Diagnosis, management, and outcomes of immune checkpoint inhibitor induced acute interstitial nephritis: A single-center experience

BACKGROUND

Immune checkpoint inhibitor (ICI)-associated acute interstitial nephritis (AIN) is a recognized complication of immunotherapy (IO), but literature on its management and outcomes is limited.

METHODS

We retrospectively reviewed patients who received ICIs and developed biopsy-proven or clinically-suspected ICI-associated AIN at the University of Virginia Comprehensive Cancer Center from 2012-2023. We analyzed baseline characteristics and clinical outcomes, including treatment interruption and rechallenge rates. Acute kidney injury (AKI) was defined as a ≥ 1.5-fold increase in baseline creatinine under seven days, a two-fold increase above the upper limit of normal, or an increase by ≥0.3 mg/dL. Kidney function returning to within 0.3 mg/dL or less than twice baseline was considered complete (CRc) and partial (PRc) recovery, respectively.

RESULTS

We identified 12 cases of ICI-AIN: four by biopsy (33%) and eight (67%) by clinical suspicion. Two patients received anti-CTLA-4 and anti-PD1, six received anti-PD1 alone, and four received chemo-immunotherapy. The majority (58%) of patients developed AIN within the first 5 cycles. Eight patients developed ≥ Grade 3 AKI, and six developed multiple irAEs. ICI was permanently discontinued in seven patients (58%) and temporarily interrupted in four (30%). The CRc and PRc rates were 67% and 8%, respectively. Upon AIN onset, the best disease response was stable disease in five patients, partial response in three, and progressive disease in three. Median overall survival was 4.87 years, and progression-free survival was 1.5 years.

CONCLUSIONS

Rechallenge with IO after kidney irAE may be possible in some patients but requires careful evaluation on an individual basis.

Phase I Study of Entinostat, Atezolizumab, Carboplatin, and Etoposide in Previously Untreated Extensive-Stage Small Cell Lung Cancer, ETCTN 10399

BACKGROUND

CREBBP and EP300 mutations occur at a frequency of 15% and 13%, respectively, in small cell lung cancer (SCLC), and preclinical models demonstrated susceptibility to targeting with HDAC inhibitors.

METHODS

Patients with treatment-naïve extensive-stage SCLC, ECOG ≤2 were enrolled and treated with entinostat orally weekly (4 dose levels, DL) in combination with standard dose carboplatin, etoposide, and atezolizumab. Cohort allocation was determined by Bayesian optimal interval (BOIN) design targeting an MTD with a DLT rate of 20%.

RESULTS

Three patients were enrolled and treated at DL1 with entinostat 2 mg. Patients were aged 69-83; 2 male, 1 female; 2 were ECOG 1, and 1 was ECOG 0. The most common adverse events (AEs) were anemia (3), neutropenia (3), thrombocytopenia (2), leukopenia (2), and hypocalcemia (2). Two experienced DLTs during cycle 1: (1) grade (Gr) 4 febrile neutropenia, and (1) Gr 5 sepsis. BOIN design required stopping accrual to DL1, and the trial was closed to further accrual. Entinostat and atezolizumab pharmacokinetics were both comparable to historical controls.

CONCLUSION

Addition of entinostat to atezolizumab, carboplatin, and etoposide is unsafe and resulted in early onset and severe neutropenia, thrombocytopenia. Further exploration of entinostat with carboplatin, etoposide, and atezolizumab should not be explored. (ClinicalTrials.gov Identifier: NCT04631029).

Impact of Lymphopenia on Definitive Treatment of Locally Advanced Cervical Cancer

PURPOSE/OBJECTIVE(S)

Pre-treatment lymphopenia prior to initiating treatment has been correlated with reduced survival in a number of different cancers. The purpose of this study is to evaluate the association between lymphopenia and survival in women with locally advanced cervical cancer (LACC) treated with primary chemoradiation (CRT).

MATERIALS/METHODS

We retrospectively reviewed patients with LACC treated at a single institution from 2005 - 2021 with available lymphocyte information. Patient and treatment characteristics were recorded including age, tumor size and stage, EBRT dose/fractionation, and brachytherapy dosimetry data. Absolute lymphocyte counts (ALC) were collected prior to initiating CRT and at 3-month intervals following CRT and graded based on severity of lymphopenia using CTCAE v 5.0. Overall survival (OS), progression free survival (PFS), and local control (LC) were calculated from the start of treatment to date of last follow-up. Kaplan-Meier survival analysis was performed to evaluate whether lymphocyte changes were associated with OS, PFS, or LC.

RESULTS

A total of 124 patients met study inclusion criteria with stage IB - IV disease (41 stage I, 41 stage II, 36 stage III, 6 stage IV) and a median follow up of 3.6 years (range 0.2-16.5 years). The median age was 49 years (range 26-77). The median EBRT dose was 45 Gy (range: 26-57.5 Gy) and 44.2% of patients received para-aortic (PA) nodal EBRT (28.8% elective and 15.4% with positive PA nodes). 5-year OS, PFS, and LC were 60.3% (95% CI 51.5-70.7), 47.5% (95% CI 39-58), and 75.5% (95% CI 67.3-82.9), respectively. Pre-treatment lymphopenia (ALC <1000 cells/mm3) was present in 11 (9%) patients. When the total cohort was divided into patients with and without pre-treatment lymphopenia, OS was statistically improved in the patients without baseline lymphopenia, with a 5-year OS of 63.2% (95% CI 53.9-73.9) versus 35.3% (95% CI 14.5-86.3) in the lymphopenia group (p = 0.034). LC also trended to being improved in the patients without lymphopenia, though this did not reach statistical significance in our small sample size of lymphopenic patients, with 5-year LC of 76.8% (95% CI 68.4-84.3) versus 67.5% (05% CI 36.6-93.8), p = 0.45.

CONCLUSION

In this single institution experience of LACC treated with definitive CRT, we found that baseline lymphopenia is associated with inferior OS. Patients with higher pre-CRT ALC may represent a population with more robust immune systems, producing more favorable tumor responses to treatment. Additional studies are warranted to investigate the evolving role of combined EBRT and systemic therapy in LACC.

Hepatotoxicity from high-dose methotrexate in primary central nervous system lymphoma

Background

High-dose methotrexate (HDMTX) is a mainstay of primary central nervous system lymphoma (PCNSL) treatment. Transient hepatotoxicity from HDMTX has been characterized in pediatric patients but not in adults. We sought to characterize hepatotoxicity in adult PCNSL patients undergoing HDMTX treatment.

Methods

Retrospective study of 65 PCNSL patients treated at the University of Virginia from 02/01/2002 to 04/01/2020 was performed. Hepatotoxicity was defined using National Cancer Institute Common Toxicity Criteria (CTC) for adverse events, fifth version. High-grade hepatotoxicity was defined as a bilirubin or aminotransferase CTC grade of 3 or 4. Relationships between clinical factors and hepatotoxicity were assessed with logistic regression.

Results

Most patients (90.8%) had a rise of at least one aminotransferase CTC grade during HDMTX treatment. 46.2% had high-grade hepatotoxicity based on aminotransferase CTC grade. No patients developed high-grade bilirubin CTC grades during chemotherapy. Liver enzyme test values decreased to low CTC grade or normal in 93.8% of patients after the conclusion of HDMTX treatment without treatment regimen changes. Prior ALT elevation (P = .0120) was a statistically significant predictor of high-grade hepatotoxicity during treatment. Prior history of hypertension was associated with increased risk of toxic serum methotrexate levels during any cycle (P = .0036).

Conclusions

Hepatotoxicity develops in the majority of HDMTX-treated PCNSL patients. Transaminase values decreased to low or normal CTC grades in almost all patients after treatment, without modification of MTX dosage. Prior ALT elevation may predict patients' increased hepatotoxicity risk, and hypertension history may be a risk factor for delayed MTX excretion.

Prognostic significance of extra-nodal extension and positive surgical margins in HPV positive oropharyngeal squamous cell carcinoma

BACKGROUND

Whether extra-nodal extension (ENE+) and surgical margin positivity (margin+) are poor prognostic factors in HPV-associated (HPV+) oropharyngeal carcinoma (OPC) remains uncertain.

RESULTS

Our study evaluated if microscopic ENE+ and/or margin+ are associated poorer recurrence free survival (RFS) and overall survival (OS) in HPV+ OPC. Patients were classified as high risk (ENE+ and/or margin+) or low risk (ENE- and margins-). Of a total of 176 patients HPV+ OPC, 81 underwent primary surgery and dad data on ENE and margin status. There was no statistically significant difference in RFS (p = 0.35) or OS (p = 0.13) for high-risk versus low-risk groups. Ongoing smoking (p = 0.023), alcohol use (p = 0.044) and advanced stage (p = 0.019) were associated with higher risk of recurrence. Only advanced stage (p-value <0.0001) was associated poorer overall survival.

CONCLUSIONS

The presence of ENE+ and/or margin+ was not an independent predictor of poor RFS or OS in HPV+ OPC.

Abstract P2-13-01: Enrollment Trends Among Patients With Breast Central Nervous System Metastasis in Active Clinical Trials

Background: Breast cancer is the second leading cause of solid tumor brain metastasis. Up to 16% of patients with metastatic breast cancer (mBC), and 50% patients with HER2+ metastatic breast cancer will develop central nervous system (CNS) metastasis overtime. Prognosis in these patients is dismal with a median overall survival of 2-15 months. Despite advances in systemic therapy of mBC, treatment options for patients with breast cancer brain metastasis (BCBM) remain limited. Although newer approaches to treat BCBM are imminently needed, BCBM patients have traditionally been excluded from clinical trials. We aimed to examine the current state of BCBM-related enrollment in ongoing prospective systemic therapy clinical trials for mBC. Methods: We performed a systematic search of the clinicaltrials.gov website on May 1, 2022 to characterize current trends in clinical trial enrollment for BCBM patients in ongoing interventional trials using the key search term “Breast Cancer”. Trial search was further limited to “open” and “interventional studies”. Data was abstracted and verified by two independent researchers. Trials were excluded if they were specific for other disease types, did not include a systemic anticancer pharmaceutical, or excluded advanced/metastatic disease. Inclusion of active CNS disease [BCMB and leptomeningeal disease (LMD)] and exclusion of CNS disease were the co-primary end points. Covariates of interest were gender, location (US, international or both), disease site (breast cancer specific vs multi-disease trials), therapy category (immunotherapy (IO), targeted therapy, endocrine therapy, chemotherapy, or combination) and sponsor type. Logistic regression was used to model inclusion of active CNS disease. Results: A total of 1720 trials were identified, and 576 trials met the inclusion criteria. 179 (31.6%) were phase I, 129 (22.4%) were phase I/II, 196 (34.0%) were phase II, 60 (10.4%) were phase III and 9 (1.6%) were phase IV. 347 (60.4%) were breast cancer specific and 229 (39.6%) were multi-site trials. 66 (11.5%) trials were specific for HER-2+ cancer and 70 (12.1%) were triple negative breast cancer specific. 238 (41.3%) trials were US only and 290 (50.3%) were pharmaceutical industry sponsored. Overall, only 29 trials (5%) included patients with any form of BCBM and only 11 trials (1.9%) allowed patients with LMD. 12 (2.1%) trials allowed patients with treated BCBMs only. In univariate models, breast cancer only trials (OR 4.07, 95% CI 1.77-9.36, p= 0.0009), trials excluding men (OR 1.97, 95% CI 1.03-3.77, p=0.0412), non-IO therapy trials (non-IO vs IO OR 3.57, 95% CI 1.08-11.82, p=0.369), and non-pharmaceutical industry sponsored trials (OR 2.65, 95% CI 1.34-5.22, p =0.0049) were more likely to include patients with active CNS disease. Additionally, inclusion of LMD (OR 7.85, 95% CI 2.19-28.17, p = 0.0016) was a significant predictor of inclusion of active CNS disease. In a combined model, disease site remained significant (breast only vs multi-site OR 4.07, 95% CI 1.77-9.36, p = 0.0009). Conclusion: The vast majority of the ongoing breast cancer clinical trials continue to exclude patients with breast cancer brain metastasis. With an increasing prevalence of breast cancer brain metastasis, evaluating intracranial efficacy of novel therapies early on in drug development remains an area of urgent unmet need.

Citation Format: Omar Elghawy, Walter Banfield, John Wang, Bethany Horton, Varinder Kaur. Enrollment Trends Among Patients With Breast Central Nervous System Metastasis in Active Clinical Trials [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-13-01.

CLRM-11 CURRENT STATE OF CLINICAL TRIALS FOR PATIENTS WITH MELANOMA BRAIN METASTASES

INTRODUCTION

Clinical trials have traditionally excluded patients with melanoma brain metastasis (MBM), despite evidence of CNS activity of systemic therapy. The true extent of variation in MBM-related enrollment criteria in ongoing melanoma clinical trials has not been evaluated.

METHODS

A systematic search of clinicaltrials.gov website was performed to characterize trends in clinical trial enrollment of MBM patients in interventional drug trials. Trial data search was limited to “open”, “interventional studies” and advanced stage melanoma in adult patients. Logistic regression was used to model inclusion of active MBMs. Covariates considered were phase of study, location, therapy type, melanoma specific, and sponsor category

RESULTS

Of a total of 475 trials identified, 365 met inclusion criteria. 230 (63.0%) were phase I, 119 (32.6%) were phase II, 14 (3.8%) were phase III and 2 (0.5%) were phase IV trials. 184 (50.4%) were pharmaceutical industry sponsored, 183 (50.1%) were specific for melanoma. Forty-seven (12.8%) trials strictly excluded brain metastasis and 173 (47.3%) strictly excluded leptomeningeal disease (LMD). 261 (71.5%) trials allowed patients with previously treated MBM, and 73 (20.0%) allowed patients with active MBMs. No explicit mention of CNS metastasis was made in 13.6% of trials and no mention of LMD was made in 43.8% trials. In univariate models, trials not employing immunotherapy (odds ratio 2.23; 95% CI: 1.2, 4.3; p = 0.0174) and non-pharma trials (odds ratio 1.98; 95% CI 1.0, 3.9; p= 0.0461) were twice as likely to include MBM patients. In a combined model, only therapy type remained significant at the α=0.05 level.

CONCLUSION

Despite the evidence of CNS activity of immunotherapy in randomized trials, only 20% ongoing trials are enrolling patients with active MBMs. Efforts should be made to tailor future clinical trial designs to include MBM patients to assess CNS activity of systemic therapeutics early on in drug development.

Phase I study of entinostat (Ent), atezolizumab (A), carboplatin (C), and etoposide (E) in previously untreated extensive-stage small cell lung cancer (ES-SCLC), ETCTN 10399

e20606

Background: A-CE has demonstrated improved overall survival in ES-SCLC, but there are currently no approved therapies targeting genomic alterations in SCLC. Mutations in acetyltransferases CREBBP and EP300 occur at a frequency of 15% and 13%, respectively, in SCLC, and PDX models with CREBBP mutations were demonstrated to be susceptible to targeting with HDAC inhibitors. Ent, a class I selective HDAC inhibitor, has also demonstrated clinical activity in a combination with pembrolizumab in patients with NSCLC and uveal melanoma with minimal hematologic toxicity at RP2D of 5 mg PO weekly. We conducted a phase I trial to evaluate the combination of Ent with A-CE for ES-SCLC, NCI ETCTN 10399. Methods: Patients (pts) with treatment-naïve ES-SCLC, stable or treated brain metastases, ECOG ≤2 were enrolled and treated on up to 4 dose levels of Ent. Allocation to cohorts was determined using Bayesian optimal interval (BOIN) design targeting a MTD with a DLT rate of 20%. Dose levels (DL) included Ent 2 mg, 3 mg, or 5 mg PO weekly on day (d) 1 in addition to 4 cycles of A-CE (A 1200 mg, C AUC 5, E 100 mg/m2 d 1-3) followed E+A for 1 year. Pre-treatment tissue and plasma collected for WES. Results: 3 pts were enrolled and treated at DL1 with Ent 2 mg. Pts were age 69-83, 2 male, 1 female, 2 were ECOG 1, 1 was ECOG 0, and 1 with prior SRS radiation for brain metastases. 2 of 3 experienced DLTs during cycle 1: (1) Grade (Gr) 4 febrile neutropenia after 2 doses of Ent and (1) Gr 5 sepsis after 1 dose of Ent. BOIN design required stopping accrual to dose level 1 and the trial was closed to further accrual. The pt without DLT experienced grade 3 thrombocytopenia after 2 doses of Ent, but recovered after holding cycle 1, day 15 Ent. This patient experienced Gr 3 neutropenia during cycle 2. The most common adverse events were anemia (3), neutropenia (3), thrombocytopenia (2), leukopenia (2), hypocalcemia (2). Of these, most were Gr 3-4: anemia (1), neutropenia (3), thrombocytopenia (2), leukopenia (1), hypocalcemia (1). Conclusions: The combination of low dose Ent 2 mg PO weekly + AC-E is unsafe and resulted in early onset and severe neutropenia, thrombocytopenia in the first 1-2 weeks and ≥Gr 3 neutropenia and thrombocytopenia prior to completing 2 cycles of treatment for all pts. There is no role for further exploration of entinostat with carboplatin, etoposide, and atezolizumab. Clinical trial information: NCT04631029.

Fertility awareness and parenting intentions among Mexican undergraduate and graduate university students

An online, cross-sectional survey was carried out between November 2017 and January 2018 to assess fertility awareness among students attending the National Autonomous University of Mexico (UNAM) in Mexico City. A total of 371 students participated in the survey (n = 228 females, 143 males). 75% of females and 74% of males believed a woman's fertility begins to decline markedly after age 40. Over 75% of all participants overestimated the probability of couples having a live birth after undergoing one cycle of IVF. With regard to parenting intentions, only 48% of females wished to have children compared to 59% of males (p = 0.037) and men were more likely to have their first child at age 30 or later (71% men vs 55% women). In the event of infertility, participants had a higher preference not to have children or to pursue adoption rather than use in vitro fertilisation (IVF). In summary, university students in Mexico City demonstrated low levels of fertility awareness and a smaller proportion indicated a wish to have children than has been reported by young people elsewhere in the world.

Towards enhanced automated elution systems for waterborne protozoa using megasonic energy

Continuous and reliable monitoring of water sources for human consumption is imperative for public health. For protozoa, which cannot be multiplied efficiently in laboratory settings, concentration and recovery steps are key to a successful detection procedure. Recently, the use of megasonic energy was demonstrated to recover Cryptosporidium from commonly used water industry filtration procedures, forming thereby a basis for a simplified and cost effective method of elution of pathogens. In this article, we report the benefits of incorporating megasonic sonication into the current methodologies of Giardia duodenalis elution from an internationally approved filtration and elution system used within the water industry, the Filta-Max®. Megasonic energy assisted elution has many benefits over current methods since a smaller final volume of eluent allows removal of time-consuming centrifugation steps and reduces manual involvement resulting in a potentially more consistent and more cost-effective method. We also show that megasonic sonication of G. duodenalis cysts provides the option of a less damaging elution method compared to the standard Filta-Max® operation, although the elution from filter matrices is not currently fully optimised. A notable decrease in recovery of damaged cysts was observed in megasonic processed samples, potentially increasing the abilities of further genetic identification options upon isolation of the parasite from a filter sample. This work paves the way for the development of a fully automated and more cost-effective elution method of Giardia from water samples.

Analysis of Parasitic Protozoa at the Single-cell Level using Microfluidic Impedance Cytometry

At present, there are few technologies which enable the detection, identification and viability analysis of protozoan pathogens including Cryptosporidium and/or Giardia at the single (oo)cyst level. We report the use of Microfluidic Impedance Cytometry (MIC) to characterise the AC electrical (impedance) properties of single parasites and demonstrate rapid discrimination based on viability and species. Specifically, MIC was used to identify live and inactive C. parvum oocysts with over 90% certainty, whilst also detecting damaged and/or excysted oocysts. Furthermore, discrimination of Cryptosporidium parvum, Cryptosporidium muris and Giardia lamblia, with over 92% certainty was achieved. Enumeration and identification of (oo)cysts can be achieved in a few minutes, which offers a reduction in identification time and labour demands when compared to existing detection methods.

FlyBoss: a web-based flystrike information and decision support system

The FlyBoss system consists of comprehensive information on flystrike management and control, programs for assisting decision making, and sortable lists of products for preventing and treating flystrike. Readily accessible, up-to-date, best-practice information on flystrike is essential for effective, humane and economic management of flystrike by Australian wool producers, particularly those who are phasing out mulesing and those looking to adopt optimal insecticidal fly-control strategies. FlyBoss provides information on breeding and management to reduce flystrike susceptibility, effective methods of treating existing flystrike and flystrike prevention programs. The FlyBoss decision aids, which are based on simulation models and incorporate local weather data and sheep susceptibility factors, can assist sheep farmers who wish to optimise sheep management, chemical treatment and non-chemical options to minimise the risk of flystrike. FlyBoss also contains comprehensive information on fly biology, sheep and environmental factors associated with flystrike and information on appropriate chemicals for various situations. FlyBoss draws on expertise from organisations throughout Australia to provide the sheep industry with easily accessible, current and locally targeted information on flystrike management. The present report briefly describes the development of FlyBoss and associated workshops and provides an overview of current recommendations for the control and prevention of flystrike.

A Wireless, Passive pH Sensor Based on Magnetic Higher-Order Harmonic Fields

A wireless, passive sensor was fabricated for remote monitoring of chemical analytes in the human body. The sensor was made of a magnetically soft film (sensing element) and a permanent magnetic film (biasing element) sandwiching a reversibly swelling hydrogel. When subjected to a low frequency magnetic AC field, the sensing element generated higher-order harmonic magnetic fields that were detected with a remotely located detection coil. In the presence of a DC magnetic field (biasing field), such as that generated from the biasing element, the pattern of the higher-order harmonic magnetic fields varied, and the magnitude of change (referred to as the harmonic field shift) was proportional to the strength of the biasing field. The hydrogel, which acted as a transducer that converted variations in the chemical concentration into changes in dimensions, physically varied the separation distance between the sensing and the biasing elements. This causes a change in the magnitude of biasing field experienced by the sensing element, thus changing its higher-order harmonic field shift allowing remote measurement of chemical concentrations. The novelty of this sensor was its wireless and passive nature, which allows it to be used inside a human body for long term chemical monitoring. A scaled-up prototype was fabricated and tested to demonstrate the pH monitoring capability of the sensor. The main structure of the prototype sensor was a polycarbonate substrate containing a larger rectangular well of 36mm×8mm×4mm on top of a smaller well of 30mm×5mm×2mm (see Fig. 1). The smaller well was filled with hydrogel made of (poly)vinyl alcohol and (poly)acrylic acid. A commercial magnetoelastic thick film, Metglas 2826MB from Metglas Inc., was attached to the step at the bottom of the larger well and allowed to rest on the hydrogel. The DC magnetic field was provided by an Arnokrome III film (Arnold Magnetic Technologies) of 30mm×6mm attached at the bottom of the sensor structure. The sensor was placed on the detection coil, and its response was measured with a spectrum analyzer while exposed to test solutions of varying pH. The sensor's harmonic field shift, when cycled between pH 7 and pH 3, was measured and plotted in Fig. 2. As shown in the figure, the hydrogel swelled when the sensor was exposed to pH 3, decreasing the harmonic field shift. The response and recovery times of the hydrogel were below 2 minutes. This experiment proves the feasibility of the technology for real-time, remote monitoring of pH. Further work includes improving the response time and sensitivity of the hydrogel, as well as miniaturization of the sensor.

Cross calibration of Hologic QDR2000 and GE Lunar Prodigy for forearm bone mineral density measurements

The purpose of this study was to carry out an in vivo cross calibration for forearm bone mineral density (BMD) between a Hologic QDR2000 (Hologic Inc., Bedford MA, USA) and Lunar Prodigy (GE Healthcare, Madison WI, USA) during equipment upgrade. Nineteen subjects (17 females and 2 males, mean age 57 yr, range: 42-79yr) attending for routine dual energy X-ray absorptiometry scanning were recruited. BMD of the nondominant forearm was measured on both instruments. Cross-calibration equations were derived for total forearm, ultradistal radius and ulna, and 33% radius and ulna. A Bland & Altman plot was used to calculate the mean difference and limits of agreement between instruments. There were significant differences in BMD at all sites. The Prodigy BMD was 15% higher at the total forearm and 20-25% higher in the cortical regions of the 33% ulna and 33% radius. The differences are smaller in the ultradistal regions, as it appears that the Prodigy underestimates BMD at low BMD. The standard error of estimate about the cross calibration was such that it cannot be used to transfer individual patients between instruments, but could be applied to clinical trial data.

Quantitative heel ultrasound variables in powerlifters and controls

OBJECTIVE

To compare by cross sectional study the quantitative heel ultrasound (QUS) variables broadband ultrasound attenuation (BUA) and velocity of sound (VOS) in male powerlifters and controls.

METHODS

Twenty four powerlifters and 21 sedentary male controls were recruited to the study. All the powerlifters were members of the British Drug Free Powerlifting Association and actively competing at the time of the study. A questionnaire was completed by all those entered into the study. This included a history of smoking and an estimation of daily intake of alcohol and calcium. For the powerlifters, the number of years spent training and time spent training each week was also recorded. The QUS variables of all powerlifters and controls were measured using a Cubaclinical II (McCue) ultrasound scanner.

RESULTS

The powerlifters had been training for a mean (SEM) of 10.6 (1.6) years and they trained for 6.5 (0.4) hours a week. The powerlifters were non-significantly older and had a significantly higher body mass index (BMI) than the controls. Calcium intake and consumption of alcohol and tobacco were similar in the two groups. The mean BUA in the powerlifters was a significant 9.5% (95% confidence interval 0.7 to 18.3%) higher than the controls (105 v 96 dB/MHZ) and 15.6% (95% confidence interval 6.8 to 24.4%) higher after adjustment using analysis of covariance for age, BMI, and alcohol and tobacco consumption (108 v 93 dB/MHZ). The mean VOS was similar in the two groups, but after adjustment it was significantly higher in the powerlifters (1671 v 1651 m/s, p<0.01).

CONCLUSIONS

The study shows the ability of heel ultrasound to discriminate between QUS variables in powerlifters and controls. The results indicate that the QUS variables BUA and VOS are significantly higher for powerlifters than for controls.

Holocene isostasy and relative sea-level changes on the east coast of England

Analysis of sea-level data from the east coast of England identifies local-scale and regional scale factors to explain spatial and temporal variations in the altitude of Holocene sea-level index points. The isostatic effect of the glacial rebound process, including both the ice (glacio-isostatic) and water (hydro-isostatic) load contributions, explains regionalscale differences between eight areas: c. 20 m range at 8 cal. ka bp and by 4 cal. ka bp relative sea-level in Northumberland was above present, whereas in areas to the south relative sea level has been below present throughout the Holocene. Estimates for pre-industrial relative sea-level change range from 1.04 ± 0.12 mm a−1 in the Fenland to −1.30 ± 0.68 mm a−1 (i.e. sea-level fall) in north Northumberland, although this may overestimate the current rate of sea-level fall. Isostatic effects will produce similar relative differences in rates of sea-level change through the twenty-first century. The data agree closely with the patterns predicted by glacio- and hydro-isostatic models, but small systematic differences along the east coast await testing against new ice models. Local scale processes identified include differential isostatic effects within the Humber Estuary and the Fenland, tide range changes during the Holocene, and the effects of sediment consolidation. These processes help explain the variation in altitude between sea-level reconstructions derived from index points taken from basal peats and those from peats intercalated within thick sequences of Holocene sediments.

Modelling western North Sea palaeogeographies and tidal changes during the Holocene

Analysis of cores collected from Late Devensian (Weichselian) and Holocene sediments on the floor of the North Sea provides evidence of the transgression of freshwater environments during relative sea-level rise. Although many cores show truncated sequences, examples from the Dogger Bank, Well Bank and 5 km offshore of north Norfolk reveal transitional sequences and reliable indicators of past shoreline positions. Together with radiocarbon-dated sea-level index points collected from the Holocene sediments of the estuaries and coastal lowlands of eastern England these data enable the development and testing of models of the palaeogeographies of coastlines in the western North Sea and models of tidal range changes through the Holocene epoch. Geophysical models that incorporate ice-sheet reconstructions, earth rheology, eustasy, and glacio- and hydroisostasy provide predictions of sea-level relative to the present for the last 10 ka at 1-ka intervals. These predictions, added to a model of present-day bathymetry, produce palaeogeographic reconstructions for each time period. The palaeogeographic maps reveal the transgression of the North Sea continental shelf. Key stages include a western embayment off northeast England as early as 10 kabp; the evolution of a large tidal embayment between eastern England and the Dogger Bank before 9 kabpwith connection to the English Channel prior to 8 kabp; and Dogger Bank as an island at high tide by 7.5 kabpand totally submerged by 6 kabp. Analysis of core data shows that coastal and saltmarsh environments could adapt to rapid rates of sea-level rise and coastline retreat. After 6 kabpthe major changes in palaeogeography occurred inland of the present coast of eastern England. The palaeogeographic models provide the coastline positions and bathymetries for modelling tidal ranges at each 1-ka interval. A nested hierarchy of models, from the scale of the northeast Atlantic to the east coast of England, uses 26 tidal harmonics to reconstruct tidal regimes. Predictions consistently show tidal ranges smaller than present in the early Holocene, with only minor changes since 6 kabp. Recalibration of previously available sea-level index points using the model results rather than present tidal-range parameters increases the difference between observations and predictions of relative sea-levels from the glacio-hydro-isostatic models and reinforces the need to search for better ice-sheet reconstructions.

A method of using a genetic algorithm to examine the optimum structure of the Australian sheep breeding industry: open-nucleus breeding systems, MOET and AI

A genetic algorithm was evaluated as a means of using a computer model to determine the optimum structure of the Australian sheep breeding industry. The model simulates an open-nucleus 3-tiered sheep breeding system to investigate the benefit of strategies such as multiple ovulation and embryo transfer (MOET) and artificial insemination (AI) in terms of both genetic improvement and dollar values. The model indicated that both MOET and non- MOET systems benefit from an open nucleus, and both could also benefit from the promotion of some ewes from the commercial flocks. However, MOET systems require a relatively large number of rams, whereas non- MOET systems should have a smaller number of rams despite the much larger number of ewes needed. Under the conditions studied here, there was only limited advantage of MOET over non-MOET schemes. The optimum structure of the MOET, non-MOET and closed systems differ substantially. A genetic algorithm is a simple method for considering a single change (such as reproductive rate, or open v. closed) that may require major changes in the industry structure to achieve the full benefits. The method could also be of value in many other situations requiring optimisation of complex models.

Profile of nurse anesthesia programs

Over time, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) and the AANA Education and Research Department have recognized the need to gather information significant to nurse anesthesia programs. The need to create a formalized mechanism to gather and analyze information has also been identified as the profession has grown. COA and the Education and Research Department have responded to this need by creating a database and a reporting mechanism in order to present information to the Assembly of School Faculty at its annual meeting. The information will be summarized in this article, which is the first formal vehicle of disseminating the data.

Outcome assessment in education programs

This article describes the move toward outcome assessment as a tool to measure student achievement and overall program effectiveness. Methods are presented by which on-site accreditation reviewers can determine if nurse anesthesia faculty perform effective assessments and utilize the results of their findings to plan for improvement. Emphasis is placed on methods by which data from multiple sources are collected and analyzed by the faculty to enhance student learning.

Accreditation of regionalized and comprehensive nurse anesthesia programs

Regionalized educational systems are becoming more common among nurse anesthesia programs and represented 41 out of 86 programs in a 1992 survey. Surveys were mailed to program directors of all nurse anesthesia programs accredited by the Council on Accreditation of Nurse Anesthesia Educational Programs to determine if the directors perceived a need for three separate categories of accreditation. Responses indicated that, although most directors saw no benefit in applying for separate academic and clinical accreditations for their own programs, they did believe the additional accreditation options should be available to all programs. Most directors also indicated that they preferred the Council to continue offering only one category of accreditation while 33 (38%) indicated they were interested in separate accreditation categories.

Faculty positions as a career choice for professionals--Part II

This is the second part of a two-part article designed to identify "why professionals choose or do not choose faculty positions." The first article reviewed the methodology and the results as they applied to the demographic data. This was published in the June 1991 issue of the AANA Journal. This article reviews the results as they apply to life cycle and certain intrinsic and extrinsic factors of the respondents. The respondents were CRNAs who had graduate degrees, or were faculty in nursing education, faculty in higher education, or nursing service personnel. The article also covers additional recommendations made by the researchers for future studies. The results showed that 71% of the CRNA faculty intended to remain in academia for the next 5 years and 75% for the next 10 years. Ninety percent of the CRNA faculty indicated they would recommend a position in teaching to others. Intrinsic factors, such as the ability to use their knowledge and opportunity to teach were important to CRNA faculty as an influence to become faculty members. Extrinsic factors of salary, fringe benefits, and the cost of malpractice insurance were among those items identified by CRNA faculty as reasons why they would not become faculty members. It is hoped that this study will assist nurse anesthesia programs, universities and colleges in faculty recruitment activities. The information was presented by the authors at the Assembly of School Faculty Meeting held in Tampa, Florida, in February 1991.

Comparison of accreditation criteria. CBHDP, NLN, and COA accreditation criteria

When a program faces accreditation from two organizations, what happens? Double jeopardy? Unnecessary repetition? Frels and Horton look at a case in point--nurse anesthesia programs. In many cases these programs are accredited by both NLN and COA. The potential problems are accentuated in this case since not all nurse anesthetist programs are located in schools of nursing.

Results of a survey of nurse anesthesia education programs: diversity, growth and regionalization

This survey was conducted in June of 1990. Questionnaires were sent to and data obtained from all civilian and military nurse anesthesia education programs. Programs were asked to provide the following information: type of conducting institution; the party responsible for the administrative costs of the program; name and location of the program's academic affiliation; the name, location, type and purpose of all clinical affiliations/sites; and distance from the conducting institution to the academic affiliation and to each clinical site. The conducting entities for civilian programs were as follows: hospital or medical center, 43 programs; academic institution, 15 programs; joint arrangement between a hospital and an academic institution, 10 programs; freestanding, 4 programs; other, 7 programs. For purposes of this survey, each branch of the military was considered to have a single program with multiple clinical sites. Two military programs identified their conducting entity as a joint arrangement between the respective branch of the military and an academic institution. The third program identified itself as freestanding with an academic affiliation. In all but seven programs, the administrative costs of the program are the responsibility of the conducting institution. The majority of programs (74%) have an academic affiliation and 68% of programs offer a graduate degree. Eighty percent of programs with an academic affiliation are located within 50 miles of the academic site. The greatest distance between a program and its academic affiliation is 350 miles. Programs reported having from 1-13 clinical sites (mean = 3.6 sites/program). Military programs, freestanding programs and programs conducted by an academic institution have the highest mean number of sites per program.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudocholinesterase activity in human cerebrospinal fluid

Pseudocholinesterase (PCHE) activity and dibucaine numbers (DN) in the cerebrospinal fluid (CSF) and plasma of 10 ASA physical status 1 and 2 patients were measured using a kinetic method. CSF had a mean PCHE activity of 0.018 +/- 0.013 unit/ml with a DN of 59 +/- 4. Whereas, PCHE activity and DN in the plasma were 0.960 +/- 0.12 units/ml and 84 +/- 3, respectively. We also measured PCHE activity and DN in the CSF and plasma of 4 patients in whom there was a recent history of intraventricular bleeding. These patients had a CSF PCHE activity of 0.340 +/- 0.07 units/ml (DN = 78 +/- 3) and a plasma PCHE activity of 0.950 +/- 0.10 units/ml (DN = 82 +/- 2). Our data show that there is a low activity of PCHE in CSF, 1/20-1/100th that of plasma. Our data also show that PCHE activity increased to 1/4 to 1/2 that of plasma in CSF of patients with bleeding into CSF.