1088. Ultrasensitive Detection of C. difficile Toxins in Stool Using Single Molecule Counting Technology: A Multicenter Study for Evaluation of Clinical Performance

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Trends in Sales Volumes of Cancer Medicines in Six Asian Countries Working Toward Universal Health Coverage

Background: In low- and middle-income (LMIC), medicines represent an important proportion of total out-of-pocket expenditures on health care and should therefore be a key target for financial protection through inclusion in benefit packages under universal health coverage (UHC). For antineoplastic medicines, this need will become even more urgent with the increasing incidence of cancers in LMIC and the availability of new, highly priced cancer. Previous studies have shown that countries have listed cancer medicines recommended in the World Health Organization (WHO) essential medicines list (EML) in their national EMLs. However, little is known about use of these medicines at country level and changes in use over time as countries work toward UHC. Aim: To analyze trends in sales volumes of cancer medicines in China, Indonesia, Kazakhstan, Malaysia, the Philippines and Thailand between 2006 and 2017. Methods: Using quarterly data from IQVIA (former IMS and Quintiles) on sales volumes in 6 middle-income Asian countries of cancer medicines (ATC-L01/02) included in the 2017 WHO EML, we estimated annual sales by international nonproprietary name, year and country. Sales volumes were estimated in total milligrams and total defined daily doses (DDD) per new cancer case. The reference DDD were taken from the German Institute of Medical Documentation and Information. We adjusted total mg and DDD by the total number of new cancer cases per country in 2012 ( Globocan 2012 ). Results: The 2017 WHO EML contains 49 medicines in the antineoplastic section; 40 of them were used in 1 or more countries included in the study. Availability of these 40 medicines ranged from 33 in Indonesia to 40 in the Philippines. The median percentage increase in sales volumes between 2006 and 2017 ranged from 42% in Thailand to 94% in Indonesia. Use of new, high-priced medicines such as trastuzumab and rituximab increased more than 90% and 72% in all countries, respectively, during the study period. Limitations: National sales volumes are extrapolated from standardized audits of procurement and sales data in sample facilities and/or distribution data supplied by wholesalers in each country and may underestimate actual sales. Given different indications for which a cancer medicine can be used and highly individualized antineoplastic treatment regimens and dosages, standardized DDD do not represent actual prescribed daily doses. Growth rates will reflect the place of the medicine within the national treatment guidelines and healthcare delivery capacity. Conclusion: This study provides evidence that use of WHO-recommended essential medicines for cancers increased in 6 Asian countries working toward UHC. Many factors are likely to have contributed to this outcome, including improvements in diagnosis and treatments. The next step in this study will be to assess the role of insurance coverage changes as a factor contributing to changes in utilization of cancer medicines.

Concordance of PD-L1 Expression Detection in Non-Small Cell Lung Cancer (NSCLC) Tissue Biopsy Specimens Between OncoTect iO Lung Assay and Immunohistochemistry (IHC)

OBJECTIVES

We report on the validity of a fully quantitative technology to determine tumor cells' PD-L1 expression compared with a standard immunohistochemical (IHC) assay in non-small cell lung cancer.

METHODS

Nineteen fresh tissue specimens were processed into single-cell suspensions using the IncellPREP Kit. Cells were treated with the OncoTect iO Lung Assay, which quantitatively assessed tumor-infiltrating lymphocytes (TILs), DNA content, and PD-L1 expression on diploid and aneuploid tumor populations.

RESULTS

Comparison of the OncoTect iO Lung Assay with IHC revealed a concordance of 95% overall (negative percent agreement, 97%; positive percent agreement, 89%). PD-L1 expression varied depending on the DNA content. The number of TILs and antigen-presenting cells (APCs) was significantly decreased in tumor compared with normal lung tissue.

CONCLUSIONS

The nonsubjective OncoTect iO Lung Assay has been shown to be at least as accurate and sensitive as IHC for the detection of PD-L1 expression while providing additional information to guide treatment.

Potentiation of GM-CSF or GCSF Induced Mobilization of Circulating Progenitor Cells by Pretreatment with IL-3 and Harvest by Apheresis

Recombinant human colony-stimulating factors (CSFs) are increasingly used for mobilizing progenitor cells in the peripheral blood (PB). 7 patients were treated with GM-CSF or GCSF at a dose of 5μg/kg/d for 5 days and after a treatment free interval received another cycle of the same cytokine after pretreatment with IL-3. Pretreatment with 5μg/kg/d of IL-3 for 7 days did not mobilize by itself but significantly potentiated GM-CSF or GCSF induced mobilization of PB progenitor cells in all 5 patients tested. As compared to the mobilization capacity of GM-CSF or GCSF alone, 7 day IL-3 pretreatment potentiated maximum values of CFU-GM by 3.7-6.3 fold in patients receiving GM-CSF (n=2) and by 1.8-3.3 fold in patients receiving GCSF leading to a 10-23 fold increase in numbers of circulating CFU-GM by the combination IL-3/GM-CSF, and a 26-101 fold increase by IL-3/GCSF, respectively. Stem cell apheresis in patients treated with IL-3 + GCSF or GM-CSF yielded enough PB-stem cells to ensure complete engraftment after ablative chemotherapy.

Strong Neutron Pairing in core+4n Nuclei

The emission of neutron pairs from the neutron-rich N=12 isotones ^{18}C and ^{20}O has been studied by high-energy nucleon knockout from ^{19}N and ^{21}O secondary beams, populating unbound states of the two isotones up to 15 MeV above their two-neutron emission thresholds. The analysis of triple fragment-n-n correlations shows that the decay ^{19}N(-1p)^{18}C^{*}→^{16}C+n+n is clearly dominated by direct pair emission. The two-neutron correlation strength, the largest ever observed, suggests the predominance of a ^{14}C core surrounded by four valence neutrons arranged in strongly correlated pairs. On the other hand, a significant competition of a sequential branch is found in the decay ^{21}O(-1n)^{20}O^{*}→^{18}O+n+n, attributed to its formation through the knockout of a deeply bound neutron that breaks the ^{16}O core and reduces the number of pairs.

How Can Acute Mountain Sickness be Quantified at Moderate Altitude?

Reports of acute mountain sickness (AMS) at moderate altitude show a wide variability, possibly because of different investigation methods. The aim of our study was to investigate the impact of investigation methods on AMS incidence. Hackett's established AMS score (a structured interview and physical examination), the new Lake Louise AMS score (a self-reported questionnaire) and oxygen saturation were determined in 99 alpinists after ascent to 2.94 km altitude. AMS incidence was 8% in Hackett's AMS score and 25% in the Lake Louise AMS score. Oxygen saturation correlated inversely with Hackett's AMS score with no significant correlation with the Lake Louise AMS score. At moderate altitude, the new Lake Louise AMS score overestimates AMS incidence considerably. Hackett's AMS score remains the gold standard for evaluating AMS incidence.

Simultaneous, single cell, flow cytometric quantification of PD-L1/TILs/cell cycle in non-small cell lung cancer tissue biopsies: Concordance of PD-L1 expression detection between flow cytometry and immunohistochemistry

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Background: Tumor cell expression of PD-L1 leads to the inhibition of immune responses specifically inactivation of cytotoxic T-cells. PD-L1 expression on tumor cells by immunohistochemistry does not provide the complete picture of therapeutic (PD-L1) and prognostic (TILs, aneuploidy) markers. Here, we report a clinical assay that quantifies tumor infiltrating lymphocytes (TILs), cell cycle/DNA content as well as PD-L1 expression on tumor and aneuploid tumor cell populations. Methods: Punch biopsies were taken from 19 fresh tissues specimens and were processed into single cell suspensions using the IVD/CE-IVD IncellPREP Single Cell Preparation Kit. Cells were fixed and permeabilized in 1 mL IncellMax. Cells were tested with the OncoTect iO Lung Assay which contains antibodies directed against PD-L1 (clone 28-8), CD45, CD3, and CD8, and a cell cycle dye. Concordance to IHC was tested by the Dako PD-L1 IHC 28-8 PharmDx Kit. Immune cell populations were quantified and aneuploidy was determined using a DNA index > 1.05. Results: The number of CD8+ CTL were significantly increased (P = 0.02) in tumor compared to normal lung tissue (37.4% to 28.2%). The number of CTL in aneuploid tumors was twice the number of CTL in diploid tumors. The percentage of antigen presenting cells (CD45+, high SSC) was decreased in the tumor cell samples relative to the normal lung tissue (P = 0.01). PD-L1 expression varies in cells depending on the cell cycle. Conclusions: In this study, the concordance between Oncotect iO and IHC was 95% (NPA-97%, PPA-89%). PD-L1 expression varies with DNA content, PD-L1 expression decreases with increasing DNA content. Though CTL are increased in aneuploid tumors, PD-L1 expression decreasing with DNA content may contribute to the association of aneuploidy with distant metastases. PD-L1 expression is a powerful determinant of treatment and aneuploidy is a powerful prognostic factor that combined yield important clinical information.

Striatale Aufnahme von 1-123-ß-CIT und I-123-IBZM bei Patienten mit extrapyramidaler Symptomatik

Ziel: In der vorliegenden Pilotstudie wurde untersucht, ob charakteristische Veränderungen der Dopamintransportfunktion und der D2-Bin-dungskapazität bei Patienten mit der klinischen Diagnose eines idiopathischen Parkinson-Syndroms (IPS) mit der SPET nachgewiesen werden können und ob sich diese Veränderungen von jenen unterscheiden, die mit sekundärem Parkinson-Syndrom (SPS) einhergehen. Methode: Bei 16 Patienten wurden SPET-Studien (Doppelkopfkamera) sowohl mit I-123-ß-CIT als auch mit I-123-IBZM 20-24 h p.i. bzw. 2 h p.i. durchgeführt (darunter 6 Pt. mit IPS, 6 Pt. mit SPS außer M. Wilson und 4 Pt. mit M. Wilson). Die Auswertung der ß-CIT-Studien erfolgte auf der Grundlage der Aktivitätsrelationen zwischen Basalganglien (BG) und Cerebellum (CER), die der IBZM-Studien unter Verwendung von BG und medialem frontalen Kortex (MFC). Ergebnisse: Die Relation BG/CER für 1-123-ß-CIT betrug 3,04 ± 0,83 bei IPS und 7,73 ± 3,28 bei SPS ohne Morbus Wilson (p< 0,05). Die Relation BG/MFC für I-123-IBZM war bei IPS jeweils kontralateral zur Symptomatik erhöht (MW = 1,75 ± 0,12 gegenüber 1,61 ± 0,16). Die entsprechenden Werte bei SPS waren gegenüber denen bei IPS nur mäßig, aber signifikant vermindert (1,58 ± 0,24 vs. 1,68 ± 0,16). Bei den Patienten mit M. Wilson war die Relation BG/MFC für IBZM zum Teil erheblich vermindert (bis 1,29), während die I-123-ß-CIT-Aufnahme mit BG/CER-Relationen von 8,00 ± 2,90 gegenüber der von Patienten mit SPS (p < 0,01) nur gering reduziert war. Schlußfolgerung: Es wird gefolgert, daß die beiden verwendeten Radiopharmaka zwar tendenziell die bei den untersuchten Krankheitsbildern erwarteten neurochemischen Veränderungen darzustellen in der Lage sind, daß aber eine Differenzierung zwischen IPS und SPS eher mit I-123-ß-CIT gelingt als mit I-123-IBZM.

Quasifree (p, 2p) Reactions on Oxygen Isotopes: Observation of Isospin Independence of the Reduced Single-Particle Strength

Quasifree one-proton knockout reactions have been employed in inverse kinematics for a systematic study of the structure of stable and exotic oxygen isotopes at the R^{3}B/LAND setup with incident beam energies in the range of 300-450  MeV/u. The oxygen isotopic chain offers a large variation of separation energies that allows for a quantitative understanding of single-particle strength with changing isospin asymmetry. Quasifree knockout reactions provide a complementary approach to intermediate-energy one-nucleon removal reactions. Inclusive cross sections for quasifree knockout reactions of the type ^{A}O(p,2p)^{A-1}N have been determined and compared to calculations based on the eikonal reaction theory. The reduction factors for the single-particle strength with respect to the independent-particle model were obtained and compared to state-of-the-art ab initio predictions. The results do not show any significant dependence on proton-neutron asymmetry.

Polydiacetylenic nanofibers as new siRNA vehicles for in vitro and in vivo delivery

Polydiacetylenic nanofibers (PDA-Nfs) obtained by photopolymerization of surfactant 1 were optimized for intracellular delivery of small interfering RNAs (siRNAs). PDA-Nfs/siRNA complexes efficiently silenced the oncogene Lim-1 in the renal cancer cells 786-O in vitro. Intraperitoneal injection of PDA-Nfs/siLim1 downregulated Lim-1 in subcutaneous tumor xenografts obtained with 786-O cells in nude mice. Thus, PDA-Nfs represent an innovative system for in vivo delivery of siRNAs.

Calcaneal Displacement Osteotomies - Less Soft Tissue Irritation in Lateral Compression Plate than Screws

PURPOSE OF THE STUDY With the concept of the lateral compression plate (LLCP) a technique has been available designed to combine the advantages of a fixed-angle fixation with a complete sinking of the implant into the proximal bone. The objective of the present study was to investigate the results of the LLCP compared with classical screw osteosynthesis (SO). MATERIAL AND METHODS 31 patients with pes planovalgus who received calcaneal displacement osteotomy and osteosyntheses with screws (n = 17) or LLCP (n = 14) between 2010 and 2015 were investigated retrospectively.The ankle-hindfoot scale, Kaikkonen score, VAS, and the SF-36 were determined preoperatively as well as at the last clinical follow-up. In addition, a radiological control of osseous integration was performed in all patients 12 weeks after surgery. RESULTS With regard to clinical scores both methods depicted significant improvement. In the overall cohort there were no pseudarthroses. In the SO group 5 cases (29%) showed hardware irritation, in the LLCP group there were none. Results in the LLCP group were significantly superior in the area of the physical section of the SF 36. CONCLUSIONS Based on the results of our study, surgical treatment of stage II pes planovalgus by means of calcaneal displacement osteotomy using the LLCP is equivalent to SO with a lower incidence of hardware irritation. Key words:pes planovalgus, lateral compression plate, osteosynthesis, screw, hardware irritation.

LEVEL OF EVIDENCE

Level IV, retrospective case serie.

Long-wavelength macromolecular crystallography - First successful native SAD experiment close to the sulfur edge

Phasing of novel macromolecular crystal structures has been challenging since the start of structural biology. Making use of anomalous diffraction of natively present elements, such as sulfur and phosphorus, for phasing has been possible for some systems, but hindered by the necessity to access longer X-ray wavelengths in order to make most use of the anomalous scattering contributions of these elements. Presented here are the results from a first successful experimental phasing study of a macromolecular crystal structure at a wavelength close to the sulfur K edge. This has been made possible by the in-vacuum setup and the long-wavelength optimised experimental setup at the I23 beamline at Diamond Light Source. In these early commissioning experiments only standard data collection and processing procedures have been applied, in particular no dedicated absorption correction has been used. Nevertheless the success of the experiment demonstrates that the capability to extract phase information can be even further improved once data collection protocols and data processing have been optimised.