we want to increase innovation and quality of care,we can’t do that from themicrocosm of just our own experience. We have to see what is out there and howwe can share ideas with our international colleagues. This is the ISMICS faculty from our most recent Winter Workshop in Seoul, South Korea (Fig. 2), under the leadership of our board directorYoungTaeKim.Youngput on an outstandingworkshop. Every one of our colleagues who work on these Winter Workshops puts in an enormous amount of effort to partner with groups all around the world. We had a simply terrific program; it was well organized, and we were treated like being invited to someone’s home. Now you can’t really do everything by yourself. You need a partner in life, and I have my wife and our children as well as my mother-in-law here today and wish to thank them for all of their understanding and support. You need partners and you also need colleagues. The old saying relates to ‘‘standing on the shoulders of giants.’’ There’s noway we could accomplish what we have without the ISMICS past presidents (Figs. 3A, B). The great thing about ISMICS is that most of these individuals are still attending and contributing to our meetings. You can usually find them in the first or second row taking notes. For just a partial example, Alan Menkis, who led a very successful ISMICS 2013; Michael Mack’s Kit Arom Lecture about surgeon innovation and professional growth; Bob Emery has been a presence at virtually every meeting; Mani Subramanian cochairs the evermore in-demand Technical Challenges session; Randy Wolf continues to lead our outreach to Asia; Narish Trehan chairs our development group and has hosted a Winter Workshop; Jim Fonger spearheaded our industry relations process; Rex Stanbridge runs our poster sessions now widely copied by other professional society meetings; John Puskus chaired our first and our most recent Consensus Conference on OP-CAB [off-pump coronary artery bypass]; Ranny Chitwood cochairs the Minimally Invasive Valve Masters Class; John Knight formulated our strategic planning initiative; and Ralph Damiano is the editor for our recently National Library of MedicineYindexed journal Innovations. All these individuals pictured in Figure 3 have contributed to ISMICS in ways too numerous to cite here and continue to contribute to ISMICS with their science; outreach; or with mentoring the young surgeons, residents, and fellows. They’ve all made significant contributions to our field as well. I personally am indebted to all

The association for surgical education CESERT grant program: the first 15 years

Abstract: Background The Association for Surgical Education established the Center for Excellence in Surgical Education Research and Training (CESERT) program in 1999 to support innovative research and education projects and programs that will advance surgical education. We sought to examine scholarly outcomes of the projects during the first 15 years of the program. Methods E-mail surveys were sent to the 24 researchers who were awarded CESERT grants. Data collection focused on recipient professional experiences, publications, and presentations stemming from CESERT-funded research and impact on career development. For grant recipients who were unable to complete the survey, we obtained publication information on studies authored by the grant recipients that described the same grant-funded topic, described similar methods, and fell within the study timeline. Results Complete survey data were obtained from 18 of the 24 grant recipients. Grants were most commonly awarded to General Surgeons (40%) and Education and Psychology PhDs (24%). Overall, 23 of the 25 projects had reached completion at the time of contact, and from these, 70 articles were published or in press. presentations were more common, with respondents documenting 84 projects locally, nationally, and internationally. Grant awards ranged from $8,122 to $97,000, with an average of $39,026. In total, the Association for Surgical Education Foundation distributed $988,000 in grant funding from 1999 to 2013. Respondents reported that CESERT funding was critical to their career as it legitimized their pursuit of educational research, helped them establish multidisciplinary and multi-institutional collaborations, provided greater visibility for their research, and helped them develop an understanding of educational principles and grant writing skills. Conclusions Overall, the CESERT program has produced remarkable results. The careful review process and monitoring protocol have ensured that high-potential studies are funded and successful. These data support continued efforts to garner resources such that CESERT grants may be awarded to fund high-quality, high-impact projects.

Human papillomavirus vaccine uptake: what works and what can we do better?

Abstract: Human papillomavirus (HPV), a sexually transmitted infection, is the main cause of cervical cancer worldwide [1]. The most common route of transmission is vaginal or anal intercourse [1], but HPV may also cause anal, oral, and throat cancer [2]. There are more than 100 strains of HPV; new screening efforts are focusing on the more high-risk HPV types (16/18), reinforcing the concept that cervical cancer is preventable [1, 3]. Efforts are already in place to reduce HPV-related cancer with 2 vaccines recommended as primary prevention [4]. The first is Gardasil (Merck & Co., Whitehouse Station, NJ), a quadrivalent vaccine that protects against HPV types 6, 11, 16, and 18 [1, 5]. It was approved by the Food and Drug Administration in 2006 for use in females between the ages of 9 and 26 years (expanded to males in 2009) [1]. The second is Cervarix (GlaxoSmithKline Biologicals, Rixensart, Belgium), a bivalent vaccine that targets HPV types 16 and 18, approved in 2009 for females between the ages of 10 and 25 years [1]. Immunization rates remain inconsistent nationwide, ranging from 6% to 75% in adolescent girls and 4% to 79% in women 18 to 26 years of age [1]. The vaccine uptake rates are even lower in young men, at less than 2% [6]. Legislation promoting HPV vaccination before school entry has been met with resistance [7]. This article discusses various interventions and highlights which ones have been most successful in increasing HPV vaccine uptake, with a focus on young women.

Retrofitting the battlements: tight junction remodeling as a novel antimicrobial approach.

Abstract: Epithelial cell layers, pathogens & infection Imagine that you are tasked with defending a castle from an invading army. You have two general options: you can attack the invaders directly or you can redefine your castle’s walls. It would probably be wise to exercise both options, and yet modern medicine’s approach to microbial pathogens has generally utilized only the first, a varied yet mono lithic drive to kill the microbes coming over or through the walls. Prescribers of antimicrobial agents know quite well that this approach can exert a high toll on your own troops. In addition, the enemy is quite good at adapting its defense and tactics to changes you make to your armory, as demonstrated by the current epidemic of antibiotic-resistant organisms. In this article, we wish to bring attention to recently gained knowledge

Comparative Analysis of Two- Versus Three-Dimensional Sonography for Nuchal Translucency Measurement.

Abstract: Objective The aim of this article is to test the hypothesis that three-dimensional (3D) sonography is correlated to the two-dimensional (2D) sonography for nuchal translucency (NT) measurement during first trimester screening (FTS). Methods We performed a prospective observational study on patients presenting for FTS. Three NT measurements were performed using the current standardized 2D method at the midsagittal planes, and NT sonography was then repeated for each case using 3D sagittal and axial plane. The Kruskal–Wallis test and the Spearman rank correlation were used to evaluate the relationship between 2D and 3D NT methods of measurement. A p -value Results The study included 366 patients with singleton pregnancies. Mean maternal age was 31.2 years, and mean gestational age was 12 3/7 weeks. The mean maximal NT measurement for 2D and 3D sagittal and axial planes were 1.65, 1.70, and 1.66 mm, respectively ( p = 0.42). The Spearman rank correlation of 2D sagittal plane sonography with 3D sagittal and axial planar sonography was 0.73 and 0.68, respectively ( p Conclusion 3D NT measurement appears to be a tool highly correlated to the conventional 2D sonographic approach. This may be useful in selected cases in which there is difficulty in obtaining optimal 2D measurements of the NT space.

Does atrial fibrillation pattern affect stroke risk? Data dredging to help the clinician

Abstract: This editorial refers to ‘Risk of ischaemic stroke according to pattern of atrial fibrillation: analysis of 6563 aspirin-treated patients in ACTIVE-A and AVERROES’[†][1], by T. Vanessche et al ., on page 281. Atrial fibrillation (AF) is the most common arrhythmia worldwide, and has a major impact on morbidity and mortality rates of those affected. In 2010, it was estimated that there were 33.5 million people worldwide with AF and ∼5 million new cases each year.1 AF has been found to double mortality and increase risk of stroke by approximately five-fold.2,3 AF and its pathogenesis and treatment continue to be topics of extensive research. Vanessche et al . have now evaluated the pattern of AF and its association with stroke risk by examining patients with AF on aspirin alone with a retrospective look at the ACTIVE-A and AVERROES databases.4 A total of 6573 patients were included in their analysis, 24% with paroxysmal, 17% with persistent, and 59% with permanent AF. Non-haemorrhagic stroke was examined as the sole outcome. The study found differing risk of embolic events by AF type, specifically that the incidence increased in permanent and persistent AF as compared with paroxysmal AF. Across the entire study population, a statistically significant hazard ratio of 1.91 (95% confidence interval 1.50–2.43) was seen for permanent/persistent AF vs. paroxysmal AF. This association was also found to be … [1]: #fn-2

Abstract P5-13-01: Association between breastfeeding and breast cancer risk by receptor status: A meta-analysis

Abstract: Background: The rising incidence of breast cancer is mainly due to changes in reproductive, lifestyle, and environmental factors, not inherited genetic mutations. Many risk factors can be modified, offering important opportunities for prevention. In the era of personalized care, treatment is subtype dependent. While most prevention strategies are not subtype specific, we wanted to see if breastfeeding confers the same protection based on subtype, especially against poorer prognostic subtypes. Methodology: Relevant articles from case-control or prospective studies were identified by searching PubMed and Scopus databases through 2013 and reference lists of relevant articles. Two researchers independently did the search and evaluated the articles. The summary risk estimates and 95% confidence intervals were calculated using random effects models (DerSimonian-Laird method) for the association between breastfeeding and breast cancer by receptor status. The reference category in most of the studies was never breastfeeding, but in a few studies this also included women who breastfed for a short time. Results: This meta-analysis of 26 articles (20 from case-control, 6 from prospective studies) published between 1983 and 2013 included 34,479 women with invasive breast cancer from 8 countries. Breastfeeding was inversely associated with breast cancer risk across all combination of subtypes: ER+ or -, PR+ or -, HER2+ or -. The relative risk reduction ranged from 12–29% when only the results adjusted for age, body mass index (BMI), parity, and family history of breast cancer were included. There did not appear to be a differential protective benefit of breastfeeding based on subtype using ever vs never analysis. (A breastfeeding dose response analysis by subtype is in progress.) Conclusion: Breastfeeding is a powerful strategy to reduce breast cancer risk, with a relative risk reduction of 12–29%. This benefit is larger than previously reported and was independent of hormone- and HER2-receptor status, suggesting mechanisms of action independent from these receptors and their ligands. To maximize breastfeeding use for the long-term health of mothers and babies, it is important to remove barriers in the home, community, and workplace as well as provide education and support before and after delivery. Citation Format: Marisa Weiss, Ying Liu, Paolo Boffetta, Graham Colditz, Ahmedin Jemel, Farhad Islami. Association between breastfeeding and breast cancer risk by receptor status: A meta-analysis [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P5-13-01.