843 Improving Practical Skills Training with In-Situ Trauma Simulation

Introduction

Safe and effective management of trauma patients requires numerous practical skills. Our in-situ trauma simulation identified key areas requiring increased training and exposure. This enabled improvement to education, patient safety and efficiency when managing these emergencies.

Method

We carried out a simulated trauma call according to ATLS principles, recording the time and person completing each task. Key areas for improvement were identified; most notably the application of Femoral Traction Splints (FTS). 0/7 doctors present were not able to do this. Subsequently, a formal training day was delivered, with 38 attendees across specialties, assessing confidence before and after the session.

Results

Prior to the training session, 52.6% of attendees did not have formal teaching using FTS and 65.8% had never used one. Confidence with FTS application was measured on a scale of 1 (not confident) to 5 (very confident), with an average score of 2.6/5.

After training, the average confidence score was 4.7/5 (p < 0.01). 100% of participants found the session very useful.

Conclusions

In-situ simulation allows identification of key areas for improvement in training of practical skills. Essential tailored teaching can then be delivered to increase exposure and confidence for these necessary practical skills.

0072 Preclinical Characterization of SUVN-G3031, a Histamine H3 Receptor Inverse Agonist for the Treatment of Narcolepsy

Introduction

Narcolepsy is a chronic sleep disorder characterized by overwhelming daytime drowsiness, sudden attacks of sleep and sometimes accompanied by cataplexy. Although the orexin deficiency is considered to be the primary cause of this disorder, lot of attention has been focused recently on targeting histaminergic neurotransmission by blockade of histamine H3 receptor (H3R). SUVN-G3031 is one of the potent and selective H3R inverse agonist currently being evaluated in a Phase 2 study as monotherapy for the treatment of narcolepsy with and without cataplexy (ClinicalTrials.gov Identifier: NCT04072380).

Methods

Binding of SUVN-G3031 in human and rat histamine H3R was evaluated in in vitro radioligand binding assay and functionality was assessed in GTPγS assay. Pharmacokinetic properties were evaluated after oral administration in rat and dog. Neurotransmitters like histamine, dopamine and norepinephrine were estimated in rat cortex using microdialysis.

Results

SUVN-G3031 is an inverse agonist at histamine H3R with hKi of 8.7 nM and showed minimal binding against over 70 target sites. SUVN-G3031 exhibited desired pharmacokinetic properties in rat and dog with excellent brain penetration in rats. SUVN-G3031 produced significant increase in histamine, dopamine and norepinephrine levels in cortex. SUVN-G3031 produced no change in the striatal and accumbal dopamine levels in rats, suggesting no propensity to induce abuse liability. SUVN-G3031 blocked R-α-methylhistamine induced water intake and produced dose dependent increase in tele-methylhistamine levels in various brain regions and in cerebrospinal fluid of male Wistar rats.

Conclusion

SUVN-G3031 is an inverse agonist at histamine H3 receptor and results from the preclinical studies presented here provide a strong evidence for the potential utility of SUVN-G3031 in the treatment of narcolepsy with and without cataplexy.

Support

None

Primary structure of ovine fibroblast growth factor-1 deduced by protein and cDNA analysis

The amino acid sequence of full-length ovine fibroblast growth factor-1 (FGF-1) was determined by a combination of protein and cDNA sequencing. FGF-1 cDNA analysis indicated that ovine kidney cells express mRNAs encoding both full-length FGF-1 and a truncated FGF-1 variant. An overall comparison of the ovine FGF-1 primary sequence to the eight species studied to date revealed a high degree of conservation, with ovine FGF-1 sharing 90 and 95% sequence identity with human FGF-1 and bovine FGF-1, respectively. Additionally, the FGF-1 proteins from the various species have conserved cysteine residues at positions 30 and 97 and contain acetylated amino-terminal alanine residues. Mass spectrometry analysis confirmed that the blocking group of ovine FGF-1 is also consistent with that of an acetyl-moiety. In contrast to the other FGF-1 proteins, the 154 residue primary sequence of ovine FGF-1 contains three unique amino acid differences: Arg9, Arg44, and Ile123. Ovine FGF-1, unlike human FGF-1, is a potent mitogenic factor for NIH 3T3 fibroblasts in the absence of heparin. In the presence of exogenous heparin, the mitogenic activity of ovine FGF-1 is potentiated slightly.

A novel approach to improve network validity using various soft computing techniques

Mobile Adhoc Networks (MANET) in modern research have many optimal energy conservation mechanisms that can be deployed easily and in a faster manner. The routing approaches associated with energy consumption play a dominant role in routing the data packets between the mobile sensor nodes within the range of optimization. However, major challenges associated with energy consumption in MANETs include reduced lifetime of sensor nodes, poor coverage, and throughput. Most methods tend to reduce the interference of data while traversing between the sensor nodes and increase the capacity of the network. This results in delays while transmitting the packets across the network, and this may result in failure of packets being transmitted. To resolve this issue, in this paper, we propose an ant colony optimization combined with a flower pollination algorithm for minimal energy consumption and throughput maximisation in MANETs. This hybrid meta-heuristic model resolves the issues, including delays, poor coverage, and reduced network lifetime. This hybrid model uses the estimation of neighbourhood distance among the nodes for optimal placement of nodes for effective location. The estimation of location is found using a flower pollination algorithm with a levy flight mechanism. The estimation is carried out in a hyper sphere model that helps in finding the coverage area of the sensor nodes. Depending upon the estimation of neighbourhood distance among the sensor nodes, the consumption of energy among the sensor nodes in MANETs is reduced. The simulation was conducted between the proposed hybrid approach and conventional soft computing heuristics, where the results show that the proposed model achieves a higher rate of energy conservation and reduces delay than other methods.

Abstract P1-07-15: Detection of molecular alterations in breast cancer through next generation sequencing of both tumor tissue and circulating tumor DNA: The UC San Diego Moores Cancer Center experience

Background: Next generation sequencing (NGS) analysis of actionable molecular alterations has the potential to guide cancer treatment, especially for patients with advanced cancer who have progressed on standard treatment. In this study, we analyzed tumor biopsies and peripheral blood from 62 patients with advanced breast cancer by two different NGS clinical-grade assays for molecular alterations in tumor tissue or in circulating tumor DNA (ctDNA). We used these results to determine if these specimens have potentially “actionable” alterations that could guide cancer therapy.

Methods: From 2014 to 2016, 62 patients with advanced breast cancer had plasma sent for ctDNA analysis (Guardant360 assay; 54 to 70 genes) Thirty-eight of these patients (61%) also had tumor biopsies evaluated by NGS (FoundationOne®; 182 to 315 genes). Alterations were defined as mutations, insertions, deletions, truncations, or rearrangements or amplifications/copy number variations. Patients that harbored multiple alterations in the same gene were not counted as having separate alterations; however, if a gene amplification and an alteration were found in the same gene these were counted as separate events. Variants of unknown significance (VUS) and synonymous mutations were excluded from both assays. Data were collected and analyzed according to a UCSD Institutional Review Board approved protocol.

Results: The median age of our patients at the time of ctDNA analysis was 55 years (range, 44 to 84 years); the median age at the time of tissue biopsy for NGS was 52 years (range, 39 to 82 years). One patient was male. The most common receptor status was estrogen receptor (ER) and progesterone receptor (PR) positive, human epidermal growth factor receptor 2 (HER2) non-amplified or negative (neg)(N=44; 71%), followed by triple negative breast cancer (ERnegPRnegHer2neg) (N=10, 16%), triple positive (N=6, 1%) and finally ERnegPRnegHER2positive (N=2, 0.03%). One patient of 38 (2%) had no tumor alteration detected and 19 of 62 had no ctDNA alterations (31%). In 38 breast cancer patients with tumor NGS results, alterations were detected in 79 unique genes, with the most frequent being TP53 (37% of patients), PIK3CA (24%) and GATA3 (24%) genes. In the 62 patients with ctDNA analysis, 31 unique genes had at least one alteration, with the most frequent being TP53 (36% of patients) and PIK3CA (23%) and EGFR amplification (11%) (GATA3 was not analyzed in the ctDNA assay). Both assays had a high rate of detection for potentially actionable mutations: 41 out of 62 patients (66%) by ctDNA and 34 out of 38 (89%) by tumor NGS. No two patients harbored identical genomic profiles by either tumor NGS or plasma ctDNA analysis except for 1 patient who had no alterations detected by either assay.

Conclusions: Plasma and tissue NGS analysis appear to be complementary assays that yield a high percentage of potentially actionable alterations in patients with advanced breast cancer. Studies of the clinical impact of NGS-guided therapy in breast cancer are warranted.

Citation Format: Shatsky RA, Parker BA, Schwab R, Helsten T, Boles SG, Subramanian R, Piccioni D, Kurzrock R. Detection of molecular alterations in breast cancer through next generation sequencing of both tumor tissue and circulating tumor DNA: The UC San Diego Moores Cancer Center experience [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-15.

Trauma as an etiologic factor of primary bone lymphoma: a report of 4 cases

Primary bone lymphoma (PBL) is a rare entity. Nevertheless, very high long-term complete remission and survival rates following adriamycin-based chemotherapy alone or combined with involved-field radiation therapy have been reported. While the etiology is unknown, factors comprising local or general immunocompromised states have been suggested. Sporadic cases of local trauma followed by the emergence of primary bone lymphoma have been described. We describe 4 patients who developed primary bone lymphoma following direct trauma to a specific bone area. All 4 are alive with no evidence of disease after being treated with a combined chemo-radiotherapy regimen.

Clinical profiling, treatment characteristics and outcome in Behcet's Disease (BD)-A retrospective cohort study from Karnataka Rheumatology Association (KRA)

BACKGROUND

Behcet's disease (BD) has a heterogeneous and unpredictable phenotype that differs in various geographical areas.

OBJECTIVE

To describe the clinical phenotype & outcome of Behcet's disease(BD) from Karnataka, India and compare them with large cohorts from endemic regions.

METHODS

Databases of practising rheumatologists from Karnataka were reviewed to retrieve clinical characteristics, course of illness, prescribing information and outcome at last follow-up of patients clinically diagnosed as BD. The classification criteria, namely revised International criteria for Behcet's disease (rICBD) and International study group (ISG) criteria were applied. Outcome was defined as complete or partial remission, persistent disease or relapse.

RESULTS

We included 72 patients, equal gender distribution and mean age 37.4 ± 12.8 years from 8 rheumatology centres. Commonest presentations were recurrent oral aphthosis 58(80.6%), genital ulcers 36(50%) and ocular manifestations 40(55.6%). Three-quarters [51/72(70.8%)] fulfilled rICBD criteria whereas only half [36/72(50%)] fulfilled ISG criteria. Apart from glucocorticoids [53/72(73.6%)], frequently prescribed therapies were colchicine 39(54.2%) and azathioprine 35(48.6%). Eleven-patients received biologics(anti-TNF-α) and JAK inhibitors to treat severe organ involvement. HLA-B*51 and pathergy tests were positive in 27/45(60%) and 12/34(35.3%) patients respectively. Outcomes were documented in 94.4%(68/72) patients at median follow-up of 24 (12;36) months. Majority [46/68(67.6%)] had complete remission, 17/68(25%) had partial remission, 4/68(5.9%) had persistent while 1/68(1.5%) had relapsing course.

CONCLUSION

Majority of BD patients had orogenital aphthosis and ocular manifestations and an excellent response to treatment. Key Points • In our region, Behçet's Disease primarily manifests with recurrent oral aphthae and ocular involvement, with comparatively lower incidence of severe genital ulcers and neurological involvement than in endemic regions. • Apart from glucocorticoids, colchicine and azathioprine are the most commonly used agents. Biologics and JAK inhibitors are prescribed infrequently, primarily in cases of severe organ involvement. • A significant proportion of patients achieved either complete or partial remission during follow-up, with no observed mortality suggesting a milder disease course and better outcome compared to endemic regions. • Gender, HLA-B*51 status, and pathergy response did not exert any significant influence on the clinical profile or outcome in BD patients in Karnataka.

Lymphatic dynamics of liver by hepatic lymphography using lipiodol ultra fluid

Hepatic lymphography by intra-parenchymal injection of four to ten millilitres (ml) of lipiodol ultrafluid, our modification of functional hepatography, performed on sixty one patients helped study lymphatic dynamics of liver. In conditions associated with significant hepatic venous outflow obstructions, such as hepatic cirrhosis, inflammatory diseases of liver and primary or secondary malignant lesions of the liver, this study delineated liver lymphatics and portal and para aortic lymph nodes. In one case mediastinal nodes were also delineated by flow of lipiodol from the bare area of the liver via trans-diaphragmatic and pleural lymphatic. The lymphangio-architecture of the opacified nodes depicted the nature of pathology inflicting them and the liver. Lipiodol in the lymphatic system, staying longer than the freely diffusible aqueous contrast, provided more detail and better information.