Abstract P6-14-03: Metastatic breast cancer alliance's patient education and access to trials: Perceptions and actions

Background

Those living with metastatic breast cancer (MBC) have distinct and shifting concerns in regard to education and decision making in considering clinical trials as a treatment option. Clinical trials designs, are becoming increasingly complex, and many patients have concerns for biomarker requirements Aims/Research Questions

· What is the status of MBCA advocacy members' and partners' digital information, education and access to metastatic breast cancer trials?

· What plans do MBCA members/partners have for the next 6-18 months to educate and inform their constituents for the 2018 rollout of BreastCancerTrials.org's (BCT)Metastatic Trial Search (MTS) and Metastatic Trial Talk (MTT) and other trial matching systems?

· What are the top 5 barriers regarding trial enrollment?

· What are best practices for MBC trial education?

Research Methodology and Design

A comprehensive analysis was conducted comprising both secondary and primary research to inform these specific aims. Secondary research was conducted using previous capture of MBCA online digital resources and strengthened to include additional research on MBCA members and partners online resources including pages specifically devoted to clinical trials and metastatic clinical trials.

Mixed methods approaches include:

1) An assessment of MBCA members' and partners' digital media presence regarding MBC trials using a standardized form and rating system, and an analysis of MBCA members 2017 use of MTS using BCT secondary data;

2) Structured, recorded interviews with selected MBCA members/ partners, sharing the results of the assessments and querying them regarding their future plans and perceived barriers; and

3) Mixed methods analyses of the interview recordings using DeDoose to assess and articulate key trends and perceptions.

Statistical Methods

Simple frequency percentages and means were used in the assessment rankings of the MBCA members. DeDoose was used to provide mixed method analyses of the MBCA member and partner interviews. Results

Analysis of the MBCA members and partners websites and digital media showed that, increasingly, both groups use the full variety of digital media to educate their constituents regarding MBC clinical trials. The 13 MBCA advocacy members providing online access to BreastCancerTrials' MTS in 2017 provided 97% of the traffic to the MTS trial matching service. System types accessing the MTS widget were 57.3% desktops, 28.6% mobile devices and 14% tablets. Table 1 shows assessment totals of 5 categories of the 13 MBCA advocacy group members' websites using MTS as compared to the 19 MBCA members not using the widget. Table 2 shows the 2017 usage of BCT's MTS with 97% of the page views coming from MBCA members.

Table 1.Assessment Ratings of MBCA Advocacy Partners on Metastatic Trial Education/AccessAwareness of Trials (e.g. explains trial Phases)Knowledge SharingInterest in Metastatic Breast CancerAction Potential for clinical trial access or enrollmentTotal (0-100)13 MBCA Advocate Members with MTS widget22.1523.0024.3124.1593.6219 MBCA Members without MTS widget13.2113.9513.5311.9552.16

Table 2.2017 Use Of Metastatic Trial SearchBCT's Metastatic Trial Search (MTS) Results2017Annual Page views33,360Unique Sessions14,295Show Trials8,100Show Trials by month675Average Time on Site (minutes)3:34Total Engagement Events5,006

Citation Format: Vollmer Dahlke DJ, Smith ML, Han G, Ory MG, Cohen E. Metastatic breast cancer alliance's patient education and access to trials: Perceptions and actions [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 P6-14-03.

Queenless honey bees build infrastructure for direct reproduction until their new queen proves her worth

The terminal investment hypothesis predicts that individuals will alter their reproductive investments based on reproductive prospects. This hypothesis, however, has never been tested at the colony-level, where reproductive prospects for thousands of individuals can change instantly with the death of a single individual: the queen. A honey bee queen's death also changes the reproductive mechanism; if the queen is not replaced, then workers reproduce directly, by producing males in reproductive comb-drone comb-before the colony dies. To test how workers respond to reproductive uncertainty, I made colonies queenless and measured comb building throughout the stages of rearing a replacement queen. Queenless workers built only drone comb throughout queen rearing, even when the colony possessed a virgin or mated queen. Only when the new queen started laying fertilized eggs did workers stop building drone comb. Despite queenless colonies being more likely to eventually rear a replacement queen (88%), than to fail (12%), workers still built drone comb for direct reproduction, even when the colony was provided with ample drone comb. Therefore, workers "pessimistically" invest in drone comb to prepare for direct reproduction, even while rearing a replacement queen to prevent that outcome. When faced with reproductive uncertainty, honey bees may "hope" for the best, but they prepare for the worst.

Thalamocortical Connections and Executive Function in Pediatric Temporal and Frontal Lobe Epilepsy

BACKGROUND AND PURPOSE

Largely accepted in the literature is the role the interconnections between the thalamus and cortex play in generalized epilepsy. However, thalamocortical involvement is less understood in focal epilepsy in terms of the effect of seizures on thalamocortical circuitry in the developing brain and subsequent cognitive outcome. We investigated thalamocortical pathway microstructure in pediatric frontal lobe epilepsy and temporal lobe epilepsy and examined the associations between pathway microstructure and measures of executive function.

MATERIALS AND METHODS

We examined thalamocortical connections in 24 children with frontal lobe epilepsy, 17 patients with temporal lobe epilepsy, and 25 healthy children using DTI. We investigated several executive function measures in patients and controls, which were distilled into latent executive function components to compare among groups, and the associations between measures of thalamocortical microstructure and executive function.

RESULTS

We found no differences in thalamocortical pathway microstructure between the groups, but aspects of executive function (mental flexibility/inhibition/shifting) were impaired in the frontal lobe epilepsy group compared with controls. In patients with frontal lobe epilepsy, younger age at seizure onset and a greater number of antiepileptic drugs were associated with DTI indices indicative of damaged/less developed thalamocortical pathways. In patients with temporal lobe epilepsy, poorer performance on all measures of executive function was associated with DTI indices reflective of damaged/less developed pathways.

CONCLUSIONS

Our results give insight into vulnerable neural networks in pediatric focal epilepsy and suggest thalamocortical pathway damage as a potential mechanism of executive function impairment in temporal lobe epilepsy but not frontal lobe epilepsy. Identifying structure-function relations can help inform how we measure functional and cognitive/behavioral outcomes in these populations.

Dependence of Tensional Homeostasis on Cell Type and on Cell-Cell Interactions

INTRODUCTION

The ability to maintain a homeostatic level of cell tension is essential for many physiological processes. Our group has recently reported that multicellularity is required for tensional homeostasis in endothelial cells. However, other studies have shown that isolated fibroblasts also maintain constant tension over short time scales without the need of cell-cell contacts. Therefore, in this study, our aim was to determine how different cell types regulate tension as isolated cells or in small clustered groupings and to investigate the role of cell-cell adhesion molecules, such as E-cadherin, in this system.

METHODS

Micropattern traction force microscopy was used to determine how bovine aortic endothelial cells, bovine vascular smooth muscle cells, mouse embryonic fibroblasts, and human gastric adenocarcinoma cells, with or without cell-cell interactions due to E-cadherin, maintain tensional homeostasis over time. Tension temporal fluctuations in single cells and cell clusters were evaluated.

RESULTS

We found that only endothelial cells require clustering for tensional homeostasis. The same was not verified in fibroblasts or vascular smooth muscle cells. Of relevance, in adenocarcinoma cells, we verified that tensional homeostasis was dependent on the competence of the adhesion molecule E-cadherin at both the single cells and multicellular levels.

CONCLUSION

These findings indicate that cell-cell contacts may be critical for tensional homeostasis and, potentially, for barrier function of the endothelium. Furthermore, the cell-cell adhesion molecule E-cadherin is an important regulator of tensional homeostasis, even in the absence of cadherin engagement with neighboring cells, which demonstrates its relevance not only as a structural molecule but also as a signaling moiety.

Automated monitoring of dairy cow body condition, mobility and weight using a single 3D video capture device

Here we propose a low-cost automated system for the unobtrusive and continuous welfare monitoring of dairy cattle on the farm. We argue that effective and regular monitoring of multiple condition traits is not currently practicable and go on to propose 3D imaging technology able to acquire differing forms of related animal condition data (body condition, lameness and weight), concurrently using a single device. Results obtained under farm conditions in continuous operation are shown to be comparable or better than manual scoring of the herd. We also consider inherent limitations of using scoring and argue that sensitivity to relative change over successive observations offers greater benefit than the use of what may be considered abstract and arbitrary scoring systems.

The cues of colony size: how honey bees sense that their colony is large enough to begin to invest in reproduction

As organisms develop, they first invest resources in survival and growth, but after reaching a certain condition they start to also invest in reproduction. Likewise, superorganisms, such as honey bee colonies, first invest in survival and growth, and later commit resources to reproduction once the number of workers in the colony surpasses a reproductive threshold. The first form of reproductive investment for a honey bee colony is the building of beeswax comb made of special large cells used for rearing males (drones). How do the workers sense that their colony is large enough to start building this 'drone comb'? To address this question, we experimentally increased three possible cues of colony size - worker density, volatile pheromone concentration and nest temperature - and looked for effects on the bees' comb construction. Only the colonies that experienced increased worker density were stimulated to build a higher proportion of drone comb. We then monitored and quantified potential cues in small and large colonies, to determine which cues change with colony size. We found that workers in large colonies, relative to small ones, have increased contact rates, spend more time active and experience less variable worker density. Whereas unicellular and multicellular organisms use mainly chemical cues to sense their sizes, our results suggest that at least one superorganism, a honey bee colony, uses physical cues to sense its size and thus its developmental state.

Development of the Australian Standard for Germanium-68 by two Liquid Scintillation Counting methods

In response to the increasing application of ⁶⁸Ge/⁶⁸Ga and ⁶⁸Ga in nuclear medicine, an international comparison of activity measurement of ⁶⁸Ge in equilibrium with ⁶⁸Ga was organised. ANSTO standardised the comparison solution by the 4π(LS)β⁺-γ coincidence extrapolation and TDCR efficiency calculation methods, with excellent agreement between the two results. The primary standard was transferred to the ANSTO Secondary Standard Ionisation Chamber. Internationally traceable Australian Certified Reference Materials (ACRMs) of ⁶⁸Ge/⁶⁸Ga can now be prepared in various measurement geometries applied in nuclear medicine.

Effect of Travel Speed on Dispersion of Aqualuer 20-20 Sprayed by a Truck-Mounted Ultra-Low-Volume Sprayer Against Caged Aedes aegypti1

The effect of travel speed of a truck-mounted ultra-low-volume (ULV) sprayer on its application efficacy was studied at St. Johns County Fairground, Elkton, FL, during summer 2015. The efficacy was assessed by spray deposition, droplet size spectrum, and 24-h mortality of caged adult Aedes aegypti, using 2 rows of sampling locations, 15 m apart and spread up to 122 m from the spray. Each location had a bioassay cage and an impinger droplet sampler, 1 m apart from each other, at 1.5 m off the ground. Aqualuer^® 20-20 (20.6% permethrin AI and 20% piperonyl butoxide) was applied at the maximum label rate, travelling at 8, 16, and 32 km/h. Three replications were completed on 3 days at least a week apart, with 1 replication of each travel speed per day. On each application day the travel speeds were rotated. Overall, a travel speed of 32 km/h achieved the highest efficacy of Aqualuer^® 20-20, followed by 16 km/h, and then 8 km/h, in an open field. In general, droplet size, deposition, and mosquito mortality increased with increasing travel speed. The increased travel speed will also enhance the work rate of a sprayer and operator, thus reducing the cost of ULV applications.

Abstract P5-17-04: Changing the DCIS conversation: Development of an alternative discourse by patient stakeholders in the COMET study

The conversation about ductal carcinoma in situ (DCIS) is structured and influenced by traditional oncology values and beliefs, resulting in current standards of guideline concordant care (GCC). It is now widely known that DCIS is a heterogeneous condition requiring a tailored treatment approach based on characteristics of the specific lesion. Further, “low-risk” DCIS—defined as low grade, hormone-receptor positive condition—may be a subset with lower likelihood of progression to invasive breast cancer. Yet, most women diagnosed with any type of DCIS are encouraged to undergo the same immediate, aggressive treatments that women diagnosed with invasive breast cancer receive. Emerging evidence suggests that surgery may not increase overall survival compared to no surgery in many women diagnosed with low-risk DCIS.

The COMET (Comparison of Operative to Monitoring and Endocrine Therapy) study is a new randomized, prospective clinical trial funded by the Patient-Centered Outcomes Research Institute that aims to determine whether active surveillance is a safe and reasonable alternative to GCC for patients with low-risk DCIS. COMET also seeks to change the way patients, providers, and other key stakeholders view DCIS management options. Thus, COMET governance integrates patient collaborators into every aspect of planning and development via a Patient Leadership Team (PLT) and an independent external multi-stakeholder advisory board (SAB). The PLT is a fully integrated, yet autonomous part of the COMET study governance and is comprised of 4 patient advocates who meet independently and with COMET Principal Investigators (PIs). The SAB is a fully external and independent body of clinicians, content experts, payers, patients and patient advocates, and policymaker advisors.

To facilitate the cultural shift, the PLT developed communication materials with language and terminology that aims to communicate a diagnosis of DCIS without increasing unnecessary fear and anxiety that often accompanies a diagnosis of invasive cancer. In collaboration with study team PI's and the SAB, PLT also has developed content for a newly established website (www.DCISoptions.org), which includes patient-centered materials that aim to help newly diagnosed patients understand that a majority of DCIS is low-risk and that they have time to make informed decisions about their care.

The PLT contends that managing DCIS is as much a cultural phenomenon as a scientific one. As such, changing the conversation about DCIS between medical providers and patients is essential for generating a cultural shift in understanding the condition, correcting risk perception, and enabling improvement in patient experience. The novel approach of a stand-alone PLT that is also integrated throughout the trial's stakeholder structure ensures patient-centered involvement across all aspects of the study. The unique talents of each stakeholder group are leveraged in a unified effort to educate the DCIS community about low-risk DCIS, with the overarching goal of enabling a patient to choose the treatment approach that best reflects her risk profile and personal preferences, thus minimizing potential physical, emotional, and financial harms.

Citation Format: Frank ES, Basila D, Collyar D, Pinto D, Smith ML, Geirisch J, Lynch T, Hwang S. Changing the DCIS conversation: Development of an alternative discourse by patient stakeholders in the COMET study [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 P5-17-04.

Effect of Nozzle Orientation on Dispersion of Aqualuer 20-20 Sprayed by a Truck-Mounted Ultra-Low Volume Sprayer Against Caged Aedes aegypti

Inconsistencies in efficacy of ultra-low volume (ULV) ground applications in the literature are linked to the lack of adjustments in sprayer parameters. To investigate the effect of nozzle orientation of a truck-mounted ULV sprayer on application efficacy, a study was conducted at St. Johns County Fairground, Elkton, FL, during the summer of 2014. The efficacy was assessed by mortality of caged adult Aedes aegypti, spray deposition, and droplet size spectrum up to 122 m from the spray line. Aqualuer 20-20 (20.6% permethrin active ingredient [AI] and 20% piperonyl butoxide [PBO]) was applied at the maximum label rate with the nozzle pointed 45° upward, horizontal (0°), or 30° downward. Mortality was recorded after 24 h, deposition was determined with fluorometry, and droplets were measured with DropVision. Overall, horizontal nozzle angle spraying Aqualuer 20-20 achieved the highest efficacy followed by a 30° downward angle, while a 45° angle showed the least efficacy in open field tests. The mortality data showed complete mortality from a 0° nozzle up to 122 m from the spray line except for 1 location at 122 m in 1 replication. The mortality from a 30° downward orientation was lower beyond 30 m from the spray line, while the mortality from a 45° upward orientation was low close to the spray line and beyond 30 m. Horizontal orientation had higher deposition than other orientations, but the differences were not significant. There was also no significant difference in droplet spectrum from all orientations.

Thoracic juxtafacet cyst (JFC): a cause of spinal myelopathy

Spinal cord compression due to synovial facet cyst in thoracolumbar spine is rare. Several etiologies of juxtafacet cysts (JFCs) in this location have been discussed, particularly overload of the arthritic facet joints. Due to the narrow caliber of the thoracic spine, JFC in this location can present with radicular pain or progressive myelopathy. We report an interesting case of a 67 year-old woman who presented with the signs and symptoms of thoracic myelopathy. A left-sided T11/12 JFC was identified on MRI and CT scans correlating with her myelopathy. She experienced a substantial improvement in her myelopathic symptoms after surgical excision of the JFC. The presentation, etiology, and therapeutic aspects of JFC are discussed in detail.

Factors associated with sickness absence among employees with chronic conditions

Background

The growing prevalence of chronic conditions in the ageing workforce has been shown to have a negative impact in terms of optimal work performance and quality of life. It is therefore important to understand the factors associated with sickness absence due to health problems.

Aims

To examine the socio-demographics, health status indicators, barriers to self-care and social support associated with working adults missing work because of chronic conditions.

Methods

We analysed data from working adults in the USA with one or more chronic conditions who completed the National Council on Aging (NCOA) Chronic Care Survey. Analyses were performed using SPSS version 22; independent sample t-tests and chi-squared tests were used to compare sample characteristics and logistic regression was used to assess factors associated with missed work as a dichotomous outcome variable.

Results

Among the 250 study subjects, employees who reported poorer general health status [odd ratio (OR) = 1.62, P < 0.05], more physician visits (OR = 1.45, P < 0.01), not having enough money for their health (OR = 3.69, P < 0.01) and a higher reliance on their co-workers (OR = 1.71, P < 0.05) were significantly more likely to report sickness absence due to their chronic conditions.

Conclusions

To reduce absences among employees with chronic conditions, employers need to understand the importance of factors such as employee income, resources and knowledge of disease self-care. US employers should explore opportunities for employees to offset health care costs, apply appropriate time-flexible work policies and encourage employees' participation in health knowledge enhancing interventions.

Rapid-eye-movement sleep-predominant central sleep apnea relieved by positive airway pressure: a case report

Central Sleep Apnea (CSA) is characterized by intermittent apneas and hypopneas during sleep that result from absent central respiratory drive. CSA occurs almost exclusively during non‐rapid‐eye‐movement (NREM) sleep due to enhanced neuronal ventilatory drive during REM sleep that makes central apneas highly unlikely to form. A 45‐year‐old obese African American female presented with co‐existing Obstructive Sleep Apnea (OSA) and CSA, not in the form of mixed or complex sleep apnea. Peculiarly, her CSA occurred only during rapid‐eye‐movement (REM) sleep, which is exceedingly rare. The patient's CSA was resolved when appropriate positive airway pressure (PAP) was prescribed. Our patient remains stable and has reported significant benefit from PAP usage. We offer possible neuro‐physiological mechanisms herein, including enhanced loop gain and/or malfunction or malformation of the pre‐Botzinger nucleus or other neurological process, that could explain the unique findings of this case.

Losartan reduces the immediate and sustained increases in muscle sympathetic nerve activity after hyperacute intermittent hypoxia

Obstructive sleep apnea (OSA) is characterized by intermittent hypoxemia, which produces elevations in sympathetic nerve activity (SNA) and associated hypertension in experimental models that persist beyond the initial exposure. We tested the hypotheses that angiotensin receptor blockade in humans using losartan attenuates the immediate and immediately persistent increases in 1) SNA discharge and 2) mean arterial pressure (MAP) after hyperacute intermittent hypoxia training (IHT) using a randomized, placebo-controlled, repeated-measures experimental design. We measured ECG and photoplethysmographic arterial pressure in nine healthy human subjects, while muscle SNA (MSNA) was recorded in seven subjects using microneurography. Subjects were exposed to a series of hypoxic apneas in which they inhaled two to three breaths of nitrogen, followed by a 20-s apnea and 40 s of room air breathing every minute for 20 min. Hyperacute IHT produced substantial and persistent elevations in MSNA burst frequency (baseline: 15.3 ± 1.8, IHT: 24 ± 1.5, post-IHT 20.0 ± 1.3 bursts/min, all P < 0.01) and MAP (baseline: 89.2 ± 3.3, IHT: 92.62 ± 3.1, post-IHT: 93.83 ± 3.1 mmHg, all P < 0.02). Losartan attenuated the immediate and sustained increases in MSNA (baseline: 17.3 ± 2.5, IHT: 18.6 ± 2.2, post-IHT 20.0 ± 1.3 bursts/min, all P < 0.001) and MAP (baseline: 81.9 ± 2.6, IHT: 81.1 ± 2.8, post-IHT: 81.3 ± 3.0 mmHg, all P > 0.70). This investigation confirms the role of angiotensin II type 1a receptors in the immediate and persistent sympathoexcitatory and pressor responses to IHT.

NEW & NOTEWORTHY This study demonstrates for the first time in humans that losartan, an angiotensin receptor blocker (ARB), abrogates the acute and immediately persistent increases in muscle sympathetic nerve activity and arterial pressure in response to acute intermittent hypoxia. This investigation, along with others, provides important beginning translational evidence for using ARBs in treatment of the intermittent hypoxia observed in obstructive sleep apnea patients.

Comparison of Two New Traps To the Biogents BG-Sentinel Trap For Collecting Aedes albopictus In North Florida

Multiple surveillance traps are currently available for adult mosquito surveillance. In this study, 2 new types, the Maxttrac™ Uno and Maxttrac™ Breeze mosquito traps, were compared against the BioGents™-Sentinel trap (BGS) for overall success in collecting Aedes albopictus in a 1,027-m² vehicle enclosure and in the field. The enclosure test results showed both traps collected significantly fewer Ae. albopictus, compared to the BGS trap. The modification of using all BG lures for each trap did not increase the number of mosquitoes collected in the 2 new traps, when compared to collection with the original lures tested in the vehicle enclosure. Field test results showed that BGS trap collected higher numbers of Ae. albopictus than the 2 new traps, regardless of switching lure or not. Overall, the BGS trap was the most effective trap and the 2 new traps could be used as additional tools for the collection of Ae. albopictus.

Modeling tensional homeostasis in multicellular clusters

Homeostasis of mechanical stress in cells, or tensional homeostasis, is essential for normal physiological function of tissues and organs and is protective against disease progression, including atherosclerosis and cancer. Recent experimental studies have shown that isolated cells are not capable of maintaining tensional homeostasis, whereas multicellular clusters are, with stability increasing with the size of the clusters. Here, we proposed simple mathematical models to interpret experimental results and to obtain insight into factors that determine homeostasis. Multicellular clusters were modeled as one-dimensional arrays of linearly elastic blocks that were either jointed or disjointed. Fluctuating forces that mimicked experimentally measured cell-substrate tractions were obtained from Monte Carlo simulations. These forces were applied to the cluster models, and the corresponding stress field in the cluster was calculated by solving the equilibrium equation. It was found that temporal fluctuations of the cluster stress field became attenuated with increasing cluster size, indicating that the cluster approached tensional homeostasis. These results were consistent with previously reported experimental data. Furthermore, the models revealed that key determinants of tensional homeostasis in multicellular clusters included the cluster size, the distribution of traction forces, and mechanical coupling between adjacent cells. Based on these findings, we concluded that tensional homeostasis was a multicellular phenomenon. Copyright © 2016 John Wiley & Sons, Ltd.

Cortical Alpha Oscillations Predict Speech Intelligibility

Understanding speech in noise (SiN) is a complex task involving sensory encoding and cognitive resources including working memory and attention. Previous work has shown that brain oscillations, particularly alpha rhythms (8–12 Hz) play important roles in sensory processes involving working memory and attention. However, no previous study has examined brain oscillations during performance of a continuous speech perception test. The aim of this study was to measure cortical alpha during attentive listening in a commonly used SiN task (digits-in-noise, DiN) to better understand the neural processes associated with “top-down” cognitive processing in adverse listening environments. We recruited 14 normal hearing (NH) young adults. DiN speech reception threshold (SRT) was measured in an initial behavioral experiment. EEG activity was then collected: (i) while performing the DiN near SRT; and (ii) while attending to a silent, close-caption video during presentation of identical digit stimuli that the participant was instructed to ignore. Three main results were obtained: (1) during attentive (“active”) listening to the DiN, a number of distinct neural oscillations were observed (mainly alpha with some beta; 15–30 Hz). No oscillations were observed during attention to the video (“passive” listening); (2) overall, alpha event-related synchronization (ERS) of central/parietal sources were observed during active listening when data were grand averaged across all participants. In some participants, a smaller magnitude alpha event-related desynchronization (ERD), originating in temporal regions, was observed; and (3) when individual EEG trials were sorted according to correct and incorrect digit identification, the temporal alpha ERD was consistently greater on correctly identified trials. No such consistency was observed with the central/parietal alpha ERS. These data demonstrate that changes in alpha activity are specific to listening conditions. To our knowledge, this is the first report that shows almost no brain oscillatory changes during a passive task compared to an active task in any sensory modality. Temporal alpha ERD was related to correct digit identification.

Single-platelet nanomechanics measured by high-throughput cytometry

Haemostasis occurs at sites of vascular injury, where flowing blood forms a clot, a dynamic and heterogeneous fibrin-based biomaterial. Paramount in the clot's capability to stem haemorrhage are its changing mechanical properties, the major drivers of which are the contractile forces exerted by platelets against the fibrin scaffold. However, how platelets transduce microenvironmental cues to mediate contraction and alter clot mechanics is unknown. This is clinically relevant, as overly softened and stiffened clots are associated with bleeding and thrombotic disorders. Here, we report a high-throughput hydrogel-based platelet-contraction cytometer that quantifies single-platelet contraction forces in different clot microenvironments. We also show that platelets, via the Rho/ROCK pathway, synergistically couple mechanical and biochemical inputs to mediate contraction. Moreover, highly contractile platelet subpopulations present in healthy controls are conspicuously absent in a subset of patients with undiagnosed bleeding disorders, and therefore may function as a clinical diagnostic biophysical biomarker.

The role of 3D printing in preoperative planning for heart transplantation in complex congenital heart disease

BACKGROUND

The presence of a structural cardiac defect in the setting of dextrocardia is extremely rare. Graspable models allow enhanced appreciation of aberrant structures and vascular relations, particularly in rare and complex cases. This is the first case report of the use of a replica of a patients' anatomy to plan the surgical strategy in the setting of dextrocardia.

AIMS

We intend to demonstrate the benefit of three-dimensional printing to enhance preoperative planning in complex congenital heart disease undergoing heart transplantation. The anomalous structures encountered include situs inversus dextrocardia, transposition of the great vessels, a single atrium and a dilated double-outlet single right ventricle.

METHODS

Computed Tomography acquisition was performed with the use of ECG multiphase gating technology and contrast enhancement. The structures of interest were segmented and the generated 3D mesh was exported as a stereolithographic (STL) file. The model was printed on a Z-Corp 250 binder jetting printer. Post processing techniques were used to enhance model strength.

RESULTS

Pre-operative 3D visualisation of the patients' anatomy allowed for a more comprehensive surgical strategy to be planned, thus reducing the intra-operative duration and cross-clamp time which are recognised to correlate with reduced patient morbidity.

CONCLUSION

The ongoing advances in medical image procurement and 3D processing software and printing technology will continue to enhance preoperative planning and thereby improve patient care. We demonstrate the pivotal role played by such technologies in advancing spatial comprehension of complex aberrant anatomy.