Planctopirus ephydatiae, a novel Planctomycete isolated from a freshwater sponge

The microbiome of freshwater sponges is rarely studied, and not a single novel bacterial species has been isolated and subsequently characterized from a freshwater sponge to date. A previous study showed that 14.4% of the microbiome from Ephydatia fluviatilis belong to the phylum Planctomycetes. Therefore, we sampled an Ephydatia sponge from a freshwater lake and employed enrichment techniques targeting bacteria from the phylum Planctomycetes. The obtained strain spb1^T was subject to genomic and phenomic characterization and found to represent a novel planctomycetal species proposed as Planctopirus ephydatiae sp. nov. (DSM 106606 = CECT 9866). In the process of differentiating spb1^T from its next relative Planctopirus limnophila DSM 3776^T, we identified and characterized the first phage - Planctopirus phage vB_PlimS_J1 - infecting planctomycetes that was only mentioned anecdotally before. Interestingly, classical chemotaxonomic methods would have failed to distinguish Planctopirus ephydatiae strain spb1^T from Planctopirus limnophila DSM 3776^T. Our findings demonstrate and underpin the need for whole genome-based taxonomy to detect and differentiate planctomycetal species.

[Molecular component-resolved allergy diagnostics in ENT]

Molecular component-resolved diagnostics (CRD) are, in addition to its research applications, being increasingly used in daily allergological routine. CRD offers improved diagnostic accuracy via a better understanding of the underlying allergen causing symptoms and helps to distinguish between true sensitization and cross reactions in polysensitized patients, thereby providing an approach for individual personalized therapy. Particularly in food allergies and anaphylaxis, CRD can stratify risks for the recurrence of reactions and their severity. The education and extended vocational training of clinical allergologists has to keep pace with the tremendous increase of knowledge in the field of molecular allergology.

Über ein partiell amelanotisches Schleimhautmelanom der Vulva

Infolge ihrer häufig partiell oder vollständig amelanotischen Ausprägung, der verdeckten Lokalisation und fehlender Risikofaktoren werden die seltenen vulvo-vaginalen Melanome erst in späteren Stadien diagnostiziert und behandelt. Wir berichten über den Fall einer 70-jährigen Patientin, die sich mit einem Wundgefühl und zwei pigmentierten Läsionen des Labium majus dextrum vorstellte. Nach diagnostischer Exzision bestätigte die histologische Befundung ein partiell amelanotisches mukosales malignes Melanom. Die Nach-Exzision mit Sentinel-Lymphknotenexstirpation ergab das Vorliegen einer maximalen Tumordicke von 1,1 mm. Die erforderliche erweiterte Nach-Resektion erfolgte als vordere Vulvektomie. Das Exzidat der Vulvektomie zeigte weiterhin Reste der In-situ-Komponente bei jedoch tumorfreien Resektionsrändern und Sentinel-Lymphknoten (SLNB 0/1). Die abschließende Tumorklassifikation ergab AJCC (2017) Stadium IB. Nach komplikationsloser Primärheilung befindet sich die Patientin im interdisziplinären dermatologisch-gynäkologischen Nachsorgeprogramm.

Is Quantitative sIgE Serology Suitable for Distinguishing Between Silent Sensitization and Allergic Rhinitis to Dermatophagoides pteronyssinus?

BACKGROUND AND OBJECTIVE

An increasing number of studies have recently discussed whether provocation tests might be replaced by specific IgE serology in patients sensitized to airborne allergens. Objective: Our study aimed to analyze the concordance between a nasal provocation test with Dermatophagoides pteronyssinus and specific IgE measurements based on real-life data.

METHODS

We retrospectively analyzed concordance between the result of the provocation test and the IgE titer for house dust mite components and extracts in 223 patients with proven sensitization to D pteronyssinus.

RESULTS

In contrast to findings from other studies, the anti-Der p 1 level alone was not sufficient to distinguish between silent sensitization and allergy to D pteronyssinus. ROC curve analysis revealed that the sum of sIgE against Der p 1 and Der p 2 is-after adjustment for total serum IgE-the best parameter for discriminating between clinically silent and relevant sensitization. However, it does not have sufficient validity to confirm a diagnosis.

CONCLUSIONS

Despite the high correlation between sIgE levels and symptoms, no serologic parameter is sufficiently accurate to distinguish between silent sensitization and clinically relevant allergy. Therefore, nasal provocation tests remain the gold standard for assessing clinical relevance in sensitization to D pteronyssinus.

Development and field testing of low-cost, quantal microbial assays with volunteer reporting as scalable means of drinking water safety estimation

AIMS

To evaluate a low-cost water quality test for at-scale drinking water safety estimation in rural India.

METHODS AND RESULTS

Within a longitudinal study to characterize variability in household drinking water safety in rural Maharashtra, we piloted a low-cost presence-absence (LCPA) microbial test designed to be used by volunteer residents in rural areas. In comparing the LCPA results with standard laboratory methods for enumeration of Escherichia coli, we found that LCPA tests using modified mTec media were highly sensitive in detecting drinking water of moderate risk (88% of tests were positive at E. coli counts of 11-100 CFU per 100 ml) and high risk (96% of tests were positive at E. coli counts of 101 + CFU per 100 ml). The LCPA tests demonstrated low specificity for E. coli specifically, due to concurrent detection of Klebsiella: 38% of LCPA tests were positive even when E. coli was not detected in a 100 ml sample by membrane filtration, suggesting the test would be conservative in risk estimation. We also found that 47% of participants in rural villages in India were willing to conduct tests and return results after a brief training, with 45% of active participants sending their water testing results via short message service.

CONCLUSIONS

Given their low cost (~US$0.50 as piloted) and open-source format, such tests may provide a compelling alternative to standard methods for rapid water quality assessments, especially in resource-limited settings.

SIGNIFICANCE AND IMPACT OF THE STUDY

The lack of availability of water quality data constrains efforts to monitor, evaluate and improve the safety of water and sanitation infrastructure in underserved settings. Current water testing methods are not scalable because of laboratory and cost constraints. Our findings indicate the LCPA or similar low-cost microbial tests could be useful in rapid water safety estimation, including via crowdsourcing.

Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma

Aims

Mobile Airways Sentinel NetworK (MASK) belongs to the Fondation Partenariale MACVIA-LR of Montpellier, France and aims to provide an active and healthy life to rhinitis sufferers and to those with asthma multimorbidity across the life cycle, whatever their gender or socio-economic status, in order to reduce health and social inequities incurred by the disease and to improve the digital transformation of health and care. The ultimate goal is to change the management strategy in chronic diseases.

Methods

MASK implements ICT technologies for individualized and predictive medicine to develop novel care pathways by a multi-disciplinary group centred around the patients.

Stakeholders

Include patients, health care professionals (pharmacists and physicians), authorities, patient’s associations, private and public sectors.

Results

MASK is deployed in 23 countries and 17 languages. 26,000 users have registered.

EU grants (2018)

MASK is participating in EU projects (POLLAR: impact of air POLLution in Asthma and Rhinitis, EIT Health, DigitalHealthEurope, Euriphi and Vigour).

Lessons learnt

(i) Adherence to treatment is the major problem of allergic disease, (ii) Self-management strategies should be considerably expanded (behavioural), (iii) Change management is essential in allergic diseases, (iv) Education strategies should be reconsidered using a patient-centred approach and (v) Lessons learnt for allergic diseases can be expanded to chronic diseases.

Myiasis in einem ulzerierten spinozellulären Karzinom – ein Fall von „aided giant tumor neglect“

Eine 91-jährige Patientin mit einem vorbekannten metastasierten Mammakarzinom stellte sich in der Hochschulambulanz der Hautklinik aufgrund eines ulzerierten Kopfhauttumors von etwa 10 cm Durchmesser vor. Obwohl sie mit jüngeren Angehörigen gemeinsam ein Haus bewohnte, zeigte die Patientin Hinweise auf eine Verwahrlosung. Histologisch zeigte sich an der Kopfhaut ein spinozelluläres Karzinom. Zusätzlich wurden 12 Maden aus der Wunde entfernt. Im hier vorgestellten Fall konnte gezeigt werden, dass bei mangelnder Pflege durch Mitbewohner durchaus zwei „giant“ Tumore auch gleichzeitig auftreten können, deren Diagnose und Therapie lange Zeit verschleppt und die im Verlauf sogar mit Maden besiedelt werden können. Wir schlagen hierfür den Begriff „giant tumor neglect (GTN)“ oder „aided giant tumor neglect (AGTN)“ vor.

Abstract P3-10-01: Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene

Background:

We have previously shown that expression of the IL8/VEGFA-metagene eliminates the good prognostic effect of TILs in TNBC (PMID 21978456, 28750120). We also showed that the VEGFA metagene predicted response to neoadjuvant bevacizumab in the GeparQuinto trial (Karn 2017 SABCS #851166). The main cellular sources of the transcripts that comprise the VEGFA metagene are unknown since mRNA profiling of bulk biopsies contains signals from different cell types.

Methods:

Individual genes that comprise the VEGFA metagene were measured in bulk tissue- and single cell-RNA-Seq from breast cancer subtypes and normal cells on different platforms (Affymetrix n=4915, Agilent n=597, Illumina n=2433, RNA-Seq n=1215, Exome Capture RNA-Seq n=226, HTG-Seq n=243, sc-RNA-Seq n=24710). For blinded, orthogonal validation we performed immunohistochemistry. Effect of neoadjuvant chemotherapy with or without bevacizumab was studied by RNA-Seq and IHC on samples from GeparQuinto trial. SWOG S0800 (GSE114403), PROMIX (GSE87455), and GeparSixto trials were used for validation. TCGA was mined for mutations and somatic CNA. RNA-Seq from GeparNuevo was used for correlation with checkpoint inhibitor treatment.

Results:

We identified a stable core of six genes (VEGFA, ANGPTL4, ADM, NDRG1, DDIT4, CSTB) in different cohorts. Strong expression of this signature was mainly restricted to TNBC subtype and associated with poor prognosis within this subgroup. Single cell RNA-Seq of breast epithelial cells from 4 reduction mammoplasties and 4 TNBC revealed that these genes are coexpressed in individual epithelial cells and not associated with endothelial cells. In line with their presumed functions in cellular stress and hypoxia, immunohistochemistry revealed strong para-necrotic expression in TNBC. Moreover, high gene expression in TNBC was associated with mutations in DNA damage control pathways, somatic copy number alterations, and lower TILs. While chemotherapy led to downregulation, bevacizumab increased expression. In multivariate analysis, high pretreatment values predict pCR to both bevacizumab and chemotherapy (OR 2.40, P=0.006), which may be explained by sensitivity of tumors which are already under cellular stress. On the other hand, expression of the VEGFA metagene seems to create an immunosuppressive environment that counteracts the positive prognostic effect of TILs. In pre-treatment biopsies from the GeparNuevo checkpoint inhibitor trial we found a negative correlation of VEGFA metagene expression with the amount of the recently identified tissue-resident memory T cell subset (CD8TRM, PMID 29942092; P=0.002), while the subsequent increase of CD8TRM during treatment was larger in tumors with high VEGFA (P=0.019).

Conclusions:

Perinecrotic carcinoma cells under stress from hypoxia and or chromosomal instability are the source of the VEGFA metagene signature. Its predictive value in TNBC suggests estimating and reporting the amount of necrosis in the pathology report may be helpful in predicting response to preoperative chemotherapy, and could be used as stratification factor in clinical trials. The signature indicates an immunosuppressive environment and should be further studied in the context of immune therapies in combinations with anti-angiogenic treatment.

Citation Format: Karn T, Denkert C, Sinn BV, Weber K, Nekljudova V, Rody A, Meissner T, Hatzis C, El-Balat A, Becker S, Solbach C, Untch M, Schneeweiss A, von Minckwitz G, Loibl S, Pusztai L, Holtrich U. Single-cell profiling identifies hypoxic carcinoma cells as source of an immunosuppressive VEGFA metagene [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-10-01.

E-cadherin, actin, microtubules and FAK dominate different spheroid formation phases and important elements of tissue integrity

Spheroids resemble features of tissues and serve as model systems to study cell–cell and cell–ECM interactions in non-adhesive three-dimensional environments. Although it is generally accepted that mature spheroids resemble tissue properties very well, no studies relate different phases in the spheroid formation processes that contribute to tissue integrity. Tissue integrity involves the cellular processes adhesion formation, adhesion reinforcement, rearrangement as well as proliferation. They maintain the structure and function of tissues and, upon dysregulation, contribute to malignancy. We investigated spheroid formation dynamics in cell lines of different metastatic potential. We dissected spheroid formation into phases of aggregation, compaction and growth to identify the respective contributions of E-cadherin, actin, microtubules and FAK. E-cadherin, actin and microtubules drive the first two phases. Microtubules and FAK are involved in the proliferation phase. FAK activity correlates with the metastatic potential of the cells. A robust computational model based on a very large number of experiments reveals the temporal resolution of cell adhesion. Our results provide novel hypotheses to unveil the general mechanisms that contribute to tissue integrity.

Summary: The phases of spheroid formation resemble different stages of cell contact formation. This facilitates studying the temporal contribution of molecules in this process.

Role of FDG PET-CT in the treatment management of Hodgkin lymphoma

Fluorodeoxyglucose (FDG) positons emission tomography (PET)-computed tomography (CT) is used in many ways at baseline and during the treatment of patients with Hodgkin lymphoma. Many properties of the technique are used in the different steps of patient's management. Initial staging with PET-CT is more accurate than conventional imaging and PET-CT also became the gold standard imaging at the end of treatment with a negative PET-CT mandatory for reaching a complete remission. Early assessment of response by PET-CT is one of the most powerful prognostic factors for progression-free survival of patients with localized and advanced stages and allows guiding treatment. Conversely, previous studies showed that there is no role of FDG PET-CT for the patient's follow-up.

Vector competence of field populations of the mosquito species Aedes japonicus japonicus and Culex pipiens from Switzerland for two West Nile virus strains

Aedes (Hulecoeteomyia) japonicus japonicus (Diptera: Culicidae) (Theobald) is an invasive mosquito species in Central Europe, where it has colonized several areas. In this study, field-collected specimens of Ae. japonicus and Culex pipiens (Diptera: Culicidae) (Linnaeus) from Zürich (Switzerland) were orally exposed to two strains (NY99 and FIN) of the avian zoonotic pathogen West Nile virus (WNV) (family Flaviviridae, genus Flavivirus). Dissemination and transmission of the viruses after incubation for 12-15 days under a fluctuating Central European midsummer temperature regime (24 ± 7 °C) was investigated by detection of viral RNA in homogenates of pools of both head/thorax and saliva by reverse transcription real-time polymerase chain reaction (PCR). Culex pipiens was susceptible to WNV NY99 only, whereas both virus strains could be detected in Ae. japonicus, with the additional isolation of WNV NY99 in Vero cell culture from one saliva pool. Given the high abundances of Ae. japonicus in many newly colonized areas, its recently demonstrated broad host range, including mammalian and avian blood hosts, and its vector competence, this species is a potential key bridge vector of WNV in Central Europe.

Abstract OT2-03-03: Delivery of a single fraction lumpectomy cavity boost using a novel immobilization device and treatment delivery system

Background: The lumpectomy cavity (LPC) boost has been shown in 2 randomized studies to improve local control in breast cancer. Hypofraction is now being used for delivery of the LPC boost in some early-stage patients. This trial delivers the LPC boost in a single fraction using a novel breast immobilization device/treatment delivery system.

Trial design: Patients are enrolled in this trial after standard resection with lumpectomy/sentinel lymph node biopsy (as appropriate) and chemotherapy (as indicated per standard of care). At the time of CT simulation for whole-breast radiation therapy (RT), the radiation oncologist evaluates breast size and LPC position. If consented for treatment, the patient receives a single fraction “boost” treatment of 8 Gy in 1 fraction followed by standard whole-breast RT to start within 7 days of completion of the boost. Whole-breast radiation is delivered in the supine or prone position with the following fractionation schemes: 4005 cGy in 15 fractions or 5000 cGy in 25 fractions.

On the day of the boost treatment, the patient is fitted with the breast immobilization device, with a plastic inner cup that is fitted so that the breast fills all or most of the cup. A rigid outer cup with a built-in stereotactic fiducial system is attached. Moderate negative pressure is applied to immobilize the breast within the cup system. Patients then undergo CT simulation in the prone position. Clip placement and LPC cavity location must meet eligibility criteria before proceeding with treatment planning and delivery.

Eligibility criteria:

Eligibility criteria: age >60 yo; female only; dx of invasive ductal or lobular carcinoma or ductal carcinoma in situ; estrogen receptor positive; successful completion of lumpectomy ± sentinel lymph node biopsy with negative margins for invasive or noninvasive cancer; greatest tumor dimension <4 cm before surgery; weight <330 lb; height <76 inches; nonlactating and nonpregnant. Various additional dosimetric factors must be met prior to treatment. If these are unable to be met, the patient will become ineligible for treatment.

Specific aims: The aim of this study is to demonstrate the feasibility and safety of delivering the LPC boost RT using a single fraction with a novel immobilization device/treatment delivery system while ensuring coverage of the target volume with appropriate dose homogeneity and conformity. Secondary aims are evaluation of patient comfort, acute toxicity (1 month), and late toxicity (1 year).

Statistical methods: A Simon 2-stage design is utilized for this trial. After evaluating the device and treatment on 8 patients in the first stage, the trial was designed to be terminated and device rejected if the dose distribution was acceptable for ≤5 patients. The first stage was completed in spring 2017 and progressed to the second stage, designed to include a total of 17 patients.

Accrual and target accrual: Target accrual for this study is 14 patients successfully treated while meeting all protocol constraints. As of 6/2017, 16 patients have been enrolled, of whom 13 have been successfully treated while meeting all protocol constraints.

Citation Format: Nichols EM, Becker S, Hong J, Cohen RJ, Mishra MV, Citron W, Cheston SB, Niu Y, Mutaf Y, Yu CX, Feigenberg SJ. Delivery of a single fraction lumpectomy cavity boost using a novel immobilization device and treatment delivery system [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT2-03-03.

Combination of baseline FDG PET/CT total metabolic tumour volume and gene expression profile have a robust predictive value in patients with diffuse large B-cell lymphoma

PURPOSE

This study evaluated the predictive significance of total metabolic tumour volume (TMTV) measured on baseline FDG PET/CT and its value in addition to gene expression profiling using a new method of gene analysis (rapid reverse transcriptase multiplex ligation-dependent probe amplification assay, RT-MLPA) in patients with diffuse large B-cell lymphoma treated with R-CHOP or R-CHOP-like chemotherapies.

METHODS

The analysis included 114 patients. TMTV was measured using a 41% SUVmax threshold and tumours were classified into GCB or ABC subtypes according to the RT-MLPA assay.

RESULTS

The median follow-up was 40 months. the 5-year progression-free survival (PFS) was 54% and the 5-year overall survival (OS) was 62%. The optimal TMTV cut-off value was 261 cm³. In 59 patients with a high TMTV the 5-year PFS and OS were 37% and 39%, respectively, in comparison with 72% and 83%, respectively, in 55 patients with a low TMTV (p = 0.0002 for PFS, p < 0.0001 for OS). ABC status was significantly associated with a worse prognosis. TMTV combined with molecular data identified three groups with very different outcomes: (1) patients with a low TMTV whatever their phenotype (n = 55), (2) patients with a high TMTV and GCB phenotype (n = 33), and (3) patients with a high TMTV and ABC phenotype (n = 26). In the three groups, 5-year PFS rates were 72%, 51% and 17% (p < 0.0001), and 5-year OS rates were 83%, 55% and 17% (p < 0.0001), respectively. In multivariate analysis, TMTV, ABC/GCB phenotype and International Prognostic Index were independent predictive factors for both PFS and OS (p < 0.05 for both).

CONCLUSIONS

This integrated risk model could lead to more accurate selection of patients that would allow better individualization of therapy.

The combined action of a passive exoskeleton and an EMG-controlled neuroprosthesis for upper limb stroke rehabilitation: First results of the RETRAINER project

The combined use of Functional Electrical Stimulation (FES) and robotic technologies is advocated to improve rehabilitation outcomes after stroke. This work describes an arm rehabilitation system developed within the European project RETRAINER. The system consists of a passive 4-degrees-of-freedom exoskeleton equipped with springs to provide gravity compensation and electromagnetic brakes to hold target positions. FES is integrated in the system to provide additional support to the most impaired muscles. FES is triggered based on the volitional EMG signal of the same stimulated muscle; in order to encourage the active involvement of the patient the volitional EMG is also monitored throughout the task execution and based on it a happy or sad emoji is visualized at the end of each task. The control interface control of the system provides a GUI and multiple software tools to organize rehabilitation exercises and monitor rehabilitation progress. The functionality and the usability of the system was evaluated on four stroke patients. All patients were able to use the system and judged positively its wearability and the provided support. They were able to trigger the stimulation based on their residual muscle activity and provided different levels of active involvement in the exercise, in agreement with their level of impairment. A randomized controlled trial aimed at evaluating the effectiveness of the RETRAINER system to improve arm function after stroke is currently ongoing.

Effects of functional endoscopic sinus surgery on the acoustics of the sinonasal tract

BACKGROUND

Nasal and paranasal cavities are supposed to contribute substantially to the vocal tract resonator properties. However, their acoustical effects as well as the effects of sinus surgery on the voice remain unclear. In this work we investigate resonance phenomena of paranasal sinuses prior to and after various rhinosurgical procedures in cadaveric human sinonasal tracts and corresponding 3D casts.

METHODOLOGY

Nasal and paranasal cavities of formalin-preserved cadavers and corresponding 3D replicas were excited by sine-tone sweeps from an earphone placed in the epipharynx. The response was picked up by a microphone at the nostrils. Different FESS procedures were performed and the acoustical responses following excitation were recorded. The measured acoustical changes in the obtained transfer functions were then evaluated.

RESULTS

Marked low frequency dips were detected in the transfer functions when sinus cavities were included in the nasal resonator system. These dips showed a significant correlation with sinus volumes. Following FESS procedures they moved upwards in frequency depending on the extent of the surgical intervention.

CONCLUSIONS

The transfer functions obtained in cadaveric situs and 3D replicas showed dips at the resonance frequencies of the paranasal cavities. Marked acoustic effects in terms of increase in dip frequency following FESS procedures were reproducibly documented.

Clinical parameters and adrenocortical activity to assess stress responses of alpacas using different methods of restraint either alone or with shearing

Shearing of alpacas is stressful and is undertaken by restraint in the standing position, cast on the floor or on a tilt table. The objectives of the study were to evaluate and compare the stress responses between different methods. The study consisted of two parts. In part one, 15 animals were restrained applying all three methods but without shearing. In part two, 45 animals in three groups of 15 were shorn using one of the three procedures. Body temperature, heart rate, respiratory rate, salivary cortisol and faecal cortisol metabolites (FCM) were measured. Part 1: restraint in a standing position was less stressful than other procedures. Part 2: the classic clinical parameters changed significantly over time but without significant differences between the methods. The number of injuries did not differ. Saliva cortisol and FCM concentrations varied in wide ranges between animals. An increase in FCM concentrations occurred in all groups but saliva cortisol concentration increased only after shearing on the ground. The recommendations of the study are to shear calm alpacas in the standing position but animals showing severe defence reactions should be shorn either cast on the ground or on a table to decrease the risk of injuries.

Abstract S1-07: Immune sculpting of the triple negative breast cancer genome

Background: Tumors with infiltrating lymphocytes (TIL) demonstrate a better prognosis particularly in TNBC and HER2 positive breast cancer. Two competing hypothesis predict contrasting relationships of TILs and genomic heterogeneity. On one hand, a strong immune response may lead to “pruning” of intratumor heterogeneity by eliminating immunogenic clones resulting in a near equilibrium, hence better prognosis, while cancers that escape the surveillance may evolve towards greater clonal heterogeneity and genomic complexity. In some cancers, the predicted neoantigens are less frequent than expected by chance also suggesting immune mediated elimination of neoplastic clones (Rooney et al. 2015). Studies also showed an inverse association between immune cell infiltration and intratumor clonal heterogeneity (Morris et al. 2016). On the other hand, cancers with greater genomic instability and mutational burden will have larger clonal heterogeneity and therefore more neoantigens and greater immune infiltration. Indeed, a positive correlation between overall mutation load and immune activity in the tumor microenvironment was observed in pooled data across a broad range of cancer types (Brown et al. 2014, Rooney et al. 2015, Schumacher and Schreiber 2015).

Methods: We assessed these two competing hypothesis and examined the relationship between genomic complexity and immune gene expression in different breast cancer subtypes. We used previously described immune metagene expression (DNA microarray n=655) as measures of immune infiltration in the TCGA data set (RNA-Seq n=1215). We compared somatic mutations, mutation count, neoantigen load, clonal heterogeneity metrics and the distribution of mutations in 119 canonical cancer genes and 12 cancer pathways between good and poor prognosis TNBC (n=208) corresponding to high and low immune infiltration.

Results:A positive but weak correlation between mutation count and immune metagene expression was observed when all breast cancer subtypes were analyzed together (P=0.08). This was driven by the generally higher mutation count and immune infiltration in TNBC. When TNBC was analyzed separately, good prognosis TNBC with high immune infiltration had lower total mutation count (P=0.021) and predicted neo-antigen count (P=0.035). Clonal heterogeneity was also lower in good prognosis TNBC (P=0.001). There was a strong inverse relationship of dispersion in mutation variant allele frequencies and immune metagene expression. CASP8 was the top enriched mutation in TNBC with high immune infiltration (P=0.007 with no adjustment for multiple testing).

Conclusions:High immune infiltration is associated with reduced intratumor heterogeneity in TNBC suggesting immune sculpting of the tumor and a near equilibrium between the cancer and immune surveillance. Surgical resection of the primary tumor may tilt the balance towards the immune system resulting in the better prognosis of high-TIL TNBC. TNBC with low immune infiltration has greater clonal heterogeneity and mutation load and may represent the consequence of escape from immune surveillance. Mutation of CASP8 may be one way to evade tumor cell killing in high-TIL TNBC as previously noted.

Citation Format: Karn T, Jiang T, Hatzis C, Sänger N, El-Balat A, Holtrich U, Becker S, Bianchini G, Pusztai L. Immune sculpting of the triple negative breast cancer genome [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S1-07.

Is it safe to perform rectal anastomosis in gynaecological debulking surgery without a diverting stoma?

AIM

Colorectal resection is frequently performed during cytoreductive surgery for gynaecological malignancy. The aim of this study was to assess the safety of colorectal anastomosis, and especially low rectal anastomosis, in the absence of a protective stoma in patients with gynaecological cancer and peritoneal metastasis.

METHOD

Patient data were retrospectively collected from a database for gynaecological cancer procedures carried out between January 2013 and July 2015. All patients who underwent a colorectal resection during cytoreduction were included in the study. The primary outcome was anastomotic leakage in the presence or absence of a diverting stoma. Secondary outcome parameters were complications and reoperations.

RESULTS

In the period of study, 43 major colorectal procedures were performed on 37 women. The most common colorectal procedure was low rectal resection (n = 22; 59%) followed by anterior rectal resection (n = 7; 19%) and sigmoid resection (n = 4; 11%). Five (14%) patients underwent Hartmann's procedure. In three (8%) patients, a diverting loop ileostomy was created.

CONCLUSION

Low rectal resection during debulking procedures for gynaecological cancers with peritoneal carcinomatosis can safely be performed by an experienced surgeon without a diverting stoma.

Wide recognition of Culex pipiens and lack of detection of Culex torrentium through biomolecular differentiation of mosquitoes in the Emilia-Romagna region, Northern Italy

The Culex pipiens complex includes species with reported differences in vector competence for arthropod-borne viruses, many of which are of significant importance to human health such as the West Nile virus and the Sindbis virus. This group of mosquitoes is difficult to distinguish morphologically; particularly as adult females. In Europe, the two species of the complex, Culex pipiens Linnaeus 1758 and Culex torrentium Martini 1925, are often found sympatrically. With the aim to characterize the presence and spread of both species in the Emilia-Romagna region, Northern Italy, mosquitoes of the complex - collected during the West Nile virus surveillance plans - were tested by multiplex real-time PCR for the detection of the two species Cx. pipiens and Cx. torrentium. A total of 24 165 mosquitoes, collected between 2012 and 2014 from 105 sites, and sorted in 204 pools, were tested. All tested pools were found to be composed of Cx. pipiens, whereas Cx. torrentium was not detected. These results indicate a likely absence of Cx. torrentium mosquitoes within the surveyed territory, whereas Cx. pipiens is widely distributed in the area mentioned. This is in line with previous reports, which describe a pre-alpine distribution of Cx. torrentium in Italy.

Denis RD, Staerz S, Stahlman J, Stamen R, Stamm S, Stanecka E, Stanescu C, Stanescu-Bellu M, Stanitzki MM, Stapnes S, Starchenko EA, Stark J, Staroba P, Starovoitov P, Staszewski R, Stavina P, Steinberg P, Stelzer B, Stelzer HJ, Stelzer-Chilton O, Stenzel H, Stewart GA, Stillings JA, Stockton MC, Stoebe M, Stoicea G, Stolte P, Stonjek S, Stradling AR, Straessner A, Stramaglia ME, Strandberg J, Strandberg S, Strandlie A, Strauss E, Strauss M, Strizenec P, Ströhmer R, Strom DM, Stroynowski R, Strubig A, Stucci SA, Stugu B, Styles NA, Su D, Su J, Subramaniam R, Succurro A, Sugaya Y, Suhr C, Suk M, Sulin VV, Sultansoy S, Sumida T, Sun S, Sun X, Sundermann JE, Suruliz K, Susinno G, Sutton MR, Suzuki S, Svatos M, Swedish S, Swiatlowski M, Sykora I, Sykora T, Ta D, Taccini C, Tackmann K, Taenzer J, Taffard A, Tafirout R, Taiblum N, Takai H, Takashima R, Takeda H, Takeshita T, Takubo Y, Talby M, Talyshev AA, Tam JYC, Tan KG, Tanaka J, Tanaka R, Tanaka S, Tannenwald BB, Tannoury N, Tapprogge S, 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Ženiš T, Zerwas D, Zhang D, Zhang F, Zhang H, Zhang J, Zhang L, Zhang R, Zhang X, Zhang Z, Zhao X, Zhao Y, Zhao Z, Zhemchugov A, Zhong J, Zhou B, Zhou C, Zhou L, Zhou L, Zhou N, Zhu CG, Zhu H, Zhu J, Zhu Y, Zhuang X, Zhukov K, Zibell A, Zieminska D, Zimine NI, Zimmermann C, Zimmermann S, Zinonos Z, Zinser M, Ziolkowski M, Živković L, Zobernig G, Zoccoli A, Nedden MZ, Zurzolo G, Zwalinski L. Performance of pile-up mitigation techniques for jets in [Formula: see text] collisions at [Formula: see text] TeV using the ATLAS detector

The large rate of multiple simultaneous proton-proton interactions, or pile-up, generated by the Large Hadron Collider in Run 1 required the development of many new techniques to mitigate the adverse effects of these conditions. This paper describes the methods employed in the ATLAS experiment to correct for the impact of pile-up on jet energy and jet shapes, and for the presence of spurious additional jets, with a primary focus on the large 20.3 [Formula: see text] data sample collected at a centre-of-mass energy of [Formula: see text]. The energy correction techniques that incorporate sophisticated estimates of the average pile-up energy density and tracking information are presented. Jet-to-vertex association techniques are discussed and projections of performance for the future are considered. Lastly, the extension of these techniques to mitigate the effect of pile-up on jet shapes using subtraction and grooming procedures is presented.

[Chronic pain : Perception, reward and neural processing]

Many chronic pain syndromes are characterized by enhanced perception of painful stimuli as well as alterations in cortical processing in sensory and motor regions. In this review article the alterations in muscle pain and neuropathic pain are described. Alterations in patients with fibromyalgia and chronic back pain are described as examples for musculoskeletal pain and also in patients with phantom limb pain after amputation and complex regional pain syndrome as examples for neuropathic pain. In addition to altered pain perception, cumulative evidence on alterations in the processing of reward and the underlying mechanisms in chronic pain has been described. A description is given of what is known on how pain and reward interact and affect each other. The relevance of such interactions for chronic pain is discussed. The implications of these findings for therapeutic approaches are delineated with respect to sensorimotor training and behavioral therapy, focusing on the effectiveness of these approaches, mechanisms and future developments. In particular, we discuss operant behavioral therapy in patients with chronic back pain and fibromyalgia as well as prosthesis training in patients with phantom limb pain and discrimination, mirror and imaginary training in patients with phantom limb pain and complex regional pain syndrome. With respect to the processing of reward, the focus of the discussion is on the role of reward and associated learning in pain therapy.

A reciprocating optical in situ tribometer with high-speed data acquisition

Tribology is the science of interacting surfaces in relative motion. Processes like the transition from static to dynamic friction are fast and complex, especially as the contacting interface is buried. A direct view at the interface, in order to gain a deeper understanding of the interaction between the materials, is therefore of great interest. The reciprocating optical in situ tribometer introduced here observes the interface of two contacting materials (one of them being optical transparent) with a high-speed camera, taking up to 230 000 frames per second. The camera is attached to an optical microscope with a magnification of up to 2500 times. Friction forces are measured by an analog laser detection setup, with a maximum sampling rate of 500 kHz. The sliding motion of the materials is realized by two displacement units. A linear positioning stage allows velocities between 500 nm/s and 100 mm/s for a maximum distance of 200 mm. For smaller velocities, and to exclude breakaway torque, a piezo actuator can be used. The maximum displacement distance of the piezo actuator is 120 μm. The smallest applicable normal load on the samples is 0.5 N which is applied by the dead weights. Tribological experiments to investigate the transition from static to dynamic friction have been performed with morphologically textured brass hemispheres in contact with the sapphire discs. Sapphire was chosen for its high hardness and optical transparency. These experiments revealed, due to the high data acquisition possible with the new setup, a so far unobserved effect during the transition from static to dynamic friction.

Einfluss von Teamarbeit auf Wohlbefinden und emotionale Erschöpfung von Mitarbeitern in der medizinischen Rehabilitation

Ziel der Studie: Emotionale Erschöpfung und Wohlbefinden von Mitarbeitern sind Indikatoren, welche im Zusammenhang mit der hohen Prävalenz psychischer und psychosomatischer Erkrankungen bei Mitarbeitern im Gesundheitswesen von Bedeutung sind. Teamarbeit kann das Wohlbefinden der Mitarbeiter positiv beeinflussen. Dies ist jedoch im Bereich der Rehabilitation noch unzureichend belegt. Ziel der vorliegenden Studie war es, Aspekte von Teamarbeit als Prädiktoren für Wohlbefinden und emotionale Erschöpfung bei Mitarbeitern in deutschen Rehabilitationskliniken zu untersuchen.

Methodik: Die Daten wurden in insgesamt 10 Rehabilitationskliniken in Südwestdeutschland erhoben, davon wurden die Mitarbeiterfragebogen aus 9 Kliniken (n=306, 70% weiblich, 68% zwischen 40 und 59 Jahre alt) mittels multipler linearer Regression ausgewertet.

Ergebnisse: Die Mitarbeiter berichteten moderate Maße an emotionaler Erschöpfung und hohes Wohlbefinden. Die Ergebnisse der Regressionsanalysen zeigen, dass Zusammenhalt (β=0,27, p<0,001), Teamorganisation (β=0,19, p<0,01) und Alter (β=0,13, p<0,05) der Mitarbeiter einen bedeutsamen Teil der Varianz von Wohlbefinden aufklären konnten (F[3, 244]=19,38, p<0,05). Durch das Kriterium Zusammenhalt (β=− 0.37, p<0,001) konnte die emotionale Erschöpfung der Mitarbeiter bedeutsam vorhergesagt werden (F[1, 244]=39,19, p<0,001).

Schlussfolgerung: Diskutiert werden die Auswirkungen der interpersonellen und strukturellen Aspekte von Teamarbeit, sowie die potentielle Relevanz von Interventionsmaßnahmen zur Verbesserung der Teamarbeit, um eine Steigerung des psychischen Wohlbefindens der Mitarbeiter zu erreichen.

Measurement of the centrality dependence of the charged-particle pseudorapidity distribution in proton-lead collisions at [Formula: see text] TeV with the ATLAS detector

The centrality dependence of the mean charged-particle multiplicity as a function of pseudorapidity is measured in approximately 1 [Formula: see text]b[Formula: see text] of proton-lead collisions at a nucleon-nucleon centre-of-mass energy of [Formula: see text] [Formula: see text] using the ATLAS detector at the Large Hadron Collider. Charged particles with absolute pseudorapidity less than 2.7 are reconstructed using the ATLAS pixel detector. The [Formula: see text] collision centrality is characterised by the total transverse energy measured in the Pb-going direction of the forward calorimeter. The charged-particle pseudorapidity distributions are found to vary strongly with centrality, with an increasing asymmetry between the proton-going and Pb-going directions as the collisions become more central. Three different estimations of the number of nucleons participating in the [Formula: see text] collision have been carried out using the Glauber model as well as two Glauber-Gribov inspired extensions to the Glauber model. Charged-particle multiplicities per participant pair are found to vary differently for these three models, highlighting the importance of including colour fluctuations in nucleon-nucleon collisions in the modelling of the initial state of [Formula: see text] collisions.

[Complement activation after induction of ocular hypertension in an animal model]

BACKGROUND

Although an elevated intraocular pressure (IOP) is known as the main risk factor for glaucoma, many studies also showed an involvement of the immune system in this disease. In this study we investigated if a moderate increase in IOP leads to activation of the complement system.

METHODS

The IOP was elevated experimentally in the left eye of rats, whereas the fellow eye served as the control. The IOP was measured at regular intervals. The number of retinal ganglion cells (RGC) was quantified via NeuN staining. To evaluate the activation of the complement system staining for C3, membrane attack complex (MAC), and mannose-binding lectin (MBL) was performed. Furthermore, we investigated possible glia activation (GFAP and vimentin) and apoptosis (Bax).

RESULTS

A moderate elevation of the IOP was noted from day 11 after induction of ocular hypertension (OHT) until the end of the study (28 days, p = 0.0005). In the OHT-group significantly fewer RGCs (p = 0.02) were detected. Additionally, we noted significant C3 and MAC activation in the ganglion cell layer (C3, p = 0.001 and MAC, p = 0.02) as well as in the total retina (C3, p = 0.002 and MAC, p = 0.012). An activation via the lectin pathway by MBL staining could not be detected (p = 0.40). At this point in time no alterations with regard to glia cells were noted (GFAP, p = 0.97 and vimentin, p = 0.99). No apoptosis via Bax pathway could be observed (p = 0.90).

CONCLUSION

The results suggest that the complement system is involved in the loss of RGCs even by a moderate IOP elevation which was indicated by significantly more C3 and MAC depositions in the OHT group.