Electronic search programs are effective in identifying patients with minimal trauma fractures

We assessed two electronic search tools that screen medical records for documented fractures. Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. A hybrid tool combining the methodology of both tools is likely to improve the identification of those with osteoporosis.

PURPOSE

Most patients who suffer a minimal trauma fracture remain undiagnosed, placing them at high risk of refracture. Case finding can be improved by electronic search tools that screen medical records for documented fractures. Here, we assessed the efficacy of two new programs, AES and XRAIT, in identifying patients with minimal trauma fracture.

METHODS

Each tool was applied to search the electronic medical record and/or radiology reports at two tertiary hospitals in Sydney, Australia, from 1 July to 31 December 2018. Samples of the extracted reports were then manually reviewed to determine the sensitivity of each program in detecting minimal trauma fractures.

RESULTS

At the two centers, AES detected 872 and 1364 cases, whereas XRAIT identified 1414 and 2180 patients with fractures, respectively. The true positive rate for "any fracture" was similar for both instruments (77-88%). However, the ability to detect "minimal trauma fractures" differed between programs and centers (53-75% accuracy), with each tool identifying separate subsets of patients. Concordance between both tools was less than half of the combined total number of minimal trauma fractures (43-45%). Considering the total number of minimal trauma fractures detected by both tools combined, AES correctly identified 52-55% of cases while XRAIT identified 88-93% of cases.

CONCLUSION

Both programs reliably identified patients with any fracture but missed individuals with minimal trauma fracture to different degrees. Hybrid tools combining the methodology of XRAIT and AES are likely to improve the identification of patients who require investigation and treatment for osteoporosis.

Soluble guanylate cyclase signalling mediates etoposide resistance in progressing small cell lung cancer

Small cell lung cancer (SCLC) has a 5-year survival rate of <7%. Rapid emergence of acquired resistance to standard platinum-etoposide chemotherapy is common and improved therapies are required for this recalcitrant tumour. We exploit six paired pre-treatment and post-chemotherapy circulating tumour cell patient-derived explant (CDX) models from donors with extensive stage SCLC to investigate changes at disease progression after chemotherapy. Soluble guanylate cyclase (sGC) is recurrently upregulated in post-chemotherapy progression CDX models, which correlates with acquired chemoresistance. Expression and activation of sGC is regulated by Notch and nitric oxide (NO) signalling with downstream activation of protein kinase G. Genetic targeting of sGC or pharmacological inhibition of NO synthase re-sensitizes a chemoresistant CDX progression model in vivo, revealing this pathway as a mediator of chemoresistance and potential vulnerability of relapsed SCLC.

Delays in diagnostic tests used to identify transthyretin amyloid cardiomyopathy (ATTR-CM) in the EU4 + UK

Background

Transthyretin amyloid cardiomyopathy (ATTR-CM) is an underdiagnosed, progressive disease characterised by amyloid protein deposits building in the left ventricle. The symptoms of ATTR-CM are like those associated with heart failure, and specialised tests are needed to identify ATTR-CM.

Purpose

This paper examines the tests used to identify ATTR-CM in France, Germany, Italy, Spain and United Kingdom and the time between these tests.

Methods

Ipsos' ATTR-CM Therapy Monitor was fielded between November 2020 and December 2020, with 210 (FR: 46, DE: 40, IT: 43, ES: 42, UK: 39) treating doctors providing data on 320 (FR: 71, DE: 63, IT: 64, ES: 63, UK: 59) patients diagnosed with ATTR-CM. Ipsos analysed information provided on the diagnostic tests ordered for the 320 patients to understand how ATTR-CM is diagnosed across the five markets, and also tracked the order in which the tests were conducted, across four batteries, to understand the flow of the diagnostic procedures.

Results

Overall, the patients in our study went through 6 diagnostic tests on average before receiving a confirmed ATTR-CM diagnosis via Echocardiogram (ECHO) with strain imaging (83%), Cardiac Magnetic Resonance Imaging MRI (75%), Genetic tests (69%), Laboratory tests (59%), Scintigraphy tests (52%), and Biopsy tests (51%) as the top tests ordered. Overall, 15% of the reported patients had an unknown order of tests. Patients in Germany, France and Italy received the most tests on average (FR: 6, DE: 7, IT: 6, ES: 5 and UK: 5). Patients in Germany also experienced the shortest delays between batteries of tests (3.2 wks. between 1st and 2nd batteries; 3.9 wks. between 2nd and 3rd batteries) and were most likely to receive a Genetic test (84%) or Biopsy test (68%) to confirm diagnosis. In comparison, patients in Spain experienced the longest testing delays (7.3 wks. between 1st and 2nd batteries; 5.8 wks. between 2nd and 3rd batteries) and went through only 5 diagnostic tests before receiving a confirmed diagnosis.

Across the markets, 59% of doctors experienced a decline in ability to diagnose patients with ATTR-CM due to COVID-19, with the degree of impact differing drastically by region (FR: 43%, DE: 20%, IT: 79%, ES: 88% and UK: 64%). With doctors indicating that 16% of their patients were untreated due to late diagnosis with advanced disease (FR: 15%, DE: 10%, IT: 16%, ES: 20% and UK: 21%), identifying suspected ATTR-CM and running the necessary tests to diagnose ATTR-CM early are essential.

Conclusion

Overall, the patients reported on in this study received upwards of 6 diagnostic tests before confirmation of ATTR-CM, with 4.5 weeks between each battery of tests. In addition to regional nuances in regard to test choice, we see evidence that there are country level differences between how quickly patients receive diagnostic tests. Further research is needed to identify ways of increasing the speed of testing and subsequent diagnosis.

Funding Acknowledgement

Type of funding sources: None. Diagnostic Procedures by Region

Changes in mitral regurgitation following acute myocardial infarction: early and long-term follow-up

Background

Mitral regurgitation (MR) is commonly observed following acute myocardial infarction (MI). Localised left ventricular (LV) remodelling in the region of papillary muscles together with impaired myocardial contractility promote MR. There is a paucity of long-term follow-up studies to determine whether the severity of MR observed post-MI, changes with time.

Purpose

This study retrospectively followed up patients with MR detected following acute MI (AMI) to investigate changes in MR severity with time and assess for pre-discharge predictors of MR regression or progression.

Methods

Clinical records of 1000 patients admitted with AMI between 2016 and 2017 to a single centre were retrospectively interrogated. One hundred and nine patients met the inclusion criteria of MR on pre-discharge transthoracic echocardiography (TTE) and follow-up TTE scans. Echocardiographic parameters were investigated to determine predictors of progression or regression at follow-up. Patients were divided according to those who had early follow-up TTE (within 1-year) and late follow-up TTE (beyond 1-year).

Results

Early follow-up TTE was performed in 73 patients at a median of 6 (IQR 3–9) months. Patients had a mean age of 69±13 years and were predominantly male 50/73 (68%). At baseline, relative MR severities were: 49/73 (67%) mild MR, 23/73 (32%) moderate MR and 1 (1%) severe MR. At follow-up, MR had completely resolved in 18/73 (23%) patients, while 39/73 (53%) had mild MR, 15/73 (21%) moderate MR and 1 (1%) severe MR. Compared to patients with no resolution of MR, those with completel resolution were younger (mean age 62±16 vs 72±11 years; p=0.015) but there were no other significant differences between the groups. Resolution at early follow-up did not significantly influence long-term mortality rates. Late follow-up TTE was performed in 69 patients at a median 2.4 (IQR 2–3.2) years. Pre-discharge, 49/69 (71%) patients had mild MR and 20/69 (29%) moderate MR. At follow-up, MR had completely resolved in 18/69 (26%), and amongst patients with persistent MR, proportion of severities were: 37/69 (54%) mild MR, 11/69 (16%) moderate MR and 3/69 (4%) severe MR. Patients with progression of mild MR were more likely to have lower left ventricular ejection fraction (LVEF: 47±15 vs 57±12%; p=0.010) and greater indexed left ventricular end-systolic volume (LVESVi: 37±23 vs 25±14 ml/m2; p&lt;0.001) on pre-discharge TTE. Resolution of MR at late follow-up was associated with a reduction in long-term mortality [deaths: 2/55 (3%) vs 3/14 (21%); p=0.022] at a mean follow-up of 4.2 years from MI.

Conclusion

MR observed following AMI completely resolved in approximately one-quarter of patients at 6-month and 2-year follow-up. Progression of mild MR at long-term follow-up appears to be associated with increased mortality and is predicted by lower LVEF and greater LVESVi pre-discharge.

Funding Acknowledgement

Type of funding sources: None.

1313 Unusual Supraannular Aortic Root Intimal Tear in a Patient with Severe Aortic Regurgitation

We present an extremely rare case of occult supraannular aortic root intimal tear in a patient presenting with acute severe aortic regurgitation (AR) and a previously undiagnosed bicuspid aortic valve.

A 41-year-old Africo-Carribean female presented to the emergency department with acute pulmonary oedema and increasing dyspnea on exertion. She had been treated empirically with antibiotics for a chest infection. Initial concerns were either aortic dissection or infective endocarditis. Transthoracic echocardiography (TTE) demonstrated a normal size left ventricle with hyperdynamic systolic function and severe AR. The patient was transferred to a tertiary cardiothoracic surgical centre for urgent surgical treatment in view of haemodynamic instability and acute AR. A gated computed tomography aortogram identified pulmonary oedema with an asymmetrically dilated aortic root (maximal diameter 45 mm).

Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and prompted Bentall procedure with mechanical aortic valve. After median sternotomy and initiation of cardiopulmonary bypass, a supraannular aortic intimal tear starting from the right coronary cusp/noncoronary cusp commissure was found with no extension into the aorta. The aortic valve was bicuspid and severe AR not amenable to repair was found. Bentall procedure was performed using the 23/26mm Carbomedics Carbo Seal Valsalva composite graft (Sulzer Carbomedics Inc, Austin, TX, USA).

The patient was discharged on the 7th postoperative day in sinus rhythm. At 30-day clinical follow-up she was symptom free with a satisfactory TTE.

The Impact of Intra-thoracic Anatomical Changes upon the Delivery of Lung Stereotactic Ablative Radiotherapy

AIMS

So far, the impact of intra-thoracic anatomical changes (ITACs) on patients treated with stereotactic ablative radiotherapy (SABR) for early-stage non-small cell lung cancer is unknown. Studying these is important, as ITACs have the potential to impact the workflow and reduce treatment quality. The aim of this study was to assess and categorise ITACs, as detected on cone beam computed tomography scans (CBCT), and their subsequent impact upon treatment in lung cancer patients treated with SABR.

MATERIALS AND METHODS

CBCTs from 100 patients treated with SABR for early non-small cell lung cancer were retrospectively reviewed. The presence of the following ITACs was assessed: atelectasis, infiltrative change, pleural effusion, baseline shift and gross tumour volume (GTV) increase and decrease. ITACs were graded using a traffic light protocol. This was adapted from a tool previously developed to assesses potential target undercoverage or organ at risk overdose. The frequency of physics or clinician review was noted. A linear mixed effects model was used to assess the relationship between ITAC grade and set-up time (time from first CBCT to beam delivery).

RESULTS

ITACs were observed in 22% of patients. Twenty-one per cent of these were categorised as 'red', implying a risk of underdosage to the GTV. Most were 'yellow' (51%), indicating little impact upon planning target volume coverage of the GTV. Physics or clinician review was required in 10% of all treatment fractions overall. Three patients needed their treatment replanned. The mixed effect model analysis showed that ITACs cause a significant prolongation of set-up time (Χ2(3) = 9.22, P = 0.02).

CONCLUSION

Most ITACs were minor, but associated with unplanned physics or clinician review, representing a potentially significant resource burden. ITACs also had a significant impact upon set-up time, with consequences for the wider workflow and intra-fraction motion. Detailed guidance on the management of ITACs is needed to provide support for therapeutic radiographers delivering lung SABR.

A search for predictive biomarkers of ovine pre-partum vaginal prolapse

Ovine pre-partum vaginal prolapse (known as bearings in sheep) occurs within a few weeks prior to lambing and unless treated both ewes and unborn lambs will die. It is a worldwide problem with no clear aetiology. Rates of prolapse in New Zealand typically vary from 0.1 to 2% per annum, varying between seasons and farms. In order to determine preclinical changes leading to prolapse, blood samples were collected prior to prolapse occurring and analysed for changes in both protein and specific hormone and vitamin levels. 650 ewes were ear tagged and blood samples were taken one month prior to the beginning of lambing; 28 of these ewes subsequently prolapsed. Using an improved proteomic method plasma samples were subjected to 2D DIGE (two dimensional differential in gel electrophoresis) to determine if there were differences between the pre-prolapse and non-prolapsing ewes. Acidic isoforms of haptoglobin, a major acute phase protein in ruminants, increased approximately 3-fold in ewes prior to prolapse occurring. Total haptoglobin quantitation was confirmed with an independent assay. Although another plasma protein, α-1B-glycoprotein, was down regulated close to prolapse, the biological significance of this is unknown. While vitamin D levels were not associated with subsequent prolapse there was, however, a negative correlation between cortisol and days to prolapse from sampling (r² = 0.36); i.e. ewes sampled closest to prolapse had higher plasma cortisol concentrations than controls. This raises the possibility that the ewes which prolapsed may have been suffering from chronic stress. Further research is needed.

The impact of COVID-19 on road safety in Canada and the United States

The COVID-19 pandemic has led to the implementation of unprecedented public health measures. The effect of these lockdown measures on road safety remain to be fully understood, however preliminary data shows reductions in traffic volume and increases in risky driving behaviors. The objective of the present study is to compare self-reported risky driving behaviors (speeding, distracted driving, drinking and driving, and drugged driving) during the pandemic in Canada and the U.S. to determine what differences exist between these two countries. Data was collected using the Road Safety Monitor (RSM), an annual online public opinion survey that investigates key road safety issues, administered to a representative sample of N = 1,500 Canadian drivers and N = 1,501 U.S. drivers. Respondents were asked about the likelihood of engaging in risky driving during the pandemic as compared to before COVID-19. Results show the majority of respondents indicated their behavior did not change, and most positively, a small proportion reported they were less likely to engage in these risky driving behaviors. However, notable proportions indicated they were more likely to engage in risky driving behaviors during the pandemic, as compared to before COVID-19. Of those who indicated this, U.S. drivers had significantly higher percentages compared to their Canadian counterparts. Behaviors most often reported by this sub-section of drivers who admit to being more likely to engage in risky driving during the pandemic were speeding (7.6%) and drinking and driving (7.6%) in the U.S., and speeding (5.5%) and distracted driving (4.2%) in Canada. Logistic regression results confirm that country was a significant factor, as U.S. drivers had greater odds of reporting they were more likely to engage in these risky driving behaviors, with the exception of speeding. Age also had a significant effect, as increasing age was associated with lower odds of reporting that these risky driving behaviors were more likely during the pandemic. Conversely, sex did not have a significant effect. Overall, the current findings suggest that a small proportion of drivers reported being more likely to engage in risky driving behaviors and the pandemic may have led to changes in the profiles of those drivers engaging in risky driving behaviors during lockdown measures. These results have important implications for policies and can inform how to manage road safety during future lockdowns.

Operationalising coastal resilience to flood and erosion hazard: A demonstration for England

Resilience is widely seen as an important attribute of coastal systems and, as a concept, is increasingly prominent in policy documents. However, there are conflicting ideas on what constitutes resilience and its operationalisation as an overarching principle of coastal management remains limited. In this paper, we show how resilience to coastal flood and erosion hazard could be measured and applied within policy processes, using England as a case study. We define resilience pragmatically, integrating what is presently a disparate set of policy objectives for coastal areas. Our definition uses the concepts of resistance, recovery and adaptation, to consider how the economic, social and environmental dimensions of coastal systems respond to change. We develop a set of composite indicators for each dimension, grounded empirically with reference to national geospatial datasets. A prototype Coastal Resilience Model (CRM) has been developed, which combines the dimensions and generates a quantitative resilience index. We apply it to England's coastal hazard zone, capturing a range of different stakeholder perspectives using relative indicator weightings. The illustrative results demonstrate the practicality of formalising and quantifying resilience. To re-focus national policy around the stated desire of enhancing resilience to coastal flooding and erosion would require firm commitment from government to monitor progress towards resilience, requiring extension of the present risk-based approach, and a consensus methodology in which multiple (and sometimes conflicting) stakeholder values are explicitly considered. Such a transition may also challenge existing governance arrangements at national and local levels, requiring incentives for coastal managers to engage with and apply this new approach, more departmental integration and inter-agency cooperation. The proposed Coastal Resilience Model, with the tools to support planning and measure progress, has the potential to help enable this transition.

Neutrophil-Lymphocyte Ratio and Absolute Lymphocyte Count as Prognostic Markers in Patients Treated with Curative-intent Radiotherapy for Non-small Cell Lung Cancer

AIMS

The neutrophil-lymphocyte ratio (NLR) and the absolute lymphocyte count (ALC) have been proposed as prognostic markers in non-small cell lung cancer (NSCLC). The objective of this study was to examine the association of NLR/ALC before and after curative-intent radiotherapy for NSCLC on disease recurrence and overall survival.

MATERIALS AND METHODS

A retrospective study of consecutive patients who underwent curative-intent radiotherapy for NSCLC across nine sites in the UK from 1 October 2014 to 1 October 2016. A multivariate analysis was carried out to assess the ability of pre-treatment NLR/ALC, post-treatment NLR/ALC and change in NLR/ALC, adjusted for confounding factors using the Cox proportional hazards model, to predict disease recurrence and overall survival within 2 years of treatment.

RESULTS

In total, 425 patients were identified with complete blood parameter values. None of the NLR/ALC parameters were independent predictors of disease recurrence. Higher pre-NLR, post-NLR and change in NLR plus lower post-ALC were all independent predictors of worse survival. Receiver operator curve analysis found a pre-NLR > 2.5 (odds ratio 1.71, 95% confidence interval 1.06-2.79, P < 0.05), a post-NLR > 5.5 (odds ratio 2.36, 95% confidence interval 1.49-3.76, P < 0.001), a change in NLR >3.6 (odds ratio 2.41, 95% confidence interval 1.5-3.91, P < 0.001) and a post-ALC < 0.8 (odds ratio 2.86, 95% confidence interval 1.76-4.69, P < 0.001) optimally predicted poor overall survival on both univariate and multivariate analysis when adjusted for confounding factors. Median overall survival for the high-versus low-risk groups were: pre-NLR 770 versus 1009 days (P = 0.34), post-NLR 596 versus 1287 days (P ≤ 0.001), change in NLR 553 versus 1214 days (P ≤ 0.001) and post-ALC 594 versus 1287 days (P ≤ 0.001).

CONCLUSION

NLR and ALC, surrogate markers for systemic inflammation, have prognostic value in NSCLC patients treated with curative-intent radiotherapy. These simple and readily available parameters may have a future role in risk stratification post-treatment to inform the intensity of surveillance protocols.

Baseline brain function in the preadolescents of the ABCD Study

The Adolescent Brain Cognitive Development (ABCD) Study® is a 10-year longitudinal study of children recruited at ages 9 and 10. A battery of neuroimaging tasks are administered biennially to track neurodevelopment and identify individual differences in brain function. This study reports activation patterns from functional MRI (fMRI) tasks completed at baseline, which were designed to measure cognitive impulse control with a stop signal task (SST; N = 5,547), reward anticipation and receipt with a monetary incentive delay (MID) task (N = 6,657) and working memory and emotion reactivity with an emotional N-back (EN-back) task (N = 6,009). Further, we report the spatial reproducibility of activation patterns by assessing between-group vertex/voxelwise correlations of blood oxygen level-dependent (BOLD) activation. Analyses reveal robust brain activations that are consistent with the published literature, vary across fMRI tasks/contrasts and slightly correlate with individual behavioral performance on the tasks. These results establish the preadolescent brain function baseline, guide interpretation of cross-sectional analyses and will enable the investigation of longitudinal changes during adolescent development.

A Systematic Review of Online Patient Resources to Support Shared Decision Making for Laparoscopic Cholecystectomy

BACKGROUND

RCS Eng, the Royal College of Surgeons of England, has published much information with regard to the consenting process. A majority of patients seek health information through online resources as well as discussing with the care givers. Therefore, it is necessary that online material is both of high quality and reliable for patients. We aimed to evaluate the quality and standard of the online patient information on laparoscopic cholecystectomy to help in the consenting process.

METHODS

A search was carried out as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Sources were assessed using five validated scoring tools: Flesch-Kincaid Reading Ease Score (readability), DISCERN and IPDAS scores (quality of content) and HONcode and the Information Standard Certification (standards of accreditation).

RESULTS

The average readability of all websites was higher than recommended for patient literature. Less than half of the sources had received HONcode or Information Standard accreditation. On grading of quality and content, across validated scoring tools, no source achieved the minimum recommended level.

CONCLUSION

Online patient information related to laparoscopic cholecystectomy is of poor quality. We recommend a multidisciplinary approach to participate in publishing more readable online resources of a higher standard to help patients and clinicians in consent and shared decision making.

Abstract 2874: Understanding small cell lung cancer metastasis using circulating tumor cell (CTC)-derived tumor explant (CDX) models

Small cell lung cancer (SCLC) accounts for about 13% of all malignant lung tumors and is characterized by an extremely low survival rate and widespread early dissemination. Over two-thirds of SCLC patients are diagnosed with metastases in multiple organs; typically liver, lymph nodes and brain. The number and site of secondary lesions at diagnosis correlates with unfavorable disease outcome. Studying metastasis in SCLC is extremely challenging, as metastatic tumor samples are rarely obtained from these patients. Our laboratory has developed a patient-faithful biobank of &gt;45 SCLC circulating tumor cell (CTC)-derived explants (CDX) models with which to study SCLC1. We implemented a resection protocol using these models to study the metastatic process in SCLC by interrogating the genetic and phenotypic components of metastatic cells using combinations of tissue pathology and next generation sequencing methods. Upon resection of the subcutaneous tumor, we detect the presence of overt macrometastatic lesions in multiple models, which in most cases retain matched organ tropism to that observed in the patient. Whereas all models so far tested disseminated to the lungs, the ATOH1 subtye2 models CDX17, CDX17P, CDX25 and CDX30P predominantly grew in the liver, and CDX3 and CDX3P (ASCL1 subtype3) preferentially colonized the brain despite having a much slower growth. CDX SCLC cells can be isolated from subcutaneous tumors and orthotopically implanted, recapitulating the same tropism. Finally, CDX cells labelled ex vivo can be re-implanted directly into the bloodstream or into the brain parenchyma giving rise to SCLC secondary tumors, providing us with an excellent tool to monitor and study several steps of the metastatic cascade, including extravasation and brain colonization. We report for the first time, brain tropic mouse models of SCLC. Molecular studies are underway to investigate the underlying genetic determinants and mechanisms underpinning metastatic spread of SCLC via transcriptomic studies of matched subcutaneous and metastatic tissues and CTCs in CDX. In parallel, CDX3P is being used to identify markers of pre-metastatic disease and brain colonization at the single cell level to identify novel therapeutic strategies and biomarkers that may benefit the significant number of SCLC patients who present with brain lesions. 1Hodgkinson et al., Nature Medicine 20, 897-903 (2014) 2Simpson et al., Nature Cancer 1, pages437-451(2020)

Citation Format: Maria Peiris-Pagès, Mitchell Revill, Derrick Morgan, Stewart Brown, Melanie Galvin, Lynsey Priest, Mathew Carter, Sheila K. Singh, Kristopher Frese, Fiona Blackhall, Kathryn Simpson, Caroline Dive. Understanding small cell lung cancer metastasis using circulating tumor cell (CTC)-derived tumor explant (CDX) models [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2874.

Measuring the structure and equation of state of polyethylene terephthalate at megabar pressures

We present structure and equation of state (EOS) measurements of biaxially orientated polyethylene terephthalate (PET, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$({\hbox {C}}_{10} {\hbox {H}}_8 {\hbox {O}}_4)_n$$\end{document}(C10H8O4)n, also called mylar) shock-compressed to (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$155 \pm 20$$\end{document}155±20) GPa and (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$6000 \pm 1000$$\end{document}6000±1000) K using in situ X-ray diffraction, Doppler velocimetry, and optical pyrometry. Comparing to density functional theory molecular dynamics (DFT-MD) simulations, we find a highly correlated liquid at conditions differing from predictions by some equations of state tables, which underlines the influence of complex chemical interactions in this regime. EOS calculations from ab initio DFT-MD simulations and shock Hugoniot measurements of density, pressure and temperature confirm the discrepancy to these tables and present an experimentally benchmarked correction to the description of PET as an exemplary material to represent the mixture of light elements at planetary interior conditions.