Conversation analysis, psychopathology and subjective experience in patients with schizophrenia

Introduction

Patients with schizophrenia show severe difficulties in interpersonal communication, including impairments in conversation skills, like the turn-taking. To our knowledge, very few studies to date have taken into account conversation analysis in order to investigate turn-taking in schizophrenia patients.

Objectives

To investigate the conversational patterns in schizophrenia patients; to assess possible associations between dialogic features, abnormal subjective experiences and symptom dimensions.

Methods

Thirty-six patients with Schizophrenia underwent an interview, subsequently analyzed with an innovative semi-automatic analysis. Positive and Negative Syndrome Scale (PANSS) was adopted for the investigation of psychopathology and Examination of Anomalous Self Experience (EASE) for Self-Disorders.

Results

Dialogic exchanges are graphically represented in Figure 1. An inverse correlation was found between participant speaking time and PANSS negative symptoms score (r = -0.44, p value < 0.05; Figure 2), whereas no associations were found between conversational variables and PANSS positive or disorganization dimensions. Finally, a positive correlation was found between the EASE item “spazialization of thought” and average pause duration (r = 0.42, p value < 0.05).

Conclusions

The finding of a relationship between negative symptoms and conversational patterns suggest that conversational features in schizophrenia are expression of the “core” negative dimension of the disorder. The association with the phenomenon of thought spatialization seems to suggest that the disturbances of the stream of consciousness impact on natural dialogic interactions. Ultimately, conversation analysis seems a promising tool to study dialogic exchanges of patients with schizophrenia.

Disclosure

No significant relationships.

Mobile laboratories: An innovative and efficient solution for radiological characterization of sites under or after decommissioning

During the operation and the decommissioning of a nuclear site the operator must assure the protection of the workers and the environment. It must furthermore identify and classify the various wastes, while optimizing the associated costs. At all stages of the decommissioning radiological measurements are performed to determine the initial situation, to monitor the demolition and clean-up, and to verify the final situation. Radiochemical analysis is crucial for the radiological evaluation process to optimize the clean-up operations and to the respect limits defined with the authorities. Even though these types of analysis are omnipresent in activities such as the exploitation, the monitoring, and the cleaning up of nuclear plants, some nuclear sites do not have their own radiochemical analysis laboratory. Mobile facilities can overcome this lack when nuclear facilities are dismantled, when contaminated sites are cleaned-up, or in a post-accident situation. The current operations for the characterization of radiological soils of CEA nuclear facilities, lead to a large increase of radiochemical analysis. To manage this high throughput of samples in a timely manner, the CEA has developed a new mobile laboratory for the clean-up of its soils, called SMaRT (Shelter for Monitoring and nucleAR chemisTry). This laboratory is dedicated to the preparation and the radiochemical analysis (alpha, beta, and gamma) of potentially contaminated samples. In this framework, CEA and Eichrom laboratories has signed a partnership agreement to extend the analytical capacities and bring on site optimized and validated methods for different problematic. Gamma-emitting radionuclides can usually be measured in situ as little or no sample preparation is required. Alpha and beta-emitting radionuclides are a different matter. Analytical chemistry laboratory facilities are required. Mobile and transportable laboratories equipped with the necessary tools can provide all that is needed. The main advantage of a mobile laboratory is its portability; the shelter can be placed in the vicinity of nuclear facilities under decommissioning, or of contaminated sites with infrastructures unsuitable for the reception and treatment of radioactive samples. Radiological analysis can then be performed without the disadvantages of radioactive material transport. This paper describes how this solution allows a fast response and control of costs, with a high analytical capacity.

CLA-supplemented diet accelerates experimental colorectal cancer by inducing TGF-β-producing macrophages and T cells

Conjugated linoleic acid (CLA) has been shown to activate the nuclear receptor PPAR-γ and modulate metabolic and immune functions. Despite the worldwide use of CLA dietary supplementation, strong scientific evidence for its proposed beneficial actions are missing. We found that CLA-supplemented diet reduced mucosal damage and inflammatory infiltrate in the dextran sodium sulfate (DSS)-induced colitis model. Conditional deletion of PPAR-γ in macrophages from mice supplemented with CLA diet resulted in loss of this protective effect of CLA, suggesting a PPAR-γ-dependent mechanism mediated by macrophages. However, CLA supplementation significantly worsened colorectal tumor formation induced by azoxymethane and DSS by inducing macrophage and T-cell-producing TGF-β via PPAR-γ activation. Accordingly, either macrophage-specific deletion of PPAR-γ or in vivo neutralization of latency-associated peptide (LAP, a membrane-bound TGF-β)-expressing cells abrogated the protumorigenic effect of CLA. Thus, the anti-inflammatory properties of CLA are associated with prevention of colitis but also with development of colorectal cancer.

Patterns of referral and waiting times for specialist Child and Adolescent Mental Health Services

BACKGROUND

During 12-month period (2012/13) around 21,480 children and young people (CYP) were referred to Child and Adolescent Mental Health Service (CAMHS) in Scotland (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). At the end of September 2012, there were 3,602 CYP still waiting for 'start of treatment' or 'removal from the waiting list', 375 (10%) CYP had waited over 26 weeks and 1,204 (33%) CYP had waited over 18 weeks (NHS Scotland, 2013, Child and Adolescent Mental Health Services waiting times in Scotland). Referral source, referral reason and the sociodemographic characteristics of CYP are not routinely collected, and therefore, associations between these factors and wait times for 'start of treatment' or 'removal from the waiting list' (i.e. the referral outcome) are unknown.

METHOD

In this exploratory study, a retrospective analysis of referral data was conducted in one CAMHS. Data for 476 referrals between 1st May 2013 and 31st May 2014 were initially analysed to define categories for each of the following key variables: referral source, referral reason and referral outcome. Data on CYP sociodemographic characteristics were extracted from referral records, including age, gender and postcode, from which Scottish Index of Multiple Deprivation quintile of residence was derived. Descriptive statistics were calculated for referral source, referral reason and CYP sociodemographic characteristics. Regression models were then built to determine predictors of a referral being rejected by CAMHS and waiting time for referrals accepted by CAMHS. Data were analysed in SPSS (Version 20).

RESULTS

Of the 476 referrals, 72% (n = 342) were accepted and 12% (n = 59) were rejected. Most referrals were made by general practitioners. Just under a third of referrals to CAMHS (31%) were for CYP with emotional and behavioural difficulties. The odds of being rejected by CAMHS were significantly higher if referred by teachers and for CYP with emotional and behavioural difficulties. Age and referral reason were significant independent predictors of waiting time after referral to CAMHS, with CYP referred for hyperactivity/inattention waiting significantly longer.

CONCLUSIONS

Policymakers should consider ways to foster dialogue and collaboration between different groups of professionals making and accepting referrals to CAMHS in order to improve timely access to appropriate mental health support services for CYP. Research is urgently needed to investigate the experiences of CYP who are either rejected by CAMHS or wait lengthy periods of time before starting their treatment with CAMHS.

Getting It Right for Every Child: A National Policy Framework to Promote Children's Well-being in Scotland, United Kingdom

POLICY POINTS

Getting It Right for Every Child (GIRFEC), a landmark policy framework for improving children's well-being in Scotland, United Kingdom, is a practice initiative signifying a distinct way of thinking, an agenda for change, and the future direction of child welfare policy. GIRFEC represents a unique case study of national transformative change within the contexts of children's well-being and universal services and is of relevance to other jurisdictions. Implementation is under way, with an understanding of well-being and the requirement for information sharing enshrined in law. Yet there is scope for interpretation within the legislation and associated guidance. Inherent tensions around intrusion, data gathering, professional roles, and balancing well-being against child protection threaten the effectiveness of the policy if not resolved.

CONTEXT

Despite persistent health inequalities and intergenerational deprivation, the Scottish government aspires for Scotland to be the best country for children to grow up in. Getting It Right for Every Child (GIRFEC) is a landmark children's policy framework to improve children's well-being via early intervention, universal service provision, and multiagency coordination across organizational boundaries. Placing the child and family "at the center," this approach marks a shift from welfare to well-being, yet there is still a general lack of consensus over how well-being is defined and measured. As an umbrella policy framework with broad reach, GIRFEC represents the current and future direction of children's/family policy in Scotland, yet large-scale practice change is required for successful implementation.

METHODS

This article explores the origins and emergence of GIRFEC and presents a critical analysis of its incremental design, development, and implementation.

FINDINGS

There is considerable scope for interpretation within the GIRFEC legislation and guidance, most notably around assessment of well-being and the role and remit of those charged with implementation. Tensions have arisen around issues such as professional roles; intrusion, data sharing, and confidentiality; and the balance between supporting well-being and protecting children. Despite the policy's intentions for integration, the service landscape for children and families still remains relatively fragmented.

CONCLUSIONS

Although the policy has groundbreaking potential, inherent tensions must be resolved and the processes of change carefully managed in order for GIRFEC to be effective. It remains to be seen whether GIRFEC can fulfil the Scottish government's aspirations to reduce inequalities and improve lifelong outcomes for Scotland's children and young people. In terms of both a national children's well-being framework within a universal public service context and a distinct style of policymaking and implementation, the Scottish experience represents a unique case study of whole-country, transformational change and is of relevance to other jurisdictions.

Abstract P4-22-09: A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced breast cancer

Background: Therapies targeting estrogen receptor (ER) signaling are standard for patients (pts) with hormone receptor positive (HR+) (ER and/or progesterone receptor [PR] positive) metastatic breast cancer (MBC). Dysregulation of the mammalian target of rapamycin (mTOR) pathway has been associated with endocrine therapy (ET) resistance. BOLERO-2 demonstrated that the addition of the mTOR inhibitor, everolimus (EVE), to exemestane doubled the PFS in HR+ HER2- MBC pts who previously progressed on nonsteroidal aromatase inhibitor therapy.The premise of this phase 2 trial in HR+ MBC is that the addition of EVE to the last ET on which the disease progressed may restore sensitivity to ET and extend the benefit of the anti-estrogen therapy.

Methods: Pts ≥18 yrs with HR+, HER2- unresectable, locally recurrent, or MBC refractory to ET in either the adjuvant or advanced/metastatic setting. 0-1 chemotherapy (chemo) regimens for MBC were permitted. Post-/ pre-/peri-menopausal women were eligible with ovarian function suppression permitted. Additional eligibility requirements include: no prior mTOR inhibitor therapy, measurable or evaluable disease, ECOG ≤2, adequate bone marrow and organ function. EVE (10 mg PO daily) was administered on a 4-wk cycle in combination with the same dose and schedule of the last ET to which their disease became resistant. Disease assessments were performed every 2 cycles and treatment continued until disease progression or unacceptable toxicity. Blood samples and archival tumor were collected respectively for the VeriStrat Assay and for the Foundation One molecular profiling platform.

Results: 48 pts were enrolled; data from 26 pts is presented. Median age 63.5 yrs (range, 36-81) with 46% ≥ 65 yrs. 14 (54%) pts had received chemo in the adjuvant setting, 9 pts (35%) received chemo for MBC, and 4 pts (15%) received chemo in both settings. All pts had at least 1 prior hormonal therapy; 9 pts received ≥ 3 hormonal agents. EVE was combined with tamoxifen (27%), AIs (61%), and fulvestrant (12%). Median time on treatment was 18.6 wks (range 1-48.9 weeks). 5 pts (19%) remain on treatment and 21 (81%) have discontinued therapy due to: disease progression - 17, toxicity -2, and other causes - 2. 23 pts were evaluable for response. 1 pt on fulvestrant plus EVE had a PR and 18 pts (78%) had SD as best response, with SD &gt; 6 mos in 7 pts, for a clinical benefit rate (CR+PR+ SD ≥ 6 months) of 35%. With a median follow up of 11 mos (range 2-16 mos), the median PFS was 6.6 months (range 3.6-9.4); the median OS has not been reached. Treatment-related adverse events consisted mostly of stomatitis, rash and fatigue with few G3 events: stomatitis 3 pts, rash 2 pts, and 1 each of fatigue, edema, and neutropenia. G1 pneumonitis was present in 2 pts. There were no G4 events or treatment related deaths.

Conclusions: In HR+ HER2- advanced/MBC patients who progressed on prior ET, the addition of EVE to the ET to which their disease became resistant, resulted in 1 PR and 7 pts with SD &gt; 6 mos. The results of the full study population will be presented. Modulation of the mTOR/AKT/PI3K pathway with EVE may extend the benefit of ET, even after tumor progression on ET alone.

Citation Format: Yardley DA, Blakely L, Hemphill B, Joseph M, Liggett W, Daniel B, Castrellon A, Shastry M, Finney L, DeBusk L, Hainsworth JD, Burris III HA. A phase 2 open label study of everolimus in combination with endocrine therapy in resistant hormone receptor-positive HER2-negative advanced breast cancer [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 P4-22-09.

Testing Hadronic Interactions at Ultrahigh Energies with Air Showers Measured by the Pierre Auger Observatory

Ultrahigh energy cosmic ray air showers probe particle physics at energies beyond the reach of accelerators. Here we introduce a new method to test hadronic interaction models without relying on the absolute energy calibration, and apply it to events with primary energy 6-16 EeV (E_{CM}=110-170  TeV), whose longitudinal development and lateral distribution were simultaneously measured by the Pierre Auger Observatory. The average hadronic shower is 1.33±0.16 (1.61±0.21) times larger than predicted using the leading LHC-tuned models EPOS-LHC (QGSJetII-04), with a corresponding excess of muons.

Fatty acid-related modulations of membrane fluidity in cells: detection and implications

Metabolic homeostasis of fatty acids is complex and well-regulated in all organisms. The biosynthesis of saturated fatty acids (SFA) in mammals provides substrates for β-oxidation and ATP production. Monounsaturated fatty acids (MUFA) are products of desaturases that introduce a methylene group in cis geometry in SFA. Polyunsaturated fatty acids (n-6 and n-3 PUFA) are products of elongation and desaturation of the essential linoleic acid and α-linolenic acid, respectively. The liver processes dietary fatty acids and exports them in lipoproteins for distribution and storage in peripheral tissues. The three types of fatty acids are integrated in membrane phospholipids and determine their biophysical properties and functions. This study was aimed at investigating effects of fatty acids on membrane biophysical properties under varying nutritional and pathological conditions, by integrating lipidomic analysis of membrane phospholipids with functional two-photon microscopy (fTPM) of cellular membranes. This approach was applied to two case studies: first, pancreatic beta-cells, to investigate hormetic and detrimental effects of lipids. Second, red blood cells extracted from a genetic mouse model defective in lipoproteins, to understand the role of lipids in hepatic diseases and metabolic syndrome and their effect on circulating cells.

Competent to Cope, Worthy of Happiness?

This article considers links between self-esteem and resilience, and suggests implications for teachers and schools. A two-dimensional model of self-esteem is employed as a theoretical framework to revisit a range of factors frequently associated with internal resilience. It is argued that because of the way in which self-referent characteristics have been conceptualized in the past, the links between self-esteem and resilience may have been underestimated. Following discussion of the theoretical issues, suggestions are made about to how this model of self-esteem can provide schools with a conceptual framework to help inform resilience-based approaches to support vulnerable children.

Measurement of the Radiation Energy in the Radio Signal of Extensive Air Showers as a Universal Estimator of Cosmic-Ray Energy

We measure the energy emitted by extensive air showers in the form of radio emission in the frequency range from 30 to 80 MHz. Exploiting the accurate energy scale of the Pierre Auger Observatory, we obtain a radiation energy of 15.8±0.7(stat)±6.7(syst)  MeV for cosmic rays with an energy of 1 EeV arriving perpendicularly to a geomagnetic field of 0.24 G, scaling quadratically with the cosmic-ray energy. A comparison with predictions from state-of-the-art first-principles calculations shows agreement with our measurement. The radiation energy provides direct access to the calorimetric energy in the electromagnetic cascade of extensive air showers. Comparison with our result thus allows the direct calibration of any cosmic-ray radio detector against the well-established energy scale of the Pierre Auger Observatory.

Solid-phase synthesis of Rhodamine-110 fluorogenic substrates and their application in forensic analysis

A novel synthesis demonstrates the rapid and efficient preparation of fluorogenic substrates containing Rhodamine-110 fluorophores for the detection of biological evidence.

Search for patterns by combining cosmic-ray energy and arrival directions at the Pierre Auger Observatory

Energy-dependent patterns in the arrival directions of cosmic rays are searched for using data of the Pierre Auger Observatory. We investigate local regions around the highest-energy cosmic rays with [Formula: see text] eV by analyzing cosmic rays with energies above [Formula: see text] eV arriving within an angular separation of approximately 15[Formula: see text]. We characterize the energy distributions inside these regions by two independent methods, one searching for angular dependence of energy-energy correlations and one searching for collimation of energy along the local system of principal axes of the energy distribution. No significant patterns are found with this analysis. The comparison of these measurements with astrophysical scenarios can therefore be used to obtain constraints on related model parameters such as strength of cosmic-ray deflection and density of point sources.

Early years interventions to improve child health and wellbeing: what works, for whom and in what circumstances? Protocol for a realist review

BACKGROUND

Child health and wellbeing is influenced by multiple factors, all of which can impact on early childhood development. Adverse early life experiences can have lasting effects across the life course, sustaining inequalities and resulting in negative consequences for the health and wellbeing of individuals and society. The potential to influence future outcomes via early intervention is widely accepted; there are numerous policy initiatives, programmes and interventions clustered around the early years theme, resulting in a broad and disparate evidence base. Existing reviews have addressed the effectiveness of early years interventions, yet there is a knowledge gap regarding the mechanisms underlying why interventions work in given contexts.

METHODS/DESIGN

This realist review seeks to address the question 'what works, for whom and in what circumstances?' in terms of early years interventions to improve child health and wellbeing. The review will be conducted following Pawson's five-stage iterative realist methodology: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions and (5) disseminate findings. The reviewers will work with stakeholders in the early stages to refine the focus of the review, create a review framework and build programme theory. Searches for primary evidence will be conducted iteratively. Data will be extracted and tested against the programme theory. A review collaboration group will oversee the review process.

DISCUSSION

The review will demonstrate how early years interventions do or do not work in different contexts and with what outcomes and effects. Review findings will be written up following the RAMESES guidelines and will be disseminated via a report, presentations and peer-reviewed publications.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42015017832.

Abstract P5-20-10: Panitumumab, Gemcitabine and Carboplatin in Triple-Negative Metastatic Breast Cancer: Preliminary Results of a Phase II Trial of the Sarah Cannon Research Institute

Background: Triple-negative breast cancer (TNBC) is a poor prognosis subtype with treatment limited to chemotherapy. Over expression of epidermal growth factor receptor (EGFR) occurs in up to 70% of TNBC providing a potential targetable receptor for treatment. Panitumumab is an approved fully human, IgG2 monoclonal anti-EGFR antibody that inhibits intracellular growth signals dependent on receptor activation. The gemcitabine/platinum combination has demonstrated activity in metastatic as well as TNBC at various schedules and doses. We therefore investigated the efficacy and safety of panitumumab in combination with gemcitabine and carboplatin in patients (pts) with TNBC.

Methods: Eligibility criteria included: females with metastatic TNBC, 0–1 prior chemotherapy regimen for metastatic disease, ECOG PS 0–1, no brain metastases, no previous EGFR inhibitors and adequate organ function. All pts received gemcitabine 1500 mg/m2 IV, carboplatin AUC = 2.5 IV, and panitumumab 6 mg/kg IV every 2 weeks. A prophylactic skin regimen consisting of moisturizer, sunscreen and topical steroid was to be used 24 hours prior to study treatment and continued until panitumumab was discontinued. Pts were restaged after 3 treatment cycles and continued treatment until unacceptable toxicity or disease progression. If treatment benefit was demonstrated, and pts were experiencing toxicity or intolerance to gemcitabine, carboplatin or both, pts were allowed to discontinue either one or both agents and continue study treatment with panitumumab as a single agent or in combination. The primary endpoint of this study is progression free survival (PFS) with accrual of 70 pts necessary to detect an improvement in median PFS from 3.6 to 5.4 months (80% power, 10% level of significance).

Results: Between May 2010 and May 2012, 61 patients were enrolled with an accrual goal of 70 pts. This analysis is based on 47 pts. Pt characteristics include: median age 56, prior hormonal therapy 4%, no prior chemotherapy for metastatic disease in 87% (28% de novo stage IV), 1 prior chemotherapy for metastatic disease in 13%. Sites of metastatic disease included local regional/lymph nodes 70%, lung 57%, liver 32%, bone 26%, and others 23%. Best response to treatment was as follows: CR − 1 (2%), PR − 14 (30%), SD − 20 (43%), PD − 11 (23%), UE − 1 (2%). As 1st line TNBC therapy, the ORR was 34%. The most common grade 3/4 heme toxicities were neutropenia − 12 (25%), leucopenia − 7 (15%), anemia − 3 (6%) and thrombocytopenia − 2 (4%). Grade 3/4 non-hematologic toxicities were rash − 4 (9% with 1 grade 4), fatigue − 3 (6%) and DVT − 3 (6%). Grade 1 and 2 rash was present in 19 and 9 pts respectively. Archival tumor tissue was collected for correlative biomarker analysis to include PI3KCA, p53, PTEN, EGFR, and K-ras status.

Conclusions: The addition of panitumumab to gemcitabine and carboplatin in metastatic TNBC was active with an ORR of 32%. No new safety signals were identified and treatment was generally well tolerated with easily manageable toxicity. Full study results and correlative biomarker assessments will be reported.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-20-10.

Correlation of SPARC, ER, PR, and HER2 tumor with progression-free survival from a phase II neoadjuvant trial of gemcitabine, epirubicin, and nab-paclitaxel

618

Background: Neoadjuvant combinations of gemcitabine (G), anthracyclines and taxanes have demonstrated substantial activity with pCR rates of 20–25%. Secreted protein acidic rich in cysteine (SPARC) is an albumin binding protein that mediates intratumoral accumulation of nab-paclitaxel (nab-P) via a SPARC-albumin binding activity and is a poor prognostic factor for survival. This study was designed to evaluate the feasibility and safety of a biweekly schedule of neoadjuvant nab paclitaxel (nab-P) with G and epirubicin (E) with SPARC tumor assessments performed in consenting patients (pts). Methods: Eligibility: Clinical T1c-T4d and/or N0–3, M0 breast cancer (T1N0M0 excluded), normal LVEF. ER/PR/HER-2 obtained for all pts. Treatment: neoadjuvant G 2,000 mg/m2, E 50 mg/m2, and nab-P 175 mg/m2 q14 days x 6 cycles followed by surgery. Post operative therapy: G 2,000 mg/m2 and nab-P 220 mg/m2 q14 days x 4 cycles. Myeloid growth factors were mandated with all cycles. Two different antibody reagents were used to probe for SPARC expression of tumoral SPARC and stromal SPARC; level 3 immunohistochemical (IHC) SPARC staining was considered positive. Results: 123 pts enrolled. Pathologic responses are available for 112 pts with 11 unevaluable. 82 pts consented to SPARC tumor testing. Median age 51 (29–72). Median tumor size 4.5 cm. 42% ER-/PR -. 55% clinical T3/T4 and 66% node positive. Pathologic complete responses (pCR) were noted in 22 pts (18%) with PRs in 84 pts (68%), and 6 SD (5%). SPARC IHC staining was available in 77 tumor samples; SPARC positivity was noted in 89% of evaluated tumors achieving pCR. Triple negative, ER negative or PR negative tumors were associated with worse PFS. SPARC + tumors showed a trend to improved PFS that was strongly associated with tumoral SPARC but not stromal SPARC. Conclusions: Dose dense neoadjuvant G, E, and nab-P is active and well tolerated with a favorable pCR rate of 20%. ER neg, PR neg, and triple negative tumors were associated with worse PFS. Despite literature reports of SPARC positivity associated with poor prognosis, SPARC+ tumors in this study showed a high concordance with tumor response and a trend to improved PFS with tumoral SPARC.

[Table: see text]

Characterization of triple-negative breast cancer utilizing microarray-based gene-expression profiling

e22014

Background: Triple-negative breast cancer (TNBC) is characterized by lack of expression of estrogen receptor (ER), progesterone receptor (PR) and HER-2. This makes it one of the most challenging subgroups for clinical decision-making. Methods: We analyzed gene-expression profiles of 200 node-negative breast cancer patients utilizing the Affymetrix HG-U133A array. After performing an unsupervised hierarchical cluster analysis using 2579 genes selected for variable expression within our dataset, we constructed metagenes for five dominant cluster (basal-like, luminal, proliferation, T-cell, B-cell). The interrelation of the median expression of these metagenes between TNBC and those cancer specimens expressing at least one of those receptors was analysed with the Wilcoxon-Mann-Whitney test. An intrinsic gene list was used to define basal-like breast cancer (BLBC). Sensitivity and specificity of TNBC to correctly classify BLBC was calculated. Metastasis-free survival (MFS) at 5 years was calculated according to Kaplan Meier. Results: Of the 200 node-negative breast cancer patients, 33 (16.5%) were triple-negative and 20 (10%) basal-like. Sensitivity of TNBC to correctly predict BLBC was 100%, specificity was 93.1%. TNBC showed an overexpression of the basal-like metagene (P=7.905e-13), an inverse relation with the luminal metagene (p=1.151e-12) and had higher proliferation and higher expression of T-cell (P=6.316e-5) and B-cell (P=3.551e-6) metagene. A higher expression of the B-cell metagene was associated with longer MFS in both TNBC (P=0.048) and BLBC (P=0.041). Conclusions: Characterization of TNBC reveals marked differences in gene-expression. Overexpression of mRNA transcripts related to the humoral immune system might serve as a protective factor in this particular subgroup.

No significant financial relationships to disclose.

Preliminary progression free survival and SPARC tumor correlatives from a phase II neoadjuvant trial of gemcitabine, epirubicin, and nab paclitaxel

Abstract #5116

Background: Neoadjuvant combinations of gemcitabine (G), anthracyclines and taxanes have demonstrated significant activity with pCR rates of 20-25% albeit with significant myelosuppression. Secreted protein acidic rich in cysteine (SPARC) is an albumin binding protein that mediates intratumoral accumulation of nab-paclitaxel (nab-P) via a SPARC-albumin specific binding activity. This study was designed to evaluate a biweekly schedule of neoadjuvant nab paclitaxel (nab-P) with gemcitabine and epirubicin (E). SPARC tumor assessments were performed in consenting patients (pts) with subsequent pathologic and survival correlatives.&#x2028; Methods: Eligibility: Clinical T1c-T4d and/or N0-3, M0 breast cancer (T1N0M0 excluded), ECOG PS 0-2, normal LVEF. ER/PR/HER2 obtained for all pts. Treatment: 6 cycles neoadjuvant G 2000 mg/m2, E 50 mg/m2, and nab-P 175 mg/m2 q14 days followed by surgery. Post operative therapy: 4 cycles G 2000 mg/m2 and nab-P 220 mg/m2 q14 days. Myeloid growth factors were mandated with all cycles. 2 antibody reagents were used to probe for SPARC expressions. For this study, level 3 immunohistochemical (IHC) SPARC staining was considered positive. Results: 123 pts have enrolled with pathologic responses available for 106. 82 pts consented to SPARC testing. Median age 51 (29-72). Median tumor size 4.5 cm. Histology: 81% ductal, 10% lobular, 9% other. 42% ER and PR negative. 55% clinical T3/T4 and 66% lymph node positive at presentation. G3/4 toxicity present in &gt;5% of pts: neutropenia 16% (febrile neutropenia 1 pt), thrombocytopenia 9% with arthralgias 11%, fatigue 10%, and infection 7%. 20 pts did not complete study treatment for the following reasons: disease progression 7, toxicity 3, pt/MD request 5, and other 5. pCR was noted in 23 pts (22%) with PRs in 76 pts (71%), and 6 SD. SPARC IHC staining was available for 76 tumors. SPARC level 3 IHC staining was noted in 65 tumors (86%); 65% were associated with a PR or pCR. Median PFS was 23 months and overall survival at 24 months is 77%. Pts who relapsed ≤16 months from diagnosis were more likely to be triple negative (p = 0.04), or ER negative (p = 0.001), or PR negative (p = 0.0006). Conclusions: Neoadjuvant dose dense GEA is active and better tolerated than other gemcitabine/anthracycline/taxane combinations. The pCR rate of 22% compares favorably with other comparable neoadjuvant regimens albeit with minimal toxicity. Pts with early relapse defined as ≤16 months from diagnosis were more likely to demonstrate a triple negative phenotype or demonstrate estrogen or progesterone receptor negativity. SPARC tumor correlatives with progression free and overall survival are on ongoing and will be presented.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 5116.

Correlation of contrast-enhanced MR images with the histopathology of minimally invasive thermal and cryoablation cancer treatments in normal dog prostates

Magnetic Resonance Imaging (MRI) is a promising tool for visualizing the delivery of minimally invasive cancer treatments such as high intensity ultrasound (HUS) and cryoablation. We use an acute dog prostate model to correlate lesion histopathology with contrast-enhanced (CE) T1 weighted MR images, to aid the radiologists in real time interpretation of in vivo lesion boundaries and pre-existing lesions. Following thermal or cryo treatments, prostate glands are removed, sliced, stained with the vital dye triphenyl tetrazolium chloride, photographed, fixed and processed in oversized blocks for routine microscopy. Slides are scanned by Trestle Corporation at .32 microns/pixel resolution, the various lesions traced using annotation software, and digital images compared to CE MR images. Histologically, HUS results in discrete lesions characterized by a "heat-fixed" zone, in which glands subjected to the highest temperatures are minimally altered, surrounded by a rim or "transition zone" composed of severely fragmented, necrotic glands, interstitial edema and vascular congestion. The "heat-fixed" zone is non-enhancing on CE MRI while the "transition zone" appears as a bright, enhancing rim. Likewise, the CE MR images for cryo lesions appear similar to thermally induced lesions, yet the histopathology is significantly different. Glands subjected to prolonged freezing appear totally disrupted, coagulated and hemorrhagic, while less intensely frozen glands along the lesion edge are partially fragmented and contain apoptotic cells. In conclusion, thermal and cryo-induced lesions, as well as certain pre-existing lesions (cystic hyperplasia - non-enhancing, chronic prostatitis - enhancing) have particular MRI profiles, useful for treatment and diagnostic purposes.

Operationalizing the concept of resilience in child neglect: case study research

BACKGROUND

There is a considerable amount of interest in resilience as a concept for child care and protection practice. This paper describes an exploratory project that drew on a set of case studies to explore the extent to which the concept of resilience can be operationalized for use with neglected children in the context of statutory social work.

METHOD

The study was carried out within a local authority in Scotland and focused on the value of the concept as an aid to assessment and planning. The study built on a published workbook that provides a structure for the assessment of potential areas of resilience and gives detailed suggestions for intervention in six domains of a child's life. Eight neglected children aged between five and 11 were recruited. Six training days on the concept were held. Questionnaires were used to gather information about the theoretical frameworks already being used. At the end of the study, semi-structured interviews were carried out with the social workers about the value of the concept. Assessment reports completed before and after the training were analysed.

RESULTS

Findings indicated that participants were familiar with the concept of resilience and that the training helped enhance their understanding of the concept. Training assisted with the provision of a more structured approach to assessment and planning. Respondents reported that the approach enhanced their knowledge of the child and they were able to identify areas for development in the six domains.

CONCLUSION

The study indicated that the concept of resilience can be operationalized for use with neglected children. Further, the case studies raised the issue of the extent to which the need for a secure base underpins other domains. The domain of positive values was also highlighted as an important area for further exploration.

Mapping of the prostate in endorectal coil-based MRI/MRSI and CT: A deformable registration and validation study

The endorectal coil is being increasingly used in magnetic resonance imaging (MRI) and MR spectroscopic imaging (MRSI) to obtain anatomic and metabolic images of the prostate with high signal-to-noise ratio (SNR). In practice, however, the use of endorectal probe inevitably distorts the prostate and other soft tissue organs, making the analysis and the use of the acquired image data in treatment planning difficult. The purpose of this work is to develop a deformable image registration algorithm to map the MRI/MRSI information obtained using an endorectal probe onto CT images and to verify the accuracy of the registration by phantom and patient studies. A mapping procedure involved using a thin plate spline (TPS) transformation was implemented to establish voxel-to-voxel correspondence between a reference image and a floating image with deformation. An elastic phantom with a number of implanted fiducial markers was designed for the validation of the quality of the registration. Radiographic images of the phantom were obtained before and after a series of intentionally introduced distortions. After mapping the distorted phantom to the original one, the displacements of the implanted markers were measured with respect to their ideal positions and the mean error was calculated. In patient studies, CT images of three prostate patients were acquired, followed by 3 Tesla (3 T) MR images with a rigid endorectal coil. Registration quality was estimated by the centroid position displacement and image coincidence index (CI). Phantom and patient studies show that TPS-based registration has achieved significantly higher accuracy than the previously reported method based on a rigid-body transformation and scaling. The technique should be useful to map the MR spectroscopic dataset acquired with ER probe onto the treatment planning CT dataset to guide radiotherapy planning.