Enhanced Thermal Conductivity of Free-Standing Double-Walled Carbon Nanotube Networks

Nanomaterials are driving advances in technology due to their oftentimes superior properties over bulk materials. In particular, their thermal properties become increasingly important as efficient heat dissipation is required to realize high-performance electronic devices, reduce energy consumption, and prevent thermal damage. One application where nanomaterials can play a crucial role is extreme ultraviolet (EUV) lithography, where pellicles that protect the photomask from particle contamination have to be transparent to EUV light, mechanically strong, and thermally conductive in order to withstand the heat associated with high-power EUV radiation. Free-standing carbon nanotube (CNT) films have emerged as candidates due to their high EUV transparency and ability to withstand heat. However, the thermal transport properties of these films are not well understood beyond bulk emissivity measurements. Here, we measure the thermal conductivity of free-standing CNT films using all-optical Raman thermometry at temperatures between 300 and 700 K. We find thermal conductivities up to 50 W m-1 K-1 for films composed of double-walled CNTs, which rises to 257 W m-1 K-1 when considering the CNT network alone. These values are remarkably high for randomly oriented CNT networks, roughly seven times that of single-walled CNT films. The enhanced thermal conduction is due to the additional wall, which likely gives rise to additional heat-carrying phonon modes and provides a certain resilience to defects. Our results demonstrate that free-standing double-walled CNT films efficiently dissipate heat, enhancing our understanding of these promising films and how they are suited to applications in EUV lithography.

Isolated frontosphenoidal craniosynostosis: An argument for genetic testing

Isolated frontosphenoidal craniosynostosis (IFSC) is a rare congenital defect defined as premature fusion of the frontosphenoidal suture in the absence of other suture fusion. Until now, IFSC was regarded as a phenomenon with an unclear genetic etiology. We have identified three cases with IFSC with underlying syndromic diagnoses that were attributable to pathogenic mutations involving FGFR3 and MN1, as well as 22q11.2 deletion syndrome. These findings suggest a genetic predisposition to IFSC may exist, thereby justifying the recommendation for genetic evaluation and testing in this population. Furthermore, due to improved imaging resolution, cases of IFSC are now readily identified. With the identification of IFSC with underlying genetic diagnoses, in combination with significant improvements in imaging resolution, we recommend genetic evaluation in children with IFSC.

Updated clinical practice recommendations for managing children with 22q11.2 deletion syndrome

This review aimed to update the clinical practice guidelines for managing children and adolescents with 22q11.2 deletion syndrome (22q11.2DS). The 22q11.2 Society, the international scientific organization studying chromosome 22q11.2 differences and related conditions, recruited expert clinicians worldwide to revise the original 2011 pediatric clinical practice guidelines in a stepwise process: (1) a systematic literature search (1992-2021), (2) study selection and data extraction by clinical experts from 9 different countries, covering 24 subspecialties, and (3) creation of a draft consensus document based on the literature and expert opinion, which was further shaped by survey results from family support organizations regarding perceived needs. Of 2441 22q11.2DS-relevant publications initially identified, 2344 received full-text reviews, including 1545 meeting criteria for potential relevance to clinical care of children and adolescents. Informed by the available literature, recommendations were formulated. Given evidence base limitations, multidisciplinary recommendations represent consensus statements of good practice for this evolving field. These recommendations provide contemporary guidance for evaluation, surveillance, and management of the many 22q11.2DS-associated physical, cognitive, behavioral, and psychiatric morbidities while addressing important genetic counseling and psychosocial issues.

Comparing consumer liking of beef from three feeding systems using a combination of traditional and temporal liking sensory methods

Research on the effects of animal diet on consumer liking of beef has yielded conflicting results. Currently it is unknown whether dynamic changes occur in liking during consumption of beef. This study applied a combination of traditional and temporal (free and structured) liking methods to determine consumer liking of beef derived from animals that were fed grain (GF), grass silage plus grain (SG) or grazed grass (GG) during finishing. Three separate panels of beef eating consumers (n = 51; n = 52; n = 50) were recruited from Teagasc Food Research Centre, Dublin, Ireland to assess striploin steaks from animals fed either GF, SG, or GG. Using the free temporal liking (TL) method, results revealed that beef from GF animals was liked significantly less (p ≤ 0.05) in terms of overall liking, tenderness and juiciness, when compared to steaks from the SG and GG animals. These effects were not observed using the structured TL or traditional liking methods. Further analysis showed the evolution of scores over time was significant (p ≤ 0.05) for all attributes using the free TL method. Overall, the free TL method yielded more discriminative data and was perceived as easier to perform by consumers compared to the structured TL method. These results show that the free TL method may provide an opportunity to elicit more in-depth information regarding consumer sensory response to meat.

An off-the-shelf otoacoustic-emission probe for hearing screening via a smartphone

Otoacoustic emissions (OAEs) provide information about the function of the outer hair cells of the cochlea. In high-income countries, infants undergo OAE tests as part of the screening protocols for hearing. However, the cost of the necessary equipment hinders early screening for hearing in low- and middle-income countries, which disproportionately bear the brunt of disabling hearing loss. Here we report the design and clinical testing of a low-cost probe for OAEs. The device, which has a material cost of approximately US$10, uses an off-the-shelf microphone and off-the-shelf earphones connected to a smartphone through a headphone jack. It sends two pure tones through each of the headphone's earbuds and algorithmically detects the distortion-product OAEs generated by the cochlea and recorded via the microphone. In a clinical study involving 201 paediatric ears across three healthcare sites, the device detected hearing loss with 100% sensitivity and 88.9% specificity, comparable to the performance of a commercial device. Low-cost devices for OAE testing may aid the early detection of hearing loss in resource-constrained settings.

ODP242 Safety of SGLT2-Inhibitors in Patients with Multiple Myeloma and Diabetes

Background

An estimated 10-20% of patients with multiple myeloma (MM) have type 2 diabetes (T2DM). About half of patients with MM will experience renal insufficiency,the risk of which increases in the setting of T2DM. While sodium-glucose cotransporter 2 inhibitors (SGLT2i) are beneficial in patients with chronic kidney disease (CKD) due to diabetic or hypertensive nephropathy, the role of SGLT2i in MM-related CKD is unknown. Moreover, as MM therapies target the immune system, concurrent use with SGLT2i may increase the risk of adverse events such as infections. The current work is the first to examine the potential benefit and safety of SGLT2i in patients with MM and T2DM.

Methods

This study was approved by the Institutional Review Board. A retrospective cohort study was performed on patients aged 18 years or older with MM who received SGLT2i therapy between March 2013 and December 2020 at a quaternary academic medical center. Electronic medical records were reviewed for the following data: demographics, comorbidities, MM parameters, medication and medical history, SGLT2i usage and duration, and hemoglobin A1c(HbA1c) and serum creatinine pre- and post-SGLT2i initiation. Data are presented as mean ± standard deviation or counts and percentages, and was analyzed using SPSS software (version 25. 0, IBM Corp).

Results

In total, 50 patients were identified. Patients who were diagnosed with MM after initiation of SGLT2i (n= 12), did not have any MM data available (n=1), or for whom SGLT2i usage could not be verified (n= 4) were excluded. Thirty-three patients were included in the final analysis. The mean age was 63 (±7.8) years, 63.6% were male, and 87.9% had active MM or MM in remission. Most had received stem-cell transplantation (55. 0%) and multiple lines of chemotherapy (63.6%) prior to SGLT2i initiation. The average HbA1c was 7.4% (±1.2%) and 20% of patients had CKD prior to SGLT2i initiation. The overall SGLT2i discontinuation rate was 42.4%, and the mean duration of therapy was 2.2(±1.5) years. Notably, 21.4% of discontinuation events were due to an increase in creatinine; however, for the entire cohort, there were no statistically significant changes in serum creatinine, total body weight, HbA1c, or 24-hour urine protein at 15 months’ follow-up. Other reasons for SLGT2i discontinuation included loss to follow-up, change of health insurance coverage for SGLT2i, and unrelated hospital admission. Genitourinary infection was not cited as a reason for any SGLT2i discontinuation.

Conclusion

SGLT2i therapy may be safe in patients with MM and T2DM, but no benefit was found with respect to serum creatinine, HbA1c, or 24-hour urine protein. Prospective research is required to further evaluate the potential benefit and safety of SGLT2i therapy in this population.

Presentation: No date and time listed

179 WHAT IS THE RISK OF FALLS DUE TO PSYCHOTROPIC MEDICATIONS IN A LARGE POPULATION-REPRESENTATIVE COHORT OF COMMUNITY-DWELLING OLDER PEOPLE?

Background

Psychotropic medications including antidepressants, anticholinergics, benzodiazepines, ‘Z’ drugs and antipsychotics, are frequently identified as Falls Risk Increasing Drugs (FRIDS), yet there is a relative lack of robust data detailing the prospective risk of falls associated with these drug classes.

Methods

Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) were included and followed from Waves 1 to 5 (Mean 7.6 years follow-up). Incidence of falls was ascertained by self-report and unexplained falls were defined as falls not caused by a slip or trip with no apparent cause. Medication lists were examined for medications of interest. Logistic Regression models, reporting odds ratio with 95% confidence intervals, were used to assess the association between medication classes and incident fall types and were adjusted for relevant covariates.

Results

2,090 participants were included (mean age at baseline 72 years, 53% female). During follow-up, over half of participants (52%, n=1,089) had a fall, with one quarter (25%, n=526) reporting an unexplained fall and almost one fifth (19%, n=394) reporting a fall causing injury. Anti-depressants were associated with an increased risk of falling (OR=3.01, 1.98-4.58, p<0.001), injurious falls (OR=1.96, 1.37-2.81, p<0.001) and unexplained falls (OR=2.71, 1.88-3.91, p<0.001) in fully adjusted models. Anti-cholinergic medications were associated with an increased risk of falling (OR=1.79, 1.11-2.88, p=0.017) and of unexplained falls (OR=1.89, 1.19-3.01, p=0.007). ‘Z’ drugs were associated with an increased risk of falling (OR=2.96, 1.64-5.32, p<0.001) and of injurious falls (OR=2.05, 1.26-3.34, p=0.004). Benzodiazepines and Anti-psychotics were not associated with incident falls in fully adjusted models.

Conclusion

Anti-depressants, anti-cholinergic medications and ‘Z’ drugs are independently associated with an increased falls risk. Given the profound impact falls can have on functional trajectory and quality of life, regular review of ongoing need for these medications should be central to the comprehensive geriatric assessment.

181 FIGHTING BACK AGAINST FRAILTY—THE INTRODUCTION OF A DEDICATED FRAILTY HUB

Background

Quarantine, lockdowns and mandatory isolation have slowed the transmission of Covid-19. However, these public health measures have amplified frailty in our vulnerable older person population by increasing social disconnection, reducing exercise and access to early interventions. In response to this increasingly dependent older population we introduced a ‘frailty hub’ in our hospital. This hub allowed early access to a geriatric review as well as a broader multidisciplinary team intervention.

Methods

We performed a cross sectional review of our new hub which was introduced in our tertiary centre to priortise care of the older person.We analysed attendees from February to June 2021 (20 weeks of data).

Results

There were 121 new patient reviews and 127 follow up consultations.Commonly requested reason for referral was medical assessment (30%), cognitive assessments (30%) and falls(28%). Referral sources were analysed and included consultant referrals (11% n = 13), GP referrals (55% n = 67), multidisciplinary team referrals (6% n = 7) and emergency department referrals (26% n = 32). The average age of those review was 79 years (range 59 years to 99 years). Of all patients 65% were reviewed by physiotherapist, 45% were seen by an occupational therapist, 10% were seen by a speech and language therapist or dietician. 85% had a medication changes. 95% had a follow up review with either a geriatrician or advanced nurse practitioner.

Conclusion

Innovation is required to appropriately target our most vulnerable frail adults.The pandemic has had a detrimental effect on some older adult’s function.Our hub is targeting this group and optimising their care.These are our preliminary findings, we plan on doing further analysis.

Genome-wide association findings from the brains for dementia research cohort

The Brains for Dementia Research (BDR) cohort (~3200) is a longitudinal clinicopathological programme, complimented with genetic analysis for the purposes of aetiological investigation into dementia. Here the data from genetic association analyses are presented from the initial collection of DNA from the BDR cohort. The aim of this study was to investigate the preliminary association signals for pathologically confirmed Alzheimer's disease samples compared to controls with no other pathology (n = 520). Genome-wide genotyping was carried out using the NeuroChip platform. Analysis utilised the standard PLINK software for association studies. Genome-wide Bonferroni significant association were observed on chr19 around the APOE/TOMM40 locus across 2 distinct linkage disequilibrium blocks. Eleven of the top 35 association signals have been identified in previous studies, in addition to an intriguing SNP association within the FPR1 gene locus. This study suggests the BDR is genetically comparable to other Alzheimer's disease cohorts and offers an independent resource to verify findings, and additional genetic data for meta-analyses.

Characterising the sensory quality and volatile aroma profile of clean-label sucrose reduced sponge cakes

The sensory and aroma quality of 30% (w/w) sucrose reduced sponge cakes incorporating clean-label replacers were investigated. The sensory quality of the reformulated sponge cakes varied, with those containing apple pomace powder (APP) showing the greatest difference to the control (SC100). Volatile profiles mainly differed in relation to compounds derived from the Maillard reaction, caramelisation and lipid oxidation. Thrity six aroma active volatile compounds were identified in the SC100, APP and oligofructose (OLIGO) sponge cakes by olfactometry. Furfural 'spicy bready' contributed most to the overall aroma of all samples, with factor dilution values differing the most for heptanal 'fatty cake crust', methional 'potato damp', and 2,5-dimethylpyrazine 'cake crust, nutty'. This study provides an in-depth insight into the impact of sugar reduction reformulation on the sensory perception of sponge cakes and demonstrates how this approach can be used to improve the sensory perception of reduced sucrose sponge cakes.

Are racial differences in obesity and insulin resistance related to aggressive breast cancer?

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Background: Black women are more likely to die of breast cancer and develop more aggressive subtypes than white women. Black women are also more likely to be obese and have insulin resistance than white women. Insulin resistance has been associated with faster tumor growth but has not been studied as a potential mediator of racial disparities in women with breast cancer. We hypothesized that black women would present with more aggressive breast cancer and this would be associated with obesity and insulin resistance. Methods: We recruited 1017 (80% white, 20% black) women with new primary breast cancer, measured fasting blood glucose and insulin, body mass index (BMI), triple negative breast cancer (TNBC) & Nottingham prognostic index (NPI). We classified aggressive breast cancer as NPI > 4.4. We calculated insulin resistance scores (HOMA) and classified insulin resistance as HOMA > 2.8. Patients self-identified race. Results: Of 1017 women, average age was 58 years (SD = 12.0). 373 (37%) were stage 2+ at time of diagnosis; 19% had an NPI > 4.4. Black women presented with higher stage of cancer than white women (stage 2+: 45% vs 35%; p = 0.01), more TNBC than white women (10% vs 5%, p = 0.01), were more insulin resistant (24% vs 11%, p < .0001), had higher BMI (31.4kg/m2 vs 26.6 kg/m2; p < .0001) and NPI > 4.4 (29% vs. 17%, p = 0.0002) than white women. HOMA score was positively but not significantly associated with NPI score (r = 0.05; p = 0.1). Multivariate mediation regression model suggested that HOMA_IR does not mediate the effect from black race to higher NPI score (β = 0.01; 95%CI: -0.017 to 0.039). Conclusions: In women with newly diagnosed breast cancer, black women are more likely to be obese, have higher HOMA & NPI scores than white women. While these data are consistent with the hypothesized relationship of hyperinsulinemia promoting more aggressive breast cancer, to date, insulin resistance does not appear to mediate the effect of race and poor prognostic breast cancer.

Which social measures relate to cancer screening & healthy behaviors?

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Background: Much of cancer health services research relies on administrative data, yet, there have been calls for more granular racial & social disparities data. Subjective SES (sSES) is associated with health status & behaviors, independent of objective SES (oSES) measures like income, education and race. We assessed the relationship between breast cancer patients’ oSES and sSES with their cancer screening and health behaviors. Methods: Data are part of a large prospective study evaluating the role of insulin resistance in women with newly diagnosed breast cancer. Patients were asked to place where they stand in their communities on the MacArthur Scale of Subjective Social Status ladder (sSES). oSES measures include race, income & education. We assessed diet, activity, breast & pap screening. Group comparisons used chi-square and t-tests as appropriate. We ran logistic multivariate models with age, race, insurance, comorbidity & income. Results: Of 1035 breast cancer patients with an average age of 58±12 yrs, 81% were White and 19% Black, 63% graduated college, 47%W & 16%B women reported an income of > $100,000/yr. The median sSES = 8; 20% had high sSES ( > 8). There were no racial differences observed in sSES (high sSES: 22% B vs 20% W; p = 0.7). More patients with high sSES graduated college (76% vs 61%, p = 0.0002) & had income > $100K/yr (62% vs 36%, p < .0001) than patients with lower sSES. Of the oSES, women with higher income were more likely to undergo both cancer screenings as compared to patients with lower income. College education did not impact cancer screenings. Black women were less likely to get pap smears. Patients with high as compared to low sSES had higher cancer screening rates and healthy behaviors. Conclusions: Income and sSES are positively associated with cancer screening and health behaviors; education & race are associated with activity & diet. Race is associated with pap screening.[Table: see text]

SUN-417 Recovery Of Central Adrenal Insufficiency In A Patient With Hypophysitis Secondary To Immune Checkpoint Inhibitors Therapy

Hypophysitis is a well-recognized immune-related adverse event that occurs in approximately 16% of patients treated with immune checkpoint inhibitors (ICIs), particularly the anti-cytotoxic T-lymphocyte associated antigen (CTLA4) monoclonal antibody, ipilimumab. While the synthesis and secretion of some anterior pituitary hormones may recover, central adrenal insufficiency is thought to be permanent. A 26-year old male with metastatic renal cell carcinoma was started on treatment with the anti-programmed cell death 1 (PD-1) monoclonal antibody nivolumab. His pre-treatment TSH was 3.27 (0.34-5.60 µIU/mL). Six weeks after his first dose of nivolumab he developed biochemical hyperthyroidism: TSH 0.04µIU/mL, FT4 2.1 (0.80-1.50 ng/dL), without symptoms. He continued treatment with nivolumab, and 11 weeks after the first dose he remained hyperthyroid (TSH undetectable, FT4 2.65 (0.80-1.50 ng/dL)). He was then started on ipilimumab in addition to nivolumab for 4 cycles. A baseline random serum cortisol drawn at 1:30pm was 15.0 (6.7 - 22.6 µg/dL). Five weeks after starting combined ICI therapy he developed sudden onset of severe fatigue, and reported feeling unable to get out of bed. Random serum cortisol was 2.0µg/dL at 1pm, and further pituitary hormone evaluation was performed: ACTH 16 (7.2-63.3 pg/mL), prolactin 47.2 (2.6-13.1ng/mL), LH 3.47 (1.2-8.6 mIU/mL), FSH 14.6 (1.3-19.3 mIU/mL), TSH 1.91, FT4 0.85, testosterone 545.46 (300-1080ng/dL). Thyroid autoantibodies (anti-TPO, thyroglobulin, TSH receptor) were normal. A diagnosis of hypophysitis was made, and he was immediately started on prednisone 1mg/kg. A brain MRI reported no pituitary abnormalities. 48 hours after starting prednisone his symptoms resolved. He remained on prednisone 20mg daily for 4 weeks, and continued treatment with the ICI’s. His pituitary labs were repeated (3pm) - ACTH 5, cortisol 4.0, TSH 1.6, FT4 0.99, Testosterone 119, LH 3.63, FSH 18.4, IGF1 195 (155-432 ng/dL). His dose of prednisone was reduced to 5mg once daily. He continued to be monitored regularly by endocrinology with follow up testing of hormone levels. Four months after the initial presentation his testosterone level improved to 973.4, but his cortisol remained low. After five months his random serum cortisol (1pm) increased to 11.0, and testosterone was 901.5. The prednisone was cautiously discontinued with close monitoring for symptoms and hormone levels. He remained asymptomatic after discontinuation of prednisone, and after two months off glucocorticoid replacement his ACTH was 24.1 and cortisol was 13.0. This case demonstrates that central adrenal insufficiency can recover in patients who develop hypophysitis from ICI therapy. Close follow up and repeated measurement of pituitary hormones may identify more patients with hypothalamic-pituitary-adrenal axis recovery.

SUN-073 Autoimmune Polyendocrine Syndrome Type 2 Presenting As New Onset Systolic Heart Failure

Background: Autoimmune Polyendocrine Syndrome Type 2 (APS2) can present with a constellation of autoimmune disorders that evolve over time. Clinical case: A 35 year old woman with a history of Addison’s disease (diagnosed age 4), Hashimoto’s thyroiditis (diagnosed age 21) with longstanding hypothyroidism on levothyroxine, and polycystic kidney disease (PCKD) presented to the emergency department of another hospital with dyspnea and lower extremity edema. Echocardiogram revealed severe mitral regurgitation and left ventricular (LV) ejection fraction (EF) 40%. She was transferred to our hospital for further evaluation. Physical examination was notable for jugular venous distention, hyperpigmentation of palmar creases and buccal mucosa, minimal lower limb edema, and normal thyroid. Initial labs revealed TSH 0.83 (0.34-5.6 µIU/mL), FT4 0.55 (0.8-1.5 ng/dL), TT3 39 (87-178 ng/dL), TPO 28.1 (<5.6 IU/mL), Tg and TSH receptor Abs were negative, TSI 0.71 (<0.55 IU/L). A transesophageal echocardiogram demonstrated a LVEF of 44% with severe LV dilation and diffuse hypokinesis. Coronary angiography did not demonstrate obstructive disease. A cardiac MRI demonstrated global hypokinesis without areas of late gadolinium enhancement. Further history revealed in the 6 months prior to this presentation, she noted 30 lbs (13.6 kg) unintentional weight loss and amenorrhea. Three weeks prior to presentation she was started on lisinopril which caused wheezing and urticaria. She reported a recent adrenal crisis and was found to have a TSH <0.01, TT3 218, FT4 4.0, and elevated TSI. Iodine uptake scan demonstrated diffuse increased uptake, consistent with autoimmune thyrotoxicosis. She was started on methimazole, fludrocortisone, and increased dose of hydrocortisone. Differential diagnosis included hyperthyroid induced adrenal crisis and heart failure, autoimmune cardiomyopathy, or idiopathic nonischemic cardiomyopathy (NICM). Labs revealed negative RF, reticulin Ab, centromere Ab, tissue-transglutaminase, and myocardial Ab non-specific fluorescence. Early AM ACTH 203.5 (7.2-63.3 pg/mL), cortisol 4.0 (6.7-22.6 µg/dL). LH 14.94 (19.2-103 mIU/mL), FSH 6.5 (4.5-22.5 mIU/mL), HgbA1c 4.9%. Hct 30.7 (34-47%), vitamin B12 254 (211-911 pg/mL), homocysteine 17.7 (<11 µmol/L), methylmalonic acid 306 (0-378 nmol/L). Despite initiation of guideline directed medical therapy and volume optimization, an echocardiogram performed 6 weeks later demonstrated a LVEF of 43%. Conclusions: APS2 has typical manifestations of adrenal insufficiency, thyroiditis, and diabetes. This patient had clear evidence for APS2, but also presented with uncommon manifestations, including NICM. She also had wheezing with ACE inhibitor, a symptom of angioedema, not known to be associated with APS2. This case illustrates the importance of diagnosis of APS2 so other manifestations of the syndrome are recognized.

SAT-094 Overweight and Obesity Associated with Immune-Related Adverse Events in Patients on Immune Checkpoint Inhibitor Therapy

Background As immune checkpoint inhibitor (ICI) therapies (PD(L)1 and CTLA-4 inhibitors) are increasingly used for treating malignancy, immune-related adverse events (irAEs) are being encountered by clinicians more frequently. Obesity is a pro-inflammatory metabolic state that has been associated with a higher risk of developing autoimmune disease, but its role in irAEs in patients treated with ICIs is not well characterized. Hypothesis We hypothesized that patients on ICI therapy who were overweight or obese would be more likely to have a grade 2 or greater irAE compared to normal or underweight patients. Methods We retrospectively collected clinical data for 398 cancer patients with baseline body mass index (BMI) data who received ICIs between January 2011 and April 2017 at our institution. Patients were categorized as having lower BMI (low or normal weight, <25) or higher BMI (obese or overweight, ≥25). An irAE was defined as an AE during ICI therapy that was ≥ Grade 2 according to the Common Terminology Criteria for AEs. We compared patient demographic and clinical characteristics between BMI categories. To determine if BMI category was associated with irAEs, we used multivariate logistic regression. Demographics and variables significantly associated with irAEs were included in the model. Results 201 (50.5%) of patients had lower BMI and 197 (49.5%) had higher BMI. 98 patients (24.6%) had an irAE and median follow up time was 8.7 months. The most common malignancies were melanoma (19.6%), non-small cell lung cancer (23.7%), hepatocellular carcinoma (14.6%), and urothelial carcinoma (12.3%). Patients were treated with blockade of CTLA-4 (11.8%), PD1/PDL1, (77.9%), combination of CTLA-4 and PD(L)1 blockade concurrently (4.0%), and sequentially (6.3%). Patients with lower and higher BMI did not differ significantly in respect to age, gender, clinical stage, or category of ICI. Race differed significantly between high vs low BMI categories, (White 60.4% vs 47.3%, Black 8.1% vs 11.9%, Hispanic 11.7% vs 8%, Asian 3.6% vs 11.9%, Unknown/other 16.2% vs 20.9%, p<0.01). Patients with higher BMI were more likely to have a preexisting autoimmune disease (10.8% vs 7.5%, p=0.04). Higher BMI was significantly associated with irAEs (odds ratio (OR) 1.79, 95% confidence interval (CI) 1.09-2.96 in a model adjusted for age, gender, race, ICI category, and preexisting autoimmune disease. Other race (compared to white race) (OR 0.40, 95% CI 0.19-0.83, PD(L)1 blockade (compared to CTLA-4 blockade) (OR 0.49, 95% CI 0.24-0.99), and preexisting autoimmune disease (OR 2.8, 95% CI 1.4-5.7) were also significant predictors of irAEs in the adjusted model. Conclusions Being overweight or obese was associated with irAEs in patients on ICI therapy. Insights into how BMI mediates the immune effects of ICI therapy can potentially elucidate how inflammation plays a role in the metabolic sequelae of obesity and adiposity.

MON-603 Racial Distribution of Endocrine Complications in Oncology Patients Treated with Immune Checkpoint Inhibitors

Background: Immune-related adverse events (irAEs) have been frequently described with the growing use of immune checkpoint inhibitors (ICI) in cancer treatment. While many autoimmune diseases are known to be more prevalent in certain racial groups, it is unknown if there are racial disparities in the rate of irAEs. Clinical trials reporting irAEs thus far have not explored their distribution in underrepresented minorities. It is important to study irAEs in racially diverse populations to better understand which patients are more likely to be impacted. Hypothesis: We sought to describe the demographics of a diverse cohort of patients treated with ICIs, as well as the racial distribution of irAEs. We hypothesized that there would be a significant difference among self-reported races experiencing ICI-related endocrine diseases. Methods: IRB approval was obtained to identify 411 oncology patients who were treated with ICIs between January 2011 and April 2017 from an EMR-based data repository. We collected data on age, gender, BMI, comorbidities, and median follow up time, which were further stratified according to self-identified race (White, Black, Hispanic, Asian, Other/Unknown). Endocrine adverse events were recorded according to race and were defined as events that were ≥ Grade 2 according to the Common Terminology Criteria for Adverse Events. We used the Fisher exact test for categorical variables and the Kruskal-Wallis test for continuous variables in the comparative analyses. Results: Of 411 patients treated with ICIs, 53.3% were White, 10.2% were Black, 10.5% were Hispanic, 7.5% were Asian, and 18.5% were Other/Unknown. The mean age was 65.3 years (67.8 in Whites, 63.7 in Blacks, 62.2 in Hispanics, 60.5 in Asians, 62.8 in Other/Unknown; p=0.0012). 38.4% were Female and 61.6% were Male. Mean BMI was 25.9 kg/m². 10.9% of all patients had pre-existing autoimmune disease (White: 11.0%, Black: 9.5%, Hispanic: 11.6%, Asian: 0, Other/Unknown: 15.8%; p=0.164). 7.3% of all patients had pre-existing thyroid disease (White: 6.9%, Black: 7.1%, Hispanic: 7.0%, Asian: 0, Other/Unknown: 11.8%; p=0.311). Mean follow up period was 8.7 months. 54 (13.1%) patients experienced any endocrine adverse effect without a statistically significant difference among racial groups (White: 16.0%, Black: 16.7%, Hispanic: 11.6%, Asian: 6.5%, Other/Unknown: 6.6%; p=0.189). 14.8% developed hypophysitis, 70.4% developed thyroid disease, 13.0% developed adrenal insufficiency, and 1.9% developed diabetes. Conclusions: Self-reported race was not associated with the development of ICI-related endocrinopathies in a diverse group of oncology patients. Further studies are needed to continue to characterize the populations experiencing immune-related endocrine complications in ICI therapy.

SUN-032 Exome Sequencing Reveals that Pathogenic RET Variants Occur at Higher Prevalence Than Previously Recognized: Data from a US Health System Biobank

Background: Multiple Endocrine Neoplasia Syndrome Type 2 (MEN2) is an inherited endocrine disorder characterized by the development of pheochromocytoma, medullary thyroid carcinoma (MTC) and parathyroid neoplasia. MEN2 is autosomal dominant and occurs from activating missense variants in the RET proto-oncogene. The estimated prevalence of MEN2 is thought to be 1 per 30,000 in the general population, and although rare, the identification of MEN2 can aid with early screening and prevention for patients and their families. Aim: The aim of our study was to investigate the prevalence and clinical manifestations of pathogenic RET variants in the multi-ethnic BioMe Biobank. Methods: We used exome sequencing and electronic health record (EHR) data from BioMe Biobank participants, who are recruited from primary care and specialty clinics across a single U.S. Health System. We evaluated exome sequence data from 30,000 BioMe participants for RET variants designated as pathogenic for MEN2 according to the clinical genetics database ClinVar. We reviewed EHR data for carriers of pathogenic RET variants. Results: In the BioMe Biobank, 5 ClinVar pathogenic variants were identified in the RET gene. Fifteen participants were heterozygous carriers of these variants; 5 were of self-reported African ancestry, 5 of Hispanic/Latino ancestry, 2 of European ancestry, and 3 of other or unknown ancestry. The age range of carriers was 23-78 years, and 60% were female. The estimated prevalence of pathogenic RET variant carriers in BioMe was ~1 in 2000. Based on EHRs, only 3 carriers (20%) were identified from usual clinical care as having the diagnosis of MEN2A. All 3 carriers with diagnosed MEN2A had the 10:43114500:T:C variant (rs75076352) and had a history of MTC and pheochromocytoma. One of the 3 carriers had a history of elevated parathyroid hormone levels and renal calculi without hypercalcemia. Two of the 3 carriers had a documented family history of MEN2A. Of the 12 pathogenic RET variant carriers without known MEN2, 9 (75%) were diagnosed with hypertension. 7 (58%) carried the 10:43119548:G:A variant (rs79658334). Of these 7 carriers, one had a thyroid nodule, three had autoimmune thyroid disease, one had an adrenal cortical adenoma with primary hyperaldosteronism and hypokalemic periodic paralysis, and two had no known endocrine conditions. Conclusions: These results from the BioMe Biobank reveal a higher prevalence of pathogenic RET variants than previously recognized. Carriers of pathogenic RET variants demonstrate highly variable expressivity for traits for which earlier diagnoses might improve outcomes; these findings have implications for cascade testing of family members. Genomic screening for pathogenic RET variants will likely improve our understanding of MEN2 on a more molecular basis.

SAT-091 Metabolic Effects of JAK1/2 Inhibition in Patients with Myeloproliferative Neoplasms

Background: Ruxolitinib is a JAK1/2 inhibitor that is FDA approved to treat certain myeloproliferative neoplasms (MPNs), including myelofibrosis (MF) and polycythemia vera (PV). The JAK family kinases are targeted in cancers due to their role in cytokine receptor signal transduction, and are also key intermediates in growth hormone, leptin and prolactin receptor signaling. Clinical trials have reported that ruxolitinib treatment was associated with weight gain, but other metabolic consequences remain unknown. Aim: We aimed to determine the metabolic consequences of JAK1/2 inhibition with ruxolitinib in patients with MPN in the clinical setting. Methods: IRB approval was obtained, and we identified patients from an electronic medical record (EMR) based database who began treatment with ruxolitinib for MPN from December 2011 to December 2016. Data collected from EMRs included age, gender, weight, height, systolic and diastolic blood pressure (SBP, DBP), medications, co-morbidities, random serum glucose, and lipid profile. We compared parameters from baseline (prior to initiating ruxolitinib) to 72±8 weeks after starting treatment. Baseline and 72 week data were compared using the Wilcoxon signed rank test. Results: 129 patients were initially identified, of which 71 had data available for weight, and at least one other metabolic parameter of interest at baseline and 72 weeks. Patient characteristics were as follows: 49.3% male; mean age at initiation of treatment was 64.6±SD11.1 years; indications for treatment were MF (77%), PV(17%), other MPNs (6%). Mean baseline weight was 73.6±16.9kg, and was 78.3±8.9kg at 72 weeks (n=71, p<0.001). Mean body mass index (BMI) at baseline was 25.6±4.6kg/m², and 27.3±5.4kg/m² at 72 weeks (n=68, p<0.001).The BMI (kg/m²) distribution for underweight (<18.5), normal (18.5-24.9), overweight (25.0-29.9), and obese (>30) at baseline were: 3%, 43%, 41%, and 13%, respectively; at 72 weeks it was 1%, 40%, 34%, and 28%, respectively (p=0.002). At 72 weeks,19% moved up a BMI class from baseline. Next, we investigated the effect of ruxolitinib treatment on BP and glucose concentrations. SBP was 124±15 mmHg at baseline and 129±18 mmHg at 72 weeks, (p=0.042, n=71). DBP was not different between baseline and 72 weeks. Glucose at baseline was 99±28mg/dL and 101±29mg/dL at 72 weeks (p=0.015, n=59). There was no change in the percent of patients with hyperglycemia (glucose ≥200mg/dL) or on treatment for diabetes at baseline (13.6%) and 72 weeks (13.6%). An insufficient number of patients had lipid data available for analysis. Conclusions: Systemic JAK1/2 inhibition was associated with weight gain, the development of obesity, and increased SBP in this cohort of patients. As pharmacological JAK1 and 2 inhibitors are developed and more widely used, it is important to gain a greater understanding of their long-term metabolic consequences.

Insulin-like growth factor receptor signaling in breast tumor epithelium protects cells from endoplasmic reticulum stress and regulates the tumor microenvironment

BACKGROUND

Early analyses of human breast cancer identified high expression of the insulin-like growth factor type 1 receptor (IGF-1R) correlated with hormone receptor positive breast cancer and associated with a favorable prognosis, whereas low expression of IGF-1R correlated with triple negative breast cancer (TNBC). We previously demonstrated that the IGF-1R acts as a tumor and metastasis suppressor in the Wnt1 mouse model of TNBC. The mechanisms for how reduced IGF-1R contributes to TNBC phenotypes is unknown.

METHODS

We analyzed the METABRIC dataset to further stratify IGF-1R expression with patient survival and specific parameters of TNBC. To investigate molecular events associated with the loss of IGF-1R function in breast tumor cells, we inhibited IGF-1R in human cell lines using an IGF-1R blocking antibody and analyzed MMTV-Wnt1-mediated mouse tumors with reduced IGF-1R function through expression of a dominant-negative transgene.

RESULTS

Our analysis of the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset revealed association between low IGF-1R and reduced overall patient survival. IGF-1R expression was inversely correlated with patient survival even within hormone receptor-positive breast cancers, indicating reduced overall patient survival with low IGF-1R was not due simply to low IGF-1R expression within TNBCs. Inhibiting IGF-1R in either mouse or human tumor epithelial cells increased reactive oxygen species (ROS) production and activation of the endoplasmic reticulum stress response. IGF-1R inhibition in tumor epithelial cells elevated interleukin (IL)-6 and C-C motif chemokine ligand 2 (CCL2) expression, which was reversed by ROS scavenging. Moreover, the Wnt1/dnIGF-1R primary tumors displayed a tumor-promoting immune phenotype. The increased CCL2 promoted an influx of CD11b⁺ monocytes into the primary tumor that also had increased matrix metalloproteinase (MMP)-2, MMP-3, and MMP-9 expression. Increased MMP activity in the tumor stroma was associated with enhanced matrix remodeling and collagen deposition. Further analysis of the METABRIC dataset revealed an increase in IL-6, CCL2, and MMP-9 expression in patients with low IGF-1R, consistent with our mouse tumor model and data in human breast cancer cell lines.

CONCLUSIONS

Our data support the hypothesis that reduction of IGF-1R function increases cellular stress and cytokine production to promote an aggressive tumor microenvironment through infiltration of immune cells and matrix remodeling.

Depression and anxiety symptoms during the transition to early adulthood for people with intellectual disabilities

BACKGROUND

The transition to adulthood is a major developmental milestone; a time of self-discovery and increased independence. For young adults (YA) with intellectual disabilities (ID), however, this period is especially challenging. The increased incidence of mental health disorders in this population, such as depression and anxiety, make this transition even more difficult, increasing caregiver burden at a time when the young adult would traditionally be gaining independence. It is not clear, however, why YA with ID are more susceptible and what factors may predict mental health symptoms.

METHOD

Potential risk and protective factors (demographic variables, coping styles, sense of hopelessness, unmet achievement of adulthood milestones, self-reflection and insight) of anxiety and depression symptoms were assessed in 55 YA with ID and a sample of age-matched controls.

RESULTS

Insight was the strongest predictor of anxiety (with gender in the controls) for YA with and without ID, with increased insight predicting fewer anxiety symptoms. However, YA with ID had significantly less insight than their aged-matched counterparts and significantly higher levels of anxiety. They were also less likely to have achieved traditional adulthood milestones. Maladaptive coping was the strongest predictor of depression for YA with ID. In comparison, both maladaptive coping and insight predicted depression in controls. More maladaptive coping predicted increased depressive symptoms in both populations, whilst increased insight predicted fewer depressive symptoms in controls.

CONCLUSIONS

Insight and maladaptive coping are potential targets in the treatment of anxiety and depression among YA with ID. Longitudinal intervention studies exploring the efficacy of such targeted programmes in reducing mental health symptoms and improving the transition to adulthood for these young people are recommended.

Head shape at age 36 months among children with and without a history of positional skull deformation

OBJECTIVE In this study, the authors examined head shape through age 36 months for children with and without a history of positional plagiocephaly and/or brachycephaly (PPB). METHODS Infants with PPB (cases) were identified through a craniofacial clinic at the time of diagnosis. Infants without diagnosed PPB were identified through a participant registry. Clinician ratings of 3D cranial images were used to confirm the presence or absence of PPB. The cohort included 235 case infants (diagnosed PPB, confirmed with 3D imaging), 167 unaffected controls (no diagnosed PPB, no deformation detected), and 70 affected controls (no diagnosed PPB, discernible skull deformation). Participants were seen in infancy (age 7 months, on average) and again at ages 18 and 36 months. At each visit, automated 3D measures of skull deformation quantified posterior flattening and generated an absolute asymmetry score. The authors also used automated 2D measures to approximate overall asymmetry (approximate oblique cranial length ratio) and calculate the cephalic index. They used linear regression to compare cases to unaffected controls and to compare affected versus unaffected controls on all measures. They also calculated the proportion of children in each group with "persistent PPB," defined as one or more head shape measures above the 95th percentile relative to unaffected controls at 36 months. RESULTS Head shape became more rounded and symmetric for children with and without PPB, particularly between infancy and age 18 months. However, children with PPB continued to show greater skull deformation and asymmetry than unaffected controls at age 36 months. These differences were large in magnitude, ranging from 1 to 2 standard deviations (SDs), and in most (85.6%) of the cases, there was evidence of persistent PPB at 36 months. Similarly, although differences were more modest (i.e., 0.26-0.94 SD), affected controls continued to exhibit skull deformation on most measures relative to unaffected controls and approximately 30% had persistent PPB. Within the case group, head shape at 36 months was similar for untreated patients with PPB and for those who received helmet treatment and for patients with and without a history of torticollis. CONCLUSIONS Although head shape continues to improve, children with a history of skull deformation in infancy continue to exhibit measureable cranial flattening and asymmetry through age 36 months.

Developing indicators for evaluation of age-friendly communities in Canada: process and results

INTRODUCTION

In 2006, the World Health Organization launched the Global Age-Friendly Cities Project to support active aging. Canada has a large number of age-friendly initiatives; however, little is known about the effectiveness and outcomes of age-friendly community (AFC) initiatives. In addition, stakeholders report that they lack the capacity and tools to develop and conduct evaluations of their AFC initiatives. In order to address these gaps, the Public Health Agency of Canada developed indicators to support the evaluation of AFC initiatives relevant to a wide range of Canadian communities. These indicators meet the varied needs of communities, but are not designed to evaluate collective impact or enable crosscommunity comparisons.

METHODS

An evidence-based, iterative consultation approach was used to develop indicators for AFCs. This involved a literature review and an environmental scan. Two rounds of key expert and stakeholder consultations were conducted to rate potential indicators according to their importance, actionability and feasibility. A final list of indicators and potential measures were developed based on results from these consultations, as well as key policy considerations.

RESULTS

Thirty-nine indicators emerged across eight AFC domains plus four indicators related to long-term health and social outcomes. All meet the intended purpose of evaluating AFC initiatives at the community level. A user-friendly guide is available to support and share this work.

CONCLUSION

The AFC indicators can help communities evaluate age-friendly initiatives, which is the final step in completing a cycle of the Pan-Canadian AFC milestones. Communities are encouraged to use the evaluation results to improve their AFC initiatives, thereby benefiting a broad range of Canadians.

A RING to rule them all? Insights into the Map3k1 PHD motif provide a new mechanistic understanding into the diverse roles of Map3k1

Despite the sizable number of components that comprise Mapk cascades, Map3k1 is the only element that contains both a kinase domain and a plant homeodomain (PHD) motif, allowing Map3k1 to regulate the protein phosphorylation and ubiquitin proteasome systems. As such, Map3k1 has complex roles in the regulation of cell death, survival, migration and differentiation. Numerous mouse and human genetic analyses have demonstrated that Map3k1 is of critical importance for the immune system, cardiac tissue, testis, wound healing, tumorigenesis and cancer. Recent gene knockin of Map3k1 to mutate the E2 binding site within the Map3k1 PHD motif and high throughput ubiquitin protein array screening for Map3k1 PHD motif substrates provide critical novel insights into Map3k1 PHD motif signal transduction and bring a brand-new understanding to Map3k1 signaling in mammalian biology.

Bacterial and fungal community composition over time in chicken litter with high or low moisture content

1. Changes in bacterial and fungal communities in chicken litter with high and low moisture content over a five week period during a single chicken grow out cycle in a poultry shed in subtropical Australia were investigated to study the association between specific microbes and odour production. 2. Microbial biomass, as indicated by DNA yields, was higher and community composition was more dynamic over time in moist compared with dry chicken litter. 3. Bacillus, Atopostipes and Aspergillus species increased in relative abundance in moist chicken litter samples over time reflecting the relatively high fitness and hence activity of these specific bacteria and this specific fungus in this environment.

Hyperinsulinemia promotes metastasis to the lung in a mouse model of Her2-mediated breast cancer

The Her2 oncogene is expressed in ∼25% of human breast cancers and is associated with metastatic progression and poor outcome. Epidemiological studies report that breast cancer incidence and mortality rates are higher in women with type 2 diabetes. Here, we use a mouse model of Her2-mediated breast cancer on a background of hyperinsulinemia to determine how elevated circulating insulin levels affect Her2-mediated primary tumor growth and lung metastasis. Hyperinsulinemic (MKR(+/+)) mice were crossed with doxycycline-inducible Neu-NT (MTB/TAN) mice to produce the MTB/TAN/MKR(+/+) mouse model. Both MTB/TAN and MTB/TAN/MKR(+/+) mice were administered doxycycline in drinking water to induce Neu-NT mammary tumor formation. In tumor tissues removed at 2, 4, and 6 weeks of Neu-NT overexpression, we observed increased tumor mass and higher phosphorylation of the insulin receptor/IGF1 receptor, suggesting that activation of these receptors in conditions of hyperinsulinemia could contribute to the increased growth of mammary tumors. After 12 weeks on doxycycline, although no further increase in tumor weight was observed in MTB/TAN/MKR(+/+) compared with MTB/TAN mice, the number of lung metastases was significantly higher in MTB/TAN/MKR(+/+) mice compared with controls (MTB/TAN/MKR(+/+) 16.41±4.18 vs MTB/TAN 5.36±2.72). In tumors at the 6-week time point, we observed an increase in vimentin, a cytoskeletal protein and marker of mesenchymal cells, associated with epithelial-to-mesenchymal transition and cancer-associated fibroblasts. We conclude that hyperinsulinemia in MTB/TAN/MKR(+/+) mice resulted in larger primary tumors, with more mesenchymal cells and therefore more aggressive tumors with more numerous pulmonary metastases.

Tumor epidermal growth factor receptor genotype and depression in stage IV non-small cell lung cancer

INTRODUCTION

Depression appears to be associated with worse survival from cancer, but underlying mechanisms for this association are unknown. In the present study, we explored the degree to which tumor genotype may be associated with depression in patients with non-small cell lung cancer (NSCLC). We examined differences in depression severity and rates of positive screens for major depressive disorder among newly diagnosed patients with stage IV NSCLC and known epidermal growth factor receptor (EGFR) genotype.

METHODS

Newly diagnosed patients (n = 53) with metastatic NSCLC attending an initial thoracic oncology consultation completed self-report questionnaires regarding demographics, smoking behavior, and depression before meeting with their oncologist. Biopsy samples were subsequently genotyped, including screening for EGFR mutations. We conducted a retrospective chart review to obtain clinical data, including tumor stage, performance status, and EGFR genotype.

RESULTS

Twelve patients (22.6%) tested positive for EGFR mutation. No EGFR mutation-positive cases met the screening criteria for major depressive disorder, in comparison with 29.3% of patients with wild-type EGFR (p = .03). Mutations of EGFR were also associated with lower depression severity than with wild-type EGFR, independent of gender, performance status, and smoking history (p < .05). This finding persisted for both the cognitive-affective and somatic domains of depression symptoms.

CONCLUSIONS

EGFR mutations were associated with lower depression severity and lower rates of probable major depressive disorder in patients with metastatic NSCLC, based on mood screening performed before results of genotyping were known. Findings support further work to explore the directionality of the associations and potential biological pathways to depression.

Nutritive value and chemical composition of pseudocereals as gluten-free ingredients

The only treatment available for patients with coeliac disease is a lifelong elimination of food products containing gluten. The gluten-free products currently available in the market are considered of low quality and poor nutritional value. In the present study, the pseudocereals amaranth, quinoa and buckwheat were studied as potential healthy ingredients for improving the nutritional quality of gluten-free breads. The pseudocereal seeds and pseudocereal-containing gluten-free breads were evaluated in terms of their protein, fat, total starch, dietary fibre, ash and mineral content as well as their fatty acid composition. The pseudocereal containing gluten-free breads showed significantly higher levels of protein, fat, fibre and minerals than the control bread. The attributes of these breads conform to the expert's nutritional recommendations for the gluten-free diet and gluten-free foods. These results suggest that the pseudocereals amaranth, quinoa and buckwheat can represent a healthy alternative to frequently used ingredients in gluten-free products.