Perianal basal cell carcinoma treated with Mohs micrographic surgery

Perianal basal cell carcinoma (BCC) is a rare lesion that accounts for less than 0.08% of all BCCs. It is challenging to diagnose, as it can be overlooked or mistaken for an inflammatory dermatosis. When discovered early and treated properly, BCC is associated with low mortality and a good prognosis. Thorough total-body skin examinations and biopsy of suspected lesions found in the perianal region is recommended. We present a case of a superficial nodular perianal BCC that was discovered following a routine total-body skin examination and was treated with Mohs micrographic surgery (MMS). Patient nonattendance is also discussed.

Boundary spanning at the science-policy interface: the practitioners' perspectives

Cultivating a more dynamic relationship between science and policy is essential for responding to complex social challenges such as sustainability. One approach to doing so is to "span the boundaries" between science and decision making and create a more comprehensive and inclusive knowledge exchange process. The exact definition and role of boundary spanning, however, can be nebulous. Indeed, boundary spanning often gets conflated and confused with other approaches to connecting science and policy, such as science communication, applied science, and advocacy, which can hinder progress in the field of boundary spanning. To help overcome this, in this perspective, we present the outcomes from a recent workshop of boundary-spanning practitioners gathered to (1) articulate a definition of what it means to work at this interface ("boundary spanning") and the types of activities it encompasses; (2) present a value proposition of these efforts to build better relationships between science and policy; and (3) identify opportunities to more effectively mainstream boundary-spanning activities. Drawing on our collective experiences, we suggest that boundary spanning has the potential to increase the efficiency by which useful research is produced, foster the capacity to absorb new evidence and perspectives into sustainability decision-making, enhance research relevance for societal challenges, and open new policy windows. We provide examples from our work that illustrate this potential. By offering these propositions for the value of boundary spanning, we hope to encourage a more robust discussion of how to achieve evidence-informed decision-making for sustainability.

Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm

Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.

Abstract P5-04-03: Aggressiveness of epithelial cancers is independent of epithelial-to-mesenchymal transition

Background: Epithelial-to-Mesenchymal Transition (EMT)is postulated to be an important step in cancer progression and controlled by multiple mechanisms including EMT transcription factors (EMT-TFs) and splicing factors such as Epithelial Splicing Regulatory Proteins (ESRP1 and ESRP2). We previously have shown that the expression of ESRP1 and ESRP2 have significantly elevated in cases with high Oncotype DX scores and in ERα-positive cells with acquired endocrine resistance (SABCS 2013). This study seeks to identify the role of EMT-TFs and ESRP1s in the determination of outcomes of patients with ER+ breast cancer.

Patients and Methods: The expression of EMT-TFs and ESRP1 was analyzed in the Affymetrix microarray and TCGA BRCA databases. Next, we generated genetically engineered knockdown models of ESRP1 to understand its functional role in endocrine resistance. We performed RNA-seq and MATS analysis to identify alternative splicing events (ASEs) between ESRP1 knockdown and control cell lines [(2C3 vs 2-control (LCC2 set) and 9C2 vs 9-control(LCC9 set)]. Validation of the ASEs was performed using a probe-based platform [Human Transcriptome Array 2.0 (HTA)] and TCGA SpliceSeq from breast tumors.

Results: High levels of ESRP1 mRNA, but not EMT-TFs, are associated with poor prognosis in human ER+ breast tumors (Affymetrix; P=2.8e-07 and TCGA; P=0.00011). Knockdown of ESRP1 in ER+ endocrine resistant breast cancer induced glandular differentiation, rather than mesenchymal features. This was associated with significant reduction in cell and tumor growth in mammary fat pad orthotopic xenograft mice models of LCC2 and LCC9. No alterations in EMT-TFs were observed in these cells. Transcriptome profiling of ESRP1 knockdown cells further revealed altered ASEs in EMT splicing gene signature, but not at the gene level. These alterations (SE-skipped exon) were further validated for ARHGEF11, ENAH, FNIP1, SCRIB, and SLK using probe based HTA platform for ESRP1 knockdown cells and TCGA-SpliceSeq ER+ BRCA tumors in ER+ ESRP1low versus ESRP1high breast tumors.

Conclusions: Our data demonstrates for the first time that high ESRP1 is associated with poor prognosis in ER+ breast cancer. Despite its involvement in regulation of EMT splicing signature, low levels (or knockdown) of ESRP1 were not associated with EMT phenotype in tumors or in endocrine-resistant ER+ cells. Taken together, our findings indicate that EMT is not important in determining prognosis in ER+ breast cancer and that ESRP1 exerts a different role in aggressive ER+ breast cancers.

Citation Format: Badve SS, Neelamraju Y, Goswami CP, Gu X, Nallamothu G, Gu Y, Vieth E, Janga SC, Ryan M, Gokmen-Polar Y. Aggressiveness of epithelial cancers is independent of epithelial-to-mesenchymal transition [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 P5-04-03.

The Integrated Genomic Landscape of Thymic Epithelial Tumors

Thymic epithelial tumors (TETs) are one of the rarest adult malignancies. Among TETs, thymoma is the most predominant, characterized by a unique association with autoimmune diseases, followed by thymic carcinoma, which is less common but more clinically aggressive. Using multi-platform omics analyses on 117 TETs, we define four subtypes of these tumors defined by genomic hallmarks and an association with survival and World Health Organization histological subtype. We further demonstrate a marked prevalence of a thymoma-specific mutated oncogene, GTF2I, and explore its biological effects on multi-platform analysis. We further observe enrichment of mutations in HRAS, NRAS, and TP53. Last, we identify a molecular link between thymoma and the autoimmune disease myasthenia gravis, characterized by tumoral overexpression of muscle autoantigens, and increased aneuploidy.

Alginate Encapsulation to Enhance Biopreservation Scope and Success: A Multidisciplinary Review of Current Ideas and Applications in Cryopreservation and Non-Freezing Storage

BACKGROUND

The development of encapsulation technologies has played an important role in improving cryopreservation outcomes for many cell and tissue types over the past 20 years. Alginate encapsulation cryopreservation (AECryo) has been incorporated into a range of applications in biotechnology, species conservation and clinical therapies, using cells from many different phyla, including higher plants, animal and human cells. This review describes the background to the origins of AECryo, the development of AECryo in higher plant tissues, broadening to current applications in algal conservation, the roles for AECryo in preserving phytodiversity, fungal species and in animal and human cells.

OBJECTIVE

The main aims are to provide information resources on AECryo in different areas of biology and to stimulate new ideas for wider applications and future improvement. The translation of this useful biopreservation strategy into new opportunities for cell cryopreservation and storage at non-freezing temperatures are also discussed.

Awareness of Medical Fitness to Drive Guidelines among Occupational Physicians and Psychiatrists

Irrespective of national guidelines for medical fitness to drive, this study investigated the cumulative expert wisdom of clinicians regarding minimum periods of driving cessation required for patients suffering from conditions that can impair driver capability. Occupational Physicians (196) and Psychiatrists (103) completed an online questionnaire. For private motorists, the modal response for anxiety and depression favoured clinical discretion, followed by three month cessations for hypomania, acute psychosis, schizophrenia and alcohol dependence and six weeks for alcohol misuse/dependence. For professional drivers the modal value for anxiety and depression was three months, rising to six months for hypomania, psychosis and schizophrenia and 12 months for both alcohol misuse/dependence. Chi-square test results indicated statistically significant differences in clinical opinion between Occupational Physicians and Psychiatrists regarding driving cessation times for drivers suffering from psychiatric and alcohol misuse conditions except for alcohol dependence. Further studies are warranted to investigate these issues in more depth.

Impact of viral hepatitis aetiology on survival outcomes in hepatocellular carcinoma: A large multicentre cohort study

While HBV and HCV are risk factors for HCC, uncertainty exists as to whether these viral infections have prognostic significance in HCC. Thus, we compared the overall survival of patients with HBV, HCV and nonviral HCC, and evaluated whether the presence of HBV and HCV predicts patient outcomes. We conducted a multicentre study of HCC cases diagnosed at six Melbourne tertiary hospitals between Jan 2000-Dec 2014. Patient demographics, liver disease and tumour characteristics and patient outcomes were obtained from hospital databases, computer records and the Victorian Death Registry. Survival outcomes were compared between HBV, HCV and nonviral hepatitis cases and predictors of survival determined using Cox proportional hazards regression. There were 1436 new HCC cases identified including 776 due to viral hepatitis (HBV 235, HCV 511, HBV-HCV 30) and 660 from nonviral causes. The median survival of HBV, HCV and nonviral HCC patients was 59.1, 28.4 and 20.9 months, respectively (P<.0001). On multivariate analysis, independent risk factors for survival included HCC aetiology, gender, BCLC stage, serum AFP, total number and size of lesions, and serum creatinine and albumin. After adjusting for these and method of detection, HBV remained an independent predictor of improved overall survival when compared to both nonviral (HR 0.60%, 95% CI 0.35-0.98; P=.03) and HCV-related HCC (HR 0.51%, 95% CI 0.30-0.85; P=.01). In this large multicentre study, HBV is independently associated with improved overall survival compared with HCV and nonviral-related HCC. Further studies are needed to determine the underlying factor(s) responsible.

Revealing the Determinants of Widespread Alternative Splicing Perturbation in Cancer

It is increasingly appreciated that alternative splicing plays a key role in generating functional specificity and diversity in cancer. However, the mechanisms by which cancer mutations perturb splicing remain unknown. Here, we developed a network-based strategy, DrAS-Net, to investigate more than 2.5 million variants across cancer types and link somatic mutations with cancer-specific splicing events. We identified more than 40,000 driver variant candidates and their 80,000 putative splicing targets deregulated in 33 cancer types and inferred their functional impact. Strikingly, tumors with splicing perturbations show reduced expression of immune system-related genes and increased expression of cell proliferation markers. Tumors harboring different mutations in the same gene often exhibit distinct splicing perturbations. Further stratification of 10,000 patients based on their mutation-splicing relationships identifies subtypes with distinct clinical features, including survival rates. Our work reveals how single-nucleotide changes can alter the repertoires of splicing isoforms, providing insights into oncogenic mechanisms for precision medicine.

Functional Return to Play after Surgical Treatment of Lower-Extremity Injuries using Global Positioning System Profiles in Elite College Football Players

Category:

Sports

Introduction/Purpose:

Return to sport criteria after surgical treatment of lower extremity injuries are highly variable and without consensus. Thigh measurements assessing atrophy, single-leg hop testing and isokinetic strength measurements are commonly used metrics when considering return to sport after surgical treatment of lower-extremity injuries. Yet, these modalities are limited in scope, as they do not fully or accurately evaluate functional movements required in elite athletics. Alternatively, using new Global Positioning System (GPS) technology, a wide breadth of functional movements can be tracked for each athlete, which can be used as a comparative self-control in the event of an injury. This data proposes a more comprehensive, dynamic and longitudinal comparison of athlete performance, which may more accurately reflect functional return to sport in elite athletes after surgery.

Methods:

Over a three-year period, GPS data was collected on thirteen elite American College Football players at a single FBS Subdivision University. A total of 300 data points per athlete were collected for every practice, scrimmage and game starting in spring prep and extending through regular season, and post-season play. A total of 5.7 million data points including total distance traveled, average and maximum velocity, acceleration profiles, and explosive change of direction through inertial movement analysis were prospectively collected and analyzed. Individual pre-injury GPS functional profiles for each of the thirteen athletes were used as baseline, healthy comparisons, and functional recovery was determined prospectively during return to play progression after lower extremity surgery. Return to sport was allowed when post-operative GPS profiles demonstrated equivalence or superiority of all parameters compared to pre-injury measurements.

Results:

All thirteen players returned to sport after all measured parameters were equal to or greater than pre-injury levels.

Conclusion:

Modern GPS technology employed during preseason, regular season and post-season establishes an individualized, baseline, profile of lower-extremity function which allows for postoperative comparison and prospective assessment of safe return to play in elite football players.

Economic evaluation of chronic disease self-management for people with diabetes: a systematic review

AIMS

To systematically review the evidence on the costs and cost-effectiveness of self-management support interventions for people with diabetes.

BACKGROUND

Self-management support is the provision of education and supportive interventions to increase patients' skills and confidence in managing their health problems, potentially leading to improvements in HbA_1c levels in people with diabetes.

METHODS

Randomized controlled trials, observational studies or economic modelling studies were eligible for inclusion in the review. The target population was adults with diabetes. Interventions had to have a substantial component of self-management support and be compared with routine care. Study quality was evaluated using the Consensus on Health Economic Criteria and International Society of Pharmacoeconomic Outcomes Research questionnaires. A narrative review approach was used.

RESULTS

A total of 16 costing and 21 cost-effectiveness studies of a range of self-management support interventions were identified. There was reasonably consistent evidence across 22 studies evaluating education self-management support programmes suggesting these interventions are cost-effective or superior to usual care. Telemedicine-type interventions were more expensive than usual care and potentially not cost-effective. There was insufficient evidence regarding the other types of self-management interventions, including pharmacist-led and behavioural interventions. The identified studies were predominantly of poor quality, with outcomes based on short-term follow-up data and study designs at high risk of bias.

CONCLUSIONS

Self-management support education programmes may be cost-effective. There was limited evidence regarding other formats of self-management support interventions. The poor quality of many of the studies undermines the evidence base regarding the economic efficiency of self-management support interventions for people with diabetes.